Tooth Cavity | Dental Caries |Tooth Decay| Tooth Caries

Dr Abi
Jul 7, 2023
7 min read

Updated: Jul 12, 2023

By- Dr. Abi Negi | Tooth Decay | Dental Caries

Table of Contents

Dental Caries
Primary Reasons
Pathogenesis
Signs and Symptoms
Can you reverse a cavity?
Prevention Strategies
Treatment of Tooth cavity?

Dental caries is defined as a multifactorial infectious disease characterized by the localized demineralization of tooth structures, primarily caused by acid-producing bacteria in the presence of fermentable carbohydrates.

It is a dynamic process influenced by factors such as oral microorganisms, host susceptibility, diet, and time. Dental caries affects the hard tissues of the tooth, including enamel, dentin, and cementum, leading to the formation of cavities or carious lesions.

Tooth Cavity | Dental Caries |Tooth Decay

Dental caries is a complex multifactorial disease influenced by several interrelated factors.

The primary etiological factors include:

Dental Plaque Biofilm

Dental caries is initiated by specific acidogenic and aciduric bacteria present in the dental plaque biofilm. Bacteria, particularly Streptococcus mutans and Lactobacillus species, metabolize dietary carbohydrates, primarily fermentable sugars, and produce organic acids, particularly lactic acid. The acid production leads to a drop in the local pH, which triggers the demineralization of tooth enamel.

Diet and Fermentable Carbohydrates

The presence of fermentable carbohydrates in the diet, such as sucrose, glucose, and fructose, provides a substrate for acid-producing bacteria. Frequent consumption of sugary and starchy foods or beverages contributes to an increased risk of dental caries.

Host Susceptibility and Oral Environment

Individual factors influence the susceptibility to dental caries. These factors include salivary flow rate and composition, quality of tooth enamel and dentin, oral hygiene practices, and tooth morphology. Saliva acts as a protective factor by buffering acids, providing remineralizing ions, and promoting clearance of food debris and bacteria.

Time and Frequency of Acid Exposure

Prolonged and frequent exposure to acidogenic bacteria and dietary sugars increases the likelihood of dental caries. Frequent snacking or sipping on sugary or acidic beverages prolongs the duration of acid attacks on tooth surfaces.

Other Factors

Various additional factors can contribute to the aetiology of dental caries, including socioeconomic status, oral microbial composition and diversity, systemic conditions affecting saliva flow or composition, and the presence of developmental defects in tooth enamel.

Pathogenesis of dental caries:

Dental Plaque Formation

Dental caries begins with the formation of a complex biofilm called dental plaque on tooth surfaces. The acquired pellicle, primarily composed of salivary glycoproteins, forms the initial layer for bacterial attachment. Early colonizers, including Streptococci and Actinomyces species, adhere to the pellicle and serve as the foundation for subsequent bacterial growth.

Acidogenic Bacteria and Fermentable Carbohydrates

Acidogenic bacteria, such as Streptococcus mutans and Lactobacillus species, are key contributors to the caries process. These bacteria metabolize dietary carbohydrates, particularly fermentable sugars like sucrose, into organic acids, primarily lactic acid. The acid production by these bacteria leads to a decrease in pH, creating an acidic microenvironment within dental plaque.

pH Decline and Demineralization

The acidic conditions within the plaque result in a drop in pH below the critical level for tooth mineral dissolution. This demineralization primarily affects the enamel, causing the release of calcium and phosphate ions from the hydroxyapatite crystals. The mineral loss weakens the tooth structure and leads to subsurface lesions.

Biofilm Maturation and Acid Tolerance

As dental plaque matures, the composition of the microbial community changes. Acidogenic and aciduric bacteria, such as S. mutans, thrive and adapt to the acidic environment, enabling them to withstand and metabolize carbohydrates in low pH conditions. This acid tolerance further perpetuates the caries process.

Remineralization and Saliva

Remineralization is a natural repair mechanism that occurs when supersaturated saliva and fluoride ions interact with the demineralized tooth surfaces. Saliva serves as a source of calcium, phosphate, and fluoride ions, which can be deposited onto the tooth structure, promoting the formation of fluorapatite crystals and restoring mineral content.

Cavity Formation

If the demineralization process overwhelms the remineralization capacity, a cavity or carious lesion may form. The lesion progresses through the enamel, advancing into the dentin. The breakdown of dentin matrix components by bacterial enzymes and acid-producing bacteria can lead to the spread of caries into the pulp, potentially resulting in pulpitis or pulpal necrosis.

Signs & Symptoms of Dental Caries

Toothache

Persistent or intermittent toothache is a common symptom of dental caries. The pain may vary in intensity and may worsen with exposure to temperature changes, particularly with hot, cold, or sweet stimuli.

Sensitivity

Increased sensitivity to hot, cold, or sweet substances can be indicative of dental caries. The tooth may exhibit heightened sensitivity when exposed to these stimuli.

Visible Discoloration or Staining

Dental caries can cause visible discoloration or staining on the affected tooth surface. The discoloration may appear as white, brown, or black spots, indicating demineralization or decay.

Pus or Abscess Formation

In advanced cases where dental caries extends into the pulp, the tooth may develop a dental abscess, leading to localized swelling, pain, and the presence of pus.

Visible Holes or Pits

As dental caries progresses, it can lead to the formation of cavities. These cavities appear as visible holes or pits on the tooth surface, indicating advanced decay.

Rough or Broken Tooth Surface

Dental caries can cause roughness or irregularities on the tooth surface, particularly in advanced stages where the decay has led to the loss of tooth structure.

Bad Breath (Halitosis)

The presence of cariogenic bacteria in the carious lesions can contribute to persistent bad breath or an unpleasant taste in the mouth.

Can YOU REVERSE A Cavity?

Once a cavity is present in a tooth, it cannot be reversed on its own. A cavity is essentially permanent structural damage to the tooth caused by tooth decay.

However, early-stage cavities, known as dental caries or incipient cavities, can be stopped or slowed down with proper dental care and hygiene practices.

By practicing good oral hygiene, such as regular brushing with fluoride toothpaste, flossing, and using mouthwash, you can help prevent further progression of the cavity and maintain the overall health of your teeth. Additionally, visiting a dentist regularly for check-ups and cleanings can help identify cavities at an early stage and provide appropriate treatment.

In the early stages, a dentist may recommend fluoride treatments or dental sealants to help remineralize and strengthen the affected tooth enamel. However, once a progresses and causes substantial damage to the tooth structure, it cannot be reversed without dental intervention.

It is important to address cavities promptly to prevent further deterioration of the tooth and potential complications, such as toothache, infection, or the need for more extensive dental procedures like root canals or extractions.

Prevention Strategies

1. Oral Hygiene: Brush your teeth at least twice a day using a fluoride toothpaste. It is recommended to use a soft-bristled toothbrush and brush all surfaces of your teeth thoroughly. Additionally, flossing daily to remove plaque and food particles from in between your teeth.

2. Fluoride: Fluoride helps strengthen tooth enamel and makes it more resistant to acid attacks. Use fluoride toothpaste and consider using a fluoride mouthwash or receiving professional fluoride treatments as recommended by your dentist.

3. Balanced Diet: Limit your consumption of sugary and acidic foods and drinks, as they contribute to tooth decay. Instead, opting for a balanced diet rich in fruits, vegetables, whole grains, and lean proteins.

4. Dental Sealants: Dental sealants are protective coatings applied to the chewing surfaces of molars and premolars. They help seal off the deep grooves and fissures, preventing the accumulation of plaque and bacteria.

5. Regular Dental Check-ups: Visit your dentist regularly for check-ups and professional cleanings. Regular dental visits allow for early detection of caries and prompt treatment.

6.Saliva Stimulation: Chewing sugar-free gum or consuming sugar-free candies stimulates saliva production, which helps neutralize acids in the mouth and prevent tooth decay.

7. Limit Snacking: Frequent snacking can contribute to tooth decay, as it increases the time your teeth are exposed to acids. Try to limit snacking between meals, and if you do snack, choose tooth-friendly options like cheese, nuts, or vegetables.

8. Limit Acidic Drinks: Acidic drinks, such as soda, sports drinks, and fruit juices, can erode tooth enamel. Limit your intake of these beverages and use a straw to minimize contact with your teeth.

9. Dental Education and Awareness: Stay informed about proper oral hygiene practices and the importance of dental care. Educate yourself and others on the best ways to prevent dental caries.

Treatment of Dental Caries

1. Dental Filling

When dental caries are detected, the decayed portion of the tooth is removed, and the resulting cavity is filled with a dental filling material. Common filling materials include silver amalgam (silver fillings) and light cure composite resin (tooth-colored fillings).

2. Root Canal Treatment / RCT

When dental caries progress to the pulp (nerve) of the tooth, causing infection or severe pain, a root canal treatment may be necessary. This involves removing the infected pulp, cleaning and shaping the root canals, and filling them with a biocompatible material. The tooth is then restored with a filling or crown.

3. Dental Crowns

If the tooth decay is extensive and compromises the structural integrity of the tooth, a dental crown may be recommended. The dental crown covers the entire visible portion of the tooth to restore its shape, function, and appearance.

4. Dental Bonding

For minor caries or cosmetic concerns, dental bonding may be used. In this procedure, a tooth-colored composite resin material is applied to the affected area and shaped to match the natural tooth contours.

5. Dental Inlays and Onlays

Inlays and onlays are indirect restorations used when a tooth has moderate decay or damage that extends beyond a traditional filling but does not require a full dental crown. They are custom-made restorations fabricated in a dental laboratory and then bonded to the tooth.

6. Extraction

In severe cases where the tooth cannot be saved or if it poses a risk to oral health, extraction (tooth removal) may be necessary. After extraction, options for tooth replacement, such as dental implants, bridges, or dentures, may be discussed.

Dental caries is a common and preventable dental condition that affects individuals of all ages. By following good oral hygiene practices, such as regular brushing, flossing, and limiting sugary foods and drinks, we can significantly reduce the risk of tooth decay. Regular dental check-ups and professional cleanings play a vital role in early detection and prompt treatment of caries. Remember, prevention is key when it comes to maintaining a healthy smile and overall oral health. Prioritizing preventive measures will help us enjoy a cavity-free future and a lifetime of strong, beautiful teeth.

Author-

Dr. Abi Negi

Dentist

10 + years of experience

Certification in Practical Implantology

Certification in Rotary Endodontics

Associate Fellowship in Laser Dentistry Certification in Laser Treatments Diploma in Practical Occlusion and Restorative Dentistry Course Advanced occlusion appliance therapy, TMD Comprehensive Course in Veneers - Ceramic & Composite Aesthetic Certified - Europe, Germany WHO Health Program Certified Certification in Laser Dentistry Fellow of the Academy of General Education (FAGE) Member of the Indian Dental Association (IDA)