Tooth Decay; its not just the candy!
Diet Is King
There are so many factors that increase or decrease our susceptibility to decay. The base line concept withouth over thinking it, is give our mouth a break from for hours each day. We do NOT need to eat a bunch of small meals like we were once taught. That myth has been busted! Do not SIP on anything for long periods of time except plain, unflavored water. Milk, juice-not a health food, bubbl'r or whatever, if consumed is best to do so with a meal vs inbetween meals. Our pH will already drop when eating so keep that drop to a short period of time and then let the mouth rest and balance itself.
The 'F' Word in Dentistry
I understand after almost 20 years of clinical experience, not EVERYONE has to floss routinely to help prevent gingivitis (inflammation of the soft tissue or gums), periodontal disease (breakdown of bone, ligaments that support the teeth) and of course decay (the loss of natural minerals in our teeth). However, I can count on one hand the grown adults I've seen who do not floss or have a perfect diet and do not suffer one or more of these afflictions. So the reality is, the majority of us need to put forth effort to our home care.
Floss, waterpik then brush if you have all those things. Hug each tooth with your floss, string or picks, one side at a time all the way under the gums. That's where the nasty oxgen-free bacteria live and those are the extra bad guys that when allowed to mature increase our risks of disease. They have a sticky, slimy matrix, like the bottom of your dog's water dish. We need to create friction to lift them, so do that. No rinsing after brushing either. Treat your toothpaste like lotion; don't eat it, its not food. Simply brush, spit and let it sit!
I love water flossers but they are unfortunately not a substitute for creating friction with floss. Waterflossers or waterpiks-brand name, are best for periodontal disease (deep pockets) and inflammation. I find flossing to be more effective against decay. Well DIET is our best weapon against decay.
With all of this in mind, I tell all my patients, my goal is that you're healthy. If you can achieve that doing things a little different than who am I to argue.
Just because your parents had poor oral health does NOT mean you have to!
Every time a patient tells me their parents had oral health so they will, its like they've accepted they're a victim and there's nothing they can do. Its called EPI-genetics and it proves your parents history is not your destiny.
The main factors impacting our risk for decay (and all other diseases, yes decay is a disease) is our diet and lifestyle (that's what epi-genetic means). If we grew up in a house with poor home care practices and poor dietary practices, we're likely to ADAPT those habits but that's not what genetics are.
I will argue that our oral microbiome, which we DO get from our mother's has an influence but many things impact and change our oral microbiome. (Covered more below).
We have to stop feeling like victims and accept that we have much more say in our health outcomes than we're taught. It INFURIATES me when I hear healthcare workers say, "Well it must be your genetics." Bull crap. Did you even run a genetic panel? That comment is so unscientific and people will believe it because its so commoly said. Let's empower each other to take our health into our hands and make good choices for healthier outcomes. It CAN be that simple for most of us. I understand the concept is simple but making changes is HARD. One thing at a time. Commit to one change and then another and do not expect prefection. Make the goal, more good than not each day.
Remember plain, unflavored water?
I cannot say enough about clean, unflavored water. In the morning when my coffee is gone, all I want is more coffee but rarely do I allow myself to jump right into another large cup/thermos. I have to make myself switch to water otherwise I know I'm not getting enough of it. When I do allow myself a second round, I usually cut it with decaf or all decaf as too much caffeine is also dehydrating. The current scientific recommendation is: HALF YOUR WEIGHT IN OUNCES. A 200lbs person needs to aim for 100oz of water daily. This is a guideline. Depending on what you're eating or otherwise drinking will influence how much water we need. Too much caffeine is hard on the stomach, GI track and can mess with sleep for most people when consumed less than six hours before bed. Yes, six hours! More on the power and necessity of sleep on that page.
Clean, plain water is essential for nearly every aspect of cognitive and physical functioning. Most people underestimate how much even mild dehydration can impair how we think, feel, and perform.
Water makes up 60 percent of your body weight, and every system in your body depends on it to function. Water flushes toxins and waste out of organs, helps carry oxygen and nutrients to cells, and provides a healthy environment for tissues.
When dehydrated, your body can’t carry out normal functions and begins to feel fatigued. In other words, if you get plenty of sleep and eat a super healthy breakfast to try to boost your energy, you’re still short-changing your health if you’re not getting enough hydration.
In specific relation to oral health,
- Water helps flush away food particles and sugars that feed cavity-causing bacteria like Streptococcus mutans.
- It dilutes acids in the mouth, reducing enamel erosion.
- It supports a balanced oral microbiome, preventing the overgrowth of harmful bacteria.
Without water, the mouth becomes a dry, acidic, which makes the mouth a great environment for harmful bacteria.
Sometimes we need electrolytes which is why I LOVE https://www.drink-lmntss.site/. LMNT is an electrolyte drink made with sodium (an electrolyte), magnesium and potassium to properly hydrate and support the mouth and body.
Its complex but not really
Wait, yeasts/fungi can cause decay too?
While Streptococcus mutans (bacteria) tend to get all the hate related to decay, it's not just bacteria. Yeasts can enhance the decay process! Turns out we have commensal yeast present. Commensal=good, pathogenic=bad.
And honestly some things we call pathogenic are actually just fine if we keep them in check. Candida albicans are like that
While Streptococcus mutans (bacteria) tend to get all the hate related to decay, it's not just bacteria. Yeasts can enhance the decay process! Turns out we have commensal yeast present. Commensal=good, pathogenic=bad.
And honestly some things we call pathogenic are actually just fine if we keep them in check. Candida albicans are like that. When they overgrow it can lead to Oral Candidiasis (Thrush) and other problems. When they overgrow it causes dysbiosis in the oral microbiome--(read to the right) which means an imbalance in the good/bad ratio.
-Antibiotics use; while necessary in VERY SPECIFIC SITUTATIONS, we need to be VERY cautious how, when and why we use antibiotics. They kill both good and bad bacteria and not enough of the good guys leads to the bad guys getting out of control.
-Corticosteroids, especially when inhaled can cause thrush. Rinse your mouth out with water after! Oral and systemic steroids suppress the immune system.
Other things like a compromised immune systems, poor diet from too much refined carbs and sugar, (carbs from breads, crackers, etc all turn to sugar! Stick to carbs from fruits and veggies.) poor oral hygiene, uncontrolled diabetes and more can make us susceptible to overgrowth. And when we have too many yeasts/fungi, then our risk of decay goes up.
What's a microbiome?
Microbiome is a fancy word to represent the complex community of microorganisms, including bacteria, viruses, and fungi, that reside in the human oral cavity. It plays a crucial role in maintaining oral health and overall well-being. We're designed to live with certain levels of all of the microorganisms so lets keep them in balance for
Microbiome is a fancy word to represent the complex community of microorganisms, including bacteria, viruses, and fungi, that reside in the human oral cavity. It plays a crucial role in maintaining oral health and overall well-being. We're designed to live with certain levels of all of the microorganisms so lets keep them in balance for our own well being.
Many but not all people have heard of the GUT microbiome and while Hippocrates wasn't literally correct about all diseases originating there, his insight foreshadowed our current understanding of the gut microbiome's significant role in systemic health. While the gut may currently be the star of the body's microbiomes, we have them all over.
When our microbiomes of the mouth and body are supported, WE are better supported. Think of them as our mini armies and repair guys planted all over the body.
Our microbiome has hundreds of times more genes than our human genome.
Functionally, microbes contribute enormously to digestion, immunity, and metabolism—so in many ways, we’re part human, part microbial “superorganism.” We need them, which is why God put them there. We have to stop being to anti-microbial! Most oral care products (especially the ones that have been around forever) are not formulated to target only the harmful stuff, kind of like an antibiotic, they just kill everything which can even increase our risk of a heart attack! Ask me why and how!
Speaking of, did you know that over HALF of heart attacks are caused directly, not indirectly by what grows in our mouths?! Most people are pretty familiar with the oral connection to the heart but it doesn't stop there. If you're gums bleed when brushing or flossing THAT'S A CRY FOR HELP FROM YOUR MOUTH! The main drivers increasing our risks for these systemic risks are chronic gum inflammation, pathogenic bacteria, and their byproducts (like LPS, proteases, and toxins) that enter the bloodstream and trigger systemic immune responses.
I've heard it too may times from patients, "No, you don't understand, my gums have always bled, this is normal for me." NO, there is nothing 'normal' about a mouth that bleeds and if you think it is, then you've been dealing with a chronic infection for a long time.
Our mouths shouldn't smell awful, bleed or have red and puffy gums. Gum tissue color should be light pink and blanche or turn white when pressed on. That bleeding is a sign of dysbiosis which means too many of the bad bacteria or yeast, overpowering the good guys. How do we get this back in check? Like all health related questions, we have to look at the individual person.
Sometimes improved home care, focusing on nasal breathing for those who habitually mouth breathe, vitamin deficiencies, your oral care products and their ingredients (many are harmful) and even side effects of prescriptions which can sometimes be adjusted when discussed with your PCP. There are various factors for each of us, which is why a diet and lifestyle conversation is necessary to narrow it down.
Stephens Curve
Stephens Curve
Bach to Chemistry on a super simplified level. pH scale. 0-6=acids, 7=neutral, 8-14=alkaline/basic.
The outer layer of the part of the teeth people see, called the enamel, breaks down and loses minerals at a pH of 5.5 and below. The oral cavity prefers to be somewhere between a pH of 6.7-7.5. If we're too acidic, we get cavities, if we're
Bach to Chemistry on a super simplified level. pH scale. 0-6=acids, 7=neutral, 8-14=alkaline/basic.
The outer layer of the part of the teeth people see, called the enamel, breaks down and loses minerals at a pH of 5.5 and below. The oral cavity prefers to be somewhere between a pH of 6.7-7.5. If we're too acidic, we get cavities, if we're too alkaline you'll build more tartar (the hard cement-like structures your hygienist scales off).
I show the above graph to patients all the time so they can wrap their mind around exactly what we're doing when we're snacking or sipping all day on drinks other than unflavored water.
Keep it simple: how many hours a day is the mouth acidic vs neutral/alkaline? Don't spend too much time on the acidic end or you'll likely develop the disease we call decay.
Our mouths should be wet, this is why God gave us saliva. It is not natural to have a dry mouth and when we have that, its harder for our good bacteria to survive. Our saliva is a necessary part of oral health but its not just the amount of saliva but what's in it. If the mouth is dry, its acidic, its that simple. So keep our mouths shut when we breathe, don't suck on candy and if your meds cause dry mouth, there are many products on the market that can help that. There's something for everyone, lets just make sure you're aware of them.