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Preventing tooth decay

In most cases, tooth decay can be prevented and even turned around in its early stages with good oral hygiene, a well-balanced diet and regular dental visits. When you go for a dental checkup, one of the things your dentist looks for is tooth decay. Using a dental instrument, your dentist looks for pits and grooves and feels for soft areas on your teeth. Sometimes the disease is visible to your dentist, but often x-rays are needed to see inside your teeth for signs of tooth decay. If signs of tooth decay are found, it is important to stop them from spreading. Depending on the stage of the disease, your dentist may try to heal it with fluoride applications. As well, your dentist may suggest making changes to your oral hygiene routine and may discuss changes to your diet.

When cavities happen

If tooth decay is left unchecked, it can spread and lead to other cavities. During your regular checkups, your dentist will find most cavities in their early stages. Treating a cavity in its early stage will stop decay from spreading to the point where there is little structure left to your tooth. If you have a small cavity, your dentist may keep an eye on it or fill it right away with a dental filling. If a large cavity is not treated, it can get bigger and cause pain. Eventually, the tooth may need root canal treatment or it may have to be removed.

In the early stages of tooth decay, only the enamel is affected. In the next stage of tooth decay the dentin is affected. In the advanced stage of tooth decay, the dental pulp is affect. It is at this point that a root canal will be necessary to treat the tooth.

How cavities form

Cavities begin with plaque. Plaque is an invisible film that occurs naturally in your mouth and sticks firmly to your teeth. It contains bacteria (germs) and forms on your teeth every day. These bacteria are quite normal and mostly harmless. They only become a problem when the plaque is not cleaned from your teeth by brushing and flossing and are allowed to build up on and between your teeth.

Here’s what happens. When sugars in the food that you eat mix with the bacteria on the plaque, this makes a mild acid. This acid forms in the plaque, causing tooth decay to slowly eat away at the enamel (hard outer layer of your tooth). Over time, the enamel gets soft and a cavity forms.

Kinds of cavities

Although cavities are more common during childhood, adults can get cavities too. There are 3 types of cavities.

• Coronal cavities: This type of cavity forms on the biting surface of your tooth, between your teeth or along your gum line. It is the most common type of cavity.

• Root cavities: This type of cavity forms on the roots of the teeth. As we grow older, our gums recede or pull away from our teeth. Years of not brushing your teeth properly and clenching your teeth may also cause your gums to recede. When your gums pull away from your teeth, the roots of the teeth are exposed. Roots do not have enamel to protect tem, so they are more likely to get cavities.

• Recurrent cavities: This type of cavity forms around an existing filling. Fillings are not as smooth as natural teeth, so tiny bits of food and bacteria can get caught at the edge of a filling. This can cause a cavity to form again on the tooth around the filling. Also, if a filling breaks, the part of the tooth that is no longer covered is more likely to get a cavity.

Taking care of cavities

The most common treatment for a cavity is a dental filling. This treatment involves your dentist removing tooth decay from your tooth and filling the hole with dental material used to fill cavities. Depending on the kind of filling you’ve chosen, there are 2 main ways to fill a cavity:

• Direct filling: These fillings are placed directly into your tooth after your dentist has cleaned out the decay. First, your dentist may give you a local anesthetic (Or freezing) so you do not feel any discomfort. Your dentist will take out all of the decay from the tooth using a drill, a laser or a compressed air device. The hole is then shaped and filled. Direct materials like amalgam and composite resin harden quickly, so the fillings can be done in 1 appointment in most cases. For composite fillings, your dentist puts a bonding material (or glue) inside the cavity. Composite resin is applied in thin layers. Each layer gets hard with the help of a special light that is held over the tooth. When the last layer of the filling is hard, your dentist shapes the filling so that it looks and feels natural.

• Indirect filling: These fillings are custom-made to fit your tooth. There are two stages involved for an indirect filling. During the first stage, your dentist may first give you a local anesthetic (freezing) so you don’t have any discomfort. Your dentist will then remove the decay from the tooth using a drill, a laser or a compressed air device. Next, a mold of your tooth is made and the hole is filled with a temporary filling. The mold of your tooth is used to make a model. A gold or porcelain filling is then made to fit your tooth using the model.

At your next appointment, your dentist removes the temporary filling and cements the new permanent filling in place.

Lasers and air abrasion

Traditionally, drills have been used to remove tooth decay from a tooth in order to prepare it for a dental filling. Today, some dentist are starting to use lasers or air abrasion instead of drills. Lasers work best on decay close to the tooth’s surface. Air abrasion uses a fine, sand-blasting spray and works best on surface decay.

Computers in dentistry

Today some dental offices are using computers to restore a cavity in a tooth. After removing the tooth decay, special cameras take 3-D photographs of your tooth. Using the photographs, the shape of the restoration (material used to fill the cavity) is designed on the computer monitor. A computer-controlled milling machine then mills the restoration out of a ceramic block. Your dentist then inserts the restoration into your tooth and gives it a final polish. Generally, this treatment can be done in 1 dental visit.

There are different kinds of materials used for dental fillings. Each king of filling has its set pros and cons. What you choose depends on your needs. Your dentist can suggest the kind of filling that is best for you, but the final choice is yours. If you have any questions or concerns about the kind of fillings that are used in your mouth, talk to your dentist before the treatment begins.

When something foreign is put into your body, there is always the chance of side effects, such as an allergy. For every filling material, there are a few people who may be allergic to it. However, this is very rare. Before you get a filling, you should tell your dentist about changes to your health since your last visit. For example, tell your dentist:

• if your are taking new medicine including herbal supplements

• if you are having medical tests

• if you have developed allergies

• if you are pregnant

Kinds of dental filling materials

Several types of dental filling materials are used to fill cavities. The most common materials are amalgams (sometimes called silver), composite resin (sometimes called plastic or white), gold, porcelain and glass ionomer. Some materials may better meet your needs than others. The following lists the different kinds of dental filling materials available to you and the pros and cons of each type.

Amalgam fillings: These fillings are sometimes called ‘’silver’’ fillings and are used to fill cavities in molars (Back teeth). They are a mix of metals such as mercury, silver and copper and tin.

Pros

• These are the least expensive type of filling.

• They last a long time.

• They are easy to put in place.

• They are direct fillings, so they can usually be done in 1 appointment.

Cons

• The silver colour may not appeal to people who want a ‘’natural’’ look.

• Tiny amounts of mercury vapour are released from the filling when you chew.

Health Canada concludes that although amalgam contributes detectable amounts of mercury to the body, these levels do not cause illness.

Health Canada recommends alternative filling materials de considered for restoring the primary teeth (baby teeth) of children where the mechanical properties of the material are suitable. Pregnant women and people who may have allergic hypersensitivity to mercury or who have impaired kidney function should avoid amalgam fillings.

For more information on mercury in dental amalgam fillings, visit the dental amalgam FAQs section on the Canadian Dental Association’s website at www.cda-adc.ca or the website of Health Canada at www.hc-sc.qc.ca.

Composite resin fillings: Also called plastic or white fillings, this kind of filling is well suited for visible areas in your mouth. A plastic filling may not always be a good choice to use for large fillings, fillings that have to be replaced or fillings on your molars (back teeth) because this type of filling may break within a few years. However, many small fillings on back teeth are being done with composite resin.

Pros

• These fillings will be the same colour as your natural teeth.

• They are direct fillings, so they can be done on 1 appointment in most cases.

Cons

• These fillings are not as dependable as amalgam or gold fillings, and they may not last as long.

• Recurrent decay is more of a problem than with amalgam or gold fillings.

Cast gold fillings: These fillings are a mixture of gold with other metals such as platinum, palladium and silver to make gold fillings more durable. Pure gold is too soft and would wear away.

Pros

• Gold is stronger than amalgam.

• Gold fillings last a long time.

• Many studies show these are the best filling for durability and wear over many years.

Cons

• Gold costs more than other kinds of fillings.

• Gold fillings are indirect fillings, so they take at least 2 appointments.

• The gold colour may not appeal to people who want a natural look.

Porcelain materials: These are the most common kind of dental ceramic used by dentists. Porcelain and metal can be combined to make a strong, tooth-coloured crown.

Pros

• Dental porcelain is the same colour as natural teeth.

• These fillings often last a long time.

Cons

• For teeth that bite down hard, like molars, ceramic may not be a good choice unless combined with a metallic structure. They are more brittle and can break or chip.

• They are indirect fillings, so at least 2 appointments will be needed.

Glass ionomer materials: These fillings are only used in places on the teeth where you do not bite down hard and often at the gum line. Other types of filling may be stronger and last longer. Glass ionomer materials are becoming more popular with patients who have high amounts of tooth decay and with elderly people who have problems brushing or have dry mouth as a side effect of their medications.

Pros

• These fillings are the same colour as your natural teeth.

• They contain fluoride, which helps stop recurrent decay in the tooth.

• They do not have to be put in layer by layer. This makes it simpler than putting in composite resins.

• They are direct fillings and can usually be done in 1 appointment.

Cons

- They are not as strong and may not last as long as other fillings.

The content of this document was inspired from a source produced by The Canadian Dental Association .