CAUSES of TOOTH DECAYCavitiesare caused by tooth decay which is a process that develops slowly but steadilydue to following reasons:1.         Plaque: Dental plaque is aclear sticky film causing a coating on the teeth. Plaque formation is due tocarbohydrates primarily which contains sugar and starch and is furtheraggravated by not removing the layer from the tooth. When the carbohydrates arenot cleaned off from the teeth, bacteria start colonizing the teeth quickly andharden with salivary salts leading to a further hard plaque or tartar a.k.

a.the calculus. Tartar makes plaque more difficult to remove and creates anenvironment for bacteria to colonize further leading to more plaque formationfrom leftover food particles.2.         Recurrent Plaque attacks: The acids in plaque causethe demineralization of the tooth’s enamel by causing erosion.

This erosioncauses tiny openings or holes in the enamel which is usually the first stage ofa cavity after demineralization. Once the enamel is worn away which is actuallya very long and a tough process and in some stages, taking a time of 3.5 – 4years on the occlusal surface of the tooth, the bacteria reach the second layerof the tooth, the dentin. Dentin is much softer than enamel and less resistantto acid attacks. Dentinal tubules, the micro-openings of the dentin thatdirectly communicate with the pulp of the tooth causing hyper-sensitivity.3.         Pathways of Destruction: If the patient is not aware or cautiousat this stage, the bacteria and acid continue to marchthrough the teeth by moving to the inner most layer a.k.

a. the pulp thatcontains nerves and blood vessels. The pulp becomes swollen and irritated fromthe bacteria, becoming scathed from attack and causing pain.

Swelling and discomfortcan even show up on the face of the patient as a result of this sometimes. SIGNS and SYMPTOMSThesigns and symptoms of a cavity vary, depending on the extent, type andlocation. When a cavity is in initial stage, there might not be any symptoms atall. As the decay spreads its fangs, there may be signs and symptoms viz. below:1.         Spontaneous pain  2.         Hypersensitivity3.         Mild to sharp pain when eating or drinkingsomething sweet, hot or cold4.

         Cavitation in the tooth5.         Brown, black or white staining  6.         Lack of pressure on biting7.         Pain on biting down RiskfactorsTherisk factors which can increase cavitation in a tooth are actuallymanifold:  1.         Location: Decay predominantlyhappens in molars and premolars as they have lots of grooves, pits, fissures, crannies,which harbour a lot of food particles and bacteria. The pits and fissures makecleaning access also difficult in such teeth.

2.         Sticky Diet or the Sugary foodsand drinks: Stickyliquids like milk, ice cream, honey, sugar, cakes, cookies,hard candies and chips etc. are more likely to cause decay than those foodsthat are easily washed away by saliva.

3.         Frequent munching, snackingor sipping: Regularmunching,snacks or sipping sugary drinks can keep the mouth in acidic environment bygiving bacteria more fuel to produce acids that attack the teeth and wear themdown. Sipping on acidic drinks like coke, pepsi or colas throughout the day alsocreates a continual acid bath over the teeth thus making them more prone todecay.4.

         Baby Bottle syndrome a.k.a. bedtimeinfant feeding: Babybottle is one thing which should be banned as babies given bedtime bottlesfilled with milk, juice or other sugary liquids cause baby bottle or nursingbottle caries also known as the rampant caries. 5.         Infrequent and Inadequatebrushing: Brushing not done after regular meals isa cardinal sin as plaque formation happens and the decay journey starts. Morethan half of the country brushes just early morning which is akin to no brushingat all in the day.

6.         Lack of fluoride: Fluoride helps preventcavities and also via the process of remineralization reverses the earlieststages of tooth decay. It is also a common ingredient in toothpaste and mouthrinses, but it needs to be added to the public water supply to be readily availableto the general populace to prevent decay.  7.         Toddler, Teenager and Seniledecay:Cavities are usually more common in very young children,teenagers and senile (old) people because of diet patterns in former two andexcessive wear, breakage and worn down teeth in the latter, making them morevulnerable to tooth root decay. Senile people are also on medications thatreduce saliva flow and increase the risk of cavities.8.

         Dry mouth: Saliva helps preventtooth decay by washing away food and plaque from the teeth by aiding inremineralization and countering the acid produced by bacteria. A few medicines,medical conditions like xerostomia, head or neck irradiation and certainchemotherapy drugs increase the risk of cavities by drastically reducing salivaproduction.9.         Micro-leakage from old restorations: Worn dental restorations weaken,break down, cause leakages or develop rough edges over the period of time whichallows plaque to build up more easily making it harder to remove, thus causingdental decay.

10.    Reflux Oesophagitis: Reflux Oesophagitis or the gastroesophagealreflux disease (GERD), heartburn cancause gastric acid to flow into the mouth via a reflux, wearing away the tooth enameland causing significant cavitation. This results in exposure of dentin tobacterial attack, thus creating tooth decay.  11.

    Eating disorders: Eating disordersinterfere with saliva production and a few of them like anorexia and bulimia cause significanttooth erosion and cavitation sometimes. Gastric acid from repeated vomiting washesover the teeth and begins to dissolve the enamel.