CARIES MANAGEMENT + HOW TOOTH DECAY HAPPENS
Tooth decay is caused by certain types of bacteria (S. mutans and lactobacilli) that live in your mouth. The bacteria feed on what you eat, especially sugars (including fruit sugars) and cooked starch (bread, potatoes, rice, pasta, potato chips, crackers etc.). Within about five minutes after you eat or drink, the bacteria begin producing acids as a byproduct of their digesting your food. Those acids then penetrate into the hard substance of the tooth and dissolve some of the minerals (calcium and phosphate). If the acid attacks are infrequent and of short duration, your saliva can help to repair the damage by neutralizing the acids and supplying minerals and fluoride that can replace those lost from the tooth. However, if your mouth is dry, if you have many of these bacteria, or if you snack frequently; then the tooth mineral lost by attacks of acids is too great and cannot be repaired naturally. This is the start of tooth decay and leads to cavities.
METHODS OF CONTROLLING TOOTH DECAY
Daily removal of plaque from your teeth is critical in controlling tooth decay. Plaque can be difficult to remove from some parts of your teeth, especially between the teeth and in grooves on the biting surfaces of back teeth. If you have a removable appliance, remove it before brushing and flossing, and clean it well also. Regular dental cleanings and checkups are an important part of reducing tooth decay.
Recommended Protocol: Using a soft toothbrush placed at 45 degree angle to the gum-line, gently slide the tips of the bristles under the gum-line. Vibrate the brush in circles or small strokes cleaning no more than two teeth at a time. Move the brush along the gums slowly cleaning every surface. Do not scrub. Use this method for all front tooth surfaces and inside surfaces near your tongue and roof of mouth. For areas behind front teeth, turn brush vertically and pulling stroke to clean teeth.
Have our dental team show you how to floss correctly.
The obvious culprits of tooth decay are sugars such as candy, sugared drinks and dried fruit. Less obvious are carbohydrates, which break down into simple sugars and can be even more adherent to tooth surfaces (especially grooves). The least well-known culprit is general mouth acidity. This can come in the form of otherwise healthy acidic foods or drinks such as tomatoes and citrus fruits. It may also be present due to systemic conditions such as acid-reflux. The key is to be smart about consumption of any of the previously mentioned foods or beverages. A good way to remove sugars from teeth or decrease acidity in the mouth is to drink water. Teeth may remain ‘soft’ for up to 12 hours after consuming acidic beverages (especially pop) and can be worn by tooth brushing during this time. A good way to avoid constant acidic conditions in your mouth is to eat regular, healthy well-spaced meals, avoid frequent snacking and drink plenty of water.
Saliva is critical for controlling tooth decay. It neutralizes acids and provides minerals and proteins that protect the teeth. If you cannot brush after a meal or snack, you can chew some sugar- free gum. This will stimulate the flow of saliva to help neutralize acids and bring lost minerals back to the teeth. Sugar-free candy or mints could also be used, but some of these contain acids themselves. These acids will not cause tooth decay, but they can slowly dissolve the enamel surface over time (a process called erosion). Some sugar-free gums are designed to help fight tooth decay and are particularly useful if you have a dry mouth. Some gums contain baking soda, which neutralizes the acids produced by the bacteria in plaque. Gum that contains xylitol as its first listed ingredient is the gum of choice. If you have a dry mouth, you could also fill a drinking bottle with water and add a couple of teaspoons of baking soda for each 8 ounces of water and swish with it frequently. Toothpastes containing baking soda are also available. Restorative treatment: Restoring teeth to control tooth decay can be done in many ways. Fillings or crowns are used to reconstruct tooth structure after all decay has been eliminated. Restorations can be done in composite, porcelain or metal materials depending on what is needed to maintain or return the function of your tooth. In some people, the grooves on the surface of teeth are too narrow to clean with a toothbrush, and will decay despite your best efforts. Early diagnosis of susceptible grooves leaves us with the most conservative options for restorative treatment. All decay must be removed before any other treatment or preventive measures are taken. Decay is a bacterial process that is transmissible, so complete elimination of the decay is necessary so new decay is less able to form.
Antibacterial Mouth Rinses
Rinses that we can provide or prescribe are able to reduce the number of bacteria that cause tooth decay and can be useful in patient at high risk for tooth decay. The reviewed literature show that OPTI Rinse, found in most pharmacies, is effective in reducing the incidence of dental caries.
Recommended Protocol: After normal flossing and brushing (1x/day) use the OPTI Rinse treatment rinse as directed.
Xylitol is a sugar substitute with sweetness equal to that of table sugar. It is an alcohol-based sugar, so unlike sucrose/glucose/fructose it is not metabolized by caries-causing bacteria in the mouth. Xylitol has been associated with a decrease in the amount of bacteria in the mouth that causes dental plaque (S. mutans). Short term consumption of xylitol decreases the amount of S. mutans in saliva and plaque. Long term use of xylitol products seems to select for a population of bacteria that is less adherent to tooth and therefore less likely to accumulate plaque to cause tooth decay. As well as benefiting the individual consuming xylitol, it may be helpful in decreasing transmission of aggressive strains of bacteria to children or kissing partners.
Recommended Protocol: Chew gum or dissolve mint in mouth three to five times a day.
MOUTHWASH ACIDITY CHART AS PER KOIS (2015)
MOUTHWASH ACIDITY CHART AS PER KOIS (2014)
TOOTHPASTE ABRASSIVITY CHART AS PER KOIS (2014)
This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.