GUIDE TO DENTAL CARIESA PATIENT’S

Dr. Jennifer Graas

A PATIENT’S GUIDE to dental caries

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Are you tired of getting told you have a cavity at every dental check-up?Or do you simply want to know more about cavities and how they happen?

One of our core values at Eau Claire Park Dental is prevention. We don’t just want to fill cavities, we want to prevent them from happening in the first place!

Cavities, also known as dental caries, are caused by a bacterial imbalance on the teeth. This imbalance occurs based on each individual’s oral environment, dietary habits, and hygiene habits. Everyone with teeth is at some risk for the infection that causes tooth decay. Large population studies have shown that even low risk individuals have a 23.6% chance of developing new cavities in the next 12 months, and that high/extreme risk patients have an 88% risk.

There are also e�ects on the rest of your body from cavities. Streptococcus mutans, a cavity cau- sing bacterial species, is the most common oral bacteria found on heart valves and coronary arte- ries when it is found in the mouth of an individual and may be a potential risk for heart disease.

By understanding what is causing an imbalance in your mouth and by making adjustments, the bacterial imbalance can be controlled and your cavity rate can be either reduced or eliminated. A caries risk assessment along with early intervention professional products, can lower decay rates anywhere from 24% to 74%.

Our goal is to help identify issues that you may face, and recommend treatment strategies that you may choose in order to improve your oral health and keep your teeth for life.

Dr. Jennifer Graas

There are 4 primary risk areas that areoften the root causes of dental caries:

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Bacterial biofilm imbalance/infection:

Dental plaque is a risk factor for cavities in 2 di�erent ways:

• If the plaque biofilm has a high concentration of cavity causing bacteria• If there is too much total bacterial plaque on your teeth

The growth and type of plaque in a patient’s mouth is influenced by the availability of nutrients (diet), the pH of the mouth, and roughness of the tooth surface (rougher surfaces are easier for bacteria to stick to).

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Dry mouth/Saliva:

Saliva is one of the most important protective mechanisms for our teeth. It contains minerals as well as antibacterial, antiviral and antifungal constitu-ents. It helps to balance the pH in the mouth, and supports remineraliza-tion of the teeth.

Lack of saliva is a major risk factor for dental disease. Some causes of dry mouth are:

• Stress, poor diet, age, heredity, alcohol, frequent tobacco use, common medications (over the counter and prescription), and some diseases• Common medications that can cause dry mouth include: antihista- mines, cold medicines, oral contraceptives, dietary supplements, pain medication, antidepressants, high blood pressure medications, acid reflux medications, seizure disorder medications, and anti-anxiety medications.

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Drinks, snacking (Diet):

Every time we eat or drink, the pH in our mouth becomes acidic. The more often we eat and drink, the more the pH in our mouth becomes acidic, and cavity causing bacteria begin to thrive over the normal bacteria in our mouth.

• Do you drink liquids other than water more than 2 times daily between meals?• Do you snack daily between meals?

If you answered yes to these questions, your dietary habits could be con-tributing to your caries risk.

Ideally, sugary or acidic foods should be limited as part of a healthy diet. In addition, while frequently snacking on “healthy foods” or being on a frequent meal diet may be better than snacking on sugary foods for your waistline, it still increases your risk of cavities.

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Poor Home Care/Wrong Home Care Product Routine:

While brushing and flossing your teeth twice a day is important to remove plaque, the actual type of toothpaste and rinses we use are what has the ability to change our oral biofilm balance and ultimately influence oral health.

Most patients receive little guidance from their dentist regarding products they should be using at home, and are bombarded with products in stores that can “do everything” and are “recommended by 4 out of 5 dentists”. The most common advice given to patients is to brush and floss more, which can be frustrating especially when they are already brushing and flossing regularly but still have cavities.

On the other hand, o�ces that are serious about recommending proper patient-specific product therapies are often met with equal frustration from patients who mistakenly believe that the dentist is just trying to “push products to make money”. The reality is less than 0.5% of our annual reve-nue is from product sales. We are a preventatively oriented dental practice and have chosen to carry and sell the CariFree therapeutic products in our o�ce due to their potential to help our patients.

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So… now that we know what causes cavities, what can we do to protect our teeth?

PROTECTIVE FACTORS AND AGENTSFluorideThere is abundant scientific evidence that demonstrates that fluoride strengthens the teeth, makes them less susceptible to acid attacks, and inhibits the production of acids by cavity causing bacte-ria. When teeth are under acid attack and fluoride is present in the mouth, it gets incorporated into the enamel making it stronger and more decay resistant.

There are many forms and concentrations of fluoride in many di�erent types of products. The most common are:

• 0.243% neutral sodium fluoride toothpaste (over the counter)• 0.05% neutral sodium fluoride oral rinse (over the counter)• 1.1% neutral sodium fluoride toothpaste (prescription)• 5.0% neutral sodium fluoride varnish (prescription)

Based on your caries risk assessment, proper products will be recommended to you.

For adults and children 6 years and older, any level of fluoride is considered safe and recommenda-tions are made based on caries risk level.

For children age 0-3, the Canadian Dental Association recommends a grain of rice sized amount of 0.243% fluoride toothpaste daily.

For children age 3-5, a pea sized amount of 0.243% fluoride toothpaste is recommended daily.

Fluorosis results from higher than recommended levels/doses of fluoride exposure, and appears as unsightly white or even brown spots on the teeth.

Other risk factors to caries:

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A proper home care program is designed to counteract the risk factors specific to each patient and move their individual caries balance toward health

Oral appliances(braces, retainers, nightguards,partial dentures, snore appliances etc)

Acid Reflux Diabetes

Other drug use(methamphetamine, marijuana, opiates/heroin, cocaine, ecstasy)

Head and Neck Radiation Therapy

SjogrensSyndrome

Bulimia

Xylitol

Xylitol is an e�ective anticaries agent and also potentiates the e�ects of even small amounts of fluoride. However, it is much less commonly found in anticaries products due to cost. In order to provide therapeutic benefit, the dental care product should have a minimum concentration of 10% xylitol. While xylitol may be listed on many product labels, you will often have to contact the manu-facturer or search online to find out how much xylitol is actually present in the product.

Xylitol works as an anticaries agent in 3 ways:• Cavity causing bacteria cannot metabolize xylitol into acid as they do many other carbohydrates and sweeteners, protecting the teeth from additional acid exposure. • Because bacteria cannot metabolize xylitol, it reduces their growth and the bacteria starve, reducing the amount of plaque and the number of bacteria in plaque. • Because it is sweet tasting, it causes an increase in salivary flow to aid in repair of damaged tooth enamel.

Xylitol is safe for all age groups (even children under 2), and can be found in oral rinses, sprays, toothpastes, gum, mints, and lollipops for children and adults.

Antibacterial Rinse

Bacteria that have formed a biofilm (plaque) are very hard to kill. The longer a bacterial biofilm po- pulation resides, the more di�cult it is to penetrate. For this reason, a broad spectrum oxidizing antibacterial agent capable of penetrating a biofilm should be considered part of a treatment stra- tegy.

A sodium hypochlorite 0.2% oral rinse kills bacteria on contact. Studies have also demonstrated that it is possible to eliminate/reduce cavity causing bacteria and replace them with healthy orga- nisms by short-term therapy with a high pH antibacterial 0.2% sodium hypochlorite rinse strategy.

This rinse protocol is also highly e�ective for the treatment of periodontal (gum) disease, and mouth ulcers (canker sores).

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Remineralization (Nanohydroxyapatite and Calcium Phosphate ions)

Various forms of Calcium phosphate ions have been added to dental care products in an attempt to mimic natural remineralization (for eg. Tricalcium phosphate, amorphous calcium phosphate, and CPP/ACP). The scientific results on these products are mixed. Some conclude there is lack of evidence or no benefit, some have demonstrated improvement. This may be because ionic forms of calcium and phosphate generally do not occur naturally in saliva and are di�cult to incorporate into enamel.

Nanohydroxyapatite particles (non-ion) mimic the building blocks of natural enamel and are e�ec-tive as an enamel repair material and anticaries agent. Hydroxyapatite and fluorapatite are the most bioavailable and stable forms for remineralization and are naturally present in high levels in saliva. It has also been shown to restore luster and remineralize enamel damaged by bleaching agents.

Which home care products have all of these protective factors? Cari-Free! This is the reason we stock these products in our practice and make it available to our patients at cost. It is hands down the most highly researched and e�ectiveproduct line out there for caries prevention.

We hope this has helped to answer any questions you have about dental caries, risk factors and prevention. If you have any further questions or would like to discuss your individual risk and prevention strategy please feel free to contact us for a consultation.

Dr. Jennifer Graas

A patient’s guide to dental caries

photo: cariefree.com

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Source:

Balance: A guide for managing dental caries for patients and practitioners by Kim Kutsch and Robert J. Bowers.