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Baris 1: {{penyangkalan medis}} ~~{{terjemah\|Inggris}}~~ {{Infobox medical condition ~~{{DiseaseDisorder infobox \|~~ \| name ~~Name~~ = Karies gigi \| \| synonyms = Karies, gigi berlubang ~~ICD10 = {{ICD10\|K\|02\|\|k\|00}} \|~~ \| ~~ICD9~~image = ~~{{ICD9\|521~~Toothdecay.~~0}} \|~~png \| caption = Spesimen gigi yang menunjukkan adanya lubang pada leher gigi (karies servikal) ~~ICDO = \|~~ \| ~~Image~~ image_size = ~~Toothdecay.png \|~~100px \| field ~~Caption~~ = ~~Kerusakan~~[[Kedokteran gigi ~~berupa lubang yang disebabkan karies\|~~]] \| symptoms = Dapat disertai [[sakit gigi\|rasa sakit]] maupun tidak, lubang pada gigi ~~Width = 150 \|~~ \| complications = Infeksi jaringan periapikal (umumnya [[abses gigi]]), maupun [[Penyakit periodontal\|periodontal]], [[kehilangan gigi]]<ref name=Lau2014/><ref name=Taber2013/> ~~OMIM = \|~~ \| onset ~~MedlinePlus~~ = ~~001055~~ \| = \| duration = Jangka panjang ~~eMedicineSubj = \|~~ \| causes = Bakteri penghasil asam akibat dari penumpukan sisa makanan,<ref name=Peads2014/> umumnya [[Streptococcus mutans\|''Streptococcus mutans'']] ~~eMedicineTopic = \|~~ \| risks = Konsumsi gula berlebih, [[diabetes mellitus]], [[Sindrom Sjögren]], obat-obatan yang memicu pengurangan keluaran [[saliva]]<ref name=Peads2014/> ~~DiseasesDB = 29357 \|~~ \| diagnosis = \| differential = [[Lesi servikal non-karies]] \| prevention = [[Menyikat gigi]], penggunaan [[fluoride]], menjaga [[higiene mulut\|kebersihan gigi dan mulut]]<ref name=WHO2012/><ref name=Oli2017/> \| treatment = \| medication = [[Parasetamol]], [[ibuprofen]] (apabila disertai rasa sakit)<ref name=Silk2014/> \| frequency = 3.6 miliar (2016)<ref name=WHO2016Epi/> \| deaths = }} '''Karies gigi''' adalah sebuah [[penyakit infeksi]] bakteri yang merusak struktur jaringan keras [[gigi]].<ref name="medline">[http://www.nlm.nih.gov/medlineplus/ency/article/001055.htm Dental Cavities], ''MedlinePlus Medical Encyclopedia'', page accessed August 14, 2006.</ref> Penyakit ini ditandai dengan lesi putih yang dapat berkembang menjadi kavitas/lubang. Jika tidak ditangani, penyakit ini dapat menyebabkan [[nyeri]], kematian saraf gigi (nekrosis), hingga infeksi periapikal dan infeksi sistemik. Berbagai bukti telah menunjukkan bahwa penyakit ini telah dikenal sejak [[zaman perunggu]], [[zaman besi]], dan [[zaman pertengahan]].<ref name="uicanthropology"/> Peningkatan prevalensi karies banyak dipengaruhi perubahan dari pola makan.<ref name="uicanthropology"/><ref name="suddickhistorical">Suddick, Richard P. and Norman O. Harris. [http://crobm.iadrjournals.org/cgi/reprint/1/2/135.pdf "Historical Perspectives of Oral Biology: A Series"] {{Webarchive\|url=https://web.archive.org/web/20071218025641/http://crobm.iadrjournals.org/cgi/reprint/1/2/135.pdf \|date=2007-12-18 }}. Critical Reviews in Oral Biology and Medicine, 1(2), pages 135-151, 1990.</ref> Kini, karies gigi menjadi salah satu penyakit gigi dan mulut paling umum di seluruh dunia. Ada beberapa cara untuk mengelompokkan karies gigi.<ref name="sonis139">Sonis, Stephen T. "Dental Secrets: Questions and Answers Reveal the Secrets to the Principles and Practice of Dentistry." 3rd edition. Hanley & Belfus, Inc., 2003, p. 130. ISBN 1-56053-573-3.</ref> Walaupun apa yang terlihat dapat berbeda, faktor-faktor risiko dan perkembangan karies hampir serupa. Mula-mula, lokasi terjadinya karies dapat tampak seperti daerah berkapur namun berkembang menjad lubang coklat. Walaupun karies mungkin dapat saja dilihat dengan mata telanjang, kadang-kadang diperlukan bantuan [[radiografi]] untuk mengamati daerah-daerah pada gigi dan menetapkan seberapa jauh penyakit itu merusak gigi. '''Karies gigi''' adalah sebuah [[penyakit infeksi]] yang merusak struktur [[gigi]].<ref name="medline">[http://www.nlm.nih.gov/medlineplus/ency/article/001055.htm Dental Cavities], ''MedlinePlus Medical Encyclopedia'', page accessed August 14, 2006.</ref> Penyakit ini menyebabkan gigi berlubang. Jika tidak ditangani, penyakit ini dapat menyebabkan [[nyeri]], penanggalan gigi, infeksi, berbagai kasus berbahaya, dan bahkan kematian. Penyakit ini telah dikenal sejak masa lalu, berbagai bukti telah menunjukkan bahwa penyakit ini telah dikenal sejak [[zaman Perunggu]], [[zaman Besi]], dan masa pertengahan.<ref name="uicanthropology">[http://www.uic.edu/classes/osci/osci590/11_1Epidemiology.htm Epidemiology of Dental Disease], hosted on the University of Illinois at Chicago website. Page accessed January 9, 2007.</ref> Peningkatan prevalensi karies banyak dipengaruhi perubahan dari pola makan.<ref name="uicanthropology">[http://www.uic.edu/classes/osci/osci590/11_1Epidemiology.htm Epidemiology of Dental Disease], hosted on the University of Illinois at Chicago website. Page accessed January 9, 2007.</ref><ref name="suddickhistorical">Suddick, Richard P. and Norman O. Harris. [http://crobm.iadrjournals.org/cgi/reprint/1/2/135.pdf "Historical Perspectives of Oral Biology: A Series"]. Critical Reviews in Oral Biology and Medicine, 1(2), pages 135-151, 1990.</ref> Kini, karies gigi telah menjadi penyakit yang tersebar di seluruh dunia. Lubang gigi disebabkan oleh beberapa tipe dari [[bakteri]] penghasil [[asam]] yang dapat merusak karena reaksi [[fermentasi]] [[karbohidrat]] termasuk [[sukrosa]], [[fruktosa]], dan [[glukosa]].<ref name="Hardie1982">Hardie, J.M. (1982). The microbiology of dental caries. ''Dental Update'', 9, 199-208.</ref><ref name="holloway1983">Holloway, P.J. (1983). The role of sugar in the etiology of dental caries. ''Journal of Dentistry'', 11, 189-213.</ref><ref name=AnthonyHRogers>{{cite book\|author = Rogers A H (editor).\|title = Molecular Oral Microbiology\|publisher = Caister Academic Press\|year = 2008\|url=http://www.horizonpress.com/oral2\|id = [http://www.horizonpress.com/oral2 ISBN 978-1-904455-24-0 ]}}</ref> Asam yang diproduksi tersebut memengaruhi [[mineral]] gigi sehingga menjadi sensitif pada [[pH]] rendah. Sebuah gigi akan mengalami [[demineralisasi]] dan [[remineralisasi]]. Ketika pH turun menjadi di bawah 5,5, proses demineralisasi menjadi lebih cepat dari remineralisasi. Hal ini menyebabkan lebih banyak [[mineral]] gigi yang luluh dan membuat lubang pada gigi. Ada beberapa cara untuk mengelompokkan karies gigi.<ref name="sonis139">Sonis, Stephen T. "Dental Secrets: Questions and Answers Reveal the Secrets to the Principles and Practice of Dentistry." 3rd edition. Hanley & Belfus, Inc., 2003, p. 130. ISBN 1-56053-573-3.</ref> Walaupun apa yang terlihat dapat berbedam faktor-faktor risiko dan perkembangan karies hampir serupa. Mula-mula, lokasi terjadinya karies dapat tampak seperti daerah berkapur namun berkembang menjad lubang coklat. Walaupun karies mungkin dapat saja dilihat dengan mata telanjang, terkadang diperlukan bantuan [[radiografi]] untuk mengamati daerah-daerah pada gigi dan menetapkan seberapa jauh penyakit itu merusak gigi. Bergantung pada seberapa besarnya tingkat kerusakan gigi, sebuah perawatan dapat dilakukan. Perawatan dapat berupa penyembuhan gigi untuk mengembalikan bentuk, fungsi, dan estetika. Walaupun demikian, belum diketahui cara untuk meregenerasi secara besar-besaran struktur gigi, sehingga organisasi kesehatan gigi terus menjalankan penyuluhan untuk mencegah kerusakan gigi, misalnya dengan menjaga kesehatan gigi dan makanan.<ref name="adaoralhealth">[http://www.ada.org/public/topics/cleaning.asp Oral Health Topics: Cleaning your teeth and gums] {{Webarchive\|url=https://web.archive.org/web/20090831095351/http://www.ada.org/public/topics/cleaning.asp \|date=2009-08-31 }}. Hosted on the American Dental Association website. Page accessed August 15, 2006.</ref> Lubang gigi disebabkan oleh beberapa tipe dari [[bakteri]] penghasil [[asam]] yang dapat merusak karena reaksi [[fermentasi]] [[karbohidrat]] termasuk [[sukrosa]], [[fruktosa]], dan [[glukosa]].<ref name="Hardie1982">Hardie, J.M. (1982). The microbiology of dental caries. ''Dental Update'', 9, 199-208.</ref><ref name="holloway1983">Holloway, P.J. (1983). The role of sugar in the etiology of dental caries. ''Journal of Dentistry'', 11, 189-213.</ref><ref name=AnthonyHRogers>{{cite book \| author = Rogers A H (editor). \| title = Molecular Oral Microbiology \| publisher = Caister Academic Press \| year = 2008 \| url=http://www.horizonpress.com/oral2 \| id = [http://www.horizonpress.com/oral2 ISBN 978-1-904455-24-0 ]}}</ref> Asam yang diproduksi tersebut mempengaruhi [[mineral]] gigi sehingga menjadi sensitif pada [[pH]] rendah. Sebuah gigi akan mengalami demineralisasi dan remineralisasi. Ketika pH turun menjadi di bawah 5,5, proses demineralisasi menjadi lebih cepat dari remineralisasi. Hal ini menyebabkan lebih banyak mineral gigi yang luluh dan membuat lubang pada gigi. == Sejarah == Bergantung pada seberapa besarnya tingkat kerusakan gigi, sebuah perawatan dapat dilakukan. Perawatan dapat berupa penyembuahan gigi untuk mengembalukan bentuk, fungsi, dan estetika. Namun belum diketahui cara bagaimana untuk meregenerasi secara besar-besaran pada struktur gigi. Maka, organisasi kesehatan gigi terus menjalankan penyuluhan untuk mencegah kerusakan gigi, misalnya dengan menjaga kesehatan gigi dan makanan.<ref name="adaoralhealth">[http://www.ada.org/public/topics/cleaning.asp Oral Health Topics: Cleaning your teeth and gums]. Hosted on the American Dental Association website. Page accessed August 15, 2006.</ref> [[Berkas:Medieval dentistry.jpg\|jmpl\|ka\|250px\|Sebuah gambar dari tahun 1300 Masehi. Seorang dokter mencabut gigi pasiennya.]] Bukti [[arkeologis]] menunjukkan bahwa karies gigi sudah ada sejak masa [[prasejarah]]. Sebuah tengkorak yang diperkirakan berasal dari satu juta tahun yang lalu dari masa [[neolitikum]] memberi petunjuk adanya karies.<ref name="uicanthropology">[http://www.uic.edu/classes/osci/osci590/11_1Epidemiology.htm Epidemiology of Dental Disease], hosted on the University of Illinois at Chicago website. Page accessed January 9, 2007.</ref> Adanya peningkatan prevalensi karies sejak masa neolitikum mungkin disebabkan banyaknya konsumsi makanan dari tumbuhan yang banyak mengandung karbohidrat.<ref>Richards, MP. [http://www.nature.com/ejcn/journal/v56/n12/full/1601646a.html "A brief review of the archaeological evidence for Palaeolithic and Neolithic subsistence."] European Journal of Clinical Nutrition, 56. 2002.</ref> Sebuah [[gurdi]] atau bor dari kayu ditemukan pada masa neolitikum. gurdi tersebut diperkirakan digunakan sebagai pelubang gigi untuk mengeluarkan [[abses]] dari gigi.<ref>Freeth, Chrissie. [http://www.britarch.ac.uk/ba/ba43/ba43feat.html "Ancient history of trips to the dentist"] {{Webarchive\|url=https://web.archive.org/web/20110213204224/http://www.britarch.ac.uk/ba/ba43/ba43feat.html \|date=2011-02-13 }} British Archaeology, 43, April 1999. Page accessed January 11, 2007.</ref> Perubahan kebudayaan berupa penemuan teknik pertanian di [[Asia Selatan]] dipercayai juga sebagai salah satu peningkat prevalensi karies. ~~==Sejarah==~~ ~~[[Image:Medieval dentistry.jpg\|thumb\|right\|Sebuah gambar dari tahun 1300 Masehi. Seorang dokter mencabut gigi pasiennya.]]~~ Sebuah teks dari [[Sumeria]] ([[5000 SM]]) menggambarkan sebuah "cacing gigi" sebagai penyebab karies.<ref name="adahistory">[http://www.ada.org/public/resources/history/timeline_ancient.asp History of Dentistry: Ancient Origins] {{Webarchive\|url=https://web.archive.org/web/20070705105101/http://www.ada.org/public/resources/history/timeline_ancient.asp \|date=2007-07-05 }}, hosted on the [http://www.ada.org American Dental Association] website. Page accessed January 9, 2007.</ref> Bukti pada kepercayaan ini juga ditemukan pada [[India]], [[Mesir]], [[Jepang]], dan [[Tiongkok]].<ref name="suddickhistorical"/> Bukti arkeologis menunjukkan bahwa karies gigi sudah ada sejak masa [[prasejarah]]. Sebuah tengkorak yang diperkirakan berasal dari satu juta tahun yang lalu dari masa [[neolitikum]] memberi petunjuk adanya karies.<ref name="uicanthropology">[http://www.uic.edu/classes/osci/osci590/11_1Epidemiology.htm Epidemiology of Dental Disease], hosted on the University of Illinois at Chicago website. Page accessed January 9, 2007.</ref> Adanya peningkatan prevalensi karies sejak masa neolitikum mungkin disebabkan banyaknya konsumsi makanan dari tumbuhan yang banyak mengandung karbohidrat.<ref>Richards, MP. [http://www.nature.com/ejcn/journal/v56/n12/full/1601646a.html "A brief review of the archaeological evidence for Palaeolithic and Neolithic subsistence."] European Journal of Clinical Nutrition, 56. 2002.</ref> Sebuah gurdi atau bor dari kayu ditemukan pada masa neolitikum. gurdi tersebut diperkirakan digunakan sebagai pelubang gigi untuk mengeluarkan [[abses]] dari gigi.<ref>Freeth, Chrissie. [http://www.britarch.ac.uk/ba/ba43/ba43feat.html "Ancient history of trips to the dentist"] British Archaeology, 43, April 1999. Page accessed January 11, 2007.</ref> Perubahan kebudayaan berupa penemuan teknik pertanian di [[Asia Selatan]] dipercayai juga sebagai salah satu peningkat prevalensi karies. Banyak [[fosil]] [[tengkorak]] yang dapat menunjukkan adanya perawatan gigi yang primitif. Di [[Pakistan]], sebuah gigi yang diperkirakan berasal dari [[5500 SM]] hingga [[7000 SM]] menunjukkan sebuah lubang yang mungkin disebabkan gurdi gigi.<ref>[http://www.msnbc.msn.com/id/12168308/ Dig uncovers ancient roots of dentistry: Tooth drilling goes back 9,000 years in Pakistan, scientists say], hosted on the MSNBC website. Page accessed on January 10, 2007.</ref> Karies juga dituliskan oleh [[Homer]] dan [[Guy de Chauliac]] dalam tulisan mereka.<ref name="suddickhistorical"/> [[Papirus Ebers]], sebuah tulisan [[Mesir kuno]] ([[1550 SM]]) menyebutkan sebuah penyakit gigi.<ref name="adahistory"/> Selama pemerintahan [[dinasti Sargonid]] [[Assyria]] pada [[668 SM]] hingga [[626 SM]], dituliskan bahwa dokter kerajaan memerlukan tindakan pencabutan gigi untuk mencegah penyebaran [[radang]].<ref name="suddickhistorical"/> Sebuah teks dari [[Sumeria]] ([[5000 SM]]) menggambarkan sebuah "cacing gigi" sebagai penyebab karies.<ref name="adahistory">[http://www.ada.org/public/resources/history/timeline_ancient.asp History of Dentistry: Ancient Origins], hosted on the [http://www.ada.org American Dental Association] website. Page accessed January 9, 2007.</ref> Bukti pada kepercayaan ini juga ditemukan pada [[India]], [[Mesir]], [[Jepang]], dan [[Tiongkok]].<ref name="suddickhistorical">Suddick, Richard P. and Norman O. Harris. [http://crobm.iadrjournals.org/cgi/reprint/1/2/135.pdf "Historical Perspectives of Oral Biology: A Series"]. Critical Reviews in Oral Biology and Medicine, 1(2), pages 135-151, 1990.</ref> Selama masa pendudukan [[Bangsa Romawi]] di [[Eropa]], proses pemasakan makanan menurunkan tingkat terjadinya karies.<ref name="Tougersugars">Touger-Decker, Riva and Cor van Loveren. [http://www.ajcn.org/cgi/reprint/78/4/881S.pdf Sugars and dental caries], The American Journal of Clinical Nutrition, 78, 2003, pages 881S-892S.</ref> Pada masa peradaban [[Yunani]] dan [[Romawi]] dan [[Mesir]], memiliki perawatan untuk meredakan rasa nyeri karena karies.<ref name="suddickhistorical"/> Tingkat kejadian karies menurun pada zaman perunggu dan besi, namun meningkat tajam pada zaman pertengahan.<ref name="uicanthropology"/> Peningkatan [[prevalensi]] karies secara periodik ini serupa dengan kejadian pada masa tahun [[1000]], ketika [[gula]] menjadi lebih mudah didapatkan di dunia Barat. Perawatan yang diberikan berupa obat-obatan [[herbal]] dan [[jampi-jampi]], serta pencabutan gigi.<ref name="suddickhistorical"/><ref>Anderson, T. [http://www.nature.com/bdj/journal/v197/n7/full/4811723a.html "Dental treatment in Medieval England"], British Dental Journal, 2004, 197, pages 419-425.</ref> Umat [[Katolik]] menyampaikan doa dengan penyertaan [[Santo Appolonia]], santo pelindung untuk [[dokter gigi]].<ref>Elliott, Jane. [http://news.bbc.co.uk/1/hi/health/3722598.stm Medieval teeth 'better than Baldrick's'], hosted on the BBC news website. October 8, 2004. Page accessed January 11, 2007.</ref> Banyak fosil tengkorak yang dapat menunjukkan adanya perawatan gigi yang primitif. Di [[Pakistan]], sebuah gigi yang diperkirakan berasal dari [[5500 SM]] hingga [[7000 SM]] menunjukkan sebuah lubang yang mungkin disebabkan gurdi gigi. <ref>[http://www.msnbc.msn.com/id/12168308/ Dig uncovers ancient roots of dentistry: Tooth drilling goes back 9,000 years in Pakistan, scientists say], hosted on the MSNBC website. Page accessed on January 10, 2007.</ref> Karies juga dituliskan oleh [[Homer]] dan [[Guy de Chauliac]] dalam tulisan mereka.<ref name="suddickhistorical">Suddick, Richard P. and Norman O. Harris. [http://crobm.iadrjournals.org/cgi/reprint/1/2/135.pdf "Historical Perspectives of Oral Biology: A Series"]. Critical Reviews in Oral Biology and Medicine, 1(2), pages 135-151, 1990.</ref> [[Papirus Ebers]], sebuah tulisan [[Mesir kuno]] ([[1550 SM]]) menyebutkan sebuah penyakit gigi.<ref name="adahistory">[http://www.ada.org/public/resources/history/timeline_ancient.asp History of Dentistry: Ancient Origins], hosted on the [http://www.ada.org American Dental Association] website. Page accessed January 9, 2007.</ref> Selama pemerintahan [[dinasti Sargonid]] [[Assyria]] pada [[668 SM]] hingga [[626 SM]], dituliskan bahwa dokter kerajaan memerlukan tindakan pencabutan gigi untuk mencegah penyebaran [[radang]].<ref name="suddickhistorical">Suddick, Richard P. and Norman O. Harris. [http://crobm.iadrjournals.org/cgi/reprint/1/2/135.pdf "Historical Perspectives of Oral Biology: A Series"]. Critical Reviews in Oral Biology and Medicine, 1(2), pages 135-151, 1990.</ref> Selama masa pendudukan bangsa Romawi di [[Eropa]], proses pemasakan makanan menurunkan tingkat terjadinya karies.<ref name="Tougersugars">Touger-Decker, Riva and Cor van Loveren. [http://www.ajcn.org/cgi/reprint/78/4/881S.pdf Sugars and dental caries], The American Journal of Clinical Nutrition, 78, 2003, pages 881S–892S.</ref> Pada masa peradaban Yunani dan Romawi dan Mesir, memiliki perawatan untuk meredakan rasa nyeri karena karies.<ref name="suddickhistorical">Suddick, Richard P. and Norman O. Harris. [http://crobm.iadrjournals.org/cgi/reprint/1/2/135.pdf "Historical Perspectives of Oral Biology: A Series"]. Critical Reviews in Oral Biology and Medicine, 1(2), pages 135-151, 1990.</ref> Ada pula bukti yang menunjukkan adanya peningkatan tingkat karies di suku [[Indian]], [[Amerika Utara]] setelah memulai kontak dengan kolonial [[Eropa]]. Sebelum kolonisasi, Indian Amerika Utara menggantungkan hidupnya pada berburu, kemudian berubah menjadi bertani [[jagung]]. Pergantian diet makan ini menyebabkan peningkatan karies.<ref name="uicanthropology"/> Tingkat kejadian karies menurun pada masa Perungggu dan Besi, namun meningkat tajam pada masa pertengahan.<ref name="uicanthropology">[http://www.uic.edu/classes/osci/osci590/11_1Epidemiology.htm Epidemiology of Dental Disease], hosted on the University of Illinois at Chicago website. Page accessed January 9, 2007.</ref> Peningkatan prevalensi karies secara periodik ini serupa dengan kejadi pada masa tahun [[1000]], ketika gula menjadi lebih mudah didapatkan di dunia Barat. Perawatan yang diberikan berupa obat-obatan herbal dan jampi-jampi, serta pencabutan gigi.<ref>Anderson, T. [http://www.nature.com/bdj/journal/v197/n7/full/4811723a.html "Dental treatment in Medieval England"], British Dental Journal, 2004, 197, pages 419-425.</ref><ref name="suddickhistorical">Suddick, Richard P. and Norman O. Harris. [http://crobm.iadrjournals.org/cgi/reprint/1/2/135.pdf "Historical Perspectives of Oral Biology: A Series"]. Critical Reviews in Oral Biology and Medicine, 1(2), pages 135-151, 1990.</ref>Umat [[Katolik]] menyampaikan doa dengan penyertaan [[Santo Appolonia]], santo pelindung untuk [[dokter gigi]].<ref> Elliott, Jane. [http://news.bbc.co.uk/1/hi/health/3722598.stm Medieval teeth 'better than Baldrick's'], hosted on the BBC news website. October 8, 2004. Page accessed January 11, 2007.</ref> Pada [[masa pencerahan]], kepercayaan bahwa "cacing gigi" sebagai penyebab karies ditepis oleh kelompok ilmuwan kedokteran.<ref>Gerabek, W.E. "The tooth-worm: historical aspects of a popular medical belief." Clinical Oral Investigations. March 1999, 3(1), pages 1-6. Abstract hosted on the PubMed [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Display&DB=pubmed here].</ref> [[Pierre Fauchard]], yang dikenal sebagai bapak kedokteran gigi masa kini, adalah salah satu pihak pertama yang menolak ide cacing gigi tersebut. Ia menyebutkan bahwa konsumsi gula yang menjadi penyebab karies gigi.<ref>McCauley, H. Berton. [http://www.fauchard.org/dentalworld/2001/DW.08/DWpfaAug01-page1.htm Pierre Fauchard (1678-1761)] {{Webarchive\|url=https://web.archive.org/web/20070404085126/http://fauchard.org/dentalworld/2001/DW.08/DWpfaAug01-page1.htm \|date=2007-04-04 }}, hosted on the Pierre Fauchard Academy website. The excerpt comes from a speech given at a Maryland PFA Meeting on March 13, 2001. Page accessed January 17, 2007.</ref> Pada tahun [[1850]], prevalensi karies meningkat lagi dan disebabkan oleh pergeseran pola makan.<ref name="suddickhistorical"/> Ada pula bukti yang menunjukkan adanya peningkatan tingkat karies di suku Indian, Amerika Utara setelah memulai kontak dengan kolonial Eropa. Sebelum kolonisasi, Indian Amerika Utara menggantungkan hidupnya pada berburu, kemudian berubah menjadi bertani jagung. Pergantian diet makan ini menyebabkan peningkatan karies.<ref name="uicanthropology">[http://www.uic.edu/classes/osci/osci590/11_1Epidemiology.htm Epidemiology of Dental Disease], hosted on the University of Illinois at Chicago website. Page accessed January 9, 2007.</ref> Pada 1890-an, [[W.D. Miller]] memulai rangkaian penelitian untuk menyelidiki perihal penyakit karies gigi. Ia menemukan bahwa ada bakteri yang hidup di rongga mulut dan mengeluarkan [[asam]] sehingga melarutkan struktur gigi ketika terdapat sisi karbohidrat.<ref>Kleinberg, I. [http://crobm.iadrjournals.org/cgi/content/full/13/2/108 "A mixed-bacteria ecological approach to understanding the role of the oral bacteria in dental caries causation: an alternative to ''Streptococcus mutans'' and the specific-plaque hypothesis."] {{Webarchive\|url=https://web.archive.org/web/20071012164427/http://crobm.iadrjournals.org/cgi/content/full/13/2/108 \|date=2007-10-12 }} Critical Reviews in Oral Biology and Medicine, 13(2), pages 108-125, 2002.</ref> Penjelasan ini dikenal sebagai [[teori karies kemoparasitik]].<ref>Baehni, P.C. and B. Guggenheim. [http://crobm.iadrjournals.org/cgi/reprint/7/3/259.pdf "Potential of Diagnostic Microbiology for Treatment and Prognosis of Dental Caries and Periodontal Disease"] {{Webarchive\|url=https://web.archive.org/web/20081217001211/http://crobm.iadrjournals.org/cgi/reprint/7/3/259.pdf \|date=2008-12-17 }}. Critical Reviews in Oral Biology and Medicine, 7(3), page 262, 1996.</ref> Penemuan Miller, bersamaan penelitian terhadap [[plak]] gigi oleh [[Greene Vardiman Black\|G.V. Black]] dan [[J.L. Williams]], membuat sebuah dasar sebagai penjelasan patofisiologi karies yang diterima hingga kini.<ref name="suddickhistorical"/> Pada [[masa pencerahan]], kepercayaan bahwa "cacing gigi" sebagai penyebab karies ditepis oleh kelompok ilmuwan kedokteran.<ref>Gerabek, W.E. "The tooth-worm: historical aspects of a popular medical belief." Clinical Oral Investigations. March 1999, 3(1), pages 1-6. Abstract hosted on the PubMed [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Display&DB=pubmed here].</ref> [[Pierre Fauchard]], yang dikenal sebagai bapak kedokteran gigi masa kini, adalah salah satu pihak pertama yang menolak ide cacing gigi tersebut. Ia menyebutkan bahwa konsumsi gula-lah yang menjadi penyebab karies gigi.<ref>McCauley, H. Berton. [http://www.fauchard.org/dentalworld/2001/DW.08/DWpfaAug01-page1.htm Pierre Fauchard (1678-1761)], hosted on the Pierre Fauchard Academy website. The excerpt comes from a speech given at a Maryland PFA Meeting on March 13, 2001. Page accessed January 17, 2007.</ref> Pada [[1850]], prevalensi karies meningkat lagi dan disebabkan oleh pergeseran pola makan.<ref name="suddickhistorical">Suddick, Richard P. and Norman O. Harris. [http://crobm.iadrjournals.org/cgi/reprint/1/2/135.pdf "Historical Perspectives of Oral Biology: A Series"]. Critical Reviews in Oral Biology and Medicine, 1(2), pages 135-151, 1990.</ref> == Epidemiologi == Pada 1890-an, W.D. Miller memulai rangkaian penelitian untuk menyelediki perihal penyakit karies gigi. Ia menemukan bahwa ada bakteri yang hidup di rongga mulut dan mengeluarkan asam sehingga melarutkan struktur gigi ketika terdapat sisi karbohidrat.<ref>Kleinberg, I. [http://crobm.iadrjournals.org/cgi/content/full/13/2/108 "A mixed-bacteria ecological approach to understanding the role of the oral bacteria in dental caries causation: an alternative to ''Streptococcus mutans'' and the specific-plaque hypothesis."] Critical Reviews in Oral Biology and Medicine, 13(2), pages 108-125, 2002.</ref> Penjelasan ini dikenal sebagai teori karies kemoparasitik.<ref>Baehni, P.C. and B. Guggenheim. [http://crobm.iadrjournals.org/cgi/reprint/7/3/259.pdf "Potential of Diagnostic Microbiology for Treatment and Prognosis of Dental Caries and Periodontal Disease"]. Critical Reviews in Oral Biology and Medicine, 7(3), page 262, 1996.</ref> Penemuan Miller, bersamaan penelitian terhadap plak gigi oleh [[Greene Vardiman Black\|G.V. Black]] dan J.L. Williams, membuat sebuah dasar sebagai penjelasan patofisiologi karies yang diterima hingga kini.<ref name="suddickhistorical">Suddick, Richard P. and Norman O. Harris. [http://crobm.iadrjournals.org/cgi/reprint/1/2/135.pdf "Historical Perspectives of Oral Biology: A Series"]. Critical Reviews in Oral Biology and Medicine, 1(2), pages 135-151, 1990.</ref> Diperkirakan bahwa 90% dari anak-anak usia sekolah di seluruh dunia dan sebagian besar orang dewasa pernah menderita [[karies]]. Prevalensi karies tertinggi terdapat di [[Asia]] dan [[Amerika Latin]]. Prevalensi terendah terdapat di [[Afrika]].<ref>[http://www.who.int/oral_health/media/en/orh_report03_en.pdf The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century - the approach of the WHO Global Oral Health Programme], released by the [[World Health Organization]]. (File in pdf format.) Page accessed on August 15, 2006.</ref> Di [[Amerika Serikat]], karies gigi merupakan penyakit kronis anak-anak yang sering terjadi dan tingkatnya 5 kali lebih tinggi dari [[asma]].<ref>[http://www.healthypeople.gov/Document/HTML/Volume2/21Oral.htm Healthy People: 2010] {{Webarchive\|url=https://web.archive.org/web/20060813100704/http://www.healthypeople.gov/Document/HTML/Volume2/21Oral.htm \|date=2006-08-13 }}. Html version hosted on [http://www.healthypeople.gov Healthy People.gov] website. Page accessed August 13, 2006.</ref> Karies merupakan penyebab patologi primer atas penanggalan gigi pada anak-anak.<ref>[http://www.adha.org/faqs/index.html Frequently Asked Questions] {{Webarchive\|url=https://web.archive.org/web/20060816085021/http://www.adha.org/faqs/index.html \|date=2006-08-16 }}, hosted on the American Dental Hygiene Association website. Page accessed August 15, 2006.</ref> Antara 29% hingga 59% orang dewasa dengan usia lebih dari limapuluh tahun mengalami karies.<ref name="DCPP">"[http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=dcp2.section.5380 Dental caries]", from the Disease Control Priorities Project. Page accessed August 15, 2006.</ref> ~~==Epidemiologi==~~ Jumlah kasus karies menurun di berbagai negara berkembang, karena adanya peningkatan kesadaran atas kesehatan gigi dan tindakan pencegahan dengan [[terapi florida]].<ref name="whostatement2">[http://www.who.int/water_sanitation_health/oralhealth/en/index1.html World Health Organization] {{Webarchive\|url=https://web.archive.org/web/20060326010127/http://www.who.int/water_sanitation_health/oralhealth/en/index1.html \|date=2006-03-26 }} website, "World Water Day 2001: Oral health", page 2, page accessed August 14, 2006.</ref> Diperkirakan bahwa 90% dari anak-anak usia sekolah di seluruh dunia dan sebagian besar orang dewasa pernah menderita [[karies]]. Prevalensi karies tertinggi terdapat di [[Asia]] dan [[Amerika Latin]]. Prevalensi terendah terdapat di [[Afrika]].<ref>[http://www.who.int/oral_health/media/en/orh_report03_en.pdf The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century – the approach of the WHO Global Oral Health Programme], released by the [[World Health Organization]]. (File in pdf format.) Page accessed on August 15, 2006.</ref> Di [[Amerika Serikat]], karies gigi merupakan penyakit kronis anak-anak yang sering terjadi dan tingkatnya 5 kali lebih tinggi dari [[asma]].<ref>[http://www.healthypeople.gov/Document/HTML/Volume2/21Oral.htm Healthy People: 2010]. Html version hosted on [http://www.healthypeople.gov Healthy People.gov] website. Page accessed August 13, 2006.</ref> Karies merupakan penyebab patologi primer atas penanggalan gigi pada anak-anak.<ref>[http://www.adha.org/faqs/index.html Frequently Asked Questions], hosted on the American Dental Hygiene Association website. Page accessed August 15, 2006.</ref> Antara 29% hingga 59% orang dewasa dengan usia lebih dari limapuluh tahun mengalami karies.<ref name="DCPP">"[http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=dcp2.section.5380 Dental caries]", from the Disease Control Priorities Project. Page accessed August 15, 2006.</ref> == Klasifikasi == Jumlah kasus karies menurun di berbagai negara berkembang, karena adanya peningkatan kesadaran atas kesehatan gigi dan tindakan pencegahan dengan [[terapi florida]].<ref name="whostatement2">[http://www.who.int/water_sanitation_health/oralhealth/en/index1.html World Health Organization] website, "World Water Day 2001: Oral health", page 2, page accessed August 14, 2006.</ref> [[Berkas:MandibularLeftFirstMolar08-15-06.jpg\|ka\|jmpl\|200px\|Celah atau fisura gigi dapat menjadi lokasi karies.]] Karies gigi dapat dikelompokkan berdasarkan lokasi, tingkat laju perkembangan, dan jaringan keras yang terkena.<ref name="sonis139"/> ~~==Klasifikasi==~~ === Lokasi === Karies gigi dapat dikelompokan berdasarkan lokasi, tingkat laju perkembangan, dan jaringan keras yang terkena.<ref name="sonis139">Sonis, Stephen T. "Dental Secrets: Questions and Answers Reveal the Secrets to the Principles and Practice of Dentistry." 3rd edition. Hanley & Belfus, Inc., 2003, p. 130. ISBN 1-56053-573-3.</ref> Secara umum, ada dua tipe karies gigi bila dibedakan lokasinya, yaitu karies yang ditemukan di permukaan halus dan karies di celah atau fisura gigi.<ref name="summit30">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 30. ISBN 0-86715-382-2.</ref> ==== Karies celah dan fisura ==== ~~===Lokasi===~~ Secara umum, ada dua tipe karies gigi bila dibedakan lokasinya, yaitu karies yang ditemukan di permukaan halus dan karies di celah atau fisura gigi.<ref name="summit30">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 30. ISBN 0-86715-382-2.</ref> ~~[[Image:MandibularLeftFirstMolar08-15-06.jpg\|right\|thumb\|Celah atau fisura gigi dapat menjadi lokasi karies.]]~~ ~~====Karies celah dan fisura====~~ Celah dan fisura adalah tanda anatomis gigi. Fisura terbentuk saat perkembangan alur, dan tidak sepenuhnya menyatu, dan membuat suatu turunan atau depresio yang khas pada strutkur permukaan email. Tempat ini mudah sekali menjadi lokasi karies gigi.<ref>Ash & Nelson, "Wheeler's Dental Anatomy, Physiology, and Occlusion." 8th edition. Saunders, 2003, p. 13. ISBN 0-7216-9382-2.</ref> Celah yang ada daerah pipi atau bukal ditemukan di gigi geraham. Karies celah dan fisura ~~terkadang~~kadang-kadang sulit dideteksi. Semakin berkembangnya proses perlubangan akrena karies, email atau enamel terdekat berlubang semakin dalam. Ketika karies telah mencapai [[dentin]] pada pertemuan [[enamel-]] dengan dental, lubang akan menyebar secara [[lateral]]. Di dentin, proses perlubangan akan mengikuti pola segitiga ke arah [[pulpa]] gigi. ==== Karies permukaan halus ==== Ada tiga macam karies permukaan halus. [[Karies proksimal]], atau dikenal juga sebagai [[karies interproksimal]], terbentuk pada permukaan halus antara batas gigi. [[Karies akar]] terbentuk pada permukaan akar gigi. Tipe ketiga karies permukaan halus ini terbentuk pada permukaan lainnya. [[~~Image~~Berkas:Interproximaldecayfiltered08-16-2006.jpg\|~~left~~ka\|~~thumb~~jmpl\|250px\|Pada radiograf ini, titik hitam pada batas gigi menunjukkan sebuah karies proksimal.]] Karies proksimal adalah tipe yang paling sulit dideteksi.<ref name="summit31">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 31. ISBN 0-86715-382-2.</ref> Tipe ini kadang tidak dapat dideteksi secara visual atau manual dengan sebuah ~~''explorer''~~eksplorer gigi. Karies proksimal ini memerlukan pemeriksaan radiografi.<ref>[http://www.newhealth.govt.nz/toolkits/oralhealth/radiography.htm Heatlh Strategy Oral Health Toolkit] {{Webarchive\|url=https://web.archive.org/web/20061005034047/http://www.newhealth.govt.nz/toolkits/oralhealth/radiography.htm \|date=2006-10-05 }}, hosted by the New Zealand's Ministry of Health. Page accessed on August 15, 2006.</ref> [[Karies akar]] adalah tipe karies yang sering terjadi dan biasanya terbentuk ketika permukaan akar telah terbuka karena [[resesi gusi]]. Bila gusi sehat, karies ini tidak akan berkembang karena tidak dapat terpapar oleh plak bakteri. Permukaan akar lebih rentan terkena proses demineralisasi daripada enamel atau email karena [[sementum]]nya demineraliasi pada pH 6,7, di mana lebih tinggi dari enamel.<ref name="banting19">Banting, D.W. "[http://www.nidcr.nih.gov/NR/rdonlyres/5A4386A8-E750-43E9-8450-651F4789D09A/0/David_Banting.pdf The Diagnosis of Root Caries] {{Webarchive\|url=https://web.archive.org/web/20060930192216/http://www.nidcr.nih.gov/NR/rdonlyres/5A4386A8-E750-43E9-8450-651F4789D09A/0/David_Banting.pdf\|date=2006-09-30}}." Presentation to the National Institute of Health Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life, in pdf format, hosted on the [[National Institute of Dental and Craniofacial Research]]. Page 19. Page accessed on August 15, 2006.</ref> Karies akar lebih sering ditemukan di permukaan fasial, permukaan interproksimal, dan permukaan lingual. [[Gigi geraham]] atas merupakan lokasi tersering dari karies akar. ~~====Deskripsi umum lainnya====~~ ==== Deskripsi umum lainnya ==== [[Berkas:Pit-and-Fissure-Caries-GIF.gif\|jmpl\|ka\|180px\|Gambar skematis gigi.]] Di samping pengelompokan diatas, lesi karies dapat dikelompokkan sesuai lokasinya di permukaan tertentu pada gigi. Karies pada permukaan gigi yang dekat dengan permukaan pipi atau bibir disebut "karies fasial", dan karies yang lebih dekat ke arah lidah disebut "karies lingual". Karies fasial dapat dibagi lagi menjadi bukal (dekat pipi) dan labial (dekat bibir). Karies lingual juga dapat disebut palatal bila ditemukan di permukaan lingual dari gigi pada rahang atas (maksila) dan dekat dengan [[pallatum durum]] atau bagian langit-langit mulut yang keras. === Laju penyakit === ~~Karies di dekat leher gigi disebut karies servikal.~~ Laju karies dapat membagi karies menjadi karies [[akut]] dan [[kronis]]. [[Karies rekuren]] berarti karies yang terjadi pada bekas karies terdahulu.{{fact\|date=2010}} ~~==Etiologi==~~ ~~[[Image:Suspectedmethmouth09-19-05closeup.jpg\|right\|thumb\|Karies yang merajalela karena penggunaan metamfetamin.]]~~ === Jaringan keras yang terpengaruh === [[Karies botol susu]] atau karies kanak-kanak adalah pola lubang yang ditemukan di anak-anak pada [[gigi susu]]. Gigi yang sering terkena adalah gigi depan di rahang atas, namun kesemua giginya dapat terkena juga.<ref>[http://www.ada.org/public/topics/decay_childhood_faq.asp ADA Early Childhood Tooth Decay (Baby Bottle Tooth Decay)]. Hosted on the American Dental Association website. Page accessed August 14, 2006.</ref> Sebutan "karies botol susu" karena karies ini sering muncul pada anak-anak yang tidur dengan cairan yang manis (misalnya susu) dengan botolnya. Sering pula disebabkan oleh seringnya pemberian makan pada anak-anak dengan cairan manis. Berdasarkan pada jaringan keras yang terpengaruh, karies dapat dibedakan menjadi karies yang memengaruhi [[enamel]], [[dentin]], atau [[sementum]].<ref>{{Cite web\|title=Tooth - American Dental Association\|url=https://www.mouthhealthy.org/en/az-topics/t/tooth\|website=www.mouthhealthy.org\|access-date=2021-03-30}}</ref> Pada awal perkembangannya, karies mungkin hanya memengaruhi enamel. Namun ketika karies semakin luas, dapat memengaruhi dentin. Sementum adalah jaringan keras yang melapisi akar gigi, maka sementum dapat terkena bila akar gigi terbuka.{{fact\|date=2010}} Ada juga karies yang merajalela atau akries yang menjalar ke semua gigi.[http://www.dent.ohio-state.edu/radiologycarie/classification.htm Radiographic Classification of Caries]. Hosted on the Ohio State University website. Page accessed August 14, 2006.</ref> Tipe karies ini sering ditemukan pada pasien dengan [[xerostomia]], kebersihan mulut yang buruk, pengonsumsi gula yang tinggi, dan pengguna [[metamfetamin]] karena obat ini membuat mulut kering. <ref>[http://www.ada.org/prof/resources/topics/methmouth.asp ADA Methamphetamine Use (METH MOUTH)]. Hosted on the American Dental Association website. Page accessed February 14, 2007.</ref> Bila karoies yang parah ini merupakan hasil karena radiasi kepala dan leher, ini mungkin sebuah karies yang dipengaruhi [[radiasi]]. Karies di dekat leher gigi disebut karies servikal.{{fact\|date=2010}} ~~===Laju penyakit===~~ === Menurut G.V. Black === ~~Laju karies dapat membagi akries menjadi karies [[akut]] atau [[kronis]]. Karies rekuren berarti karies yang terjadi pada bekas karies terdahulu.~~ [[G.V. Black]] mengklasifikasikan karies gigi menjadi 6 kelas berdasarkan letaknya. * '''Kelas I''' : Karies pada permukaan occlusal yaitu pada 2/3 occlusal, baik pada permukaan labial/lingual/palatal dari gigi-geligi dan juga karies yang terdapat pada permukaan lingual gigi-geligi depan. '''Kelas II''' : Karies yang terdapat pada permukaan proximal dari gigi-geligi belakang temasuk karies yang menjalar ke permukan occlusalnya. '''Kelas III''' : Karies yang terdapat pada permukaan proximal dari gigi-geligi depan dan belum mengenai incisal edge. '''Kelas IV''' : Karies pada permukaan proximal gigi-geligi depan dan telah mengenai incisal edge. '''Kelas V''' : Karies yang terdapat pada 1/3 cervical dari permukaan buccal/labial atau lingual palatinal dari seluruh gigi-geligi '''Kelas VI''' : Karies yang terdapat pada daerah ''incisal edge'' gigi depan atau pada ujung cups dari gigi belakang == Penyebab == ~~===Jaringan keras yang terpengaruh===~~ Ada empat hal utama yang berpengaruh pada karies: permukaan gigi, [[bakteri kariogenik]] (penyebab karies), karbohidrat yang difermentasikan, dan waktu.<ref>Soames, J.V. and Southam, J.C. (1993). ''Oral Pathology'', second edition, chapter 2 - Dental Caries.</ref> === Gigi === Bergantung pda jaringan keras mana yang terpengaruh, maka dapat dibedakan karies yang mempengaruhi enamel, dentin, atau sementum. Pada awal perkembangannya, karies mungkin hanya mempengaruhi enamel. Namun ketika karies semakin luas, dapat berpengaruhi dentin. Sementum adalah jaringan keras yang melapisi akar gigi, maka sementum dapat terkena bila akar gigi terbuka. Ada penyakit dan gangguan tertentu pada gigi yang dapat mempertinggi faktor risiko terkena karies. [[Amelogenesis imperfekta]], yang timbul pada 1 dari 718 hingga 14.000 orang, ada penyakit di mana enamel tidak terbentuk sempurna.<ref name="neville89">Neville, B.W., Douglas Damm, Carl Allen, Jerry Bouquot. "''Oral & Maxillofacial Pathology.''" 2nd edition, 2002, page 89. ISBN 0-7216-9003-3.</ref> [[Dentinogenesis imperfekta]] adalah ketidaksempurnaan pembentukan dentin. Pada kebanyakan kasus, gangguan ini bukanlah penyebab utama dari karies.<ref>Cate, A.R. Ten. "''Oral Histology: development, structure, and function.''" 5th edition, 1998, p. 1. ISBN 0-8151-2952-1.</ref> Anatomi gigi juga berpengaruh pada pembentukan karies. Celah atau alur yang dalam pada gigi dapat menjadi lokasi perkembangan karies. Karies juga sering terjadi pada tempat yang sering terselip sisa makanan. ~~==Signs and symptoms==~~ ~~[[Image:Dentalexplorer01croppedfiltered.jpg\|right\|thumb\|100px\|Dental explorer used for caries diagnosis.]]~~ === Bakteri === Until caries progresses, a person may not be aware of it.<ref>[http://www.hpb.gov.sg/hpb/default.asp?pg_id=865&aid=198 Health Promotion Board: Dental Caries], affiliated with the Singapore government. Page accessed on August 14, 2006.</ref> The earliest sign of a new carious lesion, referred as incipient decay, is the appearance of a chalky [[white]] spot on the surface of the tooth, indicating an area of demineralization of enamel. As the lesion continues to demineralize, it can turn brown but will eventually turn into a cavitation, a "cavity". The process before this point is reversible, but once a cavitation forms, the lost tooth structure cannot be [[Regeneration (biology)\|regenerated]]. A lesion which appears [[brown]] and shiny suggests dental caries was once present but the demineralization process has stopped, leaving a stain. A brown spot which is dull in appearance is probably a sign of active caries. [[Berkas:Streptococcus mutans 01.jpg\|ka\|jmpl\|250px\|Preparat ''Streptococcus mutans''.]] Mulut merupakan tempat berkembanganya banyak bakteri, namun hanya sedikit bakteri penyebab karies, yaitu ''[[Streptococcus mutans]]'' dan ''[[Lactobacillus\|Lactobacilli]]'' di antaranya.<ref name="Hardie1982"/><ref name=AnthonyHRogers/> Khusus untuk karies akar, bakteri yang sering ditemukan adalah ''[[Lactobacillus acidophilus]]'', ''[[Actinomyces viscosus]]'', ''[[Nocardia spp.]]'', dan ''[[Streptococcus mutans]]''. Contoh bakteri dapat diambil pada plak. === Karbohidrat yang dapat difermentasikan === As the enamel and dentin are destroyed further, the cavitation becomes more noticeable. The affected areas of the tooth change color and become soft to the touch. Once the decay passes through enamel, the dentinal tubules, which have passages to the nerve of the tooth, become exposed and cause the tooth to [[toothache\|hurt]]. The pain can be worsened by heat, cold, or sweet foods and drinks.<ref name="medline">[http://www.nlm.nih.gov/medlineplus/ency/article/001055.htm Dental Cavities], ''MedlinePlus Medical Encyclopedia'', page accessed August 14, 2006.</ref> Dental caries can also cause [[halitosis\|bad breath]] and foul tastes.<ref>[http://www.med.nyu.edu/patientcare/patients/library/article.html?ChunkIID=11496 Tooth Decay], hosted on the New York University Medical Center website. Page accessed August 14, 2006.</ref> In highly progressed cases, [[infection]] can spread from the tooth to the surrounding [[soft tissue]]s which may become life-threatening, as in the case with [[Ludwig's angina]].<ref>[http://www.nlm.nih.gov/medlineplus/ency/article/001047.htm Ludwig's Anigna], hosted on Medline Plus. Page accessed on August 14, 2006.</ref> Bakteri pada mulut seseorang akan mengubah glukosa, fruktosa, dan sukrosa menjadi [[asam laktat]] melalui sebuah proses [[glikolisis]] yang disebut [[fermentasi]].<ref name="holloway1983"/> Bila asam ini mengenai gigi dapat menyebabkan demineralisasi. Proses sebaliknya, remineralisasi dapat terjadi bila pH telah dinetralkan. Mineral yang diperlukan gigi tersedia pada air liur dan pasta gigi berflorida dan cairan pencuci mulut.<ref>Silverstone, L.M. (1983). Remineralization and dental caries: new concepts. ''Dental Update'', 10, 261-273.</ref> Karies lanjut dapat ditahan pada tingkat ini. Bila demineralisasi terus berlanjut, maka akan terjadi proses pelubangan. ==~~Diagnosis~~= Waktu === Tingkat frekuensi gigi terkena dengan lingkungan yang kariogenik dapat memengaruhi perkembangan karies.<ref name="bnf">[http://www.nutrition.org.uk/home.asp?siteId=43&sectionId=649&parentSection=321&which=undefined "Dental Health"] {{Webarchive\|url=https://web.archive.org/web/20070714175457/http://www.nutrition.org.uk/home.asp?siteId=43&sectionId=649&parentSection=321&which=undefined \|date=2007-07-14 }}, hosted on the British Nutrition Foundation website, 2004. Page accessed August 13, 2006.</ref> Setelah seseorang mengonsumsi makanan mengandung gula, maka bakteri pada mulut dapat memetabolisme gula menjadi asam dan menurunkan pH. PH dapat menjadi normal karena dinetralkan oleh air liur dan proses sebelumnya telah melarutkan mineral gigi. Demineralisasi dapat terjadi setelah 2 jam.<ref>[https://web.archive.org/web/19991010224323/http://www.dent.ucla.edu/ce/caries/ Dental Caries], hosted on the University of California Los Angeles School of Dentistry website. Page accessed August 14, 2006.</ref> [[Image:ToothMontage3.jpg\|thumb\|right\|300px\|This preoperative photo of tooth #3, '''(A)''', reveals no clinically apparent decay other than a small spot within the central fossa. In fact, decay could not be detected with an explorer. Radiographic evaluation, '''(B)''', however, reveals an extensive region of demineralization within the dentin (arrows) of the [[Commonly used terms of relationship and comparison in dentistry\|mesial]] half of the tooth. When a [[Burr (cutter)\|bur]] was used to remove the [[Commonly used terms of relationship and comparison in dentistry\|occlusal]] [[tooth enamel\|enamel]] overlying the decay, '''(C)''', a large hollow was found within the crown and it was discovered that a hole in the side of the tooth large enough to allow the tip of the explorer to pass was contiguous with this hollow. After all of the decay had been removed, '''(D)''', the [[pulp chamber]] had been exposed and most of the mesial half of the crown was either missing or poorly supported.]] Primary [[diagnosis]] involves inspection of all visible tooth surfaces using a good light source, [[Mouth mirror\|dental mirror]] and [[explorer (dental)\|explorer]]. Dental [[radiographs]], produced when [[X-ray]]s are passed through the [[jaw]] and picked up on film or digital sensor, may show dental caries before it is otherwise visible, particularly in the case of caries on interproximal (between the teeth) surfaces. Large dental caries are often apparent to the naked eye, but smaller lesions can be difficult to identify. Unextensive dental caries was formerly found by searching for soft areas of tooth structure with a [[explorer (dental)\|dental explorer]]. Visual and [[Tactition\|tactile]] inspection along with radiographs are still employed frequently among dentists, particularly for pit and fissure caries.<ref>Rosenstiel, Stephen F. [http://www.lib.umich.edu/dentlib/nihcdc/abstracts/rosenstiel.html Clinical Diagnosis of Dental Caries: A North American Perspective]. Maintained by the University of Michigan Dentistry Library, along with the National Institutes of Health, National Institute of Dental and Craniofacial Research. 2000. Page accessed August 13, 2006.</ref> === Faktor lainnya === Some dental researchers have cautioned against the use of dental explorers to find caries.<ref name="summit31">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 31. ISBN 0-86715-382-2.</ref> In cases where a small area of tooth has begun demineralizing but has not yet cavitated, the [[pressure]] from the dental explorer could cause a cavitation. Since the carious process is reversible before a cavitation is present, it may be possible to arrest the caries with [[Fluoride therapy\|fluoride]] to remineralize the tooth surface. When a cavitation is present, a restoration will be needed to replace the lost tooth structure. A common technique used for the diagnosis of early (uncavitated) caries is the use of air blown across the suspect surface, which removes moisture, changing the optical properties of the unmineralized enamel. This produces a white 'halo' effect detectable to the naked eye. [[Optical fiber\|Fiberoptic]] [[transillumination]], [[laser]]s and disclosing dyes have been recommended for use as an adjunct when diagnosing smaller carious lesions in pits and fissures of teeth. Selain empat faktor di atas, terdapat faktor lain yang dapat meningkatkan karies. Air liur dapat menjadi penyeimbangan lingkungan asam pada mulut. Terdapat keadaan di mana air liur mengalami gangguan produksi, seperti pada [[sindrom Sjögren]], [[diabetes mellitus]], [[diabetes insipidus]], dan [[sarkoidosis]].<ref name="neville398">Neville, B.W., Douglas Damm, Carl Allen, Jerry Bouquot. "''Oral & Maxillofacial Pathology.''" 2nd edition, 2002, page 398. ISBN 0-7216-9003-3.</ref> ~~==Causes==~~ [[Berkas:Suspectedmethmouth09-19-05closeup.jpg\|ka\|jmpl\|ka\|250px\|Karies yang merajalela karena penggunaan metamfetamin.]] There are four main criteria required for caries formation: a tooth surface ([[tooth enamel\|enamel]] or [[dentin]]); cariogenic (or potentially caries-causing) [[bacteria]]; fermentable [[carbohydrate]]s (such as [[sucrose]]); and time.<ref>Soames, J.V. and Southam, J.C. (1993). ''Oral Pathology'', second edition, chapter 2 - Dental Caries.</ref> The caries process does not have an inevitable outcome, and different individuals will be susceptible to different degrees depending on the shape of their teeth, oral hygiene habits, and the buffering capacity of their saliva. Dental caries can occur on any surface of a tooth that is exposed to the oral cavity, but not the structures which are retained within the bone.<ref>Kidd, E.A.M. and Smith, B.G.N. (1990). ''Pickard's Manual of Operative Dentistry'', Sixth Edition. Chapter 1 - Why restore teeth?.</ref> Obat-obatan seperti [[antihistamin]] dan [[antidepresan]] dapat memengaruhi produksi air liur.<ref>[http://www.ada.org/public/topics/dry_mouth.asp Oral Health Topics A-Z: Dry Mouth] {{Webarchive\|url=https://web.archive.org/web/20090830070204/http://www.ada.org/public/topics/dry_mouth.asp \|date=2009-08-30 }}, hosted on the [http://www.ada.org American Dental Association] website. Page accessed January 8, 2007.</ref> Terapi [[radiasi]] pada kepala dan leher dapat merusak sel pada [[kelenjar liur]].<ref>[http://www.cancer.gov/cancertopics/pdq/supportivecare/oralcomplications/Patient/page5 Oral Complications of Chemotherapy and Head/Neck Radiation], hosted on the [http://www.cancer.gov/ National Cancer Institute] website. Page accessed January 8, 2007.</ref> Penggunaan [[tembakau]] juga dapat mempertinggi risiko karies.<ref name="neville347">Neville, B.W., Douglas Damm, Carl Allen, Jerry Bouquot. "''Oral & Maxillofacial Pathology.''" 2nd edition, 2002, page 347. ISBN 0-7216-9003-3.</ref> Tembakau adalah faktor yang signifikan pada penyakit [[periodontis]], seperti dapat menyusutkan [[gusi]].<ref>[http://www.perio.org/consumer/smoking.htm Tobacco Use Increases the Risk of Gum Disease] {{Webarchive\|url=https://web.archive.org/web/20070109123411/http://www.perio.org/consumer/smoking.htm \|date=2007-01-09 }}, hosted on the [http://www.perio.org/index.html American Academy of Periodontology] {{Webarchive\|url=https://web.archive.org/web/20051214140958/http://www.perio.org/index.html \|date=2005-12-14 }}. Page accessed on January 9, 2007.</ref> Dengan gusi yang menyusut, maka permukaan gigi akan terbuka. Sementum pada akar gigi akan lebih mudah mengalami demineralisasi.<ref name="banting19"/> ~~=== Teeth ===~~ [[Karies botol susu]] atau karies kanak-kanak adalah pola lubang yang ditemukan di anak-anak pada [[gigi susu]]. Gigi yang sering terkena adalah gigi depan di rahang atas, namun kesemua giginya dapat terkena juga.<ref>[http://www.ada.org/public/topics/decay_childhood_faq.asp ADA Early Childhood Tooth Decay (Baby Bottle Tooth Decay)] {{Webarchive\|url=https://web.archive.org/web/20060813180046/http://www.ada.org/public/topics/decay_childhood_faq.asp \|date=2006-08-13 }}. Hosted on the American Dental Association website. Page accessed August 14, 2006.</ref> Sebutan "karies botol susu" karena karies ini sering muncul pada anak-anak yang tidur dengan cairan yang manis (misalnya susu) dengan botolnya. Sering pula disebabkan oleh seringnya pemberian makan pada anak-anak dengan cairan manis. There are certain diseases and disorders affecting teeth which may leave an individual at a greater risk for caries. [[Amelogenesis imperfecta]], which occurs between 1 in 718 and 1 in 14,000 individuals, is a disease in which the enamel does not form fully or in insufficient amounts and can fall off a tooth.<ref name="neville89">Neville, B.W., Douglas Damm, Carl Allen, Jerry Bouquot. "''Oral & Maxillofacial Pathology.''" 2nd edition, 2002, page 89. ISBN 0-7216-9003-3.</ref> [[Dentinogenesis imperfecta]] is a similar disease. In both cases, teeth may be left more vulnerable to decay because the enamel is not as able to protect the tooth as it would in health.<ref name="neville94">Neville, B.W., Douglas Damm, Carl Allen, Jerry Bouquot. "''Oral & Maxillofacial Pathology.''" 2nd edition, 2002, page 94. ISBN 0-7216-9003-3.</ref> Ada juga karies yang merajalela atau karies yang menjalar ke semua gigi.<ref>[http://www.dent.ohio-state.edu/radiologycarie/classification.htm Radiographic Classification of Caries] {{Webarchive\|url=https://web.archive.org/web/20060823184853/http://www.dent.ohio-state.edu/radiologycarie/classification.htm \|date=2006-08-23 }}. Hosted on the Ohio State University website. Page accessed August 14, 2006.</ref> Tipe karies ini sering ditemukan pada pasien dengan [[xerostomia]], kebersihan mulut yang buruk, pengonsumsi gula yang tinggi, dan pengguna [[metamfetamin]] karena obat ini membuat mulut kering.<ref>[http://www.ada.org/prof/resources/topics/methmouth.asp ADA Methamphetamine Use (METH MOUTH)] {{Webarchive\|url=https://web.archive.org/web/20080601035323/http://www.ada.org/prof/resources/topics/methmouth.asp \|date=2008-06-01 }}. Hosted on the American Dental Association website. Page accessed February 14, 2007.</ref> Bila karies yang parah ini merupakan hasil karena radiasi kepala dan leher, ini mungkin sebuah karies yang dipengaruhi [[radiasi]]. In most people, disorders or diseases affecting teeth are not the primary cause of dental caries. Ninety-six percent of tooth enamel is composed of minerals.<ref>Cate, A.R. Ten. "''Oral Histology: development, structure, and function.''" 5th edition, 1998, p. 1. ISBN 0-8151-2952-1.</ref> These minerals, especially [[hydroxyapatite]], will become soluble when exposed to acidic environments. Enamel begins to demineralize at a pH of 5.5.<ref>Dawes, Colin. "''What Is the Critical pH and Why Does a Tooth Dissolve in Acid?''." Journal of the Canadian Dental Association. Volume 69, Number 11, pages 722 - 724. December 2003. Hosted [http://www.cda-adc.ca/jcda/vol-69/issue-11/722.pdf online]. Page accessed August 14, 2006.</ref> [[Dentin]] and [[cementum]] are more susceptible to caries than [[Tooth enamel\|enamel]] because they have lower mineral content.<ref>Mellberg, J.R. (1986). Demineralization and remineralization of root surface caries. ''Gerodontology'', 5, 25-31.</ref> Thus, when root surfaces of teeth are exposed from gingival recession or periodontal disease, caries can develop more readily. Even in a healthy oral environment, the tooth is susceptible to dental caries. == Tanda dan gejala == The anatomy of teeth may affect the likelihood of caries formation. In cases where the deep grooves of teeth are more numerous and exaggerated, pit and fissure caries are more likely to develop. Also, caries are more likely to develop when food is trapped between teeth. Seseorang sering tidak menyadari bahwa ia menderita karies sampai penyakit berkembang lama.<ref>[http://www.hpb.gov.sg/hpb/default.asp?pg_id=865&aid=198 Health Promotion Board: Dental Caries] {{Webarchive\|url=https://web.archive.org/web/20100901014808/http://www.hpb.gov.sg/hpb/default.asp?pg_id=865&aid=198 \|date=2010-09-01 }}, affiliated with the Singapore government. Page accessed on August 14, 2006.</ref> Tanda awal dari [[lesi]] karies adalah sebuah daerah yang tampak berkapur di permukaan gigi yang menandakan adanya demineralisasi. Daerah ini dapat menjadi tampak coklat dan membentuk lubang. Proses tersebut dapat kembali ke asal atau reversibel, namun ketika lubang sudah terbentuk maka struktur yang rusak tidak dapat diregenerasi. Sebuah lesi tampak coklat dan mengkilat dapat menandakan karies. Daerah coklat pucat menandakan adanya karies yang aktif. Bila enamel dan dentin sudah mulai rusak, lubang semakin tampak. Daerah yang terkena akan berubah warna dan menjadi lunak ketika disentuh. Karies kemudian menjalar ke [[saraf]] gigi, terbuka, dan akan terasa nyeri. Nyeri dapat bertambah hebat dengan panas, suhu yang dingin, dan makanan atau minuman yang manis.<ref name="medline"/> Karies gigi dapat menyebabkan napas tak sedap dan pengecapan yang buruk. ~~[[Image:Streptococcus mutans 01.jpg\|right\|thumb\|A gram stain image of ''Streptococcus mutans''.]]~~ <ref>[http://www.med.nyu.edu/patientcare/patients/library/article.html?ChunkIID=11496 Tooth Decay] {{Webarchive\|url=https://web.archive.org/web/20180630212354/http://www.med.nyu.edu/patientcare/patients/library/article.html%3FChunkIID%3D11496 \|date=2018-06-30 }}, hosted on the New York University Medical Center website. Page accessed August 14, 2006.</ref> Dalam kasus yang lebih lanjut, infeksi dapat menyebar dari gigi ke jaringan lainnya sehingga menjadi berbahaya.<ref>[http://www.nlm.nih.gov/medlineplus/ency/article/001047.htm Ludwig's Anigna], hosted on Medline Plus. Page accessed on August 14, 2006.</ref> === ~~Bacteria~~Diagnosis === [[Berkas:Dentalexplorer01croppedfiltered.jpg\|ka\|jmpl\|125px\|''Dental explorer'', alat diagnostik karies.]] [[Diagnosis]] pertama memerlukan [[inspeksi]] atau pengamatan pada semua permukaan gigi dengan bantuan pencahayaan yang cukup, [[kaca gigi]], dan eksplorer. Radiografi gigi dapat membantu diagnosis, terutama pada kasus karies interproksimal. Karies yang besar dapat langsung diamati dengan mata telanjang. Karies yang tidak ekstensif dibantu dulu dengan menemukan daerah lunak pada [[gigi]] dengan eksplorer.<ref>Rosenstiel, Stephen F. [http://www.lib.umich.edu/dentlib/nihcdc/abstracts/rosenstiel.html Clinical Diagnosis of Dental Caries: A North American Perspective] {{Webarchive\|url=https://web.archive.org/web/20060809104659/http://www.lib.umich.edu/dentlib/nihcdc/abstracts/rosenstiel.html \|date=2006-08-09 }}. Maintained by the University of Michigan Dentistry Library, along with the National Institutes of Health, National Institute of Dental and Craniofacial Research. 2000. Page accessed August 13, 2006.</ref> Beberapa peneliti gigi telah memperingatkan agar tidak menggunakan eksplorer untuk menemukan karies.<ref name="summit31"/> Pada kasus di mana sebuah daerah kecil pada gigi telah mulai terjadi demineralisasi namun belum membentuk lubang, tekanan melalui eksplorer dapat merusak dan membuat lubang. The mouth contains a wide variety of bacteria, but only a few specific species of bacteria are believed to cause dental caries: ''[[Streptococcus mutans]]'' and ''[[Lactobacillus\|Lactobacilli]]'' among them.<ref name="Hardie1982">Hardie, J.M. (1982). The microbiology of dental caries. ''Dental Update'', 9, 199-208.</ref><ref name=AnthonyHRogers>{{cite book \| author = Rogers A H (editor). \| title = Molecular Oral Microbiology \| publisher = Caister Academic Press \| year = 2008 \| url=http://www.horizonpress.com/oral2 \| id = [http://www.horizonpress.com/oral2 ISBN 978-1-904455-24-0 ]}}</ref> Particularly for root caries, the most closely associated bacteria frequently identified are ''[[Lactobacillus acidophilus]]'', ''[[Actinomyces viscosus]]'', ''[[Nocardia spp.]]'', and ''[[Streptococcus mutans]]''. Bacteria collect around the teeth and gums in a sticky, creamy-coloured mass called [[dental plaque\|plaque]], which serves as a [[biofilm]]. Some sites collect plaque more commonly than others. The grooves on the biting surfaces of [[molar (tooth)\|molar]] and [[premolar]] teeth provide microscopic retention, as does the point of contact between teeth. Plaque may also collect along the [[gingiva]]. In addition, the edges of [[dental filling\|fillings]] or [[crown (dentistry)\|crowns]] can provide protection for bacteria, as can intraoral appliances such as orthodontic braces or removable partial [[denture]]s. Teknik yang umum digunakan untuk mendiagnosis karies awal yang belum berlubang adalah dengan tiupan udara melalui permukaan yang disangka, untuk membuang embun, dan mengganti peralatan optik. Hal ini akan membentuk sebuah efek "halo" dengan mata biasa. [[Transiluminasi]] serat optik direkomendasikan untuk mendiagnosis [[karies kecil]].{{fact\|date=2010}} ~~=== Fermentable carbohydrates ===~~ == Perawatan == Bacteria in a person's mouth convert [[sugar]]s ([[glucose]] and [[fructose]], and most commonly [[sucrose]] - or table sugar) into acids such as [[lactic acid]] through a [[glycolytic]] process called [[Fermentation (food)\|fermentation]].<ref name="holloway1983">Holloway, P.J. (1983). The role of sugar in the etiology of dental caries. ''Journal of Dentistry'', 11, 189-213.</ref> If left in contact with the tooth, these acids may cause demineralization, which is the dissolution of its [[mineral]] content. The process is dynamic, however, as remineralization can also occur if the acid is [[Neutralization\|neutralized]]; suitable minerals are available in the mouth from saliva and also from preventative aids such as fluoride toothpaste, dental varnish or mouthwash.<ref>Silverstone, L.M. (1983). Remineralization and dental caries: new concepts. ''Dental Update'', 10, 261-273.</ref> Caries advance may be arrested at this stage. If sufficient acid is produced over a period of time to the favor of demineralization, caries will progress and may then result in so much mineral content being lost that the soft [[organic compound\|organic]] material left behind would disintegrate, forming a cavity or hole. Struktur gigi yang rusak tidak dapat sembuh sempurna, walaupun remineralisasi pada karies yang sangat kecil dapat timbul bila kebersihan dapat dipertahankan.<ref name="medline"/> Untuk lesi yang kecil, florida topikal dapat digunakan untuk merangsang remineralisasi. Untuk lesi yang besar dapat diberikan perawatan khusus. Perawatan ini bertujuan untuk menjaga struktur lainnya dan mencegah perusakan lebih lanjut.{{fact\|date=2010}} [[Berkas:Amalgam.jpg\|ka\|jmpl\|Amalgam dapat digunakan sebagai media untuk penyembuhan karies.]] ~~=== Time ===~~ Secara umum, pengobatan lebih awal akan lebih nyaman dan murah dibandingkan perawatan lanjut karena lubang yang lebih buruk. Anestesi lokal, [[oksida nitro]], atau obat lainnya dapat meredam nyeri.<ref>[http://www.ada.org/public/topics/anesthesia_faq.asp Oral Health Topics: Anesthesia Frequently Asked Questions] {{Webarchive\|url=https://web.archive.org/web/20060716134755/http://www.ada.org/public/topics/anesthesia_faq.asp \|date=2006-07-16 }}, hosted on the American Dental Association website. Page accessed August 16, 2006.</ref> Pembuangan bor dapat membuang struktur yang sudah berlubang. Sebuah alat seperti sendok dapat membersihkan lubang dengan baik.<ref name="summit128">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 128. ISBN 0-86715-382-2.</ref> Ketika lubang sudah dibersihkan, maka diperlukan sebuah teknik penyembuhan untuk mengembalikan fungsi dan keadaan estetikanya. Material untuk penyembuhan meliputi [[amalgam]], [[resin]] untuk gigi, [[porselin]], dan [[emas]].<ref name="DCPPtx">"[http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=dcp2.section.5402 Aspects of Treatment of Cavities and of Caries Disease]" from the Disease Control Priorities Project. Page accessed August 15, 2006.</ref> Resin dan porselin dapat digunakan untuk menyamakan warna dengan gigi asal dan lebih sering digunakan. Bila bahan di atas tidak dapat digunakan, maka diperlukan zat ''crown'' yang terbutat dari emas, porselin atau porselin yang dicampur logam.{{fact\|date=2010}} The frequency of which teeth are exposed to cariogenic (acidic) environments affects the likelihood of caries development.<ref name="bnf">[http://www.nutrition.org.uk/home.asp?siteId=43&sectionId=649&parentSection=321&which=undefined "Dental Health"], hosted on the British Nutrition Foundation website, 2004. Page accessed August 13, 2006.</ref> After meals or snacks containing sugars, the bacteria in the mouth [[metabolize]] them resulting in acids as by-products which decreases [[pH]]. As time progresses, the [[pH]] returns to normal due to the buffering capacity of [[saliva]] and the dissolved mineral content from tooth surfaces. During every exposure to the acidic environment, portions of the inorganic mineral content at the surface of teeth dissolves and can remain dissolved for 2 hours.<ref>[http://www.dent.ucla.edu/ce/caries/ Dental Caries], hosted on the University of California Los Angeles School of Dentistry website. Page accessed August 14, 2006.</ref> Since teeth are vulnerable during these periods of acidic environments, the development of dental caries relies greatly on the frequency of these occurrences. For example, when sugars are eaten continuously throughout the day, the tooth is more vulnerable to caries for a longer period of time, and caries are more likely to develop than if teeth are exposed less frequently to these environments and proper oral hygiene is maintained. This is because the [[pH]] never returns to normal levels, thus the tooth surfaces cannot remineralize, or regain lost mineral content. Pada kasus tertentu, diperlukan [[terapi kanal akar]] pada gigi.<ref>[http://www.agd.org/consumer/topics/rootcanaltherapy/main.asp What is a Root Canal?], hosted by the Academy of General Dentistry. Page accessed on August 16, 2006.</ref> Terapi [[kanal gigi]] atau terapi endodontik, direkomendasikan bila pulpa telah mati karena infeksi atau trauma. Saat terapi, pulpa, termasuk saraf dan pembuluh darahnya, dibuang. Bekas gigi akan diberikan material seperti karet yang disebut [[gutta percha]].<ref>[http://www.aae.org/patients/faqs/rootcanals.htm FAQs About Root Canal Treatment], hosted on the American Association of Endodontists website. Page accessed August 16, 2006.</ref> Pencabutan atau [[ekstraksi gigi]] juga menjadi pilihan perawatan karies, bila gigi tersebut telah hancur karena proses pelubangan.{{fact\|date=2010}} The carious process can begin within days of a tooth erupting into the mouth if the diet is sufficiently rich in suitable carbohydrates, but may begin at any other time thereafter. The speed of the process is dependent on the interplay of the various factors described above but is believed to be slower since the introduction of fluoride.<ref name="summit75">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 75. ISBN 0-86715-382-2.</ref> Compared to coronal smooth surface caries, proximal caries progress quicker and take an average of 4 years to pass through enamel in permanent teeth. Because the [[cementum]] enveloping the root surface is not nearly as durable as the enamel encasing the crown, root caries tends to progress much more rapidly than decay on other surfaces. The progression and loss of mineralization on the root surface is 2.5 times faster than caries in enamel. In very severe cases where oral hygiene is very poor and where the diet is very rich in fermentable carbohydrates, caries may cause cavitation within months of tooth eruption. This can occur, for example, when children continuously drink sugary drinks from baby bottles. On the other hand, it may take years before the process results in a cavity being formed, if at all. == Pencegahan == ~~=== Other risk factors ===~~ [[Berkas:Toothbrush 20050716 004.jpg\|ka\|jmpl\|Menggosok gigi adalah salah satu tindakan pencegahan karies.]] === Kebersihan mulut === In addition to the four main requirements for caries formation, reduced saliva is also associated with increased caries rate since the buffering capability of saliva is not present to counterbalance the acidic environment created by certain foods. As a result, medical conditions that reduce the amount of saliva produced by [[salivary gland]]s, particularly the [[parotid gland]], are likely to cause widespread tooth decay. Some examples include [[Sjögren's syndrome]], [[diabetes mellitus]], [[diabetes insipidus]], and [[sarcoidosis]].<ref name="neville398">Neville, B.W., Douglas Damm, Carl Allen, Jerry Bouquot. "''Oral & Maxillofacial Pathology.''" 2nd edition, 2002, page 398. ISBN 0-7216-9003-3.</ref> Medications, such as antihistamines and antidepressants, can also impair salivary flow.<ref>[http://www.ada.org/public/topics/dry_mouth.asp Oral Health Topics A-Z: Dry Mouth], hosted on the [http://www.ada.org American Dental Association] website. Page accessed January 8, 2007.</ref> Moreover, 63% of the most commonly prescribed medications in the United States list [[xerostomia\|dry mouth]] as a known side effect.<ref name="neville398">Neville, B.W., Douglas Damm, Carl Allen, Jerry Bouquot. "''Oral & Maxillofacial Pathology.''" 2nd edition, 2002, page 398. ISBN 0-7216-9003-3.</ref> Radiation therapy to the head and neck may also damage the [[cell (biology)\|cell]]s in salivary glands, increasing the likelihood for caries formation.<ref>[http://www.cancer.gov/cancertopics/pdq/supportivecare/oralcomplications/Patient/page5 Oral Complications of Chemotherapy and Head/Neck Radiation], hosted on the [http://www.cancer.gov/ National Cancer Institute] website. Page accessed January 8, 2007.</ref> Kebersihan perorangan terdiri dari pembersihan gigi yang baik.<ref name="adaoralhealth"/> Kebersihan mulut yang baik diperluklan untuk meminimalisir agen penyebab penyakit mulut dan membuang plak gigi. Plak tersebut mengandung [[bakteri]].<ref>[http://www.dentistry.leeds.ac.uk/OROFACE/PAGES/micro/micro2.html Introduction to Dental Plaque]. Hosted on the Leeds Dental Institute Website, page accessed August 14, 2006.</ref> Karies dapat dicegah dengan pembersihan dan pemeriksaan gigi teratur. === Pengaturan makanan === The use of [[tobacco]] may also increase the risk for caries formation. [[Dipping tobacco\|Smokeless tobacco]] frequently contains high sugar content in some brands, possibly increasing the susceptibility to caries.<ref name="neville347">Neville, B.W., Douglas Damm, Carl Allen, Jerry Bouquot. "''Oral & Maxillofacial Pathology.''" 2nd edition, 2002, page 347. ISBN 0-7216-9003-3.</ref> Tobacco use is a significant risk factor for periodontal disease, which can allow the [[gingiva]] to [[Receding gums\|recede]].<ref>[http://www.perio.org/consumer/smoking.htm Tobacco Use Increases the Risk of Gum Disease], hosted on the [http://www.perio.org/index.html American Academy of Periodontology]. Page accessed on January 9, 2007.</ref> As the gingiva loses attachment to the teeth, the root surface becomes more visible in the mouth. If this occurs, root caries is a concern since the cementum covering the roots of teeth is more easily demineralized by acids in comparison to enamel.<ref name="banting19">Banting, D.W. "[http://www.nidcr.nih.gov/NR/rdonlyres/5A4386A8-E750-43E9-8450-651F4789D09A/0/David_Banting.pdf The Diagnosis of Root Caries]." Presentation to the National Institute of Health Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life, in pdf format, hosted on the National Institute of Dental and Craniofacial Research. Page 19. Page accessed on August 15, 2006.</ref> Currently, there is not enough evidence to support a causal relationship between smoking and coronal caries, but there is suggestive evidence of a causal relationship between smoking and root-surface caries.<ref>[http://www.cdc.gov/tobacco/sgr/sgr_2004/pdf/executivesummary.pdf Executive Summary] of U.S. Surgeon General's report titled, "The Health Consequences of Smoking: A Report of the Surgeon General," hosted on the [http://www.cdc.gov CDC] website, page 12. Page accessed January 9, 2007.</ref> Untuk kesehatan gigi, pengaturan konsumsi gula penting diperhatikan.<ref name="bnf"/> Gula yang tersisa pada mulut dapat memproduksi asam oleh bakteri. Pengonsumsian [[permen karet]] dengan [[xilitol]] dapat melindungi gigi. Permen ini telah popler di [[Finlandia]].<ref>[http://www.xylitol.net/eng/index.php?action=item-view&item-action=view&item-hash=088f5f675b05714db3f50065561e8692 "History"] {{Webarchive\|url=https://web.archive.org/web/20070630055737/http://www.xylitol.net/eng/index.php?action=item-view&item-action=view&item-hash=088f5f675b05714db3f50065561e8692 \|date=2007-06-30 }}, hosted on the Xylitol.net website. Page accessed October 22, 2006.</ref> Efek ini mungkin disebabkan ketidakmampuan bakteri memetabolisme xilitol.<ref>Ly KA, Milgrom P, Roberts MC, Yamaguchi DK, Rothen M, Mueller G. ''[http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16556326 Linear response of mutans streptococci to increasing frequency of xylitol chewing gum use: a randomized controlled trial].'' BMC Oral Health. 2006 Mar 24;6:6.</ref> [[Berkas:FluorideTrays07-05-05.jpg\|ka\|jmpl\|Perlatan medis untuk memberi florida pada gigi.]] === Tindakan pencegahan lainnya === ~~== Pathophysiology ==~~ [[Terapi florida]] dapat menjadi pilihan untuk mencengah karies. Cara ini telah terbukti menurunkan kasus karies gigi.<ref>Cate, A.R. Ten. "''Oral Histology: development, structure, and function.''" 5th edition, 1998, p. 223. ISBN 0-8151-2952-1.</ref> Florida dapat membuat enbamel resisten terhadap karies.<ref>Ross, Michael H., Gordon I. Kaye, and Wojciech Pawlina, 2003. "''Histology: a text and atlas.''" 4th edition, p. 453. ISBN 0-683-30242-6.</ref> Florida sering ditambahkan pada pasta gigi dan cairan pembersih mulut. Penelitian baru-baru ini menunjukkan bahwa pemberian radiasi [[laser]] intensitas rendah dengan laser ion [[argon]] dapat mencengah karies enamel dan lesi daerah bercak putih.<ref>''[http://jada.ada.org/cgi/content/abstract/137/5/638 In vitro caries formation in primary tooth enamel: Role of argon laser irradiation and remineralizing solution treatment] {{Webarchive\|url=https://web.archive.org/web/20071012174107/http://jada.ada.org/cgi/content/abstract/137/5/638 \|date=2007-10-12 }}''. Journal of the American Dental Association, Volume 137, Number 5, p. 638-644. Page accessed August 18, 2006.</ref> Sedang dikembangkan pula, [[vaksin]] untuk melawan bakteri karies. Pada [[2004]], vaksin ini telah berhasil diujicobakan pada hewan,<ref>[https://archive.today/20120530044628/www.wired.com/medtech/health/news/2004/05/63510 New Drill for Tomorrow's Dentists]. WIRED Magazine, May, 2004. Page accessed May 24, 2007.</ref> dan uji coba klinis pada manusia pada Mei [[2006]].<ref>{{ cite web \|url=http://www.planetbiotechnology.com/products.html \|title=Planet Biotechnology:Products \|publisher=Planet Biotechnology}}</ref> ~~[[Image:Pit-and-Fissure-Caries-GIF.gif\|thumb\|120px\|The progression of pit and fissure caries resembles two triangles with their bases meeting along the junction of enamel and dentin.]]~~ == Catatan kaki dan sumber == ~~===Enamel===~~ <div class="reflist4" style="height: 300px; overflow: auto; padding: 3px noprint" > {{reflist\|2}} Enamel is a highly mineralized acellular [[Tissue (biology)\|tissue]], and caries act upon it through a chemical process brought on by the acidic environment produced by bacteria. The effects of this process include the demineralization of crystals in the enamel, caused by acids, over time until the bacteria physically penetrate the dentin. [[Enamel rod]]s, which are the basic unit of the enamel structure, run perpendicularly from the surface of the tooth to the dentin. Since demineralization of enamel by caries generally follows the direction of the enamel rods, the different triangular patterns between pit and fissure and smooth-surface caries develop in the enamel because the orientation of enamel rods are different in the two areas of the tooth </div> <!--- The preceeding sentence is unclear to the uninitiated reader --->.<ref name="kidd">Kidd, E.A.M. and O. Fejerskov. "[http://jdr.iadrjournals.org/cgi/reprint/83/suppl_1/C35.pdf What Constitutes Dental Caries? Histopathology of Carious Enamel and Dentin Related to the Action of Cariogenic Biofilms]," Journal of Dental Research, 83(Spec Iss C):C35-C38, 2004.</ref> As the enamel loses minerals <!--- Is this an acceptable way to put it? --->, and dental caries progress, they develop several distinct zones, visible under a light microscope. From the deepest layer of the enamel to the enamel surface, the identified areas are the: translucent zone, dark zones, body of the lesion, and surface zone.<ref>Darling, A.I. "[http://jdr.iadrjournals.org/cgi/reprint/42/1/488.pdf Resistance of the Enamel to Dental Caries]," Journal of Dental Research, 42(1): 488-496, 1963.</ref> The translucent zone is the first visible sign of caries and coincides with a 1-2% loss of minerals.<ref name="robinson">Robinson, C., R.C. Shore, S.J. Brookes, S. Strafford, S.R. Wood, and J. Kirkham. "[http://crobm.iadrjournals.org/cgi/reprint/11/4/481.pdf The Chemistry of Enamel Caries]," Critical Reviews in Oral Biology & Medicine, 11(4):481-495, 2000.</ref> A slight remineralization of enamel occurs in the dark zone, which serves as an example of how the development of dental caries is an active process with alternating changes.<ref name="cate417">Cate, A.R. Ten. "''Oral Histology: development, structure, and function.''" 5th edition, 1998, p. 417. ISBN 0-8151-2952-1.</ref> The area of greatest demineralization and destruction is in the body of the lesion itself. The surface zone remains relatively mineralized and is present until the loss of tooth structure results in a cavitation. ~~===Dentin===~~ Unlike enamel, the dentin reacts to the progression of dental caries. <!--- It was unclear in the preceeding section that enamel 'does not* react to the progression of caries ---> After [[tooth development\|tooth formation]], the [[ameloblast]]s, which produce enamel, are destroyed once [[amelogenesis\|enamel formation]] is complete and thus cannot later regenerate enamel after its destruction. On the other hand, dentin is [[dentinogenesis\|produced]] continuously throughout life by [[odontoblast]]s, which reside at the border between the pulp and dentin. Since odontoblasts are present, a stimulus, such as caries, can trigger a biologic response. These defense mechanisms include the formation of sclerotic and tertiary dentin.<ref>"[http://www.usc.edu/hsc/dental/PTHL312abc/312b/09/Reader/reader_set.html Teeth & Jaws: Caries, Pulp, & Periapical Conditions]," hosted on the [http://www.usc.edu/hsc/dental/ University of Southern California School of Dentistry] website. Page accessed June 22, 2007.</ref> In dentin from the deepest layer to the enamel, the distinct areas affected by caries are the translucent zone, the zone of bacterial penetration, and the zone of destruction.<ref name="kidd">Kidd, E.A.M. and O. Fejerskov. "[http://jdr.iadrjournals.org/cgi/reprint/83/suppl_1/C35.pdf What Constitutes Dental Caries? Histopathology of Carious Enamel and Dentin Related to the Action of Cariogenic Biofilms]," Journal of Dental Research, 83(Spec Iss C):C35-C38, 2004.</ref> The translucent zone represents the advancing front of the carious process and is where the initial demineralization begins. The zones of bacterial penetration and destruction are the locations of invading bacteria and ultimately the [[decomposition]] of dentin. ~~[[Image:Smooth Surface Caries GIF.gif\|thumb\|120px\|left\|The faster spread of caries through dentin creates this triangular appearance in smooth surface caries.]]~~ ~~==== Sclerotic dentin ====~~ The structure of dentin is an arrangement of microscopic channels, called dentinal tubules, which radiate outward from the pulp chamber to the exterior cementum or enamel border.<ref name="ross450">Ross, Michael H., Gordon I. Kaye, and Wojciech Pawlina, 2003. ''Histology: a text and atlas.'' 4th edition. Page 450. ISBN 0-683-30242-6.</ref> The diameter of the dentinal tubules is largest near the pulp (about 2.5 μm) and smallest (about 900 nm) at the junction of dentin and enamel.<ref name="cate152">Cate, A.R. Ten. "''Oral Histology: development, structure, and function.''" 5th edition, 1998, p. 152. ISBN 0-8151-2952-1.</ref> The carious process continues through the dentinal tubules, which are responsible for the triangular patterns resulting from the progression of caries deep into the tooth. The tubules also allow caries to progress faster. In response, the fluid inside the tubules bring [[immunoglobulin]]s from the [[immune system]] to fight the bacterial infection. At the same time, there is an increase of mineralization of the surrounding tubules.<ref name="summit13">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 13. ISBN 0-86715-382-2.</ref> This results in a constriction of the tubules, which is an attempt to slow the bacterial progression. In addition, as the acid from the bacteria demineralizes the hydroxyapatite crystals, [[calcium]] and [[phosphorus]] are released, allowing for the precipitation of more crystals which fall deeper into the dentinal tubule. These crystals form a barrier and slow the advancement of caries. After these protective responses, the dentin is considered sclerotic. Fluids within dentinal tubules are believed to be the mechanism by which pain receptors are triggered within the pulp of the tooth.<ref>Dababneh, R.H., A.T. Khouri and M. Addy. "[http://www.nature.com/bdj/journal/v187/n11/full/4800345a.html Dentine hypersensitivity - an enigma? a review of terminology, mechanisms, aetiology and management]." British Dental Journal, vol. 187, no. 11, December 11, 1999. Page accessed June 22, 2007. The referred to theory is the widely-accepted hydrodynamic theory of sensitivity.</ref> Since sclerotic dentin prevents the passage of such fluids, pain that would otherwise serve as a warning of the invading bacteria may not develop at first. Consequently, dental caries may progress for a long period of time without any sensitivity of the tooth, allowing for greater loss of tooth structure. ~~==== Tertiary dentin ====~~ In response to dental caries, there may the production of more dentin toward the direction of the pulp. This new dentin is referred to as tertiary dentin.<ref name="cate152">Cate, A.R. Ten. "''Oral Histology: development, structure, and function.''" 5th edition, 1998, p. 152. ISBN 0-8151-2952-1.</ref> Tertiary dentin is produced to protect the pulp for as long as possible from the advancing bacteria. As more tertiary dentin is produced, the size of the pulp decreases. This type of dentin has been subdivided according to the presence or absence of the original odontoblasts.<ref name="transdentinal">Smith, A.J., P.E. Murray, A.J. Sloan, J.B. Matthews, S. Zhao. "[http://adr.iadrjournals.org/cgi/reprint/15/1/51.pdf Trans-dentinal Stimulation of Tertiary Dentinogenesis]," Advances in Dental Research, 15, pp. 51 -54, August, 2001. Page accessed June 23, 2007.</ref> If the odontoblasts survive long enough to react to the dental caries, then the dentin produced is called "reactionary" dentin. If the odontoblasts are killed, the dentin produced is called "reparative" dentin. In the case of reparative dentin, other cells are needed to assume the role of the destroyed odontoblasts. [[Growth factor]]s, especially [[TGF beta\|TGF-β]],<ref name="transdentinal">Smith, A.J., P.E. Murray, A.J. Sloan, J.B. Matthews, S. Zhao. "[http://adr.iadrjournals.org/cgi/reprint/15/1/51.pdf Trans-dentinal Stimulation of Tertiary Dentinogenesis]," Advances in Dental Research, 15, pp. 51 -54, August, 2001. Page accessed June 23, 2007.</ref> are thought to initiate the production of reparative dentin by [[fibroblast]]s and [[Mesenchymal stem cell\|mesenchymal]] cells of the pulp.<ref name="summit14">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 14. ISBN 0-86715-382-2.</ref> Reparative dentin is produced at an average of 1.5 μm/day, but can be increased to 3.5 μm/day. The resulting dentin contains irregularly-shaped dentinal tubules which may not line up with existing dentinal tubules. This dimishes the ability for dental caries to progress within the dentinal tubules. ~~==Treatment==~~ ~~[[Image:Amalgam.jpg\|right\|thumb\|An amalgam used as a restorative material in a tooth.]]~~ Destroyed tooth structure does not fully regenerate, although remineralization of very small carious lesions may occur if dental hygiene is kept at optimal level.<ref name="medline">[http://www.nlm.nih.gov/medlineplus/ency/article/001055.htm Dental Cavities], ''MedlinePlus Medical Encyclopedia'', page accessed August 14, 2006.</ref> For the small lesions, topical fluoride is sometimes used to encourage remineralization. For larger lesions, the progression of dental caries can be stopped by treatment. The goal of treatment is to preserve tooth structures and prevent further destruction of the tooth. Generally, early treatment is less painful and less expensive than treatment of extensive decay. [[Anesthetic]]s — local, [[nitrous oxide]] ("laughing gas"), or other prescription medications — may be required in some cases to relieve pain during or following treatment or to relieve anxiety during treatment.<ref>[http://www.ada.org/public/topics/anesthesia_faq.asp Oral Health Topics: Anesthesia Frequently Asked Questions], hosted on the American Dental Association website. Page accessed August 16, 2006.</ref> A [[dental drill\|dental handpiece]] ("drill") is used to remove large portions of decayed material from a tooth. A spoon is a dental instrument used to remove decay carefully and is sometimes employed when the decay in [[dentin]] reaches near the [[pulp (tooth)\|pulp]].<ref name="summit128">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 128. ISBN 0-86715-382-2.</ref> Once the decay is removed, the missing tooth structure requires a [[dental restoration]] of some sort to return the tooth to functionality and aesthetic condition. Restorative materials include dental [[amalgam]], [[Dental composite\|composite]] [[resin]], [[porcelain]], and [[gold (element)\|gold]].<ref name="DCPPtx">"[http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=dcp2.section.5402 Aspects of Treatment of Cavities and of Caries Disease]" from the Disease Control Priorities Project. Page accessed August 15, 2006.</ref> Composite resin and porcelain can be made to match the color of a patient's natural teeth and are thus used more frequently when aesthetics are a concern. Composite restorations are not as strong as dental amalgam and gold; some dentists consider the latter as the only advisable restoration for posterior areas where chewing forces are great.<ref>[http://www.ada.org/public/topics/fillings.asp Oral Health Topics: Dental Filling Options], hosted on the American Dental Association website. Page accessed August 16, 2006.</ref> When the decay is too extensive, there may not be enough tooth structure remaining to allow a restorative material to be placed within the tooth. Thus, a [[Crown (dentistry)\|crown]] may be needed. This restoration appears similar to a cap and is fitted over the remainder of the natural crown of the tooth. Crowns are often made of gold, porcelain, or porcelain fused to metal. ~~[[Image:Toothdecay.jpg\|left\|thumb\|A tooth with extensive caries eventually requiring extraction.]]~~ In certain cases, root canal therapy may be necessary for the restoration of a tooth.<ref>[http://www.agd.org/consumer/topics/rootcanaltherapy/main.asp What is a Root Canal?], hosted by the Academy of General Dentistry. Page accessed on August 16, 2006.</ref> [[Root canal]] therapy, also called "endodontic therapy", is recommended if the pulp in a tooth dies from infection by decay-causing bacteria or from trauma. During a root canal, the pulp of the tooth, including the nerve and vascular tissues, is removed along with decayed portions of the tooth. The canals are instrumented with endodontic files to clean and shape them, and they are then usually filled with a rubber-like material called [[gutta percha]].<ref>[http://www.aae.org/patients/faqs/rootcanals.htm FAQs About Root Canal Treatment], hosted on the American Association of Endodontists website. Page accessed August 16, 2006.</ref> The tooth is filled and a crown can be placed. Upon completion of a root canal, the tooth is now non-vital, as it is devoid of any living tissue. An [[Extraction (dental)\|extraction]] can also serve as treatment for dental caries. The removal of the decayed tooth is performed if the tooth is too far destroyed from the decay process to effectively restore the tooth. Extractions are sometimes considered if the tooth lacks an opposing tooth or will probably cause further problems in the future, as may be the case for [[wisdom teeth]].<ref>[http://www.aaoms.org/public/Pamphlets/WisdomTeeth.pdf Wisdom Teeth], packet in pdf format hosted by the American Association of Oral and Maxillofacial Surgeons. Page accessed on August 16, 2006.</ref> Extractions may also be preferred by patients unable or unwilling to undergo the expense or difficulties in restoring the tooth. ~~==Prevention==~~ ~~[[Image:Toothbrush 20050716 004.jpg\|right\|thumb\|[[Toothbrush]]es are commonly used to clean teeth.]]~~ ~~=== Oral hygiene ===~~ Personal hygiene care consists of proper brushing and [[Dental floss\|flossing]] daily.<ref name="adaoralhealth">[http://www.ada.org/public/topics/cleaning.asp Oral Health Topics: Cleaning your teeth and gums]. Hosted on the American Dental Association website. Page accessed August 15, 2006.</ref> The purpose of oral hygiene is to minimize any etiologic agents of disease in the mouth. The primary focus of brushing and flossing is to remove and prevent the formation of [[Dental plaque\|plaque]]. Plaque consists mostly of bacteria.<ref>[http://www.dentistry.leeds.ac.uk/OROFACE/PAGES/micro/micro2.html Introduction to Dental Plaque]. Hosted on the Leeds Dental Institute Website, page accessed August 14, 2006.</ref> As the amount of bacterial plaque increases, the tooth is more vulnerable to dental caries. A toothbrush can be used to remove plaque on most surfaces of the teeth except for areas between teeth. When used correctly, dental floss removes plaque from areas which could otherwise develop proximal caries. Other adjunct hygiene aids include [[interdental brush]]es, [[water pick]]s, and [[mouthwash]]es. Professional hygiene care consists of regular dental examinations and cleanings. Sometimes, complete plaque removal is difficult, and a dentist or [[dental hygienist]] may be needed. Along with oral hygiene, radiographs may be taken at dental visits to detect possible dental caries development in high risk areas of the mouth. ~~=== Dietary modification ===~~ For dental health, the frequency of sugar intake is more important than the amount of sugar consumed.<ref name="bnf">[http://www.nutrition.org.uk/home.asp?siteId=43&sectionId=649&parentSection=321&which=undefined "Dental Health"], hosted on the British Nutrition Foundation website, 2004. Page accessed August 13, 2006.</ref> In the presence of sugar and other carbohydrates, bacteria in the mouth produce acids which can demineralize enamel, dentin, and cementum. The more frequently teeth are exposed to this environment, the more likely dental caries are to occur. Therefore, minimizing snacking is recommended, since snacking creates a continual supply of nutrition for acid-creating bacteria in the mouth. Also, chewy and sticky foods (such as dried fruit or candy) tend to adhere to teeth longer, and consequently are best eaten as part of a meal. Brushing the teeth after meals is recommended. For children, the [[American Dental Association]] and the European Academy of Paediatric Dentistry recommend limiting the frequency of consumption of drinks with sugar, and not giving baby bottles to infants during sleep.<ref>[http://www.eapd.gr/Parents/Pregnant%20mother%20all.htm A Guide to Oral Health to Prospective Mothers and their Infants], hosted on the European Academy of Paediatric Dentistry website. Page accessed August 14, 2006.</ref><ref>[http://www.ada.org/public/topics/decay_childhood_faq.asp Oral Health Topics: Baby Bottle Tooth Decay], hosted on the American Dental Association website. Page accessed August 14, 2006.</ref> Mothers are also recommended to avoid sharing utensils and cups with their infants to prevent transferring bacteria from the mother's mouth.<ref>[http://www.aapd.org/media/Policies_Guidelines/G_InfantOralHealthCare.pdf Guideline on Infant Oral Health Care], hosted on the [http://www.aapd.org American Academy of Pediatric Dentistry] website. Page accessed January 13, 2007.</ref> It has been found that [[milk]] and certain kinds of [[cheese]] like [[cheddar cheese\|cheddar]] can help counter tooth decay if eaten soon after the consumption of foods potentially harmful to teeth.<ref name="bnf">[http://www.nutrition.org.uk/home.asp?siteId=43&sectionId=649&parentSection=321&which=undefined "Dental Health"], hosted on the British Nutrition Foundation website, 2004. Page accessed August 13, 2006.</ref> Also, chewing gum containing [[xylitol]] (wood sugar) is widely used to protect teeth in some countries, being especially popular in the [[Finland\|Finnish]] candy industry.<ref>[http://www.xylitol.net/eng/index.php?action=item-view&item-action=view&item-hash=088f5f675b05714db3f50065561e8692 "History"], hosted on the Xylitol.net website. Page accessed October 22, 2006.</ref> Xylitol's effect on reducing plaque is probably due to bacteria's inability to utilize it like other sugars.<ref>Ly KA, Milgrom P, Roberts MC, Yamaguchi DK, Rothen M, Mueller G. ''[http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16556326 Linear response of mutans streptococci to increasing frequency of xylitol chewing gum use: a randomized controlled trial].'' BMC Oral Health. 2006 Mar 24;6:6.</ref> Chewing and stimulation of flavour receptors on the tongue are also known to increase the production and release of saliva, which contains natural buffers to prevent the lowering of pH in the mouth to the point where enamel may become demineralised.<ref>Bots CP, Brand HS, Veerman EC, van Amerongen BM, Nieuw Amerongen AV. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15218894&query_hl=9&itool=pubmed_docsum Preferences and saliva stimulation of eight different chewing gums]. Int Dent J. 2004 Jun;54(3):143-8.</ref> ~~[[Image:FluorideTrays07-05-05.jpg\|right\|thumb\|Common dentistry trays used to deliver fluoride.]]~~ ~~=== Other preventive measures ===~~ The use of [[dental sealant]]s is a good means of prevention. Sealants are thin plastic-like coating applied to the chewing surfaces of the molars. This coating prevents the accumulation of plaque in the deep grooves and thus prevents the formation of pit and fissure caries, the most common form of dental caries. Sealants are usually applied on the teeth of children, shortly after the molars erupt. Older people may also benefit from the use of tooth sealants, but their dental history and likelihood of caries formation are usually taken into consideration. [[Fluoride therapy]] is often recommended to protect against dental caries. It has been demonstrated that [[water fluoridation]] and fluoride supplements decrease the incidence of dental caries. Fluoride helps prevent decay of a tooth by binding to the hydroxyapatite crystals in enamel.<ref>Cate, A.R. Ten. "''Oral Histology: development, structure, and function.''" 5th edition, 1998, p. 223. ISBN 0-8151-2952-1.</ref> The incorporated fluoride makes enamel more resistant to demineralization and, thus, resistant to decay.<ref>Ross, Michael H., Gordon I. Kaye, and Wojciech Pawlina, 2003. "''Histology: a text and atlas.''" 4th edition, p. 453. ISBN 0-683-30242-6.</ref> Topical fluoride is also recommended to protect the surface of the teeth. This may include a fluoride [[toothpaste]] or mouthwash. Many dentists include application of topical fluoride solutions as part of routine visits. Furthermore, recent research shows that low intensity [[laser]] radiation of [[argon]] ion lasers may prevent the susceptibility for enamel caries and white spot lesions.<ref>''[http://jada.ada.org/cgi/content/abstract/137/5/638 In vitro caries formation in primary tooth enamel: Role of argon laser irradiation and remineralizing solution treatment]''. Journal of the American Dental Association, Volume 137, Number 5, p. 638-644. Page accessed August 18, 2006.</ref> Also, as bacteria are a major factor contributing to poor oral health, there is currently research to find a [[Caries vaccine\|vaccine for dental caries]]. As of 2004, such a vaccine has been successfully tested on non-human animals,<ref>[http://www.wired.com/medtech/health/news/2004/05/63510 New Drill for Tomorrow's Dentists]. WIRED Magazine, May, 2004. Page accessed May 24, 2007.</ref> and is in clinical trials for humans as of May [[2006]].<ref>{{ cite web \|url=http://www.planetbiotechnology.com/products.html \|title=Planet Biotechnology:Products \|publisher=Planet Biotechnology}}</ref> ~~==Catatan kaki dan sumber==~~ ~~{{reflist}}~~ == Referensi == <div class="reflist4" style="height: 220px; overflow: auto; padding: 3px" > <div class="references-small"> {{col-begin}} Baris 225 ⟶ 189: '''Sumber tercetak''' * Anderson, T. [http://www.nature.com/bdj/journal/v197/n7/full/4811723a.html "Dental treatment in Medieval England"], British Dental Journal, 2004, 197. * Ash & Nelson, "Wheeler's Dental Anatomy, Physiology, and Occlusion." 8th edition. Saunders, 2003. ISBN 0-7216-9382-2. * Baehni, P.C. and B. Guggenheim. 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Page accessed on August 15, 2006. {{col-end}} </div> </div> == Pranala luar == * {{en}} [http://www.animated-teeth.com/tooth_decay/t2_tooth_decay_caries.htm What causes cavities; an indepth look] * {{en}}[http://www.lib.uiowa.edu/hardin/md/toothdecaypictures.html Links to tooth decay pictures (Hardin MD/Univ of Iowa)] * {{en}}[http://oralhealth.dent.umich.edu/CDRAM/Coronal.htm Caries Diagnosis - Coronal Caries] {{Webarchive\|url=https://web.archive.org/web/20070723162439/http://oralhealth.dent.umich.edu/CDRAM/Coronal.htm \|date=2007-07-23 }} from the University of Michigan, School of Dentistry. * {{en}}[http://www.who.int/nutrition/topics/dietnutrition_and_chronicdiseases/en/ Diet, Nutrition and the prevention of chronic diseases] (including dental caries) by a Joint [[WHO]]/[[FAO]] Expert consultation (2003) . * {{en}}[http://www.db.od.mah.se/car/data/cariesser.html Image showing various stages of dental caries] {{Webarchive\|url=https://web.archive.org/web/20070831121542/http://www.db.od.mah.se/car/data/cariesser.html \|date=2007-08-31 }} * {{en}}[http://www.whocollab.od.mah.se/sicdata.html Global Oral Health - CaPP] {{Webarchive\|url=https://web.archive.org/web/20101009180752/http://www.whocollab.od.mah.se/sicdata.html \|date=2010-10-09 }}, a chart containing caries data from selected countries. {{Authority control}} ~~[[Kategori:Penyakit gigi]]~~ [[Kategori:Gigi]] ~~[[ar:نخر الأسنان]]~~ [[Kategori:Penyakit gigi dan mulut]] ~~[[zh-min-nan:Chiù-khí]]~~ [[Kategori:Patologi mulut]] ~~[[bg:Кариес]]~~ ~~[[ca:Càries dental]]~~ ~~[[cs:Zubní kaz]]~~ ~~[[da:Caries]]~~ ~~[[de:Zahnkaries]]~~ ~~[[el:Τερηδόνα]]~~ ~~[[en:Dental caries]]~~ ~~[[es:Caries]]~~ ~~[[eo:Kario]]~~ ~~[[fa:پوسیدگی دندان]]~~ ~~[[fr:Carie dentaire]]~~ ~~[[hr:Karijes]]~~ ~~[[it:Carie dentaria]]~~ ~~[[he:עששת]]~~ ~~[[lt:Dantų ėduonis]]~~ ~~[[hu:Fogszuvasodás]]~~ ~~[[ml:ദന്തക്ഷയം]]~~ ~~[[nl:Cariës]]~~ ~~[[ja:う蝕]]~~ ~~[[no:Karies]]~~ ~~[[pl:Próchnica zębów]]~~ ~~[[pt:Cárie]]~~ ~~[[qu:Kiru ismu]]~~ ~~[[ru:Кариес]]~~ ~~[[sk:Zubný kaz]]~~ ~~[[sr:Каријес]]~~ ~~[[sh:Karijes]]~~ ~~[[fi:Karies]]~~ ~~[[sv:Karies]]~~ ~~[[tg:Кариеси дандон]]~~ ~~[[zh:齲齒]]~~