Caries is one of the most common diseases worldwide. In the UK, 99% of all adults are affected. This means that bacterial infections of the oral cavity occur 5 times more often than asthma and even 7 times more often than allergies. If we talk about a hole in the tooth, almost everyone can contribute their own little story of suffering. Children are just as affected as adults and seniors.

In the following paragraphs you will learn:

  1. Why tooth decay doesn’t start with a hole in the tooth.
  2. The role of saliva in preventing tooth decay.
  3. How a hole in the tooth can be treated without drilling.

Tooth decay – the definition


What exactly is tooth decay? Colloquially, an answer is quickly found – tooth decay is a hole in the tooth. Tooth decay starts much earlier. It is a lengthy process until the tooth is damaged. The teeth don’t rot either. Rather, dental caries means demineralization of the tooth substance. This decalcification of the teeth progresses.

If you do not do anything about it, a hole will appear in the tooth: The tooth substance will break down and cavities will form. Tooth decay penetrates the enamel.

The enamel comes off the teeth, especially in older people. Caries quickly develops on the exposed tooth neck. The dreaded pain occurs at the latest when the caries has reached the living core of the tooth. Because there are blood vessels and nerves. If the tooth pulp rots, it can die.

Medicine distinguishes 2 types of tooth decay:

Initial caries

In the case of initial caries, the surface of the tooth is still intact. The descaling has already started. If there is an established caries, the tooth surface is defective.

Caries affects different layers of the tooth:

  • Superficial caries – the tooth enamel is defective.
  • Caries media – the second layer of the tooth (dentin) is defective.
  • Caries profunda – all tooth layers are defective.
  • Caries sicca – the caries stands still.

Anyone can get tooth decay. In children and adolescents, tooth decay usually occurs on the chewing surfaces and where the teeth touch. In old age, the disease occurs more often at the junction of teeth and gums.

In many cases, tooth decay can be stopped. But if left untreated, the disease progresses: the tooth pulp becomes infected. The infection can extend into the maxillary sinus and muscle tissue. The tooth can be lost in the process.

How is a hole made in the tooth?

It takes a long time before tooth decay is visible to us. Because it’s a lengthy process. The time until tooth decay breaks out varies. The reason: The texture of the tooth substance varies from person to person. Diet and individual dental care are also crucial.

Every tooth is surrounded by a sticky film of bacteria. The doctor calls this layer plaque. When eating and drinking, the food components come into contact with plaque. The bacteria produce acids from the sugar contained in the food. These acids attack the tooth enamel and sooner or later lead to tooth decay.

Most of the plaque is located on the gumline and on the surface of the molars. The risk of tooth damage is particularly high as a result. If the caries has broken through the enamel, the dentin is at risk. Dentine caries means that the dreaded hole in the tooth is visible.

Tooth decay and its causes

Several factors influence the development of tooth decay. Hundreds of types of bacteria live in the oral cavity. The microorganisms keep the oral flora healthy. Some bacteria feed on sugar and excrete acids as metabolic products. The acids dissolve minerals from the tooth enamel. This starts the breakdown of the tooth.

Dental hygiene versus bacteria

Frequent tooth brushing reduces the number of bacteria in the mouth. After each meal, the bacterial film slowly re-forms on the teeth. In the case of irregular or inadequate dental care, a thick layer is created. The bacteria that cause caries multiply in the plaque. Caries is therefore often due to poor oral hygiene.

Brushing your teeth after every meal promotes dental health. There are exceptions: citrus fruits or cola roughen the tooth enamel. So that you do not wear it off while you brush, you must wait at least half an hour before you pick up your toothbrush.

Not all sugar is created equal

Those with a sweet tooth are more likely to develop tooth decay. Because household sugar, grape sugar and fructose attack the teeth. The bacteria can use sucrose, glucose and fructose particularly well.

Complex carbohydrates have long-chain sugar compounds. Consuming whole grain products therefore does not promote tooth decay.

Immune strength against tooth decay

Whether the bacteria have an easy job also depends on the nature of the immune system. If the immune system is weakened, tooth decay is more common. The chronically ill and the elderly are particularly at risk.

By the way: the immune system is also attacked by taking cortisone preparations and antibiotics.

Saliva protects against tooth decay

We often underestimate the spit. Saliva can help against tooth decay. The liquid in the oral cavity supports teeth cleaning, repels harmful acids and ensures that the tooth enamel is remineralized. The saliva contains all the important minerals that a damaged tooth surface need.

Low salivation promotes the development of tooth decay. The same effect can be observed when saliva is very diluted. Bottle caries, for example, occurs in small children. Food components that the saliva does not remove are increasingly deposited on the tooth crown and in the spaces between the teeth.

Saliva cleanses the oral cavity and dilutes the harmful acids. Since our spit also contains hydrogen carbonate, ingested fruit acids can be partially intercepted. As a result, the harmful substances do not stay in the oral cavity as long.

Tooth decay and its symptoms

The symptoms of tooth decay depend on the stage. Initially, tooth decay usually does not cause pain. However, those who miss treatment run the risk of the infection spreading. Then the first symptoms appear.

Tooth decay in the early stages

In the initial stage (initial stage), caries is hardly visible. You probably won’t notice the disease until whitish stains begin to form on your teeth. This is a sign that minerals are loosening from your teeth. As a result, the tooth enamel loses substance and becomes porous. Over time, the white spots change color and turn yellowish or brown. The reason: They absorb colorings from food.

At this stage, those affected can still make up for the mineral deficit. Regular and careful oral hygiene can help rebuild tooth structure. Toothpastes containing fluoride support the mineralization of the teeth.

Caries worsens if thorough and targeted dental care is not taken. Minerals are lost, the tooth substance breaks down and a hole (dentine caries) is created. At the latest now the disease penetrates into consciousness, because the first pain occurs. The teeth react to hot and cold or are painful because the bacteria have reached the tooth nerve.

Caries at an advanced stage

The pain has become a constant companion. The tooth is sensitive to stimuli. Chewing is difficult. Pain also occurs when the tooth rests and does not have to endure any loads. Many ailments worsen at night. A general discomfort in the oral cavity occurs and bad breath can be an additional burden.

An untreated tooth decay at this stage can be dangerous if the inflammation affects the jaw bone, the bacteria can enter the bloodstream and damage other organs.

Toothache comes in many forms. There may also be painless sections. Nevertheless, do not postpone a visit to the dentist! Because when the pain suddenly stops, nerves and blood vessels have already died. If there is no treatment, the infection spreads and an abscess develop.

Caries as a repeat offender – secondary caries

If tooth decay recurs after treatment, it is often due to inadequate care: If there is insufficient oral hygiene, tooth decay often re-forms on the edges of fillings or crowns. Over time, small gaps develop between the tooth and the filling or between the crown edge and the gums. You can’t reach these small cracks with the toothbrush. Bacteria have an easy job. Medicine speaks of secondary caries.

With adequate dental care, secondary caries is rare. It can appear on the neck of the tooth, between the teeth, or on the edges of fillings and crowns. A quick treatment is necessary so that the infection does not spread to other teeth. The therapy includes the removal of the tooth tissue infected by bacteria and rendering the pathogens harmless by filling and sealing.

To support the treatment, the dentist can prescribe a disinfectant in the form of a mouthwash solution. It promotes the killing of harmful bacteria in the mouth.

Another thing is caries recurrence. Here, tooth decay occurs on a part of the tooth that has not been adequately treated. In this case, the dentist has made an error in treatment.

Children risk group

Children and adolescents are particularly likely to develop tooth decay. Their enamel is not as strong as it is in adults. Deep grooves and furrows run between the molars. The doctor speaks of fissures. These are difficult to reach with a toothbrush. Children are often less careful about dental care.

An incipient caries can be stopped by sealing the fissures. Before the treatment, the endangered areas are cleaned with special brushes. The dentist then seals the fissures with plastic.

Treat tooth decay

If there is a hole in the tooth, there is no way around the drill: Before the dentist puts on the filling, he removes the destroyed tooth tissue with a diamond grinder or round bur. For you as a patient, the uncomfortable part of the treatment begins, because drilling causes pain: The pressure exerted by the instrument irritates the nerve fibers. In addition, the rotation of the drill generates heat. And the cold water in the mouthwash creates another stimulus. The intensity of the pain depends on the depth of the damage. To avoid pain, many patients have the tooth anesthetized locally before treatment.

When inserting the fillings, the dentist checks the bite of the jaw. There must be no feeling of a foreign body in the mouth. Otherwise, problems with chewing and pain in the jaw joint can occur.

In the case of advanced tooth damage, the dentist has to rebuild the tooth shape from the outside. Matrices serve as a template so that the tooth finds its natural shape again. A kind of band surrounds the tooth. Then the dentist puts on the filling. The matrix prevents the filling compound from escaping and running over the tooth.

Throbbing pain indicates that tooth decay has reached the tooth nerve. The treatment goes beyond simply sealing. A root filling serves to protect the affected nerve tissue. The substance contains calcium hydroxide and is supposed to support the dentin in its regeneration. After inserting the root filling, the normal tooth filling follows.

Tooth decay and fillings

Different materials can be used to treat caries:

  • Ceramics
  • Plastic (composite and compomer)
  • Metal (gold)
  • amalgam

These materials are plastic fillings. The dentist fills the substance into the tooth as a liquid. The material hardens there.

Most caries is treated with plastic fillings. Are also on the market inlays. An inlay made in the laboratory compensates for the hole in the tooth.

The type of filling depends on various factors. Since the filling materials have different properties and are not the same in terms of value, the dentist looks for individual solutions. The costs are also important: the health insurance company does not pay for every tooth filling. Inlays e.g., B. are very expensive and no cash benefits.

Composite against tooth decay

Composite consists of a salt of silica and plastic. The material is durable and dimensionally stable. According to the application scheme, composite adapts very well to the existing tooth color. If the damage to the tooth is minor, the dentist cleans the hole and adds composite in the same operation. The fabric hardens under a special light.

Treat tooth decay with compomer

Only sensitive tooth necks and milk teeth can be treated with compomer. The material is too soft for the heavily loaded chewing surfaces. Another disadvantage: the shelf life of compomer is limited. Therefore, compomer fillings must be checked regularly by the dentist.

Tooth decay and gold

The method of filling holes in the tooth with thin gold foil is new to the market. The dentist places the foil on the affected tooth and taps it into the existing hole. This allows the contour of the tooth to be reproduced well. A gold hammer filling is very complex. In addition, the filling is conspicuous and therefore not suitable for front teeth. One advantage is the durability of the material. The health insurers have not yet paid for the treatment.

Amalgam against tooth decay

Many people view treatment with amalgam critically. The filler has come under discussion because of its mercury content. Amalgam also consists of silver, tin and copper. Mercury is bound in a solid state in the fillings and is therefore not dangerous. However, when the fillings are replaced, mercury can loosen and enter the oral cavity.

Amalgam is an approved and financed dental filling. According to scientific research, the danger of dental fillings containing amalgam is no greater than with mercury, which is ingested with food. In any case, dentists only use amalgam to a limited extent in children and pregnant women.

Caries without drilling

In the initial stages, thorough oral care helps to protect teeth from serious damage. The dentist does not pick up the drill immediately. Incipient caries can be stopped by applying gels or varnishes. These substances seal the attacked surface of the tooth. The fluoridation of the teeth stimulates the storage of minerals on the defective tooth surfaces.

Lasing instead of drilling

Laser technology is an alternative to drilling. The bacteria can be removed by the laser beams. The patient finds the treatment less painful compared to drilling.

Attention: A laser treatment is not a cash benefit. You bear the costs yourself.

Compressed air instead of drilling

This method is being tested by doctors in the USA. With the help of compressed air, tiny active substance particles reach the carious tooth. The particles are supposed to promote the shedding of bacteria. As a result, the dentist should get by without a drill and remove the bacteria only with a suction device.

Scraping instead of drilling

The Swedes are testing another method: They use a special gel. When applied to the defective tooth area, the substance softens. The carious material can then simply be scraped off. The dentist does not need the drill.

Both methods are not yet standard in London dental practices.

Trap the bacteria in and drill out

In contrast, the Icon method has already arrived in London dental practices. The dentist does not drill the tooth. Instead, he fills the hole with plastic from the outside. The inclusion of the bacteria means that they are no longer viable.

Tooth decay versus fluoride

Fluorides harden tooth enamel and can prevent tooth decay. You can take the active ingredient or have it applied directly to the teeth as a gel.

In England, fluorides are not added to drinking water or milk, as is the case in many countries. To improve your fluoride supply, you can use table salt with iodide and fluoride. After cleaning your teeth, the dentist can apply fluoride to the surfaces of your teeth.

Fluoride is a substance that should be treated with caution. Those who ingest too much of it can develop fluorosis. Milky-white to brown stains form on the teeth. In areas with fluoridated drinking water, the numbers are alarming: between 40 and 80% of children there are affected. Lifelong tooth damage can be the result.

Is tooth decay contagious?

Tooth decay is considered a bacterial infection. All infections of this type are contagious. But the risk of infection in normal everyday life is hardly a concern. Everyone has bacteria that can cause tooth decay. Various risk factors are necessary for this to happen. Kissing or sharing eating utensils or toothbrushes are not critical to the development of tooth decay.

Adults are not at risk. The situation is different for small children, as the oral flora of small children is structured differently. They have far fewer microorganisms than adults. If the children have no teeth yet, the bacterial colonization in the oral cavity is completely absent. If a mother wets the child’s pacifier with her saliva, she can transmit tooth decay. The scientists argue about how high the risk of infection actually is.

Is tooth decay hereditary?

On this point too, opinions often differ. Tooth decay is not inheritable. If the disease occurs more often in certain families, hereditary factors can certainly play a role.

These factors are inheritable:

  • Composition of saliva
  • Salivary flow rate
  • Formation of the fissures in the tooth surface

Many eating habits have a direct impact on the likelihood of tooth decay in families. If sweets are often served and family members tend to do their dental care sporadically, the risk of tooth decay increases.

The position of the teeth and possible misalignments in the jaw are also inheritable. A close tooth position makes it difficult to clean the teeth. If you do not use dental floss, it is difficult to reach the narrow spaces between your teeth with a toothbrush.

After caries treatment

After the treatment at the dentist, the pain is a thing of the past. At least ideally. Shortly after the treatment, the anesthetic injection is still effective. A few hours later the pain can start again. It is not uncommon for teeth to settle down 2 to 3 days after treatment. The tooth can also remain sensitive to pressure for some time. Many patients complain of pain at night. Because when the tooth is lying down, the blood flow to the tooth is stronger, which makes the pain feel more intense.

If the pain has not subsided after a few days, go to the dentist. Cooling the tooth can help against acute pain. Pain reliever medication only helps in the short term, but does not solve the problem.

Chewing gum against tooth decay?

Chewing gum – is there a better way to prevent tooth decay? Clinical studies have confirmed that it actually works: chewing sugar-free gum after a meal helps prevent tooth decay. 20 minutes are enough. In this way, more saliva is formed and fewer food components stick to the teeth. This creates fewer harmful acids. But brushing your teeth cannot replace chewing gum.

Brushing your teeth at least twice a day and flossing them thoroughly once is the best way to prevent tooth decay. You can look after your teeth with a healthy diet that is as sugar-free as possible. In addition, do not miss the annual check-up at the dentist. It checks the condition of your teeth and detects tooth decay before it is visible to you.

Treating tooth decay – what does the health insurance fund pay for?

The assumption of the costs for the legally insured depends on the medical report. The condition of the complete set of teeth is decisive. The dentist records this in the treatment and cost plan. The statutory health insurances determine a standard care for each submitted report. According to the Social Code (SGB) V, Section 12, Paragraph 1, they assume the costs of “sufficient, appropriate and economic” services.

Submit the treatment plan, a pre-treatment with your health insurance. Only after the examination is it clear what proportion of the costs this will cover and what amount you will have to pay out of your own pocket.

For dental fillings, standard care provides for plastic or amalgam. Simple amalgam fillings subsidize the health insurers completely. For high-quality fillings adapted to the individual tooth color, however, the health insurance fund only pays the amount intended for the amalgam filling. You pay the difference yourself. In the case of caries in the anterior region, the health insurers also cover the full cost of plastic fillings.

Example: If you have a carious tooth treated in the lateral area, only one amalgam filling is paid for. For a composite filling in an individual tooth color, you have to expect additional costs between 40 and 120 £. That is why private dental insurance is worthwhile. Tooth preservation from London Dentaly, for example, covers up to 100% of your costs for inlays, onlays and plastic fillings.


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