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Dental decay explained



 Tooth decay, or 'dental caries' begins as a local chalky spot or loss of minerals on the outside enamel of a tooth. Bacteria living in your mouth eat a portion of the sugars and simple carbohydrates you consume and metabolise them to acids which start eating holes in your teeth. You can interrupt the process at many stages:

1. Starve the bacteria. Avoid sucrose (white sugar) and sweet foods - these are bacterial favourites and easiest for them to digest. But don't be 'conned' into thinking that honey or raw sugar are healthier - the bacteria love them too.

2. Minimise the frequency of sugar intake. After you eat something sweet it takes 2 hours for your salive to clear the acids produced. Mouth bacteria are like little babies - they need frequent feeds. Don't feed them regularly and they will go away, or at least be kept in check by less harmful bacteria. This means regular meals are less harmful than many snacks or grazing throughout the day.

3. Consistency / texture is important. Sweet sticky food such as cakes, toffees, lollies, dried fruit, jams etc are more harmful or cariogenic (decay promoting) than sugar in liquid form eg soft drinks, mixers or cordials, which again are more problematic than solids, eg chocolate, a dry biscuit or eating desert with your meal. 

Fresh fruit, although sweet, contains plenty of water and fibre, so it tends to end up in your stomach, not on your teeth. So, diet is very important, but not just what you eat, but how often and in what form. In general, the less processed the food is the better, and most savoury foods are 'tooth neutral' in terms of decay potential. Some dairy products eg cheese or joghurt even have a protective effect due to the protein casein.

Another way to interrupt the decay process is by physically removing the dental plaque (bacterial film) from your teeth on a regular basis. Tooth brushing does this quite well, but a toothbrush cannot get to all surfaces of the teeth (especially where they touch each other), so flossing or removing plaque from between your teeth eg with interdental brushes, flossettes, or toothpicks is also recommended at least once a day.

Decay causing bacteria are quite 'clever' - they use some of the sugar you consume to create a 'glue' which helps attach them to your teeth so they cannot be easily removed by rinsing for example. This is called a 'biofilm', and becomes a complex community of different bacterial colonies, their food stores and protective devices living on your teeth. The longer it stays undisturbed the harder it is to remove, and the more 'dangerous' and selfsustaining it becomes. Brushing and flossing (or equivalent) disrupt the plaque biofilm, so remember to brush and floss at least once a day. Twice a day brushing is recommended as most people are not as perfect as we would like to be.

Early dental decay is a reversable process. Minerals lost from the surface of the enamel can go back into the enamel. Your saliva does this automatically. You can help the process by supplying the required minerals from toothpaste, fluoride gels, tooth mouse or other reminerizing solutions.

Decay takes time - up to a year in many cases from a small chalky spot to an actual cavity forming in a tooth. Once a cavity has formed and the enamel structure has been lost, the bacteria move into their new home and continue eating away at your tooth. At this stage remineralisation is no longer sufficient. The bacteria must be physically removed and replaced with a filling material to compensate for the lost tooth structure. Sometimes the amout of tooth structure eaten away is significant, and more complex restorative techniques are needed, such as a crown. In addition, the decay process may progress towards the 'pulp'(living core or 'nerve') of the tooth and cause sensitivity, or even pain and infection if ignored. Complex treatment or even removal of the tooth may be needed, so clearly it is best not to allow decay to progress to this stage.

Se my blog:"Prevention is better than cure" for further ideas

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