Dental diseases — caries, periodontitis, and pulpal diseases

Almost everything the dentist treats stems from a small number of basic diseases of the mouth and teeth. As a dental assistant you do not make diagnoses, but you must understand what is going on to be able to set up correctly, advise the patient and recognise when something requires extra attention. The training regulations therefore single out odontological pathology — diseases of the pulp, the apical and marginal periodontium and the oral mucosa — as a separate subject in the main programme.

Caries occurs when bacteria in the bacterial plaque that continuously forms on the teeth convert sugar from the diet into acid. The acid dissolves the hard substance of the tooth over time and initially causes early often invisible damage to the enamel which later can develop into an actual hole (cavity) if not stopped. The earlier a caries attack is detected the greater the chance of treating it non-operatively — that is without drilling — through good oral hygiene diet changes and fluoride.

• 01Enamel — the hardest tissue in the body the outer visible layer on the tooth crown.
• 02Dentin — lies under the enamel more sensitive and faster attacked by caries than enamel.
• 03Pulp — the tooth's 'nerve', the soft tissue inside with blood vessels and nerve fibers.
• 04Cement and root membrane (periodontium) — fastens the root to the jawbone.

If plaque sits along the gum line, gingivitis develops — an inflammatory condition of the gums that shows up with redness, swelling and bleeding, typically during tooth brushing. Gingivitis is reversible: if the buildup is removed and oral hygiene improves, the gums heal again. If inflammation continues untreated, it can spread to the deeper supporting tissue around the tooth and develop into periodontitis, where the bone around the root breaks down. Periodontitis is not fully reversible — lost bone support does not come back on its own — and is therefore one of the main reasons adults lose teeth.

When caries or trauma reaches the pulp, the tooth can become inflamed or die (lose vitality). This often causes pain and can spread to the tissue around the root tip (the apical periodontium), where an abscess or cyst can form. Such conditions are typically treated with endodontic treatment (root canal treatment), where the infected tissue is removed from the root canal, which is then cleaned and filled. As an assistant you meet concepts here such as the vitality test — a method to assess whether the pulp is still alive — which according to the training regulations you must be able to perform yourself.

Beyond caries and periodontal diseases, the clinic also encounters dental trauma — for example a front tooth that is knocked loose or breaks in a fall or a sports injury — where quick and correct first aid can determine whether the tooth can be saved. The training regulations also mention simple changes in the oral mucosa as part of the knowledge you should have, so you can be alert to anything that looks unusual and pass it on to the dentist.

“The better you understand the illness behind the treatment, the easier it is to explain to the patient why this particular intervention is necessary.”