Dental Hygiene 101: Let’s Talk About Tooth Decay

In my first Dental Hygiene 101 article I focused on how the teeth and the oral cavity affect our overall health, the importance of keeping our teeth, and some of the challenges associated with age.

There are two ways that most of us lose teeth: either from the breakdown of the tooth structure from dental decay (cavities) or from periodontal (gum) disease. Today, let’s focus on tooth decay; how it occurs and how it can be prevented. While the process of dental decay is the same, much has changed since the early radio and TV advertisements promoting dental health.

Many of our generation in the United States may remember Crest toothpaste’s “look, Mom, no cavities” advertisements of the 1950s, with a young boy running in to tell his mom the good news that he didn’t have cavities, or Pepsodent’s jingle “You’ll wonder where the yellow went, when you brush your teeth with Pepsodent” (these can be found on YouTube for a good laugh).

Tooth Anatomy

Teeth are made up of three layers: the enamel, the tooth’s strong protective outer surface, the dentin, the softer middle layer of the tooth, and the pulp, which contains the tooth’s nerve and blood and lymph vessels. (Did you know each tooth has tiny lymph vessels?)

Think of the enamel as you do your skin; the skin is the body’s physical first line of defense in keeping bacteria out of the body. The enamel is the tooth’s physical first line of defense in keeping bacteria out of the dentin and pulp.

Decay Process

Acid is the enemy of the tooth! Whether acid is produced by the bacteria in the mouth OR from ingesting acid in products such as sodas, it is the cause of the enamel losing minerals (calcium and phosphate).

Stage One: Tooth Demineralization

The first stage in the decay process occurs when the enamel is first compromised by bacteria which produce acid, causing the tooth enamel to lose minerals. Early demineralization appears as white or chalky spots. At this stage, decay can often be stopped or reversed!

Stage Two: Enamel Decay

If the acid attacks continue, the enamel breaks down further, creating a hole or cavity. This damage is irreversible and is treated with a filling.

Stage Three: Dentin Decay

The decay moves through the enamel and into the dentin. Because dentin is less resistant to acid than enamel, the decay spreads faster and moves to the pulp. This damage is irreversible and is treated with a root canal or extraction.

Preventing and Reversing the Decay Process

Like many things we thought we’d “outgrow” (hello, adult acne!), tooth decay can become more of an issue as we age. The effects of a high carb/high acid diet, dry mouth, and exposed roots can lead to an oral environment prone to decay. A change in our dexterity can make cleaning our teeth more challenging.

Here are some easy preventative strategies you can start today:

Diet

If you enjoy occasional acidy drinks or sticky carbohydrate snacks, go ahead and enjoy them but be smart. Solutions include:

• Consume cavity producing drinks (i.e. soda) and foods (i.e. sticky carbohydrates) all at once rather than sipping and snacking on them all day. This is so the “acid attack” on your teeth is for a shortened period of time. Once you have consumed the cavity producing drink or food, rinse your mouth with water.
• Do not brush right after consuming an acidy drink. Allow 30 minutes to pass so that you don’t scrub the acid into your teeth.
• Use Xylitol gum or lozenges. Xylitol is a natural anti-bacterial agent that targets the bacteria specific to cavities, Streptococcus mutans.

Dry Mouth

While dry mouth caused by low saliva production is uncomfortable and makes chewing and digesting food more difficult, saliva also plays a protective role against tooth decay. Saliva both flushes debris off of our teeth and neutralizes the acids in the mouth. Solutions for a dry mouth include:

• Proper removal of sticky plaque from teeth on a daily basis using a toothbrush and another aid to get between the teeth (this is not always floss!).
• Use toothpaste containing Hydroxyapatite. A calcium-phosphate product (which is what teeth are made of), it will repair early demineralization! Hydroxyapatite can be found in toothpastes with or without fluoride. NOTE: The debate on the pros and cons of fluoride are beyond the scope of this article.
• Use baking soda rinses to neutralize acids. One teaspoon of baking soda to 8 ounces of warm water.
• Use saliva substitutes. These over-the-counter products mimic natural saliva and can be found in lozenges or sprays or gels. The gel-based products work well if dry mouth wakes you up at night. While saliva substitutes won’t neutralize acids or re-mineralize enamel, they do make chewing and swallowing easier and food doesn’t stick to the teeth. Try a few different products to find the one that works for you.

Exposed Roots

Often the roots of the teeth, which in health are inside the jaw bones, become exposed in age due to gum recession. Without the protective covering of enamel, roots are more susceptible to decay. Solutions include:

• Using a toothpaste containing Hydroxyapatite for cavity prevention and to reduce the sensitivity often associated with exposed root surfaces.
• The more gum recession around the teeth, the more space between them; thin floss doesn’t remove the debris and plaque in these spaces. The use of thicker “interdental” cleaners helps. Examples are Proxabrushes, Superfloss and Stimudents.
• Waterpiks are helpful as the pulsing water helps flush debris from larger spaces between teeth.
• Since roots are covered by cementum, which is much softer than enamel, a soft bristled toothbrush is a must. A great manual choice is the Swiss made Curaprox.

Dexterity Changes

Even if you don’t have dexterity challenges, an electric (also called power) toothbrush provides better plaque removal than a manual toothbrush. Solutions include:

• Choose the brand you buy based on budget; you don’t need to purchase the most expensive high-tech brush to improve effectiveness over a manual brush!
• Consider the brush head size. If you have a small mouth or limited ability to open, look for a small brush head size, often the round brush head is smaller.
• As with manual toothbrushes, look for a soft bristle head.
• Change the toothbrush head at the correct interval or it will lose its effectiveness.

Next month Dental Hygiene 101 will cover gum disease.

Join the Conversation:

What dental concerns or questions do you have? What practices have made a huge difference in your oral health?