Tooth decay: hole in the tooth – what helps?

Almost everyone suffers from it during their life: a hole in the tooth caused by tooth decay. The problem can affect everyone, from small children with milk teeth to adults, and can take very different courses. In this article, you will discover what tooth decay is, how to recognize dental disease, what causes tooth decay, and how to prevent it.

What is tooth decay?

A medical definition of the disease could be that tooth decay is a multifactorial disease of the tooth structure that can damage or destroy the affected tooth. Tooth substance is the dental term for tooth enamel, tooth bone (dentin) and root cement. Multifactorial means that there are several causes of tooth decay.

Tooth decay is a disease of the teeth that damages their complex components. This is also called a hole in the tooth or tooth decay. Tooth decay cannot be cured because it is a progressive disease which, 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 tooth decay. An imbalance of remineralization and demineralization is the central part. 

Our mouth is home to many bacteria, including streptococci, which feed on carbohydrates (i.e. sugar). Sugary food particles and dead cells can form a sticky film on the teeth. Very viscous saliva promotes this accumulation, as the saliva is usually used to rinse the mouth. This so-called plaque  (tartar) offers the perfect breeding ground for the bacteria mentioned above.

Their excretions are organic acids that attack our tooth structure. The pH value in the mouth, which is otherwise heavily regulated, drops due to the acidity. Hydroxyapatite, the primary substance in our tooth enamel, goes into solution with our saliva, i.e., dissolves. This process is called demineralization, i.e. the loss of minerals. 

The good news is that this process is reversible. In this initial stage, our enamel can be remineralized by the new 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, tooth decay can develop if there is an imbalance between the breakdown and regeneration of tooth substance.

Despite the re-storage of minerals, the bacteria, in many cases, further destroy the tooth enamel that has become softer due to demineralization. There is 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 tooth decay?

We only influence some of the possible causes that can play together in the development of caries. Unfortunately, we are often blamed for some other factors. For example, poor oral hygiene and frequent sugar consumption are among the most common causes of tooth decay.

The main risk factors are:

• poor or incorrect oral hygiene
• Imbalance of bacteria in the mouth (e.g. when taking antibiotics)
• Lack of fluoridation of the enamel, i.e. insufficient supply of fluoride to the teeth
• Misaligned or crowded teeth that make dental hygiene difficult
• defective dentures or fillings
• Saliva composition (thick saliva, too little saliva)
• unfavourable eating habits (irregular meals, lots of sweets in between)
• sugary foods (such as soft drinks )
• Insufficient tongue and cheek activity: When chewing, our cheek and tongue usually ensure that food is pressed between the teeth and does not remain between the teeth and cheek or in the lower tongue area. Food left in the mouth encourages plaque.
• Taking medication (opioids or antidepressants to reduce salivation)
• smoking and alcohol

 

What stages and types of tooth decay are there?

To understand the different types and stages, one must first understand the tooth structure:

The tooth consists of its hard coat layer, the tooth enamel (only in the crown area) and the slightly softer layer underneath, the dentin. The inner pulp supplies it. The supplying blood vessels, regenerating cells, nerves and connective tissue are in the pulpa. The crown of the tooth is followed from below by the root of the tooth, with which the tooth is anchored in the jawbone via the periodontium. These relationships make it clear why untreated tooth decay can lead to tooth loss.

When caries progresses, the following stages  are distinguished:

• Initial caries: demineralization of the enamel (reversible, i.e. reversible)
• Caries superficial (enamel caries): enamel defect caused by caries (irreversible from here)
• Caries media (dentine caries): The caries have penetrated to the dentin
• Caries profound: The caries has come close to the pulp
• Caries profunda complicate: The caries have reached the pulp

Depending on where on the tooth the tooth decay starts, there are different types  :

• Caries in the interdental spaces (approximal caries)
• Smooth surface caries (starting from the smooth surfaces of a tooth)
• Tooth decay in the fissures (the grooves in the chewing surfaces)
• Root caries (caries in the root of the tooth, usually only occurs when the roots of the tooth are exposed)

Usually, the affected areas are difficult to reach when brushing your teeth.

How do I know if I have tooth decay, and what does tooth decay look like?

The symptoms of tooth decay depend on the stage and the area affected.

For example, there are usually no symptoms to be noticed in the case of initial caries. Enamel caries can already cause slight pain or sensitivity. In addition, you can sometimes see a defect on the tooth with the naked eye, a white spot in the early stages of a tiny dark discolouration.

If the caries spread further into the tooth’s interior, toothache, temperature sensitivity, and sensitivity to certain foods, such as citrus fruits, occur. If caries spreads under a filling or a crown, this can also lead to loosening of the filling and failure of the fixed denture. In the later course, it often comes to unpleasant bad breath.

If caries gets into the pulp or the root area, it can cause severe inflammation if left untreated. If this is the case, the only option is often removal (extraction) to prevent more severe abscesses. Tooth decay should, therefore, be taken seriously, as it can also become dangerous if left untreated.

You should visit the dentist if you have the symptoms mentioned or even recognize a visible defect. He has various diagnostic tools available for the examination. Usually, the tooth is examined with a probe, then an X-ray is taken.

How can caries be treated?

If the caries exceed the stage of initial caries, the trip to the dentist is unavoidable. Depending on the extent of the infection, the dentist removes the infected tissue and provides the tooth with a filling, an inlay or a crown. If the pulp is inflamed, a root canal treatment must be done beforehand. If the tooth is severely damaged, it may need to be extracted.

Self-treatment of advanced caries is, therefore, not possible. Under no circumstances should you try to remove caries yourself.

 

How can you prevent tooth decay?

The most effective way to prevent tooth decay is undoubtedly 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, you can pay special attention to using fluoride toothpaste, which remineralizes the enamel. The use of mouthwash is also recommended.

In addition, you should have your teeth cleaned professionally every six months. If you have problems with plaque and tartar due to saliva, you can shorten the interval in consultation with the dentist treating you. 

If you have profound tooth fissures, the dentist can seal them to counteract plaque build-up and make cleaning easier. 

Since the streptococci in the mouth feed on sugar, a low-sugar diet is recommended. In addition, the long-term consumption of acidic foods and drinks also promotes the demineralization of tooth enamel. So eating right can be very important.

The sugar substitute xylitol can help you eat less sugar. In addition, it is assumed that regular intake even has a preventive effect against tooth decay. That is why xylitol is also contained in many dental care chewing gums.

Is tooth decay contagious?

Because bacteria and bacteria cause tooth decay can be transmitted, tooth decay is contagious. However, this only affects adults. 

Babies and small children, however, whose oral flora still has to be built up, can quickly develop caries due to bacterial contamination. This is also why tooth decay often affects the milk teeth of children and toddlers.

To prevent this, parents should not lick the baby’s or toddler’s spoon, for example, as this can lead to an increased bacterial load in the child’s oral flora, which is not yet developed. 

caries in children

Children are not only particularly frequently affected by tooth decay because of their incomplete oral flora. In addition, the enamel of milk teeth is more sensitive than that of permanent teeth, and oral hygiene is often more difficult for children. Baby bottles with juice or sweetened tea can also promote the development of milk tooth decay.

To prevent tooth decay in children, parents should brush their children’s teeth once a day with fluoride-containing children’s toothpaste at an early stage, after the first teeth have erupted. From the age of two, teeth should be brushed twice a day.

Regular check-ups at the dentist are also a must for children. If necessary, the dentist can also seal the deep grooves on the chewing surfaces of children with a varnish containing fluoride to prevent the development of tooth decay.