Tooth decay is highly widespread among the global population, in both adults and children, as well as in developed and developing countries.
Decay is related to refined sugar intake, to incorrect dental hygiene, and to a higher or lower family tendency to suffer the disease. If the public water supply has fluoride, children who have grown up drinking it will have less tooth decay.
The Decay Concept
Decay is a tooth infection. The bacteria we normally have in our mouths fulfil different functions; however, in certain circumstances, such as in the presence of sugar and poor hygiene, they produce acids which attack and perforate the enamel, thereby forming a cavity or caries.
Initially, when it is small, a cavity will only affect the enamel. However, with time, it will spread to the dentine, causing you to feel discomfort when consuming cold or hot drinks or food, sweets or when chewing.
If, during a check-up, your dentist finds a caries which has previously given you no trouble, it will require a filling.
A filling consists of cleaning the cavity and removing all tissue affected by bacteria. We then fill the cavity with a white paste tinted to match the shade of your tooth, known as composite, which will restore your tooth to its complete anatomical shape. We do all of this under local anaesthesia, meaning that it causes absolutely no pain.
Sometimes in an X-ray taken during the check-up, or with the probe, we discover that the cavity is larger than we initially thought, although fortunately it may still not have caused you any trouble or pain. In cases such as these, a filling is not sufficient given that, on removing the tissue affected by the caries we will come to the nerve. This means that, before reconstructing the tooth, we must devitalise or carry out root canal treatment on the piece.
Don’t forget that, while a filling effectively cures a tooth suffering from decay, if you don’t take good care of your teeth by brushing them properly, the same or another tooth may suffer further decay.
If we allow the caries to develop without treatment, it will deepen and spread to the pulp, or the centre of the tooth, where we find the nerve, the artery and the vein.
The first signs of the problem is if you feel pain when eating or drinking something cold or hot, or when chewing. If you feel pain while you’re not eating, it means that the nerve has been affected, or in other words, that the bacteria has spread either to the pulp or to the centre of the tooth, causing infection.
The infection causes the arteries to inflame, and these in turn compress the nerve. That’s what causes the pain. The pain may be constant or pulsating, like a heartbeat.
In cases such as these we start by treating the infection with antibiotics in order to eliminate the bacteria, also prescribing anti-inflammatory medication to reduce swelling in the area. We then proceed to clean and empty the area, removing any remaining germs. This is known as devitalisation or root canal treatment.
Finally, we apply the permanent filling. In cases like these the filling is so big that we call it a reconstruction.
Remember that sometimes you may have a deep caries which, unusually, causes no pain. In other words, no alarm bells ring to warn you that your tooth is affected by a spreading infection. This normally leads to a sudden gumboil accompanied with intense pain and swelling.
At other times when you have had no initial pain, you may suddenly be affected by a chronic asymptomatic infection. This means that, while the infection inside your tooth is causing you no pain, your body will have created a barrier around the infected root, creating a cyst.
A cyst like this can sometimes remain in your mouth for years without producing symptoms, simply appearing in a check-up X-ray. The cyst may also try to empty its content outwards, causing an abscess, or a sort of spot, which sometimes festers.
The main point of these explanations is to show you the different ways a caries can develop. But at the end of the day, the bottom line is that ignoring a caries may eventually lead to the loss of a tooth.
Preventing tooth decay
It is essential to clean your teeth properly from childhood, also taking care with your diet and making sure not to eat a lot of sweets between meals, when you don’t have the tools you need to brush your teeth.
A yearly check-up with your dentist will encourage you to take good care of your teeth, as well as detecting lesions before it’s too late. At our Dental Clinic in San Sebastián we will advise you on the best treatment for your condition.