What are cavities or dental decay?
Decay or dental caries is a disease in which the tooth is destroyed
by softening as a result of growth of microorganisms on and around the
teeth in presence of food particles
How do cavities form on the tooth?
The microorganisms that exist in mouth along with the food remains form
a sticky thin, translucent layer on the tooth called dental plaque.
The plaque in initial stages can easily be removed by brushing and flossing.
If it is not removed, the plaque gets attached firmly to the teeth and
the bacteria multiply and in the process release mild acids that destroy
the tooth structure. The enamel gets destroyed layer by layer and the
bacteria gradually penetrate deeper into the tooth. The affected part
of the tooth gets weakened and breaks during chewing and results in
a cavity. The process is slow and continues until proper treatment is
executed.
How do you detect decay in initial stages?
The dentist can detect initial decay by examination of the teeth and
by taking an X-ray. Usually decay in between teeth can be spotted on
a bitewing X-ray and on the grinding surface by probing these areas.
Do' black spots' on the teeth indicate decay?
Grooves and pits on the grinding surfaces easily get stained by food
stuffs and beverages Hence all black spots are not decay and only black
spots which have softened the tooth are the areas of decay .The detection
should be done by a dentist.
Initial decay/ caries between teeth can be spotted on bitewing X-rays. In later stages, when more destruction takes place food usually gets impacted between teeth. A dental checkup will confirm the detection.
What are the areas of tooth prone for decay?
The grinding surface of teeth usually has many grooves and pits and
is therefore prone for accumulation of food and microorganisms. Thus
the grinding surface of the back teeth shows high incidence of dental
decay. In addition the area around the contact between the teeth, is
also the starting point of decay. Other areas of decay are the pits
found on the outer surface of the molars and small pits on the inner
side of the upper front teeth
No, but usually lower incisors, canines and upper canines are least prone. The first permanent molars are most commonly affected by caries as their grinding surface is often full of deep pits and grooves that tend to accumulate food and microorganisms. In addition the first permanent molars erupt early at a time when the oral hygiene of children is poor. Proper, regular tooth brushing with fluoride containing tooth pastes can help to make the tooth more resistant to decay.
Does decay spread from one tooth to other?
No, it does not. However, it can start on many teeth simultaneously.
Do all cavities on tooth cause pain?
The pulp of the tooth contains the nerve endings and blood vessels and
is protected by the outer enamel and dentin layer. Shallow cavities
at the depth of enamel and the surface of dentin are painless. As the
depth of the cavity increases in dentin the tooth becomes painful on
eating hot, cold, sour or sweet foods. Once the decay reaches pulp the
pain is intolerable.
Can a badly decayed tooth be saved?
If sufficient sound tooth structure remains, then the tooth can be saved
by covering the whole tooth with a metal crown / cap. A dentist specialized
in crown and bridge prostheses will be the best person to treat such
teeth.
Can a filled or restored tooth get decayed?
Yes, even a cavity filled with a permanent filling can develop dental
caries below the filling. Hence, better care by brushing, flossing the
restored tooth along with routine checkup will enhance the long-term
success.
Does regular brushing keep decay away?
Yes to a great extent, since it controls the formation of dental plaque
that predisposes to decay. However, other factors like deep grooves
and pits on the grinding surface of teeth, weak teeth with less calcium
content can make them more susceptible to decay
Is decay of teeth only due to eating of chocolates
and sweets?
Sticky and sweet foodstuff promote plaque and growth of caries causing
microorganisms. This predisposes to dental caries. In addition other
causes include poor oral hygiene, teeth having deep grooves and pits
etc.
Should decay in milk teeth be filled?
Milk teeth are important for the overall growth and development of children
and in particular the jaws and face. In addition they maintain the space
for incoming permanent teeth. Hence, they need to be saved with restorations
until their exfoliation.
Does decay occur in old age?
Yes, it does but less frequently and is commonly seen on the exposed
part of the root. Advancing age usually results in recession of the
gums resulting in exposure of the root surfaces of the teeth. Food and
plaque easily accumulates around these areas leading to decay if the
oral hygiene is poor
Does an abscessed tooth need to be removed?
Dental abscess is the extension of infection from the tooth to the underlying
bone. Once, active infection is controlled by antibiotics, the tooth
is treated by special procedure called root canal filling. This helps
the tooth to be retained in position and function normally.
Why do teeth not white in some people?
Just as skin is of different shades in different people, teeth also
exist in different shades of white. A close observation of a single
tooth shows that at the tip, it is translucent and becomes darker as
it approaches the neck of the tooth. Sometimes external and internal
stains do change the colour of teeth. These can be ruled out on examination
by a dentist.
Does feeding babies with milk through out
the night help teeth get stronger?
No, infact the sugar content of milk will promote decay. These children
develop a rampant form of dental caries involving several teeth in the
mouth. This form of caries is called nursing bottle caries. Nursing
bottle caries is usually associated with prolonged bottle feeding of
sugar containing drinks such as milk and juices. They may occur due
to bottle-feeding at bedtime or during sleep and lack of cleansing of
the teeth thereafter. Nursing caries can also occur due to prolonged
on demand breast feeding at night due to lactose sugar present in the
milk. This form of dental decay affects many teeth and may be seen as
marked discoloration of the teeth. In later stages the teeth may fracture.
The child often experiences pain on brushing and eating cold or hot
food substances
Is it true that raw vegetables & fibrous
food lower the chances of decay.
Refined form of food easily sticks in and around the teeth and enhance
formation of dental plaque whereas eating fibrous food helps in cleansing
the teeth during chewing. Decay is more frequently seen in urban people
who eat more refined foods and hence is known as a of disease of modern
civilization.
Does diet help in prevention of decay?
Yes, a balanced diet of essential proteins, carbohydrates, minerals
and vitamins keeps the mouth healthier. Reduction of refined food, specially
sweet and sticky food, and eating fruits and vegetables and other fibrous
food have a big role in reducing decay.
Is it true that fluoride prevents decay?
Yes, studies have shown that fluorides can prevent decay by up to 50%
if they are supplemented and monitored in water, food and tooth paste.
In addition the patient should maintain good oral hygiene.
How does fluoride prevent decay?
Fluorides have the ability to get incorporated into the tooth structure
and make the teeth more resistant to dental decay. The use of fluorides
may even arrest progression of caries which are in the initial stages.
Fluoride when consumed during formation of teeth gets incorporated in
the tooth structure and makes the enamel stronger. It also has an anti
-bacterial effect on several germs that cause decay and makes dental
plaque difficult to attach to the tooth.
What are the different forms of fluoride available
for prevention of decay?
Fluoride when added in drinking water (in one part per million parts
of water) helps prevent caries in the entire population of a particular
region. This has been tried in many cities around the world with great
success. Fluorides are also available in tablet form, varnishes, filling
materials, food products like salt and toothpastes. However, except
tooth pastes all other forms need to be consulted and monitored by the
dentist before consumption.
What are protective coats/varnish that help
to prevent decay?
Application of fluoride gels and varnish by the dentist can make the
teeth more resistant to decay. However, this application does not last
for long time and hence it has to be applied frequently.
What are pit and fissure sealants?
In some children the grinding surface of teeth tend to have very deep
pits and grooves which predispose to stagnation of food and microbes.
Such teeth can be treated with appropriate sealants to reduce their
depth. These are called pit and fissure sealants.
Is it true that some type of chewing gums
help prevent decay?
Yes, only sugar free chewing gums containing xylitol has shown promising
results in reducing decay, while others that contain sugar do not help.
When is it appropriate to fill a cavity?
Although cavities in teeth need not be treated as an emergency, (unless
associated with an abscess), they should be filled as early as possible
since, decay is a slow progressive process and without many symptoms
until the tooth is grossly destroyed. Sometimes even a small spot may
show massive destruction below it. Treating the decay at the intial
stage helps conserve tooth structure.
Can any dentist do all types of fillings?
Any dentist can do routine fillings. Badly decayed teeth and root canal
treatment are better handled by a dentist specialized in restorative
dentistry and endodontics.
What is a temporary filling?
If the dental decay is close to the pulp a medicated layer of filling
is placed over the affected area and a temporary filling is done. Once
the pulp heals the temporary restoration is removed and a permanent
filling is done.
While temporary fillings are meant to last a few months only the permanent fillings last longer. Well made permanent fillings can last decades if not a life time
Can a filling last lifetime?
A well done permanent filling, with proper maintenance by the patient
usually lasts 20-25 years or more.
Can gold be used as filling material for cavities?
Yes, gold in pure form was one of the oldest materials used in dentistry.
Since it is very technique sensitive and better materials have emerged,
gold is no longer used routinely. But gold is still used as an alloy
or with other metals to fabricate crowns and other prostheses.
Pure silver is mixed with several other metals like copper, tin and mercury to make it into a semisolid form that is packed into the cavity and then allowed to harden. It has been used in dentistry for over 100 years and does function well in the mouth. This type of restorative material is called silver amalgam. Is the mercury present in the silver filling poisonous?
No, the mercury when mixed with silver alloy reacts and forms various compounds and only tiny traces are left in the filling. Studies have shown that this tiny trace of free mercury does not leach out and is not harmful to the body.
Why do silver filling appear grey/ black in
colour?
The surface of the silver filling needs to be polished once it is set.
Once it is polished the shine of silver is seen. However, most dentists
do not do this and hence it appears grey in colour.
Although they are considered permanent they may fracture in some instances. Fillings that are large in size or old can fracture over a period of time due to heavy biting force. Hence regular monitoring by the patient and check up by the dentist is necessary for long term success. Can you fill a cavity with a material that is the same colour as the tooth?
Filling materials are available that are similar in color to tooth colour. These are thus very esthetic in appearance and match the color of the teeth. These filling materials are called composites. Can opposing teeth be restored with different type of metals?
Usually the dentist makes sure that opposing teeth are restored using the same material. When dissimilar metals are used on opposing teeth it can result in pain due to generation of galvanic current and also corrode the weaker metal over a period of time
Can a permanently filled tooth get damaged?
Yes fillings can get damaged or can fracture. Most filling materials
do not bond with the structure of the tooth. Hence a small micro gap
may exist between the tooth and the filling. These micro-gaps tend to
transport food and microorganisms into the deeper regions of the tooth
below the filling and thus once again initiate dental decay deep inside.
Thus extra care should be taken to maintain hygiene around restorations.
Yes, a filled tooth is more susceptible to dental decay than a normal tooth. Hence, better care in the form of brushing and flossing and routine checkup can enhance the long-term success of the restoration.
Can you fill a cavity without drilling the
tooth?
A drill is used to clean and remove all the infected (decayed) areas
of tooth and create a box like cavity. This ensures that the filling
material can be easily stuffed into the cavity and stays inside. Today's
high speed drills do not cause much vibration and run at very high speed
unlike the slow speed drills of yester years and thus are more comfortable
for the patient.
Do deep cavities require any additional treatment?
Cavities that are too close to the pulp require medicated restoration
for a period of time which will allow the pulp to recover from attack
of germs and toxins and helps to form a protective barrier around the
affected area. Once this is formed the tooth can receive a routine filling
What is erosion of teeth?
It is loss of tooth structure due to action of some chemicals. It is
commonly seen in people who have gastric problems or consume excess
of citrated drinks.
What is abrasion of teeth?
It is wearing of teeth due to mechanical causes such as due to brushing
of the teeth with a hard brush, grinding of teeth, needle biting, etc.
Why do teeth become sensitive?
A normal tooth has outer enamel that protects from external stimuli
like heat, cold, sour food, etc. Once the enamel is lost due to erosion,
abrasion or decay the inner sensitive dentin gets exposed. The dentin
has nerve endings that transmit sensations and therefore cause sensitivity.
How is sensitivity treated?
In initial stages, protective desensitization tooth pastes that are
commercially available are useful. They have to be applied for a long
period of time to get adequate relief. If erosion/abrasion/cavity is
noticed they have to be filled and in severe cases, protection with
metal caps may be necessary
