Dental Caries (Cavities
? What Is It
Dental caries is the medical term for tooth decay or cavities. It is
caused by acid erosion of tooth enamel. Many different types of bacteria
normally live in the human mouth. They accumulate (along with saliva,
food particles and other natural substances) on the surface of the teeth
in a sticky film called plaque. Plaque forms especially easily in
cracks, pits or fissures in the back teeth; between teeth; around dental
fillings or bridgework; and near the gum line. Some of the plaque
bacteria convert sugar and carbohydrates (starches) in the foods we eat
into acids. These acids dissolve minerals in the surface of the tooth,
forming microscopic pits or erosions that get larger over time.
The damage can occur anywhere the tooth is exposed to plaque and acid,
including the hard outer enamel on the tooth crown or the unprotected
root of the tooth that has been exposed by gum recession. Caries can penetrate the
protective enamel down to the softer, vulnerable dentin (main body of
the tooth) and continue through to the soft tooth pulp and the sensitive
nerve fibers within it. No one really knows what causes the pain
associated with cavities, but theories include inflammation caused by
bacteria, exposure of the root surface and an imbalance of fluid levels
in the tubules inside the dentin.
Symptoms
Early caries may not have any symptoms. Later, when the decay has eaten
through the enamel, the teeth may be sensitive to sweet foods or to hot
and cold temperatures.
Diagnosis
A dentist will look for caries at each office visit,
regardless of whether it is a routine visit or an appointment made by
the patient because of pain. The dentist will examine the teeth visually
and will probe the teeth with an instrument called an explorer to
determine if there are pits or areas of damage. Periodically, or if the
dentist suspects hidden caries, X-rays will be taken by looking at the
teeth.
Expected Duration
How long caries lasts is determined by the stage at which it is found.
White spots, indicating early caries that has not yet eroded through the
enamel, may be reversed if acid damage is stopped and the tooth is
given a chance to repair the damage naturally. Caries that has destroyed
enamel cannot be reversed. Most caries will continue to worsen and
deepen and with time, the tooth may decay down to the root. The amount
of time the erosion takes will vary from person to person. Caries can
erode to a painful level within months or it can take years to reach
that stage.
Prevention
Cavities can be prevented by reducing the amount of plaque and bacteria in the mouth. The best way to do this is by daily brushing and flossing and
professional dental cleanings twice a year. You also can reduce the
amount of acid in your mouth by eating sugary or starchy foods less
frequently during the day. Your mouth will remain acidic for several
hours after eating, so snacking throughout the day is more likely to
lead to caries than avoiding between-meal snacks. Chewing gum that
contains xylitol helps to counteract the acidity that occurs after
eating.
Teeth can be strengthened by fluoride.
A dentist can evaluate your risk of caries and then suggest appropriate
fluoride treatments. In children, new molars can be protected by having
the dentist apply a sealant as soon as the teeth come fully into the
mouth.
Treatment
The standard treatment for caries is to fill the tooth.
After the dentist removes the decayed material in the cavity (usually
following the use of anesthesia to block the pain), the cavity is
filled. Fillings usually
are made of a dental amalgam, which is a silver-gray material made from
silver alloyed with copper or other metals in order to improve
durability, or of a composite resin, which is tooth-colored for a better
appearance. Amalgams are used primarily in molars and premolars. Resins
are used primarily in the front teeth, although it is possible to use
them in all teeth. Gold inlay may be used if greater strength is needed,
but this is more expensive.
If a cavity is large with extensive erosion, the remaining tooth may not
be able to support the amount of filling material that would be needed
to repair it. In this case, the dentist will remove the decay, fill the
cavity, and cover the tooth with an artificial crown.
Sometimes the crown of the tooth remains relatively intact, and there is
more damage in the interior of the tooth. In these cases, the dentist
may refer you to a dental specialist called an an endodontist for root canal treatment.
In this procedure, the endodontist removes the tooth's pulp and
replaces it with an inert material. In most cases, the tooth's natural
crown will need to be replaced with an artificial crown.
When To Call A Professional
The early stages of decay are usually painless. Only regular
professional examinations and X-rays can detect early trouble. If you
develop sensitivity to chewing or to hot, cold or sweet foods or
beverages, contact your dentist.
Prognosis
If a cavity goes undiagnosed, it likely will cause the tooth to erode
significantly. Eventually, the tooth may be destroyed by uncontrolled
decay.
Having caries increases your risk of more caries for several reasons:
- The same oral care and dietary habits that contributed to the plaque and acids that caused the initial cavity may cause more decay
- Bacteria tend to adhere to fillings and other restorations more than to smooth teeth, so those areas will be more susceptible to new caries
- Cracks or gaps in the fillings may allow bacteria and food to enter the tooth, leading to decay from beneath the filling
Reference : Badr abdulmeslh
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