Main
- Caries starts with the enamel: acids from the bacteria in plaque leach minerals out of it, and at this stage there is usually no pain.
- The destruction reaches the dentine: then a brief reaction to cold or sweet appears, and afterwards a cavity forms.
- Frequent sweet snacks are more harmful than a single portion: each snack re-acidifies the environment in the mouth and prolongs the attack on the enamel.
- It is treated by a dental therapist: at the spot stage, monitoring and remineralisation are possible; when the dentine is affected, the tissue is removed and a filling is placed.
- An examination and targeted X-rays once every year to eighteen months help to spot hidden defects between the teeth before they make themselves felt.
What is tooth decay
Caries is the destruction of the hard tissues of the tooth by acids produced by plaque bacteria. We look at how this process starts, what speeds it up and who experiences it more often.
What happens in the body
The hard tissues of the tooth are destroyed by acids produced by plaque bacteria. Plaque is a sticky film that constantly forms on the surface of the teeth and is retained in the grooves and at the gum margin. The bacteria in plaque break down sugar from food and drinks and release acid directly onto the tooth surface. The acid gradually leaches minerals from the enamel, and it becomes softer and more pliable. In the early stage this process is not painful, so a person usually notices nothing and does not change their habits. The longer plaque stays in one place, the deeper the acid penetrates into the tooth tissues. It is precisely because there is no pain at the start that destruction is noticed late, when it is harder and more expensive to correct.
What causes it to develop
- Plaque: a sticky film of bacteria accumulates on the teeth and holds the acid at the surface, preventing saliva from washing it away.
- Frequent sugar: what matters is not so much the total amount of sweets as how often they are consumed during the day.
- Five sweets at once: sweets eaten one after another give one acid attack, while those spread over the day give several separate ones.
- Hard-to-reach places: the grooves on the chewing surface and the spaces between the teeth retain plaque longer than smooth areas.
- Saliva: it washes away food residues and partly returns minerals to the enamel, so its work affects the tooth's resistance.
- Conclusion: destruction is triggered not by one-off sweets but by a combination of retained plaque and frequent sugar intake.
Who experiences it more often
Destruction of the hard tissues of the tooth occurs in people of any age, but in some it progresses faster than in others. In children the enamel is not yet mature, and in older people it is thinned, so both groups are more vulnerable to acid attacks. Those who frequently snack on sweets during the day get more acid attacks than those who eat sweets rarely and all at once. People with dense plaque in the grooves and spaces between the teeth lose minerals faster because saliva hardly reaches there. Crowded teeth and fillings create additional places where plaque is retained longer than usual. In those who produce less saliva, natural protection is weaker, and the tooth tissues are destroyed more noticeably. That is why it is important to look not only at the amount of sweets but also at how often they enter the mouth.
What symptoms can occur?
Early-stage tooth decay is almost imperceptible, so it is not always possible to notice it on your own. Characteristic signs help you understand that the process has affected the sensitive layers, and when they appear, a visit to the doctor should not be postponed.
How it is noticed at the very beginning
Early tooth decay causes no sensations at all, and only a doctor can notice it during an examination. A person usually does not feel any changes until the process reaches the sensitive layers of the tooth. The first signal is often a brief reaction to cold or sweet things, which quickly passes. Sometimes food begins to get stuck between the teeth in the same place, and this repeats day after day. The tongue may catch on roughness on the surface of the enamel, although outwardly the tooth looks normal. Such little things are easy to put down to fatigue, lack of sleep or accidental sensitivity after hot tea. If nothing is changed, a visible spot gradually appears on the enamel, and then a cavity. Having noticed any of these signs, it is reasonable to show the tooth to a dentist without waiting for pain.
The signs that occur most often
- A chalky or dark spot on the enamel: the area differs in colour from the rest of the surface and signals the onset of destruction.
- A brief reaction to cold and sweet things: the unpleasant sensation quickly passes on its own, but indicates that the protection of the enamel is compromised.
- Food getting stuck between the teeth in the same place: constant repetition points to a hidden cavity or a change in the contact between the teeth.
- Roughness that the tongue catches on: the surface is no longer smooth, and this is noticeable when the tongue moves along the row of teeth.
- A visible cavity: there is already a hollow in the tooth, and in this case a visit to the doctor should not be postponed.
When to seek help urgently
Examinations and tests
Examination for caries begins with an inspection of the oral cavity and clarification of complaints. Additional methods help to see what is hidden from the eyes and to distinguish caries from other conditions.
How the examination begins
The examination begins with an inspection of the oral cavity, and the doctor uses a probe and a mirror. The mirror helps to examine hard-to-reach areas, while the probe checks tissue density and sensitivity. On the contact surfaces between teeth, the defect is often covered by the neighbouring tooth and remains invisible. Therefore, once every year to a year and a half, targeted images are taken to assess the condition of hidden areas. If probing causes pain, this changes the course of the examination and requires clarification. Checking the reaction to cold helps to distinguish caries from pulpitis when complaints are ambiguous. It is worth recalling in advance when the unpleasant sensations appeared and telling the doctor about it.
What is prescribed and what it shows
What is worth preparing for the appointment
- Discharge summaries: past dentist's conclusions show how the condition of the teeth has changed and help the doctor see the dynamics.
- Images: previously taken X-ray images allow comparison of the picture and avoid repeating unnecessary investigations.
- Complaints: describe when and from what the unpleasant sensations appear, this clarifies the direction of the examination.
- Chronology: recall how long ago you noticed the changes and whether you have sought help about this before.
- Questions: formulate in advance what you want to clarify with the doctor so as not to forget at the appointment.
Which doctor should I see?
The section explains which doctor to consult for tooth decay, what happens at the first appointment and what stages the treatment consists of. It also separately covers which part of the result depends on how regularly you are seen by a specialist.
Which specialist manages this condition
Tooth decay is managed by a dental therapist, that is, a doctor in the "Dentist" field who treats teeth without surgical intervention. If there is no such specialist nearby, make an appointment with a general dentist at the state polyclinic at your place of residence. At the first appointment the doctor examines the oral cavity, assesses the condition of each tooth and determines how deeply the hard tissues are affected. The condition of fillings and the edges of the gums is checked separately, because that is where plaque most often accumulates. If the lesion is noticeable only as a change in the colour of the enamel, the doctor may suggest observation and remineralisation without a drill. When the destruction has already reached the dentine, the affected tissues are removed and a filling is placed. The patient should gather information about previous treatment in advance so that the doctor can assess the picture more accurately.
What the treatment consists of
- Examination and assessment: the doctor studies the condition of each tooth and determines the depth of the lesion in order to choose the appropriate scope of care.
- Remineralisation: at the spot stage the enamel is strengthened and the tooth is taken under observation, so a drill may not be needed.
- Removal of affected tissues: the destroyed areas are removed in order to stop the process from spreading further inside the tooth.
- Filling: the cleared cavity is filled with a filling and the shape of the tooth is restored, returning its chewing function.
- Checking the result: the doctor assesses how accurately the surface has been restored and sets the date of the next examination.
What depends on the patient themselves
How regularly you are seen by a dentist determines how early new changes on the teeth can be noticed and how much the treatment will cost. If a person comes for an examination at the time appointed by the doctor, the lesion is more often detected at the spot stage, when a drill can be avoided. With long intervals, the process manages to reach the dentine, and then removal of tissues and a filling are already required. The patient decides for themselves whether to maintain oral hygiene and whether to come for a follow-up appointment, and this directly affects the condition of the fillings. The edges of a filling wear down over time, and destruction that is invisible from the outside may begin again underneath them. A person who postpones the visit until pain appears usually faces a deeper lesion. Therefore, it is sensible to keep the same schedule of examinations and not to miss the dates appointed by the doctor.
What helps prevent an exacerbation?
Preventing a flare-up of caries is helped not by a one-off effort, but by a stable set of daily habits and regular check-ups at the dentist. Below is what exactly depends on the person themselves and why these actions reduce the risk of repeated damage to the hard tissues of the tooth.
What to change in your habits
Brushing your teeth twice a day with fluoride toothpaste takes only two minutes, but it is precisely this that removes the soft plaque in which the bacteria that destroy enamel live. Floss or interdental brushes are needed where the toothbrush does not reach — in the spaces between the teeth and along the gingival sulcus, and without them the plaque remains untouched. Sweet snacks between main meals are more dangerous than a dessert at the table, because each snack re-acidifies the environment in the mouth. Snacking on sweets less often is more beneficial than simply eating less sweets at a time: frequency matters, not just quantity. Professional hygiene once every six months removes dense plaque and tartar in places the home toothbrush cannot reach. In children, fissure sealing is carried out on the permanent chewing teeth — the natural grooves on the surface of the tooth are sealed so that food remnants do not linger there. If you brush your teeth immediately after acidic food or drink, you can damage the softened enamel, so it is better to wait and rinse your mouth with water.
What should be kept under control
- Regularity of brushing: twice a day for two minutes with fluoride-containing toothpaste — a basic measure that cannot be replaced by occasional intensive brushing.
- Spaces between the teeth: floss or an interdental brush helps clean the areas inaccessible to the toothbrush, and it is precisely there that new damage most often begins.
- Frequency of sweet snacks: the more often sugar is in the mouth, the longer the acidic environment that destroys enamel persists.
- Condition of the edges of fillings and crowns: over time gaps form there in which plaque accumulates, so these areas are examined at every visit.
- Professional hygiene: once every six months it removes plaque and tartar in hard-to-reach places and allows changes to be noticed at an early stage.
- Fissure sealing in children: coating the natural grooves on the permanent chewing teeth reduces the risk of damage in the most vulnerable zones.
How often to see the doctor
A regular check-up at the dentist is needed even when the teeth do not hurt and look healthy on the outside, because the initial changes in the enamel are often unnoticeable. A chalky spot may appear on the surface of the tooth without pain and without a cavity — at this stage the intervention is minimal, whereas an advanced process already requires a completely different amount of work. The doctor examines not only the visible surfaces, but also the spaces between the teeth, the edges of fillings and crowns, where plaque accumulates. Professional hygiene once every six months removes what cannot be removed by a home toothbrush, and at the same time allows the condition of the tissues to be assessed over time. If a person wears braces, has crowded teeth or often snacks on sweets, the intervals between visits should be discussed separately. In children, fissure sealing is carried out on the permanent chewing teeth, and the timing of its re-examination is also determined by the doctor. Skipping check-ups when feeling well is the most common reason why changes are detected late, when it is already more difficult to preserve one's own tissues.
What is worth remembering
Caries develops gradually and does not make itself known for a long time, so it is useful to keep it in mind even when there are no complaints. Below are the conclusions that help to understand the essence of the disease and to notice changes in time.
Main conclusions
Caries begins with damage to the hard tissues of the tooth under the action of acids produced by bacteria in dental plaque. First the enamel is affected, and at this stage a person usually feels no pain and does not notice any changes. Then the process involves the dentine located under the enamel, and then a reaction to sweet, cold or hot appears. Next, a cavity forms, into which food debris and microbes get, and the inflammation may spread to the nerve of the tooth. A check-up at the dentist and attention to one's own sensations while eating help to notice the onset. Regular tooth brushing and limiting frequent sweet snacks reduce the risk, but do not replace a professional examination. If pain appears or a dark spot on the tooth is noticeable, a visit to the dentist should not be postponed.
