Tooth decay: History and treatment options

Appearance of tooth decay: a story that does not date from yesterday

Tooth decay is one of the most widespread infectious diseases in the world, characterized by an irreversible destruction of hard tissues (enamel and dentin), and tends to evolve towards the pulp (center of the tooth). It is transmissible and caused by microorganisms of dental plaque under the influence of local and general factors.

It is therefore a multifactorial disease, which is well demonstrated by keyes diagram:
keyes diagram
When caries have appeared?
Research has shown that dental diseases have emerged with the introduction of sugary foods and cereals in our diet. These allowed the cariogenic bacteria to evolve since these products are the preferred meals of Streptococcus Mutans (the bacteria responsible for cavities).
These bacteria do not directly attack our teeth, but by digesting carbohydrates, they produce an acid capable of destroying tooth enamel, the hardest tissue in our body. Thus, these organisms are partially involved in the occurrence and development of caries.
According to the specialists, this problem is not new. In fact, it would have grown in importance about 10,000 years ago, when the human diet became based on sugars.

Tooth decay treatment options:

stages of tooth decay
The treatment of tooth decay depends on its severity and location.
There are 5 stages of caries evolution: 0, 1, 2, 3, 4, and 5. They are determined by the size of the carious cavity; the larger the number, the more advanced the stage.
For each stage, the therapeutic indication is different but, in the majority of cases the tooth can be kept alive.

Initial stage:

At the initial stage, there is no carious cavity. On the other hand, white spots signifying the demineralization are present, which, untreated, can worsen and create cavities. This one is reversible and does not require a surgical treatment.

The principle of the treatment of the initial caries consists in trying to restore the physical properties of the email lost during the carious process. This treatment can be performed using non-invasive methods. The goal is to promote remineralization of the affected tooth with calcium, phosphorus and fluoride preparations.
After treatment, you are supposed to take care of your teeth in order to avoid the reappearance of the lesions.

Advanced stage:

When the carious cavity is visible, we are no longer in the reversible stage. Cavity has irreversibly destroyed the hard tissues of the tooth and requires surgical treatment.

If the decay only affects the enamel and dentin, the dentist removes the damaged tissue and clogs the voids with “sealing material”. The most common are:
Amalgam: resistant but not aesthetic, harden in a few hours once applied.
Resin-based composites: which have a natural tooth color. They harden quickly.
inlay and onlay preparations
Dentists can also treat cavities through inlays-onlays. Indicated if the tooth has been very damaged. It helps to restore the shape of the tooth and provides sufficient resistance to it for better durability. Made in the laboratory from an impression of the dental preparation, composed of ceramics or metals, they are more expensive than amalgams and composites.
Whatever the technique proposed by the dentist, the goal of the treatment is to stop the spread of cavities and ensure a seal, to prevent any recurrence.
For extensive decay or weakened teeth, you may need a crown — a custom-fitted covering that replaces your tooth's entire natural crown. Your dentist drills away all the decayed area and enough of the rest of your tooth to ensure a good fit. Crowns may be made of gold, high strength porcelain, resin, porcelain fused to metal or other materials.
If decay has attacked the pulp, the dentist must remove the nerve from the tooth and disinfect the dental canal before closing it. The tooth is devitalized.
Tooth extraction: Unfortunately, it can happen that a tooth becomes fragile and impossible for the dentist to save it. Here are the main causes that justify tooth extraction: Severe caries that has reached a very advanced stage. Broken tooth that has not been treated. After extraction, the missing tooth will leave a gap. If possible, consider getting a bridge or a dental implant to replace the missing tooth.