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Tooth Decay: Causes, Symptoms, and Treatment

Tooth decay, also known as dental caries, is a destructive disease of the tooth hard tissues (enamel and dentin). It is the most common dental disease worldwide. Almost every person suffers from tooth decay at least once in their lives, whether in milk teeth or permanent teeth. There are several factors involved in the development of decay, include bacteria in the mouth, poor oral hygiene, and consumption of sugary foods and drinks. If decay is left untreated, it gets larger and affects deeper layers of the tooth, causing severe pain. Maintaining good oral hygiene is the best protection against tooth decay.

Causes of Tooth Decay

Tooth decay occurs when acids produced by bacteria attack the tooth enamel. Some oral bacteria decompose carbohydrates, turning them into acids. These acids lead to a decrease in oral pH (acidic environment) and remove minerals from the tooth enamel, causing the formation of holes in the enamel. These holes are known as cavities. The development of decay is influenced by several factors:

  • Poor oral hygiene.
  • Carbohydrates, especially sugar.
  • Dental Plaque: it is a sticky layer accumulates on your teeth after eating a lot of sugar and starches. It contains bacteria and food debris. If you didn’t clean your teeth, plaque will harden into tartar (calculus).
  • Low salivary flow (dry mouth).

Saliva plays an important role in the prevention of tooth decay. It counteracts the harmful effect of acids. The saliva neutralizes acids in the mouth and flushes bacteria away from the tooth surface. Low salivary flow is a risk factor for tooth decay.

Symptoms of Tooth Decay

The tooth consists of 3 layers, from outside to inside: the enamel, the dentin, and the dental pulp. There are no nerves in the tooth enamel, so it causes no pain when acids attack it. In the early stage, the acids decalcify the enamel, causing the formation of white spots on the tooth surface. However, the tooth remains intact. With time, the white spots turn brownish and cavities occur. Then, the decay extends to the dentin which is sensitive. If the decay reaches the dentin, it will cause toothache.

In the dentin, the tooth decay can spread much faster until it reaches the dental pulp (tooth nerve). The pulp contains nerves, blood vessels, and connective tissues. If the decay reaches the dental pulp, it will cause inflammation and severe pain. In this stage, the tooth may need root canal treatment.

Diagnosis of Tooth Decay

The dentist will examine the oral cavity, using a mirror and probe. Tooth decay is not always visible as it can occur between teeth. Therefore, the dentist may take an x-ray. The x-ray shows if there is a decay between teeth and how far the tooth decay progressed. Also, it can determine whether the decay is under a tooth filling or at crown margins.

Tooth Decay Treatment

In the early stage, tooth decay can be reversed if the enamel is still intact. The enamel can recover by applying a fluoride (remineralization). However, if the enamel is already damaged and cavities are formed, the dentist will remove caries under local anesthesia. Then, he/she places a toot filling, for example, amalgam or composite. If the decay reaches the pulp, the dentist may perform a root canal treatment. If the decay has already destroyed the tooth so heavily that it can no longer be filled, the dentist may recommend a dental crown to restore the shape and function of the tooth.

Prevention of Tooth Decay

Here are some tips to prevent tooth decay:

  • Brush your teeth regularly: brush your teeth at least twice a day and use a fluoride toothpaste. Don’t brush your teeth immediately after meals (especially if it was acidic), but wait 30 minutes.
  • Floss your teeth regularly: use a dental floss and interdental brushes to remove plaque in the interdental spaces and gum line.
  • Dental sealants: visit your dentist to apply a protective plastic coating on the chewing surfaces of back teeth. This protective coating is known as a dental sealant. It protects the tooth from plaque and acids.
  • Chew sugar-free gums: chewing sugar-free gums or mint stimulates the salivary flow which washes away food debris and counteracts the harmful effect of acids.
  • Limit sugary and acidic drinks: such as soft drinks and energy drinks.
  • Eat healthy foods: avoid sticky foods and foods high in sugar. Eat healthy foods such as fruits and vegetables.
  • Visit your dentist regularly: go to your dentist twice a year for check-ups. The earlier tooth decay is detected, the better the prognosis.


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