Almost everyone suffers it in the course of his life: a hole in the tooth, caused by caries. The problem can affect anyone from small children with their baby teeth to adults, and it can vary greatly. What caries is, how you can recognize the dental disease, what causes caries and how you can prevent it, you will learn in this article.
What is caries?
A medical definition of the disease might be: Dental caries is a multifactorial disease of tooth structure that can lead to damage or destruction of the affected tooth. Dental hard tissue is the dental term for enamel, dentin and root cementum. Multifactorial means that there are several causes for a caries disease. In simple terms, caries is a disease of the teeth that damages their hard components. It is then also referred to as a hole in the tooth or tooth decay. Caries cannot be cured because it is a progressive disease that, if left untreated, can result in the destruction or loss of the tooth.
Causes: How does tooth decay occur?
Various causes play a role in the development of caries. The main contributor is an imbalance of remineralization and demineralization. Our oral cavity is home to many bacteria, including streptococci, which feed on carbohydrates (i.e. sugar). Sugar-containing food residues and dead cells can settle on the teeth as a sticky film. Very thick saliva favors this buildup, since saliva is normally used to rinse the mouth. This so-called plaque (dental plaque) provides the perfect breeding ground for the above-mentioned bacteria. Their excretions are organic acids that attack our tooth structure. The acid causes the otherwise highly regulated pH value in the mouth to drop. This causes hydroxyapatite, the main substance of our tooth enamel, to dissolve with our saliva, literally dissolving. This process is called demineralization, or the loss of minerals. The good news is that this process is reversible. In this initial stage, our enamel can therefore be remineralized by the renewed storage of mineral salts such as hydroxyapatite or fluorapatite – for example, when brushing our teeth with fluoride toothpaste. The two processes of demineralization and remineralization happen continuously in our oral cavity. However, if the relationship between the breakdown and rebuilding of tooth substance becomes imbalanced, caries can develop. This is because, despite the re-storage of minerals, in many cases bacteria manage to further destroy the enamel that has become softer as a result of demineralization. This results in a hole in the tooth. This destruction is irreversible and should be treated by the dentist, otherwise it will continue to progress.
What promotes the development of caries?
On many of the possible causes that can interact in the development of caries, we have no control, some other factors, unfortunately, we often have ourselves to blame. For example, poor oral hygiene and frequent sugar consumption are among the most common causes of tooth decay. The main risk factors are:
- Lack of or improper oral hygiene
- Imbalance of bacteria in the mouth (for example, when antibiotics are administered).
- Lack of fluoridation of the enamel, so too low supply of fluoride to the teeth.
- Tooth malocclusions or tooth misalignments, which complicate dental hygiene.
- Defective dentures or fillings
- Saliva composition (thick saliva, too little saliva).
- Unfavorable eating habits (irregular meals, a lot of sweets in between).
- Sugary foods (such as soft drinks).
- Too little tongue and cheek activity: during chewing, our cheek and tongue normally ensure that food is pressed between the teeth and does not remain between the teeth and cheek or in the sublingual area. Food debris remaining in the mouth promotes plaque.
- Medication intake (opioids or antidepressants reduce saliva secretion).
- Smoking and alcohol
What are the stages and types of tooth decay?
To understand the different types and stages, you must first understand the tooth structure:
The tooth consists of its hard mantle layer, the enamel (only in the crown area) and the underlying slightly softer layer, the dentin.It is supplied by the pulp lying inside. The pulp contains the supplying blood vessels, regenerating cells, nerve tissue and connective tissue. The tooth crown is joined from below by the tooth root, with which the tooth is anchored in the jawbone via the tooth-supporting apparatus. These connections make it clear why untreated caries can lead to tooth loss. The following stages are distinguished in the progression of caries:
- Initial caries: demineralization of the enamel (reversible, ie reversible).
- Caries superficialis (enamel caries): enamel defect due to caries (irreversible from here).
- Caries media (dentine caries): The caries has penetrated to the dentin.
- Caries profunda: The caries has come to near the pulp
- Caries profunda complicata: The caries has reached the pulp
Depending on the location of the tooth from which the caries originates, there are also different types:
- Caries in the interdental spaces (approximal caries).
- Smooth surface caries (starting from the smooth surfaces of a tooth).
- Caries in the fissures (the furrows in the occlusal surfaces).
- Root caries (caries in the root of the tooth, usually occurs only when the roots of the teeth are exposed).
Usually affects the places that are difficult to reach when brushing teeth.
How do I know if I have tooth decay and what does tooth decay look like?
The symptoms of caries depend on the stage and the affected area. In initial caries, for example, no symptoms are usually noticeable yet. With enamel caries, there may already be mild pain or sensitivity. In addition, sometimes you can already see a defect on the tooth with the naked eye, a white spot in the early stages or later a small dark discoloration. If the caries spreads further inside the tooth, toothache, sensitivity to temperature and sensitivity to eating certain foods, such as citrus fruits, will occur. If caries spreads under a filling or under a crown, it can also cause the filling to loosen and the fixed denture to fail. In later stages, it also often leads to unpleasant bad breath. If the caries reaches the pulp or root area, it can cause severe inflammation there if left untreated. If this is the case, removal (extraction) is often the only option to prevent more severe processes, such as abscesses. Caries should therefore be taken seriously, because it can also be dangerous if left untreated. If you have the symptoms mentioned or if you can already see a visible defect, you should definitely see your dentist. The dentist has various diagnostic tools at his disposal. As a rule, the tooth is examined with a probe and then an X-ray image is taken. Recognize oral diseases – these images help!
How can caries be treated?
If the caries exceeds the stage of initial caries, the way to the dentist is unavoidable. The dentist then removes the affected tissue and restores the tooth with a dental filling, an inlay or a crown, depending on the extent of the infestation. If the pulp is already inflamed, a root canal treatment must be performed first. If the tooth is severely damaged, it may have to be extracted. Consequently, self-treatment of advanced caries is not possible. Under no circumstances should you try to remove caries yourself.
How can caries be prevented?
The most effective way to prevent caries is certainly proper oral hygiene. This includes, for example, brushing your teeth twice a day, using an electric toothbrush and cleaning the spaces between your teeth with dental floss or interdental brushes. When brushing, special care can be taken to use fluoride toothpaste, which remineralizes the enamel. The use of mouth rinses is also recommended. In addition, you should have your teeth professionally cleaned every six months. If you have problems with plaque and tartar due to saliva, you can shorten the interval in consultation with your dentist. If you have very deep fissures, your dentist can also seal them to prevent plaque buildup and make brushing easier. Since streptococci feed on sugar in the mouth, a low-sugar diet is recommended. In addition, prolonged consumption of acidic foods and beverages also promotes demineralization of tooth enamel. The right diet can thus be very decisive.The sugar substitute xylitol can help to reduce sugar intake. It is also believed that regular use can even prevent tooth decay. That is why xylitol is also contained in many dental care chewing gums.
Is tooth decay contagious?
Because tooth decay is caused by bacteria and bacteria can be transmitted, tooth decay is contagious. However, this does not usually affect adults. Babies and young children, however, whose oral flora has yet to be established, can easily develop tooth decay due to bacterial infestation. This is also the reason why caries very often affects the milk teeth of children and toddlers. To prevent this, parents should not, for example, lick the baby’s or toddler’s spoon, as this can lead to an increased bacterial load in the child’s oral flora, which has not yet developed.
Caries in children
Children are particularly affected by caries not only because of their incompletely developed oral flora. In addition, the enamel of milk teeth is more sensitive than that of permanent teeth and oral hygiene is often more difficult in children. Teat bottles with juice or sugared tea can also promote the development of milk tooth decay. To prevent caries in children, parents should brush their children’s teeth once a day with a fluoride-containing children’s toothpaste at an early stage, as soon as the first teeth have erupted. From the age of two, teeth should be brushed twice a day. Regular visits to the dentist for preventive care are also mandatory for children. If necessary, the dentist can also seal the deep grooves of the chewing surfaces of children with a fluoride-containing varnish to prevent the development of caries.
