Dental caries (tooth decay) is a major oral health problem in most industrialized countries, affecting 60–90% of schoolchildren and the vast majority of adults. Cavities start small and gradually become bigger when they’re left untreated. Because many cavities don’t cause pain in the beginning, it can be hard to realize that a problem exists. Regular dental appointments can detect tooth decay early.
What Are the Symptoms of tooth decay?
Tooth decay may not cause any pain. But if you have dental caries, you might have:
- toothache – either continuous pain keeping you awake, or occasional sharp pain without an obvious cause; it can sometimes be painless
- tooth sensitivity – you may feel tenderness or pain when eating or drinking something hot, cold or sweet
- grey, brown or black spots appearing on your teeth
- bad breath
- an unpleasant taste in your mouth
What Are the Causes of Tooth Decay?
Cavities are caused by tooth decay — a process that occurs over time. Here’s how tooth decay develops:
- Plaque forms. Dental plaque is a clear sticky film that coats your teeth. It’s due to eating a lot of sugars and starches and not cleaning your teeth well. When sugars and starches aren’t cleaned off your teeth, bacteria quickly begin feeding on them and form plaque. Plaque that stays on your teeth can harden under or above your gum line into tartar (calculus). Tartar makes plaque more difficult to remove and creates a shield for bacteria.
- Plaque attacks. The acids in plaque remove minerals in your tooth’s hard, outer enamel. This erosion causes tiny openings or holes in the enamel — the first stage of cavities. Once areas of enamel are worn away, the bacteria and acid can reach the next layer of your teeth, called dentin. This layer is softer than enamel and less resistant to acid. Dentin has tiny tubes that directly communicate with the nerve of the tooth causing sensitivity.
- Destruction continues. As tooth decay develops, the bacteria and acid continue their march through your teeth, moving next to the inner tooth material (pulp) that contains nerves and blood vessels. The pulp becomes swollen and irritated from the bacteria. Because there is no place for the swelling to expand inside of a tooth, the nerve becomes pressed, causing pain. Discomfort can even extend outside of the tooth root to the bone.
Everyone who has teeth is at risk of getting cavities, but the following factors can increase risk:
- Tooth location. Decay most often occurs in your back teeth (molars and premolars). These teeth have lots of grooves, pits and crannies, and multiple roots that can collect food particles. As a result, they’re harder to keep clean than your smoother, easy-to-reach front teeth.
- Certain foods and drinks. Foods that cling to your teeth for a long time — such as milk, ice cream, honey, sugar, soda, dried fruit, cake, cookies, hard candy and mints, dry cereal, and chips — are more likely to cause decay than foods that are easily washed away by saliva.
- Frequent snacking or sipping. When you steadily snack or sip sugary drinks, you give mouth bacteria more fuel to produce acids that attack your teeth and wear them down. And sipping soda or other acidic drinks throughout the day helps create a continual acid bath over your teeth.
- Bedtime infant feeding. When babies are given bedtime bottles filled with milk, formula, juice, or other sugar-containing liquids, these beverages remain on their teeth for hours while they sleep, feeding decay-causing bacteria. This damage is often called baby bottle tooth decay. Similar damage can occur when toddlers wander around drinking from a sippy cup filled with these beverages.
- Inadequate brushing. If you don’t clean your teeth soon after eating and drinking, plaque forms quickly and the first stages of decay can begin.
- Not getting enough fluoride. Fluoride, a naturally occurring mineral, helps prevent cavities and can even reverse the earliest stages of tooth damage. Because of its benefits for teeth, fluoride is added to many public water supplies. It’s also a common ingredient in toothpaste and mouth rinses. But bottled water usually does not contain fluoride.
- Younger or older age. In the United States, cavities are common in very young children and teenagers. Older adults also are at higher risk. Over time, teeth can wear down and gums may recede, making teeth more vulnerable to root decay. Older adults also may use more medications that reduce saliva flow, increasing the risk of tooth decay.
- Dry mouth. Dry mouth is caused by a lack of saliva, which helps prevent tooth decay by washing away food and plaque from your teeth. Substances found in saliva also help counter the acid produced by bacteria. Certain medications, some medical conditions, radiation to your head or neck, or certain chemotherapy drugs can increase your risk of cavities by reducing saliva production.
- Worn fillings or dental devices. Over the years, dental fillings can weaken, begin to break down, or develop rough edges. This allows plaque to build up more easily and makes it harder to remove. Dental devices can stop fitting well, allowing decay to begin underneath them.
- Heartburn. Heartburn or gastroesophageal reflux disease (GERD) can cause stomach acid to flow into your mouth (reflux), wearing away the enamel of your teeth and causing significant tooth damage. This exposes more of the dentin to attack by bacteria, creating tooth decay. Your dentist may recommend that you consult your doctor to see if gastric reflux is the cause of your enamel loss.
- Eating disorders. Anorexia and bulimia can lead to significant tooth erosion and cavities. Stomach acid from repeated vomiting (purging) washes over the teeth and begins dissolving the enamel. Eating disorders also can interfere with saliva production.
Treatment options for tooth cavities
Tell your doctor about uncomfortable symptoms like tooth sensitivity or pain. Your dentist can identify tooth decay after an oral exam. However, some cavities aren’t visible from an oral exam. So your dentist may use a dental X-ray to look for decay.
Treatment options depend on severity. There are several ways to treat a cavity.
A dentist uses a drill and removes decayed material from a tooth. Your dentist then fills your tooth with a substance, such as silver, gold, or composite resin.
For more severe decay, your dentist may place a custom-fit cap over your tooth to replace its natural crown. Your dentist will remove decayed tooth material before starting this procedure.
When tooth decay causes the death of your nerves, your dentist will perform a root canal to save your tooth. They remove the nerve tissue, blood vessel tissues, and any decayed areas of your tooth. Your dentist then checks for infections and applies medication to the roots as needed. Finally, they fill the tooth, and they might even place a crown on it.
If your dentist detects a tooth cavity in its early stage, a fluoride treatment may restore your tooth enamel and prevent further decay.
Preventing tooth cavities
Tooth cavities are a common dental problem, but you can reduce your risk by doing the following:
- Brush your teeth at least twice per day with a fluoride toothpaste.
- Floss at least once daily, as recommended by the American Dental Association.
- Eat fewer sugary and acidic foods, like sweets, candy, juice, soda, and refined carbohydrates.
- Limit snacking between meals.
- Consider getting dental sealants on your teeth.
The following foods can help fight tooth decay:
- fiber-rich fruits and vegetables
- calcium-rich foods
- xylitol sugarless chewing gum
- unsweetened black or green tea
- water with fluoride
Also, don’t forget to visit your dentist at least twice per year for regular teeth cleanings. This allows you to get treatment for any problems your dentist finds, and it will help prevent future dental problems.
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