Tooth Decay (Caries)

Tooth decay is common both in adults and children. It is however an essentially totally preventable disease. Unfortunately the UK is going through a glut of decay in children, often necessitating hospital admission for extractions. Most people will get decay at some points in their life, and most holes caught early enough can be easily restored. Frequent decay must however ring alarm bells.

Decay happens because bacteria present in the mouth metabolise sugars to produce acids. These acids then microscopically dissolve the tooth, and so the hole starts. If there are no sugars, or a much reduced number of bacteria then decay will not occur. Few of us if any will have a diet containing no refined sugars, but if we keep the intake of such sugars to regular mealtimes and not between meals, the body can generally cope. Saliva is important in decay prevention as it contains bicarbonate, an alkali, which helps to neutralise the acids present.

Patients who are short of saliva be it due to side effects of medications eg drugs used to treat depression, anxiety, pain, allergies, and colds (antihistamines and decongestants), obesity, acne, epilepsy, hypertension (diuretics), diarrhoea, nausea, psychotic disorders, urinary incontinence, asthma (certain bronchodilators), and Parkinson’s disease. Radiotherapy to the head and neck are is also a potent cause of lack of saliva, as can be Sjogren’s syndrome, an autoimmune connective tissue disease. Such patients are likely to be far more prone to decay and stringent preventive measures may be necessary.

Medication aside, it is undeniable that some people do appear to be more prone to decay than others, even within the same family. Either one accepts that such patients will get more decay, fillings and maybe extractions or those susceptible need to adhere to a more stringent preventive regime than others less susceptible. This can be difficult with siblings, but unfortunately there is no easy answer.

Sugars taken at mealtimes can normally be coped with by the body, sugars taken between meals are the main danger area. This can be in the form of sweets, biscuits, snacks, even flavoured crisps, along with sugar in tea, coffee and hot chocolate and not forgetting most fizzy drinks and energy drinks. Sweets are often fine in moderation but are best kept to eg the end of a meal.

Fluoride is the only chemical agent that has been shown to be really worthwhile in decay prevention. Fluoride used topically, such as in toothpaste, or by contact with fluoridated water becomes incorporated into the enamel, both in adults and children, making it more resistant to dissolving in the mouth acids. Dentists are also able to apply fluoride products to help strengthen the teeth. Under the Government Directive, Delivering Better Oral Health, dentists are required to apply fluoride varnish to children’s teeth on a regular basis, up to the age of 16.

Decay often presents as dark shading or frank cavities in the teeth. However not all dark areas are decay that need treatment, and regular dental check ups are necessary to determine what needs filling and what can be treated preventatively, and potentially reversed. Decay which is not treated effectively can lead to involvement of the nerve with associated pain, the need of root canal treatment, or extraction.

In summary, prevention of decay involves

  • good, effective, brushing and cleaning between the teeth.
  • use fluoride toothpaste appropriate for the age of the patient and where necessary fluoride applications from a dentist.
  • and most importantly of all, restrict sugars to regular mealtimes.
  • In addition, use of Xylitol gum on a regular basis may also reduce germs and provide some benefit. Use of any sugar free chewing gum will also stimulate saliva and help neutralize the acids.
  • regular dental examinations.

Detailed information sheets on prevention of decay for different ages are available at the practice to take away.