Dental Decay – What you need to Change to Prevent it
What is Dental decay?
The most common disease in the world is dental decay or dental caries as we dentists call it. It is a sugar dependant disease that rots teeth causing cavities.
The good news is it easily prevented if you follow some pretty simple rules.
Why choose Dr Workman to look after you?
Not only is Dr Workman a very good dentist, he has genuine caring nature and always makes sure you feel truly looked after. This is why he has such a loyal following of, families, young professionals right through to our older generation. With over 12 years experience, he is young, passionate, great at what he does and has an excellent aesthetic eye. If you would like a dental professional you can really trust, who places your health, happiness and comfort as an absolute priority, then you would be hard pushed to look any further. If you have typed ‘dentist near me’ then our state of the art Maroubra dental practice won’t be far away.
How does a cavity form?
Bacteria contained in dental plaque feast on sugar in your diet and produce an acid.
This acid causes your teeth to start breaking down.
The breaking down process or dissolving of your tooth enamel is called ‘demineralisation’ and over time it will dissolve its way through your enamel and into your dentine.
Before it hits dentine… if we catch it early enough… we can instigate preventative changes and potentially remineralise the enamel.
Once into dentine, a layer which isn’t as strong and is directly connected to the nerve of the tooth, decay progresses more quickly.
Our teeth work hard to try and protect ourselves from the invading bacteria by laying down extra layers and sending them off on a wild goose chase around the ADJ or enamel dentine border.
Eventually, if untreated the bacteria will begin to affect the pulp or dental nerve, causing inflammation.
If we catch this process in time, a filling which will remove and restore the infected part of the tooth, will be sufficient.
However, if this progresses as far as the nerve then the treatment will end up being a root canal or should you choose, a tooth extraction.
Eventually if you don’t do anything, an abscess will form and the tooth will become very painful.
Are you connecting the dots?
Small hole= simple treatment
Big hole= more pain= more expense= extensive treatments.
The key therefore is catching things early and this is why regular 6 monthly check-ups are so important.
Signs and Symptoms
Dental caries progress very slowly and doesn’t always present with symptoms.
This means caries often go un-noticed and if left to progress may need far more treatment.
It is important for the dentist to pick it up early as it makes life much easier for everyone.
Dr Jamie will carefully examine your teeth from all sides using a mirror, magnifying loupes and high intensity light to check everything carefully.
He will systematically make his way around your mouth, checking all fillings, teeth, crowns, bridges etc.
He’ll lightly scratch off suspected dark areas to determine if they are staining, or actually a cavity.
In order to determine if you have decay in your back teeth, he will take two small bitewing x-rays which will clearly show if any problems are present.
These x-rays are taken based on your risk for dental decay.
High risk every 6 months to a year.
Low risk about every 2 years.
What are some of the signs and symptoms you may notice yourself:
1. A dark spot– this could be staining or it could be a cavity.
2. Sensitivity – there are various causes for this of which a cavity is one.
3. If floss tears or gets stuck– could indicate decay between your teeth.
4. A rough tooth – when sufficient decay has occurred, part of the tooth may collapse and may be ‘discovered’ by your tongue.
5. Pain– this could range from a mild sensitivity through to a sharp pain that lasts a bit longer or a raging toothache that disturbs your sleep and goes up to your eye.
Small occasional pain is likely to indicate less damage to the nerve of the tooth- more severe pain, longer lasting pain would suggest that the tooth nerve may be affected beyond repair. [See Jamiethedentist.com for an in depth discussion of these symptoms: reversible pulpitis and irreversible pulpitis].
What’s your risk for dental decay?
It won’t matter whether Dr Jamie treats all your cavities, or not… if you don’t change the environment in your mouth and create good mouth habits…you will simply get fresh cavities in other areas or around existing fillings or crowns.
Let’s look at what would make you high risk (more likely to get new decay and cavities):
1. Medical History – Medically or physically compromised or with learning disabilities.
2. Age – Young vulnerable teeth or older patients with lots of work done, partial dentures, poor saliva flow, cognitive or physical problems that reduce ability to keep teeth clean.
3. Teeth– awkwardly placed teeth, misaligned teeth, lots of recession, unfavourable points and fissures – anything in fact, that makes cleaning more difficult. Also genetically weak teeth or poorly formed teeth.
4. Dental work– the more work you have done the higher the risk. Extractions and missing teeth, many fillings, root canals and crowns all suggest a high risk.
5. New decay– around existing restorations or in new places, particularly in areas that would be regarded as easy to keep clean.
6. Saliva– if you have a dry mouth with little or no flow or poor quality saliva, you essentially lack natural protection to buffer acids in your mouth.
7. Dental recalls– irregular or infrequent visits or if you go only when you are in pain and rarely for check ups and cleans.
8. Dental appliances– if you wear anything that creates difficulty cleaning such as braces or partial dentures.
9. Diet– poor diet: high in sugar, particularly refined sugar, frequent snacking and frequent sugary intake of food and drink.
10. Oral hygiene– poor tooth brushing technique, no regular cleaning between the teeth with little brushes or floss.
11. Fluoride– little or no fluoride in the water or using non- fluoride toothpaste.
Even with some of the symptoms above, good hygiene and regular 6 month check ups can significantly reduces your risk- by identifying problems and early, treatment you can get your game up to scratch.
What causes dental caries?
There are a number of ingredients that are required in order to get a cavity.
You must have:
1. Bacteria (found in plaque)
2. Sugar (food for the bacteria)
3. Not enough protection (fluoride/saliva)
4. Time– cavities do not simply appear over night! They occur over months and years – your mouth is constantly trying to protect itself against the dissolving acids produced by the bacteria – so, create the right environment to enable it to do its job!
How do you Prevent Dental Caries?
Since we cannot eliminate the bacteria or the sugar 100%, we need to tackle prevention from all angles.
Thus in order to prevent a cavity we can take the three following steps:
1. Decrease the amount of bacteria/plaque– we do this with effective cleaning… that is, you guessed it… tooth brushing, flossing and using interdental brushes for the larger gaps between the teeth.
2. Decrease the amount and frequency of your sugar intake– the major factor, as you have heard, is the frequency of sugar consumption, so, spending good periods of time where you drink nothing but water is key to success.
Also avoid sugar near bed- time… as you know our saliva rate falls when we sleep and we lose our mouth’s natural protection so more damage is done.
3. Increase protection– If you aren’t using a fluoride toothpaste… you really should be…
If you are in the higher risk category, this should be a high fluoride toothpaste!
The most common one is Neutrafluor 5000 by Colgate.
You can also increase your protection by chewing sugar free gum after eating and having a glass of water to rinse away food and drink from your teeth.
If you have a dry mouth (xerostomia) then it is extra important to use products aimed at stimulating this (such as BIOTENE mouthwash or sugar free lozengers) in addition to the advice above.
We can also place fissure sealants to protect immature enamel in children and stop plaque and food pushing into the biting surfaces of the teeth where they can be more difficult to clean.
|Treatments||White fillings | Inlays and onlays | Crowns | Fluoride | Oral hygiene|
|Cost||See treatment page for details|
How do you treat dental decay?
Early enamel caries can sometimes be reversed by good hygiene and the use of fluoride.
Decay that has progressed into dentine will require a filling for the most part. However, if a significant portion of the tooth has been lost an inlay, onlay or dental crown may be required to protect the remaining tooth long term.
If the decay has reached the nerve- affected it beyond repair, or caused an abscess, then a root canal or extraction will be needed.
If it has progressed further, say, so far through the tooth and under the gum that we would struggle to restore it, there may be no option but to take it out.
- Dr Jamie’s education site; Jamiethedentist.com where you can hear him speak and read about TOPIC in a lot more detail.
- These other excellent resources: