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causing inflammation. Your body’s immune system responds by sending white blood cells to the pulp to fight the bacteria. The blood vessels around the tooth dilate (widen) to accommodate the extra blood and white cells. The widened vessels press on the nerves entering the tooth, causing a toothache. The acid may also reach the nerves, causing more pain, especially if the decay reaches nerve endings in the dentin. If a large number of bacteria invade the pulp chambers, the nerve of the tooth usually dies, because the white blood cells cannot overcome the infection. Once the nerve dies, the pain stops, but a pocket of pus may begin to form in the tissue around the tip of the root of a tooth (tooth abscess; see page 1104).

Cavities

If the enamel of a tooth has been eroded, bacteria in the mouth can destroy the dentin. If the decay is not treated, the bacteria can reach the pulp chamber, causing pain and inflammation.

For most people, tooth decay has no serious health risks if it is detected and treated early. However, some people, such as those who have heart disease, are at serious risk if bacteria from an infected tooth enter the bloodstream and travel to the heart. Because an infection can damage the heart valves and can lead to congestive heart failure (see page 570), people who are at risk need to take prescription antibiotics to eliminate the infection before having a tooth removed. People who have a blood clotting disorder such as hemophilia (see page 618) or who are taking anticlotting medication should consult their doctor before having a tooth removed because it might be difficult to stop the bleeding after the procedure. To prevent bleeding, the doctor may take precautions such as temporarily lowering the dosage of a person’s anticlotting medication or prescribing a clotting factor (a protein in blood that is essential for blood clotting) to a person who has a clotting disorder. If bleeding occurs, a dentist can stop it by stitching the socket closed or by applying pressure to the socket with sterile gauze pads.

Symptoms

The early stages of tooth decay usually do not cause symptoms. In the later stages, the main symptom may be a mild toothache that occurs when you eat something sweet, sour, hot, or cold. As the cavity continues to grow, you may experience more intense pain and an unpleasant taste in your mouth that is produced by food and bacteria that are packed into the cavity.

In the final stage of decay, the pulp of the tooth becomes inflamed. If this occurs, you may have persistent pain after eating sweet, sour, hot, or cold food. You may also experience sharp, stabbing pains, sometimes in the jaw above or below the decayed tooth. It may be hard to tell which tooth is causing the pain.

If you have a persistent unpleasant taste in your mouth, if you have a toothache, or if your teeth seem unusually sensitive to the foods you eat, see your dentist. Early detection and treatment of tooth decay can help you avoid more extensive treatment and can help prevent more serious problems such as an infected root canal or tooth loss.

Diagnosis

During a dental checkup (see page 1103) your dentist will examine your teeth for early signs of tooth decay; evaluate the condition of existing restorations, such as fillings, crowns, or bridges; and inspect your gums and mouth for signs of infection or other problems. He or she may also take X-rays to check for hidden signs of decay, such as cavities between the teeth or bone loss below the gum line.

Treatment

If a cavity is detected early, your dentist will clean and fill it to prevent further decay. If the decay is advanced, your dentist may recommend that you see an endodontist (a dentist who specializes in root canal treatment) for a root canal (see page 1104). In rare cases, a dentist will remove a tooth that is very badly decayed. Prevention is the best course for tooth decay.

Preventing Tooth Decay

You can keep tooth decay to a minimum by keeping your teeth and gums healthy (see next page). In addition to daily brushing and flossing and regular dental checkups