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Tooth Decay / Cavities

Definition :
Cavities are decayed areas of your teeth that develop into tiny openings or holes. Cavities, also called tooth decay, are caused by a combination of factors, including not cleaning your teeth well, frequent snacking and sipping sugary drinks.

Cavities and tooth decay are one of the most common health problems around the world. They're especially common in children and young adults. But anyone who has teeth can get cavities, including infants and older adults.

If cavities aren't treated, they get larger and the decay can become severe enough to cause serious toothache pain, infection, tooth loss and other complications. You probably know that regular dental visits and good brushing and flossing habits go a long way toward preventing cavities and tooth decay. But you may be surprised to learn that cheese may also help prevent cavities, and that potato chips may be more harmful than a candy bar. Detecting and treating cavities and tooth decay early can save you pain and expense later — as well as your teeth.

Causes :
Your mouth, like many other parts of your body, naturally contains many types of bacteria. Some of these bacteria thrive on food and drinks that contain sugars and cooked starches, also known as fermenting carbohydrates. When these carbohydrates aren't cleaned off your teeth, the bacteria can convert them into acids starting within just 20 minutes. The bacteria, acids, food particles and saliva then form into dental plaque — a sticky film that coats your teeth. If you run your tongue along your teeth, you can feel this plaque several hours after you've brushed. The plaque is slightly rough and is more noticeable on your back teeth, especially along the gumline.

The acids in plaque attack minerals in the tooth's hard, outer surface, called the enamel. This erosion causes tiny openings or holes in the enamel — cavities. Once spots of enamel are worn away, the bacteria and acid can reach the next layer of your teeth, called dentin. This layer is softer and less resistant to acid than enamel is, so once tooth decay reaches this point, the decay process often speeds up.

As tooth decay continues, the bacteria and acid continue their march through the layers of your teeth, moving next to the pulp, or the inner material of the tooth. The pulp contains nerves and blood vessels. The pulp becomes swollen and irritated from the bacteria. The bone supporting the tooth also may become involved. When a cavity and decay is this advanced, you may have severe toothache pain, sensitivity, pain when biting or other symptoms. Your body also may respond to these bacterial invaders by sending white blood cells to fight the infection. This may result in a tooth abscess.

This process of tooth decay takes time. Permanent teeth are stronger than primary teeth and may hold off decay for a year or two. Saliva also helps wash away some of the bacteria and acid. But as the decay erodes each layer of your tooth, the process speeds up.

Tooth decay most frequently occurs in the back teeth — the molars and premolars. These teeth have lots of grooves, pits and crannies. Although these grooves are great for helping chew food, they can also collect food particles. These back teeth are also harder to keep clean than your smoother and more accessible front teeth. As a result, plaque can build up between these back teeth and bacteria can thrive, producing acid that destroys the enamel.

Risk Factor :
Cavities are one of the most common worldwide health problems, and everyone who has teeth is at risk of getting them. But some factors increase the risk that you'll get a cavity or develop tooth decay. These risk factors include :

  • Certain foods and drinks. Some foods and drinks are more likely than others to cause decay. Fermentable carbohydrates are the biggest problem. These foods cling to your teeth for a long time. Fermentable carbohydrates include all sugars and most cooked starches. Examples include milk, honey, table sugar, soda, raisins, cake, hard candy, breath mints, dried fruit, cookies, dry cereal, bread and potato chips. Some food that may seem like obvious culprits may not be after all. For instance, although candy bars, jelly beans and caramels are sticky and sugary, they're easily washed away by saliva, making them less of a threat than are potato chips, which stubbornly stick to your teeth.
  • Frequent snacking or sipping. When it comes to your teeth, the amount of sugary snacks you eat is less important than when you eat them. If you frequently snack or sip sodas, acid has more time to attack your teeth and wear them down. This is also why parents are encouraged not to give babies bottles filled with milk, formula, juice or other sugar-containing liquids at bedtime. The beverage will remain on their teeth for hours and cause erosion — often called baby bottle tooth decay. If you're nursing or feeding an infant formula, talk to your health care providers about how to prevent early tooth decay. They may suggest having your baby drink some water after eating to help rinse away the sugary milk or formula.
  • Not brushing. If you don't clean your teeth after eating and drinking, plaque builds up, eroding your teeth.
  • Bottled water. Adding fluoride to public water supplies has helped decrease tooth decay by offering protective minerals for tooth enamel. But today, many people drink bottled or filtered water that doesn't contain fluoride, and they may miss out on the protective benefits of fluoride. On the other hand, some bottled water may contain added fluoride, and if your drinking water also contains fluoride, babies and children could then get too much fluoride. Talk to your child's dentist about the amount of fluoride he or she may be getting and check ingredient labels on your bottled water.
  • Older age. An increasing number of older adults still have their natural teeth. However, over time, these teeth can wear down and become more vulnerable to tooth decay and cavities. Older adults also have more decay on root surfaces.
  • Receding gums. When your gums pull away from your teeth, plaque can form on the roots of your teeth. Tooth roots are naturally covered with a coating called cementum, but the cementum is quickly lost when the root surface is exposed. The underlying dentin is softer than enamel and can become decayed more easily, leading to root decay.
  • Dry mouth. Dry mouth is a lack of saliva. Saliva has an important role in preventing tooth decay. It washes away food and plaque from your teeth. Minerals found in saliva help repair early tooth decay. Saliva also limits bacterial growth that can dissolve tooth enamel or lead to mouth infections. And saliva neutralizes damaging acids in your mouth.
  • Weak or rough dental fillings. Over the years, dental fillings can become weak and begin to breakdown, or the edges can become rough. Either of these situations can allow plaque to build up more easily and make it harder to completely remove plaque.
  • Eating disorders. Anorexia and bulimia can lead to significant tooth erosion and cavities. Stomach acid from vomiting, for instance, washes over the teeth and erodes the enamel. Eating disorders can also interfere with saliva production. In addition, some people with eating disorders sip soda or other acidic drinks throughout the day, which creates a continual acid bath over the teeth.
  • Heartburn. Gastroesophageal reflux disorder (GERD), acid reflux and heartburn can cause stomach acid to flow into your mouth, wearing away the enamel of your teeth.
  • Close contact. Some harmful, decay-causing bacteria in the mouth can be passed from one person to another by kissing or sharing eating utensils. Parents or even child care providers may pass along harmful bacteria to infants and children, for example.
  • Certain cancer treatments. Having radiation to your head or neck areas can increase the risk of getting cavities by changing the saliva produced in the mouth, which allows more cavity-producing bacteria to thrive.

When to seek medical advice :
You may not be aware that a cavity is starting, so visiting your dentist regularly is your best protection against cavities and tooth decay. However, a toothache or tooth pain is commonly a telltale sign of a cavity. If your teeth or mouth hurt, visit your dentist as soon as possible.

In addition to pain, contact your dentist if you develop any of these signs or Symptoms:

  • Red, tender or swollen gums
  • Bleeding gums
  • Gums that are pulling away from your teeth, which may make your teeth seem longer
  • Pus around your teeth and gums when you press on the gums
  • A bad taste in your mouth
  • Unexplained bad breath
  • Loose teeth
  • Changes in the way your top and bottom teeth touch
  • Changes in the feel of your dentures
  • Sensitivity to sweet, hot or cold foods or beverages
  • You avoid brushing or cleaning certain teeth or areas because of pain

If a cavity is treated before it starts causing pain, there's a smaller chance of significant damage requiring more involved treatment. That's why it's important to have regular dental checkups and cleanings even when your mouth feels fine. By the time you notice symptoms, the damage is getting worse.

Symptoms :
The signs and symptoms of cavities and tooth decay vary depending on the severity and location of the cavity. When a cavity or decay is just beginning, you may not have any symptoms at all.

But as decay gets worse, it may cause such symptoms as :

  • Toothache or tooth pain
  • Tooth sensitivity
  • Mild to sharp pain when eating or drinking something sweet, hot or cold
  • Pain that lasts even after you stop eating or drinking
  • Visible holes or pits in your teeth
  • Pain when you bite down
  • Pus around a tooth

Diagnosis :
Your dentist can detect a cavity and tooth decay pretty easily. Your dentist will ask about tooth pain and sensitivity. Your dentist will examine your mouth and teeth and may probe your teeth with dental instruments to check for soft areas. You may also have dental X-rays, which can show cavities and decay.

Your dentist will also be able to tell you specifically which of the three types of cavities you have :

  • Smooth surface decay. This is decay on a flat surface of a tooth, where bacteria can remain for a long time and acid can dissolve the tooth enamel. It most commonly involves the cheek side of teeth at the gumline. This is also the type of decay that's generally easiest to prevent and treat, unless it occurs on the smooth contacting surfaces between the teeth.
  • Pit and fissure decay. This is decay that affects the pits and grooves on the chewing surface of your back teeth. This decay can progress quickly if you don't practice good oral hygiene or get prompt treatment.
  • Root decay. This type of decay occurs on the surface over tooth roots. It's most common among older adults with receding gums.

Complications :
Cavities and tooth decay are so common that you may not take them seriously. And you may think that it doesn't matter if children get cavities in their baby teeth. However, cavities and tooth decay can have serious and lasting complications, even for children who haven't yet gotten their permanent teeth.

Complications may include :

  • Pain
  • Tooth abscess
  • Tooth loss
  • Broken teeth
  • Chewing problems
  • Serious infections

In addition, when cavities and decay become very painful and severe, they can interfere with daily living. The pain may prevent you from going to school or work, for instance. If it's too painful or difficult to chew or eat, you may lose weight or have nutrition problems. If cavities result in tooth loss, it may affect your self-esteem. In rare cases, an abscess from a cavity can cause serious or even life-threatening infections when not properly treated.

Treatment:
Treatment of cavities and decay depends on how severe they are and your particular situation. Treatment options include :

  • Fluoride treatments. Fluoride is a mineral that helps prevent cavities and helps teeth repair themselves. If your cavity is just getting started, a fluoride treatment may be able to help restore enamel. Professional fluoride treatments contain more fluoride than what's found in over-the-counter toothpaste and mouth rinses. Fluoride treatments may be in a liquid solution, a gel, foam or varnish that is brushed onto your teeth or placed in a tray that fits over your teeth. Each treatment takes a few minutes. Your dentist may suggest having periodic fluoride treatments.
  • Fillings. A filling is material that replaces decayed areas of your teeth. Fillings, sometimes called restorations, are the main treatment option when the decay has progressed beyond the initial enamel-erosion process. Your dentist drills away the decayed material inside your tooth. The gap is then filled to restore the tooth shape. Fillings are made of various materials, such as tooth-colored composite resins, porcelain, or combinations of several materials. Silver amalgam fillings contain a variety of materials including small amounts of mercury. Some people don't like using mercury fillings because they fear possible health effects. While some medical studies have shown these fillings to be safe, they remain controversial.
  • Crowns. If you have extensive decay or weakened teeth, you may need a crown rather than a filling to treat your cavity. The decayed area is drilled away. A crown is then fit over the remaining portion of tooth. Crowns are made of gold, porcelain or porcelain fused to metal.
  • Root canal. When decay is severe and reaches the inner material of the tooth, you may need a root canal. In this procedure, the pulp of the tooth is removed and then replaced with a filling.
  • Tooth extractions. A severely decayed tooth may need to be removed entirely. Having a tooth extracted can cause the other teeth in your mouth to move, so if possible, consider getting a dental implant to replace the missing tooth.

Prevention:
Good oral and dental hygiene can help prevent cavities and tooth decay. Follow these tips to help prevent cavities :

  • Brush after eating or drinking. Brush your teeth at least twice a day and ideally after every meal, using fluoride-containing toothpaste. To clean between your teeth, floss or use an interdental cleaner. If you can't brush after eating, at least try to rinse your mouth with water.
  • Rinse your mouth. If your dentist feels you are at higher risk of developing a cavity, using a fluoridated mouth rinse can help reduce your risk.
  • Visit your dentist regularly. Get professional tooth cleanings and regular oral exams, which can help prevent problems or spot them early. Your dentist can recommend a schedule for your situation.
  • Consider dental sealants. A sealant is a protective plastic coating that's applied to the chewing surface of back teeth — sealing the grooves in the teeth most likely to get cavities. The sealant protects tooth enamel from plaque and acid. Sealants can help both children and adults. The Centers for Disease Control and Prevention strongly recommends sealants for all school-age children. Sealants last for several years before they need to be replaced.
  • Drink some tap water. Adding fluoride to public water supplies has helped decrease tooth decay significantly. But today, many people drink bottled water that doesn't contain fluoride.
  • Avoid frequent snacking and sipping. Whenever you eat or drink something, you help your mouth create acids that destroy your tooth enamel. If you snack or drink throughout the day, your teeth are under constant attack.
  • Eat tooth-healthy foods. Some foods and beverages are better for your teeth than others. Avoid foods that get stuck in grooves and pits of your teeth for long periods, such as chips, candy or cookies. Instead, eat food that protects your teeth, such as cheese, which some research shows may help prevent cavities, as well as fresh fruits and vegetables, which increase saliva flow, and unsweetened coffee, teas and sugar-free gum, which wash away food particles.
  • Consider fluoride treatments. Your dentist may recommend a fluoride treatment, especially if you aren't getting enough fluoride naturally, such as through fluoridated drinking water. In a fluoride treatment, your dentist applies concentrated fluoride to your teeth for several minutes. You can also use fluoridated toothpaste or mouthwash.
  • Ask about antibacterial treatments. Some people are especially vulnerable to tooth decay, perhaps because of medical conditions, for instance. In these cases, your dentist may recommend special mouth rinses or other antibacterial treatments to cut down on harmful bacteria in your mouth.

Check with your dentist to see which methods are best for you.

 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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