CAVITIES
Definition:
Cavities are permanently damaged areas in the hard surface of your teeth that develop into tiny openings or holes. Cavities, also called tooth decay or caries, are caused by a combination of factors, including bacteria in your mouth, frequent snacking, sipping sugary drinks and not cleaning your teeth well.
Description:
Cavities and tooth decay are among the world's most common health problems. They're especially common in children, teenagers and older adults. But anyone who has teeth can get cavities, including infants.
If cavities aren't treated, they get larger and affect deeper layers of your teeth. They can lead to a severe toothache, infection and tooth loss. Regular dental visits and good brushing and flossing habits are your best protection against cavities and tooth decay.
Symptoms
The signs and symptoms of cavities vary, depending on their extent and location. When a cavity is just beginning, you may not have any symptoms at all. As the decay gets larger, it may cause signs and symptoms such as:
- Toothache, spontaneous pain or pain that occurs without any apparent cause
- Tooth sensitivity
- Mild to sharp pain when eating or drinking something sweet, hot or cold
- Visible holes or pits in your teeth
- Brown, black or white staining on any surface of a tooth
- Pain when you bite down
When to see a dentist
You may not be aware that a cavity is forming. That's why it's important to have regular dental checkups and cleanings, even when your mouth feels fine. However, if you experience a toothache or mouth pain, see your dentist as soon as possible.
Causes
Cavities are caused by tooth decay — a process that occurs over time. Here's how tooth decay develops:
- Plaque forms. Dental plaque is a clear sticky film that coats your teeth. It's due to eating a lot of sugars and starches and not cleaning your teeth well. When sugars and starches aren't cleaned off your teeth, bacteria quickly begin feeding on them and form plaque. Plaque that stays on your teeth can harden under or above your gum line into tartar (calculus). Tartar makes plaque more difficult to remove and creates a shield for bacteria.
- Plaque attacks. The acids in plaque remove minerals in your tooth's hard, outer enamel. This erosion causes tiny openings or holes in the enamel — the first stage of cavities. Once areas of enamel are worn away, the bacteria and acid can reach the next layer of your teeth, called dentin. This layer is softer than enamel and less resistant to acid. Dentin has tiny tubes that directly communicate with the nerve of the tooth causing sensitivity.
- Destruction continues. As tooth decay develops, the bacteria and acid continue their march through your teeth, moving next to the inner tooth material (pulp) that contains nerves and blood vessels. The pulp becomes swollen and irritated from the bacteria. Because there is no place for the swelling to expand inside of a tooth, the nerve becomes pressed, causing pain. Discomfort can even extend outside of the tooth root to the bone.
Risk factors
Everyone who has teeth is at risk of getting cavities, but the following factors can increase risk:
- Tooth location. Decay most often occurs in your back teeth (molars and premolars). These teeth have lots of grooves, pits and crannies, and multiple roots that can collect food particles. As a result, they're harder to keep clean than your smoother, easy-to-reach front teeth.
- Certain foods and drinks. Foods that cling to your teeth for a long time — such as milk, ice cream, honey, sugar, soda, dried fruit, cake, cookies, hard candy and mints, dry cereal, and chips — are more likely to cause decay than foods that are easily washed away by saliva.
- Frequent snacking or sipping. When you steadily snack or sip sugary drinks, you give mouth bacteria more fuel to produce acids that attack your teeth and wear them down. And sipping soda or other acidic drinks throughout the day helps create a continual acid bath over your teeth.
- Bedtime infant feeding. When babies are given bedtime bottles filled with milk, formula, juice or other sugar-containing liquids, these beverages remain on their teeth for hours while they sleep, feeding decay-causing bacteria. This damage is often called baby bottle tooth decay. Similar damage can occur when toddlers wander around drinking from a sippy cup filled with these beverages.
- Inadequate brushing. If you don't clean your teeth soon after eating and drinking, plaque forms quickly and the first stages of decay can begin.
- Not getting enough fluoride. Fluoride, a naturally occurring mineral, helps prevent cavities and can even reverse the earliest stages of tooth damage. Because of its benefits for teeth, fluoride is added to many public water supplies. It's also a common ingredient in toothpaste and mouth rinses. But bottled water usually does not contain fluoride.
- Younger or older age. In the United States, cavities are common in very young children and teenagers. Older adults also are at higher risk. Over time, teeth can wear down and gums may recede, making teeth more vulnerable to root decay. Older adults also may use more medications that reduce saliva flow, increasing the risk of tooth decay.
- Dry mouth. Dry mouth is caused by a lack of saliva, which helps prevent tooth decay by washing away food and plaque from your teeth. Substances found in saliva also help counter the acid produced by bacteria. Certain medications, some medical conditions, radiation to your head or neck, or certain chemotherapy drugs can increase your risk of cavities by reducing saliva production.
- Worn fillings or dental devices. Over the years, dental fillings can weaken, begin to break down or develop rough edges. This allows plaque to build up more easily and makes it harder to remove. Dental devices can stop fitting well, allowing decay to begin underneath them.
- Heartburn. Heartburn or gastroesophageal reflux disease (GERD) can cause stomach acid to flow into your mouth (reflux), wearing away the enamel of your teeth and causing significant tooth damage. This exposes more of the dentin to attack by bacteria, creating tooth decay. Your dentist may recommend that you consult your doctor to see if gastric reflux is the cause of your enamel loss.
- Eating disorders. Anorexia and bulimia can lead to significant tooth erosion and cavities. Stomach acid from repeated vomiting (purging) washes over the teeth and begins dissolving the enamel. Eating disorders also can interfere with saliva production.
Complications
Cavities and tooth decay are so common that you may not take them seriously. And you may think that it doesn't matter if children get cavities in their baby teeth. However, cavities and tooth decay can have serious and lasting complications, even for children who don't have their permanent teeth yet.
Complications of cavities may include:
- Pain
- Tooth abscess
- Swelling or pus around a tooth
- Damage or broken teeth
- Chewing problems
- Positioning shifts of teeth after tooth loss
When cavities and decay become severe, you may have:
- Pain that interferes with daily living
- Weight loss or nutrition problems from painful or difficult eating or chewing
- Tooth loss, which may affect your appearance, as well as your confidence and self-esteem
- In rare cases, a tooth abscess — a pocket of pus that's caused by bacterial infection — which can lead to more serious or even life-threatening infections
Prevention
Good oral and dental hygiene can help you avoid cavities and tooth decay. Here are some tips to help prevent cavities. Ask your dentist which tips are best for you.
- Brush with fluoride toothpaste after eating or drinking. Brush your teeth at least twice a day and ideally after every meal, using fluoride-containing toothpaste. To clean between your teeth, floss or use an interdental cleaner.
- Rinse your mouth. If your dentist feels you have a high risk of developing cavities, he or she may recommend that you use a mouth rinse with fluoride.
- Visit your dentist regularly. Get professional teeth cleanings and regular oral exams, which can help prevent problems or spot them early. Your dentist can recommend a schedule that's best for you.
- Consider dental sealants. A sealant is a protective plastic coating applied to the chewing surface of back teeth. It seals off grooves and crannies that tend to collect food, protecting tooth enamel from plaque and acid. The Centers for Disease Control and Prevention (CDC) recommends sealants for all school-age children. Sealants may last for several years before they need to be replaced, but they need to be checked regularly.
- Drink some tap water. Most public water supplies have added fluoride, which can help reduce tooth decay significantly. If you drink only bottled water that doesn't contain fluoride, you'll miss out on fluoride benefits.
- Avoid frequent snacking and sipping. Whenever you eat or drink beverages other than water, you help your mouth bacteria create acids that can destroy tooth enamel. If you snack or drink throughout the day, your teeth are under constant attack.
- Eat tooth-healthy foods. Some foods and beverages are better for your teeth than others. Avoid foods that get stuck in grooves and pits of your teeth for long periods, or brush soon after eating them. However, foods such as fresh fruits and vegetables increase saliva flow, and unsweetened coffee, tea and sugar-free gum help wash away food particles.
- Consider fluoride treatments. Your dentist may recommend periodic fluoride treatments, especially if you aren't getting enough fluoride through fluoridated drinking water and other sources. He or she may also recommend custom trays that fit over your teeth for application of prescription fluoride if your risk of tooth decay is very high.
- Ask about antibacterial treatments. If you're especially vulnerable to tooth decay — for example, because of a medical condition — your dentist may recommend special antibacterial mouth rinses or other treatments to help cut down on harmful bacteria in your mouth.
- Combined treatments. Chewing xylitol-based gum along with prescription fluoride and an antibacterial rinse can help reduce the risk of cavities.
Diagnosis
Your dentist can usually detect tooth decay by:
- Asking about tooth pain and sensitivity
- Examining your mouth and teeth
- Probing your teeth with dental instruments to check for soft areas
- Looking at dental X-rays, which can show the extent of cavities and decay
Your dentist will also be able to tell you which of the three types of cavities you have — smooth surface, pit and fissure, or root.
Treatment
Regular checkups can identify cavities and other dental conditions before they cause troubling symptoms and lead to more-serious problems. The sooner you seek care, the better your chances of reversing the earliest stages of tooth decay and preventing its progression. If a cavity is treated before it starts causing pain, you probably won't need extensive treatment.
Treatment of cavities depends on how severe they are and your particular situation. Treatment options include:
- Fluoride treatments. If your cavity just started, a fluoride treatment may help restore your tooth's enamel and can sometimes reverse a cavity in the very early stages. Professional fluoride treatments contain more fluoride than the amount found in tap water, toothpaste and mouth rinses. Fluoride treatments may be liquid, gel, foam or varnish that's brushed onto your teeth or placed in a small tray that fits over your teeth.
- Fillings. Fillings, also called restorations, are the main treatment option when decay has progressed beyond the earliest stage. Fillings are made of various materials, such as tooth-colored composite resins, porcelain or dental amalgam that is a combination of several materials.
- Crowns. For extensive decay or weakened teeth, you may need a crown — a custom-fitted covering that replaces your tooth's entire natural crown. Your dentist drills away all the decayed area and enough of the rest of your tooth to ensure a good fit. Crowns may be made of gold, high strength porcelain, resin, porcelain fused to metal or other materials.
- Root canals. When decay reaches the inner material of your tooth (pulp), you may need a root canal. This is a treatment to repair and save a badly damaged or infected tooth instead of removing it. The diseased tooth pulp is removed. Medication is sometimes put into the root canal to clear any infection. Then the pulp is replaced with a filling.
- Tooth extractions. Some teeth become so severely decayed that they can't be restored and must be removed. Having a tooth pulled can leave a gap that allows your other teeth to shift. If possible, consider getting a bridge or a dental implant to replace the missing tooth.
Preparing for your appointment
If you're experiencing pain or sensitivity in your teeth, make an appointment with your dentist as soon as possible. Here's some information to help you get ready for your appointment.
What you can do
Before your appointment, make a list of:
- All medications, vitamins, herbal remedies or other supplements you're taking, and dosages
- Any allergies to medications or bad reactions you've had to local anesthetics
- Questions to ask your dentist
Basic questions to ask your dentist may include:
- Do I have a simple cavity, or do I need a crown or a root canal?
- How many visits will it take to treat this tooth?
- When will the pain go away?
- What can I take for the pain?
- How long should I wait before I eat or drink after this procedure?
- Are there other steps I can take to prevent cavities?
- Does my local water supply contain added fluoride?
- Are there any brochures or other printed material that I can have? What websites do you recommend?
Don't hesitate to ask other questions during your appointment.
What to expect from your dentist
Your dentist may ask you some questions. Be ready to answer them to save time to go over topics you want to focus on. Questions may include:
- Do extremes in food temperature or sweet foods cause you pain?
- Does biting down make your pain worse?
- How often do you brush your teeth?
- How often do you floss your teeth?
- Do you use toothpaste that has fluoride?
- Do you eat a lot of sweets or drink sugary beverages or sodas?
- Have you noticed dryness in your mouth?
- What medications do you take?
What you can do in the meantime
While you're waiting for your appointment, you can take some steps to control your tooth pain. For example:
- Take an over-the-counter pain reliever, if your doctor has said it's OK for you.
- Use an over-the-counter anesthetic specifically designed to soothe painful teeth.
- Use warm water to brush your teeth.
- Use toothpaste designed for sensitive teeth.
- Thoroughly clean all parts of your mouth and teeth — don't avoid painful areas.
- Avoid foods or beverages that are hot, cold or sweet enough to trigger pain.
CLEFT LIP AND CLEFT PALATE
Definition:
Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth (palate) or both. Cleft lip and cleft palate result when facial structures that are developing in an unborn baby don't close completely.
Description:
Cleft lip and cleft palate are among the most common birth defects. They most commonly occur as isolated birth defects but are also associated with many inherited genetic conditions or syndromes.
Having a baby born with a cleft can be upsetting, but cleft lip and cleft palate can be corrected. In most babies, a series of surgeries can restore normal function and achieve a more normal appearance with minimal scarring.
Symptoms
Usually, a split (cleft) in the lip or palate is immediately identifiable at birth. Cleft lip and cleft palate may appear as:
- A split in the lip and roof of the mouth (palate) that affects one or both sides of the face
- A split in the lip that appears as only a small notch in the lip or extends from the lip through the upper gum and palate into the bottom of the nose
- A split in the roof of the mouth that doesn't affect the appearance of the face
Less commonly, a cleft occurs only in the muscles of the soft palate (submucous cleft palate), which are at the back of the mouth and covered by the mouth's lining. This type of cleft often goes unnoticed at birth and may not be diagnosed until later when signs develop. Signs and symptoms of submucous cleft palate may include:
- Difficulty with feedings
- Difficulty swallowing, with potential for liquids or foods to come out the nose
- Nasal speaking voice
- Chronic ear infections
When to see a doctor
A cleft lip and cleft palate are usually noticed at birth, and your doctor may start coordinating care at that time. If your baby has signs and symptoms of a submucous cleft palate, make an appointment with your child's doctor.
Causes
Cleft lip and cleft palate occur when tissues in the baby's face and mouth don't fuse properly. Normally, the tissues that make up the lip and palate fuse together in the second and third months of pregnancy. But in babies with cleft lip and cleft palate, the fusion never takes place or occurs only part way, leaving an opening (cleft).
Researchers believe that most cases of cleft lip and cleft palate are caused by an interaction of genetic and environmental factors. In many babies, a definite cause isn't discovered.
The mother or the father can pass on genes that cause clefting, either alone or as part of a genetic syndrome that includes a cleft lip or cleft palate as one of its signs. In some cases, babies inherit a gene that makes them more likely to develop a cleft, and then an environmental trigger actually causes the cleft to occur.
Risk factors
Several factors may increase the likelihood of a baby developing a cleft lip and cleft palate, including:
- Family history. Parents with a family history of cleft lip or cleft palate face a higher risk of having a baby with a cleft.
- Exposure to certain substances during pregnancy. Cleft lip and cleft palate may be more likely to occur in pregnant women who smoke cigarettes, drink alcohol or take certain medications.
- Having diabetes. There is some evidence that women diagnosed with diabetes before pregnancy may have an increased risk of having a baby with a cleft lip with or without a cleft palate.
- Being obese during pregnancy. There is some evidence that babies born to obese women may have increased risk of cleft lip and palate.
Males are more likely to have a cleft lip with or without cleft palate. Cleft palate without cleft lip is more common in females. In the United States, cleft lip and palate are reportedly most common in Native Americans and least common in African-Americans.
Complications
Children with cleft lip with or without cleft palate face a variety of challenges, depending on the type and severity of the cleft.
- Difficulty feeding. One of the most immediate concerns after birth is feeding. While most babies with cleft lip can breast-feed, a cleft palate may make sucking difficult.
- Ear infections and hearing loss. Babies with cleft palate are especially at risk of developing middle ear fluid and hearing loss.
- Dental problems. If the cleft extends through the upper gum, tooth development may be affected.
- Speech difficulties. Because the palate is used in forming sounds, the development of normal speech can be affected by a cleft palate. Speech may sound too nasal.
- Challenges of coping with a medical condition. Children with clefts may face social, emotional and behavioral problems due to differences in appearance and the stress of intensive medical care.
Prevention
After a baby is born with a cleft, parents are understandably concerned about the possibility of having another child with the same condition. While many cases of cleft lip and cleft palate can't be prevented, consider these steps to increase your understanding or lower your risk:
- Consider genetic counseling. If you have a family history of cleft lip and cleft palate, tell your doctor before you become pregnant. Your doctor may refer you to a genetic counselor who can help determine your risk of having children with cleft lip and cleft palate.
- Take prenatal vitamins. If you're planning to get pregnant soon, ask your doctor if you should take prenatal vitamins.
- Don't use tobacco or alcohol. Use of alcohol or tobacco during pregnancy increases the risk of having a baby with a birth defect.
Diagnosis
Most cases of cleft lip and cleft palate are noticed right away at birth and don't require special tests for diagnosis. Increasingly, cleft lip and cleft palate are seen on ultrasound before the baby is born.
Ultrasound before birth
A prenatal ultrasound is a test that uses sound waves to create pictures of the developing fetus. When analyzing the pictures, a doctor may detect a difference in the facial structures.
Cleft lip may be detected with ultrasound beginning around the 13th week of pregnancy. As the fetus continues developing, it may be easier to accurately diagnose a cleft lip. Cleft palate that occurs alone is more difficult to see using ultrasound.
If prenatal ultrasound shows a cleft, your doctor may offer a procedure to take a sample of amniotic fluid from your uterus (amniocentesis). The fluid test may indicate that the fetus has inherited a genetic syndrome that may cause other birth defects. However, most often the cause of cleft lip and cleft palate is unknown.
The goals of treatment for cleft lip and cleft palate are to improve the child's ability to eat, speak and hear normally and to achieve a normal facial appearance.
Care for children with cleft lip and cleft palate often involves a team of doctors and experts, including:
- Surgeons who specialize in cleft repair, such as plastic surgeons or ENTs
- Oral surgeons
- Ear, nose and throat doctors (ENTs, also called otorhinolaryngologists)
- Pediatricians
- Pediatric dentists
- Orthodontists
- Nurses
- Auditory or hearing specialists
- Speech therapists
- Genetic counselors
- Social workers
- Psychologists
TREATMENT
Treatment involves surgery to repair the defect and therapies to improve any related conditions.
Surgery
Surgery to correct cleft lip and palate is based on your child's particular situation. Following the initial cleft repair, your doctor may recommend follow-up surgeries to improve speech or improve the appearance of the lip and nose.
Surgeries typically are performed in this order:
- Cleft lip repair — within the first 3 to 6 months of age
- Cleft palate repair — by the age of 12 months, or earlier if possible
- Follow-up surgeries — between age 2 and late teen years
Cleft lip and palate surgery takes place in a hospital. Your child will receive a general anesthetic, so he or she won't feel pain or be awake during surgery. Several different surgical techniques and procedures are used to repair cleft lip and palate, reconstruct the affected areas, and prevent or treat related complications.
In general, procedures may include:
- Cleft lip repair. To close the separation in the lip, the surgeon makes incisions on both sides of the cleft and creates flaps of tissue. The flaps are then stitched together, including the lip muscles. The repair should create a more normal lip appearance, structure and function. Initial nasal repair, if needed, is usually done at the same time.
- Cleft palate repair. Various procedures may be used to close the separation and rebuild the roof of the mouth (hard and soft palate), depending on your child's situation. The surgeon makes incisions on both sides of the cleft and repositions the tissue and muscles. The repair is then stitched closed.
- Ear tube surgery. For children with cleft palate, ear tubes may be placed to reduce the risk of chronic ear fluid, which can lead to hearing loss. Ear tube surgery involves placing tiny bobbin-shaped tubes in the eardrum to create an opening to prevent fluid buildup.
- Surgery to reconstruct appearance. Additional surgeries may be needed to improve the appearance of the mouth, lip and nose.
Surgery can significantly improve your child's appearance, quality of life, and ability to eat, breathe and talk. Possible risks of surgery include bleeding, infection, poor healing, widening or elevation of scars, and temporary or permanent damage to nerves, blood vessels or other structures.
Treatment for complications
Your doctor may recommend additional treatment for complications caused by cleft lip and cleft palate. Examples include:
- Feeding strategies, such as using a special bottle nipple or feeder
- Speech therapy to correct difficulty with speaking
- Orthodontic adjustments to the teeth and bite, such as having braces
- Monitoring by a pediatric dentist for tooth development and oral health from an early age
- Monitoring and treatment for ear infections, which may include ear tubes
- Hearing aids or other assistive devices for a child with hearing loss
- Therapy with a psychologist to help the child cope with the stress of repeated medical procedures or other concerns
Coping and support
No one expects to have a baby with a birth defect. When the excitement of new life is met with the stress of discovering that your baby has a cleft lip or cleft palate, the experience can be emotionally demanding for the entire family.
For parents and family
When welcoming a baby with cleft lip and cleft palate into your family, keep these coping tips in mind:
- Don't blame yourself. Focus your energy on supporting and helping your child.
- Acknowledge your emotions. It's completely normal to feel sad, overwhelmed and upset.
- Find support. Your hospital social worker can help you find community and financial resources and education.
For your child
You can support your child in many ways:
- Focus on your child as a person, not on the cleft.
- Point out positive qualities in others that don't involve physical appearance.
- Help your child gain confidence by allowing him or her to make decisions.
- Encourage confident body language, such as smiling and holding the head up with shoulders back.
- Keep the lines of communication open. If teasing or self-esteem issues arise at school, this can help your child feel safe in talking with you about it, so you can help address these issues.
Preparing for your appointment
If your child was diagnosed with cleft lip, cleft palate or both, you'll be referred to specialists who can help create a treatment plan for your child. Here's some information to help you get ready and what to expect from your doctor.
What you can do
Before your appointment:
- Find out any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance, such as restrict your baby's diet.
- Make a list of any signs or symptoms your baby is experiencing, including any that may seem unrelated to the reason for the appointment.
- Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Make a list of questions to ask your doctor. List your questions from most important to least important in case time runs out.
Some questions to ask your doctor may include:
- Does my baby have a cleft lip, cleft palate or both?
- What caused my baby's cleft lip or cleft palate?
- What tests does my baby need?
- What is the best treatment plan?
- What are the alternatives to the treatment approach that you're suggesting?
- Are there any restrictions that my baby needs to follow?
- Should my baby see a specialist?
- Are there brochures or other printed material that I can have? What websites do you recommend?
- If I choose to have more children, is there a chance they may also have cleft lip or cleft palate?
Don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- Does your family have a history of cleft lip and cleft palate?
- Does your baby have problems while feeding, such as gagging or having milk come back up through the nose?
- Does your baby experience any symptoms that worry you?
- What, if anything, seems to improve your baby's symptoms?
- What, if anything, appears to worsen your baby's symptoms?
Preparing and anticipating questions will help you make the most of your appointment time and allow you to cover other points you want to address.