Not just sugar and brushing: the tips that will prevent cavities in the teeth

We all know the unpleasant feeling at the dentist when a “new hole” is discovered, but it is important to understand that tooth decay – or as it is popularly called “holes in the teeth” – is not only the result of sweet foods or improper brushing (although these are significant in the development of the disease), but a complex, multifactorial disease, which is affected not only by diet and hygiene – but also by the composition of the saliva, the quality of the enamel layer, and more.

Caries is a bacterial disease, and its clinical manifestations are the result of dynamic relationships between the bacteria, the oral environment, and behavioral and social factors.

Beyond the well-known guidelines: proper oral hygiene, annual visits to the dentist, professional teeth cleaning and more – there are other ways to prevent the formation and progression of tooth decay.

In recent decades, the treatment of tooth decay has undergone a fundamental change – from dental treatment (surgical/restorative, which is based only on removing the tooth material and completing the shape of the tooth) that is performed after the formation of tooth decay, to treatment that places the emphasis on prevention and identifying the unique risk factors for each patient.

The conditions for the formation of tooth decay are the presence of bacteria + high levels of sugars from food and drink + the nature of the tooth itself. The caries bacteria, which are part of the community of organisms in the oral cavity, feed on sugars. The products of the bacteria’s breakdown of the sugar are acidic and these cause demineralization, or breakdown, of the tooth material. The process of developing caries is based on a balance between demineralization and mineralization – caries is caused when there is a violation of the balance between factors that promote caries and factors that prevent the disease.

When there is increased and frequent consumption of carbohydrates that can be broken down by caries bacteria, there is a change in the composition of the bacteria in the mouth, in the form of proliferation and growth and increasing the clinical expression of the disease on the tooth material. Beyond the clear nutritional guideline of reducing the consumption of foods high in sugar – we must pay attention to the duration of exposure and the manner in which sugars are consumed. Beyond reducing the amount, we must strive to reduce the number of exposures.

The effect of sugars can be reduced in several ways:

1. Consuming caries promoting foods next to a meal – The secretion of saliva during a meal is increased, and since the saliva contains factors that protect the tooth material from the acidity caused by those bacteria, the destructive effect of those foods will be less immediately at the end of a meal compared to consuming them as a snack or snack between meals.

2. Drinking water immediately after consuming sugars/carbohydrates – The mechanical washing of the water removes large excesses of food, and in addition, the water reduces the effect of the high acidity and acts as a diluent.
3. Reduction in sticky foods that tend to remain on the tooth surfaces for longer periods of time – for example, dried fruits. Although these are sweet derived from fruits, their texture makes them foods that increase the risk of tooth decay. Unlike the fruit in its natural form, the dried fruit adheres to the various surfaces of the tooth and remains in certain areas that are more challenging to clean for a long time. This way, this sugar is more available for the caries bacteria to break down.

The salivary liquid secreted through glands located in the oral cavity consists of liquids, minerals, electrolytes and various molecules. Among its important functions is shielding the tissues of the oral cavity, buffering and resisting the acid secreted by caries bacteria, protecting the tissues of the oral cavity against infections. The quality of saliva can be affected by a variety of local or systemic conditions in the body, among others – autoimmune diseases, damage from viruses/bacteria, blockages in the salivary ducts, radiation treatments, hormonal changes and more. Normal functioning of the salivary glands is characterized by the production of saliva in sufficient quantity and appropriate quality.

The risk of caries increases in situations of dry mouth – a low amount of saliva, or saliva with a thick texture – because there is not enough washing of the saliva from the tooth tissues, and thus the effect of the bacterial activity is more destructive. The simple solution to most situations of dry mouth is increased fluid intake.

The tooth enamel (enamel) is the outer layer of the tooth and its function is to protect the inner layers of the tooth. It is a calcified and hard tissue and is composed mostly (96%) of minerals, it lacks the ability to build and cannot regenerate, therefore once it is damaged the damage remains.

Already from the first stages of life, even while the fetus is developing in the womb, tooth sprouts begin to form – both of the deciduous teeth (milk teeth) and of the permanent teeth. It is a long and complex process, which lasts for many years, in which the body invests a lot of energy and resources.

In the first stages of tooth development, the enamel layer is partially calcified, and as the process continues, the level of calcification increases. The teeth erupt when the enamel is only calcified at a level of about 85%, and after 2-4 years from the eruption of the tooth, the mineralization process is complete. Email that has not reached a full calcification level, is more vulnerable to tooth decay. That is, in the first years after the tooth erupts, it is more susceptible to damage – especially to caries.

One of the important indicators of enamel maturity and quality is the ratio between the levels of phosphate and calcium in it. In falling teeth, this ratio is usually normal, because the entire calcification process takes place during pregnancy, when the body controls and balances the conditions. However, in permanent teeth, the enamel calcification process is often less successful, as it is more influenced by environmental factors, including nutrition, exposure to fluoride, and more.

That’s why it’s important to know: the first years after the eruption of the permanent teeth are critical. What happens during this period – in terms of nutrition, hygiene and exposure to substances – will affect the quality of the enamel (and the teeth), which, as mentioned, will not be renewed and will accompany us throughout the life of the tooth.

Dr. Etty Goman is an expert in oral rehabilitation, from the Ashdod and Ramat Hasharon clinics