A cavity is a hole in your tooth. Cavities are caused by tooth decay – the process of wearing down the tooth enamel that is caused by bacteria on the teeth.
Tooth decay happens as a result of sugar being left on the teeth – for example, after eating candy, cakes, cereals, breads, or other foods that contain starches, sugars and carbohydrates. Sugar is the culprit for tooth decay because bacteria that live on our teeth love to eat sugar – and when bacteria eat sugar, they digest the sugar and convert it into acid, which then goes to work attacking the enamel of our teeth.
This probably sounds menacing – it’s not! It’s perfectly normal to eat carbohydrates and sugar; it’s perfectly natural to have bacteria on your teeth – all people do. The problem happens when sugar is left to sit for extended periods on the surface of your teeth – or when we eat too much sugar and do not have a balanced diet. Then the bacteria in our mouths get out of control, leading to buildup of plaque – that thick, opaque substance on the surface of teeth – and the acid buildup on the surface of our teeth gets to be overwhelming. This is when tooth decay and cavities happen.
How can cavities be prevented?
Here are the two most important things you can do to prevent cavities:
- Eat a good, balanced diet. Most people in modern-day America eat far too much sugar and carbohydrates. This is one of the contributing factors to the obesity rate, and it also leads to poor dental health. If you drink lots of soda and eat lots of sugary foods every day, you are going to be at higher risk for cavities. The health of your teeth is connected to the health of the rest of your body – and it starts with the kind of food that you are putting into your body.
- Brush and floss every day. Think of the process of avoiding cavities as an ongoing battle – every day, the bacteria in your mouth go to work trying to damage your teeth, and you need to keep stopping them. By brushing your teeth (twice a day – once before bedtime and once in the morning) and flossing every day, you are helping to slow the buildup of plaque and avoid the harmful acids that can break down your tooth enamel over time. There’s no “magic bullet” for fighting cavities; instead it’s a process of ongoing, steady resistance.
What if I brush and floss, and still get cavities? Is something wrong with me?
Some people are at higher risk for getting cavities – even if they don’t have a high-sugar diet, even if they do have good brushing and flossing habits. Often people think of cavities as something that only happens to children who eat too much candy – but cavities can occur in older adults as well. Some people are at higher risk for cavities due to family history or due to the unique characteristics of their teeth. Pregnant women are often at higher risk for cavities because of the sugar cravings that often accompany pregnancy – so if you’re pregnant, pay extra attention to your dental care.
Cavities are best avoided – as with so many other aspects of health, “an ounce of prevention is worth a pound of cure.” If you can do your best to avoid getting cavities, your teeth will thank you for it.
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When you get a cavity in one of your teeth, you will need to get a filling. This is also called a “restoration” because it involves repairing and renewing a tooth. There are several main options for dental fillings – talk with your dentist to determine which option is best for you.
Fillings fall into two main categories: direct and indirect restorations. The type of filling you receive is affected in part by the type of restoration you need.
In a direct restoration, the work is fairly straightforward and uncomplicated –the dentist is able to remove any tooth decay, create the filling and complete the work of repairing the tooth all within the same office visit.
With an indirect restoration, the dental work is usually a bit more complicated and requires two or more visits to your dentist – for example, there might be bridgework involved that affects multiple teeth, or crowns or veneers to repair damaged teeth, or other complications. Your dentist will take an impression of your affected teeth and send the work to a dental laboratory to create the permanent restoration. Then, at a follow-up appointment, your dentist will do the final step of cementing the restoration onto your teeth.
Depending on whether you need a direct or indirect restoration, you and your dentist can choose from the following types of filling materials. Each one has its various advantages and disadvantages; your dentist can help you decide on the material that is best for your needs.
Direct restoration fillings:
- Amalgam: This is the most common type of filling and has been used for over 100 years. The amalgam is made from a mixture of mercury, silver and other metals – they are often called “silver fillings” because of their silver color.
- Advantages: Inexpensive, durable, highly resistant to further tooth decay, and can usually be placed in just one office visit. Amalgam also performs well as a biting surface – it holds up to the pressures and wear of chewing and eating over time.
- Disadvantages: Placement of amalgam requires the removal of a small amount of healthy tooth material. Amalgam also tends to be less attractive looking than some of the other options for filling material – after all, natural teeth are not silver. For this reason, amalgam fillings are usually used only on the back teeth.
A note about amalgam and mercury: Some individuals and advocacy groups have questioned the safety of dental amalgam because it contains mercury and releases a small amount of mercury vapor over the course of its life. Dental amalgam has been the subject of numerous research studies over the years, and no valid scientific research has proven that dental amalgam causes harm to patients, except in rare cases of allergy. So if you need to get amalgam fillings, rest assured that they are safe – and if you do have an allergy to the materials, a different filling can be used.
- Composite resin: Composite is made from a combination of acrylic resin and glass-like particles that create a natural-looking tooth material.
- Advantages: Natural looking – the color can be matched to your existing teeth. It tends to allow for the preservation of a greater portion of the original tooth.
- Disadvantages: Composite fillings are usually more expensive than metal fillings. They also tend to wear down faster and can be prone to breaking more often – resulting in the need for additional dental work in the future to repair or replace the fillings. Composite fillings cannot be used for certain situations – as always, talk to your dentist.
- Glass ionomer: Glass ionomers are made from acrylic and glass powder and are used primarily for small fillings.
- Advantages: Natural tooth color. Low incidence of allergic reaction – most people do not have allergies to this material. Glass ionomer fillings can be made to include fluoride to help resist further tooth decay.
- Disadvantages: This is not as durable of a filling material as the other options – it is only used for small fillings and in areas that are not subject to a lot of heavy biting and chewing. This material can become rough as it ages, resulting in plaque buildup. It is also more costly than amalgam fillings – similar in price to composite resin.
- Resin ionomer: This type of filling is made from glass filler, acrylic acids and acrylic resin. It is often used for fillings in baby teeth and on non-chewing surfaces.
- Advantages: Natural tooth color – is even more translucent than glass ionomer fillings. Can contain fluoride. More durable than glass ionomer.
- Disadvantages: Not recommended for biting surfaces in adult teeth; less durable than composite and amalgam.
Indirect restoration fillings:
- Porcelain (ceramic): This type of filling material is commonly used in indirect restorations. The ceramic porcelain can also be fused to metal as part of the tooth restoration – which improves the durability of the filling but also increases the complexity and cost of the dental work.
- Advantages: Natural tooth color. Requires very little healthy tooth material to be removed.
- Disadvantages: Tends to be more brittle than other materials. May not be recommended for molars. Usually requires two or more office visits to place the filling, and tends to be more costly.
- Gold (or other metal) alloy: Gold alloys (containing gold, copper and other metals) are another option for indirect restorations.
- Advantages: Excellent durability, does not break under stress.
- Disadvantages: Gold is usually the highest-cost option for a filling. Not a “natural” tooth color.
As always, talk with your dentist to find the right choice of fillings for your needs.
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