How to Prevent Tooth Decay Re-Visited

In a previous article I wrote on ideas for preventing tooth decay. I would like to re-visit this topic because despite the fact that we have the means available to completely prevent this disease it is still very rampant in our society. Take a look at this well-written article on WEBMD:

http://www.webmd.com/oral-health/guide/tooth-decay-prevention

I liked this article and thought it was a good practical summary of prevention ideas similar to my article on prevention. However, cavity prevention cannot be achieved simply by reading a list of instructions in every case. There is a reason why less educated and people with lower socioecconomic status have a much higher rate of tooth decay: more than likely they were never taught the habbits that lead to oral health and they probably don't understand how this disease process works. I would like to expound on this article and the one I wrote previously. Tooth decay is a multifactorial disease meaning there are a lot of causes. However, Understanding a few basic ideas of how tooth decay works can help you change your daily habits and prevent new cavities from forming.

We were taught in dental school that 3 conditions must exist for a cavity to form:
#1 an agent: bacteria
#2 a succeptible host: you
#3 an environment that supports the agent or reduces hosts defenses.

#1 Tooth decay is the result of a bacterial infection. Your mouth is chuck-full (yes this is a very scientific term) of bacteria! The specific types of bacteria that cause cavities like Streptococcus Mutans are passed from mother to child. Cavity causing bacteria eat and digest sugar and other easly broken down carbohydrates then they produce acid. This acid is what starts to brake down your tooth structure forming a cavity. The bacteria cannot be eliminated completely with our current treatments. Even after rinsing with Listerine (which does kill them) they will re-bound, antibiotics would have a similar effect except with more negative side effects.

#2 Tooth decay is the result of a succeptible host: you! These bacteria need a hard surface to attach to: your teeth! Newborn babies that do not have teeth yet have very low numbers of these cavity causing germs. As soon as infants get some teeth especially molars with grooves in them the levels of cavity causing bacteria go up exponentially. Part of your succeptibility to decay may be genetic. Some people may have natural cavity protection in the form of good anti-cavity saliva and less succeptible tooth anatomy. However there are aspects of you that you can change. "Soft teeth" is usually not the reason for your decay. There are very rare disorders where the dentin or enamel on your teeth does not form properly thus this person would truely have soft teeth.

#3 Cavities are the result of an environment conducive to the growth of specific bacteria. If I were a cavity causing bacteria I would love the following environment: a dry mouth and plenty of carbohydrates frequently placed in the mouth of my host throughout the day and especially right before bed. The frequency of carbohydrate or sugar consumption throughout the day is a risk factor for tooth decay.

We learned about something in dental school called the Stephen's curve which describes the pH or acidity of your mouth immediately after eating a sugary or carbohydrate rich food. In some people who have poor quality or low quantity of saliva it takes a long time (more than 30 minutes) for the acid to be neutralized or brought above the critical pH of 5.5 (the critical pH is the acidity level at which your enamel begins to dissolve or de-mineralize). If this type of person is snacking on crackers, sipping soda, eating bread, or cookies 5-6 times throughout the day then there teeth may be in an acidic environment all day long. People with very dry mouths may have an oral environment which is constantly below the critical pH of 5.5. However in someone with normal salivary function the acid is neutralized within 20 minutes but even in this case the person could spend a significant portion of the day with their teeth being dissolved!

Now a few things you can do about it: You can't completely eliminate the bacteria or change your genetics but you can drastically change the environment that the bacteria live in.

#1: Chew a piece of sugar free gum or suck on a sugar free mint after meals and snacks. The main goal here is saliva stimulation immediately following a meal... Why? Because saliva in most cases is very effective at neutralizing the acid produced by the bacteria and washing away excess bacteria and food debris. Unfortunately a great deal of our modern medicines have the side effect of inhibiting the production of saliva causing dry mouth. This is why people can go their whole life without having much decay then all of the sudden when they start taking medicines which cause dry mouth (Xerostomia) they get a lot of cavities. If you have a dry mouth then you need to see your dentist and ask him or her about how to prevent decay with aggressive high strength fluoride therapy and saliva substitutes.

For everyone with normal saliva flow the sooner you can stimulate saliva following a meal, snack or drink of soda the faster you will reduce the acid levels in your mouth to normal and thus prevent decay. So chew some xylitol sweetened gum! If you don't have any gum then buy some, if you can't buy some then get a drink of water after a snack or meal.

#2 Don't rinse with anything including water for at least 30 minutes after you brush your teeth (with ADA approved fluoride toothpaste). Fluoride has the opposite affect from sugar on your teeth, it re-mineralizes rather than dissolves the tooth structure. The problem with fluoride is that it has poor substantivity meaning it does not stick to your teeth very well. After brushing your teeth you should spit the remaining paste out THEN DO NOT RINSE WITH WATER! If you rinse after brushing you are washing away most of the protective fluoride. Fluoride needs contact time with your teeth and in your saliva to help repair the damage done by the acid producing bacteria. It is especially important if you have a high risk for cavities to expose your teeth to fluoride right before bed as the fluoride can remain in your mouth uninterrupted for 7-8 hours. If you don't brush and floss your teeth before you go to bed then you are letting the bacteria dissolve your teeth for 7-8 hours!

In short your teeth are constantly in a flux of either being re-mineralized or de-mineralized. Tooth decay depends on how well you keep your teeth in the re-mineralized category. Your job is to stop the teeth from dissolving by stimulating saliva with a sugar free gum or sugar free candy and help the teeth re-mineralize or solidify by allowing your fluoride toothpaste to sit on your teeth uninterrupted for as long as possible.

Or if you want it in even simpler terms... For cavities: Fluoride & Saliva GOOD, frequent sugar exposure without anything to neutralize the acid BAD!

I'm glad I don't have to go to school tomorrow it's getting late!

Here are some other suggestions for preventing cavities:

7 Ways to Prevent Cavities
http://dentistry.about.com/od/dentalhealth/tp/preventing_cavities.htm