Tooth decay is also known as dental caries, teeth cavity or rotten tooth. This is a condition where the tooth is demineralized and damaged by microbial actions causing a defect in the tooth structure resulting in a hole or craterlike depressions. These commonly present themselves in the form of black colored spots or holes.
As you may already know the tooth cavity is also called by some people as tooth decay. This is mainly because in olden days people actually believed that there were worms present inside the human teeth which cause the decay of the tooth structure, resulting in a foul smell inside the mouth. This, however, is a myth.
There are no big worms inside your decayed teeth. But instead, there are certain microorganisms present inside our mouth which cause tooth cavities. BTW tooth cavities are also known as tooth caries or dental caries.
A Brief History Of Tooth Cavity
Dental caries and the associated gum diseases (otherwise known as Periodontal diseases) are arguably the most common forms of chronic diseases in the world.
Although teeth cavities have been present among humans since the time immemorial, the prevalence of this disease increased tremendously in recent modern times, thanks to our unhealthy dietary habits.
This incidence of ‘dental caries increase’ went on uninterruptedly till the early 1970s, when suddenly the trend started reversing in certain segments of people in this world. This, however, was later attributed to the presence of Fluoride content in the drinking water. This discovery later resulted in Fluoride being added to almost all the public water supply sources in many countries.
Types of Dental Caries
Dental caries/teeth cavities can be divided into the following stages depending on the extension of damage that has been already caused.
Early/ Enamel Dental Caries
This is the earliest stage of development of the tooth cavity and the best time to treat. Microorganisms are still at the outer surface of your teeth called Enamel. The demineralization isn’t very extensive and there is no significant infection.
In this stage, the person usually doesn’t experience pain or sensitivity and the caries is asymptomatic.
Dentine is the second layer of normal human teeth. If the early enamel caries is left untreated the microorganisms start entering the second layer of teeth, that’s Dentin. And such caries is called Dentinal caries.
At this stage, the person may start feeling sensitivity to hot and cold food items. There might be a slight to moderate amount of pain present when biting or chewing certain food items especially sweets, and cold items like ice creams.
When dentinal caries is left untreated the microorganisms advance into the third or the final layer of the tooth called Pulp. Pulp chamber is the area which consists the nerve supply to the tooth.
So once microorganisms reach this layer, pain is almost inevitable. Infection is also certain which may result in swelling.
Excruciating pain on lying down and swelling are the two major symptoms one notices in case of advanced infection caused by dental caries.
Why Worry About Tooth Cavities?
Tooth cavities if not treated at the earliest can develop into chronic infections causing severe excruciating pain and other complications. This is the most important reason why you should always prevent and/or treat dental caries.
Teeth Loss or Edentulism
If it’s not treated at the right time dental caries will finally result in the loss of teeth structure. Which in turn results in diminished chewing capacities of the person and thereby gives way to nutritional deficiency. Teeth loss can also affect the overall appearance of the face in an undesirable way.
Fatal Dental Infections
In rare cases, if tooth caries is left untreated for a very long time, the infection spreads deep inside and the microorganisms mainly bacteria may infiltrate into the main circulatory system of the body (blood) causing a condition called Septicemia and death.
In some cases, the dental infection spreads downwards causing a condition called Ludwigs Angina. This also may turn to be lethal if not handled properly. Click here to read more about tooth infection.
The Cost of Dental Treatment
Finally the cost of treatment 🙂
Not all are born rich in this world. Getting the necessary treatment for dental caries can be really costly. The statement prevention is better than cure holds good in the case of tooth decay as well.
The cost of dental cavities to our modern society is really enormous. People are spending billions of dollars on treating dental cavities every year in the US and other parts of the world.
Walter Loesche described dental caries as
“perhaps the most expensive infection that most individuals have to contend with during a lifetime”.
What Exactly Is a Tooth Cavity/Dental Caries and Why Does This Happen?
By definition Tooth cavity or Dental caries is an infectious microbiologic disease of the teeth that results in localized dissolution and destruction of the calcified tissues.
The formation of the cavity on the teeth is the result of the destruction of the teeth surface. These cavitations on teeth are primarily caused by bacterial infection.
The Reason for Tooth Cavity Formation
Although there are millions of microorganisms present in our mouth not all of them are harmful or cause dental caries. It only happens when a certain group of bacteria creates an acidic environment that starts the process of demineralization of the teeth.
The group of bacteria that are mainly associated with causing teeth cavities or dental caries are Streptococcus mutans.
BTW here is a quick fact.
The gelatinous mass of bacteria adhering to the tooth surface is termed dental plaque.
The bacteria present in this plaque which is attached to the tooth surface, depend on refined carbohydrates for energy production. When they start the metabolization process of these refined carbohydrates, organic acids are produced as by-products, which start to demineralize the crystalline structure of the tooth enamel causing tooth cavity or dental caries.
But this demineralization isn’t a continuous process. If that was the case, most people would have lost all of their teeth to dental caries within a matter of a few days.
Luckily that isn’t the case.
There is a continuous series of exacerbations (increase) and remissions(decrease) in the acid production that happens around the tooth surface inside our mouth, depending on the availability of refined carbohydrate at a particular moment.
If there is no Carb available in the oral cavity or the mouth, the Ph of the Saliva goes on increasing. In simple terms, the saliva loses its acidity. This is when the remineralization process begins and our body’s defense mechanism starts to repair the teeth surface that has been damaged by the microorganisms.
However, the complete remineralization of the tooth surface isn’t possible as the bacteria have already penetrated the tooth structure. This can be only restored by a mechanical cleaning and intervention by the dentist.
If there is some food particle stuck on your teeth surface especially in a form of Carbohydrate, it gives the perfect environment for bacteria to produce acids and cause dental caries. That’s the reason why your dentist advises you to brush teeth twice a day.
Moral of the story: The more acidic your saliva, the more tooth decay. If you can reduce the acidity of your saliva, you, in fact, can prevent dental caries for most of your life.
Another reason for dental caries to happen in your mouth is the failure of the bodies defense system. Saliva forms our main defense against dental caries and infection inside the mouth. For some reason, if there is the lack of saliva production in the mouth decaying of teeth will begin. For example, in a condition called ‘Xerostomia”, there is partial or complete lack of saliva production. In such cases, there is higher prevalence of tooth cavities in affected individuals.
How To Prevent Teeth Cavities Or Dental Caries?
One important step that we can take to prevent dental caries formation is to prevent the formation of dental plaque.
But how exactly can we prevent the formation of dental plaque?
Pit and Fissure Sealants for Kids
As you may have already noticed, our teeth have pits and fissures on their surface. These pits and fissures are the most common sites of formation of dental caries in our mouth.
One of the ways to prevent dental caries by starting is by blocking these pits and fissures using a certain material called Pit and Fissure Sealants.
These are not your typical permanent fillings but act as barriers in stopping microorganismal activity for a certain amount of time.
Sealing the pits and fissures just after tooth eruption may be the single most important event in providing their resistance to caries.
Maintaining An Acid-Free Environment
This simply means that you need to reduce eating simple carbohydrates like Sucrose or Sugar. If you can’t live without eating them wash your mouth thoroughly within 5 minutes of eating. There shouldn’t be any food item stuck on your tooth surface or between the surface of two adjacent teeth.
Regular Oral Health Check-Ups
Go and visit your dentist at least once in six months. Also, don’t forget to look for dark spots or small crater-like defects on your teeth on a regular basis.
Brush Twice a Day
This is the gold standard in the dental industry. Brushing has to be done once in the morning when you get up and once before sleeping in the night. Why? Because when you sleep, there may be food particles stuck inside your mouth which provide a great environment for bacteria to show their skills.
As your mouth isn’t being used for any other activity like talking or eating or drinking during sleep, it gives the perfect uninterrupted access to your teeth for the bacterias. Have you ever noticed the bad breath or the foul smell in your mouth, when you wake up every morning?
That’s because of the bacterial activity.
So it is always advisable to brush your teeth before sleeping and also when you wake up after a long nights sleep.
Using dental floss to clean the interproximal surfaces or space between teeth is also a very effective way of preventing tooth cavities from being formed. Flossing daily is recommended.
But it should be done properly. An improper flossing technique can cause injury to Gingiva (gums) and surrounding structures.
Dental scaling or professional teeth cleaning should be done at the dentist’s clinic at least once in six months.
Dental scaling involves the process of removing the plaque and calculus (plaque, when left untreated, becomes hard and turns into calculus) using mechanical instruments called scalers.
Getting rid of plaque and calculus regularly can prevent dental caries from happening to a major extent. Click here to read about gum disease in detail.
How To Manage Tooth Cavity Associated Pain At Home?
If you get an excruciating pain related to your teeth the first line of treatment is to approach your dentist.
If the clinic is closed or if it’s difficult to reach the dentist’s office immediately, you can go for certain over the counter medications to relieve the pain. But please remember to visit the dentist at the earliest to prevent any further complications.
How to Treat Tooth Cavities or Dental Caries?
The choice of treatment of dental caries depends on the stage in which its detected by the Dentist.
In most cases, the dentist will advise an IOPA or an X-ray of your teeth in question, to make sure to what extent the damage has been done by the microorganisms.
Restorations or Fillings
The tooth cavity in its earliest stage or in the early dentinal stage is treated using fillings or restorations. Cleaning of affected tooth structure is done using a rotary handpiece with a head called ‘bur’.
In most cases, the procedure is carried out under Local Anaesthesia. Once the cleaning has been done and all the affected and infected demineralized structure has been removed, the filling is done using a certain restorative material called Composites or certain dental cement.
Previously Amalgam was the first choice of dentists for dental fillings, which was also popularly known as ‘silver fillings’. In between, for some time, people had questions about the safety of amalgam because of the presence of Mercury in it. This however been clarified now and FDA believes that dental amalgam is completely safe in adults and children of 6 and above.
Root Canal Treatment
If the caries is detected in the advanced stage the only choice of treatment left is the ‘root canal treatment’.
Depending on the extent of damage done and the presence of infection, root canal treatment can be limited to one visit or may extend up to 3 or more visits to the dental clinic.
This procedure is mostly carried out under local anesthesia. A hole is drilled using a rotary instrument and access will be created to the innermost layer of the tooth. Then the infected nerve tissue of the tooth will be removed using certain instruments called ‘reamers and/or files’.
Once the cleaning is complete and all the infected tissue has been removed the canals are filled with certain fillers and finally the cavity is closed using the traditional filling material.
This, in most cases, is followed by a placement of a crown ( a kind of cap made up of metal, ceramic, porcelain etc).
Extraction or Removal of Teeth
In case the tooth structure is badly damaged because of dental caries and can’t be saved either by normal restorative procedures or by root canal treatment, the only choice of treatment left for the dentist is the removal of that particular tooth.
This procedure is done under local anesthesia. Once the tooth is removed, a suture will be placed to prevent further bleeding. Once the wound is healed and everything is normal you can opt for the replacement of tooth which was removed earlier.
All of the above procedures may be accompanied by a course of analgesics and antibiotics depending on the severity of the case and the level of infection and pain.