Dental Caries Health Article

Diagnosis

Tooth decay develops at varying rates. It may be found during a routine six-month dental checkup before the patient is even aware of a problem. In other cases, the patient may experience common early symptoms, such as sensitivity to hot and cold liquids or localized discomfort after eating very sweet foods. The dentist or dental hygienist may suspect tooth decay if a dark spot or pit is seen during a visual examination. Front teeth may be inspected for decay by shining a light from behind the tooth. This method is called transillumination. Areas of decay, especially between the teeth, will appear as noticeable shadows when teeth are transilluminated. X rays may be taken to confirm the presence and extent of the

decay. The dentist then makes the final clinical diagnosis by probing the enamel with a sharp instrument.

Tooth decay in pits and fissures may be differentiated from dark shadows in the crevices of the chewing surfaces by a dye that selectively stains parts of the tooth that have lost mineral content. A dentist can also use this dye to tell whether all tooth decay has been removed from a cavity before placing a filling.

Diagnosis in children

Damage caused by baby bottle tooth decay is often not diagnosed until the child has a severe problem, because parents seldom take their infants and toddlers for dental check-ups. Dentists want to initially examine primary teeth between 12 and 24 months. Children still drinking from a bottle anytime after their first birthday are likely to have tooth decay.

Treatment

To treat most cases of tooth decay in adults, the dentist removes all decayed tooth structure, shapes the sides of the cavity, and fills the cavity with an appropriate material, such as silver amalgam or composite resin. The filling is put in to restore and protect the tooth. If decay has attacked the pulp, the dentist or a specialist called an endodontist may perform root canal treatment and cover the tooth with a crown.

In cases of baby bottle tooth decay, the dentist must assess the extent of the damage before deciding on the treatment method. If the problem is caught early, the teeth involved can be treated with fluoride, followed by changes in the infant's feeding habits and better oral hygiene. Primary teeth with obvious decay in the enamel that has not yet progressed to the pulp need to be protected with stainless steel crowns. Fillings are not usually an option in small children because of the small size of their teeth and the concern of recurrent decay. When the decay has advanced to the pulp, pulling the tooth is often the treatment of choice. Unfortunately, loss of primary teeth at this age may hinder the young child's ability to eat and speak. It may also have a bad effect on the alignment and spacing of the permanent teeth when they arrive.

Prognosis

With timely diagnosis and treatment, the progression of tooth decay can be stopped without extended pain. If the pulp of the tooth is infected, the infection may be treated with antibiotics prior to root canal treatment or extraction. The longer decay goes untreated, however, the more destructive it becomes and the longer and more intensive the necessary treatment will be. In addition, a patient with two or more areas of tooth decay is at increased risk of developing additional cavities in the future.

Scientists are working on several advances in the reversal and prevention of tooth decay. The advances under development include: Smart fillings to prevent further tooth decay, toothpaste to strengthen and restore tooth minerals, and mouthwashes and chewing gums that reverse early decay. Scientists are studying the use of calcium phosphate cements (CPC), used to repair cranial defects, for fractures and bone loss from gum disease. CPC might provide a successful drug delivery system in Smart fillings to prevent tooth decay from recurring around existing fillings and surrounding teeth. Other calcium phosphate-based technologies used in chewing gum and mouth rinses are being tested to remineralize hard tooth tissues or slow demineralization produced by caries. Scientists are researching controlled-release fluoride systems, placed between the teeth or in tooth pits and fissures, that deliver high fluoride concentrations to localized areas. Research is also being done on the use of filling materials to repair exposures of the tooth pulp, which could eliminate the need for root canal therapy.