Dental cavities next to periodontal diseases (commonly known as pyorrhea), are the most frequent and destructive of all the oral structures.

The CAVITY is an infectious disease that provokes the destruction of hard tooth tissues, and can even reach internal dental parts (dental pulp) causing the famous odontalgies (toothaches) that thousands and thousand of people have suffered and suffer throughout the ages.

These odontalgies indicate the presence of an infection at the dental pulp, this is why the pain has a pulp origin, mentioned in other chapters.

In future reference you will also find that cavities can be painless when the affected area is the enamel and instead the patient refers a sensibility to temperature changes (hot/cold), sweets and acids when the dentine is affected.

Cavities have a multifactor origin, various factors intertwine in order for bacteria to act and produce dental destruction.

Acids produced by bacteria cause Ph to decrease and therefore dental enamel begins to dissolve at a PH lower than 5.5.

Cavities at Upper Central Incisors

For a cavity to take place a combinations of factors must be present: SUGAR + SUSCEPTIBLE TOOTH + ACID BACTERIA PRESENCE+ TIME OF PRESENCE.

If we were to analyze this factors, you will note that in others chapter we have covered sugar and bacteria, remaining tooth susceptibility.

The factor tooth susceptibility is determined by a genetic mold and this explains, like in many other diseases, that cavities have a herederitary character and therefore a genet predisposition.

The factor time of presence, means that the longer sugars have present in the mouth, implies greater adhesion of the bacteria and a greater energy support for them. This is why it is very important to brush teeth after every meal.

FACTORS THAT FAVOR CAVITY DEVELOPMENT

There are general and local factors that favor cavity presence in human beings.

General Factors:

• Genetic Predisposition
• Age: there is a higher predisposition within ages associated to hormonal changes (puberty, menopause, pregnancy)
• Race: less cavities in pure races
• Areas rich in elements: calcium, phosphor, fluorine, etc. less presence
• Sex: slightly more frequent in women
• Professionals: more frequent in bakers and in general sugar handlers
• Pregnancy: due to hormonal alterations during this period
• Eating Patterns: diets rich in carbohydrates
• Metabolism, Hepatic and Endocrine Diseases: higher probability

Local factors:

• Morphologic alterations of the dental piece: the deeper the dental groove, more plaque retention and therefore higher probability of cavities.
• Dental Malposition: this determines a greater number of retentive areas of bacterial plaque
• Bad Oral Hygiene: the retention of bacterial plaque increases the appearance of cavities.
• Chewing on one side: this enables self cleaning while chewing to the side not in use, allowing bacterial plaque to accumulate and therefore increasing cavity appearance
• Fluorine Presence: in drinking water, food, toothpastes , etc.
• Oral retainers: they favor the adhesion of bacterial plaque at their inner side and if oral hygiene is poor, there is greater contact between tooth - retainer - plaque, which favor cavity.

Retainer: Cause of Cavities

MOST FREQUENT CAVITY AREAS

There are some areas in the dental pieces where cavities develop easier. This areas are usually those with a larger retention of bacterial plaque and they are:

• Occlusal sides or masticatory premolars and molars: dental grooves, fosse and fissure depth, determine a greater plaque retention and therefore greater segregation of acids in the metabolism of carbohydrates.

Occlusal Cavities

• Dental piece proximal side: these are the neighboring sides (mesial and distal) between two dental pieces and in them there is a grater retention of food remains and bacterial plaque

Proximal Cavities

• Dental Piece Free side: most frequent at the cervical area of the tooth (area close to the gums)

Cervical cavities (free sides)

• Superior Incisor Palatal side: in a fosse located under the cingulum
• Molars vestibule side (side that touches the inner cheeks)
• Radicular Side: at the root of the dental piece

Radicular Cavity

The areas where the appearance of cavities is lesser are at the cusp's point of molars and premolars and at the incisal edges of incisors and canines.