Dental Cavities: Symptoms, Causes, Risk Factors, Treatment and Prevention

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Cavities (also called dental carries or dental cavities or tooth decay) are permanently damaged area in your enamel (the outermost very hard and white surface of your teeth) of teeth. Cavities are one of the most common health problems throughout the world, especially among children and teenagers as well as among elderly people. Initially there is tiny opening in the damaged enamel, but if left untreated they gradually become larger in size and also involve deeper layers of your teeth. Cavities can lead to toothache, infection and even loss of your affected tooth if left untreated. The best way to prevent dental cavity is to brush and floss regularly (after every meal) and regular visit (at least once every 6 months) to your dentist.

What are symptoms of dental cavities?

The symptoms depend on the location and extent of damage. Initially there may not be any symptoms. However, as the cavity starts growing in size and extent, it may lead to following symptoms,

  • Toothache is the most common presenting symptom (which brings the patient to a doctor)
  • Tooth sensitivity (abnormal sensation to hot or cold things when it touches the affected tooth)
  • There may be small hole that is visible.
  • Pain when you bite, especially hard things
  • Stain (brown or black) on the surface of tooth.

How dental cavity formation occurs?

Cavities occur due to decay of teeth. Tooth decays develops over time and in stages,

  • Plaque formation: Our oral cavity naturally contains many types of bacteria and most of them thrive on food and drinks that contain sugar. And if you do not clear these sugars from your teeth, the bacteria quickly grows by feeding on the sugar and start producing acids. The rapidly growing bacteria form bacterial plaque that is a sticky film that coats your teeth. Bacterial plaque is more noticeable on your back teeth, especially close to your gums; hence dental cavities are more common in back teeth (lower molars). If the bacterial plaque is not removed while it’s soft, it becomes hard and difficult to remove and becomes a good place for bacteria to hide.
  • Plaque stage: The acids in bacterial plaque remove minerals from your enamel. This erosion causes tiny openings or holes or cracks in the enamel that is the first stage of cavities. If the process continues and the enamel is worn away, the bacteria and acid can reach the next layer of your teeth the dentin. Dentin is softer than enamel and less resistant to acid, hence, the process of cavity formation takes place rapidly if enamel is broken.
  • Abscess formation: As tooth decay continues to develop, the bacteria and acid continue to move deeper, moving to the next inner tooth material (pulp) that contains nerves and blood vessels. The pulp becomes inflamed (swollen and irritated) due to bacteria and acid. At this stage you may have a severe toothache, sensitivity, pain when biting hard things and other symptoms of dental cavities. Your body’s defense mechanism may respond to this bacterial invasion by sending white blood cells to fight the infection and there may be formation of pus (dead white blood cells). This is tooth abscess or a pocket of pus that’s caused by a bacterial infection and presence of dead white blood cells that die in fighting the invading bacteria.

What are the risk factors of developing dental cavities?

Practically anyone with teeth is at risk of developing cavity. However, some factors increase the risk of cavities, such as

  • Location of tooth: cavities are more common in back teeth, such as molars and premolars and much less common among front teeth. Cavities are also common in lower teeth, than upper teeth (infrequent). Molars and premolars have lots of grooves and pits where food particles can get deposited and lead to bacterial growth and plaque formation. It is also difficult to clean those teeth due to location, as they are not easy to reach with tooth brush.
  • Certain foods and drinks that can stick to your teeth can increase risk of cavities such as milk, ice cream, honey, sugar, dried fruit, cake, cookies, hard candy, breath mints, dry cereal, and chips. These foods cannot be washed away easily by saliva. Keep in mind to brush teeth after eating such foods.
  • Frequent eating: if you have habit of eating/snacking frequently, that may provide regular food to bacteria too that are present in your mouth and increase risk of cavity formation.
  • Inadequate fluoride in water/food can cause cavities. Fluoride is important for cavity prevention, hence, it is provided in water supply and various toothpastes. However, excess fluoride can also damage teeth by causing dental fluorosis.
  • Improper and inadequate brushing (ideally we should brush after every meal) can increase risk of cavity formation.
  • Bedtime feeding of infants can increase risk of dental cavities. Any sugar containing liquid given to baby at bed time will remain for many hours in the mouth when baby is asleep and bacteria can feed on that and lead to plaque formation and initiate cavity formation.
  • GERD or gastro-esophageal reflux disease cause gastric acid to regurgitate to esophagus and mouth and acid in that reflux can cause erosion of teeth enamel and lead to cavity.
  • Eating disorders such as anorexia nervosa and bulimia nervosa can cause cavities. Repeated vomiting seen in eating disorders can damage enamel and cause cavities.
  • Dry mouth, due to less salivary secretion may not be able to wash away food particles that remain in mouth that in turn cause development of plaques and cavities. Saliva also contains various acid neutralizing substances.
  • Old and worn out dental devices and fillings may lead to gradual development of cavities. Plaques can develop and cavity formation starts.
  • Cavities are common among children, teenagers and elderly persons.

What complication may occur due to dental cavities?

One should not ignore cavities as they may lead to various complications such as,

  • Tooth abscess
  • Broken tooth
  • Chewing problems
  • Position shift of permanent tooth
  • Severe pain that may interfere daily activities. Toothache can be extremely painful, even more painful than fracture of bone.

Treatment of dental cavities:

Dental cavity is very common dental health problem. Most experts recommend regular visit to your dentist. Depending on various aspects your dentist may recommend the following modalities for treatment, either alone or in combination.

  • Fillings: this is usually done if the cavity formation has progressed beyond early enamel erosion stage. Various filling materials are used such as porcelain, resins or combination of various materials.
  • Root canals: when cavity formation has reached up to pulp after erosion of enamel and dentin, root canal treatment (RCT) is done. This is done to repair and save a badly damaged and infected tooth due to cavity. The diseased tooth pulp is removed and filled with filling material and medication and sealed.
  • Crowns: this is done to a badly damaged tooth, where the pulp is not infected. A custom fitted crown is used to replace enamel of the damaged tooth. Crown can be made of resins, porcelain, gold or combination.
  • Tooth extraction: tooth may have to be extracted, if it cannot be saved by root canal or crown, to prevent infection from spreading to nearby teeth. The gap that forms after extracting the damaged tooth can be filled using dental implant.
  • Fluoride treatment: this is done if cavity formation can be detected at very early stage. Using extra fluoride may restore minor enamel erosion that is seen at the early stage of dental cavity. Extra fluoride may be provided through toothpaste, rinse, gel or foam.

Prevention of dental cavities:

Following preventive measure can be helpful in preventing dental cavities,

  • Visit your dentist regularly, at least once every six months, as recommended by most experts. Ask your dentist how frequently you should visit. Regular visit can help spot cavity and other dental problems early and take preventing measures.
  • Brush and floss after eating every time, preferably with fluoride toothpaste.
  • Rinse your mouth if you cannot brush and floss after every meal. If you have risk of developing cavity, rinse mouth using antibacterial mouth rinse.
  • Many public water supplies add fluorine these days to tape water. Make it a habit of drinking tape water to get adequate fluoride.
  • Eat tooth healthy foods. Eat more fresh fruits and vegetables, which are tooth healthy and avoid foods that get stuck to your teeth.
  • Avoid snacking frequently and sipping drinks frequently.
  • Consider using teeth sealants. Sealants are plastic coating placed over molars and premolars (where cavity formation is common), which protect enamel from acid and bacteria. Sealants can be used by children as well as adults and is recommended by USFDA for all school age children.
  • Consider using fluoride treatment. Consult your dentist for this.
  • If you have a medical condition that increase risk of dental cavities, ask your dentists about using antibacterial mouth rinse that can prevent cavities.

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2 Comments

  • Veronica Marks December 10, 2015 09.38 pm

    I didn’t know that the tooth’s location was a factor in possibly developing cavities. I’ll have to be more mindful of brushing and flossing my back teeth just to be sure I don’t end up with more fillings. My teeth are pretty terrible, and I inevitably have at least one cavity each time I visit the dentist!

    Reply 
  • Jenn December 10, 2015 11.34 pm

    I wish we would have gotten a dental implant for my husband when he got one of his molars extracted. Now the empty socket gets food stuck in it. He’s gotten this habit of making this sucking sound, like he’s cleaning out the socket, even when he doesn’t have food stuck in it. I’m sure it’s more annoying for him to not even have the tooth there… but the sounds he makes now to clean it out are driving me nuts!

    Reply 

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