Cavities, also known as tooth decay or dental caries, are a prevalent oral health issue affecting people of all ages. They occur when the hard outer surface of the teeth, known as enamel, is permanently damaged and forms tiny openings or holes.
The development of cavities is attributed to a combination of factors, including the presence of bacteria in the mouth, frequent consumption of sugary snacks and drinks, and inadequate oral hygiene practices. However, there are many other risk factors that can make you more susceptible to cavities.
Cavities and tooth decay are considered to be among the most common oral health problems globally. While they can affect individuals of any age, they are particularly common in children, teenagers, and older adults.
Even infants and toddlers can develop cavities due to prolonged exposure to sugary substances, especially when they are given in a bottle or sippy cup over an extended period, particularly during naptime or bedtime. As such, cavities in infants are commonly referred to as baby bottle tooth decay or early childhood caries.
When left untreated, cavities progressively increase in size and penetrate deeper layers of the teeth. This can result in severe toothaches, infections, and even tooth loss. Therefore, taking preventive measures is crucial in maintaining good oral health.
How are cavities formed?
Cavities develop through a gradual process as follows:
Step 1: Plaque formation
Dental plaque, a sticky film that forms on the teeth, is the initial step in cavity development. Plaque is created when sugars and starches from food and beverages combine with bacteria in the mouth. If plaque is not removed through proper oral hygiene practices such as brushing and flossing, it can harden into tartar, which provides a protective shield for bacteria.
Step 2: Plaque attacks
Plaque produces acids that erode the hard outer enamel of the teeth. This process removes minerals from the enamel, leading to the formation of tiny openings or holes on the tooth surface, known as the early stage of cavities. The sudden attack can happen due to various factors such as hormonal changes during pregnancy. If left untreated, the bacteria and acid can penetrate deeper into the tooth, reaching the dentin layer. Dentin is softer than enamel and is more susceptible to acid damage. It contains tiny tubes that connect to the nerve of the tooth, causing sensitivity.
Step 3: Continued destruction
As tooth decay progresses, the bacteria and acid advance into the inner tooth material called the pulp. The pulp consists of nerves and blood vessels and becomes inflamed and irritated due to the presence of bacteria. The swelling within the tooth causes pressure on the nerve, resulting in tooth pain. In some cases, the discomfort can extend beyond the tooth root and affect the surrounding bone.
Symptoms of Cavities
The signs and symptoms of cavities may vary depending on the stage of decay and the affected tooth. Common symptoms include:
- Tooth sensitivity: Teeth may become sensitive to hot, cold, or sweet stimuli.
- Toothache: Persistent or intermittent pain in the affected tooth.
- Visible holes or pits in the teeth: Cavities may appear as visible dark spots or holes on the surface of the tooth.
- Discoloration or staining of the tooth: The affected tooth may change color, forming yellow, brown, or black stains
- Bad breath: Persistent bad breath or an unpleasant taste in the mouth.
- Tooth sensitivity to pressure: Discomfort or pain when biting down or applying pressure on the affected tooth.
- Swelling or pus around the tooth: Indication of an infection or abscess.
If you experience any of these symptoms, it is important to seek dental care promptly to prevent the progression of cavities and maintain optimal oral health.
Risk factors of cavities
There are various risk factors can increase the likelihood of cavities but do not guarantee their occurrence. By practicing good oral hygiene, maintaining a healthy diet, and visiting the dentist regularly, the risk of cavities can be significantly reduced.
Having a history of cavities is a significant risk factor for future cavities. If you have had cavities before, it indicates that you may be more susceptible to developing new cavities unless changes are made to your oral hygiene habits and dental care.
2. Cavity-causing bacteria
The presence of an abundant amount of cavity-causing bacteria in the mouth increases the risk of developing cavities. These bacteria feed on the sugars and starches present in the mouth, producing acid that erodes tooth enamel and leads to cavity formation.
3. Frequent sugar consumption
Eating sugar frequently provides an ample food source for cavity-causing bacteria. When these bacteria are fed regularly, they produce more acid, which increases the chances of developing cavities. Limiting the intake of sugary foods and beverages can help reduce the risk.
4. Poor-quality crowns and fillings
If you have poorly placed or deteriorating dental fillings or crowns, they can create spaces where plaque can accumulate and be difficult to clean through regular brushing and flossing. This allows bacteria to thrive and increases the risk of cavities.
5. Inadequate oral hygiene
Not maintaining proper oral hygiene practices, such as regular brushing and flossing, allows bacteria to grow and multiply in the mouth. Without regular removal of plaque, the bacteria can damage tooth enamel and contribute to the development of cavities.
6. High Acidic Foods Intake
Consuming acidic foods and beverages can erode the protective enamel layer of teeth, making them more susceptible to cavities. For instance, citrus fruits, sodas, and certain juices, can gradually wear down the enamel, increasing the risk of cavities. Gastric reflux and vomiting, often associated with conditions like bulimia, introduce additional acid into the mouth, further contributing to enamel erosion.
7. Not Getting Enough Fluoride
Fluoride plays a crucial role in strengthening tooth enamel and protecting against cavities. Insufficient fluoride intake can weaken the enamel, making teeth more prone to decay. Using fluoride toothpaste, drinking fluoridated water, and receiving professional fluoride treatments can help enhance enamel strength and reduce the risk of cavities.
8. Nursing Too Long (Bottle and Breast)
Prolonged bottle feeding or breastfeeding, particularly without proper oral hygiene practices, can increase the risk of cavities in infants and toddlers. The continuous exposure to milk or other sugary liquids allows bacteria to produce acid, leading to tooth decay. It is important to transition children to a cup and encourage regular brushing to maintain good oral health.
9. Cavities Under Fillings
Cavities that develop beneath dental fillings indicate either a problem with the filling itself (e.g., age, improper placement, or fracture) or inadequate oral care around the filling. If a cavity forms underneath a filling, it suggests that other teeth may also be at a higher risk of developing cavities.
10. Bad Family Dental Health
Family dental health can influence an individual’s risk of cavities. Poor oral hygiene practices being passed down through generations, genetic abnormalities affecting tooth structure, or a higher prevalence of cavity-causing bacteria within the family can contribute to an increased risk of cavities. Family members can impact each other’s oral health habits, making it essential for everyone to prioritize oral hygiene and preventive dental care.
11. Exposed Root Surfaces
Receding gums can expose the tooth roots, which lack the protective enamel covering. The roots are composed of dentin, which is more susceptible to acid erosion at a higher pH than enamel. Weak acids that may not affect the enamel can lead to cavities by eroding the exposed roots.
12. Defect in Your Enamel
If you have a defect in your enamel, such as enamel that didn’t form correctly or congenital abnormalities like amelogenesis imperfecta, you may be more prone to cavities. These defects compromise the protective barrier of the enamel, making teeth more vulnerable to decay.
13. Having a Disability
Individuals with disabilities or special needs may face challenges in maintaining proper oral hygiene, and caregivers may not always prioritize oral care for those under their care. Difficulties in performing oral hygiene practices can increase the risk of cavities and other oral health issues.
14. Dry Mouth
Dry mouth, or xerostomia, occurs when there is insufficient saliva production. Saliva plays a crucial role in protecting teeth against cavities by neutralizing acids and helping to remineralize enamel. Reduced saliva flow can increase the risk of cavities, and medication or treatment may be necessary to manage dry mouth.
15. Genetic Abnormality of Your Teeth
Genetic variations can affect tooth anatomy, such as deeper grooves in the biting surface or incomplete enamel coverage. These abnormalities create areas where bacteria can accumulate and lead to cavities. Other genetic abnormalities, like localized microdontia (smaller teeth), can also contribute to difficulties in cleaning and maintaining oral hygiene.
16. Having Lots of Large Fillings
Having multiple large fillings increases the number of tooth-filling interfaces in the mouth. If bacteria infiltrate the gaps between the filling and the tooth, it becomes challenging to clean them out thoroughly, creating a breeding ground for cavity-causing bacteria and increasing the risk of cavities.
17. Chemotherapy and Radiation Treatment
Cancer treatments like chemotherapy and radiation in the head and neck region can have adverse effects on oral health. These treatments can reduce salivary flow, leading to dry mouth (xerostomia), which increases the risk of cavities.
18. Eating Disorders
Eating disorders, such as anorexia nervosa and bulimia, can contribute to an increased risk of cavities. Individuals with eating disorders often have an imbalanced diet, lacking essential nutrients for maintaining oral health. Moreover, in the case of bulimia, the repeated exposure of teeth to stomach acid during purging can erode the enamel, making the teeth more susceptible to cavities.
19. Drug and/or Alcohol Abuse
Substance abuse, including drugs and alcohol, can have detrimental effects on oral health and increase the risk of cavities. Drug abuse can lead to poor oral hygiene practices, unhealthy dietary habits, dry mouth, and an increased likelihood of neglecting oral care. Alcohol abuse can also contribute to dry mouth, in addition to containing high amounts of sugar that increases risk of cavity development.
20. Irregular Dental Care
Avoiding regular dental check-ups and neglecting oral care can put individuals at a higher risk of developing cavities. Regular dental visits allow for early detection of dental issues and preventive measures to be taken. Otherwise, small problems can go unnoticed and progress into more significant dental issues, including cavities.
21. Not Knowing What Plaque Is or how to remove it
Lack of awareness about plaque, a sticky film that forms on teeth, can be a risk factor for cavities. Understanding what plaque is and how it contributes to tooth decay is crucial for maintaining good oral hygiene practices. You will be better equipped to take appropriate measures to prevent its buildup and minimize the risk of cavities.
Even if someone is aware of plaque, not knowing how to effectively remove it can lead to an increased risk of cavities. Proper oral hygiene techniques, including brushing and flossing, are essential for plaque removal. Without regular and effective plaque removal, bacteria can thrive, producing acid that attacks the teeth and causes decay.
22. Medical conditions
Studies show that there’re some medical or health conditions that have a direct impact on the health of your teeth and gums by making your mouth more vulnerable to bacterial attack and causing tooth decay, among other oral problems.
In some cases, it is the systemic disease that affects your oral health, and in others, it is the medication or treatment administered that increases your vulnerability. From diabetes to cancer treatments, these illnesses or treatments can erode tooth enamel, cause a dry mouth and bad breath, etc.
23. Being Poor
People with lower income or socioeconomic status often face challenges in accessing dental care and maintaining good oral health. Limited financial resources can make it difficult to afford regular dental visits and necessary treatments. As a result, individuals with lower income may have higher rates of tooth decay compared to those with higher income. Efforts have been made to provide free dental care to low-income individuals, but the disparity in dental health between socioeconomic groups remains a significant issue.
24. Dental Anxiety
Dental anxiety or phobia can lead to avoidance of dental visits and necessary dental treatments. Fear of the dentist can prevent individuals from seeking regular care, allowing dental problems, including cavities, to go untreated. Understanding the reasons behind dental phobia and seeking appropriate support or strategies to manage anxiety can help individuals overcome this risk factor and maintain better oral health.
While braces can improve the alignment and appearance of teeth, they can pose challenges when it comes to oral hygiene. The brackets and wires of braces make it more difficult to effectively brush and floss, creating areas where plaque can accumulate. If proper oral hygiene practices are not followed during orthodontic treatment, the risk of developing cavities increases. Extra effort, such as using floss threaders or interdental brushes, is necessary to clean between the brackets and wires and prevent plaque buildup.
The progression of cavities can be prevented or slowed down through effective oral hygiene practices and regular dental check-ups. Brushing the teeth twice a day with fluoride toothpaste, flossing daily, limiting sugary and starchy foods, and visiting the dentist for professional cleanings and examinations are essential for preventing cavities and maintaining optimal oral health.
Through routine dental visits, your dentists can detect early signs of tooth decay and provide appropriate treatments to prevent further tooth damage.
Mayo Clinic. (2020). Cavities/tooth decay.
American Dental Association. (n.d.). Cavities (Tooth Decay).
National Institute of Dental and Craniofacial Research. (2018). Dental Caries (Tooth Decay) in Children (Age 2 to 11).
Centers for Disease Control and Prevention. (2021). Dental Caries (Tooth Decay) in Adults (Age 20 to 64).