Tooth Decay - the Most Common Dental Disease

What Is a Cavity?

Cavities, also known as dental caries or simply as tooth decay, are a dental disease that is caused when bacteria form a sticky coating on the teeth, called plaque. If plaque is not regularly removed by brushing, it can produce acids that attack and slowly destroy the tooth’s enamel, which is the outermost protective layer of the teeth. This will then need to be corrected through dental treatment.

Cavities are a widespread disease. However, with good oral hygiene, a healthy diet and regular dental check-ups, they can be effectively prevented. It's essential to remove cavities early on as they can lead to severe oral health issues, along with visible markings such as a black spot on tooth frontages.

Cavity or Discoloration: What Does a Cavity Look like?

Cavities first appear on the tooth surface – they are usually in tooth grooves or between the teeth where the brush struggles to reach. Bacteria then settle in the resulting tooth plaque and are hard to remove manually. The external appearance of cavities can vary depending on the severity and location. For a layman, it's hard to tell if it's a cavity or discoloration. Here is what cavities can look like in different stages:

Stage 1: Initial Cavity

In the early stage, cavities are often hard to detect as they develop within the tooth enamel. It can be hard to even see an early tooth cavity; front teeth won’t even necessarily reveal the issue, as there are usually no visible signs on the surface. However, a thorough dental examination may reveal small white spots or discolorations.

Stage 2: White Spots

As the dental caries progress, the white spots on the teeth can become larger and more pronounced. They usually appear in areas near the gum line or between the teeth. These spots are signs of the beginning of enamel demineralisation.

Stage 3: Brown or Black Spots

When the enamel's demineralisation continues, the white spots can turn into brown or black lines on teeth. These spots are often a visible sign of cavities, indicating that the enamel is already damaged.

Stage 4: Tooth Decay or Holes

In advanced stages, cavities can lead to visible holes in the teeth. These holes can vary in size and shape and are often surrounded by brown or black discolorations. Teeth affected by cavities are usually sensitive to heat, cold, and sweets.

Stage 5: Tooth Erosion

Untreated cavities can further destroy the enamel and the underlying dentin. This can lead to severe damage where the affected tooth loses its shape and structure. In extreme cases, the affected tooth might be so severely damaged that it breaks or needs to be extracted.

How Does Tooth Decay Develop?

In general, the onset of cavities is strongly associated with the food that is consumed, oral hygiene, and how regular one’s dental check-ups are. Cavities develop gradually over several months and often go unnoticed in the beginning due to a lack of any obvious symptoms of tooth decay.

First, plaque forms. This sticky, colourless substance accumulates on the teeth and consists of bacteria, saliva, and food remnants. Bacteria metabolise sugars and carbohydrates from food, producing acid in the process.

The acid then attacks the tooth enamel. While enamel is usually very resistant, constant acid attacks can significantly soften it and leach out minerals. This process is known as demineralisation, and at this point the appearance of a black dot on tooth or gum surfaces may begin.

Once the enamel softens, holes are able to form more easily. These holes gradually grow as the acid leaches more minerals from the enamel and then attacks the dentin, which is the underlying layer. This is the point when dental caries start causing pain.

If untreated, the cavity can burrow into the tooth's inner layers, leading to significant damage. At this stage, dental fillings or even root canal treatments may be required to save the affected tooth. If tooth decay has completely eroded the tooth, the only option left might be to completely extract it.

To prevent cavities, it's essential to maintain good oral hygiene, visit the dentist regularly, limit sugary foods and drinks, and ensure a balanced diet. Fluoridated toothpaste and mouthwashes can also help strengthen teeth and protect against getting dental carries.

Typical Tooth Decay Symptoms: How to Detect Cavities in Time?

Cavities can often be asymptomatic in their early stages and might only be detected once substantial damage to the enamel or inner tooth substance has occurred. However, it's crucial to detect decay as early as possible to prevent severe issues. With the following tips, cavities can often be detected in time:

• Regular dentist visits: the best way to detect cavities early on is to schedule regular appointments with the dentist. They can identify a cavity on x-ray, and even visual examinations are sometimes enough. Catching decay early means treating it before it causes pain or other symptoms.

• Changes in tooth colour and texture of teeth: white spots or other discolourations on the teeth might be an early warning sign of dental caries.

• Sensitivity: if you suddenly feel heightened sensitivity to hot, cold or sweet food and drink, this may indicate a cavity. This sensitivity often occurs when the enamel is already damaged.

• Gum problems: whether it’s a back or front tooth cavity, the decay can also affect the surrounding gums at any point. Inflammation, redness or bleeding while brushing may be signs of advanced cavities.

To detect tooth decay in time, you should adhere to your dental appointments, even if you don't feel or see any symptoms. Regular teeth cleaning and examination allows your dentist to detect cavities at an early stage and take appropriate measures for treatment before they worsen.

How Can You Get Rid of Tooth Decay?

The treatment of dental caries depends on their severity. In the early stages, cavities can often be halted or even reversed through improved oral hygiene and changes in dietary habits. However, if the decay progresses and reaches the enamel or dentin, dental treatment will be necessary. The most common treatments for dental caries include:

• Fillings: when caries have broken through the tooth enamel and created a cavity in the tooth, the dentist will clean the affected area and then fill it in. If you’ve ever wondered, ‘what does a cavity look like on x-ray?’, you’ll see an image of the hollow portion of your tooth as part of this process. Fillings can be made from various materials, including amalgam, plastic, or ceramic, and they serve to repair the tooth, remove any pain and restore its normal functionality.

• Dental crowns: if the tooth is severely damaged by decay, a dental crown may be necessary. In this procedure, the affected tooth is filed down, and an artificial crown is placed on top to restore and protect the tooth’s structure and function.

• Root canal treatment: if tooth decay has reached the dental pulp and caused an infection, root canal treatment may be necessary. This involves removing the infected tissue, cleaning the root canal and then sealing it.

• Tooth extraction: in extreme cases where the tooth is severely damaged by dental caries and no other treatment option is viable, tooth extraction may be required. The extracted tooth can then be replaced with implants, bridges, or dentures.

The choice of the appropriate treatment option depends on various factors, including the extent of the decay, its location in the mouth, and the individual needs of the patient. It is important to seek medical advice early to discuss the best measures for treating dental caries and ensuring long-term dental health. However, prevention always remains the best strategy to prevent tooth decay and avoid costly dental treatments.

Sources:

Dr. Ananya Mandal (2023): ‘Treatment and Prevention of Tooth Decay’, last accessed 20.09.2023

NHS: Tooth Decay, last accessed 20.09.2023

Caitlin Rosemann: ‘Cavities: What Are They and How Do We Prevent Them?’, last accessed 20.09.2023