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Dental Caries

Alternate Names

  • cavities
  • tooth decay
  • dental decay
  • Tooth with Abscess
  • Dental X-rays

Definition

Dental caries, or cavities, are very common. They begin with acid on the tooth. The acid is made from the bacteria in dental plaque. The plaque bacteria feed on sugars and starches from the diet and change them into acid. This acid eats into tooth enamel, or the outer layer of the tooth, and dentin, the major part or core of the tooth. The tooth then gradually dissolves and the bacteria move into the damaged tooth structure.

What is going on in the body?

Plaque is a bacterial mass and it sticks everywhere on the teeth. It is especially hard to remove from the grooves of the teeth, between the teeth, and around the gumline of the teeth. Fillings, crowns, dentures, partials, orthodontic bands, and retainers make good hiding places for bacteria.
Brushing and flossing are important in preventing cavities. Once acid producing bacteria works its way through the tiny cracks in the enamel, it reaches into the dentin, where it spreads more quickly.
In time, the bacteria reaches the nerves and blood vessels in the center of the tooth, called the pulp. When this happens, the harmful products of the bacteria infect the pulp and a tooth abscess, or pocket of pus, soon follows.
This can happen with very little warning since the bacterial attack is so gradual that there may be no pain or sensitivity until the cavity is quite large.

Risks

What are the causes and risks of the disease?

There is no way to predict how fast the decay process will eat through the tooth structure and damage the blood vessels and nerve fibers within the pulp of the tooth. When this happens, the tooth will become infected and an abscess may form.
The sooner a cavity is found, the simpler the treatment.

Prevention

What can be done to prevent the disease?

Dental decay is almost always a completely preventable disease. The key to prevention is removing plaque and bacteria before acid can eat away the tooth. Keeping the mouth and teeth clean with good oral hygiene habits can completely prevent this disease. Brushing carefully at least twice a day, flossing at least daily, using fluoride toothpaste, limiting sugars and starches in the diet, and regular dental checkups can all help prevent tooth decay.

Also, drinking water that is supplemented with fluoride or taking fluoride supplements can prevent dental caries. Fluoride application by a dentist may also be helpful.

Diagnosed

How is the disease diagnosed?

A dentist or hygienist can identify tooth decay early in order to try to keep the treatment as simple as possible. Examining the teeth with a mirror and a dental probe is a simple way to find most cavities. Dental x-rays will help find cavities when the cavities are still very small or are hidden from sight.

Long Term Effects

What are the long-term effects of the disease?

Cavities that are treated early usually do not have any long-term effects. If untreated, further destruction and invasion of the tooth occurs. This may progress to nerve irritation, causing pain and sensitivity of the tooth. A tooth abscess may form, which can rarely lead to a serious infection of the blood or heart damage. Even death is possible if treatment is never sought, though this is quite rare in the US.

Other Risks

What are the risks to others?

This disease is not contagious and poses little risk to others.

Treatments

What are the treatments for the disease?

Simple fillings are used to treat small cavities. The dentist removes the softened or decayed material from the tooth. The hole left in the tooth is then filled with a restorative material. This is usually done with the help of local anesthetics, or "numbing" medicine, so that the person does not feel any pain during the procedure.
The dentist will recommend the best kind of filling material to use. Usually, a silver-mercury filling or a resin material is used, although filling material that does not contain mercury is available.
When the cavity is larger, gold or porcelain restorations or crowns may be needed to reestablish form and function of the remaining tooth structure.
If the decay has already reached the nerves and blood vessels in the center of the tooth, a root canal may be necessary in addition to restoring the tooth. A root canal is a procedure to remove diseased pulp from the deep part of the tooth. The area is then cleaned and sealed with filling and a crown, or cap, over the top of the tooth.
If the tooth has an abscess and a root canal treatment is not performed, the tooth will usually have to be removed. Antibiotics may be need to be given.
The earlier a cavity is found, the simpler and less expensive it is to treat.

Side Effects

What are the side effects of the treatments?

Any surgery or dental procedure carries a risk of bleeding, infection, and reactions to pain medicine. A root canal may cause nerve damage, which may result in tingling or numbness in the area of the surgery. Antibiotics may cause allergic reactions, stomach upset, or other side effects. Other side effects depend on the specific drug used.

After Treatment

What happens after treatment for the disease?

In almost all cases, treatment is successful and a person may return to normal activities. Further monitoring is required to catch future cavities at an early stage and avoid complications.

Monitor

How is the disease monitored?

People should report any symptoms of tooth pain or sensitivity. Regular dental check-ups, roughly every 6 months or more often in some cases, are advised for monitoring. X-rays of the teeth may also be used for monitoring.

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