I am a dental hygienist. I have practiced clinically for more than 40 years. If I have seen this scenario once, I have seen it hundreds of times. A patient who has been seen for several years comes in for routine dental hygiene care (cleaning appointment). Unfortunately, this appointment we find tooth decay starting under crowns, on molars, in areas the patients normally keeps very clean.
The dental hygienist and dentist need to be detectives in order to help the patient stop the decay. Removing the decay and placing a filling or crown is NOT the answer. Of course, this is important, but we need to know the cause and how to prevent more decay.
If we look at the four things necessary to put your teeth at risk for tooth decay, we begin by asking the patient questions with this list in mind. There are four (4) components that have to be in place to get a cavity.
Lets investigate these one at a time.
Tooth: The crown of our teeth (the part we see) is composed of enamel. Enamel is the hardest material in the body. The acids, however, can breach that hard surface, causing a hole or cavity. Unfortunately, most adults have some periodontal disease, that results in bone loss and exposed root surfaces. Root surfaces are softer than enamel and more easily decayed. This is the area most older people develop tooth decay.
The best ways we have learned to protect the tooth from tooth decay are to:
Bacteria: Even patients who take excellent care of their teeth can get cavities on their root surfaces. The bacteria are probably not the main culprit.
A lack of saliva can create an acidic environment in the mouth, as well. Many medications we can result in xerostomia or dry mouth. A change or addition in medication, an illness, change in diet can all affect your oral health.
Your dentist or dental hygienist should always update your medical history, including changes such as those mentioned. Sometimes it is a change we think is small or inconsequential that makes the difference.
Sugar/Fermentable Carbohydrates: As we investigate how our older adults are taking in sugar and fermentable carbohydrates, we commonly find them sneaking into their diets in small by catastrophic forms. Consider sugars in these forms (The American Dental Association has a very thorough list):
What are some healthy alternatives? Glad you asked.
Time: Remember that 20 minute time frame the bacteria need to start creating the acids? It is hard to change habits, but little alterations can help. Are you sipping on your beverage or candy because your mouth is dry? Are you sipping on a beverage during the day as you work? Try these strategies:
Dry mouth, a common side effect of many medications, reduces the amount of saliva in the mouth. Saliva keeps the pH of our mouth neutral. Saliva contains minerals that help remineralize the tooth. Without it, the pH becomes more acidic and minerals are leached from the tooth in order to try to neutralize the oral environment. Ask your physician if you have a lot of trouble with dry mouth. Together you may be able to find an alternative medication.
The short answer is yes. If you have active caries lesions (cavities), they are filled with bacteria. First, you need to get the bacteria removed and the cavity filled. Then you have to change your habits in order to make your mouth uninhabitable for the cavity 'causing' bacteria. But, let's go back further.
The long answer to the question is much more complex. Like most other diseases humans are prone to, a lot of things have to happen for it to manifest itself. This is a story of prevention.
Tooth decay is the result of a preventable disease called dental caries. The result of untreated dental caries is a caries lesion or cavity. You read it correctly. This disease is preventable. The bacteria responsible for reeking most of the havoc of this disease are transmissible. You were not born with these bacteria in your mouth. They are passed on to use by loving parents, grandparents, siblings, or even fellow toddlers in the playroom.
There are four (4) components that have to be in place to get a cavity.
Let's address these one at a time.
Host/Tooth: Rarely are people born with weak teeth. Oh, there are diseases that causes weak teeth with defective or no enamel, but they are rare. Our teeth normally erupt healthy. It is the first 18-24 months in the mouth, when our immune systems are developing, that they become compromised if parents are not vigilant. To keep the newly erupting teeth healthy, the rule of thumb is to always wipe them with a clean wash cloth or use a small tooth brush after you feed the baby. Infant formula and breast milk contain sugars essential for growth, but not so good if left on their little teeth too long (20 minutes). Never put a baby to bed with a bottle that contains anything but water, since they are bathing their teeth in sugar, creating the perfect environment for tooth decay to start.
Bacteria: We all have them. Most are good and important to our digestion and general health. The bacteria that 'cause' tooth decay, however, are not among the good guys. The rule of thumb here is to avoid sharing saliva, where many of the bacteria live, with your infant or toddler. How does that happen? Sharing food, toys, and toothbrushes; pre-chewing food (yup, people do that). Never clean a pacifier with your saliva. In otherwise, reduce the chance of infecting your baby with caries causing bacteria. Of course all of this may be OK if you or the other people loving on your baby are at low risk for dental caries. A few bad bacteria may get transmitted to your child, but we can keep them from growing in numbers by performing good regular oral hygiene. Read on.
Food (sugars and fermentable carbohydrates): Our bodies need carbohydrates to function properly, but the recommendations are to eat complex carbohydrates in the form of fresh fruits, vegetables, and legumes. In American culture, it is almost impossible to avoid the fermentable carbohydrates, though. We should all learn to curb them for lots of reasons, but that is for another blog post ;-). The rule of thumb here is to choose beverages that have no sugar (water), and snack on complex carbohydrates, such as fruit, vegetables, nuts. There are snacks that we can choose that actually have tooth-protective properties (white cheese, almonds, for example).
Time: So what does time have to do with all this? The bacteria that 'cause' tooth decay need about 20 minutes of exposure time to turn your cookie, cracker, or juice into an acid. It is actually the acid that causes the decay. The bacteria are really just the acid factories. If we look back on what we have read so far, the fewer bacteria (acid factories) you have in your mouth, the longer it is going to take to produce enough acid to cause a cavity. The less of their favorite foods the bacteria have to eat, the longer it will take to produce enough acid to cause cavities. The rule of thumb is to (1) avoid snacking, (2) remove the carbohydrates from your mouth (brush/floss/rinse) after snacking, and (3) minimize acidic beverages between meals.
Wow! That was a lot of information. My recommendation or RULE OF THUMB is to take baby steps. This post is basically about how to reduce the risk of ever developing tooth decay. It starts with protecting infants. Start small, wherever you think you have the best chance of success. Don't worry if you fail. We all fail now and then. I hate to even call it failing. It is part of learning. Just forget it, and keep trying.
I have gone through how to prevent or reduce the risk of developing dental caries. So what if you already have it? What if you are grandparent or relative and the new baby in your family is kissable? What can you do? Stay tuned for Can I Stop Getting Cavities: Part 2.
Clark MB, Slayton RL. Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics. 2014;134:626-633 http://pediatrics.aappublications.org/content/pediatrics/134/3/626.full.pdf Accessed January 11, 2019
Featherstone JDB, Crystal YO, Chaffee BW, Shan L, Ramos-Gomez FJ. An Updated CAMBRA Caries Risk Assessment Tool for Ages 0-5 Years. CDA J. 2019;47(1):37-47. https://www.cda.org/Portals/0/journal/journal_012019.pdf. Accessed January 5, 2019
Elena Francisco, RDHAP, MS has been practicing dental hygiene for over 40 years and has been an RDHAP since 2005.
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