Dental cavities, also known as tooth decay or dental caries, are damaged areas on the hard surface of your teeth. This common issue arises when acids, formed by bacteria in your mouth breaking down sugars and starches from food, erode the tooth’s protective outer layer, the enamel. Addressing these areas of decay promptly is important to prevent them from enlarging and causing more significant problems.
How Cavities Progress
Tooth decay begins with initial demineralization, where acids cause the enamel to lose minerals, often appearing as white spots on the tooth surface. If this demineralization continues untreated, the enamel breaks down further, and these white spots may darken to a brownish color, leading to the formation of cavities.
As the decay deepens, it reaches the dentin, the layer beneath the enamel. Dentin is softer than enamel and contains tiny tubules that lead to the tooth’s nerve, making decay progress faster and often causing increased sensitivity. If the decay continues, it will eventually reach the pulp, the innermost part of the tooth. This can lead to irritation and swelling within the pulp, which, due to the confined space, can press on the nerves, causing pain.
Recognizing Advanced Cavity Symptoms
As a cavity progresses, symptoms become more noticeable, indicating a serious stage of decay. Persistent toothache, ranging from mild discomfort to severe, throbbing pain, is a common sign, especially when chewing or biting down. Heightened sensitivity to hot, cold, or sweet foods and drinks can also signal that decay has reached deeper, more sensitive layers of the tooth, like the dentin.
Visible changes can include dark brown or black spots, or noticeable holes or pits on the tooth surface. In advanced stages, an unpleasant taste in the mouth or persistent bad breath may occur due to bacterial activity within the decay. Swelling or pus around the affected tooth, along with tenderness or redness of the gums, can indicate a bacterial infection has spread to the surrounding tissues, potentially forming an abscess.
When a Simple Filling Is No Longer Possible
A simple dental filling is typically effective for cavities confined to the enamel and early stages of dentin involvement. However, a filling becomes an insufficient solution when the decay has advanced significantly, particularly when it reaches the tooth’s pulp. The pulp houses the tooth’s nerve and blood vessels, and once bacteria invade this area, it can lead to irreversible inflammation or infection.
At this stage, a filling alone cannot address the infection or damage to the pulp. Attempting to place a filling over an infected pulp would not resolve the underlying issue and could trap bacteria, potentially worsening the infection. If the cavity has caused a throbbing toothache or intense pain that lingers after exposure to hot or cold, it often signifies pulp involvement, making a traditional filling no longer a viable treatment. Delaying treatment at this point allows bacteria to spread further, potentially leading to an abscess or even tooth loss.
Alternative Treatments for Advanced Decay
When tooth decay has progressed beyond the point where a simple filling is effective, other procedures become necessary to save the tooth and alleviate symptoms. Root canal therapy is a common treatment for advanced decay that has reached the tooth’s pulp, causing infection or significant damage. During this procedure, the infected pulp is carefully removed, the inside of the tooth is cleaned and disinfected, and then filled with a rubber-like material called gutta-percha to seal it. This process helps to stop the infection from spreading and can save the tooth from extraction.
Following a root canal, a dental crown is often placed over the treated tooth. A dental crown is a custom-fitted cap that covers the entire tooth, restoring its shape, size, and strength, and providing protection against further damage. Crowns are also used for large cavities where there isn’t enough healthy tooth structure remaining to support a traditional filling.
When decay is too extensive to save the tooth, extraction may be the only option. This involves surgically removing the tooth from its socket to prevent infection from spreading and to relieve severe pain. After extraction, options like dental implants or bridges can be considered to replace the missing tooth and maintain oral function.
Avoiding Advanced Cavities
Preventing cavities from reaching an advanced stage involves consistent oral hygiene practices. Brushing your teeth at least twice a day with fluoride toothpaste for two minutes each time helps remove plaque and food particles that contribute to decay. Flossing daily is equally important, as it cleans between teeth and below the gumline where toothbrushes cannot reach, removing plaque from about one-third of tooth surfaces.
Limiting the consumption of sugary and starchy foods and drinks also reduces the fuel for acid-producing bacteria in your mouth. Drinking fluoridated water can further strengthen tooth enamel and help remineralize early areas of decay. Regular dental check-ups, typically every six months, are important for early detection of cavities before they become painful or require extensive treatment. Dentists can identify and address small areas of decay, sometimes even reversing them with fluoride treatments.