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dental caries

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Tooth with Abscess

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Alternative Names
cavities, tooth decay, dental decay

Dental caries, or cavities, are very common. They are caused by acid attacking the tooth. The acid is made from the bacteria in dental plaque. The plaque bacteria feed on sugars and starches from the diet and change them into acid. This acid eats into tooth enamel, or the outer layer of the tooth, and dentine, the major part or core of the tooth. The tooth then gradually dissolves.

What is going on in the body?
Plaque is a bacterial mass and it sticks everywhere on the teeth. It is especially hard to remove from the grooves of the teeth, between the teeth, and around the gum line of the teeth. Fillings, crowns, dentures, partials, orthodontic bands, and retainers make good hiding places for bacteria. Brushing and flossing are important in preventing cavities.

Once acid works its way through the tiny cracks in the enamel, it reaches into the dentine, where it spreads more quickly. In time, the plaque bacteria reaches the nerves and blood vessels in the centre of the tooth, called the pulp. When this happens, the harmful bacteria infect the pulp and a tooth abscess soon follows. This can happen with very little warning since the bacterial attack is so gradual that there may be no pain or sensitivity until the cavity is quite large.

What are the signs and symptoms of the disease?
In most cases there is tooth sensitivity to sweet foods and hot and cold food or drinks. If a tooth is sensitive to heat, it frequently requires root canal therapy.

There may be no symptoms until a cavity becomes very large or a tooth abscess forms. An abscess can cause pain, swelling, and fever.

What are the causes and risks of the disease?
There is no way to predict how fast the decay process will eat through the tooth structure and damage the blood vessels and nerve within the pulp of the tooth. When this happens, the tooth will become infected and an abscess may form.

The sooner a cavity is found, the simpler the treatment.

What can be done to prevent the disease?
Dental decay is almost always a completely preventable disease. The key to prevention is removing plaque and bacteria before acid can eat away the tooth. Keeping the mouth and teeth clean with good oral hygiene habits can prevent this disease.

Brushing carefully at least twice a day, flossing at least daily, using fluoride toothpaste, limiting sugars and starches in the diet, and regular dental checkups all help prevent tooth decay.

How is the disease diagnosed?
A dentist or hygienist can identify tooth decay early in order to try to keep the treatment as simple as possible. Examining the teeth with a mirror and a dental probe is a simple way to find most cavities. Dental x-rays will help find cavities when the cavities are still very small or are hidden from sight.

What are the long-term effects of the disease?
Cavities that are treated early usually do not have any long-term effects. If untreated, further destruction and invasion of the tooth occurs. This may progress to nerve irritation, causing pain and sensitivity of the tooth. A tooth abscess may form, which can rarely lead to a serious infection of the blood or heart damage. Even death is possible if treatment is never sought, though this is quite rare in developed countries.

What are the risks to others?
This disease is not readily contagious and poses no risk to others.

What are the treatments for the disease?
Simple fillings are used to treat small cavities. The dentist removes the softened or decayed material from the tooth. The hole left in the tooth is then filled with a restorative material. This is usually done with the help of local anaesthetics, or "numbing" medication, so that the person does not feel any pain during the procedure.

The dentist will recommend the best kind of filling material to use. Usually, an amalgam filling or a resin material is used. When the cavity is larger, gold restorations or crowns may be needed to re-establish form and function of the remaining tooth structure.

If the decay has already reached the nerves and blood vessels in the centre of the tooth, a root canal may be necessary in addition to restoring the tooth. A root canal is a procedure to remove diseased pulp from the deep part of the tooth. The area is then cleaned and sealed with filling and a crown, or cap, over the top of the tooth. If the tooth has an abscess and a root canal treatment is not performed, the tooth will usually have to be removed.

The earlier a cavity is found, the simpler and less expensive it is to treat.

What are the side effects of the treatments?
Any surgery or dental procedure carries a risk of bleeding, infection, and reactions to pain medication. A root canal filling may rarely cause nerve damage, which may result in tingling or numbness in the area of the surgery. Antibiotics may cause allergic reactions, stomach upset, or other side effects. Other side effects depend on the specific drug used.

What happens after treatment for the disease?
In almost all cases, treatment is successful and a person may return to normal activities. Further monitoring is required to catch future cavities at an early stage and avoid complications.

How is the disease monitored?
People should report any symptoms of tooth pain or sensitivity. Regular dental check-ups, roughly every 6 months or more often in some cases, are advised for monitoring. X-rays of the teeth may also be used for monitoring.

Author: Marvin Goldfogel, DDS
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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