what are dental caries

Dental caries is a term used to refer to tooth cavities or decay. It’s caused by certain types of bacteria that produce acid from sugar and destroy the tooth enamel and the dentine over time.

What Causes Dental Caries?

The mouth is naturally full of bacteria. However, when they build up in the mouth, they form a thick and sticky layer on the teeth called plaque. Plaque is made up of saliva, food debris, and bacteria. Plaque forms in various places, including:

  • Between the teeth
  • Close to the gum line
  • Around bridge work and dental fillings
  • Grooves, pits, and cracks in the teeth

Over time, bacteria turn carbohydrates and sugar we eat (and that is left in the mouth) into acids. This acid gradually dissolves the enamel, which is the protective covering of the tooth. The erosion of the enamel finally gives way to the development of pits (1). At first, they are tiny and not easy to detect. However, they get larger with time.

Additionally, the acid formed can seep through the pores created in the enamel and find its way to the dentine layer. The dentine layer is softer than the enamel and forms the largest part of the tooth. As both the enamel and dentine break down, tooth caries is formed.

If the decay is not dealt with, it will keep progressing and eventually find its way to the pulp layer. This results in tooth sensitivity and pain as the nerve endings are exposed.

If you have any pressing dental issues or questions, you can book an appointment online or contact us directly on (+356) 2125 7253 (Skyparks Business Centre, Malta International Airport), or (+356) 2155 7323 (Dingli Street, Victoria, Gozo). For international patients, it is recommended to request a free e-consultation where we can discuss your individual case and treatment options.

What are the symptoms?

The symptoms experienced as a result of dental caries often vary, depending on the extent of damage and the location. When a cavity is in its early stages, there may not be any noticeable symptoms. However, as the decay progresses and digs deeper into the tooth, signs, and symptoms start to manifest. Some of the symptoms include:

  • Tooth sensitivity
  • Toothache and spontaneous pain, which occurs out of the blues
  • A sharp or mild pain experienced when drinking or eating something hot, cold or sweet
  • Visible pits or holes in the teeth
  • Black, brown or white staining on the tooth surface
  • Pain when you bite down on your teeth


Dentists inspect teeth for cavities during every appointment. A quick visual inspection often does the trick. But from time to time, they may feel the need to probe around using an explorer. An explorer is a tool that is designed to check for pits and any damaged areas on the teeth. And while they give patients peace of mind, usually these methods don’t catch cavities in their early stages.

If you suspect you have dental caries, you should schedule a dental x-ray appointment. X-rays can pick up on even tiny pits between the teeth. They also display advanced cavities, including its stage (whether it has gotten to the pulp or not).

Other modern procedures for detecting tooth decay include using liquid stain. The dentist will brush the stain over your teeth and then rinse with water. The stain rinses off well on the healthy teeth but sticks to pits and cavities.

Other dentists use lasers and other high tech technologies and devices to pick up on dental cavities. Usually, these high-end tech devices can pick up on the earliest stages of dental cavities. At the very early stages, the damage can be repaired (2).

Dental Caries Treatments

Dentists use four ways to handle dental caries.


This is the most common form of treatment. The process involves drilling into the affected spots on the teeth and removing the decayed substance. The clean space that is left is filled with a dental filling material. Depending on the location of the caries, different filling materials can be used. However, composite resin is the most common filling material.

Crowns, Inlays or Onlays

These are also a great option. However, we use them when the cavities have destroyed a large percentage of the tooth. When tooth decay is advanced and needs large fillings, the tooth becomes vulnerable to cracking and breaking. In such situations, we try to salvage the tooth using porcelain or alloy crown covering.

Root Canal

When the tooth decay makes it to the pulp layer and damages the nerves in this layer, you’ll experience pain. At this stage, we opt to remove the dead or damaged nerve endings along with the surrounding pulp (blood vessels and tissue) and fill up the space left (known as a root canal). We place a crown on top to seal the filling.


In cases where dental caries has progressed to a ‘beyond repair’ stage, the tooth has to be extracted or the infection may spread to the jaw. And since tooth removal leaves a gap on the gum, the tooth alignment is affected over time. To prevent this from happening, we recommend installing a partial denture, dental implant or a bridge.

How to Prevent Dental Caries

brushing your teeth


We recommend brushing your teeth twice a day for two minutes or longer. Use a fluoride paste, rinse or gel when brushing your teeth. Fluoride reduces acid levels in the mouth and aids the remineralisation of tooth substance softened by acids (3).


In addition to brushing your teeth, you should floss regularly, especially if you have a sweet tooth. Sugary foods supply bacteria with the raw materials they need to produce acid, which eats away your enamel.

What Happens If Caries Is Left Untreated

When caries is not treated, it develops into painful tooth decay. Lack of treatment may also cause uncontrolled decay in the mouth, leading to the loss of multiple teeth.

Note that the longer the tooth caries stays untreated, the closer you get to tooth removal as the only treatment option.

When Should You Call A Dentist?

You should have regular dental appointments. During these appointments, your dentist will pick up on any tooth decay in its early stages. However, if you notice your teeth are sensitive to eating or drinking cold, hot or sweet substances, you should contact your dentist as soon as possible.

We recommend scheduling regular dental checkups. These checkups reveal and catch a lot of problems before they become serious. They help you maintain a perfect and healthy smile

Have You Tried Our Free e-Consultation Service?

If you are worried about a dental related issue, interested in travelling to Malta for a dental holiday or have questions about any of the treatments we offer, please contact us using our new free e-Consultation service. One of our highly-qualified team will respond to your query as soon as possible. Our e-Consultation service is live 9am – 6pm Monday to Friday.

If you would like to schedule an in-person consultation at Savina Dental, please book your appointment using this form.

Savina Clinic – Dental & Implantology Centres are friendly, state-of-the-art practices in Malta and Gozo dedicated to comprehensive quality dental care. Savina Dental is an innovative dental practice in Malta and prides itself on the high-quality customer service, low waiting room times, attention to detail and the advanced dental technology at their disposal.

Joseph Xuereb
Principal Dental Surgeon & Owner of Savina Dental Clinics, Dr Joseph Xuereb BChD (Hons), MFGDP(UK), MGDS RCS(Eng), FFGDP RCS(UK), FICD is a general dental practitioner with a special interest in Implant and Restorative Dentistry. Dr Joseph & the teams' full biographical information can be found here.