Odontologia Pediatrica

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1. ¿Qué es la caries y qué la causa?

La caries dental es una infección del diente; es una enfermedad bacteriana destructiva de las estructuras dentales producida por una serie de microbios que viven en nuestra boca. Las caries son, además, la enfermedad crónica infantil más común.

Al comer, los azúcares ingeridos que se han quedado en la boca se metabolizan por la placa bacteriana y, al metabolizarse, se producen unos ácidos que hacen que el pH intraoral descienda. El descenso del pH intraoral ataca la estructura mineral del esmalte provocando su desmineralización.

2. ¿A partir de cuando puede aparecer?

La caries de la primera infancia o “Caries del Biberón” puede producirse desde el mismo instante en que aparecen los primeros dientes en la boca del niño. Desde este mismo instante, pues, es conveniente empezar la limpieza bucal de sus dientecitos, que se llevará a cabo con una pequeña gasa húmeda.

Sin embargo, el factor tiempo juega también un papel importante. Cuanto más se tarde en iniciar los procesos de higiene dental, más probabilidades tendrá el niño de presentar caries.

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3. ¿Por qué se produce?

Por la confluencia de varios factores, principalmente las bacterias que producen ácido, los dientes susceptibles, los hidratos de carbono fermentados (dulces, leches etc…), el tiempo ( la frecuencia con que los dientes están expuestos a los ácidos derivados del azúcar) y la calidad de la higiene oral. Todo ello provoca un estado idóneo para la rápida propagación de las bacterias que provocan los ácidos que deshacen el esmalte del diente.

Cuando se perfora el esmalte, los microbios no se preocupan en abrir más la puerta y se dirigen hacia el interior del diente, infectando la dentina ya que ésta es una estructura orgánico mineral mucho más blanda, ideal para estos microbios.

Actualmente, sabemos que en la boca o cavidad oral se produce un ciclo contínuo de desmineralización y remineralización en la superficie del diente, por lo que podemos considerar a la caries como un proceso dinámico.

Si el pH, o acidez, en la superficie del diente se sitúa por debajo de 5.5 se producirá una desmineralización con liberación de iones calcio (Ca++) y fosfato (PO4-), que quedarán en la saliva. Ya que la saliva es una solución saturada de estos iones, existe la posibilidad de que éstos vuelvan a la superficie del diente cuando se recupere el pH. Si el ph de la saliva sube por encima de 5.5, se favorecerá la vuelta de los iones perdidos y toda lesión, que sólo afecte al esmalte, podrá remineralizarse.

Si este equilibrio se rompiese y predominara la desmineralización (debido a periodos prolongados de acidez) se producirá la pérdida de componente mineral creando una cavidad en el diente que supondrá la necesidad de un tratamiento restaurador en el que se procede a la eliminación de la caries y recuperación del tejido perdido mediante un material restaurador.

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