Why Me?
Dear Friends,
I just read a great book called “Why Me? The unfair reason you get cavities and what to do about it.” I get this question a lot from patients, especially more mature patients that haven’t had a cavity in years. This book sheds a lot of light on the causes of tooth decay and unlike most of us have been led to believe…it’s NOT just sugar that causes cavities. There are actually 5 things that contribute to cavity risk:
Lack of saliva (very common with many medications)
Diet
Bacteria (biofilm microbes)
Genetics (we now know this plays a role)
pH (some drinks and foods have very acidic pH levels)
Here’s some of the causes of lack of saliva or dry mouth:
Aging
Medications (pain, antidepressants, BP, antipsychotics, acid reflux, seizure, cold, etc)
Sjogren’s syndrome (autoimmune condition)
Diabetes
Smoking
Stress
Poor diet
CPAP
Radiation
Autoimmune diseases
Basically, snacks and ANYTHING other than water can cause erosion because of their acidity. Also, the FREQUENCY with which you eat plays a large role. A lot of people will say, “I eat healthy, I don’t eat a lot of sugar” but it’s more about the frequency of your eating than the content. Our mouth needs time after we eat to send saliva to bathe the teeth and remineralize the teeth. When we eat anything acidic there is a process where the low pH environment pulls calcium out of our teeth. Our saliva is meant to raise the pH and remineralize the teeth. When there’s not enough saliva or too frequent meals or snacks the teeth don’t have time to remineralize and the incidence of cavities increases. Nibbling, grazing or sipping on a drink for prolonged periods with anything other than water causes periods of prolonged low pH and increases decay risk. If you need to eat frequently you can use a high-pH oral spray after eating or drinking to raise the pH in your mouth. We carry a product called CTX2 in our office to help people with dry mouth or frequent eaters/drinkers. It is the best product I have found on the market because it has the highest (most basic) pH. You can also order it on their website at carifree.com, along with other rinses, gums, etc. You can get a free copy of the “Why Me” book on their website also.
Let’s talk about water while we’re on it. Tap water is the best because the pH is usually right around 7, which is neutral…in other words not acidic or basic. Most bottled water is more acidic (ph=4) than tap water and may be a source of erosion and enamel breakdown. Bottled water may be as acidic as soda and diet sodas are also very acidic. It is ok to have some of these drinks but the point is you want to limit them and you definitely don’t want to get in the habit of sipping on them throughout the day.
Genes account for 10% of the role in decay and environment and behavior account for 60%, so even if your genes set you up for higher risk the environment greatly influences the expression of those genes.
Fluoride strengthens teeth and protects against acid attacks by combining with hydroxyapatite (building block of enamel) to make fluorapatite, which makes teeth more resistant to future acid attacks. I do like fluoride’s benefits as a topical agent but not as a drinking additive.
Xylitol is a product many of you have probably seen or used. It comes in many gums and lozenges now and is great at fighting cavities. It is a natural sugar that is actually a good sugar. Plaque microbes eat it thinking they have more sugar to feed on but they cannot digest it and they die off. Xylitol also makes fluoride more effective.
When bacteria get out of control and start changing the microbiome in our mouth it can take some time to re-establish a healthy microbiome. Sodium hypochlorite can re-establish a healthy biofilm and can be used from ages 6 and up. This can also be beneficial for gum disease, canker sores, implants, bridgework and during orthodontic treatments. There is a product called CTX3 on the carifree.com website that is good for this.
We now know that lack of care and genetic factors can cause Periodontal disease and has been shown to double the risk of heart attacks and triple the risk for strokes. . Essentially, high-risk bacteria enter the bloodstream and cause widespread inflammation which causes arterial plaques, which causes clots, which causes heart attacks and strokes. Also, adults over 50 years old have a 70% higher risk for Alzheimer’s if they had gum disease (periodontitis) over 10 years.
In the last 50 years our calorie consumption has increased more than 20%. We also eat half our calories from grains and fats, a major shift from before when we ate more fruits, vegetables, meat and dairy—in other words, whole foods, not processed stuff. Sugar is the most addictive substance on the planet and it is in almost everything. Eat more whole foods and less sugar and processed foods for optimal body and teeth health.
We sell and recommend a product called CTX4 to many patients that have a higher decay rate or signs of acidic erosion in their mouth. You cannot get this product from the carifree.com website but you can pick it up at our office anytime. They only sell certain products through dental offices due to the higher content of fluoride, etc.
MAIN POINTS- Drink mostly water (filtered tap is best…I use Brita), eat mostly whole foods that aren’t processed and that don’t have a high sugar content. NEVER sip on sodas, tea/coffee with sugar added or sports drinks over prolonged periods. Use a fluoridated toothpaste twice daily and floss once daily. If you have a dry mouth or a history of cavities, use a prescription strength fluoride product like CTX4 once per day. If you eat frequently, consider using CTX2 to raise the pH in your mouth to fight acids. In case you’re wondering, I am not paid by carifree.com to hawk their products. It is simply the best stuff I have found after searching for over 20 years. If you have any questions or concerns please email me at drcook@austincitydental.com and I will be happy to discuss further.
In Good Health,
Dr. Steve