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Tooth Decay

“The use of fluoride-containing dentifrice (toothpaste) is critical for dental caries prevention.”
“Over 50% of 5-9 year olds have at least one cavity. This increases to 78% among 17 year olds.” – U.S. Surgeon General’s Report.

  1. What is tooth decay?
  2. What causes tooth decay?
  3. What are dental plaque, calculus and tartar?
  4. How does decay progress through the tooth?
  5. What are the symptoms of tooth decay?
  6. How does the dentist discover decay?
  7. Which tooth surfaces are most likely to decay?
  8. Why are regular brushing and flossing necessary?
  9. What measures should be taken to prevent tooth decay?
  10. How can decayed teeth be saved?
  11. Toothache/pain chart. What is causing my pain?

1. What is tooth decay?

  • Tooth decay is a disease that destroys teeth.
  • It can result in the loss of teeth if it is not treated.

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2. What causes tooth decay?

  • Tooth decay is caused by the bacteria in dental plaque.
  • The bacteria feed on dietary sugars and release acids, which dissolve and destroy the teeth.

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3. What are dental plaque, calculus and tartar?

  • Dental plaque is a thin coating of bacteria and food particles that sticks to teeth.
    • It cannot be rinsed off, but it can be removed by brushing, flossing and dental scaling.
    • It causes tooth decay and gum disease.
    • The longer that plaque is allowed to remain on teeth, the greater are the risks of gum disease.
  • If plaque is not removed, it can harden to form calculus, also called tartar.
  • Calculus should be removed by a dentist or hygienist, as it cannot be removed by brushing.
  • Diets rich in soft, sticky, carbohydrate foods (refined sugars) assist plaque formation.

See Diet and Decay

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4. How does decay progress through the tooth?

  • The first layer of tooth to be affected is the outermost, the enamel.
  • It then spreads to underlying dentine.
  • The decay can eventually reach the pulp, which is the name for the nerves and blood vessels of the tooth.
Click to enlarge
Spread of decay

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5. What are the symptoms of tooth decay?

  • The symptoms of decay will vary according to the extent to which it has spread into the tooth.
    • Decay is quite painless in the early stages when only the enamel is affected.
    • When decay has spread to the dentine, pain can be caused by sweet foods, such as chocolate, sugary snacks and drinks.
    • When the decay spreads deeper, sensitivity can be felt with hot and cold drinks.
    • Severe ongoing pain that is caused by hot food and drinks indicates that the nerves and blood vessels have become affected by the decay.
      This condition is called a pulpitis.

Visit our Pain Chart to learn more about the causes of pain (#11 above)

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6. How does the dentist discover decay?

  • The dentist uses a special fine explorer instrument to discover cavities that have developed.
  • Regular check ups by the dentist, and periodic x-rays will ensure that decay will be detected soon after it has started.
    X-rays can reveal decay that cannot be detected by visual dental examination.
  • A dull white patch on the tooth could be a sign of early decay.
Click to enlarge
Illustration of x-ray
showing decay

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7. Which tooth surfaces are most likely to decay?

  • The chewing surfaces of back teeth with their grooves and pits, are usually the first to decay.
    This is because dental plaque accumulates in these areas.
  • The tooth surfaces where adjoining teeth meet are also common places for decay to start.
  • Tooth decay can start around and under old fillings that have cracked, chipped or broken down.
  • Decay can also occur at the gum line, which is at the neck of the tooth.

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8. Why are regular brushing and flossing necessary?

  • Plaque formation is an ongoing process which starts again soon after brushing.
    This is why regular brushing and flossing are necessary to keep plaque off the teeth.
    • Brushing cleans mainly the surfaces of the teeth that can be seen.
    • Floss removes dental plaque from between the teeth where the toothbrush cannot reach.

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9. What measures should be taken to prevent tooth decay?

  • Tooth decay can be prevented by home care and oral hygiene, professional care and diet control.
  • Home Care and Oral Hygiene
    • Regular brushing and flossing are essential:
    • Brush your teeth at least twice a day, after breakfast and before bedtime.
    • Regular flossing will remove harmful plaque from the areas between teeth, that the brush cannot reach.
    • Special brushes and devices, prescribed by the dentist, can help to clean areas in the mouth that are difficult to reach.
    • Your dentist may recommend a mechanical or ultrasonic toothbrush to remove dental plaque.
    • The surface application of fluoride is made with the daily use of fluoride toothpastes and mouthwashes.
      Fluoride is a chemical that hardens the enamel of a tooth, and increases its resistance to decay. It can also help to stop the early stages of decay.
  • Professional care
    • Adults and children should see the dentist twice a year.
    • Regular visits to the dentist for professional examination and cleaning are essential.
    • The early detection and treatment of decay and gum disease will only be possible with regular dental inspection.
    • X-rays will help the dentist to find early signs of decay.
    • Fissure sealants can be applied to back teeth to protect them from decay.
    • Fluoride applied to the teeth by the dentist will also help to prevent decay.
Click to enlarge
Before sealants
Click to enlarge
After sealants
  • Diet Control
    • Reduce the amount of refined carbohydrate in your diet.
    • This includes the refined sugar found in table sugar, biscuits, cakes, chocolates, sweets, and fizzy soft drinks.
    • The acid in carbonated soft drinks, including diet drinks, is harmful to teeth.
    • Fruit, vegetables and juices, which contain natural sugars are preferable.

See Oral Hygiene, Diet and Decay, Fissure Sealants and Fluoride

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10. How can decayed teeth be saved?

  • Decayed teeth can in most instances be saved.
  • Early decay is easily treated by first removing the decay, and then replacing the lost tooth substance with a filling.
  • Larger areas of decay can be restored with inlay restorations or replacement crowns.
  • Even when decay has reached the nerves and blood vessels of the tooth, the tooth can still be saved. It is dealt with by having a root canal treatment, followed by restoration of the tooth.

See Tooth Restoration

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11. Toothache / pain chart. What is causing my pain?

Pain chart <!–

Pain chart 1 of 2

Pain chart 2 of 2–>

Pain severity
+ = Small degree
++ = Medium degree
+++ = High degree
Acute = Fast developing
Apical = End of root
Chronic = Slow forming
Periodontal = Around the tooth
Pulp = Nerves and blood vessels of tooth

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