What is tooth decay/cavities?

Early cavities can be detected by a dentist during a routine examination with the aid of dental x-rays.  These cavities can then easily be treated with fillings in order to prevent progression. 

Signs and symptoms

Signs and symptoms of cavities vary depending on the location and the extent of these.  In the earlier stages, you may not encounter any symptoms but as the cavity progresses and increases in size, you may encounter one of the following signs and symptoms:

• Stains on any surface of your teeth.  These may appear as a white, black, or brown stain. 

• Holes or pits in your teeth that are visible

• Sensitive teeth while eating or drinking something cold, hot, or sweet

• Pain on biting down

• Spontaneous toothache that appears without any known trigger

Causes of tooth decay

Tooth decay is a process that occurs over a period of time, resulting in cavities.  The process involves the following:

1. Plaque formation

Dental plaque is a sticky layer or film that forms on the teeth. It may be colorless or pale yellow.  It is formed usually due to poor oral hygiene and an excess intake of sugar and starch. Bacteria in the mouth then feed on the residual sugar and starch from the diet, resulting in plaque formation. This plaque then hardens and gets deposited over or under your teeth into tartar (calculus).

2. Acid attacks

The acid in the plaque removes minerals from the enamel of your teeth.  This gradual erosion causes tiny holes within your teeth which starts of the process of forming cavities.  The holes within the enamel allow bacteria and acid to make way to the next layer, called dentine.  This layer is less mineralised than enamel and therefore less resistant to the acid.  Tiny tubules within this layer communicate with the area of the tooth containing the nerve, causing sensitivity.      

3. Progression into the Pulp

Decay then progresses from the dentine into the pulp, the area which houses the tooths’ blood and nerve supply.  The bacteria within the pulp cause it to become swollen and irritated.  As the tooth is a hard structure there is no space for the swelling to expand within the tooth and as a result this compresses the nerve within the tooth, causing pain.    

Risk factors

A number of factors increase the risk of an individual developing tooth decay.  Below is a list of the most common risk factors:

1. Location of your tooth

Decay is more prevalent in molars and premolars compared to canines and incisors.  These back teeth tend to have pits and grooves, which collect food particles that remain in contact with the tooth surface for longer.   

2. Inadequate brushing

This results in plaque remaining on the tooth surface, which then harbors bacteria that produce the acid causing cavities in the tooth.  

3. Frequent snacking

This does not allow your teeth to recover between acid attacks and therefore helps create a constant acidic environment around your teeth.

4. Dry mouth

This is caused due to a lack of saliva.  The reduction in saliva can occur as a result of medications, medical conditions, and radiotherapy to the head and neck region.  A reduction in saliva means that it is not able to wash away food and plaque on your teeth as effectively.  Saliva also contains substances that counter the acid produced by the bacteria.

5. Inadequate fluoride

Fluoride is a naturally occurring mineral that strengthens the enamel making it less prone to decay.  Fluoride can also reverse the earliest stages of tooth damage. 

Complications 

When early signs and symptoms of tooth decay are ignored, the decay progresses leading to complications. These include:

1. Severe pain

2. Abscess in the tooth

3. Damaged/broken teeth

4. Swelling

5. Tooth loss

Prevention

The simple measures can help reduce your risk and prevent tooth decay.  Here are some tips that will be of great benefit:

• Brush twice daily using a toothpaste containing a minimum of 1350ppm fluoride.  Interdental cleaning is very important

• Avoid frequent snacking and sipping of sugary foods

• Visit your dentist regularly