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What Are Cavities?

By: Graziano Giglio, DDS & Paul R. Kamen, DDS, FACD

Most of know what getting a cavity means - an unwanted trip to the dentist resulting in a filling or, in some unpleasant cases, a root canal. But what exactly are cavities, and how do they form? And what options do you have when it comes to treating them? Below, two experienced dentists discuss the ins and outs of tooth decay.

How do cavities form?
PAUL KAMEN, DDS: Cavities are actually a demineralization of the tooth surface. If you eat sweet foods, bacteria on your teeth create acids. The acids actually leach out the enamel of the tooth structure and begin to invade the tooth causing destruction of some of the softer parts of the tooth and eventually decay of the tooth.

Where do most cavities form?
GRAZIANO GIGLIO, DDS: Most of them form inside pits and fissures on top of teeth-the nooks and crannies.

There are other types of cavities that occur between teeth. They're caused by getting a piece of food stuck there for a long period of time. Plaque accumulates around it. The bacteria make acid which then demineralizes both teeth. We can prevent these types of cavities by flossing.

How does brushing prevent cavities?
GRAZIANO GIGLIO, DDS: Brushing removes the food and the bacteria, and also coats the teeth with some fluoride which also prevents cavities. It coats and protects them and also remineralizes them.

How often should people brush and floss?
PAUL KAMEN, DDS: You should brush twice a day. For most people, flossing once a day is adequate. Although if you feel that you're getting food stuck between your teeth-especially people who have lots of fillings or whose teeth are very, very close together, they tend to have that feeling that something is stuck in-between-it certainly doesn't hurt to floss more and get that food out between each meal. I would also add that I like to see patients spend at least one time during the day brushing in a very concerted way, for about seven minutes. Brushing really properly, really taking the time to get into those gum crevices. Get to the back teeth, get to the inside surfaces of the teeth, and then of course, to floss.

What about sealants? What are they and how do they prevent cavities?
PAUL KAMEN, DDS: Sealants are a kind of polymeric resin that dentists use to cover the pits and fissures in you teeth. Microscopically, they're kind of like the Grand Canyon for bacteria. But they're very, very hard to get to. The bristle of a toothbrush could not fit into one of those little microscopic fissures. Dentists place these sealants over them to prevent the bacteria, prevent the plaque from settling into those fissures.

GRAZIANO GIGLIO, DDS: They last about 15 years. But they only prevent cavities from food building up inside these crevices, not in between teeth. You still have to floss.

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When you get a cavity, you have to get a filling. Are there different kinds?
PAUL KAMEN, DDS: There are many options today. The old standard option was to get an amalgam filling. An amalgam is a combination of metal-combining mercury and other metallic elements. We still use those. But today we're using a lot more fillings made out of composites, out of polymeric plastic-based materials that look more like teeth and are more cosmetic. You don't see all that silver.

GRAZIANO GIGLIO, DDS: For a large cavity in a visible area, I recommend a ceramic filling of some sort. It's an inlay or an onlay. We make a mold of the tooth. Then it goes to the laboratory. The laboratory fabricates a piece, like a jigsaw puzzle that fits right into whatever is missing from the tooth.

Another option is gold which most people got before these ceramic fillings which was an option as opposed to the silver. Gold will last a lot longer than silver. Some of these gold fillings last 35 years.

Are gold fillings much more expensive?
GRAZIANO GIGLIO, DDS: A gold filling is more expensive than conventional composite or silver filling. Conventional silver filling may cost $250 whereas the gold may cost $1200, depending on the size of one. The ceramic filling cost the same as the gold. But they have only been around for about ten years. We don't know how much longer they're going to last.

What is a root canal?
PAUL KAMEN, DDS: The root canal is actually a little channel in the tooth. It's actually the nerve that connects the tooth to the bone. The tooth is really a living organism. It's not just a piece of calcium.

If that nerve space is violated by decay or fracture of the tooth, or for any of a variety of reasons, the nerve becomes infected. Root canal treatment involves actually removing that nerve tissue and replacing it with an inert material. That's how we save many, many teeth that otherwise would be lost.

What does the root canal process involve?
GRAZIANO GIGLIO, DDS: First, you have to excavate the cavity. Then you have to go to a root canal specialist who takes the nerve out, cleans the area, disinfects it and then places a rubber material in there. Then you need to go to a restorative dentist or a prosthodontist who can then place a post in the tooth and then a cap or a crown.

You can go from having a small little cavity to a root canal-it's a big jump now in terms of how much money you spend and the type of work that you need. I would advise patients to get in when you have a cavity. Get in as soon as possible. Take care of it because if it does go into the nerve, then you end up needing root canal. You end up spending somewhere in the range of $3,000 to restore that tooth as opposed to a $250 filling.

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