Even though cavities allow dental professionals like me to stay in business, I do wish that scientists can soon find a solution to this million-year-old problem. I have had a lot of dental work done over the years and fully understand what kind of physical, emotional, and financial pain cavities can cause. Until that solution becomes available, we should focus on cavity prevention, which will save all of us a lot of time, money, and frustration in the long run. 

Doctor Babic, what exactly is a cavity?

A cavity is what you get from tooth decay- damage to a tooth. It CAN be prevented. However, it usually gets bigger, and intervention is needed to prevent further progress.

What are the signs and symptoms of a tooth cavity?

The symptoms of a cavity will depend on how large it is and where it is in your mouth. Small cavities most likely won’t cause any pain or symptoms. However, you may notice the following with big cavities:

• Pain when you eat or drink sweet, hot, or cold things
• Constant throbbing pain that wakes you up at night
• Holes you can detect with your tongue or finger
• Stains (black/brown/white)
• Pain when you bite down

Children usually get cavities on the biting surface while most adults get cavities on both the biting surface and between teeth. Among elderly people, cavities on the tooth root are common because gums often shrink and because saliva production decreases. I will talk more about the relationship between saliva and cavities later.

What causes cavities?

News flash! In everyone’s mouth, there are bacteria that can cause cavities. You may think your mouth is a sterile environment, but everyone has the cavity-causing bacteria. Those bacteria break down food debris or sugar on the tooth surface, and they produce acids afterward (think of them as excretions). The acids are what lead to tooth decay and damage. The bacteria particularly love sugar, as sugars are their main energy source. Therefore, people who consume a lot of sugar-rich foods get a lot of acids produced by the bacteria and are susceptible to cavities.

The good news is that saliva in your mouth often protects your teeth from this damage because it is somewhat alkaline/basic and prevents food debris and sugar from sticking to your teeth. If you spend more money than what you have or make, you will become broke. If you produce more acids than what your saliva can buffer, you will get tooth decay.

Studies have shown that frequent snacking gives your teeth and saliva less time to recover from the damage caused by acids, so this is something to be mindful of.

The following things put you at a greater risk of getting cavities:

• Sticky foods and drinks– Bacteria love these!
• Improper brushing– If you leave food debris and sugar in your mouth, you are giving bacteria more opportunities to create acids (or their excretions)!
• Lack of fluoride in your drinking water– Fluoride found in toothpaste, mouthwash, and some tap water helps to prevent cavities and can reverse early tooth damage.  
• Dry mouth– Without protection by saliva, your teeth become more susceptible to decay. People who are on many medications or have conditions reducing saliva production are at risk
• Eating disorders and acid reflux– Stomach acid can dissolve the outer layer of your teeth 

Gotcha. What should I do to lower my chance of getting cavities then?

These are what I strongly recommend you to do:

• Brush twice a day, two minutes each time with a fluoride toothpaste (some people need extra-strength fluoride toothpastes)
• Floss daily (I can’t stress the importance of it enough)
• Eat a balanced diet and cut down on snacking.
• See Dr. Babic or Dr. Tien at Comfydent Smiles for regular checkups and cleanings. 🙂

Doctor Babic, how do you find cavities?

I use X-Ray images to find cavities forming between teeth (Look at the image above). Biting surface cavities are found with a probing instrument that looks like a hook. If there is a sticky spot, I know there is a cavity. Most dentists recommend a dental visit every 6 months because it takes several months for a cavity to become noticeable and because it is best to address the issue when it is small. 

What are my treatment options if I have a cavity or multiple cavities?

Treatment depends on how bad the cavity is. Every tooth has multiple layers. Small cavities contained within the outermost layer (or enamel) can sometimes be reversed with fluoride and improved oral hygiene.

If the cavity gets to the dentin layer, which is right underneath the enamel, then I need to take out the decayed portion of the tooth with a drill. The type of restoration to be placed after removing the decay depends on the amount of the remaining tooth structure:

• Filling– This is my first option because it is the most conservative option. For this to make sense, there should be a lot of healthy tooth structure after removal of decay. Fillings, if too big, are susceptible to fracture. The available materials are silver alloy, gold, porcelain, or a composite resin. Each material has different physical properties and appearance. Some people have raised concerns about mercury-based fillings called amalgams, but the American Dental Association, the FDA, and other public health agencies are of the opinion that amalgams are safe.
• Crowns– These are placed when there is not enough tooth structure for durable fillings. These work by bracing the remaining tooth structure. The available materials are gold, porcelain, porcelain-fused-metal, and zirconia.
• Root canal therapy– A root canal is necessary when the decay advances to the pulp layer (see the images above). Think of the pulp layer as the nerve. Pulp damage usually accompanies severe pain and cause an abscess. When the pulp is damaged (or when there is a tooth nerve damage), the dentist removes the decay and the entire pulp layer in order to get you out of pain and to put medication into the space. A crown is often needed after a root canal procedure to prevent tooth fracture (any tooth becomes more brittle after a root canal).
• Extraction– This is the last resort. A root canal is not worthwhile when there is little healthy tooth structure above the gum line.

It is my duty as a health care provider to not only treat dental cavities but also raise awareness of the public. Next week, I will talk about what causes bad breath and what you can do to be more attractive to your partner or your date. 🙂

If you have any more questions regarding this topic, please submit your question here or book an appointment with our doctors here.