How to save your sparkle

How does tooth decay (caries) develop?

Tooth decay is the most widespread dental disease and is mainly caused by bacteria in dental plaque combined with inadequate oral hygiene and the consumption of sugary foods.

When the bacteria in plaque are fed with food, especially sugars and carbohydrates, they produce acids that attack the tooth enamel. The acids initially demineralise the enamel, causing white spots. As decay progresses, the damage penetrates deeper into the tooth and eventually appears as holes on the tooth surface.

Decay is not only promoted by bacteria in plaque and high sugar intake, but also by reduced saliva production and individual predispositions, such as insufficient mineralisation of the enamel, which can encourage the formation of caries.

Where there are fewer bacteria, less harmful acid is produced that can attack the tooth and cause decay. Good oral hygiene and regular dental care are therefore crucial to keep bacterial levels under control and minimise the risk of caries.

What symptoms occur?

In the initial stage, known as initial caries, the affected tooth often does not yet cause pain. White or yellowish-brown spots on the teeth are the first visible signs. A rough surface can sometimes be felt with the tongue.

With advanced caries, affected teeth become very sensitive and react to heat, cold or certain foods, particularly sweet or acidic items.

How is caries treated and what therapeutic options are available?

Early caries is treated at an early stage with fluoride. A drilling procedure is necessary, however, when decay is already advanced. Under local anaesthesia, the decayed tissue is removed and the resulting cavity is filled, for example with composite. This filling material offers strong protection against wear of the tooth (abrasion).

If the decay has progressed so far that removing the affected tissue would result in a large defect, a full-ceramic restoration is often performed. This can be delivered as an inlay, partial crown or full crown. Ceramic rebuilds the tooth and protects it from further decay.

If caries has reached the tooth nerve, a root canal treatment is necessary. The root canals are thoroughly cleaned and sealed with a bacteria-tight filling. The tooth must then be crowned to prevent it from breaking.

What health consequences can untreated caries have?

Caries can have far-reaching effects on general health, not only on the teeth. If left untreated, it can lead to gum inflammation, tooth loss and even serious infections.

Moreover, studies have found links between caries and other conditions such as cardiovascular disease and diabetes. Early detection and treatment of caries are therefore crucial to avoid possible health consequences.

What role does fluoride play in caries prevention?

In many countries, fluoride is added to drinking water to help prevent caries. However, excessive fluoride intake can cause so-called fluorosis. This occurs when children receive too much fluoride while enamel is forming, which can lead to tooth discolouration.

Too much fluoride can also affect bone development and cause growth disturbances and anaemia. For daily fluoride intake there are therefore limits. When using toothpaste there is also a risk of swallowing it, especially in children under six years, which is why toothpastes for this age group contain less fluoride.

How does hydroxyapatite work as an alternative to fluoride in caries prevention?

High-quality clinical studies confirm the caries-preventive efficacy of hydroxyapatite. This is a biomimetic active ingredient that occurs naturally in bone and teeth, for example in dentine and enamel. The results of these studies indicate that fluoride-free toothpastes containing hydroxyapatite are at least as effective and may even offer better protection against caries than conventional fluoride toothpastes.

In addition, hydroxyapatite improves gum health and has proven in meta-analyses to be the most effective ingredient for preventing and alleviating tooth sensitivity. Another advantage of hydroxyapatite is that it is harmless if swallowed and is not subject to quantity restrictions like fluoride. Hydroxyapatite therefore provides clinically proven caries protection, is safe for all age groups and, unlike fluoride, does not require warning labels or strict regulations.

Simple measures to significantly reduce caries risk

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• Caries is best treated at an early stage. If the dentist thoroughly removes plaque and applies fluoride, the enamel can recover before cavities form.
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• Maintain thorough oral hygiene and brush your teeth at least twice daily. Make sure to use high-quality oral care products – from the toothbrush to the toothpaste and mouthwash.
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• Replace your toothbrush regularly – generally at least every three months and after respiratory infections such as colds – or replace the brush head for electric toothbrushes.
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• Using dental floss or fine interdental brushes to remove plaque and support a healthy oral flora is also strongly recommended.
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• Reduce sugar intake to a minimum, since sugar is a food source for bacteria. Ideally, teeth should be brushed about 30 minutes after consuming sweets and other sugary foods.
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• Acidic foods and drinks such as soft drinks, sour fruit juices and refreshment drinks can damage enamel. They should be consumed rarely or preferably not at all. It is not only the amount but also the duration that acids act on the teeth that matters. After a meal or after a sip of an acidic drink, saliva takes about 30 to 60 minutes to rebalance the acidity. If such drinks are sipped throughout the day, the acid level in the mouth can remain at a harmful level for too long and attack the enamel.
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• Chewable foods such as raw vegetables and wholegrain bread exercise the chewing apparatus and stimulate saliva flow. Saliva neutralises acid in the mouth and helps remove bacteria from the tooth surface.
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• You may not always be able to brush your teeth after eating, especially on the go. A good alternative is sugar-free chewing gum, which stimulates saliva flow and thus helps prevent caries.
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• Rinsing with mouthwashes that neutralise the pH in the mouth and thereby disrupt bacterial acid production has a similar effect. Caries risk can be significantly reduced if you rinse with mouthwash for two minutes after eating.
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• Regular water drinking stimulates saliva flow, rinses away food residues and helps remove acids from the teeth.
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• Fluorides promote the mineralisation of teeth and thus make them more resistant to acids and bacteria. Fluoridated toothpastes are available for daily use. Fluoride lozenges, as well as special fluoride-containing mouthwashes and dental gels, can also be used for increased caries risk. Always observe the limits.
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• Regular dental visits every six months are recommended for comprehensive caries prevention. The dentist examines teeth and gums. After removing stubborn deposits, teeth are polished and sealed with fluoride-containing agents. This strengthens the enamel and offers additional protection against caries. The dentist also provides advice and demonstrates optimal oral care techniques.
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• Baby teeth have a less hard dental substance than permanent teeth and are therefore particularly susceptible to caries; prevention in children is therefore especially important. In addition, caries can progress more rapidly in baby teeth, possibly leading to tooth loss after a short time. For this reason, using children's toothpastes that strengthen enamel is particularly important.
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• Children's molars are especially at risk. Bacteria can settle in the pits, fissures or grooves of teeth. To prevent bacterial colonisation, the dentist may recommend sealing the large molars of children with susceptible teeth using a plastic sealant. This sealing is painless, quick and can reduce the risk of caries. The sealant typically lasts several years but must be checked at follow-up appointments for integrity.
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A radiant smile is the ultimate beauty accessory, giving confidence and drawing attention from others. An early investment in dental care pays off in the long run with a naturally beautiful smile.