Cavities : Prevention and Management

Overview

What are cavities ?

Cavities, dental caries, or teeth decay are holes in the hard surfaces of the teeth. They are indications of irreversible structural damage to the teeth. They begin small, but if ignored, they continue expanding and can lead to pain and infection. The fact that many cavities don’t hurt at first may make it difficult to spot an issue. Children, teenagers, and older adults are particularly prone to cavities; however, everyone with teeth, including infants, can get it. One of the most widespread medical problems that have gone untreated throughout the world.¹Overview | Researched based study from Cdc.gov

Symptoms

Symptoms of cavities

Tooth decay symptoms include:

• Sensitivity of the teeth to cold or hot food or beverages.
• Tooth discoloration – white spot, black spot, or brown stain.
• Teeth that have visible holes or pits.
• A toothache or jaw pain.
• Inflamed or bleeding gums.
• Pus discharge from gums.
• An unpleasant aftertaste.
• Swelling of the face.²Symptoms | Researched based study from Clevelandclinic.org
• Bad breath.
• Fever.

Causes

What are the possible causes of cavities ?

A variety of variables like the following might cause cavities to form:³Causes | Researched based study from Medlineplus.gov

• Oral bacteria – most commonly lactobacillus and streptococcus mutans.
• Dietary sugars – include glucose, sucrose, and fructose.
• pH of the saliva.
• Insufficient dental hygiene.
• Teeth with surface imperfections.

Stages

Stages of tooth decay

Plaque formation

• Food and beverages that are sweet or starchy are turned into acid by bacteria.³Stages | Researched based study from Medlineplus.gov Dental plaque is this gooey material that covers the teeth and is formed with time when bacteria, acid, food, and saliva combine.

Demineralization of enamel

• The acids formed demineralizes teeth by removing minerals from the hard outer enamel.

Decay of the enamel

• More acid deposits on demineralized areas produce tiny holes or voids, resulting in enamel degradation or decay. Until this point, there has been no sensitivity or toothaches.

Decay of the dentin

• Enamel degradation causes acid and bacteria to access the underlying layer of the tooth called the dentin, which is more vulnerable to damage than the enamel. As a result, tooth sensitivity develops.

Pulpal injury

• Bacteria and acids keep flowing through the teeth, passing through the pulp, including blood vessels and nerves. The bacteria cause the pulp to swell and irritate, causing pain.

Abscess or pus buildup

• Even after causing pulpal damage, if a dentist does not treat the infection, it may spread to the nearby tissues and result in pus buildup in the bone or gum tissue around the affected tooth.

Risk

Risk factors

A person’s risk of getting cavities increases by a few factors, such as:

Family history

• The likelihood of having cavities increases if parents or siblings have more than one cavity.⁴Risk | Researched based study from Nlm.nih.gov

Age

• Young children and adolescents frequently have cavities. Additionally, older adults are more susceptible as their teeth weaken and gums recede, making them more vulnerable to root decay. Additionally, they might be under medication that inhibits saliva production.

Fluoride deficiency

• Cavities and tooth damage can result from inadequate fluoride intake.

Poor dental hygiene

• If someone doesn’t brush their teeth frequently, plaque builds, and tooth decay can start and progress over time.

Eating habits

• Snacking between meals and consuming excessive amounts of sweet, sticky, starchy food raises the risk. Additionally, consuming soda or carbonated drinks make the teeth more vulnerable to cavities.

Feeding at night

• When newborns or babies are milk, formula, or juice before bed, these substances stay on the teeth for hours during their sleep and cause tooth rot, known as “baby bottle tooth decay.”

Eating disorders

• In anorexia and bulimia, stomach acid runs over the teeth due to frequent vomiting or purging, eroding the enamel.

The shape and position of the teeth

• Premolars and molars located farther back are more challenging to clean than the front teeth. Additionally, teeth with numerous grooves, pits, and uneven surfaces may gather food particles and result in cavities.

Dry mouth

• Radiotherapy to one’s head or neck, Sjogren’s syndrome, diabetes, and drugs, including anti-depressants and some chemotherapeutic drugs, can all result in dry mouth.⁵Risk | Researched based study from Nidcr.nih.gov

Old dental fillings

• Dental fillings may become brittle, start to degrade, or form jagged edges over time. As a result, plaque may gather more easily, leaving cleaning harder.

Heartburn

• Acid reflux, or gastroesophageal reflux disease (GERD), can result in stomach acid flowing into the mouth, eroding tooth enamel and making them vulnerable to tooth decay.

Prevention

Preventing cavities

Here are some steps to prevent dental cavities

• Use fluoride toothpaste – At least twice daily, and ideally just after each meal, clean the teeth with a soft-bristled toothbrush and fluoride-containing toothpaste.
• Floss your teeth regularly – Use an interdental brush or floss between the teeth at least once every day to keep them clean.⁶Prevention| Researched based study from Nidcr.nih.gov
• Use a mouth rinse – those at a high risk of developing cavities may use fluoride mouthwash as a dentist directs. For some patients, the dentist may prescribe anti-bacterial mouthwash.
• Regular dental visits – receive regular oral checkups and expert teeth cleanings to help discover or avoid issues early.
• Dental sealants – conceal the food-collecting grooves and pits, shielding tooth enamel from acid and plaque. Used mainly in kids of school-going age.⁷Prevention| Researched based study from Nidcr.nih.gov
• Refrain from munching and frequently drinking to protect the teeth from continuous damage.
• Consume tap water – fluoride is a mineral added to most public water sources, which can significantly prevent tooth decay, which one might miss out on if they solely consume fluoride-free bottled water.
• Get fluoride treatments – professional fluoride dental treatments may help prevent dental caries if a person has fluoride deficiency or is at high risk of developing cavities.
• Combination therapies – help lower the incidence of cavities. These include chewing xylitol-based gum, taking prescription fluoride, and using an antimicrobial mouthwash.

Complications

Complications associated with cavities

If left untreated, cavities may result in the following complications:

• Sensitive teeth.
• Tooth pain.
• Jaw ache.
• Tooth loss.
• Broken tooth.
• Issues with chewing and eating.
• Pain that limits daily activities.
• Loss of self-esteem or confidence after a tooth loss.
• After tooth loss, the position of other teeth may alter.
• Weight loss brought on by eating problems.
• Pus or swelling around a tooth.
• Osteomyelitis.
• Ludwig’s angina.⁸Complications| Researched based study from Nlm.nih.gov
• Sepsis.

Diagnosis

Diagnosis of cavities

Cavity diagnosis may involve

• Inquiring about the patient’s teeth sensitivity or pain.
• Check the teeth and mouth.
• Search for white, yellow, or brown spots on the teeth.
• Examine the teeth with a dental probe for pits or soft spots.
• Request dental X-rays to determine the size of cavities.
• Other approaches may include fiberoptic illumination (FOTI) ⁹Diagnosis| Researched based study from Nlm.nih.gov and digital fiberoptic illumination (DIFOTI).

Management

Management of dental cavities

Dentist manages the cavity based on their severity as follows:

Remineralization

• To repair and restore the damaged enamel through a process known as remineralization, specialized fluoride therapies like gels, foams, or varnishes are used. These contain more fluoride than tap water, toothpaste, and mouth rinses.¹⁰Management| Researched based study from Nlm.nih.gov

Dental restorations or fillings

• When a cavity develops in a tooth, a dentist drills out the rotten tissue and fills the gap with gold, silver amalgam, or tooth-colored material.

Root canal treatment

• Reduces the pain caused by advanced tooth decay. An endodontist extracts the tooth’s pulp during root canal therapy, then refills each canal and pulp cavity with a specialized filler. ¹¹Management| Researched based study from Wiley.com

Dental crown

• A custom-fitted covering that replaces the entire natural crown of a tooth if it has weakened by extensive decay. Crowns can comprise resin, porcelain bonded to metal, high-strength porcelain, and other materials.

Removal of the tooth

• Cavities that are too deep and has lost a lot of tooth structure can no longer be repaired and must be extracted and replaced with an implant or dental bridge.

Prognosis

Prognosis

The extent and seriousness of dental caries, the patient’s health, and oral hygiene practices all affect the prognosis for dental caries. Regular dental exams can aid in the early detection of cavities and possibly stop them from progressing into full-blown cavities. If a cavity forms, it is crucial to have it treated by a dental professional to prevent additional harm to the tooth’s structure and the spread of infection to the pulp and other forms, leading to difficulties.