San Francisco Dental Care - Tooth Decay: The Modern Model

Tooth decay is a bacterial infection of a tooth that causes a cavity. Before the widespread acceptance of oral hygiene and professional maintenance, the concept of how a cavity was formed was considered a “top-down” infection. In this traditional model, tooth decay started on the tooth’s surface within the pits and grooves where bacterial dental plaque became easily trapped. When exposed to sugars, the bacterial plaque produces acid that decalcifies and softens the tooth’s enamel surface, thereby causing a cavity.

Today’s modern model is based on a “bottom-up” progression. With the public’s acceptance of frequent regular tooth brushing, flossing, professional dental hygiene visits, and the use of fluorides for remineralizing teeth, the outer enamel surface of a tooth has become more resistant to tooth decay. Nonetheless, some pits and grooves extend so deeply down microscopic channels that it is impossible for a toothbrush bristle or fluoride to penetrate into these areas (see Figure 1). Tooth decay can then start below the surface of a tooth. By the time the decay becomes detectable at the tooth’s surface, it has already become a large cavity (see Figure 2). That is why most fillings end up being larger than the “tiny cavity” seen during a dental examination.

The practice of Minimally Invasive Dentistry is a preventive and optimally health oriented approach that is based on the early diagnosis and treatment of a cavity before it destroys and weakens a tooth so much that it needs a larger filling, onlay, or crown, or even a root canal if the nerve of the tooth becomes infected too. Our use of the DIAGNOdent® laser allows us to accurately diagnosis these sub-surface cavities. Some studies also show that ozone can arrest the progression of tooth decay so that the overly aggressive drilling out of unaffected tooth structure to ensure removal of all of the tooth decay can be minimized. Ozone, an activated form of oxygen, is a potent antimicrobial. Call us to find out more about these alternative options.