Dental Caries

Tooth decay (dental caries, cavities) is the most common of all oral diseases. It occurs in all ages but is more common in children and young adults.

CAUSES

Bacteria in your mouth combine with foods (particularly sugars and starches) to produce plaque. Plaque is a substance that sticks to the hard surfaces of teeth. The bacteria in the plaque produce acids that attack the enamel of teeth. Repeated acid attacks dissolve the enamel and create holes in the teeth. Root surfaces of teeth may also get these holes.

Other contributing factors include:

  • Frequent snacking and drinking of cavity-producing foods and liquids.

  • Poor oral hygiene.

  • Dry mouth.

  • Substance abuse such as methamphetamine.

  • Broken or poor fitting dental restorations.

  • Eating disorders.

  • Gastroesophageal reflux disease (GERD).

  • Certain radiation treatments to the head and neck.

SYMPTOMS

At first, dental decay appears as white, chalky areas on the enamel. In this early stage, symptoms are seldom present. As the decay progresses, pits and holes may appear on the enamel surfaces. Progression of the decay will lead to softening of the hard layers of the tooth. At this point you may experience some pain or achy feeling after sweet, hot, or cold foods or drinks are consumed. If left untreated, the decay will reach the internal structures of the tooth and produce severe pain. Extensive dental treatment, such as root canal therapy, may be needed to save the tooth at this late stage of decay development.

DIAGNOSIS

Most cavities will be detected during regular check-ups. A thorough medical and dental history will be taken by the dentist. The dentist will use instruments to check the surfaces of your teeth for any breakdown or discoloration. Some dentists have special instruments, such as lasers, that detect tooth decay. Dental X-rays may also show some cavities that are not visible to the eye (such as between the contact areas of the teeth).

TREATMENT

Treatment involves removal  of the tooth decay and replacement with a restorative material such as silver, gold, or composite (white) material. However, if the decay involves a large area of the tooth and there is little remaining healthy tooth structure, a cap (crown) will be fitted over the remaining structure. If the decay involves the center part of the tooth (pulp), root canal treatment will be needed before any type of dental restoration is placed. If the tooth is severely destroyed by the decay process, leaving the remaining tooth structures unrestorable, the tooth will need to be pulled (extracted). Some early tooth decay may be reversed by fluoride treatments and thorough brushing and flossing at home.

PREVENTION

  • Eat healthy foods. Restrict the amount of sugary, starchy foods and liquids you consume. Avoid frequent snacking and drinking of unhealthy foods and liquids.

  • Sealants can help with prevention of cavities. Sealants are composite resins applied onto the biting surfaces of teeth at risk for decay. They smooth out the pits and grooves and prevent food from being trapped in them. This is done in early childhood before tooth decay has started.

  • Fluoride tablets may also be prescribed to children between 6 months and 10 years of age if your drinking water is not fluoridated. The fluoride absorbed by the tooth enamel makes teeth less susceptible to decay. Thorough daily cleaning with a toothbrush and dental floss is the best way to prevent cavities. Use of a fluoride toothpaste is highly recommended. Fluoride mouth rinses may be used in specific cases.

  • Topical application of fluoride by your dentist is important in children.

  • Regular visits with a dentist for checkups and cleanings are also important.

SEEK IMMEDIATE DENTAL CARE IF:

  • You have a fever.

  • You develop redness and swelling of your face, jaw, or neck.

  • You develop swelling around a tooth.

  • You are unable to open your mouth or cannot swallow.

  • You have severe pain uncontrolled by pain medicine.