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Dental disease is potentially life threatening as a defect in a tooth from a dental cavity or from periodontal disease or from neglected decay (caries) can lead to tooth infections that worm their way into the blood stream, can lead to dental abscesses and to sepsis. In people with heart valve problems this can cause bacterial endocarditis, which has the potential to become a life threatening infectious condition. When people are in their thirties or forties, it is not uncommon to develop the first root canal problem. When a cavity gets deep enough to affect the blood supply of the nerve that supplies the tooth with sensory fibers, the nerve dies off and the person may not feel that there is anything wrong with the tooth unless it is checked out by a dentist. Eventually the deeper nerve fibers or the neighboring nerves of the adjacent teeth get irritated and the patient feels a deep gnawing pain. This is when the patient is usually seen by the dentist and a root canal followed by a crown is often required. Before a number of common dental conditions are described in more detail, here is a brief description of the anatomy of a tooth. A tooth has a crown and a root. The crown is coated with a very hard enamel layer and is what we see when a person smiles. The root is buried in the mandibular or maxillary bone, which gives the tooth a very solid footing. The pulp chamber is surrounded by a hard, but porous dentin layer, which is coated with enamel on top and with the bone-like cementum over the root. Gingiva is part of the supportive tissue of the teeth and together with the periodontal ligaments and connective tissue attaches the teeth firmly within the alveolar bone where the teeth are anchored. The pulp contains the nerve endings and blood and lymphatic vessels that enter the pulp cavity through the root canal. The other important ingredient in the oral cavity is the constant secretion from the salivary glands that bathe the teeth in saliva and keep the bacterial flora diluted. The tongue with its very sensitive nerve endings helps to spot remaining food particles on top and between the teeth, which helps to clean and protect the teeth from decay.



Tooth Decay

Tooth decay occurs mostly on top of the enamel coating, which can occur in the crown of any tooth. In elderly persons where there is less saliva for protection and the root is more exposed because of gingiva retraction, severe tooth decay at the root level can cause the loss of several teeth. As early tooth decay, called caries, is painless in the first few months, the only rational approach is to have regular check-ups with the dentist every 6 months. The dentist will use a sharp instrument to probe for soft spots in the enamel. These usually start around micro fissures in the tooth that can extend down to the dentin level. Other tests such as X-rays will also show the extent of the tooth decay. When dental cleaning has not been done every 6 months, a thin coat of plaque from old decayed food and bacteria is on top of the enamel. The bacteria produce acids that burn holes into the enamel. Mutans streptococci with varies subspecies specialize in growing in plaque. Cola drinks with phosphoric acid, sugar and other sweets that feed the mutans bacteria all contribute to the tooth decay process.

Signs and symptoms

Sometimes there is a discoloration of the enamel, but as long as the tooth decay involves only the enamel layer, there is no pain. Pain starts when the cavity invades the dentin level of the tooth. Sensitivity with cold and hot foods and beverages indicates that there is a defect in the enamel that reaches down to the dentin level. This is a late sign telling the patient to quickly see a dentist. If this does not happen, chewing becomes painful as well and the patient may awake in the middle of the night with a tooth ache. As the dentin is porous, bacteria find it easy to invade into the pulp cavity leading to a pulpitis and root canal infection.


The dentist needs to assess the depth of the tooth decay and remove anything that is decayed. This is done by drilling. More severe cavities need to be X-rayed to determine the depth of the decay. If the pulp has been affected, a root canal treatment with a crown is the treatment of choice. If the decay involves only the superficial enamel, a filling will preserve the tooth with its root intact. There has been a heated debated about the use of silver amalgam, which contains silver, mercury, tin, copper, zinc and other traces. Over the years this has been providing fillings that lasted on average of 14 to 15 years. Newer materials have been developed and are now very popular because of the fear of systemic mercury blood poisoning. For those of you who may be skeptical about the effects of mercury from fillings, here is a You tube link to convince you otherwise. Mercury poisoning has been first detected in children with autism, but lately more and more evidence has accumulated regarding Parkinson’s disease and Alzheimer’s disease as neurological disorders that can be directly linked to mercury fillings (the more fillings, the more severe the disease).

Composite resins that have a more pleasing appearance and have been used in the past for repairs of the visible front teeth, are now used more and more for molar teeth, even though they last only half as long as the traditional silver/mercury amalgam fillings. Newer porcelain or ceramic inlays are now being used as well, but it is not known yet how long these will last. The “gold standard” is the use of gold inlays and gold crowns as they last 30 to 40 years. However, this needs to be combined with an aggressive prevention program consisting of dental cleaning and fluoride treatment every 6 months and daily brushing with a soft tooth brush after every meal and flossing once every 24 hours. Flossing prevents gingivitis and periodontal disease. It takes only 24 hours for soft tartar to form (=plaque) and within a few days this gets calcified and becomes hard plaque that will not be removed with regular brushing. Personally, I would recommend that you ask your dentist to replace all silver amalgam fillings (they contain mercury) with these latter materials.


1. Suzanne Somers: “Breakthrough” Eight Steps to Wellness – Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008



Last modified: October 22, 2014

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.