How does tooth decay develop?
introduction
Probably no disease is as common worldwide as tooth decay or in German Tooth decay. In the German population, only one percent of people are considered completely caries-free. Caries begins on the enamel surface of the tooth and progresses deeper towards the dentin (Dentine) continued. If left untreated, the tooth decay can penetrate to the pulp and, in the worst case, lead to tooth loss.
The tooth substance destroyed by caries cannot be reproduced or replaced by the body, which is why the carious lesion must be removed from a certain stage in order to restore the functionality of the affected tooth. But are there ways to prevent the development of caries and the progression of this disease and to take preventive measures?
Causes of the development of caries
The number one cause of tooth decay is poor oral hygiene. If you brush your teeth seldom or not sufficiently carefully, you leave food residues inside the oral cavity. This gives the bacteria naturally occurring in the oral cavity a free path to metabolize the leftovers into acids.
Find out more about correct dental care at: Oral hygiene - this is how it works
But why do patients with good oral hygiene still have a problem with tooth decay? This shows that tooth decay is influenced by several factors. If the enamel is genetically not optimally built up, the tooth is much more vulnerable and more prone to caries formation. Diseases such as amelogenesis imperfecta or dentinogenesis imperfecta also favor the development of caries.
Saliva also plays a major role. One of the functions of saliva is to use its integrated buffer system to buffer acids that are formed within the oral cavity and to neutralize the pH value. This enables thin saliva to neutralize the acid generated in the mouth by bacteria and minimize the risk of tooth decay. The buffer capacity differs between the patients, i.e. in some patients the saliva can buffer more acids than in others.
If the amount of calcium salts in saliva is reduced, the risk of caries increases due to a reduced buffer function. The amount of saliva production is also relevant. The average daily value of saliva production is one to one and a half liters. Older patients with dry mouth or irradiated tumor patients often have a problem with increased caries formation, due to the fact that the buffer function of the saliva is missing due to the reduced amount of saliva and the pH value remains in the acidic range for much longer.
This could also be of interest to you: Dry mouth - what to do
Which factors contribute to the development of caries?
Four causal factors must come together for the development of caries. These four factors include the tooth as a host, food as a substrate, the microorganisms themselves and time. W.D. As early as 1889, Miller established the still fundamental theory of the development of caries, which states that caries can only develop at all if these four factors combine.
If only one factor is missing, it is practically impossible. In addition to the 4 fundamental factors, there are also influencing factors, such as the composition of the saliva or the individual genetic and anatomical composition of the hard tooth substances, which can make caries more difficult or easier. In connection with this, tooth decay can only develop if microorganisms can settle on a tooth for a certain period of time and a metabolizable substrate is available.
If the substrate is removed promptly by brushing your teeth or flossing, the bacteria have no food to metabolize and cause tooth decay. The bacterium is one of the bacteria that are primarily responsible for the development of caries Streptococcus mutans.
How does caries develop?
Caries occurs when microorganisms can settle on a tooth for a long period of time if there is a substrate (= food residues). The metabolism of microorganisms, such as bacteria, breaks down the food into acids. These acids decalcify the hard tooth substances and thus damage the tooth. That damage is tooth decay.
The bacteria within the oral cavity are always present and, with poor oral hygiene and food that is beneficial to them, can settle on the tooth in the form of plaque. Plaque is a dental plaque that cannot be removed by simply rinsing it with water and can only be removed by mechanical teeth cleaning.
Read more about plaque removal at: Remove plaque
Good substrate or food for the bacteria are low-molecular carbohydrates, including above all the table sugar sucrose, which is also called cane or beet sugar. The bacteria are able to break down the sucrose through their metabolism into glucose (= simple sugar) and fructose (= fruit sugar). The metabolic process produces acid as a waste product for the bacteria, which damages the tooth as caries. The pH value in the oral cavity becomes acidic, which supports the bacteria in the development of caries and the demineralization of the tooth enamel.
Scientific studies have made it clear that primarily sucrose is particularly cariogenic and its breakdown products (glucose and fructose) do not serve the bacteria as actively as a substrate. Fructose, the fruit sugar in fruit, is rather unattractive for bacteria. However, reasons why this is the case are still unclear.
Furthermore, tooth decay has a tendency to enlarge and widen. After decalcifying the enamel, the caries destroys it until it has reached the next layer of hard tooth substance, the dentin. Since the dentin is softer and therefore more permeable than the enamel, the carious lesion eats its way more quickly here. Is the tooth pulp (pulp) eventually infected by the tooth decay, the nerves and blood vessels inside are destroyed and the tooth dies. Read more about this at: Dead tooth
To a certain extent, tooth decay is reversible, which means that it can be reversed or stopped. If only the superficial enamel layer of the tooth is weakened by initial caries that cannot yet be felt with a dental probe, fluoride application can reduce the tendency to spread and convert the active form of the caries into an inactive form. The caries in the development phase can be permanently prevented from spreading through regular fluoridation.
This might interest you: Fluoridation of teeth
How long does caries take to develop?
The time it takes for caries to develop can vary widely and depends on many factors. The genetic makeup and the associated structure of the hard tooth substances play a major role.
If the enamel is robust, caries can develop over several years; if the enamel is not as hard, the caries can have manifested itself over weeks and months. If the saliva flow rate is still reduced and the enamel is softer, the development of caries can progress even faster. Poor oral hygiene can exacerbate this issue.
In the case of normally developed tooth enamel that has not yet been weakened by acid, it is assumed that it takes an average of 4 years from initial caries to reaching the inner third of the enamel near the pulp. Since the tooth enamel is much softer in milk teeth than in permanent teeth due to a different composition, tooth decay can develop and spread much faster here. But because caries only causes symptoms such as pain or tenderness in the dentin, the development of caries usually goes unnoticed by the patient.
You might also be interested in: Tooth decay in children
It is therefore difficult to narrow down how quickly or slowly caries can develop, since regular fluoride application can prevent caries from progressing or even make it inactive. If caries has progressed too far and has already reached the dentin, even fluoride cannot remedy the tendency for the caries to spread. In general, however, it can be said that, due to the nature of the substances in the dentin, the progression of caries is much faster than in the harder tooth enamel.
Also read: How do you recognize tooth decay?
Prevent the development of caries
It is quite possible to prevent the development of caries. First of all, good oral hygiene should be mentioned.
Regularly brushing your teeth at least twice a day prevents food particles from sticking to the teeth for a long period of time and thus being metabolized by bacteria. Furthermore, daily use of dental floss, interdental brushes or the like to clean the interdental spaces is effective in order not to leave tooth residues in the oral cavity for a long period of time. Professional teeth cleaning at the dentist's at least once a year has been shown to reduce the risk of tooth decay and strengthen a healthy oral flora.
Another prophylactic measure is fluoridation. The weekly use of low-concentration fluoride preparations results in a sustained reduction in the risk of tooth decay, as the fluoride accumulates in the tooth enamel and strengthens it. Preparations for home use once a week would be, for example, gel preparations such as Elmex jelly, which is applied to the rows of teeth once a week. After application, you should not eat or drink for half an hour to ensure its effectiveness and not to rinse off the agent directly.
In addition, diet also plays a crucial role. Since the bacteria primarily adopt sucrose, it makes sense to keep the amount of household sugar in the food as low as possible, or to clean the teeth from the food residues shortly after consumption.
Find out more at. Diet for healthy teeth
