How Cavities Start

Sweets are the biggest culprit in causing cavities

Finding a cavity during a routine trip to the dentist is a familiar- if unpleasant – experience for many people; but most don’t realize that tooth decay is actually a disease process caused by bacteria, which can transmitted between people. Properly referred to as dental caries, this common oral disease affects children and adults of all ages… and is mostly preventable if you understand how the disease begins and spreads.

A cavity is actually a hole in the tooth. The hole is the end result of an infection by bacteria that produce acids which dissolve tooth structure. The dentist fills these holes as they are discovered but unfortunately, placing a filling the tooth without reducing the number of harmful bacteria in the mouth doesn’t usually cure the disease, and new cavities are likely to develop. Over 500 varieties of oral bacteria are found in the mouth, including the acid-producing Streptococcus mutans which is largely responsible for cavities. When they are not thoroughly and regularly removed by careful brushing and flossing, bacteria reproduce and thrive in a sticky substance that allows them to adhere to and destroy tooth surfaces. The key to controlling the caries disease process is to eliminate or control the cause – that sticky bacterial colony known as dental plaque.

Sugary or starchy foods that are left over in the mouth after eating provide a source of food for Streptococcus mutans, which creates acid as a waste product. Acids in the mouth break down and dissolve the minerals, primarily calcium in the teeth. As you probably are aware, brushing and flossing removes both the leftover food particles and the plaque, and is therefore a first line of defense against tooth decay. However, sometimes even people who have good oral hygiene develop cavities.

What is the explanation?

Bacteria are too small to be seen and can easily work their way underneath tiny cracks and openings that typically develop over time around old fillings, crowns and bridge work. Furthermore, when the molars are being formed, often deep and narrow grooves develop in the chewing surfaces. These grooves are wide enough to allow acids and microscopic bacteria to enter but too narrow to be cleaned with your tooth brush. That’s why even people who take excellent care of their teeth and have had great checkups for years still need periodic dental x-rays and professional examinations.

Because the risk of getting a cavity is directly related to both bacteria and the acid level in your mouth there are several steps you can take to prevent the caries process from starting:

• Don’t allow sweet drinks or foods to linger in the mouth over long periods of time. The longer teeth are exposed to these substances the more time bacteria will have to feed on it and produce acids that will bathe and destroy the teeth.

• Avoid sour candy and limit food and drink like soda, tea, and citrus fruits which increase the acidity of the mouth and harm the enamel.

• Stay away from anything sweet that sticks to the teeth. Foods like fruit rollups or taffy are obvious problems, but even “healthy” foods like raisins can stick and become be a source of food for decay causing bacteria!

• Brush twice and floss at least once daily to remove plaque.

• If you can’t brush after eating or drinking, rinse with water.

• Maintain regular dental checkups with periodic x-rays to check under fillings and between teeth where the dentist can’t see.

• Consider placing sealants (a semi-permanent plastic coating) on molars when they first erupt around age 6; this will keep harmful bacteria from invading deep inaccessible grooves.

• Make sure everyone in the family has had a checkup and is controlling their cavity risk factors when a new baby is on the way. Oral bacteria are transmitted between family members!

• Fluoride helps to remineralize teeth that have been “softened” with acids. Use fluoride toothpaste and ask your dental professional whether you are at high risk for cavities. Fluoride or another type of mouth rinse may also be recommended in either an over the counter or prescription strength.

• A one ounce piece of cheese eaten at the end of a meal helps neutralize acids.

• Xylitol, a sugar alcohol found in many products or sold as a sweeter chemically interacts with bacteria, preventing them from reproducing and reducing the acidity of the mouth. Ask your dental professional how you can incorporate Xylitol products into your diet.

• Specialized laser instruments are available to detect early cavities that are still too small to see. If detected early, in many cases these can be repaired (remineralized) without drilling and filling simply by adding minerals back into the dissolving tooth structure.

Managing dental caries is about more than just filling cavities. Though you may not have been aware of it, your dentist assesses your risk factors for tooth decay, including dietary and oral hygiene habits, family history and sometimes even body chemistry and saliva flow. A variety of techniques can be implemented at home and in the dental office to lower your risk for developing cavities and the dentist can make specific recommendations based on his assessment. Do you have a positive experience with any of the decay prevention techniques discussed in the article? We would like to hear from you!

Tea Time!

Do you have Green tea on your grocery list? If so, you are not alone… it is heavily marketed for its potential health benefits ranging from weight loss to cancer prevention, heart health and more. Recent scientific research supports what Asian medical practitioners have believed for nearly 5000 years: many of the reported general health benefits of tea are genuine, and regular consumption may even improve your oral health!

According to an article that appeared in the Journal of Periodontology, green tea promotes healthy teeth and gums because it contains antioxidants called catechins that interfere with the body’s inflammatory response to the oral bacteria responsible for periodontal disease. Evidence suggests that green tea may have an anti-cavity benefit as well, but interestingly, researchers at the University Of Illinois School Of Dentistry have reported that drinking black tea may also lead to fewer cavities. Black tea seems to inhibit the formation of dental plaque by suppressing the ability of decay-causing bacteria to grow, stick to the teeth and produce the destructive acids that cause decay. This is great news, since about 80% of all the tea consumed in Western countries is the Black Oolong variety.

A few important cautionary notes are in order before incorporating more tea into your diet:

• When sugar is added to the tea, the anti-cavity effect may be lessened or negated – if you must use a sweetener, consider using Xylitol which is a sugar substitute that has its own anti-bacterial effect.

 

• Preparation is important! Releasing the catechins for maximum antioxidant benefit requires that tea be brewed and steeped for 3 to 5 minutes.

 

• Tea stains! Like most pigmented liquids, tea can leave a brown stain behind on your teeth. Rinse with water after drinking tea to keep stain to a minimum, and consider using a whitening toothpaste. Remember that regular professional cleanings and perhaps a simple cosmetic whitening procedure available in the dental office can keep your smile looking its best!

Alternative medicine fads come and go, and it can be a challenge to differentiate between the ones that have some real health benefit from those that have little value or may actually be dangerous. As a general rule, it is a good idea to verify claims about products and practices with reliable sources and research before incorporating any supplement or practice into your diet or self care routine. Your dental team is here to help, and a great resource for all of your oral health questions.

Enjoy the many benefits of a perfectly brewed glass of ice tea (or a cup) this summer … with all of its many benefits, and we look forward to hearing from you!

Baby Teeth are Not Just for Kids!

Parents commonly ask whether it is necessary to fill a cavity in a child’s baby tooth since they are temporary. The simple answer is YES! Baby teeth are only around for a couple of years, but they not expendable. Keeping them healthy and intact until they fall out naturally has a major impact on a child’s health and the correct positioning of permanent teeth.

A child has twenty primary (baby) teeth which form in the jaw before birth and begin to appear in the mouth at about four or five months of age… just about the time he is ready to begin tasting solid foods. These first teeth are not only important for chewing and nutrition, but for proper development of facial muscles and speech. As you might imagine, losing baby teeth too early can have long term effects, lasting well into adulthood.

Baby teeth are also space holders for the permanent teeth which are developing under the gums. When a permanent tooth is sufficiently developed, the roots of the baby tooth it will replace begin to dissolve, causing it to loosen. Gradually, the permanent tooth pushes the primary tooth out and takes its place. Occasionally a child may have a baby tooth that never develops, in which case there will usually be no permanent tooth under it either. More commonly, a baby tooth may be present but no permanent tooth has developed under it; when this occurs, many times the baby tooth roots never dissolve and the tooth is never lost. These conditions are called “hypodontia” and they rarely present major dental problems, especially when a dentist detects them early and is able to help parents plan ahead.

When a primary tooth is lost too soon, the permanent tooth has no guide to follow. To complicate matters, when there is nothing to fill the space left by a missing baby tooth, the space may begin to close causing the permanent replacement to erupt into the wrong position. The result can be crowded permanent teeth which may lead to speech disturbances and and bite problems that may require braces (orthodontics) to correct. A dentist can often prevent these complications by placing a small device called a space maintainer in the child’s mouth until the permanent tooth begins to erupt.

Sometimes, when a cavity in a primary tooth is small and the tooth is likely to be lost naturally before it causes any pain, the dentist will recommend simply “keeping an eye on it” to spare the child any discomfort from the filling procedure. Occasionally early tooth decay can even be completely repaired by just using fluoride on a regular basis. Advanced cavities must be addressed more aggressively because can be very painful for kids, just as they are for adults – they can even cause severe, life threatening infections.

Regular dental checkups are important and they can help detect small cavities early when they can be most easily repaired. Baby teeth are usually a nice, bright white color when they are healthy; so parents should be on the lookout for suspicious brown spots or other discolorations on their child’s pearly whites and be alert to signs that the child might be experiencing mouth discomfort.

The American Dental Association recommends that children have their first “well baby” dental visit before their first birthday…because preventing cavities and trauma is the best way to ensure that a child will keep his baby teeth intact until the tooth fairy is ready to claim them (rumor has it that she isn’t paying out that well these days anyway!).

February is Children’s Dental Health Month!

National Children’s Dental Health Month is sponsored every February by the American Dental Association (ADA) to raise awareness about the importance of developing good habits at an early age and scheduling regular dental visits to help ensure a lifetime of good oral health.

Whether you have kids or just love kids, there is no doubt that it can be a challenge to keep up with them. Parents understandably have many questions about caring for their children’s teeth, and with the many conflicting messages in the media it’s hard to know what’s best. Your dental health professional can help sort out all the information, but there are some important guidelines to bear in mind:

Taking care of your child’s oral health actually begins even before pregnancy!

Expectant parents should meet with their dentist and pediatrician to discuss nutritional guidelines for pregnant mothers and children, as well as important developmental milestones. Every child is different, but in general you can expect that:

• 6 weeks after conception the early tooth “bud” forms.
• 3 to 4 months gestation the hard tissue that surrounds the teeth is formed,
• Beginning 4-6 months after birth, the first baby teeth begin to erupt – often sooner for girls than for boys, and permanent teeth are already forming under the gums.
• Beginning at about age 6, the first permanent molar erupts behind the last baby tooth and soon after, the front baby teeth begin to fall out to make room for the permanent ones.

The American Academy of Pediatric Dentistry recommends that a child have their first dental office visit before age 1.

While this might seem surprising, one in four children develops a cavity before they are four years old. Your child’s oral health is influenced by many factors including the oral health and habits of the parents and siblings, genetics and diet. It’s a good idea meet with dental professionals early on to discuss potential problems before they start, and to establish a care plan for your child that includes:

• Caring for an infant’s or toddler’s mouth at home and at school
• Decisions about using fluoride
• How to manage oral habits like pacifier, finger or thumb sucking
• How to prevent and manage trauma and emergencies
• Teething and developmental milestones
• Diet and oral health

Plan ahead for bottle battles and sippy-cup strategies

Milk, formula, juice, and other drinks such as soda all have sugar in them. The more time the teeth are bathed in these liquids, the greater the risk of getting cavities. Most parents will agree that weaning children from bottles and sippy cups is easier said than done; but from an oral health perspective, it’s smart to eliminate them completely around one year- or as soon as possible after tooth eruption. The National Institute of Health suggests other strategies for minimizing risk, including:

• Don’t put children to bed with a bottle containing anything but water.
• Don’t let baby have a bottle or sippy cup to carry around between feedings.
• Don’t dip baby’s pacifier in anything sweet.

Brushing and flossing is important, but it’s not as easy as it looks!

Seasoned parents know that once children start asserting their independence, it can be difficult to convince them to cooperate with someone trying to brush their teeth. Teach children to accept help – and someone else’s hands in their mouth- from infancy. Even before the first tooth appears, it’s a good practice to remove sugars and bacteria by gently wiping the gums with a soft damp cloth after feeding. Introduce an age-appropriate toothbrush (the right size and shape) once several baby teeth have come in. Use a fluoride free toothpaste until the child can be trusted not to swallow it- and use only a pea sized drop on the brush.

It’s encouraging when a child enjoys brushing and does it often, but most children don’t have the motor skills and manual dexterity to brush by themselves until they are at least eight or nine. Until that time, they will need help and supervision. Every child is different, so talk to your dental provider to find out how your child is doing and what you can do to help.

Let’s face it- flossing is hard to do, even for grown-ups. Children have an extra hard time, because they lack the coordination to do it until they are teens. Disposable hand held floss “picks” can help, but it’s easy to misuse them and cause an injury to the gums. Let children begin practicing once their permanent front teeth erupt around age 7. Before that, and for all of the back teeth, give them a hand!

X-rays are essential. If the dentist can’t see a cavity, chances are you can’t either.

It is very common for parents to say, “My child doesn’t need x-rays. He doesn’t have any problems”, but cavities often begin between the teeth where they can’t be seen, and where the toothbrush doesn’t reach. By the time pain is felt the cavity is often big enough to require a large filling, a root canal or an extraction.

Sometimes, a dentist will recommend taking X-rays on a very young child if they are at high risk for cavities; but more often than not, children can’t hold the x-ray film or sensor in their mouth without help until they are somewhat older. This is generally not a problem, because baby teeth usually have plenty of space between them to allow the dentist to visually check for cavities.

Once the first permanent molar erupts at about age 6, spaces begin to get tighter and it’s important to take x-rays to check for cavities between the teeth. Sometimes, fluoride can heal early cavities so they don’t have to be drilled.

Furthermore, some children never develop one or more of their permanent teeth. This is rarely a major problem but it is important to know about it in advance to plan ahead for braces (orthodontics) if necessary. When no permanent tooth exists, the baby tooth doesn’t always loosen and fall out by itself. In fact, it’s very possible to keep the baby tooth in place for many years as long as it is well cared for, thereby avoiding a variety of potential complications.

Modern Dental X-rays are extremely safe, and without them your dentist has an incomplete picture of your child’s oral health. Knowing in advance what is developing under the gums and between the teeth can help avoid long term problems.

Fluoride

Fluoride is safe, effective and has been recommended by the American Dental Association for 50 years for the prevention of cavities. The dental provider may apply it during checkups in a gel, foam, rinse or varnish; and a variety of prescription and over the counter products containing fluoride are available for home use. The dentist or hygienist will provide you with individualized recommendations for your child.

The American Dental Association advises against using fluoridated water for mixing infant formula because it can damage developing tooth enamel; the local health department can provide information about water fluoridation. Parents should keep fluoride products, including toothpaste out of children’s reach and be alert for signs of fluoride overdose (abdominal pain, vomiting, and diarrhea) if they suspect a child has ingested a large amount of these products.

Sealants

Permanent molars (and sometimes premolars) develop with deep narrow grooves in them. Bacteria that cause cavities become trapped in the grooves, but toothbrush bristles are too large to clean them. A sealant is a plastic coating that is painted on to the chewing surface of to fill in the grooves and create an easily cleanable surface. The sealant can’t be applied once an obvious cavity has developed, so the dentist may recommend sealants as soon as the first permanent molars begin to erupt around age 6.

Children’s oral health is a team effort… and it’s all about prevention.

Armed with the right information and a good oral health team, teachers, parents and caregivers can help establish the foundation necessary for life-long oral health. It’s a team effort that requires a variety of different strategies from good nutrition to regular professional care.

It’s probably no surprise to hear that despite our best efforts to intervene, kids don’t always brush very well; and to make matters worse they probably (at least occasionally) eat and drink things that they shouldn’t. They fall down, they have accidents, and they are sometimes faced with oral health issues that no one can prevent or predict.

The key to a lifetime of healthy smiles in spite of it all is to have a plan in place to compensate for kids being… well, kids.