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Dec 27, 2016

Caries

The environment present in the mouth, referred to as the oral environment, is tough. Teeth are exposed to strenuous activity every day but are built to resist them. The most common reason for damage to a healthy tooth is caries. So, what is caries?

Caries is caused by a chemical reaction. If you feed bacteria with carbohydrates, they will begin producing acids. In order to maintain a neutral pH in the oral environment, calcium is “borrowed” or released from the teeth, resulting in a local decalcifying of the tooth and caries is formed.

The mouth does have defence mechanisms against this chemical reaction. One of them is saliva, which flushes away acid and bacteria. Saliva also contains substances which can repair small cavities in a tooth.      


A tooth consists of a very durable layer of enamel. Below the enamel is the softer dentine and in the center of the tooth is the pulp tissue.


When a caries lesion reaches the pulp, the tissue deteriorates and dies (necrosis), causing bacteria to continue through the root canal system. Often, but not always, this is associated with pain.

It is difficult for the acid to “dissolve” the enamel. But once a cavity is created, the process accelerates. The acid corrodes the dentine, which is softer than the enamel. If the caries reaches the pulp tissue, it deteriorates and dies, and bacteria can continue through the root canal system.

Young teeth are softer
In younger teeth, the enamel is softer, but over time substances are stored in the enamel making it stronger. That is why most caries occurs before the age of 20 years. However, in older age, the saliva production can decrease, which in turn increases the risk of caries. Fluoride (as in toothpaste) is the main reason that kids nowadays have fewer cases of caries. Fluoride strengthens the enamel and can help “heal” small lesions.

Oral hygiene is important to fight caries but diet is more important
If you do not clean your teeth twice a day, bacteria and food debris will form a layer on the surface of the teeth, called plaque. Plaque is not always visible. If you also eat a sugar-rich diet, especially over several meals a day, the plaque will become extra sticky and acidic, increasing the risk of caries formation.

The acid attack starts when you eat
The acid attack begins the moment you start eating. All carbohydrates contribute to acid formation. It is not so much what you eat but how often. Many small meals, over the day, do not give the mouth the chance to neutralise the oral environment and increases the risk of caries.

 
Caries builds in areas where bacteria (and plaque) can accumulate, like in the deep grooves of the chewing surfaces, between the teeth or near the gum line. The joint between old fillings or crowns is also a weak point.

Occasionally, caries is clearly visible like in these pictures, but often an x-ray is required.

The Snö dental team is trained to discover if you are a high or low-risk caries patient. We will work together with you to prevent caries from building further. If caries occurs, the treatment approach today is a lot less invasive and focuses on preserving tooth substance.

Caries detection without X-ray
At Snö, we have invested in DiagnoCam, a technique that can be used to find and follow caries without the need for many x-rays. A laser light and a specially designed camera can see through the tooth and detect specific types of caries.


A photograph from DiagnoCam where we can spot the caries cavity without an x-ray.

Worth thinking about (also good for other risks like periodontitis and bad breath)

  • Brush your teeth twice a day with fluoride toothpaste.
  • Clean the space between the teeth every day. You only need to clean between the teeth you want to keep:).
  • Rinse your mouth after meals with water. This reduces the acid attack.
  • No eating in-between meals (one or two intakes is normally acceptable between meals; note that it is not the amount you eat, but the frequency). No matter how good you are at cleaning, many small meals will increase the risk of caries.
  • Extra fluoride treatment should be used, but only when we recommend it.  We will top it up by local, topical treatment when necessary. Fluoride will be layered in the enamel, thereby strengthening it.
  • Visit the dentist and hygienist regularly (depending on your risk assessment between 3-18 months). Listen to our recommendations. We are specialised in helping you keeping tour teeth healthy for the rest of your life. Remember that our goal is to drill as little as possible, and not to do root fillings and large restorations. The goal is to keep you caries free all your life. The best treatment is the one we never need to do.
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