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.
Elena Francisco, RDHAP, MS has been practicing dental hygiene for over 40 years and has been an RDHAP since 2005.