What is tooth decay?Tooth decay is caused by bacteria which converts sugar from food into acid, and occurs underneath plaque on tooth surfaces. It tends to take place in the grooves on the biting surface and between teeth where brushing is less effective and plaque accumulates. The first signs of tooth decay, which are usually visible, are known

as “white spots”. These appear white as enamel becomes porous due to its dissolu-tion underneath plaque, and can be detected by a dentist through a thorough examination of your teeth. In the last decade, our understanding of how tooth decay occurs has changed. We now know that it is a continuous process occurring in cycles throughout the day. The process usually takes months or years to result in a cavity (hole) that needs to be filled. When acid is produced in plaque, the tooth slowly dissolves. Fortunately, when acid is not present, the tooth hardens with minerals which naturally occur in the mouth. Hence, the tooth is in a continuous cycle of being dissolved and then hardened again.The possibility of white spots worsening and becoming cavities depends on the balance

between how much the tooth is dissolved (demineralization) and hardened (remineralization). To prevent cavities, you and your dentist have to shift the balance between demineralization and remineralisation of enamel, enabling less dissolution and more hardening of the tooth structure.

Issue 2.1July 2011

The first signsof tooth decayWhat you and your dentist can do about it.

Prof. Roger Ellwood BDS, MDS, MSc, PhD, FFPH

Director of Clinical Research –Colgate- Palmolive, Europe

How can we stop white spots becoming cavities?This can be achieved by reducing the amount of plaque by using a fluoridated toothpaste, and cleaning thoroughly with a toothbrush, and dental floss or inter-dental brush. You can also reduce the amount and frequency of sugar consumption during the day, so that less acid will be produced and teeth be hardened more easily. Fluoride has been proven to help reduce dental caries by shifting the balance between demineral-ization and remineralization. It can harden enamel, increasing its resistance to the dissolution process, and reversing the early stage of caries. When tooth decay occurs, fluoride chemically alters the enamel dissolution process to enable more hardening of the tooth. Fluoride has been incorporated into

toothpaste and mouthwash, and also the products used in dental practice such as varnish and gels. During your dental visit, your dentist may apply fluoride treatment to help harden the tooth structure, and provide oral hygiene instructions to show where and how you can brush more effectively. After your dental examination, ask your dentist if you have any of the first signs of tooth decay so as to ensure the best chance of

stopping them from becoming cavities. Besides, you can concentrate brushing the areas where the white spots occur in order to remove plaque. You may also change your diet to reduce the quantity and

frequency of sugar intakes. Fluoride in tooth-paste and mouthwash can help tackle the first signs of tooth decay. Your dentist may also recommend the use of an additional fluoride product such as a mouthwash. If you have any white spots, remember to ask your dentist what else you can do to stop them from becoming cavities and leading to unnecessary fillings.

Figure 2: More extensive

“White Spot” decay

Figure 1: First signs of tooth

decay “White Spot”