Comeaux Dental of The Woodlands & Spring in Texas will take a deeper dive into the causes of cavities. This is for both parents of young children and adults who are interested in a better understanding of these conditions. Since there is no way to restore large amounts of missing or damaged teeth structure, treatment for cavities is focused on prevention.
What are Dental Caries (Cavities), and how do they work?
Dental caries, or Latin "rot", also known as tooth decay, or a "cavity", is a bacterial infection that results in the destruction and demineralization of the hard tissues (enamels, dentins, and cementum) of the teeth. Acid is produced by bacteria from food debris that has accumulated on the tooth's surface. The following factors can cause demineralization of teeth: Carbohydrates, plaque, and dry mouth are more common than factors that help to remineralize teeth (i.e. Tooth decay can occur due to the presence of saliva, calcium, fluoride, and saliva. Dental decay is the most common childhood chronic disease. According to the American Academy of Pediatric Dentistry, 60% of children will experience tooth decay before they turn five.
Signs and symptoms of dental caries (Cavities).
Most people are first aware of tooth decay after they feel pain. This is despite not having regular dental exams. Tooth pain is usually felt only after the decay has reached a significant depth within the tooth structure. A person suffering from caries might not realize that the disease has reached a large portion of their tooth. A chalky white spot appearing on the tooth's surface is the first sign of decay. This indicates enamel demineralization. This is called a "microcavity" or a white spot lesion. As it loses minerals, the area can become brown and eventually cave-in, creating a cavity. Remineralization can reverse the process before a cavity forms. The lost tooth structure can't be regenerated once a cavity has formed. The previous demineralization may be indicated by dark brown spots. Active decay is more visible and has a lighter color.
The tooth's layers become more visible as the decay progresses. Additionally, the tooth's affected areas change in color and are easier to probe. The decay can penetrate the enamel and expose the dentinal tubules that lead to the pulp of the tooth. This causes pain. An extensive amount of internal decay can cause a tooth to fracture. Normal chewing forces will not be able to fix it. If the decay is severe enough to allow bacteria to enter the pulp, a toothache may occur. The pain will be more frequent. Untreated dental decay can lead to toothache, necrosis (death), and even infection. The tooth's pulp tissue will become less sensitive to heat and cold, but it can still be sensitive to pressure. Bad breath and bad taste in the mouth can also be caused by dental caries.
Dental Caries: Causes
Caries can occur when there are four things that are required: the tooth surface (dentin or enamel), caries-causing bacteria, fermentable carbohydrate (such as sucrose) and time. Caries can occur even if these factors are present. Caries is not inevitable. People are more susceptible to it depending on their oral hygiene habits, their tooth shape, their saliva buffering capacity, their carbohydrate intake and their oral hygiene habits. Caries can develop on any tooth surface that is exposed to the cavity.
Streptococcus mutagens, Streptococcus sobrinus and lactobacilli are the bacteria that cause dental cavities. Plaque is a sticky mixture of bacteria, saliva, and food. In the presence of fermentable carbohydrate such as sucrose or fructose, these bacteria can cause disease. When the pH of their environment drops below 5.5, teeth are vulnerable to damage. This is called the critical pH. It indicates an acidic environment. The pH of saliva is increased (decreased acidity). This is why it is essential for remineralization. Low salivary flow or other factors can make it more susceptible to developing caries. The majority of disease (80%) is found in places that are difficult to reach with a toothbrush. These include between the teeth, inside small fissures or pits within the teeth.
Certain foods and beverages have a pH below 5.5, which can lead to demineralization without bacteria. This is called erosion and not caries, as the acid is not bacterial. The pH of the mouth can be affected by frequent regurgitation (bulimia or reflux disease).
Congenital Enamel Defects
Some conditions are extremely rare where the enamel is not properly formed or produced in a smaller amount. This makes these patients more susceptible to tooth decay and caries.
Minerals make up approximately 96% of the tooth enamel. These minerals, particularly hydroxyapatite are susceptible to dissolution when exposed (pH less that 5.5) to acidic environments. Because they contain a lower amount of minerals, the enamel is more vulnerable to caries than enamel. The development of caries may also be affected by the anatomy of the mouth - misaligned or misaligned teeth can lead to more food getting trapped between them.
Mouth Bacteria
There are many types of bacteria in the mouth, but Streptococcus Mutans or Lactobacilli are the most common to cause caries. These bacteria strains appear to produce high levels of lactobacilli as a result of the metabolism of dietary sugars. This bacterium is not present in infants, but they are often inoculated by their primary caregiver (i.e. The primary caregiver (i.e. mom or dad) usually inoculates infants. Sharing utensils with children under 5 years old can lead to the spread of bacteria that causes cavities. Plaque tends to accumulate in difficult-to-brush areas (pit and fissures at the biting surface for molars), or in small pockets where the teeth are inserted into the gum tissue. Plaque can also accumulate below the gum line. Plaque buildup can not only increase the likelihood of tooth decay but also cause gum inflammation and bone loss. Research has also shown that higher levels of bacteria in the mouth can increase the risk of developing diseases in other parts, including the heart.
Fermentable Carbohydrates Cause Cavities
Through a process known as fermentation, bacteria in the mouth convert common sugar into acids. These acids can cause tooth demineralization if they come in contact with the tooth. This can eventually lead to a cavity. Carcinogenicity refers to the impact sugars can have on dental caries. Sucrose appears to be more cariogenic than glucose or fructose.
Dental Acid Exposure Causing Cavities
Caries development is affected by the frequency with which teeth are exposed (to cariogenic or acidic environments). The bacteria in your mouth convert sugar to acid, which causes pH to drop after eating. The buffering power of saliva helps to bring pH back to normal as time passes. Some of the inorganic minerals on the teeth' surface can dissolve after exposure to acid. This can happen for up to two hours. Dental caries development is dependent on acid exposure. Teeth are particularly vulnerable to acidic conditions.
If the diet contains sufficient carbohydrates, the caries process can start within days after a tooth erupts. The introduction of fluoride may have slowed down the formation of caries. It takes an average of four years for interproximal (caries between teeth) to break through enamel in permanent teeth. Root caries is more common than other forms of decay because the cementum covering the root surface is less durable than the enamel surrounding the crown. Root caries progresses 2.5 times faster than enamel. Caries can occur within months of tooth eruption in severe cases where oral hygiene is poor or where there is a high intake of fermentable carbohydrates. This could happen, for instance, if children continue to drink sugary drinks from their baby bottles.
Other Factors that Cause Cavities
A decreased salivary flow rate can lead to increased caries. The buffering power of saliva is one of the best natural defenses against tooth demineralization. Widespread tooth decay can result from medical conditions that decrease the production of salivary glands. Sjogren's syndrome and diabetes mellitus are some examples. Antidepressants and antihistamines, as well as medication, can also cause a decrease in salivary flow. The most well-known stimulant is methylamphetamine ("methmouth") which can severely block the flow of saliva.
Tetrahydrocannabinol, the active chemical substance in cannabis, also causes a nearly complete occlusion of salivation, known in colloquial terms as "cotton mouth". Radiation therapy to the neck and head may also cause damage to the salivary gland cells, which can lead to a decrease in output. Evidence suggests that smoking may increase the likelihood of developing caries.
Tooth decay has been linked to neonatal and intrauterine lead exposure. All atoms that have electrical charges similar to bivalent Calcium mimic the calcium ion may also promote tooth decay.
The main social determinant of oral health is poverty. Poor dental hygiene has been shown to be a major cause of dental caries. This is linked to lower socioeconomic status.
Pathophysiology and Caries of the Dental Teeth (Cavities).
Enamel
Enamel, a highly mineralized acellular tissue, is degraded by the bacteria that produce lactic acid. The bacteria can physically penetrate the dentin by demineralizing the enamel crystals.
Dentin
The progression of dental caries is what the dentin reacts with and unlike enamel. The ameloblasts that produce enamel are destroyed after tooth formation. They cannot then regenerate it later. Odontoblasts, located at the border of the pulp and dentin, produce dentin continuously all through life. Odontoblasts can produce more dentin when they are stimulated by a stimulus such as caries. This defense mechanism includes the formation of altered dentin.
The hydrodynamic theory states that fluids in the dentin may be responsible for pain receptors being activated within the pulp. The altered dentin blocks the flow of fluids so that pain that might otherwise be a sign of invading bacteria does not occur initially. Dental caries can progress over a longer period of time, without any sense of sensitivity, which may lead to greater tooth loss.
Diagnosis and Treatment of Dental Caries (Cavities).
Infected-Abscessed-tooth-pain
Caries presentation can be very variable. The risk factors and stages are the same, however. It may initially appear as a small area of chalky (smooth-surface caries), but it could eventually become large cavitation. Caries can sometimes be visible. X-rays can be used to detect damage and other areas that are not visible. To minimize the possibility of tooth recurrence, tooth restorations also include disclosing solutions.
Primary diagnosis is the examination of all visible tooth surfaces with a light source, dental mirror, and explorer. Dental radiographs (Xrays) can reveal dental caries that are not otherwise visible. While large dental caries is often obvious to the naked eye and can be easily identified, smaller lesions may not be as apparent. For diagnosing pit and fissure caries, dentists often use radiographs as well as visual and tactile inspection. Uncavitated early caries can often be diagnosed by blowing air on the surface of the suspected area. This removes moisture and alters the optical properties. Pit and fissure caries can sometimes be difficult to spot. The bacteria can reach the dentin through the enamel. However, the outer surface of the tooth may then remineralize, particularly if fluoride is present. This caries, also known as "hidden" caries, can still be seen on x-ray radiographs. However, a visual inspection of the tooth will show that the enamel is intact or minimally perforated.
Classification of Dental Caries.
Rampant decay and early childhood diseases
Early childhood caries (ECC), also known as "baby bottles caries" or "bottlerot", is a type of decay that occurs in children who have deciduous (baby). Although the maxillary anterior are most commonly affected, all teeth can be affected. This type of decay is often caused by children drinking sweetened liquids (including milk) or giving them sweetened liquids multiple times a day.
Rampant caries is another type of decay. This refers to advanced or severe decay that affects multiple surfaces of many teeth. Rampant caries can be caused by poor oral hygiene, drug-induced dryness, and/or high sugar intake. Radiation-induced caries may be used to describe rampant caries that have been caused by radiation to the neck and head.
Oral Hygiene Prevents Dental Caries (Cavities)
Proper brushing and flossing are essential for personal hygiene. Oral hygiene serves to reduce the presence of etiologic agents that can cause disease. Brushing and flossing are designed to prevent plaque formation (dental biofilm). Plaque is mainly made up of bacteria. As the plaque buildup increases, the tooth becomes more susceptible to dental caries. You can use a toothbrush to clean plaque from accessible surfaces. However, it is not recommended for cleaning between teeth and inside fissures or pits. Dental floss can be used to remove plaque from any areas that might develop interproximal cavities. Interdental brushes, mouthwashes, and water picks are all other adjuncts to oral hygiene.
Gum disease (periodontal disease) can be prevented by oral hygiene more effectively than tooth decay. Under pressure, food can be forced into pits and fissures during eating. Carbohydrate-fueled acid demineralization can occur in areas where saliva, fluoride toothpaste, and the toothbrush have no access to remove food trapped, neutralize acid, or remineralize teeth structure. Occlusal caries are a common cause of tooth decay in children. It can account for 80 to 90% of all caries. After eating fiber such as celery, saliva is trapped in the food and can be used to neutralize acid, dilute carbohydrates and remineralize teeth structure. Because of their long-term presence in the oral cavity and complex surface anatomy, permanent first and second malocclusions are at the greatest risk.
Regular dental exams and professional cleaning are part of professional hygiene. Radiographs can be taken at your dental visit to check for possible dental caries in high-risk areas. "Bitewing" xrays are used to visualize between the crowns of the back tooth.
Dental Health: Dietary Modification
The frequency of sugar intake is important more than the sugar amount. Acids are produced by bacteria in the mouth when sugar is present. Dental caries can be more common if teeth are more often exposed to this environment. Avoid snacking as it can provide nutrition for acid-creating bacteria. Chewy and sticky foods, such as candy and dried fruit, tend to stick to teeth longer, increasing exposure time and the chance of developing caries. American Dental Association and the European Academy of Pediatric Dentistry recommend that sugar-laden beverages be limited in frequency. Young children shouldn't be put to bed with milk bottles. This can increase the risk of developing caries and could cause damage to their teeth. To prevent bacteria transfer from mother to child, mothers should not share cups and utensils with infants. This is known as vertical transmission.
Certain dairy products, such as cheddar cheese, can counter tooth decay when consumed soon after eating foods that could be harmful to the teeth. It is likely that the buffering ability of dairy products, such as cheddar cheese, helps to counter the acidic effects. Chew gum containing xylitol, a naturally occurring sugar alcohol, is used widely to protect teeth in many countries. Xylitol has a negative effect on dental biofilm because bacteria cannot use it like sugars. This prevents the formation of bacterial acids. Chewing and stimulating the flavor receptors on your tongue can also increase saliva production and release. This saliva contains natural buffers that prevent pH from dropping.
Dental sealants are a useful tool for caries prevention. Sealants are thin, plastic-like coatings that are applied to the chewing surfaces on the molars. They prevent food from getting trapped in pits or fissures. This prevents the local plaque bacteria from absorbing carbohydrates, which reduces the likelihood of developing pit and fissure caries. Sealants are applied to the teeth of children immediately after the tooth emerges. However, sealants can also be used for adults if necessary. Sealants can become worn over time, and may need replacement. Dental professionals should inspect them frequently.
Calcium, which is found in milk and green veggies, is frequently recommended to protect against dental cavities. Fluoride is a binding agent that bonds to the enamel hydroxyapatite crystals and strengthens teeth. The tooth surface is less prone to decay and demineralization once the fluoride has been bound. Enamel made with calcium is also more resistant to demineralization. Topical fluoride intake is more popular than systemic intake. These may include fluoride toothpaste, professional varnish or mouthwash. Fluoride toothpaste should be rinsed off after brushing. This can lead to a higher concentration of fluoride residue. A majority of dental professionals recommend that patients receive topical fluoride solutions during routine visits. They also recommend the use of xylitol or amorphous calcium phosphate products. Initial findings suggest that there may be a "caries vaccine".
Treatment Dental Caries (Cavities)
The severity of the condition will determine whether treatment is necessary. If the conditions are right, non-cavitated lesions may be treated and remineralization of these can occur. This may mean that you need to make changes in your diet, reduce the intake of refined sugars, and improve your oral hygiene. For example, brush your teeth twice daily with fluoride toothpaste. You also need to floss regularly. This non-operative treatment of carious lesions is called "nonoperative". It does not require drilling. The individual must be motivated and understand the importance of non-operative treatment. Otherwise, the decay will not stop.
A dental restoration ("operative treatment") is often recommended after a lesion has been cavitated. This is especially true if there is dentin involved. To prevent the disease from progressing underneath the restoration, it is necessary to remove all decay before restoration can go ahead. If the decay is sealed, it can sometimes be left behind. This seal isolates bacteria from the substrate. Stepwise caries removal is a technique that prevents the exposure of the dental pulp. It also reduces the amount of tooth substance that must be removed before the final filling is placed. Too often, enamel must be removed as it can cause fractures and is not supported.
The tooth structure of a damaged tooth does not completely regenerate. However, remineralization may be possible if dental hygiene is maintained at an optimal level. To encourage remineralization of small lesions, it is possible to use topical fluoride. Treatment can stop the progression of dental caries in larger lesions. Treatment is intended to preserve the tooth structure and prevent further damage. To ensure the integrity of your fillings, a dentist should inspect them regularly.
Treatment Modalities For Dental Caries
Cavity fillings
Treatment of severe decay is generally more expensive and quicker than early treatment. In some cases, local anesthetics or nitrous oxide ("laughing gases") may be necessary to ease pain or anxiety. Young patients who have severe anxiety or special needs such as those with severe dental problems may need IV sedation in the office or general anesthesia in a hospital. To remove large amounts of decayed tooth material, a dental handpiece ("drill") can be used. When the pulp is affected by decay, a spoon is a dental instrument that can be used to remove it. A dental restoration is used to restore the tooth's function and aesthetic appearance after the decay and damaged tooth structure have been removed.
Treatment Materials
Dental amalgam, composite resins, stainless steel crowns, and porcelain are all options for restorative materials. Composite resin and porcelain can match the natural color of patients' teeth. They are therefore more commonly used when aesthetics are an issue. A filling is not recommended for cases where the tooth structure has been severely damaged or destroyed by decay. A crown is required to protect these teeth from damage.
Endodontic therapy is sometimes necessary to restore a tooth. If the pulp of a tooth has become infected by decay-causing bacteria, or trauma, endodontic therapy (also known as "root canal") is recommended. The root canal involves the removal of the pulp, along with the nerve and vascular tissues. Endodontic instruments are used to clean and shape the canals. They are usually then filled with gutta percha, a rubber-like substance. A crown can then be placed and the tooth is now filled. The tooth becomes non-vital after a root canal is completed. It is without any living tissue. Sometimes, a "pulpotomy", or procedure to remove the living tissue from primary teeth (baby) is performed. These cases are when bacteria have infected the pulp of the tooth's coronal portion, but not the root pulp. These teeth require that the coronal pulp be removed and the healthy root pulp maintained. The crown is then placed on top of the tooth and filled with a restorative material.
Teeth with severe dental caries can also be treated by extraction. If the tooth has been severely damaged by decay, it is necessary to extract it. Sometimes, extractions are recommended if there is no opposing tooth or the tooth is likely to cause complications or problems in the future. This may also be true for wisdom teeth. Patients who are unable to or unwilling to pay the cost or difficulty of restoring the tooth may prefer extractions.