The tooth decay process starts with dental plaque (a sticky mixture of bacteria, food and debris). Bacteria, which naturally live in everyone's mouth but thrive in plaque, utilize carbohydrates from the diet, especially refined sugar, to produce acid. Acid, if produced frequently, will demineralize (dissolve) the tooth enamel structure, which is the hardest substance in the human body. From there the acid will continue to eat through the underlying dentin layer until the bacteria and their waste products reach the pulp (nerve). Left untreated, tooth decay can lead to root infection and eventually loss of the tooth.

There are visible signs of a cavity. Initially, it will appear as a small white spot, which in time will turn brown. As the decay continues, a hole in the tooth may become apparent. There are also warning symptoms such as sensitivity while brushing or sensitivity to hot or cold foods or to breathing in air. Of course, a painful toothache is a definite sign.

Prevention

The most important prevention technique is daily removal of plaque with flossing and brushing. If possible, good oral hygiene should be practiced after every meal.

Using fluoride to strengthen the enamel and help remineralize teeth is a highly reliable prevention tool. Use only an American Dental Association-recommended toothpaste with fluoride. Many dentists give topical fluoride treatment to children up to age 18. They can also fabricate custom trays to be used at home with a gel fluoride for adults who have rampant caries or who are predisposed to having tooth decay. Dentists also recommend fluoride drops or vitamins for infants who don't live in areas in which the public water supply is fluoridated. Call your dentist to see if your water is fluoridated.

Diet is significant in caries prevention. . Studies have shown that the nature and frequency of sugar intake is more important than the amount. If the sugary food is very sticky, like caramel, gummy bears or jam, it will remain on the teeth for a longer period of time. If you or your children are constantly snacking on sugary foods, there is a continuous acid attack on your teeth.

What do we do to prevent this potential problem? Avoid having sugar in the mouth for long periods of time. Stay away from sucking candies and chewing gum (unless sugarless) and refrain from drinking soda pop regularly (unless diet). Try to cut down on the number of snacks per day. If you must snack, substitute foods that most people like but that don't promote tooth decay. Examples are popcorn, pretzels, fruits, nuts, cheese, pizza and vegetables.

Consuming sugary foods with a meal or for dessert has a less detrimental effect, because increased saliva flow during meals helps to wash the food away. Also, it is usually nearer the time that most people will brush their teeth. Keeping this in mind, it is better for children to eat sweets at a time and place that allows them to brush soon afterwards. As your children are growing, make sure they get plenty of calcium (dairy products) so that their tooth enamel develops properly.

Finally, because you may be asymptomatic and unaware of the beginning of tooth decay, it is critical that you visit your dentist every six months for a check-up. Some cavities are hard to detect, especially those between the teeth. Sometimes, only bitewing x-rays can discover them. Your dentist will also give you a professional prophylaxis (cleaning), which is an important part of prevention.