Tooth decay • Prevent painful holes in the tooth

Author: Nadja Lebkuchen, medical writer | medproduction
Last update:
November 30, 2020

Caries is often to blame for sore teeth. The main cause of this dental disease is the bacterium Streptococcus mutans. The earlier the dentist discovers the tooth decay, the gentler the treatment will be. Effective prevention is possible!

Brushing your teeth properly is the best way to prevent tooth decay.
© iStock.com/andresr

Caries is a disease of the teeth that can damage the enamel, dentin and root of the tooth. It does not develop overnight, but rather gradually. The disease can affect one or more teeth. Primary caries means that the new caries occurs on a tooth that has not yet been affected and has not been treated. But tooth decay can also develop again on teeth that have already been treated, for example under fillings or crowns. Dentists call this secondary caries.

The tooth disease can be recognized by discoloration, the typical "hole in the tooth" and toothache. The word caries comes from the Latin: "Caries" means something like "rottenness" or "decay", which describes the condition of a carious tooth well. This is why tooth decay used to be called tooth decay.

Recognize oral diseases through pictures

Recognize oral diseases through pictures

Tooth decay in children

Caries is widespread worldwide and occurs in almost all social classes. A high-sugar diet and poor dental and oral hygiene promote education. In Germany, tooth decay occurs less often in children than it did a few years ago: eight out of ten of 12-year-old children, i.e. 81 percent, are caries-free. One reason for this: Parents pay more attention to preventive measures such as regular tooth brushing and visits to the dentist.

Tooth decay: causes and risk factors

The cause of tooth decay are called bacteria Streptococcus mutans. The bacterium converts the sugar in food and drinks by metabolizing them into aggressive acids, above all into lactic acid. These first attack the outermost layer of the teeth, the tooth enamel, and decalcify (demineralize) it. In addition, caries bacteria produce a thin, sticky biofilm that sticks to the teeth: the so-called plaque. In addition to the germs, this also contains saliva and food residues. The plaque offers caries bacteria ideal conditions, to multiply.

In the case of untreated tooth decay, the bacteria penetrate the dentin and decompose the tooth from the inside out – the typical caries holes develop. If the tooth decay spreads further towards the root of the tooth, only a root canal treatment or pulling the tooth will help.

The risk of caries varies from person to person. It depends, among other things, on the composition of the saliva. If the pH of the saliva is low (acidic), the risk of tooth decay is greater. Because the saliva cannot sufficiently neutralize the harmful acids in the mouth. The amount of saliva that a person produces, the diet (lots of sugar and sweets) and poor oral hygiene also play a role in the development of caries.

Does wearing face masks promote tooth decay?

Due to the corona pandemic, mouth and nose protection has been mandatory nationwide in Germany since the end of April. Since then, wearing a mask has become a constant companion in everyday life. Some dentists have suggested that wearing masks frequently could encourage tooth decay. The reason: Many people tend to breathe through their mouths instead of breathing through their noses when they wear a mouth and nose mask. This, in turn, promotes dry mouth, which promotes tooth decay. Anyone who frequently wears masks should therefore pay more attention than usual to thorough oral hygiene and, if necessary, take measures against dry mouth.

Overview of causes and risk factors:

  • Dental plaque as a cause of tooth decay: The bacteria form a sticky plaque (biofilm) that sticks to the teeth and in which they can multiply. It is important to have the dentist regularly remove harmful biofilm.

  • Sugar is a risk factor: People who eat a lot of sugar increase their risk of tooth decay. Large quantities can be found in sweets such as chocolate, cakes, pies or candies. But also in foods in which you do not immediately suspect the sugar, for example in mustard or ketchup. Even more important than the amount of sugar consumed seems to be the frequency with which the bacteria get a "sugar load" during the day. So it's better to eat sweets once a day instead of sucking candy all day. Then brush your teeth well. The same applies to the consumption of foods that contain a lot of acid, for example citrus fruits. Because this acid also affects the teeth.

  • Poor oral hygiene: Many people do not care for their teeth adequately or incorrectly. Poor oral hygiene makes teeth more prone to tooth decay.

  • Family factors: Tooth decay is more common in some families, although the dental disease is not hereditary. Rather, experts suspect that similar eating habits (e.g. lots of sugar) and the same poor oral and dental hygiene are the reasons. Parents are role models for their children in these areas.

  • Other risk factors: Some areas of the teeth are particularly prone to tooth decay. These include small furrows (fissures) and pits on the tooth surface, the areas between the teeth, exposed roots and the lower part of the tooth crown where it meets the gums. You should brush and clean these particularly well.

Is tooth decay contagious?

Caries is a bacterial infectious disease and is therefore contagious: it is transmitted from person to person via saliva. Even small children are often infected with the bacteria, for example when parents kiss their offspring or lick the pacifier and then stick it in the child's mouth.

Recognize the symptoms of tooth decay

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Symptoms vary depending on the stage of the dental disease. The most famous symptom of tooth decay is the typical toothache. In this case, the tooth decay is usually more advanced. Overall, dentists differentiate between different stages of caries.

Hole in a tooth? Caries symptoms at a glance:

  • White spots (white spots) on the tooth in the initial stage: Minerals are loosened from the tooth (decalcification) and the tooth enamel becomes porous.

  • Dark discolorationwhen dyes accumulate in the white areas.

  • Roughened enamel: The dentist gets stuck with the probe in the bumps.

  • Hole in a tooth.

  • Toothachewhen the caries has reached the dentin under the enamel.

  • Inflammation in the pulp.

  • sensitivity the teeth against sweet, cold or hot food.

  • Severe toothache: Most of the time, the tooth caries is deeper, the tooth root is inflamed (root inflammation) and a root canal treatment follows.

Tooth decay: diagnosis by the dentist

A dentist can usually diagnose "tooth decay" at first glance based on the typical discoloration and holes in the teeth as well as possible toothache. The dentist first uses a mirror to examine all teeth for dark discoloration, as this is an indication of tooth decay. With a special probe – a pointed instrument – he checks the surface of the teeth. In the case of unevenness, it gets stuck with the probe.

An X-ray examination shows which teeth are affected by tooth decay and the extent of the dental disease. For example, caries can only affect the enamel, but also the dentin, medulla or root. The dentist can also see on the X-ray whether caries has formed under fillings, inlays or crowns or between the teeth.

Brush your teeth – the right way!

Brush your teeth - the right way!

Remove tooth decay: treatment with fillings & Co.

There are several ways to treat tooth decay. Many people have probably already become acquainted with the unpleasant drill. But there are also other options. The therapy depends on how badly the tooth has been attacked and destroyed by the caries.

Fluoride for tooth decay in the early stages

When caries begins, white spots appear on the tooth surface. In the early stages, the teeth can possibly be remineralized with fluoride. For example, fluoride gels are used, which the dentist spreads on the affected tooth.

Drill out caries

With the help of a drill, dentists remove the attacked tooth substance as far as necessary. They try to conserve and preserve the healthy tooth substance as much as possible. Most patients find therapy with the drill painful. Local anesthesia of the affected tooth is useful.

Laser treatment

Caries removal by laser is also offered in some dental practices. This technique should be largely painless. The unpleasant, screeching noise of the drill, which many find frightening and tormenting, is also eliminated.

Dental fillings

After drilling away the caries, dentists fill the hole again. There are various filling materials, the selection of which depends on the future degree of stress, aesthetic demands and wishes, but also on the patient's wallet. The dentist brings the filling into the hole and hardens it there.

You can find detailed information on different fillings, advantages and disadvantages as well as costs here.

  • amalgam: The silver-colored, soft and inexpensive amalgam is suitable for extensive fillings in the invisible side area. Despite its mercury content, amalgam is still considered to be harmless to health. Use is permitted in dentistry. Nevertheless, the EU Parliament has now passed a regulation according to which dentists are no longer allowed to use amalgam as a tooth filling in pregnant women, breastfeeding women and adolescents under 15 years of age from July 2018. Medically necessary cases are excluded.

  • Plastics (composites): The material is tooth-colored and plugs holes in front and incisors as well as large holes.

  • Ceramics: Ceramic fillings hardly differ from your own teeth in terms of structure and color, they are well tolerated and also very stable.

  • gold: Gold fillings are rarely used in this country, partly for aesthetic reasons. One advantage, however, is that gold fillings last a very long time.

  • Glass ionomer cement and compomers: These materials are mainly used to treat deciduous milk teeth or to attach denture materials. They are only suitable as a temporary filling for a transitional period because the materials have a limited shelf life. They also usually do not withstand the pressure of chewing when eating for long.

Inlays for large holes

In addition to the "normal" fillings, there are so-called inlays, which a dental technician makes in the laboratory and which the dentist then places in one piece in the hole. However, such inlays are comparatively expensive.

Root canal treatment

If the caries has spread to the root of the tooth and the pulp (pulp), a root canal treatment is necessary. The dentist removes inflamed tissue and flushes bacteria from the root canal. This is then closed with a filling. Root canal treatment is usually not bearable without anesthesia. With this treatment method, however, the damaged tooth can often still be saved.

dentures

Sometimes the caries damage is so great that a filling is no longer possible. Then various forms of dentures such as bridges, crowns, prostheses or implants have to help.

  • Crowns or partial crowns: The dentist grinds the tooth and completely covers it with a crown. It can be made from different materials such as ceramic, plastic or metal – depending on the requirements. The partial crown does not completely envelop the tooth, but only stabilizes partial areas of the tooth crown.

  • bridge: Sometimes the tooth is so badly damaged that the dentist cannot preserve it and has to pull it out. Periodontitis or accidents can also lead to tooth loss. Tooth gaps can be closed with the help of a bridge. One or more artificial teeth are attached to existing teeth. A bridge can therefore also replace several teeth.

  • Dental implants are small pins that are firmly screwed into the jaw (artificial tooth roots, "dowels"). A few weeks later, when the implant has healed, a crown is attached to it.

  • Prosthesis / partial prosthesis: These artificial dentures are not firmly anchored in the teeth, but can be removed, for example in the evening before going to bed.

These foods ensure beautiful and healthy teeth

These foods ensure beautiful and healthy teeth

Prevent tooth decay with the right dental care

There are many ways you can effectively prevent tooth decay. At some points you can start yourself, for example with nutrition and good oral and dental hygiene. But regular visits to the dentist, who can detect tooth decay at an early stage, or the removal of plaque from the teeth, are also part of a good prophylaxis. The declining number of children and adolescents who develop tooth decay today shows that this works.

To the dentist twice a year!

As a precaution, see your dentist twice a year – not just when you have a toothache. If he detects tooth decay in good time during the check-ups, the damage to the tooth is usually less severe and the treatment is much gentler. In the early stages of caries, teeth can sometimes be remineralized using fluoridation. Also, tell your dentist how to care for your teeth. Perhaps there are other things you can do to improve your dental health and prevent tooth decay.

Good dental and oral hygiene

Thorough dental and oral care are the be-all and end-all of caries protection:

  • Brush your teeth properly! At least twice a day, brush your teeth thoroughly with a toothbrush that has not yet worn out the bristles. Replace them more often, otherwise the cleaning effect will decrease. When it comes to cleaning, manual and classic electric (with rotating brush heads) and sonic toothbrushes are about equally good. Do not scrub your teeth, but brush them properly (follow the instructions from the dentist or the instructions for use for electrical devices). For many, cleaning is easier with the electric variants.

  • Above all, clean yourself before bedtime teeth and then do not eat or drink anything that contains sugar. So your teeth are protected all night. If you acidic foods If you have eaten, you should wait at least half an hour before brushing your teeth, as acids attack the tooth enamel.

  • toothpaste: There are now countless toothpastes with different ingredients. Make sure that the toothpaste contains fluoride. These are often missing from toothpastes from the organic market. Toothpastes should also not contain too many substances that promote abrasion (especially whitening toothpastes!), As these damage the tooth enamel.

  • Interdental brushes and dental floss: Food residues often get stuck in the spaces between the teeth and on the tooth necks near the gums. You should therefore clean them regularly (preferably daily) with dental floss and space brushes. Both aids for teeth are available in drugstores or on the Internet, for example.

A healthy diet to protect against caries

You can also prevent tooth decay with the right diet. Consume as little sugar as possible through food and drinks. It's better to eat sweets only once a day and not suck on sugary candies all day. The caries bacteria are less happy about the amount of sugar, but rather about their constant intake. Caution is also advised with hidden sugar, for example in fruit juices, ready-made mueslis or honey.

Also, drink plenty of water. This rinses your mouth, removes sugar and food particles, and stimulates saliva production. This is especially important after eating acidic foods, for example fruit. If you consume sugary or acidic drinks: Do not rinse your mouth with them, but swallow the liquids directly.

Tip! There are many sweets and foods out there today that contain sugar substitutes. These sugar substitutes do not damage the teeth. So it is better to use sugar-free candies or chewing gum.

Stimulate saliva production with sugar-free chewing gum

Saliva is a real all-rounder that has a protective effect on the development of caries. The composition of this liquid in the mouth varies from person to person. The saliva contains minerals that are deposited in the tooth enamel, harden it and thus counteract tooth decay. Also neutralized the saliva has acids that could attack the tooth and has an antibacterial effect. Saliva liquefies the food ingested and ensures that it can be removed from the mouth more quickly. This means that fewer food residues stick to the teeth. Make sure you have sufficient saliva production by chewing sugar-free (!) Chewing gum after eating.

Fluoride against tooth decay

An adequate supply of fluoride is considered to be good caries prophylaxis. Fluoride is found in many dental care products, such as toothpaste and gels, varnishes and mouthwashes. Some foods are also fortified with fluorine, such as table salt.

Fluoride products are either over the counter or the dentist applies them. However, you must not overdose on fluoride. Particular caution is required with children. Let your dentist advise you on the correct use and dosage.

Fissure sealing

The surface of teeth is often fissured and has many grooves and depressions (fissures) in which bacteria can settle well. These places are often difficult to get to with a toothbrush. Fissure sealing can protect healthy teeth from tooth decay. The dentist usually closes the fissures with a plastic. The fissure sealing remains effective for seven to ten years. For children between the ages of six and 18, the statutory health insurance companies cover the costs of the measure. Supplementary dental insurance may also cover the costs for adults.

Professional tooth cleaning

Professional teeth cleaning (PZR) can also prevent tooth decay. Specially trained prophylactic assistants tackle every single tooth in several steps: They remove hard and soft plaque, polish, fluoride and give tips on dental and oral care. They show you, for example, how to use dental floss and interdental brushes correctly. Not all statutory health insurance companies pay for professional teeth cleaning – it is best to ask beforehand. Many, however, contribute to the costs. For a PZR you have to reckon with 80 to 100 euros. Depending on the condition of the teeth, dentists recommend professional teeth cleaning every six months.

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