Dental Cavities

Introduction

Cavities are holes or openings present on the hard surface of the teeth. These are permanent damage to the teeth and are primarily irreversible conditions. They are also known as dental caries, dental decay or tooth decay. They can occur for many reasons. But basically due to excess sugar intake, improper brushing, bacteria in the mouth, improper cleaning of the teeth, and frequent eating of snacks.

What Are Dental Caries?

Dental caries is defined as a bacterial disease of the calcified tissues of teeth and is characterized by demineralization of the inorganic and destruction of the organic substance of the tooth.

Who Is Affected by Dental Caries?

Dental caries is seen in all age groups, including infants, children, adults, and older adults. If the dental caries is not treated at the correct time, the decay will progress deeply and result in toothache, tooth infection, tooth structure loss, or sometimes complete tooth loss. Proper brushing and flossing can help prevent the formation of dental caries.

What Causes Dental Cavities?

The causes for dental caries are as follows:

1. Plaque Formation - The excess intake of sugar, starch, candies, and other sugary foods and not brushing properly may lead to plaque formation. Plaque is a filmy coat or film-like covering around the surface of the teeth. It is formed due to excess intake of sugar and improper cleaning. Because bacteria develops in the filmy coat around the teeth, plaque also thickens and spreads, either on the gum line or deeper to the gum line to form calculus. It creates a shield around the teeth and makes them difficult to remove.

2. Plaque Progression - The formed plaque progresses into the enamel, the hardest substance of the teeth. It erodes the enamel or forms a hole removing the enamel layer of the tooth's surface. It gradually moves to the dentin surface, deeper to the enamel. The dentin is softer than enamel and gets easily destroyed by the plaque. The dentin layer of the teeth has a tubular structure called dentinal tubules, which connect the dentin to deeper areas of the tooth, the dental pulp. In this way, the plaque progresses. The plaque has acid contents, and bacteria in it causes erosion of the tooth surface. This erosion causes a small hole in the tooth surface. When it progresses to dentin, it develops sensitivity.

3. Plaque Causing Destruction - The plaque then progresses deep into pulp, the innermost structure of the teeth. The pulp has blood vessels and nerve supply. The plaque involving the pulp causes pulpal swelling and irritation. It is primarily due to the bacteria in the plaque. As the pulp has no space to expand, during pulpal swelling caused by plaque, it will cause further infection in the teeth, around the root, and the bone. When the infection spreads to the pulp, it will cause some pain.

What Are the Risk Factors of Dental Caries?

The risk factors for dental caries are as follows:

1. Tooth Location - The teeth located posteriorly have an increased risk of developing dental caries because of the location and structure. The posterior teeth have grooves, cusps, fissures, and pits. This will lead to the deposition of sugary foods and cavity formation.

2. Improper Brushing - Improper brushing results in incomplete removal of sugary foods leading to food deposition and dental caries.

3. Eating Disorder - Certain eating disorders like anorexia and bulimia can cause erosion that can develop into dental caries. Vomiting causes the stomach acid to enter the oral cavity, resulting in erosion, which further develops into caries.

4. Dry Mouth - Saliva protects teeth from the acid produced by bacteria, thereby preventing the formation of plaque and food debris. A lack of saliva causes dry mouth, which may become a risk factor for cavity formation. The dry mouth may be caused by some medications, radiation therapy to the head and neck, and certain medical conditions.

5. Gastroesophageal Reflux Disease - Gastroesophageal reflux disease is a condition that causes reflux of stomach acid into the oral cavity causing the tooth to be exposed to the stomach acid. This further causes the teeth to lose the enamel covering. The bacteria directly attacks the dentin and causes dental caries.

6. Age-Related Factor - Dental caries is commonly seen in younger and older people. In young children, the increased intake of sugar causes the dental cavity, whereas, in older people, the dental cavity is caused by the wearing of the teeth' enamel surface due to attrition and aging, receding of the gums. Specific medications taken by older people also cause dry mouth, thus leading to dental caries.

7. Food and Diet - Certain foods that tend to stick to the tooth surface for an extended period, such as hard candies, honey, dry cereals, mint, sugar, chocolates, milk, ice cream, cake, soda, cookies, dry fruits, and chips cause dental caries. The frequency of sticky food intake also increases the risk of dental caries.

8. Bedtime Sugary Beverages - The infants and toddlers may get nursing bottle caries. Drinking milk, juice, or other sugar-containing liquids at night might cause the beverages to stick to the tooth during sleep, which becomes a risk factor for dental cavity formation.

9. Less Fluoride - Fluoride is a naturally occurring mineral that helps prevent dental caries. It is a common ingredient in toothpaste and mouthwashes. The fluoride is added to the public drinking water supplies. Certain places with less fluoride may lead to dental caries.

10. Old Dental Restoration - The old dental restoration will wear out, weaken, and break at the edges, creating a space for the plaque to accumulate and produce dental caries.

What Are the Symptoms of Dental Caries?

The symptoms of dental caries depend on the location and period of cavity formation. Dental caries at the initial stages will not show any signs, but later when it progresses, it will show different symptoms such as,

• Brown or black stains on the surface of the teeth.

• Black holes or cavities.

• Pits in the tooth surface.

• Sensitivity.

• Acute, sharp pain can be present continuously or while chewing or drinking cold or hot food.

How Are Dental Caries Diagnosed?

The following methods can help diagnose dental caries,

• Clinical examination of teeth.

• Pits or cavity in the teeth surface.

• Intraoral periapical radiographs.

• Orthopantomogram.

• Percussion using dental probe into the dental cavity.

• Probing using a dental probe into the dental cavity.

What Is the Treatment for Dental Caries?

The treatment methods of dental caries vary according to the depth and location of dental caries. Regular dental checkups help in identifying dental caries at the earliest stage. So the treatment procedure will be conservative, and no extensive treatment is needed. Dental caries can be prevented or reversed before it causes pain. But once dental caries cause pain, extensive treatment procedures have to be followed.

1. Fluoride Restoration - Fluoride treatment is available in gel, liquid mouthwash, foam, and varnish. The fluoride is added to dental caries at the initial stage. This fluoride can stop the further development of dental caries and also remove dental caries. The fluoride restores the tooth enamel and helps in reversing dental caries if it's at the initial stages only.

2. Dental Restoration - Dental caries can be treated with dental restoration or filling after removing dental caries or cleaning dental caries. Dental glass ionomer cement, composite, amalgam, and porcelain materials are used for restoration purposes.

3. Root Canal Treatment and Crowns - If dental caries reach the pulp, then the restoration will not be a successful treatment plan for dental caries. In this case, a root canal treatment has to be done. It involves removing dental caries, cleaning the infection, providing intracanal medicaments, and replacing it with gutta-percha resin. The permanent restoration can be placed on the tooth after completing root canal treatment. Crowns can also be used after root canal treatment to maintain esthetics and prevent tooth breakage after root canal treatment. Crowns are made of ceramic or porcelain, metal, porcelain fused metal, gold, resin.

4. Extraction of Teeth - If dental caries go deeper and the tooth structure is broken, it is a grossly decayed tooth. These teeth cannot be restored using restoration material. The root canal treatment also will not be successful. These teeth have to be extracted. After extraction and complete healing, the teeth have to be replaced using a dental bridge or implant to prevent a shift of the neighboring teeth.

What Are the Complications of Dental Caries?

Dental caries will have specific and long-lasting complications and effects, which are usually not well noted and taken seriously.

• Tooth sensitivity.

• Toothache.

• Swelling.

• Pus discharge.

• An abscess around the teeth.

• Tooth loss.

• Difficulty in chewing due to pain.

• Difficulties in chewing due to tooth loss after dental caries.

• Malocclusions after removing grossly decayed primary teeth.

• Teeth may get broken.

• Damage to the tongue and buccal mucosa caused by sharp cusp tips.

• Periodontal problems, including pocket formation in the gingiva.

• Cellulitis (a potentially serious bacterial skin infection).

• Osteomyelitis (infection in a bone).

What Are the Preventive Methods of Dental Caries?

1. Fluoridated Water - People need fluoride minerals, so it has been added to public water supplies. The intake of fluoridated water prevents dental caries.

2. Fluoridated Toothpaste - Fluoridated toothpaste, that is, the toothpaste that has fluoride as an ingredient, can be used. This also prevents dental caries.

3. Fluoridated Mouthwash - Mouthwash or mouth rinse that has fluoride and other chlorhexidine products can also be used to prevent dental caries.

4. Proper Brushing - One should brush your teeth twice a day, using a toothbrush and toothpaste after meals. This helps remove the food deposits and other sticky foods and plaque from the tooth surface. One can also use interdental brushes to remove debris between the teeth.

5. Dental Floss - Dental floss is a thread-like structure that helps remove debris and food entrapment between the tooth surface.

6. Proper Diet and Nutrition - Proper healthy diet, including fruits and vegetables, should be taken. Avoid sticky foods and if sticky foods are taken, brush the teeth to prevent dental caries. Certain foods are needed for healthy teeth. Taking calcium-rich foods and fruits and vegetables will increase the salivary flow and prevent dental caries. Avoid snacks and other beverages which will have an acid attack on the enamel surface of the teeth and cause dental caries.

7. Fluoride Gel - The fluoride gel is applied to children aged 5, 9, and 13 years, using customized trays to prevent dental caries. The fluoride gel is applied in the tray, and then the tray is inserted into the oral cavity and placed for three to five minutes; then, the patient is asked not to wash or rinse the mouth for half an hour at least. This helps in the prevention of dental caries.

8. Regular Dental Check-Up and Cleaning - Regular dental check-ups and cleaning help remove plaque and and identify and treat dental caries (if any) in the early stages.

9. Pit and Fissure Sealant - Pit and fissure sealant are restorative materials placed along the pits in the posterior teeth of all age groups, including children and adults. It controls the acid attack on teeth and plaque formation, thus preventing the occurrence of dental caries.

10. Xylitol Gum - Antibacterial mouth rinse can also prevent dental caries. It is usually given when the medical condition causes dry mouth and causes dental caries. The xylitol gum-chewing along with antibacterial mouthwash also helps in reducing dental caries.

When to See a Dentist for Dental Caries?

Most people would not notice the black stain or pit on the tooth surface and get to know of it only when they get a toothache. But when toothache starts, dental caries would have gone to the deep layers of the tooth structure. So dental check-up every six months once is needed to identify dental caries and prevent its further progression.

Conclusion:

Deposition of sugary foods and beverages on the tooth surface, which are not adequately removed by brushing, results in dental caries. Treating the dental carious lesion at an early stage not only saves the tooth structure but also prevents exposure to pain and reduces treatment costs.