Imagine yourself as the textbook description of the “perfect” dental patient.  You visit your oral health care provider twice a year for regular check-ups and cleanings, brush your teeth at least twice a day and floss daily, you maintain a nutritious and well-balanced diet, and you stay away from sugar and sugary drinks. You may be doing just about everything right, but everyone’s mouth is a natural breeding ground for common bacteria, and there lies the cause of tooth decay, leading to caries or cavities.

Tooth decay is the destruction of your tooth enamel, the hard, protective, outer layer of your teeth. Tooth decay is a problem for children, teenagers and adults and it all starts with plaque, a sticky film of bacteria that constantly forms on your teeth. When you eat or drink sugary foods or beverages, including alcohol, the bacteria in plaque produce acids that attack tooth enamel, and cause it to break down forming a cavity.

Cavities are very common in children, but adults suffer with aging changes like gum recession and an increased chance and incidence of gum disease.  Exposed tooth roots and plaque are vicious enemies. Tooth roots, covered with a softer tissue than enamel, are susceptible to decay and can be sensitive to touch, and hot and cold temperatures. Adults are also susceptible to decay around a tooth edge, or margin. According to the American Dental Association (ADA) many older adults lacked benefits of fluoride and modern preventive dental care when they were growing up, and they often have a number of silver, or amalgam, dental fillings. Over the years, these fillings may weaken and tend to fracture and leak around the edges. Bacteria accumulate in these tiny crevices causing acid to build up which leads to further tooth decay and cavities.

How can you help prevent tooth decay?  Brush twice a day with a fluoride toothpaste. Clean between your teeth daily with floss, or an interdental cleaner. Eat nutritious and balanced meals, and limit snacking, and sugary foods and drinks. Check with your dentist about the use of supplemental fluoride, which strengthens your teeth, and about dental sealants (plastic protective coating) applied to the chewing surfaces of the back teeth (more prone to decay). Visit your dentist twice a year for professional cleanings and oral examination.

What are your options for filling a cavity?  When it comes to having a cavity filled, it’s important to know that you have the right to decide! The ADA encourages you to talk with your dentist in advance so that together you may choose the material that’s right for you. You and your dentist will review and discuss what material to use for a filling, taking into account the size and location of your cavity, cosmetic considerations, how long the filling could last and insurance coverage and out of pocket costs.

There are three common choices for dental fillings, the top two being the most popular:

Composite resins, or tooth-colored fillings, are a mixture of glass or quartz filler that provide good durability and resistance to fracture in small-to-mid-size fillings that need to withstand moderate pressure from chewing.

Upside: They are well suited for use in front teeth or visible parts of teeth, the shade/color can be closely matched to the color of existing teeth, they chemically bond to tooth structure, providing further support, and can be used to repair chipped, broken, or worn teeth. Sometimes less tooth structure needs to be removed.

Downside: Composite fillings wear out sooner and may not last as long as amalgam fillings under the pressure of chewing, particularly if used for large cavities. Increased chair time and more than one office visit may be required; materials can chip off the tooth and the fillings can cost up to twice the cost of amalgam fillings.

Amalgam, sometimes described as a "silver" filling, is made from a combination of metals that include mercury, silver, tin, and copper.

Upside: Amalgam fillings have been used for generations by dentists and are durable, are less expensive that composite or gold fillings, and last at least 10-15 years.

Downside: Aesthetically, the silver color can produce a gray hue to the surrounding tooth, the dentist must destroy part of the tooth to hold the filling, and the filling can crack or fracture due to pressure, heat or cold. 1% of patients are allergic to mercury in amalgam fillings. Tooth-colored materials are more natural looking than amalgam fillings.

Gold Fillings, also called inlays or onlays, are composed of an alloy of gold, copper and other metals.

Upside: Gold has been used in dentistry for more than 1,000 years due to its durability.

Downside: Gold is more expensive than amalgam, and less natural looking than tooth-colored fillings.

So now you have the 411 on tooth decay and your action plan choices. But when it comes to choice in your daily and overall oral health care, I recommend the best one of all: PREVENTION!






What you need to know about tooth decay, cavities and fillings options.

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