Fighting Cavities, Dentistry's Most Important Role

Dentistry continues to evolve. Advertisements on television, radio, the Internet and in news papers tout Cosmetic Dentistry, Sleep Dentistry, Holistic Dentistry, and Boutique Dentistry. However, the more dentistry expands and improves, the more society's pressures continue to prevail on dentistry to treat the classic dental problem, tooth decay.

In an April 2007 press release from the Centers for Disease Control and Prevention, the headline trumpets, "Oral Health Improving for Most Americans, But Tooth Decay Among Preschool Children on the Rise ." This report of the results of a 5 year, national survey represent the most up to date information on the incidence of cavities also known as dental caries and tooth decay.

The report highlights disparities between racial groups. For example, while 31% of Mexican-American children 6-11 had experienced tooth decay in their adult teeth, compared with only 19% of non-Hispanic white children. Family economics plays an important role in the incidence of caries. The rate of untreated decay among children 6 - 11 from families with income below federal poverty lines is three times the rate of children of families with higher incomes.

Decay begins as small, soft spots on teeth. The spots may have dark stain, or they may be yellow, or orange. The surface of the teeth may appear chalky white. When the decay becomes large enough, the tooth may break or become painful. Dental infection results when the bacteria in the decay invades the dental pulp, the soft inside part of the tooth that includes nerves and blood vessels.

Three factors control the prevalence of decay, the presence of bacterial plaque, the presence of sugar, and the individual's resistance to decay. Improve just one of these factors, and dental caries becomes less likely.

Tooth decay is the result of a bacterial infection. Bacteria coat the teeth in a layer called plaque. When exposed to sugar, the bacteria release acid. The acid softens dental enamel, the hard outer layer of teeth, and the dentin, the inner layer of teeth that is slightly less hard. The softened tooth structure is tooth decay.

Leave plaque alone, and it will thicken, stain, and may harden into tartar (calculus). Dental plaque is very soft, like vanilla pudding stuck to the teeth. Scuff up plaque with a tooth brush and floss, and it is easy to rinse away with water. While helpful, no special equipment or costly rinses are necessary. Even sugar free chewing gum removes some plaque. Without bacteria, no amount of sugar will cause decay.

While the advantage of reducing sugar is self evident, parents may not realize how much sugar is in some seemingly healthy foods. Some breakfast cereals have as much sugar as grain. One brand of breakfast bar has multiple kinds of sugar presumably so that sugar is not first on the list of ingredients. That particular brand of breakfast bar even adds non-sugar sweetener.

Fruit juice may have some health benefits, but check the nutrition guide, and there is plenty of sugar. Fruit drink has as little as 10% juice with even more sugar. Some drinks that boast 100% juice may increase sweetness by adding more juice concentrate (juice with less sugar).

Drying fruit removes water and leaves a sticky, gooey, sugary, natural gum drop. Of course, there may be some health benefits to eating raisins, prunes and dried apricots. However, free snacking on any of these sweet delights will increase tooth decay as readily as manufactured fruit snacks. Let's not forget manufactured fruit snacks like the ones that roll up, look like a measuring tape or the gooey shapes that are full of a sugary liquid. Only give these treats out as candy, not as a substitute for natural fruit.

Help reduce decay by shopping for low sugar cereal. Ask children to drink more water. Limit sweets to meal time deserts. Offer children healthy snacks, and when appropriate, sugar free candy.

Improve resistance to decay with fluoride, a dietary supplement that hardens teeth, by covering deep crevices with plastic sealants, or improve plaque removal, by brushing and flossing better, and the rate of tooth decay lessens.

Dentists treat tooth decay by removing it. In the simplest case, the dentist will use a drill, laser or air abrasion machine (sand blaster) to remove the decay. Then, the dentist fills the cavity.

Deeper decay that damages more of the tooth may require restoration with a crown or a cap that covers the entire tooth. Treatment may include removal of infected pulp (root canal). In the worst case, there is so much decay that the tooth is not repairable. Then, removing the tooth becomes the only option.

Sometimes, the dentist catches decay at a very early stage on an x-ray image. Careful brushing and flossing and judicious use of fluoride can reverse the damage.

In spite of the years of training and experience of the average dentist, the average parent is much more effective in the fight against cavities. Parents should brush their children's teeth two or three times a day until the child can tie their own shoes. Until then, children do not have the necessary coordination to brush well. Parents should be sure that their children avoid carbonated beverages - even sugar free soda is acidic enough to help cause tooth decay. Limit sweets - candy should not be every day fare. Children should visit their dentist beginning with the appearance of the first tooth or by a year old, then at least every six months after.