Dental Hygiene Monthly: Dental Caries

Dear Patients,

Dental caries, more commonly known as cavities, are the number one infectious disease worldwide. Cavities are an infectious disease because the bacteria which cause them are spread from person to person. The bacteria are easily passed between people through saliva. Cavities are defined as the breakdown of the calcified structures of the tooth. The cavity forming process is actually very simple. The bacteria which cause cavities is present in the mouth, the bacteria break down sugars to form acids, the acid then causes the tooth to begin to demineralize (breakdown).

Cavities can appear several ways. Usually a patient will not notice a cavity unless it is causing discomfort or is very big. At its worst a cavity will appear as a large hole in a tooth. This can be seen with a naked eye. However, earlier stages of cavity formation are not as obvious. In the very beginning a cavity will appear as a whiter area on a tooth. This is known as demineralization. At this point the cavity is just starting and can be reversed through improved homecare and fluoride use. If this progresses the lesion will move further into the enamel. It will not be visible looking in the mouth however; it will be visible on an x-ray. We see these lesions in between teeth very often. The need for regular x-rays cannot be stressed enough. X-rays will catch small cavities in between teeth before they become a bigger and more expensive problem for patients. If the cavity progresses even more it will move deeper into the tooth and may begin to cause some discomfort or sensitivity. At this point it may be visible to the patient. The cavities in between the teeth would still only be seen on an x-ray. Further deterioration to the tooth would likely become increasingly apparent to the naked eye. When the dentist examines patients after cleanings he carefully studies the patients’ teeth on the x-ray and in their mouth. He uses a tool in the mouth called an explorer to look for cavities. If he finds a sticky area on the tooth this is usually indicative of a cavity. The hygienist and dentist work as a team to thoroughly evaluate each patient clinically and determine what risk factors exist that might contribute to cavity formation.

Eating a diet that is high in sugars and carbohydrates enables the bacteria to form cavities. If the sugar is present the bacteria will turn it into acid. The acid lowers the pH of the mouth allowing cavities to form. If sugars are not consumed for awhile then the pH will increase and stabilize. However, if sugars are consumed frequently and closely together the pH of the mouth will remain very acidic. This is the perfect environment for cavities to develop. Many people, me included, enjoy eating sweets. The key is to limit the sugar you consume and avoid grazing on carbohydrates or sugars throughout the day. The most cariogenic foods are those which are soft and/or sticky. Limit foods like white breads, chewy candies, fruit chews, juices, and pops. Eliminating those foods or limiting them to no more than one time during the day would allow the pH of the mouth to return to a neutral state, and help prevent cavities.

Diet is not the only risk factor for cavities. Dry mouth is another risk factor. Saliva cleanses and lubricates the oral cavity. Without adequate saliva the oral environment is far more susceptible to cavities. If you feel that you may suffer from dry mouth it is important to discuss it with the dentist or hygienist. There are many ways to treat this problem. Inadequate homecare also puts you at greater risk. Orthodontics and appliances are also contributing factors to the decay process. If you do not properly clean around braces and appliances plaque and bacteria will accumulate and lead to cavities. It is incredibly frustrating to see a patient go into braces with few or no cavities, have braces placed and be shown how to brush and floss, then to see them get the braces off and have several cavities throughout their mouth.

Cavities can form on any part of the tooth. They have been found on the chewing surfaces of teeth, the roots, in between teeth, and the smooth front or back of teeth. The cavities that form on the chewing part of the tooth are most commonly seen in children. The deep pits and grooves on this portion of the tooth make it difficult to keep bacteria free. This is why sealants are placed on children’s adult molars soon after they erupt. The sealants cover the pits and grooves to protect against cavity formation. When we see cavities in between teeth they are the product of not flossing. By simply flossing these cavities are easily preventable. Plaque accumulation around the gum line on teeth is very common. When a patient is not brushing often or well the result in this area is decay. Decay on smooth surfaces such as around the gum line is the product of poor brushing. Root decay, on the other hand, occurs much easier. The root is less mineralized than the rest of the tooth. The lack of mineralization on the root means bacterial acids cause cavities to form there more quickly. If you have areas of root exposure using fluoride along with good homecare is vital.

Tooth decay is fully avoidable. Obviously brushing and flossing will be your ally in the fight against cavities. That is only one piece of the puzzle. Limiting frequent sugary snacks and drinks such as coffee with sugar in it will also help. Remember that if you suffer from dry mouth finding a way to treat it will be beneficial as well. Using fluoride can not only help to prevent decay but can remineralize the earliest stages of cavities. People with many cavities throughout their mouth should ask the dentist about prescription fluorides. If you have an unusually high amount of decay and don’t feel that any of these risk factors apply to you, it would be a good idea to investigate possible systemic risks. Even with multiple risk factors being present good homecare will remove the bacteria that cause cavities to form. Keep in mind that an ounce of prevention is worth a pound of cure!


Laura Dagostino, RDH

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