We have a guest post today! Dr. Zachary Taylor is an expert in general and cosmetic dentistry and has given extensive research to understand the relationship between dental health and his patient’s overall health, which has shaped his practice into one heavily focused on preventive care and overall oral health and stability. Dr. Taylor has amazing insights into the complex world of cavities, he is straightforward and honest. So if you are someone who fears the dentist and often has cavities you need to read what Dr. Taylor has to say.
Are you a person that seems to always get cavities? Are you confused every time you leave the dentist office because you seem to need a couple fillings every year? Let me tell you, you are not alone. You may even question the skill or integrity of your dentist, but let me explain what may be happening before you get more frustrated.
What most people call cavities, we dentists call CARIES. Caries is the technical name of the disease. Wait, what? Disease? Yes. In fact, caries, or cavities is an actual disease, caused by bacteria and is contagious (that’s right- you can spread cavities to other people via the spread of bacteria in your mouth). Here are some facts about this disease.
And here are some other facts to tease your brain over the cause of this disease. We’ll get into how all of these things are related later.
CARIES THE DISEASE
First, unfortunately most dentists don’t take the time to learn exactly what this disease is and how we might best treat and manage it. We certainly don’t get enough information in dental school to really understand caries, which is frustrating considering dental school is supposed to teach us the fundamentals of our profession.
THIS IS WHAT I WAS TAUGHT IN DENTAL SCHOOL*: PLAQUE = CAVITIES
*By-the-way this is not meant to insult Creighton University. I believe Creighton is one of the best dental schools in the country.
I learned that bacteria caused cavities and if people would just brush and floss their teeth to eliminate bacteria, they wouldn’t get cavities. So when I started my practice and saw a patient who had a cavity, this is how our conversation would typically go:
I would tell the patient they have a cavity and they need a filling to fix it. Then I would proceed to give them oral hygiene instructions to ensure they understood they needed to brush and floss more in order to remove more plaque. Then they would tell me, “But Dr., I brush every day, twice per day, and I floss almost every day.”
Well, they have a cavity, so I would automatically think they were lying to me. I would proceed to ask them how they are brushing and flossing to make sure they understood that they just weren’t doing those things correctly.
Seriously?! Sadly, I admit, it took me a few years and a lot of continuing education to start to understand the caries disease process. I have many patients who are extremely meticulous about cleaning their mouth and yet are still fighting this disease while getting carious lesions every year. IT’S NOT JUST ABOUT PLAQUE . Caries is a multifactorial disease, but all these factors have one common denominator – ACID.
FIGHT AGAINST DRY MOUTH FOR BETTER SALIVA PRODUCTION AND ACID NEUTRALIZATION
Many patients of mine suffer from a lack of saliva (dry mouth) as a common side effect to many medications. Remember the stats above? 25% of Americans take FIVE or more medications EVERY DAY! How many of those medications have a side effect of “dry mouth”? Probably every one of them. Most of these patients are aware they have dry mouth but some are not.
YOU MAY HAVE DRY MOUTH IF YOU ANSWER YES TO A MAJORITY OF THESE QUESTIONS…
Do you find yourself sipping water throughout most of the day? Do you wake up with a severely dry mouth? Do your cheeks sometimes stick to your teeth or does your tongue sometimes stick to the roof of your mouth? These are signs of dry mouth. If you suffer from these things and get cavities frequently – DON’T FEEL ASHAMED. You do not have a dirty rotten mouth. You probably take very good care of your mouth. But you are definitely experiencing dry mouth and therefore fighting an uphill battle.
Some patients don’t take medicine but develop a dry mouth after menopause or for men after the age of about 60. This problem is a common development as we age. For example, one of my patients had been disease free for over ten years. She had impeccable oral hygiene. During one of her last exams I found ten teeth (TEN!!) that were decayed and needed treatment. What changed? – Medications and age changed the amount and content of her SALIVA.
If you’re sucking on hard candies to cure your dry mouth, you’re only compounding your caries problem. Instead, consider sucking on xylitol mints and chewing xylitol gum throughout the day; specifically 10 mints and/or 6 pieces of gum.
WHAT YOU’RE DRINKING ON A REGULAR BASIS WILL HAVE A HUGE IMPACT ON YOUR MOUTH’S ACIDITY
Some people are more prone to caries because of their diet – and I’m not just talking about sugar. But remember the sugar facts from above? The average American consumes 23 teaspoons of sugar daily and 51 POUNDS of high fructose corn syrup per year! On top of that, I wonder how many energy drinks and sports drinks like Gatorade we consume.
I find myself sometimes asking patients what they specifically eat and drink; I want to know EVERYTHING they eat and drink, especially if they are all of the sudden getting cavities or if they regularly have a mouth full of cavities.
Much of our high fructose corn syrup intake and sugar intake comes from soda. Soda, energy drinks, and Gatorade are the devils in dentistry. Not only do they contain sugar, which decay-causing bacteria love, but they are also highly ACIDIC. You may be thinking “Well what about diet soda?” Though lacking in sugar, these drinks present a world of problems on their own for your body. Regardless of their sugar content, they’re still just as acidic as regular soda and thus will cause the same damaging problems for your teeth. Check out the list at the end of this post that shows the pH of some common drinks. You’ll be amazed.
OTHER HEALTH PROBLEMS TO WATCH OUT FOR THAT PRODUCE AN INCREASE IN ACIDITY IN YOUR MOUTH
Some patients of mine are under acid attack not just from what they eat and drink but also from acid reflux disease . These patients commonly understand the risks associated with acid reflux regarding their systemic health, but rarely do they think about what that stomach acid is doing to their teeth. Stomach acid will literally dissolve your teeth. If you have frequent heartburn, this is also something you should let us know. Frequent heartburn is often a symptom of acid reflux disease. Acid reflux disease increases your risk for esophageal cancer as well, so it’s wise to see your general physician about managing acid reflux with medication.
Another factor to consider is your genetics. Again, in school we were taught this was a disease of plaque and many professors still today may say genetics do not play a role in your dental health but I completely disagree. Research has actually been able to map a gene that is related to getting cavities on your lower front teeth. Some patients tell me that their parents had bad enamel and that they think they might also have bad enamel. Some patients I see simply have teeth that developed without a sufficient amount of or sufficiently hard enough enamel to protect their teeth from acid attack.
CAN CARIES BE CURED?
Yes, of course! If you have caries disease (in other words, if you have some cavities) you get rid of the caries by REMOVING decay and SEALING the teeth. This is the process of filling the hole with a composite filling or replacing the tooth with a crown or onlay.
Occasionally a cavity will be placed on “watch” instead of cutting into the tooth and immediately repairing the cavity. This is a more complex process that it may seem. We’ll take into account the patient’s past caries history and their current caries risk . If they’re a patient who hasn’t had a cavity in 20 years; if they don’t have any crowns, root canals, or missing teeth; and if they don’t have a lot of plaque on their teeth then we can assume a small dark spot on the x-ray could be caries or could be arrested caries (tooth decay in which the area of decay has stopped progressing and infection is not present). In this case, we would decide to just take note and keep an eye on the spot rather than unnecessarily repair the enamel.
However, if the patient has had other cavities in the last few years, has multiple crowns and root canals, and/or is missing teeth then that same small dark spot on the x-ray would be more alarming and would probably warrant repair. Deciding which caries to treat and which to “watch” is a pure judgement call but should be based on the patient’s history and current risk.
Once you’ve been diagnosed and treated, your next step is to attempt to decrease your risk for future caries by brushing, flossing, having professional cleanings, and watching what you eat and drink.