What is tooth decay (caries or cavities)?

Tooth decay (destruction of tooth structure) is the disease known as caries or cavities. Tooth decay is one of the most common disorders, second only to the common cold. It's also a highly preventable disease caused by bacteria and many contributing factors. It can occur when foods containing carbohydrates (sugars and starches), such as milk, soda, raisins, candy, cake, fruit juices, cereals, and bread, are left on the teeth. Bacteria that normally live in the mouth change these foods, producing acids. The combination of bacteria, food, acid, and saliva form a substance called plaque that sticks to the teeth. Over time, the acids produced by the bacteria eat away at the tooth enamel, causing cavities.

Who is at risk for tooth decay?

We all host bacteria in our mouths which makes everyone a potential target for cavities. Risk factors that put a person at a higher risk for tooth decay include:

• High levels of the bacteria that cause cavities

• Diets high in sweets, carbohydrates, and sugars

• Water supplies with limited or no fluoridation

• Poor oral hygiene

• Reduced salivary flow

• Age (children and older adults are at an increased risk for tooth decay)

• Diets high in sweets, carbohydrates, and sugars

What are the signs and symptoms of tooth decay and dental caries?

The following are the most common signs and symptoms of tooth decay and dental caries. However, each child may experience them differently. Signs may include white spots on the teeth that appear first. Then, an early cavity appears that has a light brown color on the tooth. The tooth color progressively becomes darker and a hole (cavitation) may appear. Symptoms, such as sensitivity to sweets and cold beverages or foods may occur. 

How is dental caries diagnosed?

Dental caries is usually diagnosed based on a complete history and physical examination of your child. This may be performed by your child's doctor or your child's dentist

How can tooth decay be prevented?

Preventing tooth decay and cavities involves five simple steps:

1. Brush your child's teeth, tongue, and gums twice a day with a fluoridated toothpaste, or supervise them brushing their teeth.

2. Floss your child's teeth daily after age 2.

3. Make sure your child eats a well-balanced diet and limit or eliminate sugary snacks.

4. Consult your child's doctor or dentist regarding the supplemental use of fluoride and/or dental sealants to protect your child's teeth against bacterial acids.

5. Schedule routine (every six months) dental cleanings and examinations for your child.

What is the treatment for tooth decay?

Specific treatment for tooth decay will be determined by your child's doctor or dentist based on:

• Your child's age, overall health, and medical history

• Extent of the disease

• Your child's tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Treatment, in most cases, requires removing the caries and replacing the lost substance of the tooth with a filling.

What are fillings?

Fillings (also called restorations) are materials placed in teeth to repair damage caused by tooth decay (caries or cavities). Advances in dental materials and techniques provide new, effective ways to restore teeth.

There are several different types of restorations, including:

• Direct restorations. These require a single visit to place a filling directly into a prepared cavity or hole. Materials used for these filings include dental amalgam, also known as silver fillings; glass ionomers; resin ionomers; and some composite (resin) fillings.
  
  Amalgam fillings have been used for decades, and have been tested for safety and resistance to wear. Dentists have found amalgams to be safe, reliable, and effective for restorations.
  
  Glass ionomers are tooth-colored materials made from fine glass powders and acrylic acids. These are used in small fillings that don't have to withstand heavy pressure from chewing. Resin ionomers are made from glass with acrylic acids and acrylic resin.

• Indirect restorations. These require two or more visits and include inlays, onlays, veneers, crowns, and bridges. These are constructed with gold, base metal alloys, ceramics, or composites. At the first visit, a dentist will prepare the tooth and make an impression of the area that will be restored. At the second visit, the dentist will place the new restoration into the prepared area. Some offices use newer technology called CAD/CAM (computer-aided design or computer-aided manufacturing) that allows them to produce the indirect restoration in the office and deliver it at the same appointment, saving the patient a return visit.

  For an indirect restoration, a dentist may use an all-porcelain, or ceramic, application. This material looks like natural tooth enamel in color and translucency. Another type of indirect restoration may use porcelain that's fused to metal, which provides additional strength. Gold alloys are used often for crowns or inlays and onlays. Less expensive alternatives to gold are base metal alloys that can be used in crowns and are resistant to corrosion and fracture. Indirect composites are similar to those used for fillings and are tooth-colored, but they aren't as strong as ceramic or metal restorations.