Tooth decay, or dental caries, is the most common disease in the world, and one of the most preventable. It happens when bacteria in plaque feed on sugars and produce acid, and that acid slowly dissolves the enamel. At first this is invisible and painless. Given time, the acid breaks through into the softer dentine beneath, a cavity forms, and eventually the decay reaches the nerve.
The earlier decay is found, the smaller and simpler the treatment. That is the whole point of regular check-ups.
How decay develops
Every time you eat or drink something containing sugar, the bacteria on your teeth produce acid for around twenty to thirty minutes. Saliva then neutralises it and repairs the enamel with minerals. If sugar comes too often, the repair never catches up, and the enamel starts to lose more mineral than it regains. That early stage shows as a chalky white patch and can still be reversed. Once the surface breaks, it cannot.
Decay favours the places plaque hides: the grooves on the biting surfaces of back teeth, the tight contacts between teeth, around the edges of old fillings, and along the gum line where the root is exposed.
How we assess it
At an Oral Health Assessment we check every surface of every tooth, and take small X-rays to see between the teeth, where most adult decay starts and where it cannot be seen by eye. We will show you what we find, explain how deep it goes, and tell you which areas need treating now and which can be watched and remineralised.
Treatment options
Very early decay, before the surface has broken, can be halted with fluoride varnish, better cleaning and a change in how often sugar appears in your day. We keep an eye on these areas at each visit.
Once there is a cavity, the decay is removed and the tooth restored with a tooth-coloured filling. For larger cavities, where there is not enough tooth left to hold a filling, an onlay or crown protects what remains. If the decay has reached the nerve, root canal treatment removes the infection and saves the tooth. A tooth is only removed when it cannot realistically be restored.
Preventing decay
- Keep sugar to mealtimes rather than grazing through the day; it is frequency, not quantity, that drives decay
- Brush twice a day with a fluoride toothpaste, last thing at night, and spit rather than rinse so the fluoride stays on your teeth
- Clean between your teeth daily; that is where fillings most often start
- Water is the best drink between meals; fizzy drinks, squash and fruit juice all count as sugar
- Chewing sugar-free gum after eating helps saliva neutralise acid
- Children’s back teeth can be protected with fissure sealants
