Tooth Decay (Cavities) Learn more

Dental caries, also known as tooth decay or a cavity, is an infection, bacterial in origin, that causes demineralization and destruction of the hard tissues of the teeth (enamel, dentin and cementum). It is a result of the production of acid by bacterial fermentation of food debris accumulated on the tooth surface. If demineralization exceeds saliva and other remineralization factors such as from calcium and fluoridated toothpastes, these once hard tissues progressively break down, producing dental caries (cavities or carious lesions, that is, holes in the teeth). Today, caries remains one of the most common diseases throughout the world. Cariology is the study of dental caries.

Depending on the extent of tooth destruction, various treatments can be used to restore teeth to proper form, function, and aesthetics, but there is no known method to regenerate large amounts of tooth structure. So at MSR Dental Surgery we always advocate preventive and prophylactic measures, such as regular oral hygiene and dietary modifications, to avoid dental caries.

A person experiencing caries may not be aware of it .The earliest sign of a new tooth decay is the appearance of a chalky white spot on the surface of the tooth, indicating an area of demineralization of enamel. This is referred to as a white spot lesion, an incipient carious lesion or a "microcavity". As the lesion continues to demineralize, it can turn brown but will eventually turn into a cavitation ("cavity"). Before the cavity forms, the process is reversible, but once a cavity forms, the lost tooth structure cannot be regenerated. A lesion that appears dark brown and shiny suggests dental caries were once present but the demineralization process has stopped, leaving a stain. Active decay is lighter in color and dull in appearance.

As the enamel and dentin are destroyed, the cavity becomes more noticeable. The affected areas of the tooth change color and become soft to the touch. Once the decay passes through enamel, the dentinal tubules, which have passages to the nerve of the tooth, become exposed, resulting in pain that can be transient, temporarily worsening with exposure to heat, cold, or sweet foods and drinks.

A tooth weakened by extensive internal decay can sometimes suddenly fracture under normal chewing forces. When the decay has progressed enough to allow the bacteria to overwhelm the pulp tissue in the centre of the tooth a toothache can result and the pain will become more constant. Death of the pulp tissue and infection are common consequences. The tooth will no longer be sensitive to hot or cold, but can be very tender to pressure. Dental caries can also cause bad breath and foul tastes.

In highly progressed cases, infection can spread from the tooth to the surrounding soft tissues. Complications such as cavernous sinus thrombosis and Ludwig angina can be life-threatening. Destroyed tooth structure does not fully regenerate, although remineralization of very small carious lesions may occur if dental hygiene is kept at optimal level.[1] For the small lesions, topical fluoride is sometimes used to encourage remineralization. For larger lesions, the progression of dental caries can be stopped by treatment. The goal of treatment is to preserve tooth structures and prevent further destruction of the tooth. Aggressive treatment, by filling, of incipient carious lesions, places where there is superficial damage to the enamel, is controversial as they may heal themselves, while once a filling is performed it will eventually have to be redone and the site serves as a vulnerable site for further decay.

In general, early treatment is less painful and less expensive than treatment of extensive decay. Local anaesthetic may be required in some cases to relieve pain during or following treatment or to relieve anxiety during treatment. A dental ” hand piece” is used to remove large portions of decayed material from the tooth. A spoon shaped caries excavator , a dental instrument used to carefully remove decay, is sometimes employed when the decay in dentin reaches near the pulp. Once the decay is removed, the missing tooth structure requires a dental restoration of some sort to return the tooth to function and aesthetic condition.

Restorative materials include dental amalgam, composite resin, porcelain, and gold. Composite resin and porcelain can be made to match the colour of a patient's natural teeth and are thus used more frequently when aesthetics are a concern. Composite restorations are not as strong as dental amalgam and gold. When the decay is too extensive, there may not be enough tooth structure remaining to allow a restorative material to be placed within the tooth. Thus, a crown may be needed. This restoration appears similar to a cap and is fitted over the remainder of the natural tooth . Crowns are often made of gold, porcelain, or porcelain fused to metal.

In certain cases, Endodontic therapy (Root canal treatment) may be necessary for the restoration of a tooth. A "root canal", is recommended if the pulp in a tooth dies from infection by decay-causing bacteria or from trauma. During a root canal, the pulp of the tooth, including the nerve and vascular tissues, is removed along with decayed portions of the tooth. The canals are instrumented with endodontic files to clean and shape them, and they are then usually filled with a rubber-like material called gutta percha. The tooth is filled and a crown can be placed. Upon completion of a root canal, the tooth is now non-vital, as it is devoid of any living tissue.

An extraction can also serve as treatment for dental caries. The removal of the decayed tooth is performed if the tooth is too far destroyed from the decay process to effectively restore the tooth. Extractions are sometimes considered if the tooth lacks an opposing tooth or will probably cause further problems in the future, as may be the case for wisdom teeth. Extractions may also be preferred by patients unable or unwilling to undergo the expense or difficulties in restoring the tooth.

Bleeding GumsLearn more

Bleeding gums or gingival bleeding is a term used by Dentist when referring to bleeding that is induced by gentle manipulation of the tissue at the interface between the gum and a tooth. Bleeding of gums is often a sign of inflammation and indicates some sort of destruction and erosion to the lining of the gum tissues . The blood comes from a lining of the inside of the gum called lamina propria after the ulceration of the lining.

There are many possible causes of gum bleeding (gingival bleeding). The main cause of gingival bleeding is the formation and accumulation of plaque at the gum line due to improper brushing and flossing of teeth. The hardened form of plaque is called tartar. An advanced form of gingivitis as a result of formation of plaque is periodontitis. Other causes that can exacerbate gingival bleeding include

  • tooth or gum infection
  • diabetes mellitus
  • placement of ill fitting dentures
  • idiopathic thrombocytopenic purpura (ITP)
  • malnutrition
  • use of aspirin and anticoagulants (blood thinners) such as warfarin and heparin]
  • hormonal imbalances during puberty and pregnancy
  • iron overload
  • leukemia

Other less common causes are:

  • vitamin C deficiency (scurvy) and vitamin K deficiency
  • dengue fever

In order to determine the periodontal health of a patient, the dentist or dental hygienist records the sulcular depths of the gingiva and observes any bleeding on probing. This is often accomplished with the use of a periodontal probe. Alternatively, dental floss may also be used to assess the Gingival bleeding index. It is used as an initial evaluation on patient's periodontal health especially to measure gingivitis. The number of bleeding sites is used to calculate the gingival bleeding score


  • Dentist or hygienists should be visited once every three months for plaque removal.
  • Soft-bristle toothbrush is recommended for brushing your teeth with gentle brushing.
  • lossing twice a day can prevent the building up of plaques.
  • Any form of Tobacco should be avoided as tobacco can aggravate the bleeding gums.
  • A balanced healthy diet (with lot of fibres) should also be included in your meal.
  • Physiotherapy programme using a toothpaste with triclosan should be used with home care.
  • If there is persistent continuation of inflammation and bleeding, consult your dentist as early as possible

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Wisdom Tooth removalLearn more

Although formally known as” third molars”, the common name is “wisdom teeth” because they appear so late – much later than the other teeth, at an age where people are presumably "wiser" than as a child, when the other teeth have already erupted. The term probably came as a translation of the Latin term.

A wisdom tooth or third molar refers to one of the three molars teeth of the human dentition. Wisdom teeth generally appear between the ages of 17 and 25 Most adults have four wisdom teeth (a third molar in each of the four quadrants). The Wisdom teeth commonly affect other teeth as they develop ,becoming impacted or "coming in sideways." They are often extracted when this occurs.

Wisdom teeth are vestigial third molars that used to help human ancestors in grinding down plant tissue. The common postulation is that the skulls of human ancestors had larger jaws with more teeth, which were possibly used to help chew down foliage to compensate for a lack of ability to efficiently digest the cellulose that makes up a plant cell wall. As human diets changed, smaller jaws gradually evolved, yet the third molars, or "wisdom teeth", still commonly develop in human mouths.

Wisdom teeth have long been identified as a source of problems and continue to be the most commonly impacted teeth in the human mouth. A lack of space to allow the teeth to erupt results in a risk of periodontal disease and caries that increases with age. Only a small minority (less than 2%) of adults age 65 years or older maintain the teeth without caries or periodontal disease and 13% maintain unimpacted wisdom teeth without caries or periodontal disease.

Some problems which may or may not occur with third molars:

  • Impacted, partially erupted mandibular third molar,
  • Dental caries and periodontal defects associated with both the third and second molars, caused by food packing and poor access to oral hygiene methods,
  • Inflamed opening covering partially erupted lower third molar, with accumulation of food debris and bacteria underneath,
  • D The upper third molar has over-erupted due lack of opposing tooth contact, and may start to traumatically occlude into the operculum over the lower third molar. Unopposed teeth are usually sharp because they have not been blunted by another tooth (attrition).

Impacted wisdom teeth are classified by :

  • The direction and the depth of impaction
  • The amount of space available for the tooth to erupt
  • The amount soft tissue or bone (or both) that covers the tooth.
  • The classification structure allows the doctor to estimate the probabilities of impaction, infections and complications associated with wisdom teeth removal . Wisdom teeth are also classified by the presence (or absence) of symptoms and disease.
  • Treatment of an erupted wisdom tooth is the same as any other tooth in the mouth.
  • If impacted, treatment can vary from the removal of infected tissue overlying the impacted tooth, to surgical extraction of the tooth or a coronectomy.
  • The upper left (picture right) and upper right (picture left) wisdom teeth are distoangularly impacted. The lower left wisdom tooth is horizontally impacted. The lower right wisdom tooth is vertically impacted

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