All about cavities

What’s in Your Mouth?

To understand what happens when your teeth decay, it’s helpful to know what’s in your mouth naturally. Here are a few of the elements:

  • Saliva -Saliva is a watery constituent found in the mouth of all organisms. Saliva constitutes 99.5% water and 0.5% of electrolytes, glycoproteins, mucus, enzymes and antibacterial compounds. They play a role in breaking down food particles entrapped within dental crevices, protecting teeth from bacterial decay.Furthermore, saliva serves a lubricative function, wetting food and permitting the initiation of swallowing, and protecting the mucosal surfaces of the oral cavity from desiccation. They reduce the level of acids in the mouth thus preventing tooth decay.
  • Plaque – Plaque is a substance that is pale yellow in colour and develops naturally on teeth. Plaque is a type of biofilm. It contains large numbers of closely packed bacteria, components taken from saliva, and bits of food. Also in the mix are bacterial byproducts and white blood cells. Plaque grows when bacteria attach to the tooth and begin to multiply. Plaque starts forming right after a tooth is cleaned. At first, the biofilm is soft enough to come off by using the fingernail. However, it starts to harden within 48 hours, and in about 10 days the plaque becomes dental calculus (tartar), which is hard and difficult to remove.
  • Calculus – Plaque absorbs minerals from saliva and these minerals form crystals and harden into calculus. Then new plaque forms on top of existing calculus. This new layer can also become hard. Calculus thus causes periodontitis and leads to other gingival problems.
  • Bacteria – We have many types of bacteria in our mouths. Some bacteria are good; they help control destructive bacteria. When it comes to decay, Streptococcus mutans and Lactobacilli are the bacteria that cause the most damage to teeth.

dental_decayHow Your Teeth Decay

Foods that break down into simple sugars in the mouth are called fermentable carbohydrates. These include the obvious sugary foods, such as cookies, cakes, soft drinks and candy. But they also include pretzels, crackers, bananas, potato chips and breakfast cereals.

Bacteria in your mouth turn the sugars in these foods into acids. These acids begin to dissolve the mineral crystals in teeth. The more times you eat each day, the more times your teeth are exposed to an acid attack.

This attack can lead to tooth decay, also known as dental caries or cavities. First, the acid begins to dissolve calcium and phosphate crystals inside a tooth. A white spot may appear on the enamel in this weakened area.

At this stage, the tooth can be repaired with the help of fluoride, proteins and minerals (calcium and phosphate) in the saliva. The saliva also helps reduce the acid levels from bacteria that attack the tooth.

Once the decay breaks through the enamel to cause a cavity, the damage is permanent. A dentist must clean out the decay and fill the cavity. Left untreated, the decay will get worse. It can destroy a tooth all the way through the enamel, through the inside dentin layer and down to the pulp or nerve of the tooth. That’s why it is important to treat caries at a very early stage, when the process can be reversed.

Types of Decay

  • Young children can get a type of decay called baby bottle tooth decay or early childhood caries. It destroys enamel quickly. This type of decay is common in children who are put to sleep with a bottle of milk or juice. The bottle exposes the teeth constantly to carbohydrates through the night. Bacteria can grow rapidly and produce acid that decays teeth.
  • In older adults, the exposed roots of teeth can develop cavities. This is called root caries. Older adults are more likely to have receding gums caused by years of hard brushing or periodontal disease.
  • They also are more likely to have dry mouth (xerostomia). The decrease in saliva results in less protection of the teeth. This increases the risk of decay. Many common medicines can cause dry mouth. Be sure to ask the doctor or pharmacist if any of your medicines cause dry mouth. This is called xerostomia induced caries
  • Decay can form beneath fillings or other tooth repairs, such as crowns. Sometimes bacteria and bits of food can slip between the tooth and a filling or crown. This can happen if the filling cracks or pulls away from the tooth, leaving a gap. This is called secondary caries.

    To prevent your teeth from decaying, you can do three things:

    • Strengthen your teeth’s defenses with fluoride, sealants and agents that contain calcium and phosphate ions.
    • Have your dentist place sealants on your back teeth.
    • Reduce the number of bacteria in your mouth.

    Fluoride penetrates into teeth. It strengthens them by replacing minerals that acid has removed. Dentists started to notice that people who drank fluoridated water have lesser cavities. Adding fluoride to water systems has been the most successful cavity prevention method to date.

    Fluoride was also added to toothpaste as it also had a major impact on cavity prevention. Now almost all toothpastes contain fluoride. Everyone should brush with a fluoride toothpaste every day. Dental offices sometimes recommend higher levels of fluoride in toothpastes, gels and mouth rinses for both children and adults.

    Sealants are protective coatings placed over the tops of the back teeth — molars. They block bacteria and acids from sticking in the tiny grooves on the chewing surfaces of these teeth. Sealants can be placed in adults and children. Children can have sealants placed on their permanent molars once they come in, around age 6. Sometimes they are also used on primary (baby) molars. Dentists can put sealants on molars with signs of early decay, as long as the decay hasn’t broken through the enamel.

    You can never get rid of all the bacteria in your mouth. But you can take steps to control and disrupt the bacteria so they don’t attack your teeth:
    • Brush twice a day.
    • Floss daily.
    • Reduce the number of times each day that you consume fermentable carbohydrates.

    Some mouthwashes reduce bacteria in your mouth. This can help prevent decay. Chewing sugarless gums, especially those with xylitol, can help reduce the number of bacteria that cause cavities and increase the flow of saliva.

    Most importantly, visit your dentist regularly. Then the dentist can find any decay early, when it can be treated and reversed.