The Basics of Tooth Decay

July 2006

By: Dr. Scott R. Harden

In the 1900’s, access to a dentist was difficult and the typical person only went to the dentist with extreme toothaches. The patient would prepare for their dental visit by inhaling some ether or taking a few swigs of liquor, prior to the dentist “pulling” their tooth.

One century later, observing the passing of one hundred years of dental advancements, patients still come into the dental office demonstrating decay and tooth loss that is over-whelming.

There is an old saying: “The more things change, the more they remain the same”.

The question remains, “why is tooth decay so prevalent even a century later”?

Bacteria that reside in our mouths still possess the same ability to damage our teeth as they did a century ago. Despite the broad-reaching preventive measures provided by the dental profession, the destructive forces of bacteria still prevail and leave many people with serious tooth decay.

There are more than 100 species of bacteria, and hundreds of species of fungi, protozoa, and viruses that have taken up residence in our mouths. Microbiologists estimate that, in addition to these known species, there are up to 500 other living, breathing organisms inhabiting our mouths. Our mouths contain more bacteria than the entire world’s population, and our bodies house approximately one trillion bacteria.
Oral bacteria, dental anatomy, immune system, oral hygiene, diet, and professional visits, all contribute to the level of tooth decay found in your teeth.

Below are some recent patient experiences:

Johnny is five years old and has significant decay in his front “baby” teeth that is so bad, his teeth must be extracted. This condition, known as “bottle caries”, occurs from children taking in juice, milk, formula, or any other liquid sweetened with fermentable carbohydrates at nap time or bedtime. Fluids pool around the teeth for hours and can cause rampant tooth decay, especially in primary upper incisors. This is related to a bacterial strain of strep, known as Streptococcus mutans. Adults need to avoid putting a child to bed with a bottle of nearly any drink except water. The child should be weaned from a bottle and be drinking from a cup by their first birthday.

William, age fourteen, completed orthodontics several years ago, and after missing several years of regular check ups, had nine cavities on various adult teeth.

Upon filling the teeth, it was found that the grooves were so deep in his teeth the bacteria had spread significantly into the nerve chamber on several of them and required root canal therapy.

Tooth anatomy plays a tremendous role in how susceptible teeth are to bacteria. Enamel on teeth typically have grooves that either fully fuse together and thus are bacteria-resistant or develop open passage ways for bacteria (most often Strep. sanguis, Strep mutans, Strep mitior) to collect down in the grooves and cause “cavities”. Children can greatly benefit from preventive care including sealants, fluoride and regular exams. Early detection of decay in adolescents in crucial to avoid large fillings, root canals, and even tooth loss.

Trevor lost all his teeth to decay and now wears complete dentures at age twenty-seven. Bacteria caused tremendous tooth decay, resulting in Trevor’s teeth to finally fracture off at the gum level. Fractured teeth typically develop an abscess and this infection is another source of bacteria that leads to gum disease. Between tooth loss and gum disease, complete dentures become a traditional result. Regular visits to the dentist and a commitment by the patient to restore their teeth is a prerequisite for healthy teeth later in life.

Maureen at 85 years old, had significant restorative care years ago, but now must have five teeth extracted and replaced by various dental procedures. She had numerous fillings and crowns that were over 20 years old. Limited dexterity, reduced oral hygiene care, limited nerve response in her teeth, and no dental visits for years having moved several times, all resulted in advanced tooth decay for Maureen.

These are all examples of recent patients that vary in age, ethnic and socio-economic backgrounds, geographic regions during childhood, and dental hygiene habits. There are many variables, but one common finding; they all had significant decay in their teeth resulting from lapses in their regular dental check-ups.

Plaque forms on your teeth 24 hours a day. Take time to brush your teeth three times a day and after every meal. Floss at least twice a day. Visit your dentist every six months to avoid the problems these patients experienced.