Tooth Decay: Information & Tooth Decay Specialists

The surface of a tooth is made up of enamel. This acts as the tooth’s protective layer, so to speak.

When you eat sugary foods, plaque builds up on the enamel. Plaque is an excellent source of food for numerous oral bacteria. Without regular and thorough cleaning, these bacteria multiply uncontrollably.

The bacteria’s metabolism produces an acid that attacks the enamel. It leaches minerals such as calcium from the enamel, thereby slowly breaking it down. This allows the acid to eat its way deeper and deeper into the enamel.

After some time, it spreads to the underlying dentin. At this point, the tooth is at risk. It is only now that tooth pain begins to occur.

In recent decades, successful caries prevention has led to a decline in caries incidence, especially among children. Nevertheless, caries still affects over 90% of people in Western industrialized nations. This makes caries the most common diet-related disease in these countries.

There are numerous bacteria in the oral cavity. They have adapted to living in dental plaque on the surface of the teeth. There, as they break down carbohydrates, sugars, and proteins, they produce acid as a byproduct.

This acid can attack tooth enamel and leach out components such as calcium. This process is called demineralization.

If plaque is not removed from the teeth, the acid level in the oral cavity eventually rises. Saliva is then no longer able to neutralize the acid in the mouth. The calcium in saliva can no longer remineralize the tooth. The breakdown of tooth enamel cannot be stopped, and tooth decay develops.

Even young children can develop tooth decay. A particularly well-known form of this is baby bottle tooth decay. This is usually caused by beverages containing sugar and fruit acids in the baby’s bottle.

Because of constant sipping from the bottle

• the incisors, in particular, are constantly exposed to acid,
• the protective saliva film on the baby teeth is washed away, and
• the sugar in the beverages promotes bacterial growth in dental plaque.

This often leads to complete tooth decay.

The bottle should therefore not be used as a permanent substitute for a pacifier. The child should only be given the bottle for drinking. As soon as the child is old enough, they should drink from a cup instead.

Tooth decay progresses through several stages. The symptoms depend on the stage of the decay.

Stage 1: Initial Caries

First, bacteria damage the outermost layer of the tooth, the enamel. Certain minerals are leached out of the enamel, causing the tooth to become demineralized. This results in small, white spots on the enamel. Remineralization of the teeth using appropriate toothpastes and mouthwashes can still counteract this process.

Since demineralization is not painful, it often goes undetected. If left untreated, the white spots on the enamel quickly turn dark.

Tooth decay appears as dark spots on the teeth © Alessandro Grandini | AdobeStock

Stage 2: Dentin Caries

The bacteria have reached the dentin, the layer beneath the enamel. Those affected first feel a throbbing pain, followed by a dull, persistent ache.

The bacteria colonize the tiny dentinal tubules that extend from the enamel to the dental pulp. As a result, the teeth now become sensitive to

• sweets,
• cold, and
• heat.

Dentin is much softer than enamel. As a result, bacteria can cause significant damage here in a very short time.

Stage 3: Deep Caries

This stage is reached when more than two-thirds of the tooth is affected. At this point, a hole in the tooth is visible to the naked eye.

The patient suffers from constant pain. If left untreated, the fourth stage of caries will develop.

Stage 4: Penetrating caries (deep tooth decay)

The bacteria have eaten their way so far into the tooth that the cavity extends all the way to the pulp chamber. There is now a connection between the pulp chamber and the oral cavity.

The bacteria are now damaging not only the dentin but also

• the dental nerve and
• the tooth’s blood supply.

This is when constant, severe pain sets in. The bacteria have infected the dental pulp and triggered an inflammatory response as a defense mechanism. This inflammation leads to an uncomfortable increase in pressure inside the tooth. Nerve fibers are compressed, causing intense pain.

If the nerve is completely destroyed, the pain suddenly subsides and quickly disappears entirely. This should be interpreted as a warning signal from your body: The tooth is dead and at risk of falling out.

Bacteria can now enter the bloodstream unimpeded via the tooth’s blood supply. They can then cause blood poisoning or serious heart conditions such as endocarditis.

Most people don’t visit the dentist until the tooth starts to hurt. By then, however, it’s already too late, because the tooth is already damaged. That’s why it’s absolutely essential to visit the dentist twice a year for a checkup. Statutory health insurance plans cover these checkups.

During such a checkup, the dentist examines all of your teeth. He or she can intervene early, even in cases of painless tooth decay in its early stages.

Using a small probe, the dentist can determine whether

• a tooth has sensitive areas or
• the tooth’s surface has become soft due to demineralization of the enamel.

X-rays can reveal areas that are not clearly visible from the outside, such as

• between the teeth or
• under existing dental fillings.

Cavities appear as dark, black spots on an X-ray. Only an X-ray can reveal how advanced and deep the cavity actually is. X-ray examination is one of the most important diagnostic methods, especially for dental fillings and crowns.

A special laser can also be used to diagnose and treat tooth decay simultaneously. When exposed to laser light of a specific wavelength, the tooth fluoresces. In areas affected by tooth decay, the tooth fluoresces differently than in healthy areas.

This difference is made visible using a spectrometer. Laser diagnostics offer the advantage of not unnecessarily exposing the body to X-rays.

Although tooth decay often runs in families, it is by no means hereditary. The frequent occurrence of tooth decay within a family is more likely due to

• similar dietary habits and
• a shared lack of or improper oral hygiene.

In recent years, however, tooth decay has been declining sharply in Germany. This can be attributed, among other things, to improved education regarding oral hygiene and preventive measures.

With early diagnosis and treatment, tooth enamel can recover. In such cases, thorough removal of dental plaque is necessary, along with the application of fluoride.

Special toothpastes and mouthwashes contain fluoride specifically for this purpose. You should look for this when making a purchase. In certain cases, the dentist may also apply a fluoride-containing varnish to the teeth. This varnish then releases small amounts of fluoride to the teeth over several days.

Dental Fillings

If the tooth is already damaged, only a dentist can help. The affected parts of the tooth must be removed and thoroughly cleaned. To do this, the dentist drills a hole in the tooth, removes the decay, and seals the tooth again.

The tooth is restored either directly with a filling or indirectly. In the indirect method, the restorative materials are customized to fit the tooth and fabricated in a laboratory.

Today, amalgam and composite resin are used as filling materials in the direct method. In the indirect method, various ceramics or metal alloys, such as gold, are used.

The materials differ not only in appearance; they also vary significantly in terms of processing and cost. Their durability depends heavily on the location in the mouth and how the material is processed.

Composite 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 tooth decay damages the pulp and the nerve. In a long and complex procedure, the tooth is drilled down to the root, and the pulp is completely removed. The resulting cavity is completely sealed with a special filling material.

Teeth without nerves no longer feel pain. However, they are more likely to fall out because, without the nerve, the tooth loses its anchorage in the periodontium. That is why you should avoid letting the condition progress to the point where a root canal is necessary in the first place.

Tooth Extraction

Untreated tooth decay can damage a tooth so severely that it can no longer be saved. In that case, the dentist must extract the tooth.

A bridge or dental implant can be placed in this spot later. However, both options involve high costs.

Early treatment is therefore always preferable. Delaying a visit to the dentist makes subsequent treatment more unpleasant and significantly more expensive.

Newer Treatment Methods for Tooth Decay

Typically, a drill is used to access the tooth and remove the decay.

Alternatively, a dental laser can be used to remove the decay. Unlike drilling, this method removes less tooth structure and does not cause the tooth to vibrate. The procedure is therefore gentler and virtually painless.

The laser delivers exactly the right amount of energy to the tooth to ionize the tooth structure, which then vaporizes. This creates a hole that must be filled, just as it would be after drilling.

In addition to drilling, there are now other treatment options for tooth decay.

However, statutory health insurance plans do not currently cover the costs of these methods. If you have supplemental dental insurance, a portion of the costs may be reimbursed. Please check with your insurance provider for details.

Infiltration: Cavity Treatment Without Drilling

One of the newest methods is the infiltration of caries that is not too advanced. This approach allows caries to be stopped without drilling or a filling.

The tooth surface, which is usually still intact, is roughened with a special acid. This creates fine pores on the surface. Through these pores, liquid composite resin can penetrate the cavity and seal it. The composite is then cured with a light. The tooth is now completely sealed, and the progression of the decay has been stopped.

Carisolv: Cavity Treatment with Gel

Another relatively new method is caries treatment with Carisolv. Carisolv is a special gel that dissolves caries. Carisolv consists, among other things, of

• the disinfectant sodium hypochlorite and
• certain amino acids.

The gel is applied directly to the affected areas on the tooth. There, it dissolves the decayed tooth structure from the tooth. The healthy tooth structure remains unaffected. After a short application time, the softened tooth structure is removed with a scraper.

It may be necessary to reapply the gel. This allows it to completely remove deeper cavities from the tooth. After treatment, the affected areas are sealed with a composite filling.

HealOzone: Cavity Treatment with Ozone

Another new method for treating tooth decay is the HealOzone ozone treatment. It can be used for small, superficial cavities.

Ozone, a highly chemically reactive gas, is an effective agent against the bacteria that cause tooth decay.

During the treatment, the tooth is first exposed to ozone gas for up to forty seconds. Scientific studies have

• the treatment has been scientifically proven to penetrate deep into the tooth, reaching the pulp, and
• bacterial elimination of up to 99.9%

.

After treatment with HealOzone, the carious areas of the tooth are remineralized using liquid agents. These contain fluoride and other minerals essential for tooth structure. These agents must be applied to the teeth regularly over a period of about one to three months. Afterward, the tooth is restored to its intact state.

Prevention is always better than treatment! It’s best to prevent tooth decay from occurring in the first place.

Take care of your teeth yourself!

Brush your teeth regularly and clean them properly. Thorough oral hygiene should be practiced at least twice a day after meals. It is essential that your toothpaste contain fluoride.

Oral hygiene should also include flossing. Flossing cleans the spaces between your teeth—areas that are difficult or impossible to reach with a toothbrush.

In addition, you can use fluoride-containing mouthwashes or supplementary dental gels.

Your dentist can tell you which toothpaste or mouthwash is right for you. He or she will also show you how to practice proper and thorough oral hygiene.

Be sure to take advantage of the checkups covered by health insurance. You can have your teeth checked for free every six months. The dentist can detect problem areas early and intervene before cavities spread.

Once a year, stubborn tartar is also removed during these checkups. This costs you nothing.

Additional Services: Professional Teeth Cleaning (PZR)

Dentists recommend having a professional teeth cleaning (PZR) performed once or twice a year.

A deep fluoridation treatment may follow the PZR. During this treatment, the dentist applies a fluoridated varnish to your teeth. Over the course of several days, this varnish releases small amounts of fluoride into the tooth. This makes the enamel stronger and less susceptible to damage from bacteria.

If your teeth have deep grooves on their surfaces, the dentist may suggest sealing them. Uneven tooth surfaces are smoothed out. These are easier to clean with a toothbrush and less prone to plaque buildup.

A complete professional teeth cleaning followed by deep fluoridation is not exactly inexpensive. Depending on the dentist and the extent of the treatment, it costs between 100 and 150 euros. Standard health insurance does not cover this treatment.

If you have private insurance or supplemental dental insurance, the costs are often covered in full.

However, there are currently no studies proving that professional teeth cleaning truly benefits patients. Professional teeth cleaning can in no way replace regular and thorough oral care at home. This, combined with regular checkups, is usually sufficient.

People with an increased risk of periodontitis, on the other hand, may benefit from professional teeth cleaning.