Signs of tooth decay

Tooth decay is permanently damaged areas on the tooth surface, developing into tiny holes in the tooth. Tooth decay is caused by a combination of factors, including bacteria in the mouth, frequent snacking, sipping sugary drinks, and poor oral hygiene.

Tooth decay is the most common oral health problem in the world. Subjects susceptible to tooth decay: children, teenagers and the elderly. If cavities are not treated, they will grow larger and affect the layers of tooth structure, leading to severe tooth pain, infection and tooth loss.

Stages of tooth decay

1. Phase 1

The first stage of tooth decay occurs when teeth are exposed to large amounts of acid produced by plaque bacteria. When plaque on teeth is not cleaned, the tooth surface will gradually lose minerals. Stage 1 tooth decay can be detected by small white spots on the teeth, with signs of loss of minerals and tooth enamel.

2. Phase 2

The second stage of tooth decay is the process of breaking down tooth enamel. White spots on teeth due to mineral loss will turn brown. This is a sign that more minerals and tooth enamel are lost. Stage 2 of tooth decay causes tooth enamel to weaken.

3. Stage 3

Beneath the enamel there is tissue called dentin. When tooth enamel wears away, dentin is exposed. Because dentin is softer than enamel, it is more sensitive. With the impact of acids produced by plaque bacteria, dentin decomposes quickly. Dentin contains tubes that lead to the teeth's nerves, so when they decompose, you will feel sensitivity and mild pain.

4. Stage 4

When the dentin completely decomposes, the pulp will be exposed - the innermost part of the tooth. Nerves and blood vessels are located in the medulla. When tooth decay begins to affect the tooth pulp, the patient experiences irritation and swelling, increased sensitivity and pain in the affected tooth area. Early pulp damage can be treated and restore tooth health, but late-stage damage may require a root canal or tooth extraction.

5. Stage 5

Stage 5 is a stage of severe tooth decay because the pulp is severely damaged, bacteria spread and multiply inside the tooth, near blood vessels and nerves, leading to severe pulp inflammation and tooth abscess. Tooth abscesses cause severe pain that can spread into the jaw, requiring immediate treatment with antibiotics, root canal treatment, or worse, tooth extraction.

What are the causes of tooth decay?

Tooth decay is the result of bacteria and acids corroding tooth enamel and dentin, attacking the tooth pulp (1). Some causes of tooth decay include the following:

• Types of plaque: Dental plaque is a transparent, sticky film that covers the teeth. They form due to eating a lot of sugar, starch and poor oral hygiene. When sugars and starches are not cleaned from teeth, bacteria will quickly attack the tooth surface and form plaque. Plaque on teeth hardens below or above the gum line, forming tartar. Tartar makes plaque harder to remove and creates a shield for bacteria.
• Acids in plaque: acids produced from the sugar and starch metabolism of bacteria in plaque cause loss of minerals in tooth enamel, on the outside of the tooth surface. This corrosion causes tiny pits or holes in the tooth enamel. From the worn enamel area, bacteria and acids can penetrate into the next layer, dentin. This layer is softer than enamel and more susceptible to attack. Dentin has small tubes that connect directly to the tooth's nerves, causing sensitivity and pain.
• Bacteria and acids attack the dental pulp: as tooth decay develops, bacteria and acids continue to attack deep into the tooth structure, through the dentin to the pulp - where nerves and blood vessels are located. The gums become swollen and irritated due to bacteria, the swelling spreads inside the tooth, and the nerves are compressed, causing pain. The discomfort can even spread beyond the tooth root to the bone.

Risk factors for tooth decay

1. Tooth enamel

About 97% of tooth enamel is hydroxyapatite, the mineralized form of calcium phosphate. They make tooth enamel the hardest material in the body, even harder than bone. However, no matter how hard tooth enamel is, it can erode over time.

Tooth enamel loss is one of the main causes of tooth sensitivity and eventually leads to tooth decay. Some factors that cause you to lose tooth enamel include: the body's natural aging process, poor oral hygiene, eating habits, some related diseases such as gastric reflux,...

2. Tooth shape

The shape of the teeth has many protrusions and grooves, which are difficult to reach when brushing. Molars and premolars have many pits and fissures that are great for grinding food but also attract bacteria and food particles. It is difficult to clean every nook and cranny of your teeth, so these teeth often suffer from cavities and other problems.

3. Tooth position

Tooth decay most commonly occurs in molars. These teeth have a lot of grooves, pits and cracks, many roots can hold a lot of leftover food, and are more difficult to clean than front teeth.

4. Saliva

Saliva helps prevent cavities by washing away food and plaque from teeth. Substances found in saliva also help fight acids produced by bacteria. Certain medications, medical conditions, radiation therapy to the head and neck, or some chemotherapy drugs can increase the risk of tooth decay by reducing salivation.

5. Diet

Foods high in sugar, foods that easily stick to teeth, etc. such as milk, ice cream, honey, sugar, soda, dried fruit, cakes, cookies, hard candy and mints, dry cereals and chips ,... The habit of snacking, eating before bed, is more likely to cause tooth decay.

Frequent snacking or sipping on sugary drinks gives bacteria in the mouth more fuel to produce acids that attack and erode teeth. Drinking soda or other acidic drinks throughout the day causes more acid to come into contact with your teeth, eroding tooth enamel.

For children, before bed, if they use formula milk, juice, etc., these drinks will stay on the child's teeth for hours while the child sleeps, nurturing bacteria that cause tooth decay. This damage is often called bottle tooth decay.

6. Brushing teeth improperly

If you do not clean your teeth immediately after eating and drinking, plaque will form quickly and the first stage of tooth decay will begin.

7. Not getting enough fluoride

Fluoride is a natural mineral that helps prevent tooth decay and can even prevent early tooth damage. Because of this benefit, fluoride is added to many public water supplies. It is also a common ingredient in toothpaste and mouthwash. But bottled water usually does not contain fluoride.

8. Young children or the elderly

Tooth decay is common in children and teenagers. However, older people are also at higher risk. Over time, teeth can wear down and gums recede, making teeth susceptible to decay. Older people may also use a variety of medications that reduce saliva production, increasing the risk of tooth decay.

9. Old fillings

Over the years, dental fillings can weaken, begin to break down, or develop rough edges. They make it easier for plaque to build up and harder to remove.

10. Heartburn

Heartburn or gastroesophageal reflux disease (GERD) can cause stomach acid to reflux into the mouth, eroding tooth enamel and causing significant tooth damage. They make dentin more susceptible to bacterial attack, causing tooth decay. Your dentist may recommend that you consult a doctor to see if acid reflux is the cause of tooth enamel loss.

11. Eating disorders

Anorexia or bulimia can cause severe tooth erosion and cavities. Stomach acid from repeated vomiting can dissolve tooth enamel. Eating disorders also interfere with saliva production.

Is tooth decay dangerous?

Tooth decay is dangerous because it can cause serious and long-term complications, even for children who have not yet grown their permanent teeth. Complications of tooth decay may include:

• Painful.
• Tooth abscess.
• Swelling or pus around the tooth.
• Damaged or broken teeth.
• Chewing problems.
• Tooth position shifts after tooth loss.

When tooth decay becomes severe, you may have problems such as:

• Toothache interferes with daily activities.
• Weight loss or nutritional problems due to difficulty eating or chewing.
• Tooth loss.
• In rare cases, a tooth abscess - a pocket of pus caused by a bacterial infection - can lead to a more serious, even life-threatening infection.

Diagnosis of tooth decay

1. Confirm diagnosis

1.1. Diagnose tooth decay at an early stage by clinical signs.

Diagnosis is based on clinical symptoms, including signs such as: damage to the tooth decay area, dry white spots on the tooth surface, and change in color of the tooth decay area when exposed to fiber optic light. When using a fluorescent laser light to shine on the teeth and measure the demineralization index, the damaged and demineralized area will change the index from 10 - 20.

1.2. Diagnosis of cavities in the formation stage is based on clinical symptoms or X-ray images

Physical symptoms

When tooth decay occurs, patients often feel sensitivity when exposed to substances that taste sour, sweet, hot, cold, etc. The sensitivity will disappear when you stop contact.

Actual symptoms

Loss of hard tissue anywhere in the tooth, depth less than 4mm and not touching the pulp. The bottom of the damaged tooth is smooth and shows signs of rotting dentin, dark in color, brown or black. Damage caused by tooth decay is often concentrated in only one tooth, sometimes spreading to neighboring teeth, forming cavities. In the case of small hard tissue loss lesions, when examined with acupuncture, signs of damage can be found without clearly seeing the cavity.

Bone marrow test

• Blowing with air: the patient feels pain and the feeling of pain will disappear when blowing is stopped.
• Cold test: sensitivity and the feeling of sensitivity will disappear when the test is stopped.
• Hot test: the patient feels pain and the pain will disappear when the test stops.

X-ray images

Dentists use dental X-rays to diagnose tooth decay. The results obtained from photos can help detect tooth decay early.

2. Differential diagnosis

Early caries lesions are distinguished by color changes compared to non-carious teeth.

Can tooth decay be cured?

Tooth decay can be cured under the treatment regimen of dental specialists and dentists. In the early stages, the damage caused by tooth decay is mild and you can prevent further mineral loss by following proper oral hygiene steps. This helps prevent teeth from losing minerals and strengthens the enamel before tooth decay develops.

Methods of treating tooth decay

1. Treat tooth decay with Fluoride

If tooth decay is detected in its early stages, fluoride treatment can restore tooth enamel and prevent further decay.

2. Dental fillings

Dentists will fill cavities with a variety of dental materials (GIC, Composite...) that have been recognized for safety by the American Dental Association, FDA and other public health agencies. Cases of allergy to fillings are very rare.

3. Porcelain crowns

When tooth decay is so severe that there is not much healthy enamel left. The dentist will remove the damaged parts, then install a crown made from gold, porcelain or porcelain and metal to restore the shape and size of the tooth.

4. Root canal treatment

If the tooth root or pulp is dead or injured by tooth decay, it cannot be cured. The dentist will remove nerves, blood vessels, and tissue along with decayed parts of the tooth. They fill the cleaned root canal with dental material to seal the canal, preventing bacteria from entering again. You may need a crown to restore the size and shape of your tooth after a root canal.

5. Tooth extraction and tooth restoration

When you have severe tooth decay that damages the entire tooth, you need to have this tooth extracted. At this time, the dentist will offer many options to restore teeth, including implanting dentures to replace lost teeth.

How to treat tooth decay at home

• Sugar-free gum: Chewing sugar-free gum after meals has been shown in clinical trials to help remineralize tooth enamel. Sugar-free gum contains a compound called casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) which has been shown to clean tooth surfaces, preventing plaque from developing.
• Vitamin D supplementation: plays an important role in helping to absorb calcium and phosphate from the foods you eat. Vitamin D is abundant in dairy products, fresh milk and yogurt. You can also get vitamin D from the sun. Many recent studies have shown that vitamin D can affect oral health.
• Use toothpaste containing fluoride: this substance plays an important role in preventing tooth decay and remineralizing tooth enamel. Regularly brushing your teeth with fluoride toothpaste will prevent tooth decay.
• Reduce sugar consumption: The World Health Organization says that eating sugar is the most important risk factor for tooth decay. They recommend reducing your sugar intake to less than 10% of your total calorie intake for the day. Do not eat sugar during a certain period of the day, giving tooth enamel a chance to remineralize.

How to prevent tooth decay

• Brush your teeth regularly: use toothpaste containing fluoride, brush your teeth at least twice a day, ideally after each meal. Use dental floss and water pick. To clean between teeth, use dental floss and a water flosser at least once a day. (2)
• Use mouthwash: If you are at high risk for tooth decay, your dentist may recommend using a fluoride mouthwash.
• Regular dental visits: Professional teeth cleanings and regular dental checkups, can help prevent or detect tooth decay early.
• Sealant: a sealant is a protective plastic coating applied to the chewing surface of molars. It seals the grooves and cracks that tend to collect food, protecting tooth enamel from plaque and acids. The Centers for Disease Control and Prevention (CDC) recommends sealants for all school-aged children.
• Drink some tap water: most public water supplies have fluoride added, which can significantly help reduce tooth decay. If you only drink bottled water that doesn't contain fluoride, you'll miss out on the benefits of fluoride.
• Avoid snacking and sipping frequently: whenever you eat or drink a beverage other than water, it helps bacteria in your mouth produce acids that can destroy tooth enamel. If you snack or drink sweets throughout the day, your teeth are under constant attack.
• Eat foods that are good for your teeth: some foods and drinks are better for your teeth than others. Avoid food getting stuck in grooves and holes in your teeth for long periods of time or brush your teeth immediately after eating. However, foods such as fresh fruits and vegetables increase salivation, and unsweetened coffee, tea, and unsweetened gum help clear away food particles.
• Antibacterial treatment: if you are especially susceptible to cavities due to certain diseases, your dentist may recommend special antibacterial mouthwash or other treatments to help reduce harmful bacteria in your mouth .
• Combination treatments: chewing sugar-free gum along with prescription fluoride and antibacterial mouthwash may help reduce the risk of cavities.

Suspected tooth decay: When should you see a dentist?

You will not be able to notice the tiny holes caused by cavities, cavities attack your teeth silently. That's why you should have your teeth checked and cleaned regularly, even if you don't have any dental symptoms yet. When you have toothache or mouth pain, see your dentist as soon as possible.