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- Bacteria and debris build up on tooth surfaces, and the bacteria produce acids that cause decay.
- Tooth pain occurs after decay reaches the inside of the tooth.
- Dentists can detect cavities by examining the teeth and taking x-rays periodically.
- Good oral hygiene and regular dental care plus a healthy diet can help prevent cavities.
- Fluoride treatments can help cavities in the enamel heal, but for deeper cavities, dentists must drill out the decay and fill the resulting space.
Along with the common cold and gum disease, cavities are among the most common human afflictions. If cavities are not properly treated by a dentist, they continue to enlarge. Ultimately, an untreated cavity can lead to tooth loss.
Risk factors for cavities
There are many risk factors for cavities:
Plaque is a film like substance composed of bacteria, saliva, food debris, and dead cells that is continually being deposited on teeth.
Tartar, also scientifically known as calculus, is hardened plaque. It may be white but is more often yellow and forms at the base of teeth.
For tooth decay to develop, a tooth must be susceptible, acid-producing bacteria must be present, and nutrients (such as sugar) must be available for the bacteria to thrive and produce acid. A susceptible tooth has relatively little protective fluoride incorporated into the enamel or has pronounced pits, grooves, or cracks (fissures) that retain plaque. Poor oral hygiene that allows plaque and tartar to accumulate can accelerate this process. Although the mouth contains large numbers of bacteria, only certain types generate acid, which causes decay. The most common decay-causing bacteria are Streptococcus mutans.
Progression of tooth decay
Decay in the enamel progresses slowly. After penetrating into the second layer of the tooth—the somewhat softer, less resistant dentin—decay spreads more rapidly and moves toward the pulp, the innermost part of the tooth, which contains the nerves and blood supply. Although a cavity may take 2 or 3 years to penetrate the enamel, it can travel from the dentin to the pulp—a much greater distance—in as little as a year. Thus, root decay that starts in the dentin can destroy a lot of tooth structure in a short time.
Smooth surface decay, the most preventable and reversible type, grows the slowest. In smooth surface decay, a cavity begins as a white spot where bacteria dissolve the calcium of the enamel. Smooth surface decay between the permanent teeth usually begins between the ages of 20 and 30.
Pit and fissure decay, which usually starts during the teen years in the permanent teeth, forms in the narrow grooves on the chewing surface and on the cheek side of the back teeth. Decay at these locations progresses rapidly. Many people cannot adequately clean these cavity-prone areas because the grooves are narrower than the bristles of a toothbrush.
Root decay begins on the root surface covering (cementum) that has been exposed by receding gums, usually in people past middle age. This type of decay often results from difficulty cleaning the root areas, a lack of adequate saliva flow, a diet high in sugar, or a combination of these factors. Root decay can be the most difficult type of tooth decay to prevent and treat.
Symptoms of Cavities
Whether tooth decay causes pain depends on which part of the tooth is affected and how deeply the decay extends. A cavity in the enamel causes no pain. The pain starts when the decay reaches the dentin. At first, people may feel pain only when hot, cold, or sweet foods or beverages come in contact with the affected tooth. This pain indicates that the pulp is still healthy. If the cavity is treated at this stage, dentists can restore the tooth, and most likely no further pain or chewing difficulties will develop.
A cavity that gets close to or actually reaches the pulp causes irreversible damage. Pain lingers even after a stimulus (such as cold water) is removed. The tooth may hurt even without stimulation (spontaneous toothache).
If irreversible damage to the pulp occurs and the pulp subsequently dies, the pain may stop temporarily. The tooth then may become sensitive when people bite or when the tongue or a finger presses on it because the area at the end of the root has become inflamed or because infection has developed at the root. Infection may produce a collection of pus (periapical abscess), which causes constant pain that is worse when people bite.
Diagnosis of Cavities
If a cavity is treated before it starts to hurt, the chance of damage to the pulp is reduced, and more of the tooth structure is saved. To detect cavities early, a dentist inquires about pain, examines the teeth, probes the teeth with dental instruments, and may take x-rays. Some dentists also use special dyes, fiberoptic lights, and/or new devices that detect cavities by changes in electrical conductivity or laser reflectivity. People should have a dental examination every 6 to 12 months. Not every examination includes x-rays. Depending on the dentist’s assessment of a person’s teeth, x-rays may be taken every 12 to 36 months.
Prevention of Cavities
Several general strategies are key to preventing cavities:
Oral hygiene
Good oral hygiene, which involves brushing before or after breakfast and before bedtime and flossing daily to remove plaque, can effectively control smooth surface decay. Brushing helps prevent cavities from forming on the top and sides of the teeth, and flossing gets between the teeth where a brush cannot reach.
Electric and ultrasonic toothbrushes are excellent, but an ordinary toothbrush, used properly, is quite sufficient. Normally, proper brushing takes only about 3 to 4 minutes. People should avoid using too much toothpaste, especially abrasive types, which may erode the teeth. Floss is gently moved back and forth between the teeth, then wrapped around the tooth and root surfaces in a “C” shape at the gum line. When the floss is moved up and down 3 times, it can remove plaque and food debris. There are many small, toothpick-like devices (called interproximal brushes) with bristles or plastic projections on the ends that can be used to clean between teeth. These devices are more effective than flossing but only if there is enough space between the teeth to accommodate them. They come in many sizes and shapes and can be used alone or with different toothpastes or rinses.
Initially, plaque is quite soft, and removing it with a soft-bristled toothbrush and dental floss at least once every 24 hours makes decay unlikely. Once plaque begins to harden, a process that begins after about 72 hours, removing it becomes more difficult.
Diet
Although all carbohydrates can cause tooth decay to some degree, the biggest culprits are sugars. All simple sugars, including table sugar (sucrose) and the sugars in honey (levulose and dextrose), fruit (fructose), and milk (lactose), have the same effect on the teeth. Whenever sugar comes in contact with plaque, Streptococcus mutans bacteria in the plaque produce acid. The amount of sugar eaten is of little consequence. The amount of time the sugar stays in contact with the teeth is what matters. Thus, sipping a sugary soft drink over an hour is more damaging than eating a candy bar in 5 minutes, even though the candy bar may contain more sugar. Infants who go to bed with a bottle, even if it contains only milk or formula, are also at risk of cavities. Bedtime bottles should contain only water.
People who tend to develop cavities should eat sweet snacks less often. Rinsing the mouth with water after eating a snack removes some of the sugar, but brushing the teeth is more effective. Drinking artificially sweetened soft drinks also helps, although diet colas contain acid that can promote tooth decay. Drinking tea or coffee without sugar also can help people avoid cavities, particularly on exposed root surfaces.
Treatment of Cavities
- Fluoride
- Fillings
- Root canal or tooth extraction
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