Tooth cavity and tooth decay

What is a tooth cavity

Tooth cavity is permanently damaged area in the hard surface (enamel) of your tooth that develop into tiny openings or holes 1). Cavities are also called tooth decay or dental caries, are caused by plaque which is a sticky, slimy substance made up mostly of the bacteria that cause tooth decay. Bacteria that live in your mouth thrive on the sugars and starches in the food you eat. Plaque builds up due to frequent snacking, sipping sugary drinks and not cleaning your teeth well. When plaque clings to your teeth the bacteria in your mouth make acids that can eat away at the outermost layer of the tooth, called the enamel. The result is a cavity or a hole that can grow bigger and deeper over time. If you have a tooth cavity it’s important to get it repaired as soon as possible.

Plaque also causes gingivitis, which is gum disease that can make your gums red, swollen, and sore. Your gums are those soft pink tissues in your mouth that hold your teeth in place. If you don’t take care of your teeth, cavities and unhealthy gums will make your mouth very, very sore. Eating meals will be difficult.

Cavities are decayed areas of your teeth that develop into tiny openings or holes. The three types of cavities are shown here in Figure 1. Smooth surface cavities occur on the smooth sides of your teeth, while root cavities develop on the surface over the roots. Pit and fissure cavities occur on the chewing surface of your teeth. Remember, not cleaning your teeth well, frequent snacking and sipping sugary drinks are the main culprits behind cavities. The first sign of tooth cavity or decay may be a sensation of pain when you eat something sweet, very cold or very hot. Sometimes decay will show as a brown or white spot on the tooth.

Dental caries (tooth decay) remains the world’s most common chronic disease in both children and adults, even though it is largely preventable. They’re especially common in children, teenagers and older adults. But anyone who has teeth can get cavities, including infants.

If you don’t go to the dentist to have the cavities treated, the acids can continue to make their way through the enamel, the cavity will get larger and affect deeper layers of your teeth and the inside parts of your tooth where the nerve endings are can begin to decay. They can lead to a severe toothache, infection and tooth loss. Regular dental visits and good brushing and flossing habits are your best protection against cavities and tooth decay.

When to see a dentist

You may not be aware that a cavity is forming. That’s why it’s important to have regular dental checkups and cleanings, even when your mouth feels fine. However, if you experience a toothache or mouth pain, see your dentist as soon as possible.

Figure 1. Tooth cavity

tooth cavity

Tooth Cavity Prevention Tips

Though cavities can be repaired, try to avoid them by taking care of your teeth. Ask your dentist which tips are best for you.

Good oral and dental hygiene can help you avoid cavities and tooth decay. Here’s how:

  • Floss your teeth at least once a day to remove plaque and food that’s stuck between your teeth after eating. Bedtime is an important time to floss.
  • Brush your teeth with fluoride toothpaste after eating or drinking or at least twice a day. The American Dental Association recommends brushing your teeth twice a day with fluoride toothpaste. Bedtime is an important time to brush.
  • Brush up and down in a circular motion. When you brush your teeth, you help remove food and plaque — a sticky white film that forms on your teeth and contains bacteria. After you eat a meal or snack that contains sugar, the bacteria in plaque produce acids that attack tooth enamel. Repeated attacks can break down tooth enamel and lead to cavities. Plaque that isn’t removed can also harden into tartar, making it harder to keep teeth clean.
  • Gently brush your gums as well to keep them healthy.
  • Limit or avoid sweets and sugary drinks, like soda or juice. Whenever you eat or drink beverages other than water, you help your mouth bacteria create acids that can destroy tooth enamel. If you snack or drink throughout the day, your teeth are under constant attack.
  • Drink some tap water. Most public water supplies have added fluoride, which can help reduce tooth decay significantly. If you drink only bottled water that doesn’t contain fluoride, you’ll miss out on fluoride benefits.
  • Consider dental sealants. A sealant is a protective plastic coating applied to the chewing surface of back teeth. It seals off grooves and crannies that tend to collect food, protecting tooth enamel from plaque and acid. The Centers for Disease Control and Prevention (CDC) recommends sealants for all school-age children. Sealants may last for several years before they need to be replaced, but they need to be checked regularly.
  • Consider fluoride treatments. Your dentist may recommend periodic fluoride treatments, especially if you aren’t getting enough fluoride through fluoridated drinking water and other sources. He or she may also recommend custom trays that fit over your teeth for application of prescription fluoride if your risk of tooth decay is very high.
  • See your dentist twice a year for regular checkups.
  • Ask about antibacterial treatments. If you’re especially vulnerable to tooth decay — for example, because of a medical condition — your dentist may recommend special antibacterial mouth rinses or other treatments to help cut down on harmful bacteria in your mouth.
  • Combined treatments. Chewing xylitol-based gum along with prescription fluoride and an antibacterial rinse can help reduce the risk of cavities.

What causes tooth cavities and tooth decay

Cavities are caused by tooth decay — a process that occurs over time. Here’s how tooth decay develops:

  • Plaque forms. Dental plaque is a clear sticky film that coats your teeth. It’s due to eating a lot of sugars and starches and not cleaning your teeth well. When sugars and starches aren’t cleaned off your teeth, bacteria quickly begin feeding on them and form plaque. Plaque that stays on your teeth can harden under or above your gum line into tartar (calculus). Tartar makes plaque more difficult to remove and creates a shield for bacteria.
  • Plaque attacks. The acids in plaque remove minerals in your tooth’s hard, outer enamel. This erosion causes tiny openings or holes in the enamel — the first stage of cavities. Once areas of enamel are worn away, the bacteria and acid can reach the next layer of your teeth, called dentin. This layer is softer than enamel and less resistant to acid. Dentin has tiny tubes that directly communicate with the nerve of the tooth causing sensitivity.
  • Destruction continues. As tooth decay develops, the bacteria and acid continue their march through your teeth, moving next to the inner tooth material (pulp) that contains nerves and blood vessels. The pulp becomes swollen and irritated from the bacteria. Because there is no place for the swelling to expand inside of a tooth, the nerve becomes pressed, causing pain. Discomfort can even extend outside of the tooth root to the bone.

Risk factors for Tooth Cavity

Everyone who has teeth is at risk of getting cavities, but the following factors can increase risk:

  • Tooth location. Decay most often occurs in your back teeth (molars and premolars). These teeth have lots of grooves, pits and crannies, and multiple roots that can collect food particles. As a result, they’re harder to keep clean than your smoother, easy-to-reach front teeth.
  • Certain foods and drinks. Foods that cling to your teeth for a long time — such as milk, ice cream, honey, sugar, soda, dried fruit, cake, cookies, hard candy and mints, dry cereal, and chips — are more likely to cause decay than foods that are easily washed away by saliva.
  • Frequent snacking or sipping. When you steadily snack or sip sugary drinks, you give mouth bacteria more fuel to produce acids that attack your teeth and wear them down. And sipping soda or other acidic drinks throughout the day helps create a continual acid bath over your teeth.
  • Bedtime infant feeding. When babies are given bedtime bottles filled with milk, formula, juice or other sugar-containing liquids, these beverages remain on their teeth for hours while they sleep, feeding decay-causing bacteria. This damage is often called baby bottle tooth decay. Similar damage can occur when toddlers wander around drinking from a sippy cup filled with these beverages.
  • Inadequate brushing. If you don’t clean your teeth soon after eating and drinking, plaque forms quickly and the first stages of decay can begin.
  • Not getting enough fluoride. Fluoride, a naturally occurring mineral, helps prevent cavities and can even reverse the earliest stages of tooth damage. Because of its benefits for teeth, fluoride is added to many public water supplies. It’s also a common ingredient in toothpaste and mouth rinses. But bottled water usually does not contain fluoride.
  • Younger or older age. In the United States, cavities are common in very young children and teenagers. Older adults also are at higher risk. Over time, teeth can wear down and gums may recede, making teeth more vulnerable to root decay. Older adults also may use more medications that reduce saliva flow, increasing the risk of tooth decay.
  • Dry mouth. Dry mouth is caused by a lack of saliva, which helps prevent tooth decay by washing away food and plaque from your teeth. Substances found in saliva also help counter the acid produced by bacteria. Certain medications, some medical conditions, radiation to your head or neck, or certain chemotherapy drugs can increase your risk of cavities by reducing saliva production.
  • Worn fillings or dental devices. Over the years, dental fillings can weaken, begin to break down or develop rough edges. This allows plaque to build up more easily and makes it harder to remove. Dental devices can stop fitting well, allowing decay to begin underneath them.
  • Heartburn. Heartburn or gastroesophageal reflux disease (GERD) can cause stomach acid to flow into your mouth (reflux), wearing away the enamel of your teeth and causing significant tooth damage. This exposes more of the dentin to attack by bacteria, creating tooth decay. Your dentist may recommend that you consult your doctor to see if gastric reflux is the cause of your enamel loss.
  • Eating disorders. Anorexia and bulimia can lead to significant tooth erosion and cavities. Stomach acid from repeated vomiting (purging) washes over the teeth and begins dissolving the enamel. Eating disorders also can interfere with saliva production.

Complications of tooth cavity and tooth decay

Cavities and tooth decay are so common that you may not take them seriously. And you may think that it doesn’t matter if children get cavities in their baby teeth. However, cavities and tooth decay can have serious and lasting complications, even for children who don’t have their permanent teeth yet.

Complications of cavities may include:

  • Pain
  • Tooth abscess
  • Swelling or pus around a tooth
  • Damage or broken teeth
  • Chewing problems
  • Positioning shifts of teeth after tooth loss

When cavities and decay become severe, you may have:

  • Pain that interferes with daily living
  • Weight loss or nutrition problems from painful or difficult eating or chewing
  • Tooth loss, which may affect your appearance, as well as your confidence and self-esteem
  • In rare cases, a tooth abscess — a pocket of pus that’s caused by bacterial infection — which can lead to more serious or even life-threatening infections.

How to know if you have a cavity

Tooth Cavity Symptoms

The signs and symptoms of cavities vary, depending on their extent and location. When a cavity is just beginning, you may not have any symptoms at all. As the decay gets larger, it may cause signs and symptoms such as:

  • Toothache, spontaneous pain or pain that occurs without any apparent cause
  • Tooth sensitivity
  • Mild to sharp pain when eating or drinking something sweet, hot or cold
  • Visible holes or pits in your teeth
  • Brown, black or white staining on any surface of a tooth
  • Pain when you bite down.

Diagnosis of tooth cavity

Your dentist can usually detect tooth decay by:

  • Asking about tooth pain and sensitivity
  • Examining your mouth and teeth
  • Probing your teeth with dental instruments to check for soft areas
  • Looking at dental X-rays, which can show the extent of cavities and decay

Your dentist will also be able to tell you which of the three types of cavities you have — smooth surface, pit and fissure, or root.

Treatment for tooth cavity

Regular checkups can identify cavities and other dental conditions before they cause troubling symptoms and lead to more-serious problems. The sooner you seek care, the better your chances of reversing the earliest stages of tooth decay and preventing its progression. If a cavity is treated before it starts causing pain, you probably won’t need extensive treatment.

Treatment of cavities depends on how severe they are and your particular situation. Treatment options include:

  • Fluoride treatments. If your cavity just started, a fluoride treatment may help restore your tooth’s enamel and can sometimes reverse a cavity in the very early stages. Professional fluoride treatments contain more fluoride than the amount found in tap water, toothpaste and mouth rinses. Fluoride treatments may be liquid, gel, foam or varnish that’s brushed onto your teeth or placed in a small tray that fits over your teeth.
  • Fillings. Fillings, also called restorations, are the main treatment option when decay has progressed beyond the earliest stage. Fillings are made of various materials, such as tooth-colored composite resins, porcelain or dental amalgam that is a combination of several materials.
  • Crowns. For extensive decay or weakened teeth, you may need a crown — a custom-fitted covering that replaces your tooth’s entire natural crown. Your dentist drills away all the decayed area and enough of the rest of your tooth to ensure a good fit. Crowns may be made of gold, high strength porcelain, resin, porcelain fused to metal or other materials.
  • Root canals. When decay reaches the inner material of your tooth (pulp), you may need a root canal. This is a treatment to repair and save a badly damaged or infected tooth instead of removing it. The diseased tooth pulp is removed. Medication is sometimes put into the root canal to clear any infection. Then the pulp is replaced with a filling.
  • Tooth extractions. Some teeth become so severely decayed that they can’t be restored and must be removed. Having a tooth pulled can leave a gap that allows your other teeth to shift. If possible, consider getting a bridge or a dental implant to replace the missing tooth.

While you’re waiting for your appointment, you can take some steps to control your tooth pain. For example:

  • Take an over-the-counter pain reliever, if your doctor has said it’s OK for you.
  • Use an over-the-counter (OTC) anesthetic specifically designed to soothe painful teeth. Sparingly apply an OTC antiseptic containing benzocaine directly to the irritated tooth and gum for temporary relief.
  • Use warm water to brush your teeth.
  • Use toothpaste designed for sensitive teeth.
  • Thoroughly clean all parts of your mouth and teeth — don’t avoid painful areas.
  • Avoid foods or beverages that are hot, cold or sweet enough to trigger pain.

Use caution with products containing benzocaine

Benzocaine has been linked to a rare but serious, sometimes deadly, condition called methemoglobinemia, which decreases the amount of oxygen that the blood can carry. So follow these guidelines:

  • Talk to your dentist or doctor about using an over-the-counter antiseptic containing benzocaine.
  • Don’t use benzocaine in children younger than age 2 without supervision from a health care professional.
  • Never use more than the recommended dose of benzocaine.
  • Store products containing benzocaine out of the reach of children.

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