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Cavities: Dental Decay, Causes and Prevention
Dear Parent,
The following is an adequately detailed summary that if read will help you understand how the dental decay process works and what can be done to minimize it. It is not intended to be a scientific guide to the study of dental decay and its prevention. It is our hope that by reading it, more understanding will be gained on how to care for you child's dental health.
There are 3 general factors of dental decay: Genetics, Oral Hygiene and Diet.
Causes of Dental Decay
Genetics:
How many little pits and grooves are formed in the teeth and how deep they are. Teeth that have many pits and grooves will have more cavities on the biting surface of the tooth then teeth that are very smooth.
How strong the enamel is. Some enamel is stronger than others. If the enamel is weak, cavities will have a tendency to form on the smooth surfaces of the teeth. The smooth surfaces are by the gum line and in between the teeth.
Mal-formed teeth – On occasion, the enamel does not form well on a tooth and has a dark chalk like appearance. The reasons for this are not all known and difficult to determine on a case by case basis. If the tooth has not formed well, it will very easily get a cavity.
Oral Hygiene:
Poor oral care leads to decay because the plaque that is made of both bacteria and food is allowed to stay on the teeth. The bacteria eat the food that is in the plaque, produce acid and this acid dissolves the first layer of the tooth called the enamel. Once the enamel has been destroyed by the acid, the dentin starts to be effected and a cavity forms. The cavity must be restored at this time for it will no reverse itself.
Diet
Frequency of food intake: The frequency of food intake is a very important factor in the development of cavities. The more frequently food is allowed in the mouth the more it is also available to the bacteria. The bacteria convert the food to acid and start to dissolve the enamel of the tooth.
Type of food eaten: Bacteria eat the sugar, a subgroup of the carbohydrate food group (Basic Food Energy Groups are: Fats, Protein and Carbohydrate.) The more intake of sugar, especially the refined sugar sucrose, the more bacteria will have access to the food that they so efficiently convert to acid and then dissolve the tooth.
Prevention of Dental Decay
Genetics
Pits and grooves in the teeth: A sealant can be applied to fill the pits and grooves making it difficult for food to get stuck in the pits and grooves and then cause decay. It is now a common practice by most dentists who treat children to place a sealant on the first and second permanent molars. Patients with deep pits and groves that are prone to decay will benefit from having a sealant placed on permanent pre-molar teeth and primary (baby) molar teeth. Dental insurance generally will cover the cost of sealants placed on the first and second permanent molars.
Weak Enamel: Fluoride. The regular use of fluoride strengthens the enamel making it harder for the acid produced by the bacteria to destroy the tooth It has been firmly established that people who live in an area where there is optimal fluoride in the water (1ppm) have 50% less decay on the smooth surfaces of the teeth. Prolonged fluoride concentrations of the 4ppm or higher can cause cosmetic damage to teeth but still have protective effects against decay. Very high doses of fluoride will cause acute poisoning and the outcome can be fatal. For this reason, it is important the patients of the toddler age be closely monitored while using products that contain fluoride.
Oral Hygiene
The plaque should be removed on a regular basis from the tooth surface. For a normal patient who is not a high risk for developing cavities, twice daily tooth brushing should be adequate if performed correctly. It is generally recommended, that the teeth be brushed in the morning after breakfast and at night after eating or right before going to bed. For patients who have teeth that are tight together and the toothbrush can't reach in between the teeth, flossing should be performed at least once daily. Use of dental floss is the only way to remove the plaque in between the teeth where cavities are likely to form. Individuals younger than the age of 5-6 years will not have the motor coordination to brush and floss their teeth adequately so the care giver must perform this function.
Diet
Frequency should be limited as much as possible. Generally, the older the child becomes, the less frequently eating is required. I recommend for those patients old enough to do so be placed on a meal schedule that includes 3 meals per day plus 2 or 3 snacks. Nothing in between meals and snacks accept water. Have juice at meal and snack time only. Children that are allowed to "graze" all day long in front of the T.V. eating candy and drinking soft drinks will have much greater risk of getting cavities than children on regular meals. Eating at regular intervals allows the high concentrations of acid in the mouth to be limited to the meal times only. In between the meal times, the saliva can wash the acid out and acid levels decrease until the next meal.
Try to limit refined sugars if possible. Good snacks low in sugar are pizza, sugar-free Jell-0, crackers, popcorn, and cheese. Cola type soft drinks are about the worst food to eat because they are high in sugar and contain acid.
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