TOOTH decay is one of the most common diseases affecting people of all ages.
It begins quietly, often without pain, but can eventually destroy the structure of a tooth and lead to infection, severe discomfort and tooth loss if left untreated.
Also called dental caries or cavities, tooth decay occurs when acids produced by bacteria in dental plaque gradually damage the tooth’s hard tissues.
The process begins in the mouth, where bacteria naturally live on the teeth. When people eat foods containing sugars and other fermentable carbohydrates, certain bacteria use these substances as fuel. They produce acids as a byproduct.
These acids attack the tooth’s enamel, the hard outer covering that protects the tooth. Repeated acid exposure can remove minerals from enamel, a process known as demineralization.
Saliva provides some natural protection. It helps wash food particles from the mouth, neutralize acids and supply minerals that support the repair of early enamel damage. Fluoride from toothpaste, drinking water and other sources can also help strengthen enamel and make teeth more resistant to acid attacks.
When acid attacks happen frequently or the protective effects of saliva and fluoride are insufficient, mineral loss can continue. An early area of weakened enamel may eventually develop into a cavity.
Tooth decay does not remain on the surface forever. Once a cavity penetrates the enamel, it can spread into dentin, the softer layer underneath.
Dentin contains microscopic channels that can transmit sensations toward the nerve-containing pulp. This is one reason a person with progressing decay may begin experiencing sensitivity to cold, heat, sweets or pressure.
If decay reaches the pulp, inflammation or infection can develop. At this stage, pain may become persistent or severe. In some cases, bacteria can spread beyond the tooth and form a dental abscess.
What increases the risk? Frequent consumption of sugary foods and drinks is an important risk factor. The frequency of exposure matters because every episode of sugar consumption can encourage acid production by oral bacteria.
Poor oral hygiene can allow plaque to accumulate. Dry mouth can also increase the risk because reduced saliva means less natural protection for the teeth.
Other factors include inadequate fluoride exposure, frequent snacking, certain medications and conditions that affect oral health.
Children are particularly vulnerable when sugary drinks and snacks are consumed frequently, although tooth decay can affect people throughout life.
Much of tooth decay is preventable. Brushing twice a day with fluoride toothpaste helps remove plaque and strengthens enamel. Cleaning between the teeth removes plaque from areas a toothbrush cannot effectively reach.
Limiting frequent sugary snacks and drinks, drinking water and maintaining regular dental examinations can further reduce the risk.
Early decay may sometimes be managed before a permanent cavity develops, depending on its severity and the individual’s circumstances. Once a cavity has formed, however, professional dental treatment is generally required.
Treatment may involve removing decayed material and restoring the tooth with a filling. More advanced decay may require root canal treatment or, when the tooth cannot be saved, extraction.
Tooth decay is therefore not simply a problem caused by eating too much candy. It is a progressive disease involving bacteria, dietary carbohydrates, acids, saliva and the tooth itself.
Recognizing the process early—and maintaining daily habits that protect enamel—can help preserve natural teeth and prevent a small cavity from becoming a major dental problem.
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Dr. Joseph D. Lim, Ed. D., is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; Honorary Life Member of the Thai Association of Dental Implantology; and Founding Chairman of the Philippine College of Oral Implantologists. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines, College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate Professor; Fellow, International Congress of Oral Implantologists; and Fellow, Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com./PN
