Patients often think that if their teeth are not in pain, then they are healthy. However, untreated tooth decay is a problem affecting roughly a quarter of adults over 20 years old. Moreover, if your teeth have been feeling sensitive, then it’s definitely a good time to get checked for cavities. In this post, I’ll discuss exactly how cavities develop, and the ways they are treated to save your teeth.
The enamel outer shell of our teeth is the hardest surface in the body. Bacteria naturally present in the mouth can cause the gradual destruction of this enamel to expose the sensitive dentin layer underneath. You may be wondering, how can this natural bacterium be so harmful? Well, when we provide it with carbohydrates, especially starchy and refined ones, it breaks them down to form an acid that erodes the tooth, causing a cavity in the tooth. Once they start to form, cavities can often be diagnosed either by an x-ray that shows a dark area where the decay has eroded the tooth or by feeling for a sticky surface on the tooth. Cavities also affect different parts of our teeth, such as in between the teeth, on the biting surfaces, or on the roots. Each area of the tooth can present different challenges to treat so diagnosing a cavity early is always beneficial.
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The Process of Identifying and Treating Different Cavities
Regular hygiene visits can help us identify cavities early before they grow and eat away more tooth structure. One of the risks in waiting too long to treat a cavity is that it can erode into the center of the tooth, allowing the bacteria to penetrate the nerve, at which point the tooth becomes significantly painful and needs a root canal. Cavities can also start as small, pinpoint areas and quickly grow to affect a large portion of the tooth that can no longer be restored with a filling but needs a crown instead. Therefore, if we treat cavities before they grow large and become painful, we eliminate the need for more extensive treatment.
As mentioned, the treatment for a cavity depends on its severity. If the cavity is found early, and is still only in the enamel, it is likely too small to treat so careful monitoring with routine x-rays is recommended. Additionally, topical fluoride application during your hygiene visit, along with using fluoridated toothpaste and mouthwash at home, can help re-strengthen the enamel, stopping the decay progression. The topical fluoride solution is especially helpful, with recommended application every six months for most adults and children, because it contains a higher concentration of fluoride than what is present in over-the-counter dentifrices. Patients with a greater risk of developing cavities, such as those with dry mouth or undergoing cancer treatment, can even benefit from more frequent applications of topical fluoride, such as every 3-4 months. Common forms of topical fluoride we use in the office include foam that’s placed in trays, or varnish that’s painted on the teeth.
Once decay has evidently progressed from the enamel into the dentin, fillings are the first treatment of choice, if there is enough tooth remaining to support it. The first step in treating any cavity, involves carefully and conservatively removing the soft, decayed portion of the tooth. Then we fill the portion of the tooth that was removed with either a tooth-colored composite resin, a ceramic material, or a metal amalgam. Your dentist will decide which material should produce the most ideal restoration and can discuss your options with you before proceeding.
As the decay grows deeper, more tooth structure is eroded until the tooth can no longer support a filling, and a crown is needed. This treatment involves a custom-designed covering placed over the entire tooth to restore it’s shape and protect it from breaking. As with a filling, the first step involves cleaning out the decayed portion of the tooth until only healthy tooth structure remains. Your dentist then makes a mold of the tooth and sends it to a dental laboratory that designs the crown. A separate visit is required to permanently cement the crown once it is made.
In the most advanced stage of a cavity, it has penetrated the nerve. If there is enough tooth left to save, root canal treatment is used to clean and shape the infected nerve canal space. This procedure is often two separate appointments depending on how infected the nerve is. In instances of severe infection, the first appointment involves placing medication in the canal after the nerve is taken out. After about a week, the root canal can be filled to complete the procedure. Typically, a crown needs be placed immediately after a root canal is done to protect the tooth from breaking.
With every stage of cavity progression, the focus is on conservative, predictable treatment. However, there are often instances where we cannot guarantee that a restoration may last a long enough time because of the severity of the decay. In these instances, it is important to understand all your treatment options and decide whether you still want to restore the tooth.
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While these are the most common treatments for tooth decay that aim to save natural teeth, your nutrition and daily oral hygiene habits play are essential to preventing decay formation and progression. Brushing twice a day—at night and in the morning—with a fluoride-based toothpaste, will remove most of the food particles that stick to the surfaces of teeth while flossing at least 3-4 times a week will help displace the food and saliva in between. Limit snacking and frequent, prolonged sipping on sugary beverages that includes coffee, juice, soda, and alcohol. Limit your carbohydrate intake, making sure to avoid foods like dried fruits, chips, cereals, and hard candies. Most importantly, talk to your dentist about your nutrition and at-home hygiene habits so she can offer tips to keep your teeth healthy. Maintaining your oral health is an ever-evolving process, and you can start today by booking your appointment with us at Nargiz Zadeh, DMD to discuss possible cavity risk factors in your life.
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