But, I'm too old to have cavities...

But I’m too old to have cavities...
But I’m too old to have cavities...

I cannot begin to count the number of times that I have diagnosed one of my adult patients with a new cavity, and I get all sorts of puzzled looks and questions. Responses will range from, "I thought cavities was a childhood thing", to, "I haven't eaten candy since I was a kid, so how can I have a cavity?", or, "I'm just too old to have a cavity, why would I get one now?". What many of us fail to recognize is that cavities, or "caries" as us dentists call them, are actually a bacterial infection of a tooth.

Cavities occur when bacteria in our mouths, such as Strep mutans, feed off the sugar from our diet for energy. The byproduct of this metabolism of sugar by the bacteria is the production of acid. That acid is what attacks the minerals in our tooth enamel, initially weakening the surface, and eventually creating a “hole”, aka a cavity. Once a true cavity is formed on a tooth, and reaches the dentin layer of the tooth (a softer inner layer of the tooth under the enamel), the cavity must be repaired by a dentist with a filling or other restoration such as a crown. If you leave the cavity untreated, it will eventually grow to the point where it can reach the nerve and you will need a root canal. Sometimes, the cavity can grow down below the gum line to the bone, and you will either need gum surgery to reach and properly restore the tooth, or you will need to have the tooth extracted.

So, we go back to our initial question, “But I’m too old to have cavities, why do I have one now?” What we must understand is that the bacteria in our mouths don’t care if the sugar is coming from candy, bubble gum, soda pop, or other “junk food”. Foods such as potatoes, rice, bread, pasta, and even alcohol, all break down to the same basic thing, sugar. The bacteria hanging out on our gums, and on that sticky film on your teeth called plaque, immediately start to metabolize the sugar, and to produce acid which causes cavities. In addition, we must understand that as adults, we may have an even greater propensity to have cavities than children? But why?

As adults, unfortunately many of us must take medications to treat our other medical conditions. Medicines such as anti-depressants, medication for high blood pressure, Synthroid to treat our underactive thyroids, anti-histamines for allergies, nasal decongestants, inhalers for asthma, and the list goes on and on, cause Xerostomia. Xerostomia is the medical name for “dry mouth”, and it wreaks havoc on our teeth. Saliva works as a buffer that stabilizes the pH in our mouths, and fights the acid that causes cavities. In addition, saliva contains minerals such as calcium and phosphate that can harden and “repair” the softened enamel. When we lose that saliva in our mouths, cavity activity spreads like wildfire. Medical conditions such as diabetes, cystic fibrosis, hypertension, stroke, Parkinson’s disease, HIV/AIDS, Sjögren's syndrome, and others also have dry mouth as a side effect. Other everyday things such as caffeine from coffee, tea, or energy drinks can also cause dry mouth (as well as the drinks being very acidic themselves). Additionally, as adults, and unlike children, many of us smoke or drink. Smoking, which contains nicotine, a stimulant, will cause dry mouth. Alcohol in the occasional beer, glass of wine, or cocktail will also dehydrate us, leading to dry mouth, it is high in carbohydrates (sugar), and tends to be acidic. Alcohol wins the triple crown in leading to conditions that are ideal to get cavities.

So, what can we do to prevent cavities as adults? As always, a good regimen of brushing and flossing is key. Brushing to remove plaque buildup on our teeth, and flossing to remove plaque from in between teeth reduces the number of bacteria that can cause acid damage. Using a Waterpik/water flosser to flush away the bacteria and food particles is of great benefit. A toothpaste with fluoride is highly recommended because the fluoride will help to remineralize the enamel that has been damaged by the acid. A fluoride rinse is also helpful for many, including those with chronic dry mouth, or who have undergone, chemotherapy, or radiation therapy in the head and neck. If you can’t brush after a meal, chew a sugarless gum containing either xylitol or sorbitol. Bacteria cannot use xylitol or sorbitol as food, so they will not produce acid. In addition, some studies have shown that xylitol can in fact even inhibit the growth of bacteria. Chewing gum will stimulate saliva production, which as we know, will help remineralize the teeth, will wash away the sugar and bacteria, and will buffer the low pH that may be present in the mouth, including neutralizing the acid produced by the cavity causing bacteria. Routine dental cleanings are also of utmost importance because they will eliminate the plaque which has hardened into calculus (which we can no longer remove ourselves by brushing or flossing), as well as lowering the overall bacterial count in your mouth.

Speak with your physician regarding your medications if they are causing you to have a dry mouth, and speak with your dentist or dental hygienist regarding your current dental health. Keeping you healthy and cavity free is truly a team effort by you, your doctor, and your dental team. We are all here to help.

Dr. Edward Alvarez is a Cosmetic and Reconstructive Dentist and Certified Acupuncturist in New York City.

Dr. Alvarez serves as a Police Surgeon for the New York State Troopers PBA and Amtrak Police Department FOP.

Dr. Alvarez is a fellow of the World Clinical Laser Institute, a member of the American Academy of Cosmetic Dentistry, the Academy of General Dentistry, and a member of MENSA.

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