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Tooth decay or dental caries results from a bacterial infection of your teeth. The millions of bacteria in the mouth break down consumed foods and drink with high carbohydrate content especially sugars or starches into acid.

The acid then combines with the bacteria, the saliva in your mouth, and small particles of food to produce a sticky film known as plaque. Over time the plaque begins to break down the surface of your tooth.

Tooth decay is one of the most widespread health problems in the UK and Jersey. 55% of adults in the UK have one or more decayed or unsound teeth. Tooth decay is also a problem for children. It is estimated that between 52% and 77% children aged 8 to 15 years have some obvious tooth decay in their permanent teeth.

As well as being one of the most widespread health conditions, tooth decay is also one of the most easily preventable ones. Limiting your consumption of sugar and starchy foods, as well as sugary drinks and brushing your teeth with fluoride toothpaste at least twice a day should prevent tooth decay.

There are a number of techniques that can help repair damaged teeth, such as fillings, and crowns. In more advanced cases of tooth decay, the tooth may need to be removed.

Symptoms

Tooth decay does not cause any symptoms until it has reached an advanced stage. This is why it is important to have regular dental check-ups as it is much easier to successful treat tooth decay in an early stage.

Most adults over 18 years and all teenagers and children under 18 years should have a check-up every six months. Your dentist will be able to recommend when you should have your next check-up.

The symptoms of advanced tooth decay include:

Toothache
Tooth sensitivity - you may experience tenderness or pain when eating or drinking something hot, cold, sweet, or breathe in cold air.
Grey, brown or black discoloured spots on your teeth.
Bad breath
Unpleasant taste in your mouth.

Plaque and the structure of your teeth

If you consume food or drinks high in carbohydrates, the bacteria will break down the carbohydrates into acid. This acid combines with the bacteria and food particles to produce plaque, which forma a thin film covering the surface of your teeth. The tooth is made up of:

Enamel - which is the hard outer coating of a tooth
Dentine - which is a softer, bone-like material that supports the enamel
Pulp - this is the centre of the tooth; the pulp is made up of soft tissue and contains nerves and blood vessels.

Plaque will first erode the enamel forming a small hole or cavity in the surface. This cavity then decays through into the dentine which is much softer than enamel so it allows the decay to accelerate. Without treatment, the plaque and bacteria enter and infect the pulp causing sometimes severe pain due to the exposed nerves.

Risk factors for tooth decay

There are a number of risk factors for tooth decay. These are:

Diet - consuming foods and drinks that are high in carbohydrates, specifically fermented carbohydrate increases the production of plaque and the risk of tooth decay. Tooth decay is often associated with sweet and sticky things, such as chocolate, sweets, sugar and fizzy drinks. However, you should be aware that starchy foods, such as crisps, white bread, pretzels, and biscuits also contain high levels of fermented carbohydrates. How often you consume these sorts of foods and drinks is more important that how much you consume. If you are constantly snacking throughout the day then the plaque has more time to attack your teeth.
Poor oral hygiene - people who do not regularly brush their teeth are at a higher risk of tooth decay. You should brush your teeth at least twice a day. Though ideally, you should brush your teeth after each of your three main meals of the day.
Smoking have a higher chance of developing tooth decay as the tobacco smoke interferes with the saliva production, which helps keep the surface of your teeth clean. Studies have also shown that passive smoking can also be a risk factor, particularly for children. (See mouth cancer and smoking articles)
Dry mouth - people who have low saliva levels in their mouth are at a higher risk of developing tooth decay. There are also some medicines which can lower the saliva level in your mouth, such as :
- Tricyclic antidepressants
- Antihistamines (used in the treatment of allergies)
- Some antiepileptic medicines
- Some antipsychotic medicines
- Beta-blockers (used to treat a number of heart conditions)
Radiotherapy can lower saliva levels in your mouth. If you are taking a medicine, or receiving a treatment, known to cause dry mouth you should drink plenty of water and make sure you have a good and effective oral hygiene regime.
Eating disorders - both anorexia and bulimia can increase the risk of tooth decay. Anorexia can interfere with salvia production while the vomiting associated with bulimia can expose the teeth to corrosive stomach acids.
Gastro-oesophageal Reflux Disease (GORD) is a digestive condition where the stomach leaks acid back and up into the throat. In some cases, the acid enters the mouth and erodes the surfaces of teeth.

Diagnosis

Your dentist should be able to spot tooth decay early by examining your mouth and/or taking X-Rays of your mouth. The types of cavities are as follows:

Pit cavities - these usually occur on the top of your back teeth and can quickly lead to more extensive tooth decay if not treated,
Smooth surface cavities - these occur on the flat surface of your tooth often at the gumline.
Root cavities - these occur on the tooth root and are more common in older people where the gums have receded.

Treatment

Fluoride is probably the most effective treatment available for preventing and limiting the spread of tooth decay. It is a naturally occurring chemical sometimes present in the water supply at an appropriate level. However in Jersey the mains water supply has little fluoride level (see article on Fluoride). Fluoride:

Helps repair damaged tooth enamel
Helps reduce the acid forming bacteria and plaque in your mouth.

Toothpaste, mouthwash and gels often contain fluoride to help you improve your oral hygiene.

Fillings and crowns - If a tooth has decayed, it may be necessary to repair the damage with a filling or crown. A filling is a small piece of either metal or resin (a type of plastic) that your dentist uses to replace the missing enamel. Some times it will be necessary to drill away some of the damaged tooth before placing the filling. Crowns are used to treat teeth that have been extensively damaged. The decayed section of the tooth is drilled away and then the crown is placed over the remaining section of the tooth. Crowns are made out of gold or porcelain.

Root canal treatment - If the decay has reached into the pulp it will be necessary to remove the pulp and replace the space left in the tooth with a root canal treatment. Further treatment will be required to restore the tooth after root canal treatment.

Tooth extraction - In the most serious cases of tooth decay the tooth may require removal to prevent the spread of infection. Losing certain teeth can affect the shape and function of the surrounding teeth so it may be necessary to replace the tooth with a denture, bridge or implant at a later stage.

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