Dr. Maneesh Rai, Dentist, Bhopal


Dental Caries


Types of Fillings




What is tooth decay, and what causes it?

Tooth decay is the disease known as caries or cavities. Unlike other diseases, however, caries is not life threatening and is highly preventable, though it affects most people to some degree during their lifetime. Tooth decay occurs when your teeth are frequently exposed to foods containing carbohydrates (starches and sugars) like chocolates, sticky sweets, ice cream, milk, cakes, and even fruits, vegetables and juices. Natural bacteria live in your mouth and form plaque. The plaque interacts with deposits left on your teeth from sugary and starchy foods to produce acids. These acids damage tooth enamel over time by dissolving, or demineralizing, the mineral structure of teeth, producing tooth decay and weakening the teeth.

How are cavities prevented?

The acids formed by plaque can be counteracted by simple saliva in your mouth, which acts as a buffer and remineralizing agent. Dentists often recommend chewing sugarless gum to stimulate your flow of saliva. However, though it is the body's natural defense against cavities, saliva alone is not sufficient to combat tooth decay. The best way to prevent caries is to brush and floss regularly. To rebuild the early damage caused by plaque bacteria, we use fluoride, a natural substance which helps to remineralize the tooth structure. Fluoride is added to toothpaste to fight cavities and clean teeth. The most common source of fluoride is in the water we drink. Fluoride is added to most community water supplies and to many bottled and canned beverages.If you are at medium to high risk for cavities, your dentist may recommend special high concentration fluoride gels, mouth rinses, or dietary fluoride supplements. Your dentist may also use professional strength anti-cavity varnish, or sealants-thin, plastic coatings that provide an extra barrier against food and debris.

Who is at risk for cavities?

Because we all carry bacteria in our mouths, everyone is at risk for cavities. Those with a diet high in carbohydrates and sugary foods and those who live in communities without fluoridated water are likely candidates for cavities.Children and senior citizens are the two groups at highest risk for cavities.

Decay that is unique to adults:
- Root cavities - As you age, your gums can recede, leaving parts of your tooth root exposed. Since there is no enamel covering your tooth roots, these exposed areas easily decay. Most people over 60 have root cavities as a result of gum disease.
- Repeated decay around existing fillings - Decay can form around existing fillings and crowns. This is because these areas are not as smooth as a natural tooth surface and can decay easier.
Cavities from dry mouth - dry mouth is present due to a decrease in saliva.

What areas are likely to decay?

Teeth next to each other because this area is hard to clean
Fissures in the "chewing" (occlusal) surface of teeth
Gum line

What can I do to help protect my teeth?

The best way to combat cavities is to follow three simple steps: Cut down on sweets and between-meal snacks. Remember, it's these sugary and starchy treats that put your teeth at extra risk. Brush after every meal and floss daily. Cavities most often begin in hard-to-clean areas between teeth and in the fissures and pits-the edges in the tooth crown and gaps between teeth. Hold the toothbrush at a 45-degree angle and brush inside, outside and between your teeth and on the top of your tongue. Be sure the bristles are firm, not bent, and replace the toothbrush after a few weeks to safeguard against reinfecting your mouth with old bacteria than can collect on the brush.. Children under six should only use a small pea-sized dab of toothpaste on the brush and should spit out as much as possible because a child's developing teeth are sensitive to higher fluoride levels. Finally, because caries is a transmittable disease, toothbrushes should never be shared, especially with your children. See your dentist at least every six months for checkups and professional cleanings. Because cavities can be difficult to detect a thorough dental examination is very important. If you get a painful toothache, if your teeth are very sensitive to hot or cold foods, or if you notice signs of decay like white spots, tooth discolorations or cavities, make an appointment right away. The longer you wait to treat infected teeth the more intensive and lengthy the treatment will be. Left neglected, cavities can lead to root canal infection, permanent deterioration of decayed tooth substance and even loss of the tooth itself.

What can your dentist do to help you avoid cavities:

Sealants...are for all ages! They are a plastic "coat" placed on the surface of a tooth to "seal" out decay. You must see your dentist twice a year to check the sealants to make sure they have not chipped or "leaked".

Provide you with oral hygiene instructions: tooth brushing and flossing and dental diet suggestions.

Have x-rays taken to check for tooth decay in and between teeth to stop them while they are small in order to save your tooth structure.

Remove decay and fill any cavities that exist because they are a good source of bacterial infection!

Smooth edges and repair gaps in existing fillings that could be areas for bacteria to grow.


Types of Fillings

Dental Fillings The very next step after decay is removed from a tooth is that something must be placed in that space to give strength back to the tooth.

Fillings :
Fillings are the best and most common restorative procedure.

Inlays and onlays : In addition to fillings, lab fabricated inlays and onlays are also sometimes used. Although many patients think of these as fillings as well, they are actually different since they are laboratory fabricated.

White fillings :
The most popular kind of 'white filling' is called a Composite filling. It is made up of a composite quartz resin (glass and porcelain) and usually contains some sort of light sensitive agent that is used during curing. They are an attractive, durable alternative to silver (amalgam) fillings. In the past, white fillings were placed only on front teeth, but recently these composite materials have been specifically designed to be able to survive the pressure of grinding when you chew.  These light cured composites are best looking and in most cases they can be inserted in one appointment.

Silver (amalgam) fillings:
Today, the use of white composite resin fillings is more in vogue by most dentists. The principal components of amalgam is Silver alloy and Mercury. American Dental Association has declared Silver amalgam fillings as totally safe and they continue to be in use . Gamma-2-free amalgams continue to be used today because they are hard, durable and inexpensive, There may  be unique circumstances that call for a silver (amalgam) filling, like placing on back teeth (molars).

White Porcelain inlay or onlay : This is used when cosmetics and wear resistance is most important for a patients. A porcelain inlay or onlay is used when the cavity is too big for a filling, but isn't so big that a crown is required. An inlay is a filling within the cusp tips of the tooth. Onlays (also known as overlays) will overlay one or more cusps in order to protect and strengthen the tooth. This type of filling costs about the same as an indirect composite inlay/onlay and takes two visits.

An inlay or onlay may also be made of gold. Gold fillings despite being expensive, have long history of use with excellent durability, wear well, and do not cause excessive wear to the opposing teeth. But they do conduct heat and cold making its presence felt in the mouth. Recent advances has brought consumer focus on aesthetic results of composites and procelain veneers and crowns.

Glass Ionomer Fillings: It is a filling material that is tooth colored and contains strontium, phosphate and fluoride ions. These fillings are a mixture of glass and an organic acid. They are also tooth-coloured but vary in translucency. Glass ionomer fillings are less aesthetic in result as compared to what is achieved by composite resins.

As far as the cavity filling preparation is concerned, glass ionomer is comparable to the composite resin. Glass ionomer is considered fairly conservative procedure as it disturbs fairly less tooth structure. This filling material interacts with the enamel and dentin and actually allows the tooth tissue to remineralize at the filling interface. This provides a true biological and chemical seal with the tooth. It is good for those who feel sensitivity with the rest of their otherwise healthy looking teeth.

The glass ionomers are chemically set and require no light cure to harden the material once placed in the cavity preparation. It however need time to fully set and harden. The glass ionomers advantage over composite resins include no shrinkage and micro leakage as bonding is acid-base reaction and not a polymerization reaction; Glass ionomers contain and release fluoride that helps prevent carious lesions; Glass ionomer has less wear as compared to composite resins.