What is tooth decay?
Dental caries is the process of tooth decay. It occurs when bacteria called dental plaque, consume sugar and produce acid that dissolves tooth enamel and dentine. Immediate treatment in the form of restoration (ie filling) is essential.
The first stage of tooth decay is called demineralisation, and it can be reversed at this time.
The 3 different types of caries
Fissure caries occur because plaque becomes trapped in the bottom of the grooves in the top of the tooth where the enamel is very thin and easily penetrated by the plaque acid. This is the most common form of caries in children.
Proximal caries occur when plaque is allowed to accumulate between the teeth. These areas are difficult to reach with a brush and caries occurs here in patients who do not floss.
Root caries occur following bone loss and/or gum recession. Because the roots are not protected by enamel, caries progresses very quickly.
Diagnodent – identifying small holes
The Diagnodent tool has become a part of every check-up as a means of detecting future dental concerns.
Traditionally, when dentists were looking for holes in your teeth they used a dental pick. The picture on the right illustrates how these can fail to identify the true depth of existing cavities in your teeth. This had little to do with the skill of the dentist, and a lot to do with how cavities grow.
Research has shown that because it often can’t reach into where the new cavity begins, we (dentists and hygienists) were missing 76% of the most common cavities. Which means that 3 out of 4 times we were saying that things were fine, when in reality, we had actually missed diagnosing the cavity. By the time it was identified, the cavity had grown sufficiently to require a full dental filling, or further treatment.
In the second picture the Diagnodent, or ‘Laser Cavity Scanner’ uses a high-tech beam of laser light to reach down into areas that the ‘pick’ or ‘explorer’ was simply unable to access.
Diagnosis is instant, accurate, and 100% comfortable. (There is no sensation at all from the laser diagnostic, unlike the pick.) Any reading on the machine above 20 is a hole.
We suggest to patients to get it fixed now rather than waiting for the hole to grow bigger, but the option is always in your hands.
Factors affecting dental caries
Plaque produces acid, dissolving the enamel. Saliva neutralises the plaque acid and contains minerals to repair the tooth structure. However, the bacteria is held together by a sticky film that excludes the saliva. If the plaque is not removed the tooth underneath it is constantly being dissolved and never repaired, leading to caries formation. Regular tooth brushing and flossing are essential to remove the plaque and let the saliva do its job.
Our saliva is the body’s natural defence against caries. We all have an individual saliva flow rate and mineral composition. It takes about two hours of normal flow to remove the plaque acid produced after eating and return the mouth to resting phase. You can speed the process up by chewing a sugar free gum for 5-10 mins. Smoking, stress, some medications, and caffeine and alcohol drinks slow down the saliva production and increase the risk of caries. Minimising these factors and drinking tap water to keep well hydrated will make the most of your saliva.
Plaque bacteria live on carbohydrates, in particular, sugars. By limiting sugary snacks, or eating them with meals, you are reducing the amount of damage the plaque acid can do. The consistency of the food is important too. Sticky lollies or dried fruit, for example, are in your mouth longer as they stick to the tooth surface.
Time could be a factor if you are eating or drinking anything containing sugar more frequently than every 2 hours. Your mouth would never get a chance to rest. The longer the time your teeth are in an acid environment the more likely they are to decay. Caries doesn’t form overnight. Long term bad habits in diet and or cleaning, or deficencies in your saliva, are to blame. If you are unsure if you are putting yourself at risk, talk to your dentist or hygienist.
Your tooth structure or shape can affect caries as some teeth have deeper groves than others, making cleaning more difficult. Fissure sealants can be placed in these grooves to reduce the risk of caries. You can strengthen your enamel by using fluoride toothpaste regularly. Fluoride works to prevent caries because when it is incorporated into the enamel structure is takes a stronger acid to dissolve the tooth. Fluoride supplements, like any medication, need to be in a dose appropriate to your age and decay rate.
Your best protection against dental caries is daily brushing, flossing, using fluoride toothpaste and maintaining regular dental visits. If you think you have a high caries rate, talk to you dentist or hygienist about toohbrushing and flossing techniques and aids, remineralising agents and fluoride, saliva testing, fissure sealants or dietary counselling.
Tooth caries are repaired with fillings. This is known as restorative dentistry.