Download How Tooth Decay Happens

How Tooth Decay Happens
Tooth decay is caused by certain types of bacteria (mutans streptococci and lactobacilli) that live
in your mouth. When they 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). If the acid attacks are infrequent and of short duration, your saliva can help to repair
the damage by neutralizing the acids and supplying minerals and fluoride that can replace those
lost from the tooth. However if your mouth is dry, you have many of these bacteria, or you snack
frequently; then the tooth mineral lost by attacks of acids is too great and cannot be repaired.
This is the start of tooth decay and leads to cavities.
Methods of Controlling Tooth Decay
Plaque removal: Removing the plaque from your teeth on a daily basis is helpful in
controlling tooth decay. Plaque can be difficult to remove from some parts of your mouth,
especially between the teeth and in grooves on the biting surfaces of back teeth. If you have an
appliance such as an orthodontic retainer or partial denture, remove it before brushing your teeth.
Brush all surfaces of the appliance also. Regular Dental check-ups and cleanings are also an
important part of reducing tooth decay.
*SUGGESTED PROTOCOL: Using a soft toothbrush placed at a 45 degree to the gumline
gently sliding the tips of the bristles under the gumline. Vibrate brush in circles or small strokes
cleaning no more than two teeth at a time. Move the brush along gums and teeth slowly cleaning
every surface. Do not scrub teeth. Use this method for all the front tooth surfaces and inside
surfaces near your tongue and roof of your mouth. For biting surfaces a longer more aggressive
stroke is appropriate to penetrate deep into surface grooves. For areas behind front teeth turn
brush vertically and use and pulling stroke to clean teeth. When flossing make sure to wrap floss
around both sides of your teeth making sure to gently take the floss underneath the gums as far as
it will go.
** New research is showing that caries is a biofilm disease. New technology allows us to
measure energy released from the biofilm to determine caries susceptibility risk.
CariScreen swab test- Used to test energy released from the cariogenic biofilm on your
teeth. Results are given within minutes to determine your caries susceptibility risk. After the
level of decay- causing bacterial is determined you can be placed in a low, moderate, or high risk
category. Test is completed in the office. Please do not eat, drink, brush, chew gum/mints, or
smoke 1 hour prior to the test. Dependant on your individual risk a caries protocol will be
formulated for you.
CariFree Treatment Rinse: A two-part treatment rinse that kills the harmful destructive
bacteria on your teeth. It has an elevated pH that is designed to offset the acidic condition of the
infection.
*SUGGESTED PROTOCOL: Use once daily after brushing. Shake each bottle before use.
Using the measuring cup, combine 5mL of A with 5 mL of B (to make 10 mL total). Vigorously
swish the combination fro one minute, spit, do not swallow. Do not eat, drink, rinse with water,
or smoke for 30 minutes after rinsing.
How Tooth Decay Happens
CariFree Mainenance Rinse: Designed to create an environment in your mouth, which
prevents the destructive bacteria from re-establishing itself. It also has an elevated pH, which
promotes a healthy oral environment.
*SUGGESTED PROTOCOL: Use once daily after brushing. Vigorously swish 10 mL for one
minute, spit, do not swallow. Do not eat, drink, rinse with water, or smoke for 30 minutes after
rinsing.
Diet: Reducing the number of sugary and starchy foods, snacks, drinks, or candies can help
reduce the development of tooth decay. That does not mean you can never eat these types of
foods, but you should limit their consumption particularly when eating between main meals. A
good rule is three meals per day and no more than three snacks per day. It is also important to
note that eating small amounts of sugary foods throughout the day is more likely to cause decay
than a large amount of sugary snack all at once.
Saliva: Saliva is critical for controlling tooth decay. It neutralizes acids and provides minerals
and proteins that protect the teeth. If you cannot brush after a meal or snack, you can chew some
sugar-free gum. This will stimulate the flow of saliva to help neutralize acids and bring lost
minerals back to the teeth. Sugar-free candy or mints could also be used, but some of these
contain acids themselves. These acids will not cause tooth decay, but they can slowly dissolve
the enamel surface over time (a process called erosion). Some sugar-free gums are designed to
help fight tooth decay and are particularly useful if you have a dry mouth (many medications can
cause a dry mouth). Some gums contain baking soda, which neutralizes the acids produced by
the bacteria in plaque. Gum that contains xylitol as its first listed ingredient is the gum of choice.
If you have a dry mouth, you could also fill a drinking bottle with water and add a couple
teaspoons of baking soda for each 8 ounces of water and swish with it frequently throughout the
day. Toothpastes containing baking soda are also available from several companies.
*SUGGESTED PROTOCOL: Saliva-Check GC America tests hydration, salivary
consistency, resting saliva pH, stimulated saliva flow, stimulated saliva pH and saliva buffering
capacity. Tests are completed in the office with results interpreted by doctor and staff.
Dependant on your individual risk a caries protocol will be formulated for you.
Restorative / Sealants: Restorative work includes any type of dental work that reconstructs
tooth structure after all the decay has been eliminated. Fillings or crowns can come in
composite, porcelain, or metal material depended on what is needed to completely return the
function of your tooth. Sealants are plastic coatings bonded to the biting surfaces of back teeth
to protect the deep grooves from decay. In some people, the grooves on the surfaces of the teeth
are too narrow and deep to clean with a toothbrush, so they may decay in spite of your best
efforts. Sealants are an excellent preventive measure for children and young adults at risk for this
type of decay.
*SUGGESTED PROTOCOL: All decay must be removed before any other treatment or
preventative measures are taken. Since decay is a bacterial process that is transmissible
complete elimination of the decay is recommended to reduce the amount of transmissible
bacteria.
How Tooth Decay Happens
Antibacterial mouthrinses: Rinses that your dentist can prescribe are able to reduce the
number of bacteria that cause tooth decay and can be useful in patients at high risk for tooth
decay. The reviewed literature showed that chlorhexidine was effective in reducing the strep
mutan population therefore, reducing the incidence of dental caries in the populations tested.
*SUGGESTED PROTOCOL: After normal brushing and flossing at night, rinse with 0.5 oz of
chlorohexidine for one minute. This should be done for seven days, once a month, for six
months. For example, if you start rinsing on January 10, rinse everyday through January 16.
Repeat again February 10-16 repeat this sequence for a full six months.
Xylitol Products: Xylitol is a sugar substitute with sweetness equal to that of table sugar.
Xylitol has a number of effects on S. mutans (bacteria responsible for the decay process) that
may account for some of its clinical effects in caries reduction. Short-term consumption of
xylitol is associated with decreased S. mutans levels in both saliva and plaque. Long-term
habitual consumption of xylitol appears to have a selective effect on S. mutans, resulting in
selection for populations less adherent to tooth surfaces. These colonies, therefore, are shed more
easily from plaque into saliva6 this effect may not only be important to the individual’s decay
experience, but may also influence the transmission of S. mutans from mothers who consume
xylitol to their children.
*SUGGESTED PROTOCOL: Xylitol comes pure in mint and gum form. Chew or use saliva
to dissolve two pieces of the product three to five times daily. Recommended dose is 7-9 grams
per day. Recommended products: Epic (1.0 grams xylitol / piece). Xylitol is now being added to
toothpastes and mouthrinses. Use as instructed on product.
Fluorides: Fluorides help make teeth more resistant to being dissolved by bacterial acids.
Fluorides are available from a variety of sources such as drinking water, toothpaste, over-thecounter rinses, and products prescribed by your dentist such as brush-on gels used at home or
gels and foams applied in the dental office. Daily use is very important to help protect against the
acid attacks.
*SUGGESTED PROTOCOL: Prevident toothpaste is to be used nightly immediately before
bed. Apply paste to a dry toothbrush, brush as normal, and spit. DO NOT rinse your mouth
with water. In order for the prescription fluoride to work at full strength it is essential not to eat,
drink, or rinse, your mouth for 30 minuets after use.
*SUGGESTED PROTOCOL: Cavity Shield or Duraflor fluoride varnish can be applied at
home or in office. Both types must be applied to all teeth three times within a 10-day period.
Patients should not eat or drink for an hour to an hour and half after application and should not
brush fluoride off for at least 12 hours.
Calcium Phosphate Products: Casein Phosphopeptide (CPP) and Amorphous Calcium
Phosphate (ACP) are milk derivatives that showed enhancement of remineralization and anticaries properties. Unlike fluoride CPP-ACP has potential as an additive to food because it can
be ingested without the risk of fluorosis. Additive benefits of CPP-ACP: it replaces lost
How Tooth Decay Happens
minerals, improves the protective qualities of saliva, improves fluoride uptake, soothes sensitive
surfaces, strengthens tooth enamel, reduce sensitivity, and can buffer plaque acid.
Methods of application include: Prophy cup application , custom tray application, at-home
follow-up applied daily indicated for post-bleaching sensitivity, root planing and scaling, as well
as during prophylaxis.
Current products include MI Paste (GC America) and Soothe Rx (Omni)
*SUGGESTED PROTOCOL: Apply a pea sized amount of MI Paste to the tip of your finger.
Use finger to rub on to the surfaces of your teeth. Once the paste is gone from you finger, use
your tongue to rub paste across every tooth surface until it is dissolved completely. Since the
product is made completely of animal products it is safe to swallow, however, if you prefer you
may spit the excess paste into the sink. Do Not eat, drink, or rinse for 3 minutes after using the
paste. Apply 2-3 times daily.