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6 Warning Signs of Tooth Decay

Recognizing these can help prevent simple dental problems from becoming worse

spinner image Decayed Tooth Pain On X-Ray
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The COVID-19 pandemic has taken a toll on oral health. Due to the fear of getting sick, people have either avoided going to the dentist or have been unable to go because of dental office shutdowns. The consequences are being seen now.

In 2021, the American Dental Association (ADA) Health Policy Institute surveyed a group of dentists. More than 30 percent said their patients had more tooth decay — cavities and gum disease — than before the pandemic. Among those surveyed, more than 70 percent had seen significant increases in patient stress-related conditions, including teeth grinding and clenching. These dentists also reported seeing an increase in chipped and cracked teeth and temporomandibular joint disorder (TMD) symptoms like headaches and jaw pain.

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Tooth decay is damage to the tooth’s surface, which is called enamel. It occurs when bacteria in your mouth make acids that attack your tooth enamel. When these bacteria combine with food, they form a soft, sticky film called plaque. The bacteria in plaque use the sugars and starches in what you eat and drink to make acids. Those acids can eat away at the minerals on your tooth enamel. Over time, plaque that isn’t removed can harden into tartar. Plaque and tartar can not only erode your teeth but also irritate your gums and cause gum disease.

“The American Dental Association recommends two visits a year to prevent decay,” says Leena Palomo, professor and chair of periodontology and implant dentistry at New York University College of Dentistry. Keeping teeth healthy requires daily care, including regular brushing and flossing, and can help you keep an eye on your teeth for any developing problems. The earlier problems are detected, the more likely your dentist can successfully treat them. Once you’ve begun to see or feel problems like tooth sensitivity and bleeding gums, decay may have already occurred, Palomo adds.

Here are some warning signs of dental decay.

1. Sensitivity to hot, cold and sweet drinks or food

Healthy teeth, according to the ADA, contain a layer of enamel that protects tooth crowns or the parts above your gumline. Under the gumline, a layer called cementum protects the roots of the teeth. Dentin, which is less dense than enamel or cementum, is the layer under the tooth enamel and is composed of microscopic, small, hollow tubes or canals. When dentin, which is protected by the enamel and cementum, is exposed, sensitivity to cold, hot, sweet and sticky food and drink can reach the nerves and cells inside the teeth, resulting in hypersensitivity. “If you don’t see a dentist when you start to feel the sensitivity, you’ll get to the point that you won’t even want to eat some of your favorite foods,” Palomo says.

2. Spots on your gums and teeth

White spots in between your teeth or close to your gums that may look a little brown or yellow are a chalky substance that’s usually an early sign of plaque that’s hardened into a material known as calculus. When this happens, says Erinne Kennedy, director of predoctoral education at Kansas City University College of Dental Medicine, only a dentist or dental hygienist can clean it from the surface of your teeth and from underneath your gums. “White lesions on your teeth may not cause any symptoms such as sensitivity, but they can be an early sign of tooth decay that you should pay attention to,” she says.

To prevent this kind of buildup, speak with your dental team about how to effectively brush, floss and perhaps rinse.

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3. Visible holes or cavities

Small holes on the hard surfaces of your teeth are signs of cavities. Cavities result in destruction of the tooth enamel, the hard outer layer of your teeth and the hardest substance in the human body. If left untreated, a cavity can lead to tooth infection or an abscess, says Kennedy, and can destroy your tooth structure. “Unless you see a dentist once the cavity process starts, that destruction will continue,” she says.

Adults who have dental fillings from their childhood may develop cavities around the edges of old fillings. Older adults, whose gums may be receding, may also develop cavities in exposed roots.

4. Bleeding and sore gums

Bleeding gums or even a little bit of pink on your toothbrush when you’re brushing or using floss to clean your teeth can be a warning sign of more serious problems. If your gums bleed easily, that could indicate gingivitis or periodontal (gum) disease. Gingivitis is the result of inflammation in the gum tissue usually caused by bacteria or plaque buildup and can be resolved by increasing your oral hygiene.

Periodontal disease symptoms usually don’t appear until the condition is advanced. If your gums are chronically inflamed and you have bone loss, your gum tissue may start to pull away from your teeth and create gaps between them. If the condition becomes advanced, it can cause teeth to shift, wobble or become painful.

When your gums are red, swollen and bleeding, it’s a sign of inflammation, and as inflammation of the gums progresses, you can develop chronic gum disease. If you notice these symptoms, the sooner you get to a dentist the better, Kennedy says. “If you don’t address these symptoms, gum disease can advance to a point where your teeth may not be able to be saved.”

5. Bad breath or bad taste in mouth

Constant bad breath or bad taste in your mouth could be a warning sign of advanced gum disease caused by the buildup of plaque on your teeth. The bacteria in your mouth cause toxins to form that irritate your gums. “When your gums are diseased, your teeth are in jeopardy,” Palomo says.

6. Pain or swelling in the mouth, neck or jaw

Throbbing pain, swelling in your teeth or gums, and shiny red swollen gums are often symptoms of a bacterial infection or tooth abscess that can spread to your ear, jaw and neck. A dental abscess is a collection of pus that forms inside your teeth and the bones that hold your teeth in place. If you have symptoms of a dental abscess, you’ll want to see a dentist. “Abscesses that are unresolved can cause substantial pain and can even become life-threatening,” Kennedy says.

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