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What Causes Cavities on Teeth
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If you’re like most people, you may believe that sugar causes cavities.  After all, candy is bad for our teeth, right?

Sugar doesn’t cause cavities.  In fact, this has been known for over 50 years!

In 1954, a man by the name of Frank Orland wanted to see if sugar caused cavities.  He conducted a pioneering research study, in which he raised 22 rats in a sterile environment.  From birth ’til death, these rats never had any contact with any germs.  He fed these rats lots of sugar throughout their entire life.

Guess how many of these rats that ate sugar every day ended up getting cavities?

Zero.

None of the rats that were raised “germ-free” got any cavities even while they were eating all of the sugary foods that they wanted.  In contrast, 38 of the 39 rats that ate the same foods but were not raised “germ-free” ended up getting cavities.

Part of his conclusion states, “Findings indicated that twenty-two rats reared under germfree conditions remained entirely free of even microscopically demonstrable dental caries. Of thirty-nine conventional control rats, possessing the usual mixed microbial populations, thirty-eight developed various lesions when maintained on the same kind of dietary regime as the germfree animals. It is deduced from this evidence that dental caries in the rat is not possible in the absence of microorganisms.”

If you only looked at Dr. Orland’s study, you may be tempted to say that it must be bacteria, and not sugar, that causes cavities.

More recently, other studies have shown that it’s possible for rats with bacteria to not have any cavities if they are not fed sugar or fermentable carbohydrates.

These studies lead us to believe that bacteria and sugar must be present in order to get cavities.  But even these two elements don’t account for the whole picture.

For example, my wife never had a cavity in the first 25 years of her life.  Like most normal people, she ate sugar and had bacteria in her mouth.

So, what really causes cavities?  There are actually four components that, when present together, cause cavities:

What Causes Cavities?

In order to get cavities, you need to have four main ingredients:

1 – Sugar
2 – Bacteria
3 – A Susceptible Tooth
4 – Time

You can take a look at this relationship in the diagram below.  If you’re interested, you can then read about how you can use this information to prevent cavities.

4 Causes of Cavities & Tooth Decay

 

1 – Sugar

For simplicity’s sake, I labeled this category as sugar.  In reality, it could be called refined carbohydrates because anything that can be broken down into sugar inside of your mouth is able to feed the bacteria that contribute to causing cavities.

For example, potato chips are made of a simple starch that can be broken down into sugar by enzymes that are found in your saliva.  How often you eat sugar is more important than how much sugar you eat in one sitting.

To learn more, read What Happens In Your Mouth Every Time You Eat or Drink, What Fermentable Carbohydrates Are & How They Hurt Your Teeth, and 50 Names for Sugar that Food Makers Use to Trick You.

2 – Bacteria

Bacteria live inside all of our mouths (unless you’re one of the rats in Dr. Orland’s study!)  It’s really fascinating to me that there are millions of little creatures living inside of everyone’s mouth — this is what first got me interested in dentistry and was the subject of my first article here at Oral Answers, What Every Human Needs to Know About Plaque.

While you can’t completely rid your mouth of all the bacteria, you can destroy the homes they build on your teeth every time you brush and floss.  By regularly brushing and flossing, you can help win the fight against the bacteria in your mouth.

3 – A Susceptible Tooth

Many people who have had their share of cavities say that they have soft enamel or that  bad teeth run in their family.  While there’s no such thing as soft enamel, people can have enamel that may not have been formed correctly.  Also, bad teeth aren’t genetic, but some people’s teeth do have deeper pits and grooves than others.

These pits and grooves can be so deep that even a bristle on a toothbrush can’t reach down to clean them out.  In these cases, these people will almost always get cavities unless they have had sealants placed on these teeth when they were kids.

There are many other factors that influence how susceptible a tooth is to getting cavities.  I will only go over a few of the more common ones.

The first is the quality and amount of the dental enamel.  Pinkham’s Pediatric Dentistry text states that enamel hypoplasia (when not enough enamel forms), even at levels that are undetectable,  increases susceptibility to tooth decay.

Saliva also plays an important role in how susceptible a tooth is to decay.  The more saliva you have, the better.  To learn more about the role that saliva plays in your oral health, read How Saliva Protects Your Teeth and Six Main Causes of Dry Mouth/Xerostomia.

The last factor I will discuss that makes your tooth more susceptible to cavities is the wearing away of tooth structure.  This commonly occurs through the process of acid erosion, which can occur by drinking these nine teeth-dissolving drinks, however there are four ways that you can wear away your teeth.

4 – Time

Darius Rucker sang the following words Hootie & The Blowfish’s hit Time back in the 90’s

Time, Why you punish me? Like a wave crashing into the shore, you wash away my dreams.

Time can in fact wash away your dreams of having healthy teeth if you give the bacteria enough time on your teeth.  In fact, you can have all three elements above and not get cavities if you don’t give the bacteria time to eat away at your tooth.

Plaque eats sugar, which produces acid that slowly eats away at your susceptible teeth.  The key is to not give the bacteria enough time on your teeth.  You can do this by brushing and flossing regularly.

To learn more, read the article Try to Keep Your Teeth Below Freezing.

Conclusion

Cavities don’t just happen spontaneously.  You need four things to get cavities: sugar, bacteria, susceptible teeth, and time.

You can’t really control the bacteria unless you live in a sterile environment.  You also can’t control the genes that sculpted your teeth into their exact formation that might make them hard to clean. You can control how much sugar you eat, your oral hygiene, and how well you treat your teeth (don’t treat your teeth like tools!)

Do you have any questions, stories, comments, or concerns about what really causes cavities?  I’d love to hear them in the comments section below.  Thanks for reading!

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Five Ways to Get Better Teeth
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Many people think they’re taking great care of their teeth. They brush and floss, but they still end up having problems.

I wrote this post with those people in mind: the ones that want to have better, healthier teeth, but don’t know quite where to start. Even if you know that you’ll end up needing crowns or veneers on your teeth, it’s important to have excellent oral hygiene so that your future dental work will last a long time.

Here’s five simple things you can do to get better teeth.

How to Get Better Teeth: 5 Things You Can Do Today

How to Get Better Teeth1 – Floss

Many people don’t want to floss because they think it’s too hard. Before I talk any more about flossing, go ahead and read the following quote from Kevin McCallister in Home Alone:

I took a shower washing every body part with actual soap; including all my major crevices; including inbetween my toes and in my belly button, which I never did before but sort of enjoyed.

Neglecting to floss is like simply taking a shower without cleaning all of your major crevices!

Learn more about the right way to floss by reading these 10 flossing mistakes.

2 – Brush for At Least Two Minutes

How long do you spend brushing your teeth every day? A lot of people only brush for 30 seconds or so.  By brushing for two minutes, you will allow the fluoride in your toothpaste to spend more time providing your teeth with its many benefits.

When you brush, do you remember to brush all sides of your teeth?

3 – Only Eat Sugar with Your Meals

Every time you eat, the pH in your mouth drops to a level where it can hurt your teeth. You can see a graph of this process in the article What Happens in Your Mouth Every Time You Eat or Drink.

The more times you eat in a day, the more times your teeth get hurt.  By eating your sugary snacks with a meal rather than on their own, you will be reducing the number of times that your teeth come under attack.

You can try substituting fruit or vegetables for a sugary snack or simply have a great-tasting chewing gum.

4 – Don’t Sweeten Your Coffee & Tea With Sugar

Try sweetening your drinks with xylitol or an artificial sweetener.  The bacteria in your mouth would love to get their hands on some sugar so they can hurt your teeth.  If you starve them, you’ll have better teeth!

Learn more about what xylitol is and how it protects your teeth.

5 – Don’t Drink Soda Pop In Between Meals

The main theme of the last three items on this list is that sugar is an enemy to your teeth.  Soda pop combines sugar and acid to wreak havoc on your teeth.

If you’re thirsty between meals, water and milk are good choices, and I’m not the only one saying that: the textbook Dental Caries by Fejerskov agrees with me.  It says, “Water and milk are safe drinks between meals.”

Ideally, you would cut soda pop out of your diet, but who wants to do that?!  If you absolutely must have your sugary, carbonated fix, check out these guidelines on how to drink soda pop and keep your teeth happy.

Conclusion

Hopefully you can try at least one of these five suggestions so that you can be on your way to having better teeth.

Do you have any questions or comments about how to get great teeth?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

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Brush All Sides of Your Teeth
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Not long ago, I did a cleaning on one of my patients and found something very similar to what I find in most of my patients — that this particular patient takes a lot better care of the side of the teeth that he can see in the mirror than the back (tongue) side of the teeth.

Brushing TeethMaybe you do the same thing.  Many years ago, some researchers spied on 85 adolescents brushing their teeth.  They found that people spent the most time brushing the sides of the teeth that you can see, a moderate amount of time brushing the biting surfaces, and the least amount of time brushing the tongue-side of the teeth!  Interestingly, the kids also spent more time brushing the lower teeth than the upper teeth.

Another study videotaped tooth brushing behavior in people aged 5 to 22 and found that less than 10% of the time was spent brushing the tongue-side of the teeth.

Why Do We Not Brush the Tongue Sides of Our Teeth?

I think we spend less time brushing the tongue-side of our teeth for a couple of reasons:

1 – We tend to focus more on cleaning the sides of the teeth that we actually see.
2 – It’s easier to brush the front side of the teeth without the obstruction of a tongue.

It seems that the more difficult something is to do, the less likely people are to do it. I think this goes along with the two reasons most people don’t floss: It’s too hard and they can’t see in between their teeth.

Speaking of flossing, are you making one of these 10 common flossing mistakes?

Do You Really Need to Brush the Tongue Side of Your Teeth?

Brushing the tongue-side of the teeth is very important.  If you don’t brush this surface of your teeth, you let the bacteria in your mouth grow on your teeth.  This can eventually cause cavities or destroy the bone that holds your teeth in your mouth.

If you’re not brushing away the plaque daily, then it can harden.  Once the plaque has hardened into tartar or calculus (click to see a picture of tartar), it can only be removed by a dental professional.  More often than not, we have to spend a lot more time removing tartar from the tongue side of the teeth when patients come in for their dental cleanings.

Conclusion

If you’re not sure if you brush the tongue side of your teeth, you can ask your dentist how you’re doing.  It might also be helpful to get some plaque disclosing tablets (be careful, some plaque disclosing solutions don’t actually highlight plaque!) and a dental mirror at a pharmacy and check for yourself.

Another helpful hint is to time how long you spend brushing the front side of your teeth and then make sure you spend just as much time brushing the tongue-side of your teeth.

Do you have any questions about brushing your teeth or dental hygiene in general?  I’d love to hear your questions, comments, and concerns in the comments section below.  Thanks for reading!

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Do You Cause Your Child's Cavities?
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It’s sad to see a two year old child with horrible teeth.  At such a young age, children don’t really understand oral hygiene.  Many times, poor oral hygiene in a toddler is the result of parents who don’t understand oral hygiene.  Since most cavities are preventable, this topic fascinates me.  With children of my own,  I have done quite a bit of research on the oral hygiene of toddlers.

The American Academy of Pediatric Dentistry publishes various “policy papers” which inform the world the status of their position on certain issues.  In their paper entitled Policy on Early Childhood Caries (ECC), they spell out five mistakes that parents make that can have a detrimental effect on the oral hygiene of their children.

I’ll list those five mistakes and talk about what you can do as a parent to avoid hurting your child’s teeth.

Smiling Toddler Girl With Teeth

Five Mistakes That Can Give Your Child Cavities

1 – Putting infants to sleep with a bottle that contains sugar. Pretty much any drink that you would give your child to lull them to sleep contains sugar.  Fruit juice and milk both contain sugars that can cause plaque to fluorish and eat away their teeth.

If you must put your child to sleep with a bottle, the only safe beverage to fill it with is water.

2 – Breast feeding on-demand after your baby’s first tooth comes in. The book Pediatric Dentistry by Pinkham states the following:

Infants who are breastfed truly “on demand” may suckle 10 to 40 times in a 24-hour period and are at risk for the consequences of prolonged acid production.  Nevertheless, many feel that the benefits of breastfeeding outweigh any harmful effects.  Dentists should advise mothers who breastfeed on demand to clean their infant’s teeth frequently, verify that systemic fluoride intake is optimal, and monitor dietary habits carefully.

Each time your baby eats, you expose his or her teeth to the harmful acids that plaque produces.  By setting a schedule to feed your baby, you can drastically reduce the opportunities that bacteria have to cause trouble in your child’s mouth.

3 – Not weaning your child from a bottle after they turn one. The American Academy of Pediatric dentistry says that “Parents should be encouraged to have infants drink from a cup as they approach their first birthday.  Infants should be weaned from the bottle at 12 to 14 months of age.”

When a child drinks out of a cup, they can drink the same quantity of liquid much more quickly than if they were drinking out of a bottle.  By not weaning your toddler from a bottle or sippy cup, you will increase the amount of time that their teeth are exposed to the sugar in their drinks, and increase their risk of getting cavities.

Although it may seem impossible to have your one-year-old child drink out of a cup, it is possible with the right training.   My wife and I began training our daughter to drink out of a small glass when she was 9 months old.  Her first glass was actually a shot glass with a small amount of water.  [Note: Neither my wife nor I drink alcohol, so we bought shot glasses for this very purpose.]  She still used this sippy cup to drink out of as well, but we gradually introduced a real glass, helping her at first.  After a while, she started to catch on.

Now, at fourteen months of age, she can independently drink out of this glass without spilling.  You might wonder why we used a real glass since it is breakable, but after she saw what happened when you drop it on the floor (which we promptly cleaned up) she hasn’t dropped another one!

4 – Habitually giving your child sugar-containing liquids in a bottle or no-spill training cup.

A paper by the American Academy of Pediatrics entitled The Use and Misuse of Fruit Juice in Pediatrics states:

It is prudent to give juice only to infants who can drink from a cup (approximately 6 months or older). Teeth begin to erupt at approximately 6 months of age. Dental caries have also been associated with juice consumption.  Prolonged exposure of the teeth to the sugars in juice is a major contributing factor to dental caries. The AAP and the American Academy of Pedodontics recommendations state that juice should be offered to infants in a cup, not a bottle, and that infants not be put to bed with a bottle in their mouth.  The practice of allowing children to carry a bottle, cup, or box of juice around throughout the day leads to excessive exposure of the teeth to carbohydrates, which promotes development of dental caries.

5 – Giving your child between-meal snacks and prolonged exposures to foods and juice or other beverages containing fermentable carbohydrates.

The Vipeholm Study was able to show us that it’s not just the amount of sugar that someone eats, but also the frequency with which the sugar is consumed that can cause tooth decay.

If you’re not sure what the Vipeholm Study is, you can read the article The Vipeholm Study: Learning About Dental Cavities.

If you can decrease the number of snacktimes that your child has per day, you will decrease the number of times that their teeth are weakened by the acidic by-products of plaque.

Conclusion

By following the above tips, you can ensure that your child will have healthy teeth.  Healthy teeth are valuable to a child’s self-esteem and overall health.  Following these tips can also start a habit of healthy eating that will remain with them throughout their life.

Do you have any questions or comments about your baby’s dental and oral health?  Please leave them below in the comments!

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Cookies - Fermentable Carbohydrates
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Fermentable carbohydrates.

You may have heard that phrase before and wondered what it means.  In this article, I’ll let you know what fermentable carbohydrates are and how they can hurt your teeth.

What Are Fermentable Carbohydrates?

Fermentable Carbohydrates Cookies and MilkCarbohydrates are sugars and starches.  They are a major source of energy for humans.  When we something with sugar or starch, like white bread, the residues can stick around in our mouth.  These carbohydrates are then broken down by the bacteria that live in our mouth through a process called fermentation.

So, fermentable carbohydrates are simply carbohydrates that can be broken down into acid by the plaque in our mouth.

How Fermentable Carbohydrates Hurt Your Teeth

Fermentable carbohydrates are broken down into acid.  The acid can then dissolve your teeth until it is eventually rinsed away by your saliva.  Luckily, our saliva can repair the damage by laying down new calcium to replace the tooth structure that was lost.

For more on this, read the article Keep Your Teeth Below Freezing.

What Contains Fermentable Carbohydrates?

Fermentable carbohydrates are found in anything that is sweetened with sugar, high fructose corn syrup, or any one of 50 other names for sugar.  Many of the starches that we eat are broken down into sugar in our mouth.  If you take a bite of bread and chew on it long enough, you’ll notice that it begins to get sweet.  This is because our spit has an enzyme called salivary amylase (ptyalin) that breaks down starch into sugar.

You might be interested in reading about the five sugars that hurt your teeth.

Conclusion

Fermentable carbohydrates are called fermentable because the bacteria (plaque) in our mouth can break them down into acids that ruin our teeth.  Brushing and flossing our teeth daily can remove the bacteria from off of our teeth and limit the amount of fermentable carbohydrate that gets turned into tooth-dissolving acid.

If you have any questions or comments about fermentable carbohydrates, feel free to leave them below in the comments section.

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Toothbrush Sanitizers Toothbrush Germs
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When I was a kid, one of my teachers once told our class that bacteria from human waste in the bathroom could find its way on to our toothbrush.  Later that day, I went home and moved my toothbrush as far away from the toilet as I could.

Toothbrush SanitizerIt has also recently been shown that bacteria can grow on our toothbrush when it’s just sitting in the bathroom and not being used.

It is reasons like these that many people are looking into purchasing toothbrush sanitizers.

I’ve often wondered if they are really worth it.  Sure, there is bacteria on my toothbrush.  Has it ever made me sick?  Probably not.  That is why I personally don’t use a toothbrush sanitizer.  I figure if it’s not broken, there’s no point in fixing it.  However, I’ll be the first to admit that I sometimes do things the wrong way.

In looking at the effectiveness of toothbrush sanitizers, we need to ask ourselves two questions:

  1. Do toothbrush sanitizers kill bacteria?
  2. If they do kill bacteria, does it really make a difference?