Caries

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Dental teeth 01

What is caries?

Caries, also known as tooth decay, is one of the most common diseases worldwide: approximately 94% of all people over the age of eighteen suffer from caries or its consequences. Although this disease is so widespread, most people do not even know what exactly caries is and what factors promote the development of caries.

Dental caries is triggered by certain bacteria. These caries bacteria live in the oral cavity and in dental plaque. They feed on sugar and excrete acids as a metabolic product, which attack the tooth enamel and dissolve out minerals (including calcium). Dentists also refer to this process as demineralization. Over time, this leads to the dreaded holes in the tooth. These can spread to the inside of the tooth.

 The extent to which the teeth are attacked by the acid depends on the extent of bacterial plaque and the carbohydrate intake in the diet. Last but not least, the time factor also plays an important role. The longer the acids act on the teeth, the greater the damage they can cause.

One thing is certain: optimal oral hygiene is of the utmost importance for effective caries prophylaxis.

 

Caries: signs and stages

Caries develops in different stages. The dental disease begins with demineralization (decalcification) of the outermost enamel layer. This initial stage – also known as “initial caries”” – is still painless and is noticeable with white spots on the teeth. Regular check-ups by the dentist are important in order to detect these first signs at an early stage and, if necessary, to be able to intervene with suitable fluoridation measures and optimized oral hygiene.

If the caries spreads to the dentine, it is called “dentine caries”. This results in the well-known “hole in the tooth”. Typical symptoms are toothache or a pulling sensation when eating sweet, cold or hot foods or drinks.

Detect caries: Symptoms at a glance

• White spots on the teeth (White Spots) • Brown spots due to food particles being deposited on the tooth surface • Toothache with sweet, hot or cold foods • "Pulling" in the tooth • Persistent, pulsating toothache when caries has reached the tooth pulp ("pulp") • Breaking off parts of the tooth/ soft spots in the tooth • Loosening of fillings • Bad breath

How does caries develop?

Dental caries is described by experts as a multifactorial disease. This means that several factors interact in the development of caries. In fact, it is particularly the interaction of caries-promoting bacteria (“plaque”), poor dental hygiene, and incorrect eating habits that promote the development of caries. A weak immune system and genetic factors can also increase the risk of caries.

What role do bacteria play in the development of caries?

A large number of different bacteria live in the oral cavity. Most of them are harmless, but some can cause caries. The latter include, for example, a germ called “Streptococcus mutans”. It lives mainly in the dental plaque, also called plaque. If this plaque is inadequately removed due to poor oral hygiene, the bacteria have an easy time of it: They break down carbohydrates (sugar!) from food in particular, producing acids such as lactic acid or acetic acid. And it is precisely these acids that attack tooth enamel. More precisely, minerals are dissolved out of the teeth as a result of the acid attack. Dentists also speak of demineralization in this context. Caries begins.

The more sugar can be converted into acids by the “caries bacteria” and the longer these acids act on the tooth enamel, the sooner a hole forms in the tooth.

Background: Caries development in detail

  •     Initial caries: Demineralization sets in. White discolorations (white spots) form on the enamel surface, which may turn brown over time (brown spots). Fluoride treatment can bring about remineralization and thus still counteract the pathological process. Optimization of oral hygiene is also an essential part of the treatment of initial caries.
  •     Enamel or dentin caries: If the demineralization caused by the carious bacteria is not stopped, they penetrate further and further into the tooth and a hole develops. Over time, the caries spreads further to the pain-sensitive dentin that lies beneath the enamel. This is when tooth pain usually occurs. The affected area must be removed by drilling to prevent further spread of caries. Since enamel cannot be regenerated, the cleaned hole must be sealed.
  •     Deep dental caries: The bacteria can even penetrate to the pulp. In this case, the only way to save the infected tooth is usually an expensive root canal treatment.
 

Secondary caries: What is it?

If the bacteria were not completely removed during dental treatment, caries can form again under the tooth crown or filling. Experts refer to this as “secondary caries” (marginal caries). Incidentally, this is the most common cause for a filling replacement at the dentist.

Caries – what to do?

Thanks to modern diagnostics at the dentist, caries can now be detected at an early stage – even before a hole has developed in the tooth. And that is a good thing! Because at this stage of caries, the tooth disease can sometimes still be stopped by appropriate measures – without drilling.

Therefore, have your teeth checked regularly by your dentist. Because caries usually starts painlessly, but can still be detected early through regular check-ups.
Early stages of caries: treatment

The following measures can be initiated by the dentist in the early stages of caries:

  •     Professional removal of bacterial plaque
  •     Professional fluoridation measures (gel, tablets)
  •     If necessary, use of an antibacterial mouth rinse to reduce cariogenic bacteria
  •     Advice on dietary changes (less sugar!)

The dentist then observes the further course and checks whether the “remineralization” of the enamel has been successful.

Fluoride has proven to be an excellent anti-caries agent.

Fluoride is used both for the prevention and treatment of caries.

  •     Daily application of toothpaste with fluoride for caries prophylaxis.
  •     Application of fluoride varnish at the dentist for the treatment of caries in its early stages

Why is fluoride used against caries? Fluorides support the remineralization of the tooth. They also counteract demineralization, i.e. the dissolution of minerals, which is typical in caries.

Treating advanced caries

If the tooth enamel is already irreversibly damaged – i.e., if there is already a “hole in the tooth” colloquially and thus tooth pain – the dentist usually drills to remove the caries.

In the process, all areas of the tooth that are destroyed or affected by bacteria are removed. Afterwards, the hole is cleaned and a filling is placed. The goal is to completely restore the tooth to its original shape and structure.

Important: Consult your dentist to find out which filling is suitable in your case.

Caries prophylaxis: The most important building blocks

Effective caries prophylaxis is based on the following four building blocks:

1. healthy diet for teeth

If you want to avoid holes in your teeth, you should take a close look at your dietary habits when it comes to dental health.

But what exactly does a tooth-healthy diet look like? We have put together some tips for you here:

  • Reduce sugary and acidic foods and beverages.
  • Avoid eating sweets over and over again throughout the day, as this provides the cariogenic bacteria in the mouth with a constant supply of “food”. Better: consciously snack on something sweet once a day and brush your teeth 30 minutes later.
    • Make sure that you always drink plenty of fluids (preferably mineral water). This helps to rinse away food residues and tooth-damaging acids.   
    • Try to eat food that is hard enough to bite into, as this not only exercises the chewing apparatus, but also stimulates the flow of saliva. This in turn supports the self-cleaning of the teeth. Whole-grain bread or raw vegetables, for example, are suitable.

2. Good oral hygiene

Alongside the right diet, thorough, conscientious oral hygiene is the key to preventing tooth decay in the first place.

This is what matters:

  •     Brush your teeth twice a day
  •     Clean the spaces between your teeth – for example, with dental floss or interdental brushes.
  •     Change your toothbrush regularly (at least every three months).
  •     Use a suitable toothpaste with fluoride to protect against caries
 

3. fluoride against caries

Fluorides also play a central role in caries prophylaxis. This is because they promote the mineralization of the teeth and make the enamel more resistant to acids. Dentists therefore recommend the daily use of a toothpaste with fluoride to protect against caries.

In addition, fluoride-containing mouth rinses or fluoride-containing gels are available if the risk of caries is increased. A fluoride varnish is also usually applied by the dentist as part of professional tooth cleaning.
Good to know: Fluoride tablets are often used in children from the first eruption of teeth for caries prophylaxis.

4. regular check-up at the dentist

Last but not least, regular dental check-ups are of particular importance in the prevention of caries. In this way, caries can be detected in the early stages (“initial caries”) and treated at an early stage – without necessarily having to drill.

Therefore:

  •     Have a dental check-up 1-2 times a year.
  •     A professional tooth cleaning is recommended 1-2 times a year
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