Dental caries (tooth decay) is a disease of the teeth resulting in damage to tooth structure. It is more common among children and young adults but it can affect any person.

Causes

Dental caries occur when the acids in plaque dissolve the enamel surface of the tooth and create holes in the tooth (cavities). Cavities are usually painless until they grow very large inside the internal structures of the tooth (the dentin and the pulp at the core) and can cause death of the nerve and blood vessels in the tooth, resulting in tooth abscess. Untreated tooth decay can result in death of the internal structures of the tooth with eventual loss of the tooth. Dietary sugars and starches (carbohydrates) increase the risk of tooth decay. The type of carbohydrate and the timing of ingestion are more important that the amount. Sticky foods are more harmful than non-sticky foods because they remain on the surface of the teeth. Frequent snacking increases the time that acids are in contact with the surface of the tooth.

Signs & Symptoms

The patient is often unaware of the presence of caries until the lesion is well advanced. Common early symptoms are sensitivity to heat and cold and discomfort after eating sugar-containing foods. Some people experience toothache, particularly after sweet or hot or cold foods or drinks. Another sign include the presence of visible pits or holes in the teeth.

Treatment

Treatment for dental caries involves filling the affected tooth. The decayed material is removed (drilling) and replaced with a restorative material such as silver alloy, gold, porcelain, or plastic. Crowns are used if decay is extensive because multiple fillings increase the risk of the tooth breaking. A covering jacket (crown) over the remainder of the tooth acts as a protective layer. Crowns are often made of gold or porcelain. A root canal treatment is recommended if the nerve (pulp) in a tooth dies from decay or from a traumatic blow. The centre of the tooth, including the nerve and vascular tissue (pulp), is removed along with decayed portions of the tooth. The roots are filled with a sealing material. The tooth is filled and a crown may be placed over the tooth. Treatment often preserves the tooth. It is advisable to go for early treatment as it is less painful and less expensive.

Prevention

As the old adage goes, prevention is better than cure. Prevention here refers to proper oral hygiene. Fluoride is often recommended to protect against dental caries. In children whose teeth are developing, ingested fluoride in their drinking water gets incorporated into the structure of the enamel and protects it against the action of acids. Topical fluoride such as fluoride toothpaste or mouthwash is recommended to protect the surface of the teeth. Many dentists include application of topical fluoride gels (applied to surfaced areas of the teeth) as part of routine visits. Other preventive measures include brushing the teeth or rinsing the mouth with water after eating sugary and chewy foods. Cut down on snacking as it creates a constant supply of acid in the mouth. Avoid constant sipping of sugary drinks or frequent sucking on candy and mints. The use of dental sealant is another good mean of cavity prevention. Sealants are thin plastic-like coating applied to the chewing surfaces of the molars. This coating prevents the accumulation of plaque on these vulnerable surfaces.