Tooth Decay

Tooth decay (dental caries) is the gradual destruction of the enamel and underlying tooth by acids made by bacteria feeding on sugars. It is the most common chronic disease in the world — and in India, where most people don't visit a dentist regularly, much of it goes untreated until pain starts.

How it develops

• Plaque bacteria + sugar → acid → enamel loss → cavity.
• Early decay is invisible and painless.
• As the cavity deepens, sensitivity to hot/cold/sweet, then spontaneous pain, then abscess.

Biggest risks

• Frequent snacking on sugary foods/drinks — the frequency of sugar exposure is worse than the total amount.
• Sweet masala chai or milk with sugar all day.
• Sipping aerated drinks, sweetened juice, fruit drinks, energy drinks.
• Poor toothbrushing (missed areas, wrong technique, too soft/no fluoride toothpaste).
• Dry mouth (some medicines, diabetes, Sjögren's syndrome, radiation to head/neck).
• Putting a baby to sleep with a milk bottle in the mouth — classic cause of early childhood caries.
• Deep grooves on chewing surfaces (in some children).
• High-fluoride water is protective; very-low-fluoride water raises risk.

Prevention

• Brush twice a day with fluoride toothpaste, floss daily.
• Spit, don't rinse after brushing.
• Reduce sugar frequency — one big dessert at a meal is less harmful than sipping sweet drinks all day.
• Rinse with water after any sugary or sticky food.
• Chewing sugar-free gum after meals helps in some people.
• Fluoride varnish (every 3–6 months for children at higher risk) and fissure sealants for permanent molars are cost-effective preventive options.
• Don't put babies to bed with milk/juice bottles.

Treatment options (depth-wise)

• Early (enamel only) — fluoride varnish, better brushing, dietary change can reverse small spots.
• Cavity in enamel/dentine — filling (composite/glass ionomer/amalgam).
• Reaching the pulp — root canal treatment + cap/crown.
• Beyond repair — extraction + replacement (implant, bridge, denture).
• Silver diamine fluoride — a low-cost option to stop decay in baby teeth and fragile dentine without drilling.

See a dentist

• Any visible dark spot, hole, or broken edge in a tooth.
• Sensitivity lasting beyond a few seconds to hot/cold/sweet.
• Facial swelling + tooth pain — urgent.
• New cavities despite brushing — rethink technique, diet, dry-mouth causes.