Dental Treatment

Cavities and Tooth Decay

How do you avoid tooth decay and cavities? A popular myth is that you aren't brushing or flossing well enough to keep the bacteria and acid from attacking you teeth. The topic of tooth decay is quite a bit more involved than that!

The darkened area shows the surfaces of the teeth that are cleaned effectively using a toothbrush.

Only three locations on each tooth that are affected by tooth decay

• The smooth surface - we can effectively deter tooth decay by proper brushing. Most individuals do this very well, and avoid cavities on these surfaces.
• The pits and fissures - these combine to create long grooves along the chewing surface of each tooth. Pits attract very small bacteria and food debris. Brushing and using fluoride toothpaste or mouth wash is the most effective way to clean them but for some individuals, there may be too many deep grooves. Your dentist may recommend sealants to protect these pits and fissures.
• The spots in-between the teeth (interproximal area) - these are completely out of reach of a tooth brush and toothpaste, but can be managed through flossing.

A natural defense mechanism against decay

The bacteria that live in plaque metabolize the food we consume, and transform it into acid. This acid attacks the tooth enamel and eventually causes tooth decay. We have minerals in our saliva that repair these decayed areas. It is only when the repairing is done more slowly than the acid attacking that we actually form a cavity.

So, how can you prevent cavities?

1. Brush after every meal or snack - keeping those smooth surfaces clean helps halt the acid attack
2. Floss after every meal or snack - this helps keep the interproximal areas clean
3. Use a fluoride toothpaste or mouthwash - this helps re-fortify and strengthen the areas that the acid has attacked
4. Stimulate your saliva flow - this will bring those minerals to the damaged areas and help dilute the acid being formed
5. The most important thing that you can do to avoid decay is to limit the frequency of your snacking and meal times. It is not possible to fight every acid attack against your teeth; however you can give your salivary minerals time to repair the acid damage. If you limit your snacking and practice good brushing and flossing habits, you can overcome and defeat dental decay.

A common myth

There is a myth that certain kinds of foods cause dental cavities. The fact is that there are certain foods that produce more acid; these are foods high in sugars and carbohydrates, and sticky foods.

If you wear braces

Individuals with braces are more susceptible to tooth decay. Food is easily trapped around the brackets and wiring, making brushing and flossing essential. Many individuals do not experience full-fledged decay; however pre-decay areas are very common. These areas appear as chalky white spots (decalcification) which are permanent and very unattractive, especially when the braces are removed.

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Dental Cavities

Dental cavities, also called dental caries, tooth decay, or rotten teeth, are all conditions in which tooth structure has been destroyed. Dental cavities are widespread throughout the world, causing pain, infection, and in extreme cases death. In America they are the most common childhood affliction, as well as the leading cause of tooth loss.

Types of dental caries

The two categories of dental caries are described and classified by their location on a tooth:

• Those found on smooth tooth surface
• Those located in the pits and fissures

General description of caries

Caries are described and named based solely on their location

• Facial/buccal caries - nearest to the cheek or lips
• Lingual caries - closest to the tongue
• Occlusal or incisal caries - on the biting or chewing surface of the teeth
• Mesial and distal caries - in-between the teeth

Pit and fissure caries

Pit and fissures are on the chewing or biting surface of the teeth. These are the areas where the enamel folds to make crevices and valleys, and are particularly susceptible to caries. Pits and fissures are difficult to clean due to their irregular shape and sometimes very deep valleys or fissures. These areas represent almost 90% of all cavities in the mouth.

Smooth-surface caries – Two types of smooth surface caries exist; proximal and root caries.

Proximal caries – form on surfaces between teeth, and are the most difficult to detect and diagnose. They usually form directly between two teeth, making detection using an instrument impossible. Radiographs are the only effective means by which these areas can be diagnosed.

Root caries – form on the teeth's root surfaces and are the third most common type of cavity. They usually appear in areas where the gum tissue has receded and has exposed root surface to bacteria and acid attacks. In a healthy mouth, the gum tissue protects and covers the root surfaces.

Other types of caries

Other caries are identified by certain stages or oral conditions of our mouths, rather than by particular locations.

• Baby Bottle Tooth Decay is found in a young child's mouth and results from excessive bottled sugary liquids
• Rampant decay is usually found in individuals with drug use, excessive sugar consumption, poor oral homecare, and/or dry mouth
• Incipient decay describes teeth that have not in the past been decayed
• Recurrent decay describes teeth that have recurring cavities

Signs and symptoms

The very first indication of cavity formation is a chalky white area (decalcification). This occurs when acids attacks the tooth enamel and remove minerals from the surface. This area can be remineralized using fluoride toothpaste or mouthwash if the decay has not yet become a hole or soft in texture. This decay will continue until the area becomes a brown spot, followed by a hole or softened area. As it continues, the tooth will start to hurt, exacerbated by cold, hot, or sweet foods. This decay can cause bad breath and a foul taste in one's mouth. If decay is allowed to progress, it can migrate into the gum tissue which may become a life-threatening condition.

Diagnosis of caries

Diagnosis of caries begins with a dental exam. This includes a dental light, explorer, and a dentist. Visual and tactile inspection is done to check all tooth surfaces for cavitation areas or "sticky" spots. Once these areas are detected a restoration is required to return the tooth to a healthy state. All areas that are not visually accessible are examined via radiographs.

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Causes of dental caries

There is no one cause for caries, but rather three key elements for their formation:

• Carie-causing bacteria
• Foods high in sugar
• Time

1. Bacteria
In every mouth there are hundreds of different bacteria. However there are only a few types (Streptococcus Mutans and Lactobacilli) that are believed to cause cavities. Bacteria clump together to form a sticky substance (plaque). Plaque adheres to rough or smooth areas that are protected from saliva. Braces, dentures, crowns, or fillings serve as great plaque and bacteria traps.

2. Fermentable Carbohydrates - Foods High in Sugars
Bacteria consume the foods that we eat and create acid as a byproduct. These acids attack the tooth, eventually causing decay. Our bodies have a natural defense system against this acid, which is our saliva. It has minerals that remineralize the areas that have been attacked by acids. This keeps our demineralization and remineralizion process in a constant balance. Excessive intake of foods high in sugars or carbohydrates creates an imbalance in this delicate system.

3. Time
The frequency of acid exposure to the teeth directly influences our caries rate. Each time that we consume food, the bacteria produce acid, which causes a drop in pH in our mouth. This drop in pH allows the demineralization process to continue for the next 2 hours. The saliva eventually neutralizes the pH and returns things back to normal; allowing the remineralization process to repair the acid damage. If acid is constantly being produced, the teeth have no chance to remineralize.

Treatment

A tooth destroyed by acid can never be returned to a completely normal state. Small caries can be remineralized using fluoride. Large caries are restored using a plastic material (composite), or a metal or porcelain crown. At the very worst, the tooth must be extracted. The goal of restoration is to preserve the tooth, and prevent further tooth destruction.

Prevention

The best way to prevent tooth decay is to practice proper brushing and flossing habits. The purpose of brushing and flossing is to remove bacteria, plaque, and food debris, so as to prevent acid production. Daily use of fluoride toothpaste and rinse can assist the remineralization process. Removing all bacteria and plaque is not possible, because the bacteria below the gum line are only accessible to the dental hygienist. This makes regular dental visits very important for caries prevention. When used properly these methods will deter most, if not all, cavity formation.

Dietary Modification

The best ways to avoid dental decay are:

• To limit the frequency of meals and snacks
• To limit foods high in sugar
• To eat foods such as cheese and milk which contain xylitol (a low-calorie sugar alternative which does not facilitate caries formation)
• To minimize snacking throughout the day, giving time to the saliva to remineralize your teeth

Eating foods that stimulate saliva helps to reduce decay by allowing the mouth to wash away acids and food debris.

Other preventive measures

The placement of sealants and the application of fluoride are effective carie-prevention methods.

• Dental sealants are usually placed on molar teeth during the ages of six to eight. They are a plastic material placed on the biting surface of the back teeth to prevent acid from attacking the pits and fissures.
• Fluoride is used either topically or systemically to strengthen tooth enamel. Many toothpastes, mouthwashes, and foams contain fluoride and can be used on a daily basis to strengthen your teeth. Many cities have added fluoride to their water supply, so have your water tested before using fluoride mouthwash, toothpaste, or foams.

Meth mouth

Meth mouth is a condition commonly observed in individuals who abuse the drug methamphetamine. One theory about the meth mouth condition is that the body is attempting to maintain blood calcium levels by drawing calcium from the bones and teeth. This in turn keeps the accelerated nervous system supplied and functioning.

Meth mouth symptoms

• Dry Mouth - Meth decreases saliva production. Many users consume excessive amounts of sugared beverages to pacify their dry mouth symptoms.
• Cracked or Fractured Teeth - Many Meth users experience high levels of anxiety, and clench or grind their teeth as a result.
• Periodontal Disease - Frequent use of Meth constricts blood supply, which deteriorates the gums and teeth.
• Poor Oral Hygiene - Many Meth users have a basic neglect of personal hygiene

Abscessed Tooth

An abscess is an infection of the tooth or the gum tissue surrounding the tooth. The most common causes are:

• Severe dental decay
• Gingivitis
• Periodontal disease
• Tooth trauma.

These conditions cause an opening in the tooth structure, allowing bacteria to infiltrate the tooth's central chamber. This infection is not limited only to the tooth, but can spread to the gum and bone surrounding the area. An abscessed tooth is usually characterized by an intense throbbing or shooting pain.

What Are the Symptoms of an Abscessed Tooth?

• High fever
• Painful chewing
• Cold & hot sensitivity
• A bitter taste
• Bad breath
• Discomfort in the affected area
• Red or swollen gum tissue
• Draining pus of the gum tissue

How Is an Abscessed Tooth Diagnosed?

Dr. DiStefano or Dr. Nguyen will tap the tooth with a metal instrument. This percussion test is intended to detect pain and sensitivity. A dental x-ray will also be taken so that the root of the tooth can be observed for infection.

How is an Abscessed Tooth Treated?

The goals of treatment are to eliminate the tooth infection and conserve the tooth. Once an abscessed tooth is diagnosed, the dentist will recommend antibiotics and schedule a root canal procedure to drain the infection. Then a protective covering (crown) will be placed over the affected tooth.

" The dental procedures we specialize in enhance our
patients' look and their quality of life! "

If you would like to learn more, or if you believe you have a dental infection, you should contact Dr. DiStefano and Dr. Nguyen to seek our services right away. We are committed to providing our patients in the Lansing area with the best family and cosmetic dentistry services available.