Tooth decay, or dental caries, is the result of acid-producing bacteria that live in plaque biofilm constantly building up on the teeth. Plaque feeds on sugars from your foods or drinks and produces acids that demineralize the tooth enamel. In the early stages, tooth decay leads to tiny holes or cavities in the enamel, which is the outer mineral structure of teeth. It then progresses to another protective layer of your teeth toward the softer portion of the tooth called dentin.

If still not treated, cavities get deeper to the center of the tooth and bacteria infect the dental pulp where the nerves and blood vessels are. This causes painful toothache and teeth sensitivity.

Left untreated, tooth decay worsens and potentially results in pulp damage, dental abscess, gum diseases, and tooth loss.

High consumption of sugary foods, carbonated drinks, and lack of oral hygiene are some key contributing factors in causing tooth decay. Therefore, daily and proper brushing with fluoride toothpaste and flossing coupled with a healthier diet and regular dental visits are the best ways to protect your teeth against tooth decay.

What causes tooth decay?

Tooth decay begins with demineralization or loss of minerals on the outermost layers of teeth as a result of acids produced by plaque. The decay can occur on either enamel that makes up the outer layer on the upper part of teeth or on cementum, a bony layer that covers the root of teeth. But where does this plaque come from?

Plaque is a naturally acquired bacterial biofilm that develops on the teeth. It is formed by proteins derived from your saliva and metabolizes your diets’ sugars.

The plaque metabolism releases acids and eats away the mineral portion of your teeth, the calcium and phosphate.

The microorganisms in plaque multiply with the aid of nutrients in our saliva and foods. If we don’t brush our teeth and clean away plaque regularly, it accumulates. As plaque remains on the surface of teeth for longer, it hardens and becomes calculus. This is often known as tartar and cannot be removed by brushing alone and requires treatments like plaque removal procedure by the dentist.

Stages of Tooth Decay

It doesn’t take as long for plaque to accumulate, and as time passes, tooth decay progresses through various stages. There are generally five Stages of Tooth Decay which are explained in more detail below.

Stage 1- Demineralization (white spots)

When a tooth decay lesion begins, it first appears as chalky white spots, lines, or, fissures on the surface of teeth.

The appearance of chalky white signs is the result of the demineralization or decalcification of the enamel. This stage is called incipient caries and occurs due to the loss of minerals in the enamel, which is the hardest and outermost layer of tooth.

White spots can be found in areas of teeth where plaque has existed and been more active. This demineralization stage is easily reversible with good homecare like appropriate brushing techniques and using fluoride toothpaste, as well as in-office treatments like fluoride varnish or fissure sealants. Your dental hygienist or dentist will provide you with the preventive treatments you need.

Stage 2- Enamel decay

As tooth decay progresses, it causes the enamel to break down more.  Bacteria infiltrate into inner structures and small hole or cavities are formed in the enamel. You may not particularly feel sensitive teeth or pain. Over time, the cavities become discolored and turn into a darker or brownish color.

You need to visit a dentist for restoration of the affected tooth since larger cavities should be treated with a filling or even dental crowns.

It is important to help damaged enamel remineralize through good oral care and slow down the caries’ speed. The decay can extend further to the dentin, and cavities will become larger if it is left untreated. This requires more intensive dental work.

Stage 3- Dentin decay

At this stage of tooth decay, the cavity has gone through the enamel into the dentin, which is the layer underneath. Dentin is softer and less mineralized than enamel structure, so decay process proceeds more rapidly.

As dentin demineralization happens even in slightly higher pH than enamel — enamel demineralizes at pH 5.5 or below while dentin at pH 6 — the acids will likely penetrate downward into the pulp and cause greater damage.

Stage 4- Pulp damage

Under normal situations, teeth are protected by overlying layers: enamel and cementum. As a result of caries or due to other reasons like fractures, cracks, or even restorative procedures, the dental pulp can get infected and damaged.

Once tooth decay progresses toward the dental pulp, which is inside the tooth, it jeopardizes your dental health seriously. Pulp is a soft tissue consisting of nerves, blood vessels, and other connective tissues. If it becomes infected, you will require root canal treatment to remove the pulp and save the tooth followed by restoration treatment. In severe cases, the tooth might not even be salvaged with a root canal and should be pulled.

Painful toothache when eating, and a greater feeling of teeth sensitivity to cold and hot temperatures are alarming symptoms to seek treatment immediately.

Stage 5- Dental abscess

When a damaged pulp is left unchecked, dental abscess can form. As a consequence of bacterial infection in the pulp, the pulp inflammation can continue throughout the entire root chambers toward the end part of the root known as the periapical region, causing the roots to rot out and gums to swell. This results in dental abscess and requires prompt treatment.

An abscess is the collection of pus and it can spread to the surrounding tissues, jawbone, and other areas of the head and neck. Your dentist may prescribe antibiotics, drain the pus, and remove the affected tooth entirely.

Tooth decay risk factors

Tooth decay is a common oral health condition. Some contributory factors play key roles in causing it like:

High sugar intake

Frequent exposure to sugar triggers the production of acids by plaque. This creates an environment favorable for bacteria to thrive and attack your teeth. Sipping on sugary drinks, eating candy, and in general, having a diet high in sugars and starches causes dental decay.

Certain foods and drinks

Soda, wine, energy drinks and carbonated beverages give your mouth a high level of acids and thus lower mouth pH rapidly. Soft drinks act as fuel for bacteria to produce more acids. Alcoholic drinks, in addition, dry your mouth, creating more risks of bacterial activity. These drinks wear down tooth enamel and lead to dental erosion.

On the other hand, sticky foods remain on teeth and the saliva in your mouth finds it difficult to wash them away. These foods can be cakes, chocolate bar, candy, dried fruits, potato chips, or honey.

Poor oral hygiene

Brushing teeth twice daily helps remove plaque. The fluoride ingredient in toothpaste contributes to the remineralization of the teeth.

Flossing daily also keeps teeth in good health. It allows you to keep the gaps and spaces thoroughly clean and remove plaque build-ups from around your teeth.

Dry mouth

Saliva is a natural mouth cleaner and has buffering capacity for teeth. It helps protect teeth through remineralization and neutralizing some degree of acids in your mouth. Lack of good salivary flow leads to dry mouth which in turn increases the risk of tooth decay or caries greatly.

The results of dry mouth can often be seen in individuals who take certain medications or undergoing chemotherapy and radiotherapy. Dry mouth is also common in individuals who use street drugs.

Read our article on methamphetamine’s effects on teeth.

Older age

It is more likely to experience gum recession in older ages. The condition can be due to untreated periodontitis or longtime wear and tear on the gums and teeth. When gums are receding and shrinking away from around the teeth, it leaves the roots of teeth exposed. This condition causes root decay, a more common problem among older people.

Younger age

Tooth decay in children is a common oral condition, so is in teens and adults. Frequent snacking on sweet foods and drinks and not cleaning teeth well increase risks of decay and cavities in early ages. When not brush their teeth, children will not get the fluoride necessary for their dental health.

As important as oral health in kids, there is even a name for children’s dental decay. Early childhood caries (ECC) requires awareness and more attention to help prevent tooth decay in very young children.

Insufficient fluoride

Fluoride, a key natural mineral substance, strengthens teeth, reverses the early stages of tooth decay, and prevents cavities. It is found in oral care products like toothpaste and mouthwash and is added to public water systems.

Fluoride acts as a remineralizer for enamel and also protects teeth against acids that erode teeth structure. Not brushing teeth twice daily with fluoridated toothpaste means not getting enough fluoride and thus being susceptible to tooth decay.

Heartburn (Acid reflux)

Individuals who suffer from gastroesophageal reflux disease (GERD) can experience a higher degree of dental erosion due to the constant flow back of stomach acid into their mouth. The acid reflux travels back through esophagus which also irritates and causes the burning feeling in the chest, known as heartburn.

Eating disorders

People with eating disorders such as anorexia, bulimia, and binge-eating disorders are at higher risks of tooth erosion and cavities.

Anorexia and bulimia cause significant loss of enamel, leading to enamel thinning, teeth sensitivity, and severe form of tooth decay. This is because of stomach acids that come into contact with teeth and dissolve enamel during vomiting and lack of quality saliva to keep the balance of acids, common symptoms of eating disorders.

Treatments for tooth decay

Tooth decay treatments depend on how far the decay has progressed and whether it is in the earlier stages or later.

Fluoride treatment

Your dental hygienist or dentist can help protect your teeth and strengthen enamel using fluoride treatment. Fluoride can be used in forms like fluoride varnish or gel. Your dentist can apply different concertation of fluoride ingredient depending on your needs.

Filling cavities

Your dentist repairs the damaged part of the tooth with fillings restoration. The decayed portion of the tooth is first drilled down. The cavity is then filled with either composite resin filling which is the tooth-colored type of filling or dental amalgam filling, the darker material.

Inlay and onlay dental restoration

For larger cavities or when regular filling may not work, dentists use a lab-made method filling type known as dental inlay or onlay to fill the damaged part of the tooth. While inlays repair the central decayed areas, onlays cover the chewing surfaces or cusps of the tooth. Ceramic/porcelain and metals like gold are the typical materials for inlays and onlays.

Dental crown

In serious cases, tooth decay has advanced so much into enamel and dentin that the major bulk of the tooth has worn down. Therefore, the damage is so severe that requires extensive removal of the upper part of the tooth. This is when your dentist will recommend crowns, a more invasive type of dental work which replaces the top part of the tooth.

Root canal treatment

When decay reaches tooth’s pulp, root canal treatment is needed. It can be done by your dentist. Or, in difficult pulp damage cases, you are referred to an endodontist. The treatment involves removing infected pulp, cleaning or if necessary, shaping the root canal and pulp chambers, sealing and filling with gutta-percha, and finally restoring the top portion of tooth with either a filling or crown restoration.

Tooth extraction

If a tooth is severely decayed and is difficult to restore, the best alternative that a dentist can do is to extract the tooth. Your dentist can then replace the missing tooth with a dental implant or a bridge.

How to prevent tooth decay?

Practicing daily oral hygiene is the best solution to prevent damage caused by plaque accumulation on the teeth. This along with an eye on your diet makes the healthier mouth and teeth to easily be achieved. Tooth decay is preventable. The good news is you can even reverse the course of decay once it is in the earlier stages of tooth decay.

Below are some simple tips for preventing tooth decay:

  • Brush your teeth. It is recommended to keep your teeth clean and gums daily, so brush your teeth twice per day and after each meal.
  • Floss regularly. Floss your teeth at least once a day.
  • Use fluoride toothpaste and mouth rinse. Brush with fluoride toothpaste to strengthen enamel and recover the lost minerals in the teeth.
  • Limit sweets and sugary/acidic drinks. Restrict foods and drinks that promote the development of tooth decay, known as cariogenic foods. The list can include refined carbohydrates in both sugars and starches and also sugary or acidic beverages.
  • Have a tooth-friendly diet. Consume foods that are healthier for your teeth and are caries preventive. Foods such as dairy products (cheese, milk, and yogurt), fish, legumes, meats, vegetables, and fruits enhance teeth health.
  • Stop snacking. Avoid snacks between your main meals to decrease risks of constant acid production in the mouth.
  • Chew sugarless gum that contain xylitol. Chewing sugarless gum flavored with xylitol helps stimulate salivary flow. Xylitol is a nonfermentable type of sugar and prevents plaque accumulation by stimulating saliva which buffers teeth.
  • See your dentist regularly. Visit your dental professional regularly for check-ups and teeth cleaning.
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