The surface of a tooth consists of enamel. This is the protective layer of the tooth, so to speak.
Dental plaque containing sugar collects on the enamel as a result of eating. Dental plaque is an excellent food source for numerous oral bacteria. Without regular and thorough cleaning, they multiply uncontrollably.
The bacteria's metabolism produces an acid that attacks the tooth enamel. It dissolves minerals such as calcium from the enamel and slowly breaks it down. This allows the acid to eat its way deeper and deeper into the enamel.
After some time, it attacks the underlying dentin. Then the tooth is in danger. It is only now that toothache occurs.
In recent decades, successful caries prophylaxis has led to a reduction in caries, especially in children. Nevertheless, caries still occurs in over 90% of people in western industrialized countries. This makes tooth decay the most common nutrition-related disease in these countries.
There are numerous bacteria in the oral cavity. They have specialized in living in the plaque on the surface of the tooth. There they produce acid as a waste product when decomposing carbohydrates, sugar and protein.
This acid can attack the tooth enamel and dissolve components such as calcium. This process is called demineralization.
If plaque is not removed from the teeth, the level of acid in the oral cavity ultimately increases. The saliva is then no longer able to neutralize the acid in the mouth. The calcium in the saliva can no longer remineralize the tooth. The breakdown of the tooth enamel cannot be stopped and tooth decay occurs.
Even small children can suffer from tooth decay. Teething bottle caries is particularly well known. This is usually caused by drinks containing sugar and fruit acid in the drinking bottle.
Due to the constant sucking on the bottle
- the incisors in particular are constantly exposed to the acid,
- the protective saliva film on the milk teeth is rinsed off and
- the sugar in the drinks promotes the growth of bacteria in the plaque.
This often leads to complete destruction of the teeth.
The feeding bottle should therefore not be used as a permanent substitute for a pacifier. The child should only be given the bottle to drink from. As soon as it is old enough, it should drink from a cup instead.
A tooth decay goes through several stages. The symptoms depend on which stage the caries disease is in.
Stage 1: Initial caries
First, bacteria damage the top layer of the tooth, the enamel. Certain minerals are dissolved out of the enamel and the tooth is demineralized. This results in small, white spots on the enamel. Remineralization of the teeth using suitable toothpastes and mouthwashes can counteract the process.
As demineralization is not painful, it often remains undetected. If left untreated, the white spots on the enamel quickly turn dark.
Caries appears as dark spots on the teeth © Alessandro Grandini | AdobeStock
Stage 2: Dental caries
The bacteria have reached the dentin, which is the layer under the tooth enamel. Those affected first feel throbbing, then dull, constant pain.
The bacteria colonize the small dentinal tubules that extend from the enamel to the tooth nerve. This is why the teeth now react sensitively to
The dentin is much softer than the enamel. Bacteria can therefore cause a great deal of damage here in a very short time.
Stage 3: Caries profunda
This stage is reached when more than 2/3 of the tooth is affected. A hole in the tooth can now be seen with the naked eye.
The patient suffers from permanent pain. If left untreated, the fourth stage of caries occurs.
Stage 4: Penetrating caries (deep tooth decay)
The bacteria have eaten so far into the tooth that the hole reaches into the cavity of the tooth. There is now a connection between the tooth cavity and the oral cavity.
The bacteria no longer only damage the dentin, but also
Permanent, severe pain now occurs. The bacteria have infected the pulp and triggered an inflammatory reaction as a defense. This inflammation leads to an unpleasant increase in pressure inside the tooth. Nerve fibers are compressed and cause great pain.
If the nerve is completely destroyed, the pain suddenly subsides and quickly disappears completely. This should be taken as a warning signal from your own body: The tooth is dead and in danger of falling out.
Bacteria can now enter the bloodstream unhindered via the tooth's blood supply. They can now cause blood poisoning or serious heart disease such as endocarditis.
Most people only visit the dentist when the tooth hurts. By then, however, it is already too late because the tooth is already damaged. It is therefore highly recommended that you visit the dentist twice a year for a check-up. The statutory health insurance companies pay for these check-ups.
The dentist examines the entire tooth during such a check-up. He or she can intervene in good time in the early stages of painless caries.
With the help of a small probe, the dentist can determine whether
- a tooth has pain-sensitive areas or
- the tooth surface has become soft due to demineralization of the enamel.
X-rays can show areas that are not clearly visible from the outside, e.g.
- between the teeth or
- under existing fillings.
Caries appears on an x-ray as a dark, black spot. Only an X-ray shows how advanced and deep the caries actually is. X-rays are one of the most important examination methods, especially for dental fillings and crowns.
Caries can also be diagnosed and treated at the same time using a special laser. Exposure to laser light at a specific wavelength causes the tooth to fluoresce. In the case of caries, the tooth fluoresces differently in these areas than in healthy areas.
This difference is made visible with a spectrometer. The advantage of laser diagnostics is that the body is not unnecessarily exposed to X-rays.
Although tooth decay often runs in families, it is by no means hereditary. The frequent occurrence of caries in a family is rather due to
- similar eating habits and
- the same lack of and incorrect oral hygiene.
In recent years, however, the incidence of tooth decay in Germany has fallen sharply. This can be attributed, among other things, to improved education regarding oral hygiene and prophylactic measures.
With early diagnosis and treatment, the tooth enamel can recover. It is then necessary to thoroughly remove the plaque by administering fluoride.
Special toothpastes and mouthwashes contain fluoride for precisely this purpose. You should pay attention to this when buying. In certain cases, the dentist can also apply a fluoride-containing varnish to the teeth. This then releases small amounts of fluoride into the teeth over several days.
Dental fillings
If the tooth is already damaged, only a dentist can help. The affected tooth sections must be removed and thoroughly cleaned. To do this, the dentist drills a hole in the tooth, removes the decay and closes the tooth again.
The tooth is either closed directly with a filling or indirectly. In the indirect procedure, the filling materials are adapted to the tooth and produced in the laboratory.
Nowadays, amalgam and plastic are used as filling materials in the direct procedure. In the indirect procedure, various ceramics or metal alloys such as gold are used.
The materials differ not only visually. They are also very different in terms of processing and cost. The durability depends very much on the place of use in the mouth and the processing of the material.
Plastic fillings should last ten to fifteen years. Amalgam and metal alloys can last thirty years or longer.
Root canal treatment
Root canal treatment is necessary when decay damages the pulp and nerve. The tooth is drilled down to the root in a long and complex procedure and the pulp is completely removed. The resulting cavity is completely sealed with a special filling material.
Nerve-free teeth no longer feel pain. However, they can fall out more easily, as the tooth with the nerve loses its hold in the periodontium. For this reason, it should not be allowed to reach the stage of root canal treatment.
Tooth extraction
Untreated caries can damage a tooth so severely that it can no longer be saved. The dentist then has to extract the tooth.
A bridge or dental implant can then be inserted in its place. However, both are associated with high costs.
Early treatment is therefore always preferable. Delaying a visit to the dentist makes later treatment more unpleasant and significantly more expensive.
Newer treatment methods for caries
As standard, a drill is used to open up the tooth and remove the caries.
Alternatively, a dental laser can also be used to remove the caries. In contrast to drilling, this removes less tooth substance and does not cause the tooth to vibrate. The procedure is therefore gentler and virtually painless.
The laser emits exactly enough energy locally into the tooth to ionize and then vaporize the tooth substance. This creates a hole that has to be sealed in exactly the same way as after drilling.
As an alternative to tooth drilling, there are also other treatment methods for caries.
However, statutory health insurance companies do not currently cover the costs of these methods. If you have supplementary dental insurance, some of the costs may be reimbursed. Please ask your insurance company about this.
Infiltration: caries treatment without drilling
One of the latest methods is the infiltration of caries that is not too far advanced. In this way, caries can be stopped without drilling and without fillings.
The tooth surface, which is usually still intact, is roughened with a special acid. This creates fine pores on the surface. Liquid resin can penetrate through these pores into the cavity and seal it. The resin is then cured with a lamp. The tooth is now completely sealed and the caries infestation is stopped.
Carisolv: caries treatment with gel
Another relatively new method is caries treatment with Carisolv, a special caries-dissolving gel. Carisolv consists of, among other things
- the disinfectant sodium hypochlorite and
- certain amino acids.
The gel is applied directly to the affected areas of the tooth. It removes the affected tooth substance from the tooth. The healthy tooth substance is not affected. After a short exposure time, the softened tooth substance is removed with a scraper.
The gel may need to be applied repeatedly. It can then completely remove deeper caries from the tooth. After treatment, the affected areas are sealed with a composite filling.
HealOzone: caries treatment with ozone
Another new procedure for treating caries is the HealOzone ozone treatment. It can be used for small, superficial caries infestations.
As a highly chemically reactive gas, ozone is a good agent against the bacteria that cause tooth decay.
During treatment, the tooth is first exposed to ozone gas for up to forty seconds. Scientific evidence shows
- the deep effectiveness down to the dental pulp and
- the dental pulp and a killing of bacteria of up to 99.9%.
have been proven.
After treatment with HealOzone, the carious areas of the tooth are remineralized with liquid agents. These contain fluorides and other minerals that are important for tooth structure. These agents must be applied to the teeth regularly over a period of around one to three months. The intact tooth is then restored.
Prevention is always better than treatment! It is best if tooth decay does not occur in the first place.
Take care of your teeth yourself!
Brush your teeth regularly and clean them properly. Thorough oral hygiene should be carried out at least twice a day after meals. Toothpaste should always contain fluoride.
Oral hygiene should also include dental floss. Dental floss can be used to clean the spaces between the teeth. These are difficult or impossible to reach with a toothbrush.
You can also use mouthwashes containing fluoride or additional tooth gel.
Your dentist will tell you which toothpaste or mouthwash is right for you. They will also show you how to carry out proper and complete oral hygiene.
You should also take advantage of the check-ups paid for by your health insurance. You can have your teeth checked free of charge every six months. The dentist can detect problem areas early and intervene before the caries spreads.
Stubborn tartar is also removed once a year. This costs you nothing.
Additional services: Professional teeth cleaning (PZR)
Dentists recommend having your teeth professionally cleaned once or twice a year.
A deep fluoridation can follow the PZR. During this treatment, the dentist applies a fluoridated varnish to the teeth. This releases small amounts of fluoride into the tooth over several days. The enamel thus becomes more robust and can no longer be destroyed so easily by bacteria.
If your teeth have deep grooves on the surface, the dentist may suggest sealing these teeth. Uneven tooth surfaces become smooth surfaces. These are easier to clean with a toothbrush and less susceptible to plaque.
A complete PZR followed by deep fluoridation is not cheap. Depending on the dentist and the extent of the treatment, it costs between 100 and 150 euros. General health insurance does not cover this treatment.
If you are privately insured or have supplementary dental insurance, the costs are often covered in full.
So far, however, there are no studies that prove that a PZR really has advantages for the patient. A PZR can in no way replace regular and careful dental care at home. This is normally sufficient in combination with regular check-ups.
However, people with an increased risk of periodontitis can benefit from a periodontal cleaning.
