What is tooth decay?

Tooth decay or dental caries is an infection of the tooth, which occurs mostly due to bacterial plaque, which has not been regularly removed. People often think, that painless tooth cannot be decayed. Cavities are most commonly appearing on places where are good conditions for the retention of food residues and bacteria and can not be reached with a toothbrush. Areas under old dental fillings, prosthetic material and elsewhere are much more susceptible for bacterial accumulation. A lot of people believe that they are having bad teeth because also their parents and grandparents have them. Some people do have increased risk of tooth decay, but the reason for this lies elsewhere.

Can tooth decay cure itself?

Initial tooth decay is visible as a white, chalky stain which is, with good oral hygiene, fluoride intake and avoiding of cariogenic food, curable and dental filling is not yet necessary. So the answer on upper question is yes, but it all depends on the degree of tooth’s deterioration. When dental cavity (hole) appears and tooth decay penetrates into the inner layer of tooth, it is necessary to remove all caries with a dental bur, otherwise tooth’s nerve can be harmed, as tooth is continuing to decay. When decay reaches a sufficient depth, symptoms appear and it is possible that tooth isn’t strong enough to reduce inflammation, so root canal treatment is needed. You will need regular six monthly check ups that allow early detection of caries, because waiting too long can worsen the situation.

What are the consequences of tooth decay?

  1. The tooth may die. If caries progresses to the tooth nerve it can become inflammed, which can be felt as toothache. Tooth eventually dies and then it is necessary to do a root canal treatment.
  2. Caries is one of the major causes of tooth loss.
  3. Worse working success. It has been shown that children with poor oral health have worse grades in school, poorer social relationships and less success later in life, because children, who are experiencing often toothaches, are less concentrated on their schoolwork.

What increases risk for a tooth decay?

Most people think that only sugar causes tooth decay, yet this is not entirely true. Cavities cannot occur, if there are no bacteria in the mouth. Cavities do not occur spontaneously. There are 4 risk factors which contribute to formation of a tooth decay (sugar, bacteria, time, teeth). Of course, there are also other factors that can increase the risk for caries formation. We can control diet and oral hygiene, but we can not control the genetics that shaped our teeth or bacteria that live in your mouth. Here are described factors that contribute to formation of caries.
  1. Sugar. Sugar, especially carbohydrates, are harmful to teeth. It is more important how many times per day you consume sugar and not so much in what quantities you eat it at once. Repeated exposure to sugar several times a day creates an acidic oral environment that causes harm to the teeth.
  2. Oral bacteria. Infection with oral bacteria already initiates in the birth canal. Oral flora is influenced by temperature, composition and quantity of saliva, mucosal resistance to infection, tooth eruption, type of food, the resistance of the immune system and other factors. The oral flora differs between people, in the same individual during different periods in life and at the local level in the same mouth. At birth mouth are filled with bacteria like staphylococci, streptococci, lactobacilli and after 5 days also other types of bacteria start to inhabitate the oral environment. Lactobacilli are the most important in the development of caries. After removal of caries their number decreases, because we eliminate infectious focuses, but after 6 months lactobacilli may rise again. Bacteria produce acid from sugars, which dissolves the surface of the teeth. Bacteria that live in the mouth can be detrimental to oral health and should be removed regularly by brushing.
  3. Teeth. Structure of teeth can vary between individuals. Those with a lot of cavities often say, they are having soft teeth and their bad teeth run in the family. Soft tooth enamel does not exist, exceptionally in the cases of amelogenesis imperfecta, which is rare disorder. Bad teeth are not genetic, but it can be true that some people have deeper grooves and fissures on the tooth surfaces, which are more difficult to clean and therefore they develop caries more sooner. This is also the reason why dentists make preventive fissure sealing on back teeth.
  4. Time. Even though all of the above factors are present but this fourth one is not, it is possible that caries do not develop. If oral bacteria have enough time to digest food and relax acid, teeth will sooner become carious. It is important to prevent bacteria to do harm on teeth which can be done by regular oral hygiene.
  5. Poor oral hygiene. The long-term retention of dental plaque is the main cause of dental caries. Plaque is through time increasing in thickness and is becoming more and more harmful.
  6. Acidic food. The acidic environment of the oral cavity causes tooth’s enamel to melt. Enamel is the part of the tooth, which is the most resistant to caries. Under the enamel lies dentine, which is much more softer and less resistant to oral bacteria which cause tooth decay.
  7. A large number of already decayed teeth. If your mouth is already filled with carious teeth and dental fillings, this is a good indication of possible new caries in the future, if no preventive care will be taken to reduce the risk. Also the occurrence of white lesions on tooth’s enamel can indicate possible development of deeper cavities.
  8. Inadequate dental fillings and crowns. The dental fillings or crowns that are not tight or are overhanging can be a cause for the accumulation of dental plaque. Those are also the surfaces that are hard to clean and are more susceptible for tooth decay.
  9. Lack of exposure to fluoride. Fluoride makes the enamel stronger and more resistant to caries development.
  10. Exposed roots of a tooth. In the case of receded gums tooth’s softer cement becomes exposed, where can easily develop root caries. Weak acids in the mouth does not harm the tooth’s enamel so much, whereas cement and dentine are more weak to resist harmful effects.
  11. Orthodontic treatment. Oral hygiene more difficult with braces on, so it is necessary to make more effort and to devote more time to proper hygiene. Interdental spaces are the most difficult to maintain clean, so tooth decay in there more frequent.
  12. Poor oral health in the family. If parents have a lot of tooth decay, there is a possibility that also children may have them, although this is not the rule. This happens, if parents don’t teach their children, that dental health is very important part of their general health and that proper oral hygiene and dental check ups are therefore needed.
  13. Dry mouth. Saliva helps protect teeth against tooth decay.
  14. Chemotherapy or radiotherapy. It can lead to reduced secretion of saliva.
  15. Eating disorder. In the case of bulimia there is often acidic pH in the oral cavity, which dissolves the tooth enamel.
  16. Drug use and alcohol. Elderly. Patients with mobility problems. People with mental disabilities. Their ability to properly clean teeth is lowered.
  17. Anxiety. People with dental phobia are visiting dentist less often than others, so this is the reason why they often have worse dental health.
  18. Unscheduled visits to the dentist. Non-regular dental check ups can’t detect early problems that occur in the oral cavity. These often grow into larger problems which are more difficult and more expensive to treat.
  19. Socio-economic factors. The lower socio-economic class is usually having poorer oral health statistics.

Where do caries most often occur?

Surfaces of teeth that are difficult to clean are resulting in frequent development of caries. These sites are:
  • biting surfaces with large dimples and grooves,
  • interdental spaces
  • edges of dental fillings, crowns, bridges
  • tooth surfaces near gums
  • on tooth roots and
  • on teeth next to the prosthesis, where the plaque easier accumulates.

How to prevent a tooth decay?

Tooth decay is an infection of the tooth, which can be prevented. There are 4 factors that prevent caries. Proper food, good oral hygiene, fluoride application and regular visits to the dentist.

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