Yes, we know: you don't always like visiting us.
And by "us," I mean "your dentists" -- the people who make sure your smile is healthy and big and sparkly.
Sure, you love our hygienists: they make your teeth shiny and don't cause you much, if any, discomfort. But then the doctor comes in to evaluate your oral health, and all you can think of is the maniacal dentist from Little Shop of Horrors singing, "I thrill when I drill a bicuspid!"
Well, here's something you might be surprised to hear: we don't really want to have to turn on the drill. We'd much rather you didn't have cavities for us to treat in the first place!
I always teach my patients that their first line of defense against cavities -- or, as we call them, dental caries -- is prevention. Brushing for two minutes twice a day, flossing daily, and using a mouthwash are great ways to help keep the cavities from forming.
But despite our best efforts, some of us -- myself included! -- have had to see a dentist to treat a cavity.
Here are five things you never knew about cavities. Some of these might surprise you.
1. A cavity is a bacterial infection
Basically, a cavity is just a hole in your tooth. But for that hole to form, a whole lot needs to happen in your mouth. Here's a brief rundown.
Dental caries, the technical term for a cavity, is caused by streptococcus mutans, a bacteria that we've all got in our mouths. As sugars enter our mouth, it's broken down by s. mutans, and secretes acid as a byproduct. This acid then starts to dissolve and soften our enamel. (The enamel, by the way, is the outer layer of the tooth, and is actually the strongest substance that our bodies make!) These soft spots provide easy routes for bacteria to enter our teeth and take up residence.
Once this happens, it becomes harder to clean off the bacteria just from brushing, flossing, and rinsing. And as long as the bacteria is there, it can continue the process of dissolving the tooth, which will eventually lead to a cavity.
2. Cavities are all about timing
Obviously we can't completely eliminate all sugar from our diet. Even healthy foods, like whole grains, fruits, etc., can be broken down into simple sugars that s. mutans feeds on. However, there are things we can do that lessen the effect of these sugars have on our teeth.
When food enters our mouth, it starts immediately being broken down into simple sugars. These sugars are then used by the bacteria as an energy source. As the sugars are broken down by the bacteria, acids are secreted as byproducts. This whole process lasts about 30 minutes -- not from the time you start eating, but from your last sugar intake.
So let's say you want to eat some Skittles. It would be better for you to down the entire bag at once rather than prolonging the snacking over an extended period of time. (And remember, if you're eating sugary foods, it's always best to do it during your meals. That way, you're making more saliva to buffer the acid and wash away the sugars.)
3. Sugar is not always the enemy
Did you know some sugars can actually be used to prevent cavities. And you thought sugar was the enemy!
Let's be clear here: certain sugars -- like those found in dietary carbohydrates -- are what the bacteria need to start the cavity process. (See #2.) However, there are some natural sugars that can stunt and even stop the cavity process. Xylitol, found in many mints and gums, is a sugar that, when ingested by bacteria, actually prevents them from breaking down sugars into acids. At therapeutic levels -- two pieces, three times a day, for at least five minutes -- it can even kill these cavity-causing bacteria.
4. Sometimes we can treat your cavities without even turning the drill on
Sure, we can drill 'em and fill 'em, but there are other methods we've got to deal with some cavities, as long as we catch them early enough.
If a cavity remains in the enamel only -- what we call an incipient lesion -- then we might be able to reverse that. In that case, we'll have you use fluoride, which is found in most toothpastes, mouthwashes, and even your tap water. Fluoride is a natural and safe way to strengthen the enamel, making it harder for the bacteria to dissolve. Fun fact: the Center for Disease Control (CDC) rated fluoride as one of the ten greatest public health achievements of the twentieth century.
Some dentists are even experimenting with "no-drill fillings," if and when they catch the cavity early enough. Here's how: The cavity process starts when the enamel is dissolved, leaving a porous texture to that area of the tooth. This treatment uses a mild acid to completely cleanse that affected tooth structure, allowing a resin material to fill in the voids and strengthen the tooth. (NPR has a nice summary you can read about "drill-less fillings." Just be sure to know that the jury is still out as to whether or not such treatments are effective.)
Upshot? Make sure you come in to see us regularly because the sooner we catch a cavity forming, the more treatment options we'll have.
5. Having cavities is the most prevalent chronic disease of childhood
Although cavities are largely preventable, they remain the "most common chronic disease of children aged 6 to 11 years and adolescents aged 12 to 19 years," according to the CDC. In fact, kids miss over 50 million hours of school each year due to dental problems and related illnesses.
About 20 percent of children aged five to 11, and 13 percent of adolescents aged 12 to 19 have had at least one untreated decayed tooth, according to a study cited by the CDC. In a different study, the CDC predicted that by the age of 15, about 60 percent of all adolescents will have experienced dental caries. And the numbers look even grimmer for children and adolescents from low-income families.
All of that dental care really adds up! In 2009, for instance, dental expenses accounted for roughly $20 billion -- almost 18 percent -- of all health care expenses for children aged five to 17.
That's a lot of money -- and to think, some of those expenses could've been avoided with twice daily brushing and flossing, and regular dental check-ups!