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What is a Dental Cavity?
Enamel is the outer layer of a tooth. The average thickness of the enamel layer on a tooth is only 2-3mm, which is about the thickness of the penny. Even though it's fairly thin, it is the hardest substance in the human body, and it is second hardest behind diamonds of all substances on the planet. Wow! That's pretty strong!
Even being so strong, people get decay (or "dental cavities") in their enamel for multiple reasons. The essential pathology is that there is pathogenic (or "bad") bacteria in the mouth that creates an acid byproduct; you have a dysregulated oral microbiome, which may sound familiar to anyone who has experienced or understands the gut microbiome. This acid byproduct erodes and weakens that enamel layer until eventually the process can't be reversed, and a lesion exists that now can only be repaired by a dental restoration.
Unfortunately, cavities are one of the most common chronic diseases. The CDC reports that 25% of young children, 50% of adolescents, and approximately 90% of adults over the age of 20 have had at least one cavity in their life. And having a cavity is no fun! If you have one, you can experience some of the following symptoms:
Symptoms of Cavities:
Sensitivity to hot and cold
Dull ache, throbbing in a specific area of the mouth
Bleeding or swollen gums
Area between teeth where floss consistently gets caught or frayed
Stains or discoloration of a tooth
Bad breath
And if left untreated, a cavity continues to get worse, and eventually, it can infect the nerve of the tooth or cause an abscess in the gums and bone around the tooth. And instead of being able to treat it with a small filling, a cavity that has progressed that far may require much more extensive therapy to stabilize the disease.
But here's the thing, cavities are almost entirely preventable! If we address the root causes of this pathology, then we can prevent cavities from occurring, & in some cases when the process has started, we can even REVERSE early damage to that enamel layer before it's too late :)
How to Prevent & Reverse Cavities:
Eat tooth-friendly foods.
Eating a diet rich in colorful fruits and vegetables, nuts, high quality fats, grass-fed dairy and meats, pastured eggs, wild-caught fish, and fermented foods (pending no individual allergies or food sensitivities). Foods that are rich in vitamin D, vitamin K, omega-3 fatty acids, and antioxidants help fortify your dental health, and avoiding sugary, heavily-processed, inflammatory foods supports a healthy gut and oral microbiome that strengthens your immune system and promotes "good" bacteria that protects against cavities.
Crispy fruits and vegetables not only contain many of the nutrients your body needs to maintain peak health, but the process of chomping on carrots or biting into apples provides mechanical debridement and can actually knock of debris from your teeth to protect against the bad bacteria. And specific to children as can be seen in the research from Dr. Weston Price, these food choices can and will have a dramatic impact on the development of the jaws, lower face, arches, and airway, in addition to protecting against cavities.
A good rule of thumb to guide you and to teach your children is to "eat a rainbow"; eating fruits and vegetables of all different colors ensures you are getting the variety of nutrients you would need to support whole-body and oral health.
Supplement to ensure your nutritional goals.
This can be applicable to both children and adults. Specific to kids, while we are going to encourage that they get all the vitamins, minerals, and nutrients they need via their interaction with their environment, we need to be realistic when we observe that there are deficiencies. And for adults, pending your latest round of comprehensive labs or recent functional health analysis, you may be deficient for other reasons associated with absorption or other systemic health issues (more on this later). But your mouth and body benefit from having good levels of the following:
fat-soluble vitamins A, D, E, K
Trace minerals like iron and selenium
Calcium
Zinc
B vitamins
CoQ10
Vitamin C (I like vitamin C products that include quercetin; just make sure whatever you get doesn't contain sugar)
Pre & Probiotics (for kids, I like hyperbiotics; and for adults, it is best if you can have your gut evaluated first to determine how you can best be supported, but there are a lot of options pending your needs & health goals)
Stay hydrated and prevent grazing.
Choosing water instead of juice or other beverages is always a good choice. Water is vital in so many physiological pathways to promote better health in general, and specifically, it ensures you have sufficient saliva to "wash" your teeth after a meal or snack. Staying away from sugary juices, energy drinks, and coffee with cream and sugar are also great choices for cavity prevention.
And while snacking on healthy options can be a great habit, it's only good if you allow some time between meals and snacks. All day grazing means that your mouth never gets the opportunity to recalibrate after a meal and neutralize your saliva to be a more tooth-friendly environment. Even if you're only eating the healthiest of foods, this can still become problematic if you are snacking all day long without 30-60 min windows (at minimum) between snacks and meals for your mouth to rebound to a safer baseline.
Use hydroxyapatite toothpaste & other related products.
Hydroxyapatite has ALL of the powerful tooth-protective and remineralization properties that you may be familiar with from fluoride, but it has none of the side effects that fluoride has been demonstrated to cause in patients. Hydroxyapatite can help protect existing crowns and fillings that you may already have in place, and it can decrease generalized sensitivity.
There are 3 main products that I recommend listed below. While they are more expensive than the toothpaste you may buy at the drugstore, remember that these products contain ingredients that disrupt your microbiome and have neurotoxic effects. You only need a pea-sized amount of toothpaste per use, and it's great to switch the whole family. A big differentiator between the brands has to do with flavor; so if you are ordering for your child and yourself, I recommend you have them be part of the process in choosing 2 different flavors to experiment with what you can use moving forward.
Risewell (this brand is great because they have mouth rinse and floss products that contain hydroxyapatite, and they also have a kid's cake-batter-flavored toothpaste, which some of my pediatric patients LOVE and others are not too crazy about this flavor).
David's (while they have many different flavors for their general "clean" toothpaste line, make sure to order the one that includes the hydroxyapatite ingredient)
These brands are available directly through their websites. You can also get them through amazon, but make sure to check the prices before finalizing your purchase; sometimes the product can be marked up 2-3x on amazon vs what you can get them for directly on the distributor's website.
And of course, once you have these products, they only work if you use them ;)
Breathe through your nose.
Proper breathing is critically important both during the day and at night while sleeping. Mouth breathing not only dries out your mouth and creates a much more challenging environment to protect your teeth against cavities, but it also causes a cascade of whole-body symptoms that predispose a patient to chronic inflammation, compromised immune system, increased cravings for foods with a high glycemic index, among other conditions that exacerbate your oral health. How we address mouth breathing is different in children vs. adults. I plan to a whole blog on this soon, but if you or a family member present with this condition and are unable to establish nasal breathing, then I recommend coming in for a comprehensive evaluation.
See your dentist regularly.
I always tell my patients that the easiest, most fun, and cheapest dentistry we can do is prevention and education. It is my goal that all of my patients can be in a healthy category where I only have to see them 2x per year to confirm all looks good, to give pertinent feedback on any changes, and/or to intervene on any small issues that may be present before they become a big problem. Reinforcement of good habits and accountability in maintaining your health are helpful tools for adults and children. And while visiting with us, we can identify any individual concerns (whether that be genetic abnormalities or lifestyle propensities) and create a custom plan to mitigate any risk to developing disease. Knowing what you're working with or up against is the first step to ensure you have the tools needed to maintain peak health.
Also, while the symptoms listed above can signal the presence of a cavity, these symptoms often don't show up until the cavity has already gotten pretty big. So 3- or 6-month wellness visits (pending what your plan is with your doctor) allow the doctor to evaluate for even the smallest or earliest signs of demineralization so that we can reverse it and prevent it from getting any larger or problematic.
For pediatric patients, that can include placement of dental sealants on permanent teeth to provide an extra layer of protection against decay while they are still mastering their oral hygiene routine; it can also include guiding the permanent teeth into proper alignment to ensure no crowding and easy-to-clean positioning of those teeth.
For adults, your plan can include addressing whole-body concerns from a functional health standpoint via collaboration with your healthcare team. It can also include identifying areas of gingival recession where you may be at higher risk for cavities so we need to take extra care
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