The Signs and Symptoms of Tooth Decay

A tooth has an outer layer of enamel, which surrounds the inner dentin and pulp tissue. The dental hard tissue contains organic and inorganic materials. The microorganisms produce acids that attack the mineralized part of the dental tissue. Dental decay is multifactorial, and the factors responsible include:

Microorganisms: Different bacteria are responsible for acid production, which aids in the demineralization of the inorganic component. The bacteria playing a significant role in tooth decay are Streptococcus, Actinomycetes, and Lactobacillus.

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Host: The tooth and saliva are the host components. Teeth with deep fissures and less accessible mechanical cleaning aids are more susceptible to decay. Saliva has mineral components that help in the remineralization of decayed teeth.

Substrate: It refers to the food component, mainly carbohydrates. Among the carbohydrates, sucrose is the most cariogenic, formed by glucose and fructose molecules. Sucrose produces lactic acid and attacks tooth structure.

Signs and Symptoms of Tooth Decay
The symptoms of tooth decay vary with the tooth location and the extent of progression of the cavity. Some cases may be asymptomatic in their initial stages, but as the disease progresses, symptoms start developing. The symptoms depend on the involvement of enamel, dentin, and pulp. The pulp is termed pulpitis when it is inflamed because of infection. It is of two types, namely acute and chronic. The signs and symptoms of tooth decay are:

Toothache: The pain may occur spontaneously or after eating. In the acute type, there is severe spontaneous pain. In the chronic type, pain is not present but may start once food debris accumulates in the decayed tooth cavity. When the decay spreads into the inner parts of the tooth, known as the pulp, there is severe pain that may interfere with daily activities.

Tooth Sensitivity: In the reversible type of decay, tooth sensitivity occurs due to minimal enamel involvement.

Pain while eating something sweet or cold

Visible black or brown discoloration

Pain on biting an object

Prevention and Treatment of Tooth Decay

Tooth decay can be prevented by proper cleaning of the tooth. A regular dental check-up, use of sugar substitutes, avoiding frequent snacking are a few ways to prevent tooth decay. In addition, fluoride-containing toothpaste and mouthwash are recommended to prevent tooth decay. The benefits of fluoride include:

Modifying the Structure of Tooth Enamel: Enamel comprises a hydroxyapatite component, which primarily contains carbonate ions. These structures have numerous imperfections, making them susceptible to decay. When fluoride is added, fluoride ion gets incorporated into these crystals, making them stronger and resistant to decay.

Prevention of Demineralization: Food particles and bacteria produce acids in the oral cavity. These acids act to destroy the minerals of the teeth, leading to demineralization. Fluoride inhibits this demineralization caused by acids.

Remineralization: Fluoride can promote remineralization of the tooth structures which have already started demineralizing. It adds calcium and phosphate ions in the saliva, which supplies these ions to the teeth, thus promoting remineralization.

Interference with Microbial Activity: Bacteria are responsible for producing acids and causing dental decay. Fluoride interferes with the glucose transport mechanism in the bacteria, thus affecting their survival.

Altered Morphology of Teeth: During developmental stages, fluoride acts to change the external features of the tooth enamel in such a way that it becomes self-cleansing. When a tooth is cleaned properly, the decay is less.

Once tooth decay has started, a fluoride sealant can be applied to re-mineralize the minimally decayed portion. When only the enamel or enamel and dentin have decayed, a dental filling is done to remove the infection and fill the cavity with an external material. A root canal treatment is the best option if the infection has reached the pulp of a tooth. In severe cases of tooth decay, the tooth may need an extraction.

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