Tooth Decay FAQ

1. What is tooth decay or dental caries?
2. What are the stages of tooth decay?
3. What are the causes/risk factors that lead to tooth decay?
4. What are the signs and symptoms of Tooth Decay?
5. What are the different tests suggested to diagnose tooth decay?
6. What are the costs of Tooth decay tests in India?
7. What are the different treatment methods suggested for tooth decay?
8. What can you do for prevention of tooth decay?

1. What is tooth decay or dental caries?

   • Dental caries takes place due to bacteria in the mouth, which eat away at the enamel of the tooth
   • A cavity, or hole is formed at the place where the acid of the bacteria causes the enamel to wear away
   • If not treated, tooth decay can cause pain, infection and tooth loss
   • The tooth consists of three layers:
     1. The enamel is the hard outer layer which does not contain any blood vessels or nerves. Due to this, the enamel is not sensitive to pain.
     2. The dentine is the middle layer and forms most part of the tooth. It is soft and forms a covering for the next layer, the pulp. Dentine is also very sensitive to pain.
     3. The center of the tooth is called as the pulp. It contains blood vessels and nerves and is considered to be the living part of the tooth.
   • The more layers that are affected by the bacteria, more is the damage
   • Dental plaque is a thin, sticky film of bacteria that keeps forming over the teeth
   • Food and drinks that contain more sugar or starch (such as milk, bread, cookies, sodas, juices etc.), help the bacteria to produce acid
   • The acid helps to wear away the topmost hard layer called as the enamel
   • The acid attacks the teeth within twenty minutes after eating

2. What are the stages of tooth decay?

   • Stage 1:
     1. A white spot, the first sign of tooth decay, appears at the place where the enamel has been worn away
     2. Tooth decay can be stopped or reversed at this point
   • Stage 2:
     1. If the decay is not stopped over a period of time, the enamel starts decaying below the surface with the upper surface still intact
     2. The enamel surface might break, making the damage irreversible
   • Stage 3:
     1. The decay reaches the dentin
     2. A filling is enough to repair the damage
   • Stage 4:
     1. The pulp is infected
     2. The blood vessels and nerves start to die leading to pus-formation
     3. Root canal therapy is the only option for treatment
   • Stage 5:
     1. The infection reaches the root
     2. The bones around the tooth get infected causing severe pain
     3. It is the final stage of infection
     4. On the affected side, there is visible swelling of cheeks
     5. The dentist may prescribe pain killers and antibiotics

3. What are the causes/risk factors that lead to tooth decay?

   Things that make tooth decay more likely are:
   • Not brushing or flossing often or not visiting the dentist regularly for checking and cleanups
   • Eating sugary and starchy foods that feed the bacteria in the mouth
   • The body is lacking fluoride. Fluoride makes the teeth more resistant to plaque and acid produced by bacteria.
   • Not having enough saliva. Saliva helps to wash away food and protects the teeth. A dry mouth may be caused by
     1. Xerostomia, usually a side effect caused by medicines, where the mouth stops producing enough saliva
     2. Sjögren's Syndrome, a disease where the immune system attacks the body's moisture producing glands. In this case the salivary glands.
     3. Breathing through the mouth
     4. Old age
   • Suffering from diabetes
   • Smoking tobacco or breathing in second hand smoke
   • Children are more likely to suffer from tooth decay than adults. The minerals in the teeth of children are new and so, they are not very strong. It is easier for the bacteria to eat away these minerals and cause cavities.
   • Babies who are put to bed with a feeding bottle in their mouth suffer a high risk of infection. Tooth decay is caused by sugar in the milk, formula or juice. Though babies are not born with bacteria in their mouths, they can get them by sharing the same forks, spoons and utensils with adults.

4. What are the signs and symptoms of Tooth Decay?

   There is no symptom of tooth decay until a cavity has formed or the tooth has been infected. When this has happened, a person may suffer from:
   • Toothache: A continuous pain or an occasional short, jabbing pain
   • Tooth Sensitivity: Tenderness or pain while eating or drinking something hot, cold or sweet
   • Swelling in the gum near an infected tooth. This can be a sign of acute tooth decay or an abscessed tooth (pulp of the tooth is infected and a pocket of pus has formed next to it).
   • Bad Breath or a bad taste in the mouth
   • White, brown, gray or black spots on the teeth

5. What are the different tests suggested to diagnose tooth decay?

   When there is severe toothache, a dentist should be consulted. Even if the pain goes away, the tooth decay will keep growing and therefore treatment should be taken. If not, the cavity could worsen or the tooth may die. To diagnose the infection, the dentist:
   • Asks questions about previous dental and medical problems and care
   • Examines the mouth and the teeth with a small mirror
   • Probes the teeth with dental instruments to look for soft areas
   • X-ray tests are performed on the mouth and the teeth to see the extent of cavities and decay, which cannot be seen with the naked eye
   • Applies a non-toxic dye on the teeth and then washes it away. The dye sticks to the decaying area and is washed clean from healthy teeth. This is a brand new technique for tooth decay diagnosis.
   • Can use a high-tech laser for tooth decay detection

6. What are the costs of Tooth decay tests in India?

   The charges of tests may differ between cities, hospitals and diagnostic centers. To get a comprehensive price list of X-ray test for tooth decay, across various cities in India, click here.

7. What are the different treatment methods suggested for tooth decay?

   For pain and swelling, steps can be taken at home to relieve it
   • Ice or cold packs against the outside of the cheeks for 10 to 15 minutes at a time, several times a day
   • An over-the-counter pain medication like acetaminophen or ibuprofen can be taken
   The treatment for tooth decay depends on how severe it is:
   • For early stages:
     1. The dentist will talk to the patient about the amount of sugar in their diet or the frequency of their meals
     2. Then a fluoride gel or paste is applied to the infected area
     3. Fluoride helps to strengthen the enamel and protects the teeth by making them resistant to the acids from the plaque
   • For damaged enamel:
     1. If cavity has formed, a filling is done on the tooth. The dental decay is removed and a local anesthetic is used to numb the tooth and fill in the gap.
     2. If the damage is severe, the whole, or part of the tooth is replaced by a dental cap. It is a man-made substitute of a part of the tooth
     3. If the tooth decay has reached the pulp of the tooth, then root canal treatment is done. A root canal removes the diseased part. To know more about the pulp of the tooth, refer question 1 .
     4. Extraction of the tooth, if it is severely damaged. Replacement is done with the help of a denture, bridge or a dental implant.

8. What can you do for prevention of tooth decay?

   • Taking good care of teeth by brushing twice a day using fluoride toothpaste, in the morning as well as at night. Teeth should also be flossed daily.
   • Annual or biannual checkups at the dentist are essential, so that problems can be found before they get too serious
   • Snacking before going to bed should be avoided as food left in the teeth overnight is more likely to cause cavities
   • Staying away from food with lots of sugar like desserts, specially in-between meals and at least one hour before going to bed
   • Avoiding smoking and alcohol, as tobacco inhibits saliva production and alcohol decays the enamel
   • Fluoride supplements should be taken, after consulting a dentist
   For children:
   • Babies should not be put to sleep with a feeding bottle filled with milk, formula or juice
   • Children should not be fed in utensils which adults use, to avoid spreading of decay- causing bacteria
   • They should also brush twice daily using fluoride toothpaste
   • Children should be kept away from tobacco smoke
   • Dentists should be consulted about sealants for children, which help to protect their teeth