Dental Cavities (Dental Caries)

  • Medical Author:
    Steven B. Horne, DDS

    Dr. Steve Horne began his career at Brigham Young University obtaining his BA in English. He earned his Doctorate of Dental Surgery in 2007 from the University of Southern California where his pursuit for academic excellence landed him on the Dean's List. He was recognized for his superior clinical skills and invited to help teach other dental students in courses on restorative dentistry, prosthodontics, and tooth anatomy. During dental school, he provided dental care for underserved populations of Los Angeles and Orange County, Mexico, and Costa Rica with AYUDA. Following dental school, Dr. Horne entered active duty with the U.S. Army and practiced dentistry at Fort Knox, Kentucky, for four years. During this time, he was deployed to Baghdad, Iraq, and received multiple Army Achievement Medals, the Army Commendation Medal, and served as Company Commander. Dr. Horne currently practices full time at Torrey Pines Dental Arts in La Jolla, California, as a general dentist. Dr. Horne is a member of the American Dental Association, the California Dental Association, and the Academy of General Dentistry. Dr. Horne is married to his wife, Christy, and they have a chocolate Labrador named Roscoe.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What are the signs and symptoms of cavities?

When a cavity advances deep into the tooth, it may produce increased sensitivity to foods that are cold, hot, or sweet. But not all cavities will cause a toothache. If they are small or progressing slowly, they may only be detected by a dentist before they cause pain. Cavities on front teeth are easiest for a person to see, and they will be visible as a light or dark brown spot. The brown spot is tooth structure that has become soft due to the acid attack from bacteria. Generally, light brown represents a fast-growing cavity and dark brown represents a slower-growing cavity. If the cavity gets large enough, part of the affected tooth may break off and leave a hole.

How are cavities diagnosed?

A dentist can detect a cavity by using a sharp instrument to feel tooth structure that has been softened by tooth decay. If a cavity forms in between the teeth, it may only be visible on an X-ray. Other diagnostic tools that are used to detect cavities include ultrasound, fluorescence, or fiberoptic transillumination. Regular dental exams are recommended so cavities can be diagnosed when they are small cavities (incipient caries or microcavities) instead of waiting until they grow large enough to produce pain and require more extensive treatment.

What is the treatment for cavities?

There are three things to consider in the treatment of dental cavities: prevention, remineralization, and restoration.

Prevention: A greater emphasis on preventive dentistry has helped reduce the incidence of premature tooth loss. Since we can't eliminate the bacteria that are in the mouth, limiting the amount and frequency of sugars and starches in our diet is the easiest way to prevent dental caries. Maintaining a healthy diet to prevent tooth decay is very important in children and toddlers both for baby teeth and as they start to get their adult teeth. Sugary soft drinks and juices are especially harmful to the teeth. When possible, sweeteners such as sucralose should be substituted for sucrose because they can't be digested by bacteria. Xylitol is another sugar substitute that actually kills bacteria, so chewing xylitol gum after meals will greatly reduce the incidence of cavities. Plaque can be removed from the outside of teeth by brushing and from in between the teeth with dental floss. Use of a mouthwash also helps by limiting the number of harmful bacteria in the mouth. A dentist will often suggest placing plastic sealants in the pits and grooves of teeth in children to protect them from decay. Visiting the dentist regularly will help prevent cavities from forming or catch them when they're small.

Remineralization: Shallow cavities can be reversed when they are treated with a substance that contains fluoride or calcium. This "rehardening" process is known as tooth remineralization. Fluoride makes the enamel more resistant to cavities and can be applied to teeth through fluoride toothpastes, supplements, dental office fluoride treatments and varnishes, and fluoridated water. The amount of fluoride exposure must be carefully controlled though, because high levels can be toxic.

Restoration: When a cavity is too large to be remineralized, it must be restored. If the cavity is still small, it can be restored with a filling made of composite or silver amalgam. If a large part of the tooth is decayed, it will need to be covered with a crown. Crowns are typically made of gold, porcelain, or zirconium. If the cavity has extended to the center of the tooth and infected the nerve, a root canal will have to be performed. Sometimes, the cavity infects a majority of the tooth surface and the tooth has to be extracted. Areas where teeth have been extracted can usually be restored with dental implants or bridges. Baby teeth that get cavities may be restored with a filling, a stainless steel crown, extraction, or pulpotomy. It is very important that kids get their baby teeth treated so that abscesses don't form and oral disease doesn't keep increasing into adulthood.

Medically Reviewed by a Doctor on 3/15/2016
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