Dental Decay part two

Once again, lets take a look at the decay model, this time shifting more toward the right, toward demineralization and decay. We are now going to break down all the components that will determine which direction this scale will tip toward. And remember - your teeth hang in the balance!

Dietary Acids

So now you should understand that it is very important to know which foods are acids or acid producers and to choose your dietary habits accordingly. But this is a real challenge because just about everything we eat produces acids in the mouth either directly or indirectly. If you click here, you can go to a website that shows how challenging it is to avoid acids in your diet. This is about the most comprehensive list of dietary acids and bases I have ever seen.

And just avoiding the acidic foods is not enough. To make matters worse consider this: sugar turns into acid in the mouth. And starches turn into sugars which turn into acids in the mouth. These starches and sugars are collectively called Fermentable Carbohydrates seen on the scale to the right and to eliminate them from your diet completely is nearly impossible. Today virtually every processed food is packed with sugar of some sort and really what are munchies when you think about it but starches and sugar!

It may be hard to limit all these things in your diet, but you can control the frequency in which you eat them. The time between eating anything acidic or acid producing is critical if we want the pH to go back to normal and remineralize our teeth. So, if we ingest anything that lowers the pH of our mouth then  we must give the saliva time to neutralize those acids before we attack it with acids again.

In other words how frequently you eat these acids and acid producers may be more important than whether you eat them or not.

It takes only 45 minutes for the mouth to regain pH neutrality. So if you had French fries and ketchup, a candy bar or pastry, and washed it down with a soda then your pH will have plummeted down somewhere in the 2.0 range. But if you let the saliva do its job, you can get back to neutral pretty quickly - as long as you don't introduce more acids in the meantime.

Needless to say you also have to remove any food particles from the teeth to allow the saliva to neutralize as quickly as possible. If you don't, then the calcium and phosphate minerals have a real hard time getting back into your tooth and - just like that - they begin to demineralize and ultimately decay. 

 

Oral Plaque and Acids

Now that you know the benefits of saliva then it begs the following question: were we given saliva because evolution anticipated that we would be eating alot of starches, acids and sugars? 

Not even close. In fact if you study the diet of early humans we had no access to any of these things in nature. Most of the acid producers in our diet are the product of civilization and the modern addiction to sugar. In early times we ate no grains at all and sugars were only what we found in limited supplies of fruits and vegetables, while most of our foods were meats and fats.

So then it begs this question: why were we born with saliva that has minerals that keep the mouth neutral?

The answer: because acid producing bacteria are always present in the mouth.

From the moment we parted our lips to let out our first cry, bacteria jumped right in, and continues to do so throughout our lifetime. Evolution decided that this would be a good thing as long as we put the bacteria to work helping us to digest our food. The digestive process begins as soon as food comes into our mouths and therefore into contact with these bacteria and the enzymes and acids which they produce.

These little chemical factories will break down sugars and starches and proteins and allow our stomachs and intestines to do their jobs so much easier. The end result is that we are able to properly extract the nutrients from our food, the definition of digestion.

The only problem is that these bacterial chemical factories never turn off. So acids are constantly being produced whether we are eating food or not. Because the bacteria are ever present and the acids they produce  are inevitable - acids which will damage our teeth - we were given saliva along with the calcium and phosphate minerals contained within it to neutralize this problem..

For this reason, despite the destructive power of plaque, our oral pH remains at a steady 7.0 which is neither acid nor base. And for this reason, the minerals in our teeth remain intact with the scale above tipped to the left. And if per chance demineralization begins to occur, the saliva is a handy source to resupply these important minerals back to our teeth.

 

The Effects of Poor Plaque Control

However if plaque is allowed to sit on the teeth for long periods of time it begins to change and becomes more dangerous. The picture above shows about 24-36 hours of plaque growth on the tooth. And there is alot more than meets the naked eye.

Plaque is for the most part colorless. So we often stain it with a "disclosing liquid" and make it red. Look at the picture to the right. That red material is actually how much plaque is on the teeth shown above.

There are hundreds of types of bacteria in this biofilm we call plaque.  Biofilms are much more dangerous than simple bacterial colonies. Biofilms combine many organisms and become a highly organized single organism more powerful than the sum of all their parts.

Your teeth are unique in that they are the only place in your body where a biofilm can form. This is because enamel does not shed its surface. Therefore, the plaque will remain undisturbed, allowing the bacteria to evolve and grow into a single biologic unit - the true definition of a biofilm.

This last concept is important enough to repeat and put in bold print - the only place in your entire body that can form a bacterial biofilm is on your teeth, because the dental surface does not shed. For that reason your teeth are also the only parts of your body that can decay under normal circumstances.

 

Old Plaque = Higher Risk of Decay

Bacteria are either aerobic (they like oxygen) or anaerobic (prefer an oxygen-free environment.)  The anaerobes are the acid producers and tooth decayers. If you look at how a biofilm evolves, it first gets stuck to the surface of the tooth. At that point the bacteria at the bottom of the pile - the ones that have been their the longest and are closest to the tooth  - become very anaerobic because there is no oxygen there. 

Put simply, just letting plaque sit in one place for too long makes it more dangerous. The picture below is a very complicated chart that shows the evolution of dental plaque as a biofilm sitting in the gingival pocket against the juncture of the enamel and the root surface.  If you look closely, the tooth is "on its side."

I do not include it here for you to memorize it  or even fully understand it. I am a dentist but it took me a while to get it! I just want you to realize that we now know a lot more about this complicated biofilm and how it affects your teeth. By the way, for any of you science geeks like me out there,  feel free to check this out because it is pretty impressive in its details!

Of all these classes of bacteria that you see up there, only a certain few strains are associated with demineralization of the tooth, and are therefore called Cariogenic Bacteria. Remember that term? It sits on the tooth decay scale to the right.

In the chart above the cariogenic bacteria are the red ones which by no coincidence are also at the bottom of the pile in the anaerobic zone. If you are unlucky enough to have higher than normal amounts of these in your mouth, or if your oral hygiene is poor and you never break the plaque up, the scale is going to tip to the right toward demineralization and decay

But If you keep this bacterial presence off your teeth, forcing the biofilm to "reform" over and over, and if you use antibacterial agents such as those found in mouthwashes and toothpastes, then you can tip the scale to the left toward remineralization and repair. 

 

Additives That Make Teeth Stronger

Take a look at the scale again, the only thing which we have not discussed are some additives which can tip the scale to the left and keep your teeth health. These are commonly found in toothpastes or dietary supplements.

Fluoride is a powerful ingredient to keep on the tooth surface at all times. It turns out that fluoride will help to facilitate the reuptake of calcium and phosphate into the Hydroxyapatite cyrstals of your tooth. And when it does, it stays in the tooth forming Fluorapatite which is harder to demineralize and break apart than it Hydroyapatite brother.

So constant application of low dose, topical Fluoride is a good thing. That is why we recommend it in toothpastes and rinses. This is why we apply it to young teeth to give them the best chance of staving off demineralization during a time when junk food eating is more prevalent. This is also why we introduce it systemically into the developing tooth in the form of water, drops or pills to create a greater amount of Fluorapatite crystals.

Another additive found in toothpastes are calcium phosphate derivatives that increase the supply of these two important minerals and tip the scale toward remineralization. It is hard to keep up with which toothpastes actually have these in them. Many manufacturers make the claim, but that is because they have fluoride in their toothpaste and nothing more. Check the labels and look for ingredients like ACP, CPP, Novamin and others.

Here is a great simple test. If a toothpaste claims to be "new and improved" and helps to repair acid breakdown on your teeth (Sensodyne Pronamel comes to mind) check the label against the regular old version of the same brand, you know the cheap boring one. If you do not see any difference between them, and they both have Fluoride, then you know what you are getting.

I will go into this subject in much more detail in the "Learning Center" tab entitled "How to Choose Oral Care Products."

 

Now lets continue with the story of how we can tell if the tooth is decaying. In other words, how is this disease diagnosed.

 

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