Until recently, the standard treatment for tooth decay remained essentially the same for nearly a century: Remove any decayed structure, then prepare and fill the cavity. But that singular protocol has begun to change recently.

Although "drilling and filling" saves teeth, it doesn't fully address the causes of decay. In response, dentists have broadened their approach to the disease—the focus now is on an individual patient's particular set of risk factors for decay and how to reduce those.

At the heart of this new approach is a better understanding of oral bacteria, the true cause of decay. Bacteria produce acid, which can erode tooth enamel and create a gateway into the tooth for decay to advance. We therefore want to lower those risk factors that may lead to bacterial growth and elevated acidity.

One of our major objectives in this newer approach is to reduce plaque, a thin film of food particles used by bacteria for food and habitation. Removing plaque, principally through better oral hygiene, in turn reduces decay-causing bacteria.

Plaque isn't the only mechanism for bacterial growth and acidity. Appliances like dentures or retainers accumulate bacteria if not regularly cleaned. Reduced saliva flow, often due to certain medications or smoking, limits this fluid's ability to buffer acid and acid reflux or acidic beverages like sodas, sports or energy drinks can disrupt the mouth's normal pH and increase the risk for enamel erosion.

Our aim, then, is to develop a long-term strategy based on the patient's individual set of oral disease risk factors. To determine those, we'll need to examine their medical history (including family), current health status and lifestyle habits. From there, we can create a specific plan targeting the identified risk factors for decay.

Some of the elements of such a strategy might include:

• Daily brushing and flossing, along with regular dental cleanings;
• Fluoride dental products or treatments to strengthen enamel;
• Changes in diet and excess snacking, and ceasing from any tobacco use;
• Cleaning and maintaining appliances, as well as monitoring past dental work.

Improving the mouth environment by limiting the presence of oral bacteria and acid can reduce the occurrence of tooth decay and the extent of treatment that might be needed. It's a more nuanced approach that can improve dental health.

If you would like more information on tooth decay prevention and treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Decay: How to Assess Your Risk.”

Although there are several potential problems people could encounter involving their teeth, gums or mouth, most fall into three basic categories. That's the finding of a recent survey conducted by the American Dental Association of more than 15,000 U.S. adults.

These categories are a triad of symptoms, each of which could arise from a variety of causes. If you're encountering any one of these, you should see your dentist as soon as possible.

Tooth pain. A toothache—or any form of pain from the mouth—could be sign of a number of possible issues. It could mean you have a decayed tooth, especially if the pain is sharp and localized. It could also indicate a gum abscess (accompanied by red and puffy gums), a sinus or ear infection, or inflammation of the jaw joints. The intensity, duration and location of the pain are all clues to its actual cause and what treatments it might require.

Biting difficulties. Does it hurt when you bite down? Among other things, you could have a loose tooth or one that's deeply decayed. The former could be the sign of advanced gum disease, which itself must be treated and the tooth stabilized (splinted) to other teeth. If the problem is advanced decay, you may need a root canal to remove diseased tissue from within the interior of the tooth, which is then filled and crowned to prevent re-infection.

Dry mouth. We're not talking about that "cotton mouth" feeling we all get now and then. This is a chronic condition known as xerostomia in which the mouth feels dry all the time. Xerostomia has several causes including smoking or treatments for cancer or other serious diseases. It might also be a medication you're taking, which has reduced your mouth's saliva production. Because dry mouth could lead to dental disease, you should take steps to relieve it.

Even if you're not having symptoms like these, there may still be something going on in your mouth that needs attention. That's why you should see your dentist on a regular basis, besides when you notice a problem, to keep your oral health in tip-top shape.

If you would like more information on potential teeth and gum problems, please contact us or schedule an appointment for a consultation.

The few teeth your one or two year old has will eventually fall out in a few years—so, why be concerned about tooth decay this early? Actually, you should: Fighting tooth decay should always be a priority, even at this early age.

Even though primary teeth are short-lived, they make a huge impact on future dental health. These early teeth help guide the eruption of permanent teeth—if lost prematurely to decay, the later teeth may come in misaligned and create a poor bite. Preserving them could help you avoid later orthodontic treatment.

Fortunately, you can help prevent decay in your child's primary teeth. Here's how.

Practice oral hygiene even before teeth. You should begin daily oral hygiene, the principal defense against tooth decay, even before their first teeth emerge. You can reduce harmful bacteria in their mouths by wiping their gums with a clean cloth after nursing. When teeth appear, begin brushing with just a smear of toothpaste.

Limit sugar consumption. Because decay-causing bacteria thrive on sugar, reduce your child's intake in snacks and beverages. For example, don't put them down for bed with a bottle filled with a sugary liquid like juice, sweetened drinks or even formula or breast milk. If you do give them a night-time bottle, fill it only with water.

Avoid bacterial transfer. Your child's immature immune system can't handle the same level of bacteria as in your mouth. So, reduce the chances of bacterial transfer that may cause tooth decay by avoiding kissing on the mouth or sharing eating or drinking utensils with your infant.

Begin dental visits early. Even though they may have few teeth by their first birthday, it's still a good time to begin your child's regular dental visits. Your dentist may be able to diagnose decay early (and treat for maximum effectiveness), as well as provide sealants, topical fluoride and other measures for preventing decay.

Tooth decay at an early age could impact your child's future dental health. Taking steps now to reduce it could help ensure they have healthy teeth and gums later in life.

If you would like more information on dental care for children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Do Babies Get Tooth Decay?”

So, when should you begin taking measures to prevent tooth decay in your child's teeth? When their teeth first begin to show? When all of their primary (baby) teeth are in? Or, wait until their permanent teeth begin erupting?

Actually, tooth decay can be a problem as early as two months of age, before a child's first tooth even comes in. In essence, then, dental disease prevention should be on your radar soon after your child is born. Here's what you can do to prevent the damage of tooth decay to their teeth now and its impact on their dental health in the future.

Start oral hygiene during nursing. Brushing and flossing are lifetime habits that reduce the risk of dental disease. When your children are young, you'll have to perform these tasks for them, ultimately training them to perform them on their own. But even earlier, before their first tooth, you'll want to clean their gums after feedings with a wet cloth to reduce disease-causing bacteria.

Initiate dental visits by age 1. It's appropriate on or before their first birthday, when most children already have a few primary teeth, to begin regular dental visits for cleanings and checkups. Seeing the dentist every six months at an early age will help your child stay well ahead of tooth decay. And starting visits early increases the likelihood it will become a regular part of their lives into adulthood.

Protect against decay. You and your dentist are partners in protecting your child from dental disease. Besides daily oral hygiene, you can also help by providing a dental-friendly diet, and especially restricting sugary snacks and avoiding sweetened liquids in bedtime bottles (including breast milk or formula). In addition to routine care, your dentist can also provide other measures to fight decay, like sealants or topical fluoride.

It's also important for you to set an example for your child to follow. Children soak up what's important to their parents—in this case, watching you take care of your teeth and seeing the dentist as a friend and ally against dental disease. That's your end goal: preventing dental disease now, and instilling the value of dental care that will last your child a lifetime.

If you would like more information on helping your child avoid tooth decay, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Taking the Stress Out of Dentistry for Kids.”

Tooth decay can be a big problem for children's primary (baby) teeth. It doesn't take long for a tooth to become infected and the infection spread to their neighbors.

But since it will eventually give way to a permanent tooth, why not just pull a diseased primary tooth? Although that sounds sensible, there are important reasons for helping a troubled primary tooth survive to its natural end.

Current usefulness. They may not be around for long, but primary teeth serve children well while they have them. They enable a child to eat solid foods to further their physical development. They also figure prominently in speech development, which could be stunted by lost teeth.

The smile factor. Young children are also honing their social skills, and smiling is an important part of learning to fit in with family and friends. A tooth that's missing for some time, especially in the “smile zone,” could affect their smile and have an adverse effect on their social development.

Future teeth health. A primary tooth reserves the space intended for the future permanent tooth, helping to ensure the incoming tooth erupts in the right position. If it's not there, however, other teeth can drift into the space, crowding the incoming tooth out of its proper alignment.

That last reason could have the most long-term effect, causing the development of a poor bite that could require extensive orthodontic treatment. To avoid this and any other physical or social consequences accompanying its premature loss, it's worth the effort to try to protect and save a primary tooth.

Preventively, we can apply sealants on biting surfaces more prone to plaque buildup (the main cause of decay) and topical fluoride to strengthen enamel. When decay does occur, we may be able to remove it and fill the tooth, cap a tooth with a steel crown, or even use a modified root canal procedure in the case of advanced tooth decay.

The best way, however, to protect your child's primary teeth is to brush and floss them every day. Removing harmful plaque vastly reduces the risk of tooth decay. Coupled with professional dental care, your child can avoid tooth decay and get the most out of their primary teeth.

If you would like more information on children's dental care, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Importance of Baby Teeth.”