Last modified on October 2020
With inputs from Dr. Pragnya Rao - General Physician
“Dental caries, or tooth decay, can be prevented by adopting healthy lifestyle habits and practicing good hygiene. Limit your consumption of sugary foods as they can damage your enamel. You should also make it a point to brush your teeth at least two times a day. If possible, also gargle your mouth with a fluoride-enriched mouthwash to keep your teeth healthy.”
– Dr. Pragnya Rao, General Physician
The high incidence of severe dental caries in India is also often attributed to the increased consumption of processed and sugary foods as well as inadequate exposure to fluoride in both drinking water and oral hygiene products. The shortage of access to quality dental caries treatment adds to the woes.
Most dental diseases and issues are largely preventable. Educating and encouraging Indian families to adopt a healthy oral care regimen, regular screening, and early detection and dental caries treatment will ensure a lower risk of oral diseases like dental caries in India.
This article will discuss the causes of dental caries, along with its symptoms, dental caries treatment and prevention strategies.
“Dental caries” or what is commonly termed “tooth decay” is caused when there is a breakdown of the tooth enamel.
The term was originally derived from the Latin word “caries”, which means “decay” and is used to describe cavities or holes in the teeth.
Dental caries affects a significant number of the Indian population as well as people worldwide. This prevalent, microbial and progressive oral disease develops due to bacterial adhesion to the teeth, primarily Streptococcus mutans, which are acid-producing bacteria that colonize the dental surface and breakdown or demineralize the teeth.
The ‘Global Burden of Disease Study 2017’ estimates that around 2.3 billion people suffer from caries of the permanent teeth globally and over 530 million children suffer from tooth decay or caries in their primary teeth.
While dental caries themselves are generally not life-threatening, untreated cavities can lead to discomfort, pain, tooth abscess or infection and even tooth loss. These are some of the common signs of dental caries. The financial costs of tooth caries treatment are also considerable, and it can significantly impact a person’s quality of life, as well as lead to lost time at school or on the job.
Keeping in mind these negative implications, therefore, it is important not to neglect dental care and pay attention to the signs of dental caries.
There are some distinct causes of dental caries or decay of the tooth. They occur when there is a buildup of bacteria in the mouth. Not all bacteria, however, cause gum and tooth infections.
The mouth hosts a wide variety of bacteria. Generally, Streptococcus mutans, Streptococcus sobrinus, and lactobacilli are found to the recurrent type of dental caries bacteria. These bacteria feed on the food debris on the surface of the teeth and produce a harmful acidic byproduct that can destroy the teeth.
Saliva, fluoride toothpaste, increased intake of calcium-rich foods, multivitamins and certain lifestyle changes can halt this demineralization process and prevent tooth decay from progressing. But in the absence of these remineralization factors, the bacteria will collect around the gums and teeth as a sticky, pale yellow film and gradually break down the hard tissues of the teeth, causing dental cavities or caries.
Numerous factors can contribute to the occurrence of tooth decay, gum disease or dental caries in India. Besides factors such as income, oral health literacy, access to dental care and the ability to perform a daily oral hygiene routine, here is what causes dental caries:
According to the Centers for Disease Control and Prevention (CDC), diabetes patients are especially prone to problems of the gum and teeth.
– Dental caries or tooth decay is an oral disease that occurs when certain bacteria produce acids that destroy the outer covering or enamel of the teeth.
– A type of bacteria called Streptococcus mutans is one of the main dental caries bacteria.
– The possible etiology of dental caries includes high consumption of sugary and refined foods, consumption of alcohol or use of tobacco, certain medical conditions or just poor oral hygiene.
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Most people who experience tooth decay or develop dental caries may, unfortunately, experience no significant symptoms until the tooth has already been considerably affected. Dental caries in India has become a common sight due to the lack of regular visits to the dentist. Routine dental visits and examinations are, therefore, both necessary and important to detect the earliest signs of dental caries.
The following are some possible symptoms that may indicate that dental caries or cavities are developing:
Toothache or pain is the most common symptom of dental caries. Patients may experience sudden or lingering pain or pain when they bite down on food.
Tooth sensitivity is another common sign of enamel erosion and vulnerability to tooth decay. When the enamel of the tooth wears away, it will expose the dentin beneath, allowing hot and cold sensations to seep through to the nerves inside the tooth. Some people may also experience a lingering or persistent sensitivity to sweet foods.
As dental erosion happens and the outer layers of the tooth wear down, a pit or hole may become noticeable. Patients may be able to see this when they look in the mirror or feel it when they run their tongue over the surface of their teeth. If the cavity or hole is in between the teeth or in the crevices or grooves of the teeth and is particularly small, however, only a dentist may be able to detect it.
A chalky white spot or stain on the surface of the tooth is often the earliest sign of tooth decay. This indicates an area of enamel demineralization and is referred to as a “microcavity”. As demineralization continues to occur the area or spot may turn brown and will gradually progress to form a cavity.
If the decay of the tooth has progressed considerably, patients may experience sharp or jarring pain when they bite down on food. It’s also possible that a tooth is weakened by extensive internal decay. In this case, it can also fracture under normal chewing forces.
The image above illustrates the five stages of tooth decay. Periodontitis or the last stage of caries development can result in severe gum infection, the loss of tooth and may even lead to other serious health complications.
– In the early stages, when cavities are just beginning to develop, there may be no noticeable dental caries symptoms.
– As dental caries or tooth decay begins to progress, symptoms such as toothache, pain or sensitivity while chewing, stains on the surface of the teeth, bad breath, and pits or holes may manifest.
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As dental caries in India is prevalent and plaguing, the diagnosis of dental caries becomes imperative. It is normally done using x-rays and the visual-tactile method. A dentist will first examine all the visible tooth surfaces of the patient using dental probes, a good source of light, and a dental mirror.
The crown and the surrounding parts of the tooth may be inspected for large dental caries, especially on the smooth occlusal surfaces. For smaller cavities that are not often apparent to the naked eye, however, radiographs or x-rays may be employed.
Radiographs or x-rays are not just better at detecting hidden caries; they are also useful to judge the extent of destruction to the tooth. If cavities are identified, they may be treated using a variety of micro-invasive or non-invasive techniques such as sealing and remineralization. In case of extensive decay though, a crown restoration or root canal may be done.
The various methods of dental caries treatment have been discussed in more detail below.
After the dentist or oral hygienist has conducted an initial examination of the patient’s gums and teeth, appropriate dental caries treatment recommendations will be made depending on the extent of decay or damage to the tooth structure for dental caries in India.
Early-stage tooth decay can in some cases be reversed, or at least its progression can be prevented, giving way to dental caries treatment. But if the cavity is deep or the decay has advanced considerably, extensive dental caries treatment may be required, and reversing dental caries becomes impossible.
The following are the dental caries treatment options that may be suggested depending on the diagnosis of dental caries which aims at reversing dental caries:
Fluoride treatment is generally recommended for early-stage tooth decay and dental caries treatment of small cavities. Fluoride will help to remineralize or rebuild tooth enamel that has eroded and will stop or help in reversing dental caries.
Dentists in India typically recommend periodic fluoride dental caries treatments for patients who do not get enough fluoride through drinking water, foods, toothpaste, mouth rinse or other dietary supplements.
A professional fluoride dental caries treatment will involve a foam, gel, solution or varnish that is applied to the teeth with a brush or cotton swab or placed in a tray and held in the mouth.
If tooth decay has progressed beyond the early stages and the tooth has a small hole or cavity, it may be repaired with a filling. Dental caries filling or restoration for dental caries is usually made of various materials including porcelain, tooth-colored composite resins, or dental amalgam.
The fillings are placed after the decay has been drilled out, and a local anesthetic may be offered to reduce discomfort during the procedure. Dental caries filling is a commonly opted procedure for dental caries treatment in India.
For teeth that have severe dental caries and are extensively decayed or cracked, dentists may recommend prosthetic restorations or dental crowns on account of dental caries treatment. These crowns are primarily placed to protect and encase weak teeth that have extensive fillings, cracks, or holes. Each crown is custom made to perfectly fit over the original tooth and may be made of different materials including gold, ceramic, resin or porcelain fused to metal.
Root canal or endodontic dental caries treatment is recommended for tooth decay in adults. This is usually done when a tooth is badly damaged or infected. During a root canal treatment, the pulp of the affected tooth will be removed, and the inside of the tooth will be cleaned, disinfected, filled and sealed. The tooth may also be fitted with a dental crown for protection.
Tooth extractions are recommended as a last resort if the tooth is severely decayed and cannot be restored. If a tooth is removed, the dentist may advise filling the gap with a partial denture, bridge or implant, so that the patient’s speech and ability to chew is not impaired.
– Dental caries are generally detected using the visual-tactile method and x-rays.
– Treatment options for dental caries include fillings or restorations, fluoride dental caries treatment, dental crowns, root canal or tooth extraction depending on the extent of tooth decay.
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When it comes to dental health, the age-old adage ‘Prevention is better than cure’ could not be more accurate: dental issues and dental caries treatment can be both traumatic and expensive. Hence preventing dental caries is always a more economical and healthier option.
Poor oral health is also linked to several diseases including heart attack, stroke, diabetic complications, irritable bowel syndrome, intestinal failure and other digestive disorders. In advanced cases, it can even cause fertility problems, interfere with fetal health and development and increase the chances of delivering low-weight, pre-term babies.
The World Health Organization or WHO, therefore, emphasizes prevention over dental caries treatment. Most of us struggle with the thought of how to prevent caries. Preventing dental caries and other oral health diseases is easy if a few simple and inexpensive measures like the ones given below are followed:
Frequent and proper brushing removes plaque and food debris from the surfaces of the teeth. The American Dental Association (ADA) recommends brushing daily. Patients must brush twice a day at least with a fluoridated toothpaste for a minimum of two minutes.
Regular flossing is essential for cleaning the proximal surfaces of the teeth. Tongue cleaners or tongue scrapers should also be used to remove food debris and dead cells from the tongue’s upper surface and prevent fungal infections.
Rinsing the mouth after meals will dislodge any loose debris or food particles stuck in between the teeth. For patients prone to an increased risk of dental caries and gum disease, using an antiseptic or fluoridated mouthwash from time to time may also help to soothe symptoms.
Visiting your dentist on an ongoing basis and getting your teeth cleaned professionally are an essential part of preventive dental care. This will ensure that any dental problems are addressed promptly and with appropriate care.
Dental sealants can serve as a protective coating for tooth enamel. This thin plastic coating, when painted on the chewing surfaces of the back teeth, will seal off the crannies and grooves of the teeth and safeguard it from bacteria and plaque.
The Centers for Disease Control and Prevention (CDC) recommends dental sealants for children of school-going age particularly.
Good oral health is also closely tied to a well-balanced diet. You should try to limit your intake of refined foods and sugar and adopt a diet rich in fruits, fibres, and vegetables.
Alcohol consumption should be limited, and smoking and the use of tobacco must be stopped. Chewing sugar-free gum can stimulate salivary flow and neutralize harmful acids released by cavity-causing bacteria.
– Treating dental problems can be expensive and traumatic and, therefore, prevention is better than cure.
– Regular brushing, flossing, rinsing the mouth, going for regular dental check-ups with a dentist and limiting consumption of alcohol and other sugary and refined foods can help prevent caries and cavities
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Ignoring cavities or leaving them untreated could lead to potential complications, and one of the key contributors to dental caries in India. Patients should be aware of all the difficulties that can arise so that they can visit their dentist promptly.
The following are some possible complications that can arise from leaving dental caries untreated:
If cavities are neglected for long, it will allow bacteria to continue to penetrate deeper into the tooth. This can affect the nerve and will cause severe or intense pain.
Dental caries can weaken the tooth structure and may put the tooth at an increased risk of cracking or breaking. This structural damage may also cause pain or problems while chewing food.
Untreated dental caries can result in rapidly developing tooth decay. If the tooth decay advances to the pulp of the tooth, it may result in swelling and pus around the tooth.
A tooth abscess or tooth infection is a pocket of bacteria and pus that form inside gums and teeth that are decaying. If a tooth abscess is not treated promptly, the infection can spread to other parts of the body and may even develop into sepsis, which is life-threatening.
Leaving cavities alone for a prolonged time can result in severe periodontal disease and eventually loss of permanent teeth in adults.
– Ignoring dental problems or leaving them untreated can lead to potential complications.
– Possible complications of untreated caries can include severe or chronic pain, difficulty chewing, pus formation, tooth abscess and even tooth loss.
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Q1. Who is at risk for dental caries?
Children, adults and teens are all at risk for developing dental caries. However, people who have a family history of dental cavities, eat foods high in sugar, snack frequently, have fractured or cracked teeth, suffer from xerostomia or dry mouth, and have undergone head or neck radiation therapy are at an increased risk.
Q2. Is flossing essential?
Yes, flossing is essential. Flossing is a useful method for getting rid of food particles and bacteria that a toothbrush cannot get to or reach.
Q3. How often should I visit my dentist?
Most dentists recommend that patients visit for regular check-ups and professional cleaning every six months. Some dental clinics may, however, only schedule annual appointments. For patients with ongoing dental problems, more frequent visits to the dentist may be advised.
Q4. Why are regular dental check-ups necessary?
Regular dental check-ups are necessary for early dental caries detection and treatment of dental problems. Most people pay a visit to the dentist only when they have a problem and sometimes, not before the problem has reached an advanced stage. When this happens, restoration and treatment of the tooth may become both difficult and expensive.
Q5. Why is smoking harmful to the teeth?
Smoking is harmful as it contains chemicals that can affect the salivary flow in the mouth. Without enough saliva, it becomes easier for oral bacteria to stick to the gums and teeth. It can also cause bad breath and yellowish stains on the surface of the teeth.
Q6. What are some natural ways to prevent dental caries?
Natural treatment for dental cavities includes oil pulling, chewing on sugar-free gum, taking vitamin D supplements, avoiding foods that are high in phytic acid or using clove oil or liquorice root.
Q7. Do cavities or tooth decay in babies need to be treated?
Yes, baby tooth decay requires treatment. When tooth decay in babies is not treated, it can affect their overall development.
Q8. How are front teeth cavities in toddlers treated?
Treatment of front teeth cavities in toddlers may include removing the decayed part of the teeth and replacing it with restoration materials or fillings. Veneers, inlays, crowns and bridges may also be placed in some cases if the tooth is weak and can fracture under pressure. A pediatric dentist will decide the appropriate course of treatment after considering factors such as the child’s overall health, age, and symptoms.
Treating dental caries through procedures such as fillings, crowns restorations, or root canal therapy is painful and fairly expensive. In India, the cost of treating tooth decay with a filling can range from Rs. 500-1500 per tooth, while a root canal treatment can range from approximately Rs. 1500-12,000.
Most of these therapeutic interventions are also only meant to ease the dental problem and will not replace the lost enamel or restore the original tooth. Preventive care is, therefore, safer and much more effective.
Regular dental screenings, proper brushing and flossing and a well-balanced diet are some simple ways to dramatically lower the risk of dental caries and tooth decay.