Tooth decay occurs due to multiple factors. It won’t occur in the absence of certain cavity causing (cariogenic) bacteria and sugar. These bacteria are but one type of the thousands of different species of bacteria which reside in your mouth. When “fed” sugar, the bacteria which live in the plaque on your teeth excrete acid as a waste product. It’s this acid that demineralizes and essentially eats through the hard outer surface (enamel) of the tooth. Your saliva helps to counteract this process, but can only do so much. If consumption of sugar is too frequent or stays in contact with the teeth for too long, decay can occur. Sometimes the quality or quantity of saliva is diminished – by factors including medications, radiation therapy, and age. This puts individuals at a greater risk of decay.
When demineralization has occurred, but not yet caused a cavity we will monitor the tooth (visually and with periodic x-rays). In some cases we’ll suggest fluoride rinses, prescription level fluoride toothpaste, or even place a high concentration fluoride “varnish” to help strengthen the enamel.
Sometimes decay can progress far enough into the tooth as to necessitate root canal therapy. Other times it may go so far below the level of the gingiva (gums) that the tooth cannot be restored and will require an extraction. If the tooth is lost there are multiple ways to replace it (implant, fixed bridge, or a removable partial).