If you’ve had a cavity and a filling before, you know it’s not all puppies, sunshine, rainbows, and unicorns. A cavity is caused by bacteria that poop plaque and pee acid on your teeth. That’s just nasty. Once a cavity gets bad enough, it won’t stop until you either get a filling, or the tooth and nerve inside the tooth are destroyed. Wouldn’t it be wonderful to never get a cavity again?

There are three factors that combine to cause a cavity: bacteria, carbohydrates, and a tooth. If we control these factors, we’ll never get a cavity again.

Bacteria

Everyone has bacteria in their mouths. You can’t get rid of it completely, and you wouldn’t want to. It’s not all bad.

However, when we eat carbohydrates (especially sugar), the bad bacteria is eating too. It produces plaque (an off-white protein cream) and acid. This acid disintegrates tooth enamel and forms a cavity.

How can we reduce the negative effect of bacteria? We can reduce their quantity and quality.

If we reduce the number of bacteria in our mouths by properly brushing and flossing, then they won’t be able to accumulate enough acid to actually cause a cavity.

These bacteria double in number about every five hours. If you don’t brush for 24 hours you will go from about 2 billion bacteria to 65 billion bacteria. Now do you think those little buggers can come together to make enough acid for a cavity? Do yourself a favor and brush at least twice a day. Is it too much to ask to brush after lunch too? Maybe, but a dentist can dream. Keep bacteria numbers low to prevent cavities.

We can also change the quality of cavity-causing bacteria. Fluoride toothpaste, alcohol based mouthwashes, and xylitol chewing gum all inhibit those bad bacteria. Also, eating cultured yogurt can put good bacteria in your mouth that compete for space to block out the bad bacteria.

Carbohydrates

Carbs, especially sugars like sucrose, fructose, and lactose, feed the bacteria that cause cavities. An alarming trend I see in dentistry is more cavities in soda drinkers. I’m talking about people that drink four or more sodas a day.

Soda and sugar do more damage to the teeth if you drink or snack between meals. Enjoy a sweet treat as part of a meal instead. If you drink a soda without a meal, rinse your mouth with water as soon as you finish the soda so it doesn’t have time to soak on the teeth.

If you limit the sugar you eat, you’re also limiting the sugar that gets to the bacteria. Sugar can be bad for your overall health, not just bad for your mouth. A diet with lots of vegetables and plenty of water is also great for the health of the mouth.

Also, think of this: what if you ate foods that are acidic enough to bypass the bacteria entirely? Cola soda has a pH of 2.8. Tooth enamel starts to dissolve when pH drops below 5.5. That means that if you drink multiple sodas per day, they may be causing cavities by directly dissolving the teeth without the need for bacteria to change sugar to acid. Consider this chart and avoid eating acidic foods too frequently:

Tooth

The teeth are the third piece of the puzzle that cause cavities. While it’s true that someone who has no teeth will never get a cavity, a denture is not recommended unless there is no other option. Would you cut off your hand and use a prosthetic to avoid a hangnail? Of course not. The idea to “just pull them all and be done with it” is just as ridiculous.

How then do we make the teeth more resistant to cavities? Genetics helps. It’s true that some people have stronger, thicker, more dense tooth enamel than others. If you think you have “bad genetics,” or “weak teeth,” let me assure you – even the weakest enamel I’ve ever seen was still harder than bone. Enamel is the hardest substance in the body. Keeping your teeth clean will prevent cavities, even if you have “weak enamel.” Bad genes is not a catch-all excuse for cavities.

Fluoride helps make enamel more dense. If the enamel is more dense, it’s going to take more acid to dissolve it. Ideally kids should drink water fluoridated to one part per million while the teeth are developing. After the teeth have developed, daily fluoride toothpaste helps to remineralize enamel that may have been damaged from acidic foods or bacteria acid.

Saliva is a beautiful thing. It’s not just water. Saliva has antibodies, proteins, enzymes, and minerals that act as a buffer to protect the teeth from acid. Now, saliva flow naturally goes down at night, so this would be the worst time to have a snack. I had a patient who would wake up at night with a dry mouth and sip on sweet tea. Don’t do that! He had new cavities every time he came in for a check up.

Sealants are a great way to protect teeth. Some natural grooves are too narrow and deep for the toothbrush bristles to get in there and clean them out. Sealants make teeth smooth and easy to clean. No grooves for bacteria to hide in.

Another way to improve teeth is to have a full set of straight teeth. Missing teeth or crooked teeth make it harder to clean the gaps and niches. Have missing teeth replaced, or get orthodontics to straighten crooked teeth.

Follow these tips and never get a cavity again! Be happy. Eat good food.

The Future of Cavities

There are some exciting research opportunities that might make cavities a thing of the past.

Alcohol instead of acid. One researcher genetically modified the bacteria that causes cavities. Instead of producing acid as a by-product, it produced alcohol, which is harmless to the teeth.

Cavity vaccine. Tooth decay is a problem that affects children more than other age groups. An inhaled vaccine could inhibit cavity-causing bacteria during this critical time in life.