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    Tooth Decay

    What is Tooth Decay
    Sign and Symptoms
    Causes of the oral environment to be acidic
    Why is Saliva Important
    How does consumption of sugary and acidic foods and drinks affect caries disease
    Why is oral hygiene important 
    How can Caries disease be managed
    Where To Seek Treatment
    National Dental Centre Singapore
    Contributed by National Dental Centre Singapore


    Dental caries or tooth decay is one of the most common chronic diseases in the world and affects people of all ages. It is an infectious disease that can be transmitted from one person to another. Cavities are the end result of the disease. The good news is, caries disease is preventable and if treated early, can be treated and controlled. Early caries lesions can even be reversed.

    What is tooth decay?
    Plaque, a sticky film of bacteria constantly forms on the surface of teeth. When you eat or drink foods containing sugars or acids, the bacteria in the plaque produce acids which attack the tooth enamel, causing loss of minerals.

    In the early stages of disease, the mineral loss can be seen visibly as a white spot lesion on the tooth surface. When the oral environment continues to be acidic, mineral loss from teeth continues until the white spot lesion develops into a small caries cavity. Left unchecked, the cavity becomes larger and larger.

    Tooth Decay Stages
    Early white spot lesions,
    discolourarion and mineral loss
    Cavitated lesions Decay left unattended may lead to tooth loss

    What are the signs and symptoms of dental caries disease?
    Early decay often goes unnoticed as there is no pain or discomfort. Many people are not aware that they have early caries disease until it has progressed to an advanced stage. In fact, early caries disease is detectable as a white spot lesion on the tooth surface. Sometimes brown discolourations may also appear.

    Other symptoms that may occur include
    • Tooth sensitivity when eating hot/cold foods
    • Tooth ache or a throbbing pain
    • Visible pits or holes in the teeth
    • Pain when biting
    • Bad breath or foul taste in the mouth
    What are the conditions that can cause the oral environment to be acidic?
    1. Poor saliva condition
    2. Diet (consumption of sugar and acid containing foods and drinks)
    3. Poor oral hygiene
    Why is saliva important?
    Our saliva plays an important role in maintaining a healthy mouth because
    • it clears leftover food debris in the mouth, removing the bacteria's nutrient-source and hence controlling its multiplication. This prevents infections.
    • it helps to digest foods and drinks consumed
    • its protective function rebalances the pH level in the mouth to a healthy one to brake bacteria activity
    • it contains antibacterial agents which help to control the caries-causing bacterial population
    • it contains minerals such as flouride, calcium and phosphate which are needed to remineralize damages tooth enamel
    The amount and quality of saliva produced has to be adequate in order for saliva to have these positive effects.

    Simple saliva tests are available to determine the condition of your saliva. Such tests will also tell if the amount of caries-causing bacteria in your mouth is normal.

    How does consumption of sugary and  acidic foods and drinks affect caries disease?
    Sugars in foods and drinks are a source of food for the bacteria in the mouth. When a person snacks frequently between meals, the bacteria in the mouth feeds on the constant supply of food to produce acids, attacking the tooth enamel. Frequent, continuous acid attacks slowly dissolve away minerals from the tooth structure and weakens it over time.

    Saliva has protective functions that slow down the demineralization (decay) process and allow remineralization (repair) to occur. It is important to allow time for the saliva to work to neutralize the acids produced by the bacteria, before eating or drinking the next sugary meal/drink. Avoid taking sugary or acidic snacks in between main meals as far as possible.

    Why is oral hygiene important?
    Good oral hygiene ensures that the film of plaque that constantly forms on the tooth surface is cleared and the tooth surface remains clean. This will deprive that bacteria of its source of food supply and limit the growth of caries-causing bacteria.

    Who are prone to caries disease?
    • People with dry mouth due to
      - Medical conditions eg. Sjogren's syndrome and other diseases affecting the salivary glands
      - Radiation therapy for treatment of head and neck cancers
      - Chemotherapy
      - Medications that affect salivary flow
    • People who are outdoors for prolonged periods, which could potentially cause dehydration
    • People who consume sugary, acidic or caffeinated foods and drinks
    • Smokers
    • People with poor oral hygiene
    • Orthodontic patients
    • People who snack frequently in between main meals
    How can Caries disease be managed?
    Managing the caries disease requires a good partnership between the dentist and the patient.

    Your dentist can
    • Help you learn about the caries disease and decay prevention
    • Analyze your diet and advise you on any changes needed
    • Advise on the appropriate oral hygiene care suited to your dentla needs
    • Perform simple treatment procedures to manage the disease including
      - Seal the deep grooves on your teeth
      - Place high concentration flouride on your tooth surfaces
      - Clean the decay from the caries cavities and fill them
    • Perform regular checks at appropriate intervals
    As a patient, your commitment is to:
    • Use the prescribed hygiene and therapeutic aids and follow the oral hygiene care regime as advised by your dentist
    • Follow the diet management plan including
      - Drinking fluoridated water
      - Consuming less sugary and acidic foods and drinks between meals to stop the acid attack on tooth surface and allow the natural repair process to take place
    The Minimal Intervention Dentistry Programmes is an initiative that provides an individualized plan to patients to manage their caries disease. The cavity in the tooth is the end result of the caries disease and is not the disease itself. The Programme identifies and treats the various contributing disease factors instead of the symptoms.

    To achieve this, a thorough assessment is carried out on your
    • diet
    • saliva functions eg. saliva flow, buffering capacity (the ability of saliva to neutralize acids), pH (acid level) of saliva
    • smount of caries-causing bacteria in your mouth
    • oral hygiene care
    • other medical and dental caries risk factors

    Strategies to control and prevent disease and repair early caries lesions will the be prescribed and put into action. Cavity restoration with the minimal amount of tooth removal will follow, if needed.

    To book an appointment with this service, please call 6324 8802.
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