Dental Decay – Dental Caries
Dental decay is the same as tooth decay. It is also known as dental caries. It results in a cavity in the tooth and if untreated can spread from the enamel (the hard outer covering of the tooth) into the softer dentine inside.
The decay can progress more rapidly in the softer dentine and will eventually reach the dental pulp (nerve and blood vessels) in the centre of the tooth and cause this to become infected and inflamed.
Once the pulp is infected it may die and bacteria can breed in the empty pulp chamber pushing beyond the end of the tooth root to form a dental abscess.
Symptoms
In the early stages of dental decay there may be no symptoms but your dentist may be able to detect an early cavity through examination and x-ray. It is for this reason that you should visit your dentist regularly as small cavities are much easier to treat than advanced decay. Once the cavity has reached the dentine you may notice sensitivity, particularly with sweet foods and drinks, acidic or hot foods.
As the decay nears the dental pulp you may suffer from toothache. If the toothache is brought on by hot or sweet foods this may last for only a few minutes. As the decay gets closer to the dental pulp the pain may be persistent and you may need to take painkillers, paracetamol or ibuprofen, to control the pain. It is essential to visit your dentist immediately or the tooth will die and you may develop a dental abscess. Toothache is a symptom indicating that something is wrong, probably with one or more teeth. Neglect will usually make matters worse, and a tooth may possibly be lost that could otherwise have been saved. Toothache is a sign that you should visit a dentist immediately.
Causes
Tooth decay is caused by the bacteria in dental plaque breaking down sugar in the foods and drinks that you eat and drink. Dental plaque is a sticky film that is constantly forming on your teeth. It contains many bacteria, some of which react with sugar (fermentable carbohydrates) in the foods which we eat and drink to form acid. This acid starts to break down the hard structure of the enamel.
Once the sugary foods have gone from the mouth salts from your saliva act to repair the damaged enamel. This process takes around 40 minutes to complete. Dental decay results as a result of many thousands of these acid attacks when the balance is in favour of the acid breaking down the tooth rather than the saliva repairing it.
It is important to cut down the number of times you have sugary food and drink. As a nation our diet has changed from three square meals a day to 7-20 snacks and this has led to an increase in the number of times the teeth come under acid attack and an increase in decay. It is important to avoid constantly snacking on sugary foods or sipping fizzy drinks.
A very small number of people who do not look after their teeth appear to be immune to dental decay. But most people who do not keep up a good oral hygiene routine will eventually get decay in some or most of their teeth. If left untreated, plaque will soon harden to form a dense chalky material called calculus which needs to be professionally removed by your dentist or dental hygienist.
Diagnosis
This is based on the pain and a physical examination and X-ray of the teeth by a dentist.
Treatment
Tooth decay is treated by drilling out all the decayed matter and filling the cavity. This will be carried out under a local anaesthetic. Several different types of filling can be used depending on the extent of the decay and your dentist will advise you on the available possibilities.
In advanced cases of dental decay where the dental pulp is affected or a dental abscess has been formed, it may be necessary to carry out a root filling on the tooth or even to remove the remaining tooth.
Prevention is more effective than cure and careful oral hygiene and home care can prevent cavities forming. Regular visits to your dentist will ensure that any problems are caught early and are easy to treat.
A late complication of neglected dental decay is a dental abscess. Once the dental pulp is infected it dies and bacteria breed in the root canal of the tooth and then force beyond the end of the root forming a dental abscess.
There is pain, particularly on biting or chewing. The surrounding gum may also be inflamed, tender and swollen. Sometimes the abscess breaks through the gum and discharges in the form of a gum boil. The pain may lessen but it is still important that the tooth is treated.
In extreme cases there may be swelling of the face and fever. It is likely your dentist will prescribe antibiotics to control the infection.
Sometimes treating the abscess means removing the tooth so that the abscess can drain. However, it is often possible to save a tooth by drilling down through it into the abscess to release the pus, and then to treat with a root filling. Antibiotics alone are of no value in treating established abscesses.
Prevention
Tooth decay can be prevented by practising good oral hygiene. This includes brushing your teeth at least twice a day with a fluoride toothpaste and cleaning in between your teeth with dental floss or interdental brushes daily. This removes the plaque forming constantly on your teeth and reduces the likelihood of acid attack.
Cut down on the amount of sugary foods and drinks to reduce the number of times your teeth are subjected to acid attack.
Chewing sugar free gum for ten minutes after a meal increases the saliva flow and helps to neutralise any acids which have been formed as a result of eating sugary foods.
Your dentist should review how frequently you need a dental checkup, tailored to your needs. If decay is treated early a filling will usually be sufficient to prevent the decay spreading to the pulp chamber within the tooth. Your dentist may also advise you to visit a dental hygienist who can remove plaque build-up and calculus from your teeth and show you the best ways to keep your teeth clean and healthy.