The Facts

Tooth decay (cavities) affects almost all of us to some degree at some point in our lives. It usually occurs in children and young adults but can affect people of any age because as we grow older, the exposed root surfaces of teeth can be susceptible to decay.

Tooth decay is the most common cause of tooth loss for younger people. You can help prevent tooth decay with good oral hygiene and a proper diet. Seniors are also prone to tooth decay, mostly due to the multiple medications they take.


Tooth decay starts when acids produced by bacteria in plaque eat away at tooth enamel. Plaque is a paste-like substance that adheres to the teeth and is formed by the combination of bacteria, acid, food, and saliva. Bacteria in plaque convert all foods, especially sugar and starch, into acids. The acids in plaque dissolve the enamel of the tooth, causing tooth decay or cavities.

There are several factors that contribute to tooth decay, such as:

  • poor dental care
  • frequently eating sugars and carbohydrates
  • low fluoride
  • a condition called xerostomia, or dry mouth, where the body does not make enough saliva
  • tooth defects such as pits and grooves
  • highly acidic environment in the mouth
  • medications which cause dry mouth

Symptoms and Complications

In the early stages, tooth decay rarely causes symptoms. However, when tooth decay has been present for a long time, the most common symptom is a toothache or sensitivity to hot, cold, sweet, or pressure. Another symptom may be a bad taste in your mouth.

The most common complication occurs when tooth decay reaches the nerve, the root, and the area at the base of the tooth. When this happens, the tooth nerve may die and, if left untreated, an abscess can develop.

Making the Diagnosis

A dentist can identify tooth decay with an oral examination. Cracks and small holes can be detected by your dentist and decay causes these areas of the tooth to soften.

Dental X-rays are sometimes needed to detect tooth decay that has not yet caused symptoms or is in between teeth.

Treatment and Prevention

If you have a toothache, non-prescription pain relievers (e.g., acetaminophen, ibuprofen) can be taken while you’re waiting for dental evaluation. Teething pain in young children can be treated the same way if the pain is not severe.

The treatment for tooth decay depends on its severity. However, once tooth decay has destroyed part of a tooth, the tooth cannot regenerate. Dentists will recommend a treatment that preserves the tooth or teeth and also prevents complications.

If the decay has just started, it may be possible for you to stop the process with a professional cleaning followed by fluoride treatments. Fluoride helps tooth enamel to recalcify, which repairs the enamel.

If you have a cavity, the standard treatment is a filling. With a filling, the decayed tooth material is removed and replaced with a hard material such as amalgam (a mixture of several metals), gold, porcelain, or composite resin. Crowns, or "caps," are used if the decay is extensive and removing the damaged parts leaves the tooth structurally weak. Crowns are made of gold, zirconia, porcelain, or a combination of porcelain and metal or porcelain and zirconia. You may need a root canal if the nerve of your tooth becomes infected or dies.

If teeth are so badly decayed that they have to be removed, they may need to be replaced with artificial teeth. This may mean a bridge, implants, or dentures. Bridges are typically composed of three or more artificial teeth joined together. These are cemented in place and do not come out. With implants, a titanium pin is inserted into the supporting bone, which fuses with the bone to grip it firmly and make it stable. Once it's secure, a single artificial tooth can be attached to it. Multiple teeth can also be replaced with implants. Dentures are a form of removable full or partial set of teeth. They are usually fixed to adjacent teeth by clasps or various chemical fixatives. Implants can also be used to hold dentures in place, these can be screw-in or snap-in type.

Good oral hygiene is the most important way to prevent tooth decay. Take care of your teeth and gums by brushing your teeth, flossing, and visiting your dentist regularly.

Tips for brushing your teeth:

  • Brush at least twice a day with fluoride-containing toothpaste.
  • Use a soft toothbrush and ensure that you brush gently for at least 2 minutes a day (most people do not brush long enough).
  • An electric toothbrush cleans better than a manual toothbrush.
  • Place the toothbrush at a 45-degree angle where the teeth meet the gums.
  • Brush gently in a sweeping movement. Vigorous brushing can damage gums and teeth.
  • Make sure that all tooth surfaces are brushed.
  • Remember to brush your tongue.

To clean babies' teeth, use a gauze square to wipe the teeth clean until a toothbrush can be used.

Tips for flossing:

  • Floss at least once a day.
  • Floss gently, because harsh flossing can damage your gums.
  • Remember that if your gums bleed, you may be flossing too hard, or your gums may not be healthy. See your dentist for advice.
  • A water flosser (e.g., Waterpik®) may replace flossing and control bacterial growth at the gum line.

These other tips may also help prevent cavities:

  • Eat nutritious meals and limit snacking. If you must eat sweet foods, do so during regular meals, when your mouth contains more protective saliva.
  • If you chew gum, switch to a sugarless brand. Chewing gum that contains xylitol also has decay preventative properties.
  • If your water supply does not contain fluoride, talk to your dentist about fluoride supplements.

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