Nkiru Odinkemelu
Tooth decay. Cavity. Dental caries. Hole in the tooth. All these mean the same thing. It is that brownish, greenish or blackish hard stains found in between some people’s gum and tooth.
It a general term for tooth destruction as a result of acid attack on hard tooth tissue occasioned by bacteria in the mouth. The formation of tooth decay does not take place within a day of bad oral hygiene. It is an accumulation of months or even years of negligence of oral health, except when it is caused by medication.
People who have higher risk for tooth decay include: lower-income families, senior citizens of all socio-economic status, people living in areas where the drinking water in not fluoridated, people with diseases and/or medication use that causes a decrease in salivary flow, people undergoing radiation therapy, people with diabetes, tobacco users, alcohol and drug users and people who consume large amounts of carbonated and sugar drinks.
Although tooth day can occur at any age, it is more prevalent in children and young as well as older adults. It is a common cause of tooth loss in young people.
Statistics in Nigeria show a prevalence of 30 per cent. According to a survey on Appraisal of the National Response to the Caries Epidemic in Children in Nigeria by Morenike Folayan, Nneka Chukwumah, Nneka Onyejaka, Abiola Adeniyi and Olubukola Olatosi, the prevalence of dental caries varies with the study location in Nigeria, ranging between 13.9 per cent to 17.4 per cent in the semi-urban settlement of Ile-Ife, to between 11.2 per cent and 48.0 per cent in urban areas such as Benin, Enugu, Lagos and Ibadan. The prevalence of caries is higher in urban than in rural areas, higher in northern than in southern Nigeria and higher in primary than in permanent dentition. This prevalence is of epidemic proportion because it is higher than the five per cent epidemic threshold.
Unfortunately, a trend analysis of the prevalence of caries over time has not been possible because studies were conducted in different age groups, using different methods, and in diverse populations. The only national data on the prevalence of dental caries in children in Nigeria was conducted in 1995, and showed prevalence as high as 30 per cent and 43 per cent in children aged 12 years and 15 years respectively, the survey further stated.
The evolving evidence points to the need for proactive action to address the dental caries epidemic among children in Nigeria, especially for caries affecting the primary dentition. A previous study conducted in Lagos showed that despite intervention, the prevalence of caries in primary dentition increased from 17.9 per cent to 20.4 per cent over a three-year period, though there was a 34.8 per cent decline in the prevalence of caries in permanent dentition over the same period.
Worse still is that out of these, over 95.6 per cent of early childhood caries is untreated, while on the global average, the prevalence is 35 per cent. Nigeria is doing much worse than the global average of untreated caries.
Causes
According to Dr. Ola Ijarogbe, Consultant Restorative Dentistry, College of Medicine, University of Lagos, dental caries occur when one takes a lot of sweet things known as refined sugar. When this happens, bacteria in the mouth which are normal inhabitants in the mouth, just as you have in other parts of the body, becomes harmful with presence of sugar. They feed on the sugar and by-product of that process is dilute acid, which results in dissolution of the hard tooth tissue known as demineralisation (the loss of calcium, iron from the tooth structure) and you have cavity formation.
“From our basic elementary biology, calcium helps strengthen bones and hard tissues in the body, but in the presence of dilute acid as a result of bacteria in the mouth feeding on refined sugar, that dilute acid is formed and that result to dissolution of the hard tooth tissue resulting in cavitations. That is what is referred to as tooth decay,” he said.
This means that the bacteria in the mouth combines with saliva and the sugar in the food that one eats to form plaque. Plaque is that clear sticky film that you can find coating your teeth in the mornings, especially when you did not brush the previous night. If not cleaned in days, the plaque becomes harder and forms tartar. Tartar is not just hard; it also forms a shield for the bacteria.
The acid in the plaque continues to eat up the teeth if nothing is done about it, starting from the enamel to the dentin, then to the pulp and finally, to the root of the tooth.
Symptoms
An individual may begin to suspect he has tooth decay at the inception of some symptoms, like: brownish, black or green spot appearing on the teeth, tooth ache, tooth sensitivity or even unpleasant taste in the mouth.
Experts have, however, warned that the above are not good for the oral health. It is expected of every person to visit a dentist twice in a year for proper check up, but in developing countries like Nigeria, reverse is the case. Statistics have it that 95 per cent of people with dental caries usually present late, which is why tooth loss is common in this part of the word.
While Dr. Ijarogbe emphasised that as soon as the teeth start erupting in the mouth, parents should present their children for examination and consultation, most people never do that until there is a problem, even at that, they present late.
Enlightening more on the symptoms of dental caries, Dr. Ijarogbe, said: “There are different layers of the tooth: the enamel, dentin and the pulp. The acid attack usually occurs on the crown and when it starts; the outer layer is what is first lost which is the enamel.
“When the enamel is lost, the destruction gets to the dentin, which contains fibres then you start having some shocking sensation when you take hot or cold drink. If it progresses, eventually, it gets into the pulp, which is the innermost layer where the blood vessels and what is called emphatic, which is loss of life to the tooth. The tooth is a living tissue and it is inside the pulp that you have blood supplying vessels, arteries and veins; so when it gets to the pulp, it is now irreversible pulpa, which is exclamation of the pulp.
“At this stage, the patient will not be able to sleep at night. If he lies down, the pain becomes troubling and it may appear like there is pus in the gum; if the person takes hot or cold drink, it lasts for a very long time before the pain subsides and before long, it progresses to the root and you start having abscess formation. The patient will have swollen jaw and if it is not well taken care of, it will get to a point where the infection spreads to the neck region and may eventually compress the breathing tube in some instances; some patients have died in the process.”
Prevention
For experts, prevention of dental caries by simply going for check-ups twice a year, avoiding refined sugar foods, and brushing with fluoridated tooth paste twice daily would have been the best bet.
Dr. Ijarogbe: “Prevention is what we always preach to people. To prevent dental caries or tooth decay or cavities, you have to avoid refined food products contained in carbonated drinks, soft drinks, cakes, sweetened chewing gum, biscuits, candy, chocolates which are the worst of all because they stick onto the teeth and allow good enough time for the bacteria to act on the surface of the tooth and cause tooth decay, you would be doing yourself more good.
“We also preach that if you can’t avoid taking them, then take them with your meals which is in between meals because if you take them at this point, the action of chewing and saliva helps to do some cleaning action to remove some of the things in the mouth; so dietary control is very key when you talk about prevention of dental caries.
“But because we know it may be difficult to avoid this in entirety, we talk about brushing twice daily, that is after the morning meal and last thing before you go to bed at night, with fluoridated toothpaste. So that way, you are able to spin out some of the debris that is left in the mouth after taking some of these things.’
Treatment
In a situation where tooth decay has already occurred, treatment will depend on the stage at which the patient is presenting in the clinic.
According to an expert, “if it is an early stage, there are some things we will advocate such that it doesn’t progress further. This is if it is still at the reversible stage within the enamel and dentil, but if it has gotten to a stage at which the patient cannot sleep at night, this also depends on the stage of that destruction too.
“There are treatment that we call root canal treatment. If it is at the reversible stage, you can still do some basic fillings, to block the cavity and prevent it from spreading further, but if it has gotten to the irreversible stage, that is if it is already in the pulp, then you have to do root canal treatment. If it is so bad that the tooth has been completely destroyed, we will have no choice but to extract the tooth and replace it with artificial tooth.”