By: Dr. Sana Akhtar
Dental cavities are an infection caused by a combination of carbohydrate comprising food stuff and bacteria that live in our mouth. There are tremendous amount of bacteria in continuously forming film called plaque, which is present on and around our teeth. When these bacteria find carbohydrates, they consume them and produce acid. Before having such food the pH in the mouth is about 6.2 to 7.0 however the exposure to acid causes the pH to drop. At a pH of 5.5 or below the acid initiates to dissolve the hard enamel that forms the outer coating of our teeth. Each exposure to these foods allows an acid to intensify the attack on teeth.
Dental enamel is the protective layer of the tooth plus the hardest tissue of human body but in an acidic environment it can be dissolved chemically. The acids that cause dental erosion may come from intrinsic, example: vomiting or gastroesophageal reflux or extrinsic sources like citrus fruits or acidic beverages. Fluoride helps tooth enamel to re-mineralize however enamel itself has no blood supply or other means of repair. If any cavity is formed in enamel by early decay it can rapidly turn into cavities and if neglected it can invade the softer dentin directly beneath the enamel and encroaches on the nerve and blood supply of the tooth enclosed within the pulp.
The matter of fact is that dental erosion does the irreversible damage to the tooth enamel due to chemical processes plus sometimes it does not even implicate bacterial action. It is the physical result of an acid attack on exposed tooth surface which makes this demineralized and softened surface vulnerable to further damage. The causative factors of which are stated below:
- The foremost source of decay is dietary which includes candy, sugar frosted breakfast cereals, carbonated or sports drinks, fruit juices, herbal teas and acidic foods such as vinegar or citrus fruits.
- Systemic diseases such as frequent vomiting, gastric reflux, alcohol abuse, eating disorders, salivary gland disease or obstructions causing reduced salivary flow.
- Some medicines are acidic, hence erosive. They can cause dental erosion on direct contact with the teeth when the medication is chewed or held in the mouth prior to swallowing. For example, chewable Vitamin C tablets and medications which reduce salivary flow as a side-effect.
- Occupational: such as battery workshops or having abrasive, dusty labor environments.
- Environmental factors such as the chlorine or other chemicals in swimming pools can cause erosion over time.
- Sports: like professional swimmers in chlorinated water or improperly pH-regulated swimming pools.
Modern life-style and dietary habits are primarily responsible for a strident increase in the prevalence of dental erosion, especially in the young population. Research has shown that constant sugar nibbling emboldens continuous demineralization because the saliva doesn't get time to neutralize the acids. Sticky foods remain in the mouth longer and grounds more damage as the bacteria have more time to produce the acid. While another exposure to acidic solution during this time causes additional rapid drop in pH extending the tooth surface demineralization. Swishing the solution around the mouth holds the acid solution in the mouth which prolongs the contact time between acid solution and tooth surface. Tooth erosion is becoming increasingly common and may have long-term concerns for the patient's dental health. It may cause mild tooth problems such as discoloration of tooth and mild sensitivity, to more severe dental complications such as indentions in the teeth, severe tooth sensitivity or cracked teeth.
Until we change our life style and return to more natural foods the development of tooth decay worsening with age will linger. You can restrict your tooth decay, prevent it entirely and even heal it once a cavity has formed. Fluoride products and dietary modification can reduce the impact of dental decay for the general community. Along with correct brushing, flossing and regular dental checks, the following dietary measures can help minimize tooth decay and erosion:
- Less consumption of sugary foods particularly those of a sticky or chewable nature. Dried fruits can be responsible for sugar and a sticky surface on teeth that encourage bacterial growth and acid production. Avoid sugary or acidic drinks between meals.
- Milk contains sugar lactose, the least cariogenic sugar hence it doesn't promote caries and this has been attributed to the presence of protective factors like calcium, phosphate and milk protein casein.
- Cheese protects against dental caries fairly because it causes more saliva to flow which neutralize acids. It also increases calcium concentration in the plaque stopping demineralization, hence small lump of cheese eaten after a meal may guard tooth enamel.
- There has been some research that shows that tea may fight tooth decay. Tea contains polyphenols which suppress the progression of bacteria in teeth.
- Don't brush your teeth immediately after having acidic foods or drinks. If teeth are brushed when in a demineralized state, a layer of tooth enamel or dentine may also be removed. Also, don't have anything except water after you have brushed your teeth at night because less saliva is produced at night.
- Follow your dentist’s instructions in order to prevent further tooth loss. Your dentist may also recommend the periodic application of fluoride gel in the dental clinic to restore tooth enamel and prevent dental erosion.
The writer is a practicing Dental Surgeon at a charitable hospital and a Lecturer in a College of Medical Sciences in Karachi, Pakistan. A lot of her articles have been published in Khaleej Times, UAE and The News International, Karachi. Recently her anthology got published in a book by Oxford University Press. Follow her on twitter at akhtar_sanaMake it favorite!