According to Dr. Margaret
Culotta-Norton, a dentist in Washington, D.C.,
and former president of the D.C. Dental Society,
cavities are the most chronic childhood disease
in the United States.
Some groups have a higher risk for cavities,
Culotta-Norton said, including:
Lower-income families (children and adults).
Senior citizens of all socio-economic status.
People living in areas where the drinking water in not fluoridated.
People with diseases and/or medication use that causes a decrease in salivary flow.
People undergoing radiation therapy.
People with diabetes.
Tobacco users — both smoking and chewing.
Alcohol and drug users.
People who consume large amounts of carbonated and sugar drinks.
Causes
Cavities are the result of two primary factors: bacteria in the mouth and a high-sugar and starch diet.
It is natural to have bacteria in the mouth but it becomes problematic in the case of poor oral hygiene.
According to the National Institutes of Health, the mouth's normal bacteria combine with food pieces
and saliva to form plaque. Plaque is a sticky, invisible substance that accumulates quickly. Foods rich
in sugar or starch make plaque stickier. If plaque stays on the teeth for more than a few days, it gets
harder and becomes a substance called tartar.
Cavities form when bacteria in plaque and tartar convert sugar into acid. According to Culotta-
Norton, Streptococcus mutans and Streptococcus sobrinus are bacteria especially likely to combine
with fermentable carbohydrates like sucrose, fructose and glucose and produce acid. “The acid
demineralizes the hard structure of the tooth, which over time creates a soft spot, or hole in the tooth
called a cavity,” Culotta-Norton said.
The destruction doesn't stop there, reports the Mayo Clinic . After the enamel is worn away, the acid
reaches the next layer of the teeth. This layer, called dentin, is softer and susceptible to acid. The
bacteria and acid continue to work their way through the tooth, into the pulp, creating a bigger and
bigger hole.
According to the NIH, cavities are most commonly found where plaque is highly prevalent, such as on
the molars, between teeth, near the gum line, and at the edges of fillings.
Symptoms
There are often no symptoms of cavities, which is why Culotta-Norton stressed the importance of
visiting a dentist and having “radiographs taken periodically so that cavities can be diagnosed and
treated early before they get large enough to cause symptoms.” She reported that the most common
early symptoms of cavities are a "chalky white or discolored spot on a tooth" and "sensitivity to
cold."
"As the cavity progresses, the decay gets near the nerve (pulp) and can cause pain, which gets
progressively worse especially with exposure to heat, cold, sweet foods or drinks," she continued. “If
the decay gets large enough, part of the tooth may fracture off, leaving a large visible hole, and the
tooth may be sensitive to biting pressure. Bad breath and or a bad taste in the mouth are also
symptoms."
Cavities on the front teeth are the easiest to see and will look like a brown or black spot. Cavities in
other parts of the mouth are often not visible without an X-ray.
Prevention
Just as there are two factors that cause cavities, there are two main factors to preventing them: oral
hygiene and diet change.
According to the NIH, good oral hygiene includes brushing your teeth at least twice a day and flossing
at least once, having a professional teeth-cleaning every six months, and having X-rays and a dental
exam annually to detect cavity development.
Reducing the amount of sugar — especially sugary drinks and juices — can help prevent cavities. You
may consider brushing your teeth or rinsing your mouth after eating sticky foods. The NIH also
suggests incorporating sugary, chewy foods such as dried fruit and candy into a meal rather than
eating them as a snack. Minimizing snacking, avoiding constant sipping of sugary drinks, and not
sucking on candy or mints can all help, too, because they produce a constant supply of acid in the
mouth.
Dentists suggests looking into dental sealants. Dental sealants may help prevent cavities and
are most frequently applied to the teeth of children after their molars come in. Sealants are thin,
plastic-like coatings on the surface of the molars that prevent the accumulation of plaque.
Fluoride is another cavity-prevention strategy encouraged by the Dentists. It can be consumed in
drinking water or as a supplement. Topical fluoride is frequently applied as part of routine dentist
visits. Your dentist may also recommend a fluoride toothpaste or mouthwash.
Treatment
Treatments for cavities include fillings, crowns and root canals. "If the lesion is very small and just
beginning, it can be treated with fluoride paste and varnish to help stop the progression of the
demineralization," Culotta-Norton said. If the cavity is formed, however, there is only one option: to
remove the decay and put a filling in its place.
According to Culotta-Norton, “If the decay is removed completely and a good filling is placed, the
cavity will be gone for a long time, sometimes forever." Though the cavity itself may not return, most
people do need to have their fillings replaced several times over a lifetime. "Acids in the oral cavity,
wear and poor oral hygiene can cause the fillings to break down, causing micro leakage and
subsequent recurrent decay to form," she said.
Fillings
Dentists do fillings by removing the decayed tooth material with a drill and replacing it with silver
alloy, gold, porcelain or composite resin. "Today, most fillings are composites or tooth-colored.
Sometime a silver filling (amalgam) has to be used," Culotta-Norton said. According to the NIH, many
dentists consider silver alloy and gold to be stronger than porcelain or resin, but because these
materials are quite visible, dentists usually only use them on back teeth. Front-tooth cavities usually
are filled with porcelain or composite resin, which more closely matches the tooth's natural
appearance.
Crowns or caps
According to Culotta-Norton, "If the cavity is very large it may be restored with a crown." These are
used if tooth decay is more extensive, the tooth is weakened and there is little remaining tooth
structure. The dentist removes the decayed or weakened part of the tooth and fits a crown over the
remainder of the tooth. Crowns are usually made of gold, porcelain, or porcelain attached to metal,
according to the NIH.
Root canal
The NIH reports that root canals are done if decay or injury has killed the nerve in the tooth. The
decayed area and the center of the tooth, including the pulp, are removed. The root is filled with a
sealing material, the tooth is filled, and a crown is usually applied.
A new treatment?
Culotta-Norton said that a new treatment for cavities may be on the horizon. A process called
electrically accelerated and enhanced remineralization (EAER) is being developed in London. She
explained that this process "accelerates the natural movement of calcium and phosphorous minerals
into the cavity to repair it. This process would eliminate drills and injections. It emits tiny electrical
currents into the tooth to push the minerals into the repair site. It encourages the tooth to repair
itself." According to The Guardian , this new process could be available by 2017.
Tooth abscesses
A tooth abscess is a complication of tooth decay. Bacteria get into the pulp of the tooth through the
cavity and cause infection. Pus then collects in the center of the tooth, causing an
abscess. Abscesses can also be caused by trauma to the tooth, such as chipping or breaking,
according to the NIH.
The NIH warns that tooth abscesses can be a serious problem, leading to complications such as tooth
loss, blood infection and infection in soft tissue, jaw bone and other areas. Untreated tooth abscesses
can cause life-threatening complications.
According to the NIH, symptoms of tooth abscesses include:
Severe toothache (the most common symptom).
Bitter taste in the mouth.
Painful chewing.
Sensitivity of the teeth to hot or cold.
Swelling of the gum over the infected tooth (it may look like a pimple).
Bad breath.
General discomfort.
Fever.
Swollen neck glands.
Swollen area of the upper or lower jaw (this is a very serious symptom).
If your toothache stops, it is still important to see a dentist. Sometimes toothaches stop if the pulp
dies, but the infection may still spread.
Treatment for abscesses
According to the Mayo Clinic , your dentist may prescribe antibiotics to kill the infection, warm salt-
water rinses to soothe the area, and over-the-counter pain relievers.
Root canals can sometimes save the tooth, but if the infection is severe the tooth may need to be
removed. Surgery may be required to drain the abscess.
This article is for informational purposes only, and is not meant to offer medical advice.
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