What is tooth decay or dental caries? ದಂತ ಕುಳಿ ಎಂದರೇನು?
Tooth decay also known as dental caries is one of the most common health problems across the world. Tooth decay causes destruction (demineralization) of the hard structures and organic matter of the tooth.
Tooth decay or dental caries begin as holes or cavities on the surface of teeth which allows for further accumulation of food particles. If left untreated, it can spread to deeper layers of the tooth. This can cause a serious problem in the form of Abscess or pus accumulation. Dental caries can be very painful and lead to tooth infection.
ದಂತ ಕುಳಿಯನ್ನು ಹುಳುಕು ಹಲ್ಲು ಎಂದೂ ಕರೆಯಲಾಗುತ್ತದೆ. ಇದು ಇಡೀ ಮಾನವ ಕುಲವನ್ನು ಕಾಡುವ ತೊಂದರೆ. ಬಾಯಿ ಅಸಂಖ್ಯ ಸೂಕ್ಷ್ಮ ಜೀವಿಗಳ ಆಗರ. ಹಲ್ಲುಗಳ ಮೇಲೆ ಆಹಾರ ಪದಾರ್ಥ ಬಹು ಕಾಲ ಇದ್ದಾಗ ಸೂಕ್ಷ್ಮ ಜೀವಿಗಳು ಅದರ ಮೇಲೆ ದಾಳಿ ಮಾಡುತ್ತವೆ. ಇದರಿಂದ ಹಲ್ಲಿನ ಹೊರಪದರದ ಮೇಲೆ ಆಮ್ಲೀಯತೆ ಉಂಟಾಗುತ್ತದೆ.
ಇದು ಹಲ್ಲು ಹುಳುಕಿನ ಮೊದಲ ಹಂತ. ಆ ಸ್ಥಳದಲ್ಲಿ ಕುಳಿ ಪ್ರಾರಂಭವಾಗುತ್ತದೆ. ನಂತರ ನಿಧಾನವಾಗಿ ಅದು ಹಲ್ಲಿನ ಇತರ ಪದರಗಳನ್ನು ಪ್ರವೇಶಿಸುತ್ತದೆ.
What are the causes of tooth decay?ದಂತ ಕುಳಿಯ ಕಾರಣಗಳೇನು?
The main cause of tooth decay or dental caries is the accumulation of food for long periods on and in between the teeth. Bacteria in the mouth act on these food substrates & produce acids like lactic acid. These acids cause de-mineralisation of the tooth surface leading to cavitation.
- Increased frequency of food intake
- Intake of sticky and soft foods
- Lack of proper oral hygiene habits
- Faulty contacts between teeth
- Dry mouth
Are some of the causes of tooth decay.
- ಹಲ್ಲುಗಳ ಮೇಲೆ ಅಥವಾ ನಡುವೆ ಆಹಾರ ಪದಾರ್ಥದ ನಿರಂತರ ಸಂಗ್ರಹಣೆ
- ದಂತ ಸ್ವಚ್ಚತೆಯ ಬಗ್ಗೆ ತಿಳುವಳಿಕೆ ಇಲ್ಲದಿರುವುದು ಅಥವಾ ಸ್ವಚ್ಚತೆ ಕಾಪಾಡದಿರುವುದು.
- ಬಹು ಬಾರಿ ಆಹಾರ ಸೇವನೆ. ಇದರಿಂದ ಹಲ್ಲಿನ ಮೇಲೆ ನಿರಂತರವಾಗಿ ಆಹಾರ ಪದಾರ್ಥದ ಸಂಗ್ರಹಣೆ
- ಸಿಹಿ ಹಾಗೂ ಮೃದುವಾದ ಆಹಾರ ಪದಾರ್ಥಗಳು ಹಲ್ಲಿನ ಮೇಲೆ ಅಂಟಿಕೊಂಡು ದಂತಕುಳಿಗೆ ಕಾರಣವಾಗುತ್ತವೆ
What are the symptoms of tooth decay?
Dental caries or tooth decay during initial stage does not show any symptoms. But on careful examination, the following symptoms of dental caries can be observed.
· Initially a chalky white spot is seen on the affected tooth surface.
· Gradually a cavity is formed. Food gets lodged in the cavity.
· Affected areas of the teeth get darker.
· At further stages, the tooth gets sensitive to hot or cold food, sweets & drinks. Bad breath.
· Severe pain on pulpal infection & pus accumulation.
At the advanced stages of tooth abscess, a bitter sensation can be felt in mouth.
What are the stages of tooth decay?
Tooth decay begins on the enamel surfaces of teeth and gradually spreads to the deeper layers. The stages of tooth decay are:
Enamel Caries: Enamel is the outermost layer of the tooth. Acid produced from bacteria acts on the enamel surface and produces cavities. At this stage, the tooth is pain-free. Food tends to get lodged in these cavities.
Dentinal Caries: Dentine is the second layer of the tooth structure. It is sensitive to changes in temperature of food & Ph(acid content). When tooth decay spreads to dentinal layer, patients may experience sensitivity or pain upon consuming food or liquids.
Pulpal Infection: Pulp is the innermost part of the tooth structure. It will have blood & nerve supply to the tooth. Once the decay spreads to the pulp, the tooth is infected.
Gradually, the infection spreads to the entire pulp and destroys it. Pus gets accumulated around the roots applying pressure over the nerve endings. This tooth abscess leads to severe pain.
ಹಲ್ಲಿನಲ್ಲಿ ಮುಖ್ಯವಾಗಿ ಮೂರು ಪದರಗಳಿರುತ್ತವೆ. ಅದರಂತೆ ದಂತ ಕುಳಿಯು ಮೂರು ಹಂತಗಳಲ್ಲಿರುತ್ತದೆ.
- ಹೊರಗಿನ ಬೆಳ್ಳಗಿನ ಪದರ ಎನಾಮೆಲ್-ಇಲ್ಲಿ ಕುಳಿಯ ಮೊದಲ ಹಂತ.ಆದರೆ ಆಹಾರವು ಕುಳಿಯಲ್ಲಿ ಸಿಕ್ಕಿ ಹಾಕಿಕೊಳ್ಳುತ್ತದೆ.
- ನಡುವಿನ ಹಳದಿಯ ಪದರ ಡೆoಟಿನ್ -ಎನಾಮೆಲ್ ಪದರದ ನಂತರ ಡೆoಟಿನ್ ಗೆ ಹುಳುಕು ಪಸರಿಸುತ್ತದೆ.ಈ ಹಂತದಲ್ಲಿ ಹಲ್ಲಿನಲ್ಲಿ ಛಳಕು ಕಾಣಿಸಿಕೊಳ್ಳಬಹುದು. ಹಲವರಿಗೆ ನೋವಿನ ಅನುಭವ ಆಗಬಹುದು
- ಮಧ್ಯ ಭಾಗದಲ್ಲಿ ಮೃದುವಾದ ಪಲ್ಪ್- ರೋಗಾಣುಗಳು ಇಲ್ಲಿ ಪ್ರವೇಶಿಸಿದಾಗ ಹಲ್ಲಿನಲ್ಲಿ ನೋವು ಕಾಣಿಸಿಕೊಳ್ಳುತ್ತದ.ಚಿಕಿತ್ಸೆ ಪಡೆಯದಿದ್ದಲ್ಲಿ ಸೋಂಕು ಬೇರುಗಳಿಗೆ ವ್ಯಾಪಿಸಿ ಕೀವು ಉಂಟಾಗುತ್ತದೆ. ತೀವ್ರ ನೋವಿನ ಅನುಭವ ಆಗುತ್ತದೆ.
What is the treatment for tooth decay or dental cavities?
The decayed tooth is treated by removing the defective structure of the tooth with drills. Once healthy tooth structure is reached, the cavity will be filled with suitable tooth filling materials.
The type of filling material chosen depends upon the stage of tooth cavity.
Decay in Enamel: The decayed portion of the tooth is cleaned and permanent restorative or filling materials like composite or silver amalgam are used to fill the cavity. These filled materials restore natural contours to the tooth structure and prevent further food accumulation, spread of infection or pain in the tooth.
Decay in Dentin: The type of filling material used is based on the proximity of the cavity to the inner pulp. If the cavity is not very close to the pulp, a permanent filling material like composite or silver amalgam is used to fill the cavity.
In case of deeper cavities, a protective sub-base and base of cement is given below the filling material to protect the sensitive pulp from thermal and chemical shock.
If the cavity wall is very close to the pulp, a lining of calcium hydroxide and a temporary restorative material are given to stimulate the formation of a protective layer between cavity and pulp. This is an attempt to save the pulpal structure from infection. If the tooth responds positively to this procedure, a permanent restoration is used to fill this cavity at a later stage.
Decay extending to the Pulp: Now the tooth is infected. Hence it cannot be filled with routine filling materials. A procedure called RCT or Root Canal Treatment needs to be carried out to clear the infection. The infected pulp is removed, canals cleaned and filled. Then the cavity is restored with permanent filling materials and a crown is put. This ensures long life for the tooth.
What are the various tooth filling materials?
Dental Filling Materials
Today, several dental filling materials are available. Teeth can be filled with gold; porcelain; silver amalgam (which consists of mercury mixed with silver, tin, zinc, and copper); or tooth-colored, plastic, and materials called composite resin fillings. There is also a material that contains glass particles and is known as glass ionomer. The location and extent of decay determines the type of filling. Let us discuss all the types of fillings.
Silver amalgam is a combination of one part liquid mercury with one part of a metallic alloy which mainly contains silver and tin. It has been used for over 150 years to restore decayed teeth and the mixture sets relatively fast to form a hard alloy. However its use has stirred controversy from the earliest days. To make the amalgam, mercury is mixed with the other metals to form a paste that can be filled in the tooth cavity.
Advantages of silver amalgam
- Durability -- silver fillings last at least 10 to 15 years and usually outlasts composite (tooth-colored) fillings.
- Strength -- can withstand chewing forces
- Expense -- is less expensive than composite fillings
Although dental amalgam is extremely strong and durable and may still be considered a material of choice for some fillings in the back teeth, it has some drawbacks.
- It is not tooth-colored so it is very visible; even more so in front teeth.
- It does not adhere to the surface of the tooth cavity, so dentists have to drill out relatively large holes in the teeth to securely fasten the filling.
- It contains mercury that is toxic in some forms. There is concern that mercury could be released during placement, normal corrosion and wear, and removal of a filling, and that it could lead not only to local effects in the mouth but also to effects in the body as a whole, for instance on the nervous system.
- Discoloration -- amalgam fillings can create a grayish hue to the surrounding tooth structure
- Allergic reactions -- a small percentage of people, approximately 1%, are allergic to the mercury present in amalgam restorations.
Cast Gold Fillings
Until recently, gold was considered to be the esthetic restoration for posterior teeth, as it does not discolour the teeth and the colour gold was considered less objectionable than other materials. As we have become more aware of esthetics in dentistry, we also have developed new techniques, even with gold, which do not destroy the beauty of a smile.
Advantages of gold fillings
- Durability -- lasts at least 10 to 15 years and usually longer; doesn't corrode.
- Strength -- can withstand chewing forces
- Gold Supports and Protects the Enamel Margins of the Tooth.
- Gold Does Not Absorb Oral Fluids : Saliva and other oral fluids will not penetrate the surface of a gold casting
- Gold Does Not Produce tooth discoloration: Gold castings do not produce discoloration of the tooth, which may occur from ion penetration with silver amalgams.
- Gold Castings Can Be Cemented Successfully Without Adhesive Bonding.
- Wear of the Gold Restoration Is Similar to Normal Wear of Tooth Structure.
- Gold Does Not Liberate Toxins.
Disadvantages of gold fillings
- Expense -- gold cast fillings are expensive; up to 10 times higher than cost of silver amalgam fillings.
- Galvanic shock -- a gold filling placed immediately next to a silver amalgam filling may cause a sharp pain (galvanic shock) to occur. The interaction between the metals and saliva causes an electric current to occur. It's a rare occurrence, however.
- Aesthetics –Many patients do not like metal "colored" fillings and prefer fillings that match the rest of the tooth.
- Gold Castings Require Considerable Care, Skill and Technique From the Operator. It also requires multiple sittings.
Resin composite fillings are made of ceramic and plastic compounds. Since resins mimic the appearance of natural teeth, these fillings have been used in front teeth for years. When they first appeared, however, resin compounds weren't strong enough to be used in back teeth, where high-pressure grinding and chewing require greater durability.
Advantages of Composite Fillings
- Aesthetics -- the shade/color of the composite fillings can be closely matched to the color of existing teeth. Composites are particularly well suited for use in front teeth or visible parts of teeth.
- Bonding to tooth structure -- composite fillings actually chemically bond to tooth structure, providing further support.
- Versatility -- in addition to use as a filling material for decay, composite fillings can also be used to repair chipped, broken, or worn teeth.
- Tooth-sparing preparation -- sometimes less tooth structure needs to be removed compared with amalgam fillings when removing decay and preparing for the filling.
Disadvantages of Composite Fillings
- Lack of durability -- composite fillings wear out sooner than amalgam fillings (lasting at least five years compared with at least 10 to 15 for amalgams); in addition, they may not last as long as amalgam fillings under the pressure of chewing and particularly if used for large cavities.
- Increased chair time -- because of the process to apply the composite material, these fillings can take a longer time to place as compared to amalgam fillings.
- Expense -- composite fillings cost much more than amalgam fillings.
- Chipping -- depending on location, composite materials can chip off the tooth
In addition to tooth-colored, composite resin fillings, two other tooth-colored fillings exist -- ceramics and glass ionomer cement.
A relatively recent development in tooth coloured filling material is ceramic whose colour and translucency mimic natural tooth. Ceramic is most often made of porcelain. After tooth preparation an impression is taken which is sent to a lab for fabrication. It is then bonded permanently to the tooth with dental cement. It generally lasts more than 15 years but can cost as much as gold fillings. By bonding the filling and the tooth together the strength
Glass ionomer fillings:
Glass ionomer is made of acrylic and a specific type of glass material. This material is most commonly used for fillings below the gum line and for fillings in young children. Cavity preparation is done in the usual way. Glass ionomers release fluoride, which can help protect the tooth from further decay. However, this material is weaker than composite resin and is more susceptible to wear and prone to fracture. Glass ionomer generally lasts five years or less with costs comparable to composite resin.
A relatively recent development in tooth coloured filling material is ceramic whose colour and translucency mimic natural tooth.
Ceramic is most often made of porcelain. After tooth preparation an impression is taken which is sent to a lab for fabrication. It is then bonded permanently to the tooth with dental cement. It generally lasts more than 15 years but can cost as much as gold fillings. By bonding the filling and the tooth together the strength increases exponentially.
Ceramic fillings, because they are made by dental technician, can be made to look extremely natural. They are more resistant to staining than composite resin material but are also more abrasive. They are mainly used for inlays, onlays and veneers.
What are dental Inlays and Onlays?
Large tooth defects wherein direct tooth fillings might not withstand the chewing forces, inlays and onlay fillings are considered.
Dental Inlays are indirect fillings made of metal and or ceramic material. The defective tooth is prepared to receive an inlay. Inlay is fabricated in the lab and then fixed over the tooth. They provide a much higher standard of support to the defective tooth.
Dental Onlays: When the tooth defect is more extensive and one or more cusps are lost, Onlays are the treatment of choice. The tooth is suitably prepared and an impression is made which is then sent to the lab. They prepare the onlay which will be fixed by the dental surgeon.
Dental crowns are a variant of onlays as they cover all the cusps of the treated tooth. A cusp refers to the raised points on the crowns of teeth. Our canine teeth for instance contain a single cusp, while premolars contain two and molars normally possess either four or five cusps.
What are the tooth decay preventive measures?
- Maintenance of proper oral hygiene: By following the proper technique of brushing & flossing, incidence of tooth decay can be reduced.
- Reducing the frequency of food or sugar intake.
- Minimizing snacking.
- Reducing frequent intake of sugary drinks.
- Avoiding kids going to bed with feeding bottles in their mouth. Chewing gums with Xylitol after food increases the saliva flow thereby flushing out food debris over and between the teeth.
- Using fluoride toothpastes & mouthwash.
- Dental sealants over newly erupted teeth would be of great help to reduce incidence of tooth cavities. A sealant is nothing but a coating applied on the tooth to protect it from decay. Applying sealants is a painless procedure.
- Topical fluoride applications over the teeth for children also bring down the rate of dental caries.