Everything You’ve Ever Wanted to Know About Cavities

Everyone has heard about cavities. We also all know that we are supposed to brush our teeth twice a day and floss once a day to avoid them. But beyond that, what do we actually know about cavities? Do we actually know anything about cavities other than the fact that we don’t want them? While cavities may not be the most interesting topic to study, understanding more about them can definitely help provide you with some inspiration to practice daily dental hygiene and schedule those dental checkups you’ve been putting off. 

Let’s start at the beginning with the simple question about what is a cavity? Back in 1000 B.C, early Babalonian and Chinese civilizations believe that cavities were caused by a worm that drank the blood of teeth and ate the tooth roots. While their theory wasn’t entirely correct, it did have some level of truth to it. 

The simple definition of a cavity is just as it sounds: a cavity is a hole in your mouth. This hole in your mouth forms when acid erodes the tooth’s enamel and causes it to wear down. There are different types of cavities and the three most common are root, pit and fissure, and smooth-surface. 

Diagram showing the different types of cavities: smooth surface cavity, pit and fissure cavity, and root cavity

Root cavities form on the tooth’s roots and are common in seniors or those with gum recession. Pit and fissure cavities are commonly found on the rear molars within those grooves on the chewing surface of your teeth. This is a common location for cavities because food can easily get stuck within these grooves. Finally, smooth-surface cavities are those that form on the flat, exterior surfaces of teeth. Out of the three types of cavities, these are the slowest-forming and least common type. No matter the type, all these cavities are caused by acid formation. How does acid form in your mouth you might ask?

Acid is a waste product of the thousands of bacteria that reside in your mouth. These bacteria, known as streptococcus mutans, are able to feed off of the foods you eat and the beverages you drink. While everyone’s mouth contains bacteria, certain people may have less or more bacteria depending on their oral habits. The more bacteria your mouth has, the more acid is produced and the higher your risk of developing cavities is. 

This brings us to our next question of how do cavities form? This question does not have an easy answer, because cavities do not form as the result of a single action. This is why some people struggle with preventing cavities. Cavities form as a result of various factors such as the state of your teeth and saliva, the amount of bacteria in your mouth, the types of foods you eat, and the frequency that a cavity-friendly environment occurs in your mouth. 

A cavity-friendly environment refers to one that promotes the active growth of bacteria. Because bacteria must adhere to the tooth in order to cause tooth decay, a cavity-friendly environment is one that promotes plaque. Plaque, also known as dental plaque, is a film of saliva, food debris, and bacteria that sits over the tooth’s enamel. 

Once on your teeth, the bacteria will begin to consume any of the foods you eat, digesting it in as little as 15 minutes. Bacteria are especially drawn to carbohydrates and sugars because these are easily digestible, and tend to avoid foods like broccoli because cellulose is not as easily digestible. This is why eating healthier can improve your oral health, while eating lots of sugars can be detrimental. 

Microscopic image of the bacteria that cause tooth decay

Like any other living organism, what goes in the bacterium must come out. This is where it gets gross. After the bacteria eats, they will then defecate, or poop, into your mouth. This process is called an “acid attack” because bacteria defecate acids that can concentrate in a single area and destroy calcium. As several of these acid attacks are excreted over time, the area being attacked will begin to dissolve, giving way to a cavity. 

However, not all acid attacks directly lead to cavities. For a cavity to form, there has to be no disruption to the bacteria, meaning that the acid is constantly being applied to the same place. If, however, the bacteria are dislodged or even moved, then the acid is not applied to the same place. Depending on how much acid was present, the enamel has the potential ability to re-mineralize any dissolved areas. This is why daily brushing and flossing is important. 

But, why do we have to brush twice a day and why is recommended that we floss at night? Well, this is because our bodies do not produce saliva at night. During the day, we have a constant flow of saliva, which dilutes the acid and reduces its ability to dissolve enamel. At night, however, there is not a steady flow of saliva, which means the acid is not diluted and can render more damage. By brushing and flossing before bedtime, we remove plaque and decrease the severity of an overnight acid attack. 

Despite our best efforts, many adults will still develop cavities at some point in their lifetime. In fact the National Institute of Dental and Craniofacial Research notes that as many as 92% of adults ages 20-64 have had a dental cavity affecting their permanent teeth. They continue to note that, on average, adults ages 20-64 have about three decayed or missing permanent teeth. 

Although these statistics may seem daunting, all hope is not lost! In most cases, cavities can easily be treated and the sooner they are identified, the easier treatment is. This is why the American Dental Association recommends visiting your dentist at least once every six months for regular dental checkups and professional teeth cleanings. 

When identifying cavities, there are various stages cavities can occur at. The earlier the stage, the easier it is to reverse the damage. However, in the later stage damaged cannot be reversed, but it must be treated. If left untreated, cavities will continue to cause harm to the tooth until the entire tooth is lost. Tooth loss is stage 6 and it is completely preventable by seeking early treatment. 

Diagram showing the various stages of cavity development

The first two stages affect only the enamel, or outermost layer of the tooth. Stage one is the presence of white spots on the tooth that indicate a loss of calcium. These white spots can generally be reversed by using a fluoride treatment to strengthen the enamel. Stage two occurs when the enamel layer has begun to disslove forming what dentists call an incipient lesion. In some cases, fluoride treatments may also be used for stage two cavities. 

Stage three occurs when the dentin layer begins to decay. The dentin layer is the middle layer of the tooth that lies just below the enamel. When cavities reach the dentin layer, there is generally some pain or discomfort within the tooth. Because of the pain, this is when dentists generally see patients who don’t otherwise come in regularly. At stage three, a dental filling is usually needed to remove the bacteria, relieve pain, and restore the tooth. 

Stage four occurs when the bacteria have reached the pulp, or innermost layer. Because the pulp is composed of nerves and blood vessels, it becomes increasingly painful when the infection sets in. Once the pulp layer has become infected, the only course of action is to have a root canal and a dental crown placed to restore the tooth. 

Stage five occurs when the pulp infection is not treated and it continues to persist. Once the bacteria reach the tooth’s roots, they cause an abscess to form at the base of the roots. Not only is this extremely painful, but it can cause the surrounding bone to become infected and puts you at a higher risk for other complications. Once decay has reached stage five, oral surgery is generally needed to restore the tooth. 

As mentioned before, stage six it tooth loss. However, there are five other stages of warnings before this point. Most people will seek help once their tooth begins to ache, around stage two or three. However, if you are attending regular dental checkups, it is very likely that you can have early signs of decay diagnosed and treated before tooth pain even develops. Regular dental checkups also means that early signs of decay may be able to be reversed, sparing you from more invasive dental procedures in the future. 

Not only that, but professional teeth cleanings are also part of regular dental checkups. Professional teeth cleanings remove the plaque and tartar from your teeth. Tartar is plaque that has been left in place over time and is hardened to the surface of your teeth. While plaque can be removed by brushing, tartar can only be removed using specialized dental tools. Just as bacteria reside in plaque, they can also reside in tartar. This is why regular teeth cleanings are so important, because they decrease the amount of bacteria in your mouth and make it a hard environment for bacteria to thrive in. 

While many people are intimidated by dental visits because they are afraid they are going to be told they have cavities, it is important to realize that having a cavity is not the end of the world. It is also important to realize that avoiding the dentist does not magically make your cavities disappear, rather it allows them the possibility to continue to grow into deeper and more serious cavities. Out of everything you’ve ever wanted to know about cavities, the most important thing to know about cavities is that you can minimize their damage with regular dental care. 

How long has it been since your last dental appointment? To minimize your risk of cavities and improve your oral health, schedule a consultation with Dr. Pasha of Pasha Dental today!  Pasha Dental is proud to provide dental services for adults and children residing in the Brooklyn, NY area as well as to residents of Staten Island, Queens, and Manhattan. 

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