CAUSES years on the occlusal surface of the tooth,


are caused by tooth decay which is a process that develops slowly but steadily
due to following reasons:

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Plaque: Dental plaque is a
clear sticky film causing a coating on the teeth. Plaque formation is due to
carbohydrates primarily which contains sugar and starch and is further
aggravated by not removing the layer from the tooth. When the carbohydrates are
not cleaned off from the teeth, bacteria start colonizing the teeth quickly and
harden with salivary salts leading to a further hard plaque or tartar a.k.a.
the calculus. Tartar makes plaque more difficult to remove and creates an
environment for bacteria to colonize further leading to more plaque formation
from leftover food particles.

Recurrent Plaque attacks: The acids in plaque cause
the demineralization of the tooth’s enamel by causing erosion. This erosion
causes tiny openings or holes in the enamel which is usually the first stage of
a cavity after demineralization. Once the enamel is worn away which is actually
a very long and a tough process and in some stages, taking a time of 3.5 – 4
years on the occlusal surface of the tooth, the bacteria reach the second layer
of the tooth, the dentin. Dentin is much softer than enamel and less resistant
to acid attacks. Dentinal tubules, the micro-openings of the dentin that
directly communicate with the pulp of the tooth causing hyper-sensitivity.

Pathways of Destruction: If the patient is not aware or cautious
at this stage, the bacteria and acid continue to march
through the teeth by moving to the inner most layer a.k.a. the pulp that
contains nerves and blood vessels. The pulp becomes swollen and irritated from
the bacteria, becoming scathed from attack and causing pain. Swelling and discomfort
can even show up on the face of the patient as a result of this sometimes.



signs and symptoms of a cavity vary, depending on the extent, type and
location. When a cavity is in initial stage, there might not be any symptoms at
all. As the decay spreads its fangs, there may be signs and symptoms viz. below:

Spontaneous pain  


Mild to sharp pain when eating or drinking
something sweet, hot or cold

Cavitation in the tooth

Brown, black or white staining  

Lack of pressure on biting

Pain on biting down



risk factors which can increase cavitation in a tooth are actually

Location: Decay predominantly
happens in molars and premolars as they have lots of grooves, pits, fissures, crannies,
which harbour a lot of food particles and bacteria. The pits and fissures make
cleaning access also difficult in such teeth.

Sticky Diet or the Sugary foods
and drinks: Sticky
liquids like milk, ice cream, honey, sugar, cakes, cookies,
hard candies and chips etc. are more likely to cause decay than those foods
that are easily washed away by saliva.

Frequent munching, snacking
or sipping: Regular
snacks or sipping sugary drinks can keep the mouth in acidic environment by
giving bacteria more fuel to produce acids that attack the teeth and wear them
down. Sipping on acidic drinks like coke, pepsi or colas throughout the day also
creates a continual acid bath over the teeth thus making them more prone to

Baby Bottle syndrome a.k.a. bedtime
infant feeding: Baby
bottle is one thing which should be banned as babies given bedtime bottles
filled with milk, juice or other sugary liquids cause baby bottle or nursing
bottle caries also known as the rampant caries.

Infrequent and Inadequate
brushing: Brushing not done after regular meals is
a cardinal sin as plaque formation happens and the decay journey starts. More
than half of the country brushes just early morning which is akin to no brushing
at all in the day.

Lack of fluoride: Fluoride helps prevent
cavities and also via the process of remineralization reverses the earliest
stages of tooth decay. It is also a common ingredient in toothpaste and mouth
rinses, but it needs to be added to the public water supply to be readily available
to the general populace to prevent decay.  

Toddler, Teenager and Senile
Cavities are usually more common in very young children,
teenagers and senile (old) people because of diet patterns in former two and
excessive wear, breakage and worn down teeth in the latter, making them more
vulnerable to tooth root decay. Senile people are also on medications that
reduce saliva flow and increase the risk of cavities.

Dry mouth: Saliva helps prevent
tooth decay by washing away food and plaque from the teeth by aiding in
remineralization and countering the acid produced by bacteria. A few medicines,
medical conditions like xerostomia, head or neck irradiation and certain
chemotherapy drugs increase the risk of cavities by drastically reducing saliva

Micro-leakage from old restorations: Worn dental restorations weaken,
break down, cause leakages or develop rough edges over the period of time which
allows plaque to build up more easily making it harder to remove, thus causing
dental decay.

Reflux Oesophagitis: Reflux Oesophagitis or the gastroesophageal
reflux disease (GERD), heartburn can
cause gastric acid to flow into the mouth via a reflux, wearing away the tooth enamel
and causing significant cavitation. This results in exposure of dentin to
bacterial attack, thus creating tooth decay.  

Eating disorders: Eating disorders
interfere with saliva production and a few of them like anorexia and bulimia cause significant
tooth erosion and cavitation sometimes. Gastric acid from repeated vomiting washes
over the teeth and begins to dissolve the enamel. 


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