Tooth decay (cavities)

Disease Description (Causes and Symptoms)

• Definition: Dental caries (tooth decay) is a disease in which the enamel on the tooth surface is demineralized by acids, and the disease spreads to the dentin and pulp.
• Causes·pathophysiology: When bacteria that cause tooth decay living in oral plaque (bacterial film) break down food (especially sugar and starch) and produce acids, the enamel is demineralized and gradually develops defects. Reduced saliva production (such as due to diabetes or after radiation therapy) promotes bacterial activity and an acidic environment, increasing the risk.
• Main symptoms:
  • Early stage (limited to the enamel): Usually asymptomatic or only mild sensory changes
  • Involvement of the enamel–dentin junction: Hypersensitivity to cold and sweet foods (tooth sensitivity)
  • Dentin involvement: Discomfort from cold and hot stimuli, pain during chewing
  • Pulp involvement (pulpitis/necrosis): Spontaneous pain, nighttime pain, worsening with hot stimuli; in severe cases, weak response to painkillers
  • When pulp necrosis becomes chronic, a periapical lesion (radiographic lesion) or abscess may develop

Treatment Methods

• Non-surgical and preventive:
  • Promote remineralization and prevention through fluoride application (toothpaste, fluoride gel, or varnish)
  • Prevention through sealant application (on the occlusal surfaces of molars)
  • Improve oral hygiene (regular toothbrushing, dental floss and interdental brushes), dietary control (limiting sugar intake), and stimulate saliva production (such as with sugar-free gum)
• Filling treatment:
  • Remove the carious area and fill it with composite resin (tooth-colored) or amalgam/gold
• When the pulp is involved:
  • Perform root canal treatment (nerve treatment) according to the diagnosis of reversible or irreversible pulpitis
  • Extract the tooth in cases of severe tooth-structure damage or root fracture, or when the tooth cannot be preserved
• Medications:
  • Pain management: NSAIDs (such as ibuprofen), and analgesics if necessary
  • Antibiotics: Used restrictively, mainly when a localized abscess is spreading or systemic symptoms (fever or enlarged lymph nodes) are present
• Special situations:
  • When dry mouth caused by diabetes or post-radiation effects is the cause, saliva substitutes and oral moisturization, blood glucose control, and joint management by dental and internal medicine departments are recommended
• Precautions:
  • If symptoms are present, do not delay seeking dental care; early treatment is necessary
  • Be sure to inform the dentist before treatment about anticoagulant or cardiovascular disease medication use, pregnancy, and other relevant conditions

Outpatient Visit Checkpoints (Including Example Questions)

• Items/information to prepare:
  • A list of currently used medications (including anticoagulants, antiplatelet drugs, and diabetes medications)
  • Previous dental treatment records (such as root canal treatment, extraction, and prosthetic treatment) and recent radiographs (if available)
  • Underlying diseases (such as diabetes, a history of radiation therapy, or an immunosuppressed state) and allergy information
  • Symptom record: Onset, relationship to stimuli (cold, hot, or sweet), pain intensity and frequency, and whether swelling or purulent discharge is present
  • Lifestyle habits: Frequent snacking or soft drink consumption, and smoking status
• Example questions for the outpatient visit (it may be useful for patients to record these themselves and bring them):
  • "When did the pain start, and which stimuli make it worse?"
  • "Do you have any recent history related to blood glucose levels (or radiation therapy, etc.)?"

Examples of General Questions to Ask the Doctor

• "Could you explain what stage my tooth decay is currently at (enamel, dentin, or pulp involvement)?"
• "What is the expected course (complications) if I do not undergo this treatment?"
• "What are the advantages and disadvantages (durability, cost, and esthetics) of the recommended filling materials?"
• "What pain management methods and side effects can be expected during and after treatment?"

Examples of Disease-Specific Questions

• "It seems that the pulp may be involved. Is root canal treatment (nerve treatment) necessary, and what are the expected success rate and number of treatment sessions?"
• "My salivary function is reduced due to diabetes or radiation therapy. What additional management (such as fluoride application, oral moisturization, or regular scaling) do you recommend to prevent recurrence?"

(Note: Visual examination, probing, and radiographs are essential for diagnosis, and the likelihood of recovery is high when the disease is detected early.)