What does a cavity look like: an overview and detailed understanding, symptoms, and 5 treatment options?
A cavity or tooth decay, or dental caries refers to a microbial disease of calcified tissues of the teeth which occur due to demineralization or destruction of the organic substances, which may appear blackish-brown discolouration looking like small, tiny holes appearing as dark spots or dark area in the mouth clinically.
These holes can be both small as dots and also as large as an entire tooth.
When the biofilm comes in contact with the fermentable dietary carbohydrates on the tooth surface, over time, it develops cavitation or tooth decay. As time progresses, the tooth appears more radiolucent than the unaffected area.
1. Are Cavities Permanent?
Dental decay or cavities are reversible if detected early and treated with appropriate care; however, if the cavities are left unattended, they can cause permanent change and loss of tooth structure, leading to complications and dental extractions or loose teeth.
Because bacteria accumulation is at the foundation of both gum disease and tooth decay, they can occur concurrently. If you observe redness at the gum line or if your gums are painful and bleed when you brush and floss your teeth, you may be developing a cavity as well as moderate gum disease.
Keep reading to learn more.
2. Etiological Factors for Dental Cavity or Caries Development:
- Dietary factors like consumption of certain foods like excess sugars or sweets and sweet food, amount of carbohydrates consumed, snacking between the meals, sticky food, and carbonated drinks can cause microorganisms that can not be seen through the naked eye and bacteria like streptococcus mutants and actinomycosis viscous to grow and develop colonies.
- Systemic factors like hereditary, pregnancy, lactation, and diabetes.
- Poor oral hygiene
- Immunological factors
- Accumulation of plaque and calculus
- Dry mouth or xerostomia
The most accepted theory for cavity or tooth decay is a chemical parasitic theory or acidogenic theory, which states that the acid produced by the microorganisms on carbohydrates results in decalcification and demineralization of enamel and the tooth structure.
Tooth decay and its size vary from small to large, also depending on the location and extent of the cavity.
With time various classifications have been recorded, but the most common types, to name a few, are:
- interproximal caries
- recurrent caries
- arrested caries
- forward or backward caries
- pre and post-eruptive caries
- pits and fissure caries
- radiation caries caused by excessive x-ray radiation
- root caries
- rampant caries
2.1. Caries Formation and Its Biofilm:
BIOFILM is nothing but dental plaque deposited on the tooth enamel surface. It consists of a community of organisms such as S. Mitis, and S. sanguis, capable of producing acids and fermenting sugars.
It is neutralized by saliva and results in carious lesions by demineralization of enamel and dentinal layers.
2.2. Signs and Symptoms of Dental Tooth Decay:
- pain radiating to the ears
- bleeding gums
- mobility of teeth
- food particle lodgment
- excruciating pain while laying down, drinking, or eating hot or cold food.
- bad breath
- visible signs of dark or discolored brown spots
2.3. Diagnosis of Dental Caries:
Traditionally caries can be detected using visual inspection, tactile sensation, radiographic examination, and transillumination using the mouth mirror.
Modern methods include visible light: QLF, DELF, DIFOTI by digital imaging or radiovisiography, also known as RVG and CBCT, laser, electric pulp testing, and ultrasound.
2.4. Pre-Treatment Assessment of The Patient:
The patient’s detailed medical history and health conditions should be taken, the recent history of hospitalization, allergies to medications, systemic diseases, and very high-risk cardiac abnormalities.
The patient’s detailed dental history, oral health or past dental problems, previous dental treatment, patient sensitivity of any procedures and experiences, and response to the dental treatment must be checked.
3. Radiographic Diagnosis or X-ray/Iopar interpretations:
What does a cavity look like on a radiograph?
Even the early signs of tooth decay can be diagnosed on the intraoral radiograph. There are various types of radiographic methods used to assess the tooth cavities, such as bitewing radiographs, xeroradiography, and occlusal radiographs, which help in easy recognition of the teeth cavities at an early stage deciduous also known as baby teeth or milk teeth and the adult permanent dentition.
Advanced dental caries or deep dental caries penetrate the tooth enamel and dentin, rendering the tooth tender on percussion, which is vital to detect teeth cavities early. Radiolucency can be seen involving the enamel, dentine, and pulp suggestive of the underlying periodontal pathology and includes loss of lamina dura and periodontal ligament space.
Patient position and the correct angulation of the radiographic film are extremely important. Patient protection and operator protection should also be kept in mind because excessive x-rays can be harmful to exposure to uncontrolled radiation.
4. How to Minimize Dental Caries
What does a cavity look like intraorally?
4.1. How To Reduce Cavity Development or Tooth Decay?
What are the necessary precautions to be taken to stop the progression of tooth discolouration and sensitive teeth?
- Reduce the intake of sugary foods and sweet foods and drinks.
- Patient education and motivation are extremely important. The proper brushing techniques should be followed. the patient is advised regular brushing, including all the chewing surfaces, flossing, and using interdental aids to remove the food particles from the proximal areas.
- Chlorhexidine mouth wash 0.12% or a fluoride rinse should be used after a few minutes or an hour of brushing, preferably fluoride toothpaste. Do not use mouth wash immediately as it may take away the full fluoride content. This step is essential to prevent cavities.
- Always use fluoride toothpaste or denitrifies of about 1ppm as it helps to prevent cavities or tooth decay.
- Deciduous teeth should be given oral prophylaxis, and fluoride treatments should be applied by stannous fluoride or APF methods.
- Maintain good oral hygiene by drinking plenty of water after food as it dislodges the food particles.
- Saliva acts as a natural cleanser as it dilutes the acid produced in the plaque biofilm; it acts by buffering mechanism assisting in the demineralization and formation of a pellicle.
- Consider taking sugar substitutes like xylitol, stevia, or natural sugars.
- Early-stage cavities or small holes, the dark spot can be treated by pits and fissure sealants.
- Fluoride can be implemented in tap water or community water, salt, and milk.
5. When to Visit a Dentist or A Dental Clinic?
It is advised that the patient should regularly keep their oral hygiene in check by routine cleaning, restoration of decayed teeth, and extractions of retained deciduous teeth or any grossly decayed tooth.
- Visit a dentist when the pain gets unbearable, sharpshooting, or excruciating pain.
- in case of intraoral or extraoral swelling
- sensitive teeth and food lodgment
- intrinsic or extrinsic staining of teeth
- underlying tooth pathology
- pericoronitis or tooth impaction
6. Treatment Planning
If the caries are left untreated, it can cause serious complications, permanent damage, and tooth structure loss. When the treatment is carried out at early stages, the procedure can be done as conservatively as possible, and the natural form can be maintained.
- URGENT PHASE: first, the objective should be to provide relief concerning the symptoms and pain management. If the patient is presenting with pain or swelling, antibiotics and analgesics should be prescribed.
- CONTROL PHASE: remove the etiological factors and eliminate potential causes of disease.
- RE-EVALUATE and follow home care and reinforce motivation.
- The DEFINITIVE PHASE includes endodontic, periodontal, or orthodontic treatment to prevent cavities and eliminate the cause of cavities.
- RE CARE AND REASSESSMENT of the patient and recall the patient for routine follow-up.
7. 5 Treatment Options to Consider
7.1. Amalgam Restorations
It is a metallic restoration composed of silver-tin-copper mixed and placed in the prepared tooth form and contoured, complying with resistance and retention; however, they are subjected to chemical corrosion and may discolour over time.
Improper dispensing of mercury may cause mercury toxicity. Hence it should be handled with care.
7.2. Composite Restoration
Popularly used composite restorations are the most preferred type of restoration. The tooth-coloured restoration works on the acid-etch technique and has strong bonds to tooth enamel and dentine to simplify the therapeutic techniques.
The cavity preparation can be kept as conservative as possible. Several modifications of the composites are available such as packable composite restorations, microfilm, flowable, nanofiller, and hybrid.
7.3. Glass Ionomer or Gic Restorations
This is one among the cement which is used extensively and in atraumatic restorative procedures due to its ease of use and excellent fluoride-releasing properties. It consists of ion-cross-linked polymer matrices surrounding the glass-reinforced filler material.
It comes in a powder and liquid form, dispensed on a mixing pad and placed in the prepared cavity.
Various modifications have been done to enhance the bond strength and properties.
Miracle mix is mixed in formulation to produce amalgam substitute. Glass ionomer restorations seem to work well for high caries risk situations.
7.4. Gold Restorations
Pure gold has been used in dentistry for several years now, and the gold is used in the form of matt gold, gold foil pellets. Principles of manipulation of direct gold include degassing and annealing.
The gold foil is compacted by hand, electro, or pneumatic mallet, compressed in a stepping motion into the oral cavity on prepared tooth structure. But this can not be used in cavities with very large tooth chambers, periodontally weekend teeth, or disabled patients who cannot sit for long procedures.
Root canal-treated teeth can not be restored with gold restorations.
7.5. RCT Or Root Canal Treatment
This involves cleaning and shaping the root canal, obturation of the roots, and finally placing a crown.
8. What Can Be Done to Maintain Oral Hygiene?
Mechanical measures for caries control include
- Tooth brushing: to reduce the number of microorganisms and bacteria, it is advised to brush twice daily or brush teeth after consuming sticky food and food rich in carbs.
- Mouth rinsing: using mouth wash dislodges debris and food.
- Flossing: it is advised to use floss after brushing the teeth as it helps the fluorinated toothpaste reach the interdental spaces and tight proximal contacts.
- Oral irrigators: used in the management of gingival infections and gum line improvement.
- Chewing gum: this can prevent dental caries by mechanical cleansing action.
8.1. Role of Dietary Control
A well-balanced diet is very important for the oral and overall health of the human body. High in fat, low in carbohydrates, and free from sugar, have low caries activity. Phosphate-rich diets are said to cause a significant reduction in the incidence of caries.
8.2. Factors Increasing Risk For Caries Are:
- high level of demineralization
- history with recurrent caries
- poor quality restorations and reinfection in RC-treated tooth
- poor oral hygiene
- inadequate fluoride exposure
- prolonged nursing
- frequent high sucrose content
- genetic abnormalities
- chemotherapy or radiotherapy
- eating disorders
- drug abuse
- alcohol abuse
- irregular dental care.
8.3. Dental Caries in Toddlers and Children
Children with prolonged use of feeders and milk formulae are said to develop dental caries. Pacifiers are used to prevent nursing bottle caries.
The most commonly affected teeth are anterior teeth and mandibular first permanent molar. It results in teeth chipping and brownish discolouration, which may affect the development and eruption of the permanent dentition.
A high frenal attachment can also cause caries in the anterior tooth region; other factors like mouth breathing also play a role.
8.4. How to Prevent Nursing Bottle Caries?
- Avoid giving bottle feeders to children when they fall asleep, brushing the child’s teeth regularly
- discontinuing bottle feeding after the age of 15 months.
- Baby teeth are sensitive to radiation, so avoid excess radiation.
- If they experience tooth sensitivity, book an appointment with the pediatrician.
- Cavities develop in interproximal areas due to debris or food deposits to make sure to rinse the oral cavity with water after meals.
9. Complications of Cavity
The untreated cavity can result in abscess formation and may lead to periodontal destruction and loosening of teeth may cause space infections and sinus tract opening and pus formation, TMJ abnormalities, and reduced mouth opening
Using hard toothbrushes may cause wasting diseases like attrition, abrasion, and erosion.
9.1. Who Are at Risk?
- patients with diabetes
- alcoholism and smoking
- systemic diseases
- physically disabled patients
- old age
- pregnancy and lactation
9.2. Some Home Remedies Include:
- oil pulling
- using clove or clove oil in the area of pain
- brushing teeth
- saltwater gargling
- chewing sugar-free gum
If the tooth sensitivity increases after the restoration, it is due to the irritation at the nerve endings or inflammation caused due to filling.
If the sensitivity or pain doesn’t go away after a while, contact your dentist for the needful.
10. Final Thoughts
If dental problems and cavities are treated on time, the tooth structure can be preserved, and the patient can be guided towards more preventive measures, and avoid developing tooth decay.
To reduce the risk of pain and infections, necessary steps should be taken to fill the cavities on time with composites and glass ionomer. In the case of swelling, fever, and increased pain and infection, contact your nearby dentist to discuss the treatment plan.
I hope now you know what a cavity looks like, and all the possible treatment options.
-Edited by Steffy Michael|26/6/22