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How cavities form and how we treat them

cavityforbradadamsblogCavities are decay in teeth that we treat with fillings. Here is a little tooth anatomy. The crown of your tooth has an outer layer called enamel, which is very hard. The next level is called dentin, which is slightly less hard. For a cavity to form it requires bacteria. Bacteria is in your saliva and can adhere to the outer layer of your teeth. When it adheres to your teeth it creates what is called a biofilm. The biofilm helps the bacteria aggregate and remain on your teeth. The biofilm uses carbohydrates (sugar) for food and after it digests the sugar it produces an acidic byproduct. When the acidity of your mouth drops to a certain level it can begin to decalcify the enamel layer of your tooth. After the decay reaches through to the dentin we must remove the decay and fill the cavity.

Tooth decay is one of the most common diseases in the world and it is very preventable. The easiest and most known and used preventive measure is to brush and floss your teeth at least two time each day. We do this because we want to remove the biofilm that attaches to the tooth. If it is not on your tooth then it cannot sit, eat sugar, and produce the acid which causes it to decalcify that area on the tooth. Flossing is very important for those areas where your teeth touch each other because it can be hard for the bristles of your toothbrush to get in between your teeth.

Another good preventive measure is to visit your dental office for routine cleanings. At your visit, the dental hygienist will clean your teeth, identify areas of concern, and advise you on your homecare routine. Your dentist will complete an oral evaluation and make recommendations based on his or her findings. As I said, brushing and flossing are great preventative measures, but should never be considered a replacement of regular visits to the dentist.

bradadamsphotoforcavityblogWhen you come to the dental office you may here us use the word ‘watch’ to describe our intention for a certain tooth or teeth. What we are saying is this. You have the start of a cavity, but it is not quite at the point where we would fill it, so we will watch it to make sure it does not get any bigger. The distinction between an area we would watch and a cavity we would fill goes back to those two layers in the teeth we talked about earlier. When we see the decay or the decalcification in the enamel, the harder outer layer, we feel comfortable monitoring that. Because that layer of the tooth is harder, the disease spreads much more slowly through that layer of the tooth and we can still do something about it. We can apply fluoride. When fluoride is applied to the teeth, in the form of a varnish or toothpaste, those areas can re-mineralize and return to normal healthy tooth structure. If you are a patient with areas to ‘watch’ we may recommend an in-office fluoride treatment and/or prescribe extra strength fluoride tooth paste for home use.

If the decay makes its way through the enamel to the dentin we can no longer watch the tooth. We must remove the decay and fill the tooth. Because the dentin is the softer internal layer of the tooth, the decay can spread much more quickly and there is no way to arrest it. If the tooth is not filled once decay crosses into the dentin, it will result in a more serious condition which will not resolve on its own.

The filling is a procedure where the dentist will remove the decay in your tooth and place filling material in that space. Placing this material in your tooth does not make that tooth immune to further decay. On the contrary, that tooth is more susceptible than a natural healthy tooth. This is because there is now an area where the filling material meets the tooth surface. This is what we call the margin. The margin can be a spot for bacteria to sneak in and start this process all over again.

In summary, here is my prescription to maintain your healthiest mouth: Brush and floss your teeth daily and keep regular visits with your dentist.

By Dr. Adams

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