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Dental cavities

Definition

Dental cavities are holes (or structural damage) in the teeth.

Alternative Names

Caries; Tooth decay; Cavities - tooth

Causes

Tooth decay is a common disorder, second only to the common cold. It usually occurs in children and young adults, but can affect any person. Tooth decay is a common cause of tooth loss in younger people.

Bacteria are normally found in your mouth. These bacteria change foods -- especially sugar and starch -- into acids. Bacteria, acid, food pieces, and saliva combine in the mouth to form a sticky substance called plaque. Plaque adheres to the teeth. It is most common on the back molars, just above the gum line on all teeth, and at the edges of fillings.

Plaque that is not removed from the teeth turns into a substance called tartar or calculus. Plaque and tartar irritate the gums, resulting in gingivitis and periodontitis.

Plaque begins to build up on teeth within 20 minutes after eating. If it is not removed, tooth decay will begin.

The acids in plaque damage the enamel covering your teeth, and create holes in the tooth (cavities). Cavities usually do not hurt, unless they grow very large and affect nerves or cause a tooth fracture. An untreated cavity can lead to a tooth abscess. Untreated tooth decay also destroys the inside of the tooth (pulp), which will require more extensive treatment, or worse case removal of the tooth.

Carbohydrates (sugars and starches) increase the risk of tooth decay. Sticky foods are more harmful than non-sticky foods because they remain on the teeth. Frequent snacking increases the time that acids are in contact with the surface of the tooth.

Symptoms

There may be no symptoms. If symptoms occur, they may include:

  • Tooth pain or achy feeling, particularly after sweet, hot, or cold foods and drinks
  • Visible pits or holes in the teeth

Exams and Tests

Most cavities are discovered in the early stages during routine dental checkups.

A dental exam may show that the surface of the tooth is soft.

Dental x-rays may show some cavities before they are visible to the eye.

Treatment

Treatment can help prevent tooth damage from leading to cavities.

Treatment may involve:

  • Fillings
  • Crowns
  • Root canals

Dentists fill teeth by removing the decayed tooth material with a drill and replacing it with a material such as silver alloy, gold, porcelain, or composite resin. Porcelain and composite resin more closely match the natural tooth appearance, and are preferred for front teeth. Many dentists consider silver amalgam (alloy) and gold to be stronger, and these materials are often used on back teeth. There is a trend to use high strength composite resin in the back teeth as well.

Crowns or "caps" are used if tooth decay is extensive and there is limited tooth structure, which may cause weakened teeth. Large fillings and weak teeth increase the risk of the tooth breaking. The decayed or weakened area is removed and repaired. A crown is fitted over the remainder of the tooth. Crowns are often made of gold, porcelain, or porcelain attached to metal.

A root canal is recommended if the nerve in a tooth dies from decay or injury. The center of the tooth, including the nerve and blood vessel tissue (pulp), is removed along with decayed portions of the tooth. The roots are filled with a sealing material. The tooth is filled, and a crown is needed in most cases.

Outlook (Prognosis)

Treatment often saves the tooth. Treatment is less painful and less expensive if it is done early.

You may need numbing medicine (lidocaine) and prescription pain medicines to relieve pain during or after dental work.

Nitrous oxide with local anesthetic or other medicines may be an option if you are afraid of dental treatments.

Possible Complications

  • Discomfort or pain
  • Fractured tooth
  • Inability to bite down on tooth
  • Tooth abscess
  • Tooth sensitivity

When to Contact a Medical Professional

Call your dentist if you have a toothache.

See your dentist for a routine cleaning and exam if you have not had one in the last 6 months.

Prevention

Oral hygiene is necessary to prevent cavities. This consists of regular professional cleaning (every 6 months), brushing at least twice a day, and flossing at least daily. X-rays may be taken yearly to detect possible cavity development in high-risk areas of the mouth.

Chewy, sticky foods (such as dried fruit or candy) are best if eaten as part of a meal rather than as a snack. If possible, brush the teeth or rinse the mouth with water after eating these foods. Minimize snacking, which creates a constant supply of acid in the mouth. Avoid constant sipping of sugary drinks or frequent sucking on candy and mints.

Dental sealants can prevent some cavities. Sealants are thin plastic-like coatings applied to the chewing surfaces of the molars. This coating prevents the buildup of plaque in the deep grooves on these surfaces. Sealants are often applied on the teeth of children, shortly after the molars come in. Older people may also benefit from the use of tooth sealants.

Fluoride is often recommended to protect against dental caries. People who get fluoride in their drinking water or by taking fluoride supplements have less tooth decay.

Topical fluoride is also recommended to protect the surface of the teeth. This may include a fluoride toothpaste or mouthwash. Many dentists include application of topical fluoride solutions (applied to a localized area of the teeth) as part of routine visits.

References

Chow AW. Infections of the oral cavity, neck, and head. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 60.

Bader JD, Rozier G, Harris R, et al. Dental caries prevention: The physician's role in child oral health systematic evidence review [internet]. Rockville, Md. Agency for Healthcare Research and Quality (US); 2004 Apr.

Chou R, Cantor A, Zakher B, et al. Preventing dental caries in children <5 years: systematic review updating USPSTF recommendation. Pediatrics. 2013:132(2); 332-50.


Review Date: 2/25/2014
Reviewed By: Ilona Fotek, DMD, MS, Palm Beach Prosthodontics Dental Associates, West Palm Beach, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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