Did you ever go to a dentist who didn’t want to drill your teeth? We don’t!
Drilling and filling “fixes” a decayed tooth but does nothing to prevent the tooth from decaying in a different spot or other teeth from decaying in the future. Decay is a disease caused by bacteria. It is even contagious, meaning it can be transmitted from one person to another. A mother with decayed teeth can transfer these bacteria to her children. Not all people with decay-causing bacteria, however, get cavities. There are other factors involved. Understanding the role of bacteria, and these other factors, enables us to treat decay like any other disease. We can, for the first time, medically prevent cavities before they form, and reverse decay, or “heal the tooth”, if decay is discovered early enough.
Simple in-office saliva tests identify decay-prone patients. High-tech instruments detect decay too small to be seen on x-rays. New medications can reverse these cavities and prevent re-occurrence.
1 – How Tooth Decay Happens
Dental caries (decay) is a bacterial infection.
Tooth decay is caused by certain types of bacteria (mutaans streptococci and lactobacilli) that live in your mouth. When these bacteria attach themselves to the teeth and multiply in dental plaque, they can do damage. The bacteria feed on what you eat, especially sugars (including fruit sugars) and cooked starch (bread, potatoes, rice, pasta, 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 can penetrate into the hard substance of the tooth and dissolve some of the minerals (calcium and phosphate). As the minerals dissolve, this part of the tooth becomes softened and a cavity begins.
But decay is not inevitable. Several factors influence this process: Eating less frequently results in fewer acid attacks of shorter duration. Your saliva can repair the damage by neutralizing the acids and supplying calcium, phosphate and fluoride to replace those lost from the teeth.
However, if your mouth is dry, or you have a lot of decay causing bacteria, or you eat often, then the tooth mineral that is lost by the attack of the acids is too great and you get a cavity.
There is a continuous battle on the surface of the tooth between demineralization (softening) and remineralization (hardening).
Demineralization is the loss of mineral from the tooth as a result of the attack of the acids produced by the bacteria described above. The acids produced in the plaque diffuse easily into the tooth- dissolving calcium and phosphate as they go. The calcium and phosphate diffuse out of the tooth and, if this process continues long enough, a cavity results.
Up until a hole is formed, the process can be reversed by remineralization in which the calcium and phosphate present in saliva diffuse back into the tooth to solidify it.
Remineralization is the natural repair process that replaces some of the mineral lost during the formation of a cavity. The mineral that is replaced is stronger than the original mineral.
This process of demineralization and remineralization is the decay balance. There is a contest between decay causing factors and protective factors.
2 – The Decay Balance
The decay balance is like a seesaw. If one side is stronger than the other, you either get decay or prevent decay.
Decay Causing Factors
- Acid producing bacteria
- Below normal salivary flow, which can be caused by medical conditions, treatments and drugs
- Frequency of eating and drinking fermentable carbohydrates like sucrose, fructose, glucose, and cooked starches
Protective Factors That Prevent Decay
- The amount of saliva and its contents
- Fluoride, calcium and phosphate that repair and strengthen damaged tooth structure
- Antibacterial medications (that reduce the acid-producing bacteria)
This new scientific understanding of the decay process has changed the way we look at cavity prevention and treatment.
An analysis of the balance can be used to assess the risk of an individual developing decay in the future, to determine why a person has decay now, and to prescribe specific treatments that reverse small cavities or prevent the formation of new ones. The balance between demineralization and remineralization is the key to progression or reversal of decay at any time. We can intervene to tip the balance by limiting the frequency of eating fermentable carbohydrates, by controlling the bacteria, by adding fluoride, and by maintaining an adequate flow of saliva.
However, when the bacterial count is too high, fluoride and diet control are insufficient. Medications are necessary to reduce the number of bacteria in the mouth. If we only follow traditional dental guidelines, placing a filling does not reduce the overall bacteria in the mouth. It removes the bacteria from that specific cavity, but does nothing to reduce the bacteria affecting the other teeth.
With this in mind, our examinations no longer just check for decay to treat. We no longer watch small cavities while they get bigger. By identifying those patients who are prone to decay, and reducing their decay-causing factors, we can prevent decay before it occurs, and reverse small cavities before they get bigger.
3 – New Decay Detection Procedures
In addition to the other parts of our routine examination which includes an analysis of the jaw joints (TMJ), a soft tissue evaluation or oral cancer screening, and periodontal probing and pocket charting, we now perform the following procedures to scientifically diagnose decay:
- Traditional visual exam
- Low dose, high contrast digital x-rays
- The Diagnodent (Laser Caries Fluorescence)
- Caries Risk Assessment Form – questionnaire that places patients at high, moderate or low risk for decay. If a patient is placed in a high or moderate risk category, further testing is indicated.
- CRT Test (Caries Risk Test) is done by culturing a sample of saliva to measure the amount of decay-causing bacteria present.
- Salivary Flow Test (measures the volume of saliva)
4 – Treatment and Medications to Prevent or Reverse Decay
Decay management by risk assessment emphasizes prevention and decay reversal.
Among the treatments we may recommend to increase the protective factors are:
- Diet counseling
- Fluoride applications in the office or at home or both.
Fluoride stops demineralization and combines with the calcium and phosphate to make the remineralized tooth stronger, and less susceptible to further decay. Fluoride works primarily on the surface of the teeth and is applied effectively in drinking water, over-the-counter toothpastes ,like Act or Fluorigard, or in prescription strength in-office and home gels, like Prevident 5000 Plus
- Xylitol-containing gum or lozenges. Xylitol, a naturally occurring substance, is used in some foods and dental products as a sweetener. Daily use lowers the level of decay causing bacteria in the mouth and also inhibits the transfer of bacteria from one person to another by altering the way bacteria stick to surfaces. Chewing sugar-free gum containing Xylitol also stimulates essential salivary flow.
- Antibacterial rinses – In moderate to high-risk patients, the overall bacteria level in the mouth must be reduced, to give the other treatments a chance to work. Antibacterial preparations, such as the Oxyfresh system which we dispense, as well as prescription strength Chlorhexidine (Peridex) are effective.
- Dental sealants- A dental sealant is a clear or shaded plastic material applied to the chewing surfaces of the back teeth. Sealants provide a barrier to prevent decay where it most often occurs. Tooth decay (dental caries) is the most widespread dental disease among children. However, we can help prevent or reduce the incidence of decay by applying sealants to young patients’ teeth. When the back teeth are developing, grooves called pits and fissures form in the chewing surfaces. They are snug places for plaque and bits of food to hide, because the bristles of a toothbrush cannot reach into them. Fluoride, which is effective decay prevention for the smooth surfaces of the teeth, is no match for the pits and fissures of the back teeth. By covering the pits and fissures with sealants, food and plaque are kept out, thereby greatly decreasing the risk of decay.
5 – Continuing Care
Meticulous home care must be maintained, and our recommendations followed. Patients are placed on a 3 to 6 month schedule of follow-up care in the office. At each visit, the teeth are cleaned and the decay balance evaluated, with CRT and salivary flow testing and a Diagnodent examination.
With careful monitoring, supportive therapy and diligent home care, decay can be prevented or reversed, and, when necessary, conservatively treated.