CONDITIONS
Tooth decay (Dental caries)
What is tooth decay?
Tooth decay is a damage to a tooth’s surface or enamel. It occurs when the outer layer (enamel) and inner part (dentine) of a tooth get weaker due to acid from sugary foods or drinks. Over time, this acid can cause a hole in the tooth. Tooth decay can impact individuals of all age groups, including very young children.
The outer layer of the tooth, known as enamel, is the hardest part of the body and acts as a protective barrier. It does not contain nerves or blood vessels, making it unable to feel pain. Beneath the enamel is dentine, which makes up most of the tooth structure and is more sensitive to pain. Dentine surrounds the central part of the tooth called the pulp. The pulp is a delicate tissue in the middle of the tooth and contains blood vessels and nerves.
What causes teeth to decay?
Decay occurs when sugars present in the food and drinks interact with the bacteria found in plaque (thin, sticky layer that forms on the teeth), resulting in formation of acids. These acids attack the teeth, causing them to gradually weaken and the enamel to dissolve. Regular exposure to acid can lead to continuous mineral loss and the development of white spots, indicating early decay. Fortunately, tooth decay can be stopped or reversed at this stage. The enamel can self-repair by utilizing minerals from saliva and fluoride from toothpaste. Additionally, dentists can also apply fluoride to aid in the restoration process. However, if the loss of minerals exceeds the capacity for restoration, the enamel weakens and eventually breaks down, forming a cavity.
What are the stages of tooth decay?
There are five stages of tooth decay.
- Demineralization: Tooth decay begins with the appearance of white spots on the tooth’s surface due to calcium loss and plaque buildup. Subsequently, bacteria in the plaque break down sugars from food, causing the enamel to erode, known as demineralization. At this stage, tooth decay can be reversed by seeking advice from a dentist on proper brushing techniques, using fluoride toothpaste, and receiving a topical fluoride treatment.
- Enamel decay: In the second stage of tooth decay, the enamel beneath the surface of the tooth starts to deteriorate, making the natural process of remineralization ineffective in restoring the enamel and minerals. This leads to the development of a lesion within the tooth. As the decay continues, irreversible harm to the tooth’s surface is possible. If a tooth fractures, it is essential to seek dental treatment promptly.
- Dentin decay: Stage three of tooth decay is called dentin decay. If left untreated, the enamel will continue to dissolve due to bacteria and acids, potentially affecting the dentin. The dentin is the layer of the tooth that lies between the enamel and the pulp. As decay progresses to the dentin, the level of pain increases, and a sharp sensation may be felt in the infected tooth. When a significant amount of the underlying enamel is weakened by the loss of calcium and phosphate minerals, it eventually collapses, forming a dental cavity. A dental filling is typically necessary to restore the tooth at this stage.
- Pulp damage: The pulp, located at the center of the tooth, consists of living tissue and cells known as odontoblasts. These cells produce dentin, the connective tissue linking the enamel and pulp. When bacteria infect the pulp, pus may form, destroying blood vessels and nerves within the tooth. This condition, often referred to as a toothache, can result in persistent pain. Root canal therapy is typically the recommended treatment at this point.
- Abscess: Abscess formation marks the final stage of tooth decay. In this stage, the infection progresses throughout the pulp and reaches the tip of the root, leading to a pocket of pus at the root tip, called an abscess. Tooth abscesses cause severe pain that may radiate to the jaw and ear. Individuals with tooth abscesses may also present with swelling of the gums, face, or jaws, swollen lymph nodes, and even fever. A tooth abscess requires immediate treatment as the infection can spread to surrounding tissues and damage even the jawbone. Treatment at this stage may involve root canal therapy, tooth extraction, or even minor surgical procedures.
What are the symptoms of tooth decay?
Symptoms are typically absent during the initial stages of tooth decay. However, as the decay progresses, individuals may experience symptoms including:
- Toothache
- Tooth sensitivity to hot or cold foods and drinks
- Visible pits or holes in the pockets
- Possible white, brown, or black staining on the surface of the teeth
- Pain when drinking or eating something hot, cold, or sweet
- Tooth pain while biting
- Red or swollen gums near the decayed tooth
How is tooth decay diagnosed?
The dentist detects tooth decay by:
- Asking about tooth pain and sensitivity.
- Looking around inside the mouth and at the teeth.
- Probing the teeth with dental instruments to check for soft areas.
- Dental X-rays can show where cavities and decay are.
How is tooth decay treated?
Regular checkups can find cavities and other dental issues before they lead to more severe problems. Seeking care early increases the likelihood of reversing initial tooth decay and preventing further deterioration. Treating a cavity before it becomes painful often requires minimal intervention.
Treatment of cavities depends on how serious they are and the situation. Treatment options include:
- Fluoride treatments. If a cavity has just started, a fluoride treatment may help restore the tooth’s enamel and can sometimes reverse a cavity in the very early stages. Fluoride treatments may be liquid, gel, foam, or varnish that is brushed onto the teeth or placed in a small tray that fits over the teeth.
- Fillings, also called restorations, are the main treatment option. Fillings are made of various materials, such as tooth-coloured composite resin or porcelain, or dental amalgam, a mixture of several materials.
- If there is a lot of decay or weakened teeth, a crown may be needed. A custom-fitted covering that replaces the tooth’s entire natural crown. The purpose of a dental crown is to protect the tooth and minimize the risk of it fracturing. The dentist removes the decayed area and an appropriate amount of the adjacent tooth structure to ensure a proper fit. Crowns may be made of gold, high-strength porcelain, resin, porcelain fused to metal, or other materials.
- Root canals. When decay reaches the inner material of the tooth, called the pulp, a root canal may be necessary. This procedure aims to restore and preserve a severely damaged or infected tooth rather than extracting it. The affected tooth pulp is extracted, and in some cases, medication is applied to the root canal to eliminate any infection. Subsequently, the pulp is substituted with a filling material.
- Tooth extractions. Tooth extractions are required when certain teeth are severely decayed and cannot be saved, necessitating their extraction.
How to prevent tooth decay?
Implementing good oral hygiene practices is an important part of preventing tooth decay. Below are some strategies that can be implemented to help avoid tooth decay.
- Brush teeth two times a day using fluoride toothpaste.
- Cleaning between teeth using dental floss every day.
- Eating a healthy diet that is low in added sugar.
- Drinking water can also help. Staying hydrated can help the production of saliva, which in turn helps to nourish tooth enamel and cleanse the oral cavity.
- Having regular dental checkups.
In summary, tooth decay is caused by bacteria in dental plaque converting sugars into acids, which can damage teeth. There are five stages of decay, with early stages being reversible and later stages causing permanent damage. Treatment options vary depending on the stage of decay, such as fluoride treatments, fillings, and root canals. Preventative measures like regular brushing, avoiding sugary foods, and dental checkups can help reduce the risk of tooth decay.
References
- Oral Health Foundation. Dental decay. Available from: https://www.dentalhealth.org/dental-decay Accessed on 3rd May 2024
- National Institute of Dental and Craniofacial Research. Tooth decay. Available from: https://www.nidcr.nih.gov/health-info/tooth-decay#overview. Accessed on 3rd May 2024
- What to know about tooth decay stages. Available from: https://www.webmd.com/oral-health/what-to-know-tooth-decay-stages Accessed on 3rd May 2024
- Tooth decay. Available from: https://www.healthdirect.gov.au/tooth-decay. Accessed on 3rd May 2024
- Mayo Clinic. Cavities and tooth decay. Diagnosis and treatment. Available from: https://www.mayoclinic.org/diseases-conditions/cavities/diagnosis-treatment/drc-20352898. Accessed on 3rd May 2024
