Caries

Sophie Matzik is a freelance writer for the medical team.

More about the experts All content is checked by medical journalists.

Tooth decay (tooth decay) is a process in which the tooth substance slowly breaks down and eventually a hole is created in the tooth. Poor oral hygiene and a diet rich in sugar promote the development of tooth decay. Symptoms range from discoloration of the teeth to severe pain. Without treatment, tooth decay continues continuously. Read everything you need to know about tooth decay here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. K02

Brief overview

What is tooth decay? Widespread dental disease in which the hard tooth substance is gradually destroyed
Causes: Interplay between microorganisms and harmful factors such as poor oral hygiene and a diet rich in sugar. Other risk factors include a lack of saliva and a weakened immune system.
Symptoms: initially often chalk-white spots or dark discoloration on the tooth, later the proverbial "hole in the tooth". Pain occurs at the latest when the tooth nerve is affected.
Tooth decay - what to do? Off to the dentist! He will first determine the extent of the tooth decay and then initiate appropriate treatment.
Prevent tooth decay: foods and drinks containing sugar only in moderation, regular brushing of your teeth, use of toothpaste containing fluoride, dental floss and interdental brushes, regular check-ups at the dentist, professional tooth cleaning (PZR), use of fluoride varnish, fluoride gels or solutions

Tooth decay: description

Most people understand tooth decay as the proverbial “hole in the tooth”. In fact, this dental disease begins much earlier: With dental caries, there is an increasing decalcification (demineralization) of the hard tooth substance (enamel and dentine underneath). Acid-forming bacteria are responsible for this demineralization. Only if the process of decalcification is not stopped does a hole eventually appear in the tooth.

The term tooth decay is often used instead of tooth decay. However, this is not completely correct from a medical point of view - the tooth substance does not rot, but is broken down.

Types of tooth decay

Doctors differentiate between different types of caries, depending on how much tooth substance the bacteria have already destroyed: In the case of initial caries, the surface is still intact and decalcification has begun. In the case of an established tooth decay, the surface is defective.

Depending on which layers of the tooth are affected, a distinction is made again between sub-forms:

Superficial caries: Defect in the enamel (superficial layer of the tooth)
Caries media: Defect up to the dentin (second layer of the tooth)
Caries profunda: Caries in all layers down to the tooth pulp, which also contains nerves
Caries sicca: Caries has come to a standstill

Caries: Affected areas of the teeth

Tooth decay is the most common dental disease worldwide. Almost everyone suffers from tooth decay at least once in their life. Baby teeth and permanent teeth can be equally affected.

Depending on the age at which tooth decay forms for the first time, the question “What does tooth decay look like?” Is answered differently, as different areas of the teeth are particularly affected depending on the age.

In young children, tooth decay affects the incisor and adjacent gums first and then slowly progresses to the edge of the tooth. This tooth decay in small children is also known as feeding bottle caries and is mainly caused by improper nutrition (for example tea sweetened with sugar) of the children.
In slightly older children and adolescents, tooth decay often first appears on the chewing surfaces. Here, too, the cause is usually an incorrect (high-sugar) diet.
In adults, on the other hand, caries predominantly occurs between the teeth. The reason for this lies on the one hand in incorrect or negligent dental care or also in heavily sweetened drinks such as coffee or tea.
In people over the age of 60, tooth necks are particularly affected by tooth decay. In old age, the gums often recede, which means that the individual tooth necks are exposed. In this area, however, the natural protective layer is thinner, so a "hole in the tooth" occurs more quickly. This type of tooth decay is also known as root caries.

Tooth decay: symptoms

Caries describes a progressive course of tooth destruction. Sometimes "only" one tooth is affected, in other cases several teeth are carious. In addition, different symptoms occur, depending on the stage of caries development.

Tooth decay: initial stage

To begin with, tooth decay is barely visible. Doctors call this period of time the initial stage. Chalky white spots slowly appear on the teeth. There, minerals are already loosening from the teeth and the tooth enamel becomes holey (porous). Dark discoloration of the teeth is also an indication of tooth decay.

Actually, the mineral loss can still be compensated at this stage: Regular and careful brushing of the teeth removes the harmful caries bacteria. And the fluoride contained in the toothpaste ensures that minerals from the saliva replace the loss in the hard tooth substance.

If the oral hygiene is inadequate, tooth decay will continue. Teeth that are seldom brushed become progressively demineralized and eventually a hole appears in the tooth. Pain can appear here for the first time. However, pain occurs at the latest when the nerves of the teeth are also attacked by bacteria. At this stage, many teeth are also very sensitive to heat, cold or very sweet foods.

Caries: late stage

Without treatment, tooth decay progresses slowly. Caries from an affected tooth can spread to other teeth. As the tooth substance deteriorates, so does the pain. An untreated tooth decay infection is very dangerous. The inflammation may spread to the jawbone and trigger inflammation here as well. Bacteria can also travel throughout the body from the mouth through the bloodstream and infect other organs.

Secondary caries (caries under filling / caries under crown)

If there has already been a hole in the tooth, the dentist drills it and closes it with a filling. However, this treatment does not guarantee that you will be protected from tooth decay afterwards. Teeth often develop what is known as secondary caries:

Over the course of several years, small gaps form in the border area between tooth and tooth filling or crown. These are too small for the toothbrush bristles to reach. However, they are big enough that microscopic bacteria can settle in them. Tooth caries also often occurs in places where a hole in the tooth has already been filled.

Tooth decay: causes and risk factors

Tooth decay is influenced by several factors: bacteria, dental hygiene, and eating habits. The development of caries is based on an interplay of these factors. Saliva and the immune system also play a role.

The story of the bacteria “Karius und Baktus” helps to explain the question “How does tooth decay?” To children in more detail. It shows what happens in the teeth when there is tooth decay. The pair of bacteria can now also be found on posters at the dentist, in the form of comics or in short stories that warn of deciduous tooth decay.

Caries bacteria

There are over 700 types of bacteria in our mouth. To a certain extent, these microorganisms are necessary for a healthy oral flora. However, some bacteria mainly feed on leftovers, especially sugar. They utilize sugar from food and thereby excrete acids as waste products. These attack the tooth enamel by leaching out minerals. If this process is not stopped, the hole will appear in the tooth at some point.

High-sugar diet

The development of caries is promoted by sweet food and drinks. Above all, household sugar (sucrose), grape sugar (glucose) and fruit sugar (fructose) can be used well by caries bacteria and thus indirectly damage the teeth. Long-chain sugar compounds, i.e. complex carbohydrates such as those found in whole grain products, do not promote tooth decay.

Dental hygiene

Brushing your teeth reduces the number of bacteria in your mouth. Immediately after each time you brush your teeth, a coating of bacteria and saliva components - called plaque or biofilm - slowly builds up on the surface of the tooth. If someone brushes their teeth infrequently, irregularly or carelessly, this plaque has enough time and opportunity to get thicker and thicker. The problem with this is that it is mainly the bacteria that multiply in it that cause tooth decay.

saliva

If there is plenty of saliva, the minerals it contains can replace losses in the hard tooth substance. An increased amount of saliva also serves to liquefy ingested food. In this way, these can be transported away more easily and are less likely to get stuck on and between the teeth. Some components of saliva also have a neutralizing effect on the acids produced by bacteria. Others have antibacterial properties.

In summary, this means: If there is little saliva, tooth decay is more likely to develop. In the interdental space and on the tooth crown, food residues can easily get stuck and stick, which caries bacteria are happy about.

immune system

The nature of the immune system also determines how well the body can defend itself against harmful bacteria. Tooth decay is a very common problem for people with a weakened immune system. The immune system is weakened, for example, in chronic diseases such as HIV or diabetes mellitus. In addition, drugs such as antibiotics or corticosteroids (e.g. cortisone) reduce the resistance of the immune system.

Is tooth decay contagious?

Tooth decay is a bacterial infection and, like other bacterial infections, is contagious. In normal everyday life, however, the risk of infection with tooth decay does not play a major role. The bacteria that are responsible for the development of tooth decay are found in everyone's mouth. In any case, individual risk factors must therefore be added before caries can break out. A transfer of caries-causing bacteria between two adults (e.g. by kissing or sharing cutlery) is therefore irrelevant for the development of caries.

The fact that tooth decay is contagious plays a role in small children. They have fewer bacteria and microorganisms in their mouths than adults, and even none at all in small children without teeth. Theoretically, adults who, for example, put the child's pacifier in their mouth to clean, may transfer their caries bacteria to the offspring. Whether the risk of infection is really that great is controversial among experts.

Family influence

Contrary to popular belief, tooth decay is not hereditary. However, tooth decay can occur more frequently in families. For example, hereditary factors such as deep tooth grooves (tooth fissures) represent a potential risk factor for tooth decay. In addition, there are eating and hygiene habits that children learn from their parents: In families where sweet food and drinks are often served and / or If little emphasis is placed on thorough and regular brushing of teeth, the risk of tooth decay in children is far higher than in other families.

Tooth decay: examinations and diagnosis

If caries is suspected, the dentist is the right contact. In a short conversation he will first collect the medical history (anamnesis). You (or your child) have the opportunity to describe the symptoms in detail. The doctor can then ask further questions, for example:

When did the symptoms first become noticeable?
Are there relatives who often suffer from dental problems?
Have you had problems with your teeth in the past?
How often do you brush your teeth a day?

This is followed by a detailed examination of the teeth. The dentist can detect tooth decay by looking closely at the teeth with a small mirror. The disease is first noticed by changes on the surface of the teeth. If such changes are present on the surface, the dentist uses a small probe (a kind of thin rod) to check how far the damage has progressed into the interior of the tooth. The treatment depends on it.

Since tooth decay is usually very difficult to detect in the initial stage, x-rays can be helpful. On it, carious spots can be seen very well. Often, incipient caries is discovered only by chance on routine X-ray images during a dental check-up.

There are also other, modern methods that can be used to diagnose tooth decay. This includes, for example, the measurement of electrical resistance and various fluorescence methods:

Electrical resistance measurement: Healthy tooth enamel moistened with saliva conducts electrical current. In the case of caries damage, this conductivity increases in the enamel, i.e. the electrical resistance - measured with the aid of a hand electrode - decreases.
Fluorescence methods: They are based on the fact that the hard tooth substance fluoresces under certain conditions. The fluorescence properties depend on the condition of the tooth substance: Carious areas fluoresce differently than healthy tooth substance.

Tooth decay: treatment

In the case of early tooth decay, improved oral hygiene and renouncing a high-sugar diet are sometimes sufficient. Often, however, tooth decay is only discovered when it has progressed further. Then the dentist has to deal with it: he usually removes the carious area on the tooth with a drill and closes the resulting hole with a filling.

You can read more about this and other options for treating carious teeth in the article Caries treatment.

Caries: disease course and prognosis

The loss of minerals can only be compensated for by yourself in the initial stage. At the latest when a hole has formed in the tooth, caries must be treated professionally (i.e. by the dentist).

After tooth decay has been recognized and treated, there are usually no more symptoms. However, a one-time caries treatment does not guarantee that symptoms will not recur. As soon as oral hygiene is neglected, tooth decay can develop again. In particular, tooth decay in milk teeth tends to form again quickly.

If tooth decay affects children, you can also consider pulling affected teeth (milk teeth) as a precaution to prevent the caries from spreading.

Prevent tooth decay

You can prevent tooth decay by consuming sugary drinks and foods in moderation and by maintaining thorough and regular oral hygiene. To do this, you should brush your teeth after every meal, regardless of whether you have eaten something sugary or not. In this way, leftover food residues are removed immediately and the bacterial coating on the teeth is reduced. If it is not possible to brush your teeth after eating, chewing gum containing xylitol can also help. Xylitol is a sugar substitute. It stimulates the formation of saliva and can partially neutralize the acids formed by the bacteria.

After consuming acidic foods (such as citrus fruits or cola), you should wait a little before brushing your teeth. Because the acid softens the enamel so that it is more easily removed when brushing. So wait about 30 minutes before brushing your teeth.

Use toothpaste that contains fluoride. It hardens the enamel and thus helps prevent tooth decay. Use dental floss and / or an interdental brush to clean the spaces between your teeth.

Proper oral hygiene is important for children: As soon as the first tooth erupts, the mouth should be cleaned regularly with a soft children's toothbrush. As soon as the child has all the milk teeth and the swallowing reflex is present, it should be switched to brushing the teeth twice a day.

Regular checkups at the dentist help in childhood and adulthood to detect tooth decay at an early stage. Professional tooth cleaning (PZR) also helps keep teeth healthy. It should be carried out at least twice a year in adolescents and adults.

If there is an increased risk of tooth decay, the dentist can apply fluoride varnish to the surface of the tooth or recommend fluoride gels or solutions for use at home.

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