Dental cavities (caries)
  • Sep 07, 2016
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Cavities are permanently damaged areas in the hard surface of teeth that develop into tiny openings or holes. Cavities are caused by a combination of factors, including bacteria in mouth, frequent snacking, sipping sugary drinks, and not cleaning teeth well.
Cavities are among the world's most common health problems. They're especially common in children, teenagers and older adults. But anyone who has teeth can get cavities, including infants.
If cavities aren't treated, they get larger and affect deeper layers of teeth and can lead to severe toothache, infection and tooth loss.

The signs and symptoms of cavities vary, depending on their extent and location. When a cavity is just beginning, there may not be any symptoms at all. As the decay gets larger, it may cause signs and symptoms such as:

  • Toothache
  • Tooth sensitivity
  • Mild to sharp pain when eating or drinking something sweet, hot or cold
  • Visible holes or pits in your teeth
  • Brown, black or white staining on any surface of a tooth
  • Pain when you bite down

When to see a Dentist
You may not be aware that a cavity is forming. That's why it's important to have regular dental checkups and cleanings, even when your mouth feels fine. However, if you experience toothache or mouth pain, see your dentist as soon as possible.

Cavities are caused by tooth decay — a process that occurs over time. Here's how tooth decay develops:
  • Plaque formation. Mouth naturally contains many types of bacteria. Some thrive on food and drinks that contain certain forms of sugar. When these sugars aren't cleaned off teeth, the bacteria quickly begin feeding on them and producing acids. The bacteria, form bacterial plaque — a sticky film that coats teeth. If tongue is run along teeth, one may be able to feel this plaque forming — it's slightly rough and it's more noticeable on back teeth, especially close to gums. If the plaque is not removed while it's soft, it becomes hard and difficult to remove — a good place for bacteria to hide.
  • Plaque attacks. The acids in plaque remove minerals in tooth's hard, outer enamel. This erosion causes tiny openings or holes in the enamel — the first stage of cavities. Once areas of enamel are worn away, the bacteria and acid can reach the next layer of your teeth, called dentin. This layer is softer than enamel and less resistant to acid.
  • Destruction continues. As tooth decay develops, the bacteria and acid continue their march through teeth, moving next to the inner tooth material (pulp) that contains nerves and blood vessels. The pulp becomes swollen and irritated from the bacteria. When decay advances to this extent, there may be severe toothache, sensitivity, pain when biting or other symptoms. Body also may respond to these bacterial invaders by sending white blood cells to fight the infection. This may result in a tooth abscess — a pocket of pus that's caused by a bacterial infection.

Risk Factors
Everyone who has teeth is at risk of getting cavities, but the following factors can increase risk:
  • Tooth location. Decay most often occurs in back teeth (molars and premolars). As these teeth have lots of grooves, pits and crannies that can collect food particles. As a result, they're harder to keep clean than smoother, easy-to-reach front teeth. Plaque can build and bacteria can thrive between back teeth, producing the acid that destroys tooth enamel.
  • Certain foods and drinks. Foods that cling to teeth for a long time — such as milk, ice cream, honey, sugar, soda, dried fruit, cake, cookies, hard candy, breath mints, dry cereal, and chips — are more likely to cause decay than foods that are easily washed away by saliva.
  • Frequent snacking or sipping. When one steadily snack or sip sodas, one gives mouth bacteria more fuel to produce acids that attack teeth and wear them down. And sipping soda or other acidic drinks throughout the day helps create a continual acid bath over teeth.
  • Bedtime infant feeding. Parents are encouraged not to give babies bedtime bottles filled with milk, formula, juice or other sugar-containing liquids. These beverages will remain on teeth for hours while the baby sleeps, providing food for decay-causing bacteria. This damage is often called baby bottle tooth decay. Letting a toddler who's transitioning from a bottle wander around drinking from a sippy cup can cause similar damage.
  • Inadequate brushing. If one doesn't clean ones teeth soon after eating and drinking, plaque forms quickly and the first stages of decay can begin.
  • Not getting enough fluoride. Fluoride, a naturally occurring mineral, helps prevent cavities and can even reverse the earliest stages of tooth damage. Because of its benefits for teeth, fluoride is added to many public water supplies. It's also a common ingredient in toothpaste and mouth rinses. Bottled water may not contain fluoride. It is pertinent that there may be excess of fluoride in ground water in certain areas leading to mottling appearance of teeth.
  • Younger or older age. Cavities are more common in children and teenagers. Over time, teeth can wear down and gums may recede, making teeth more vulnerable to root decay. Older adults also may use more medications that reduce saliva flow, increasing the risk of tooth decay.
  • Dry mouth. Dry mouth is caused by a lack of saliva, which helps prevent tooth decay by washing away food and plaque from your teeth. Substances found in saliva also help counter the acid produced by bacteria and can even help repair early tooth decay. Certain medications, some medical conditions, radiation to head or neck, or certain chemotherapy drugs can increase risk of cavities by reducing saliva production.
  • Worn fillings or dental devices. Over the years, dental fillings can weaken, begin to break down or develop rough edges. This allows plaque to build up more easily and makes it harder to remove. Dental devices can also stop fitting well, allowing decay to begin underneath them.
  • Eating disorders. Anorexia and bulimia can lead to significant tooth erosion and cavities. Stomach acid from repeated vomiting (purging) washes over the teeth and begins dissolving the enamel. Eating disorders can also interfere with saliva production.
  • Heartburn. Heartburn or gastroesophageal reflux disease (GERD) can cause stomach acid to flow into mouth (reflux), wearing away the enamel of teeth and causing significant tooth damage. Dentist may recommend consultation with physician to see if gastric reflux is the cause of enamel loss.

Cavities and tooth decay are so common that one may not take them seriously. And one 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 don't have their permanent teeth yet.
Complications may include:
  • Pain
  • Tooth abscess
  • Pus around a tooth, especially when you press on your gums
  • Broken teeth
  • Chewing problems
  • Positioning shifts of permanent teeth after losing baby teeth prematurely
When cavities and decay become severe, one may have:
  • Pain that interferes with daily living, preventing going to school or work.
  • Weight loss or nutrition problems from painful or difficult eating or chewing
  • Tooth loss, which may affect appearance, as well as confidence and self-esteem
  • In rare cases, a tooth abscess that can cause serious or even life-threatening infections

Preparing for Dentist appointment
If  experiencing pain or sensitivity in teeth, make an appointment with a dentist as soon as possible. Here's some information to help you get ready for your appointment, and what to expect from your dentist.

What you can do
Before your appointment, make a list of:
  • All medications, vitamins or other supplements one is taking and their dosages
  • Any allergies to medications or bad reactions to local anaesthetics
  • Questions to ask the dentist
Some basic questions to ask the dentist include:
  • Do I have a simple cavity, or do I need a crown or a root canal?
  • How many visits will it take to treat this tooth?
  • When will the pain go away?
  • What can I take for the pain?
  • How long should I wait before I eat or drink after this procedure?
  • Are there other steps I can take to prevent cavities?

Tests and Diagnosis
Types of Cavities
Dentist can usually detect tooth decay easily by:
  • Asking about tooth pain and sensitivity
  • Examining mouth and teeth
  • Probing teeth with dental instruments to check for soft areas
  • Looking at dental X-rays, which can show the extent of cavities and decay

Treatments and Drugs
Most dentists recommend regular checkups to identify cavities and other dental conditions before they cause troubling symptoms and lead to more-serious problems. The sooner one seeks care, the better ones chances of reversing the earliest stages of tooth decay and preventing its progression. If a cavity is treated before it starts causing pain, one probably may not need extensive treatment.
Treatment of cavities depends on how severe they are and particular situation. Treatment options include:
  • Fluoride treatments. If cavity is just getting started, a fluoride treatment may help restore tooth's enamel. Professional fluoride treatments contain more fluoride than the amount found in tap water, over-the-counter toothpaste and mouth rinses. Fluoride treatments may be liquid, gel, foam or varnish that's brushed onto teeth or placed in a small tray that fits over teeth. Each treatment takes a few minutes.
  • Fillings. Fillings, sometimes called restorations, are the main treatment option when decay has progressed beyond the earliest enamel-erosion stage. 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.
  • Crowns. If one has extensive decay or weakened teeth, one may need a crown — a custom-fitted covering that replaces tooth's entire natural crown. Dentist will drill away all the decayed area and enough of the rest of the tooth to ensure a good fit. Crowns may be made of gold, porcelain, resin, porcelain fused to metal or other materials.
  • Root Canals. When decay reaches the inner material of tooth (pulp), one may need a root canal. This is a treatment to repair and save a badly damaged or infected tooth instead of removing it. The diseased tooth pulp is removed. Medication is sometimes put into the root canal to clear any infection. Then the pulp is replaced with a filling.
  • Tooth Extractions. Some teeth become so severely decayed that they can't be restored and must be removed. Having a tooth pulled can leave a gap that allows other teeth to shift. If possible, consider getting a bridge or a dental implant to replace the missing tooth.

Good oral and dental hygiene can help you avoid cavities and tooth decay. Below are some tips to help prevent cavities. Ask the dentist which tips are best.
  • Brush with fluoride toothpaste after eating or drinking. Brush teeth at least twice a day and ideally after every meal, using fluoride-containing toothpaste. To clean between teeth, floss or use an interdental cleaner. If one can't brush after eating, at least try to rinse mouth with water.
  • Rinse mouth. If one has a high risk of developing cavities, dentist may recommend use of mouth rinse with fluoride.
  • Visit Dentist Regularly. Get professional teeth cleanings and regular oral exams, which can help prevent problems or spot them early.
  • Consider Dental Sealants. A sealant is a protective plastic coating that's applied to the chewing surface of back teeth, sealing off the grooves and crannies that tend to collect food. The sealant protects tooth enamel from plaque and acid. Sealants can help both children and adults. Sealants last up to 10 years before they need to be replaced, though they need to be checked regularly to ensure they're still intact.
  • Avoid frequent snacking and sipping. Whenever eating or drinking beverages other than water, mouth bacteria create acids that can destroy 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 teeth than others. Avoid foods that get stuck in grooves and pits of teeth for long periods, such as chips, candy or cookies, or brush soon after eating them. However, foods such as fresh fruits and vegetables increase saliva flow, and unsweetened coffee, tea and sugar-free gum help wash away food particles.
  • Ask about antibacterial treatments. If especially vulnerable to tooth decay — for example, because of a medical condition —dentist may recommend special antibacterial mouth rinses or other treatments to help cut down on harmful bacteria in mouth.

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