Dental decay
Clinical definition of dental decay
Dental decay is characterised by the loss of mineral ions from the tooth caused by the presence of bacteria in plaque and their acidic by-products.
Early mineral loss (known as demineralisation) is only visible microscopically, but further loss becomes evident in enamel as a chalky appearance on the tooth – a white spot lesion.
The basic carious process can also be called an acid attack. Bacterial plaque builds up on the tooth surface. When sugars enter the mouth they are absorbed by this layer. Inside the bacterial cells the sugars are broken down (or metabolised) and acid is produced.
The acids accumulate in the plaque layer and start to demineralise the tooth. Find more detail about demineralisation and remineralisation.
Why we need to address dental decay
Dental decay, also known as tooth decay or dental caries, is a widespread condition in the Western World and a particular problem in Scotland.
NDIP (National Dental Inspection Programme) research in 2008 highlighted that in 42% of Scottish children have signs of dental decay by the time they reach Primary 1 and this figure is even higher in areas of deprivation.
It has become apparent that dental caries is essentially a disease associated with social deprivation. In Scotland, lower levels of caries are now being seen in the more affluent areas.
As shown in the P1 dental decay graph, quintiles 1 and 2 have already reached the 2010 National Target of 60% with no obvious decay experience, while quintiles 4 and 5 – the most deprived areas – fall well short, with only 42% of P1 children in quintile 5 having no obvious decay experience.
Graph title: Proportion of P1 children with no obvious decay experience by Scottish Index by Multiple Deprivation Quintile.
Prevention
Dental decay is a process that is preventable by following basic oral health messages.
These are:
- brush teeth twice a day with a fluoride toothpaste
- supervised toothbrushing until the age of seven
- foods and drinks containing sugar should be kept to a minimum and are best given at mealtimes
- register with a dentist and visit regularly
- spit out toothpaste, don’t rinse after brushing (to give the fluoride time to work).
In early stages, there are effective treatments for preventing the decay from causing pain and requiring a filling or eventual tooth loss. However, sometimes dental extraction is the only treatment option.
Failure to prevent dental decay in the pre-school child, through modifying poor dental related behaviour of both child and parent, will generally condemn the majority of affected children to a lifetime cycle of dental treatment (SIGN 83: ‘Prevention and Management of Dental Decay in the Pre-School Child’) (external link).
Demineralisation and remineralisation
Demineralisation (loss of minerals) can be followed by remineralisation (gain in minerals) where the tooth takes up mineral ions, and in some early stages this can be enough to reverse the early carious process.
However, as this is a dynamic process (with remineralisation being followed again by demineralisation) it is only when the demineralisation occurs much more often than the remineralisation that the teeth are at risk of cavitation (breaking down to form a cavity).