What causes cavities - Bluegrass Oral Health
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What Causes Cavities

What Causes Cavities

Wow, I begin to shudder when I approach this topic. It’s just a tough one.

You ever feel like your six-month checkup is like passing a test?

Hygienist: The doctor will be back in just a second.

You(Waiting): Don’t ask me about my weekend. I don’t care about the weather. Just give it to me straight Doc.

Doc: You have no cavities.

The rest of the appointment is a breeze, and you get in your car feeling like a good person again.

Believe it or not, telling people they have cavities is one of the worst parts of my profession. I find myself apologizing to people after I break the news, almost as to share the burden in some way. The only thing that makes it better is taking solace in knowing that I’m going to fix things.

On the other hand, my favorite appointment of all is the first six month checkup after we’ve completed somebody’s work and I get to congratulate them and shake their hand. It’s that first appointment that’s so tough.  

Me: You have five cavities and need a crown

Patient thinks, while seeing dollar signs flash before them: Ok, give me the spiel on what I’m doing wrong with my mouth and life.

What causes cavities?  Sit back, keep an open mind, and please no eye rolling. I’m only informing, not brow beating you today. And by the way, it’s worth noting that my wife found a cavity on me last month that I still haven’t fixed, so don’t feel bad.

First off, as a blue-blooded, proud and native Kentuckian I’m allowed to say this.  

Kentuckians have horrible teeth!  

Come as a shock to anyone reading? What’s more is that we have tons of really good dentists and two really good dental schools (most states have one or none). Kentucky ranks second in the nation for edentulism (having no teeth). Thank you, West Virginia!  

Kentuckians love to make excuses ,and I’ve heard from great ones over the years:

It’s genetic

The baby took all the calcium out of my teeth

The dentist ruined my teeth

We had well water

I was born with soft teeth

There are small truths to each of these, but none of them entirely hold water. How you were raised plays a huge role in your oral health. Our parents have bad teeth (I know mine do). They didn’t know or have the resources to care for their teeth like we do now. Toothbrushes and toothpaste weren’t nightly rituals, and they thrived on cokes and processed food. This was the 70’s and 80’s. So what happened?  

They were frustrated with their teeth and didn’t pass on good habits to their kids. By the time you were 12 you likely had already done enough damage to your teeth from Mountain Dew, push pops,  fruit roll ups, and juice boxes that the cards were stacked against you for the rest of your life. Add smoking, chewing tobacco, Bazooka bubble gum, and our school lunch programs, and it’s amazing any of us have teeth at all.

We have an unbelievable amount of bacteria in our mouths. But there is one particularly bad actor — strep mutans, the bacteria that feeds on sugars.

Sugar

This means: granulated sugar, starches, carbohydrates, corn syrup, cokes, and generally all processed foods and drinks. And yes, this also means your morning Starbucks.

When the most abundant bacteria in your mouth -strep mutans- eats sugar, its byproduct is acid — the acid then causes cavities and erodes your teeth. Remove the sugar or remove the bacteria and you have no cavities. Seems simple, right?

This state has been flooded by Mountain Dew and Monster Energy drinks.  I used to work in a DNA lab before I was a dentist and know that stuff will literally take the paint off of your car. Coke is such a strong acid that it was required by law to dispense it in an “Acids” container instead of the sink. It has so much sugar that only a small sip will activate those strep mutans to start producing acid.  

Think of it like an engine that runs on sugar. Now what I hear all the time is, “I only drink one a day.”  You could pump a bucket of it into your belly if you want to, but what matters is how often it touches your teeth.  The worst offenders are those who have one coke, or one large sugary coffee that they sip on throughout the morning.  If you take a sip every 5-10 minutes for three hours, you might as well be holding it in your mouth.  

Your mouth is flooded in sugars all day and is a haven for bacteria. What we need to do is change the chemistry and biology of your mouth.  What we’re worried about is breaking up the biofilm, the plaquey, spongy, breeding ground for bacteria that adheres to your teeth. There’s only one way to do this — good ole’ mechanical scrubbing.  

You’ve got to get in there and give it a full two minutes twice a day. Floss as much as possible to get where your toothbrush can’t.

There are two major components to every toothpaste:  a surfactant or soap that breaks up the biofilm and washes it away and a fluoride that remineralizes your teeth and makes them stronger. My favorite toothpastes are Crest Pro Health and Colgate Total — they have longer substantivity (they kill the bacteria for longer in your mouth). It takes about 12 hours for enough bacteria to repopulate to start producing acid again. That’s where the brushing twice a day comes in.  

Ever heard of morning breath? That’s those bacteria having a party in your mouth while you’re sleeping. It’s gross. Brush your teeth before you go to bed to kill those bacteria and get the sugars out of your mouth.  I don’t care what shift you worked or how late the game was — make it a habit! I actually like brushing with two different kinds of toothpastes: one in the morning and one at night.  Although it’s not proven, I think that it kills bacteria from two different ways and keeps them from becoming resistant.

I don’t care what commercials or Pinterest says, when the enamel on our teeth is damaged there is no good way to get it back.  t’s very difficult to remineralize and will always be more susceptible to cavities. Most of the damage has occurred before people are old enough to know better. A filling is nothing more than a patch for a tooth. Take a tire. Is a patched tire ever as good and dependable as a brand new one?  No.  

We’re asking 80+ years out of our teeth.  What do you know of that last for 80 years?  Think of how much we use them — they are really amazing. There’s no better day than today to start taking care of your mouth. If you didn’t take care of your mouth as a kid, double down on your kids. Talk to your dentist and become a healthier, better you!