CARIES

Facts about tooth decay

1. If there were no fermentable sugars in your diet, you would never get a
single cavity. This applies even to the rare person who's teeth are in fact
"soft". This also holds even if you never brush your teeth! I once treated a
woman who's teeth were soft enough to absorb overall color from normal foods. The
enamel was so soft that while preparing the teeth for crowns, the diamond bur cut
through them like they were made of hard chalk! Believe it or not, she had never had
a single cavity! The reason for this was that she had been told as a child that her teeth
were especially susceptible to decay and to avoid sugar as much as possible. She was
also a consistent brusher because of the yellow cast to her teeth. I placed crowns on her
teeth due to their appearance, not because they were decayed.
3. Almost everyone who is prone to caries has a specific habit in which one form of
sugar or another soaks the teeth many, many times a day. These sugar habits
account for perhaps 95% of all caries! If you can identify the habit, and substitute a
diet drink, or a non sugI'll go further into some of the specific sugar habits later in this
piece, but for now, understand that the epidemic of tooth decay in America was caused by the
sudden availability of sugared food products and had this seminal event never happened, the
poor fellow pictured here would not have been featured on this page! ared food in its place,
the decay simply stops where it is.

Q. But even diet soda contains acid from the carbonation (carbonic acid) as
well as citric acid and even other forms of acid added to enhance the flavor.
Since these acids occur in diet soda as well as in sugared soda, why is it that
diet soda doesn't cause decay??
A. All the non sugar related acids in soda (including carbonic acid) are so soluble in
water that they are washed off the teeth almost immediately before they can cause much
decalcification of the tooth structure. On the other hand, the sugar in regular soda is
very sticky and remains on the teeth for a long time. In addition, the bacteria in plaque
use sugar as a raw material to create dextrans which are the molecular units
composing the viscous sticky stuff that makes plaque adhere to the teeth. The dextrans
have the property of absorbing more sugar which is turned into acid by the plaque
bacteria causing the plaque to remain acidic for twenty minutes or more after each
exposure to sugar.
I have never tried to dissolve a nail in a bottle of Coke, but if it did dissolve, it would be
from the prolonged exposure of the iron to the carbonic acid from the carbonation in the
soda, and not from the sugar. If a diet soda is drunk in the ordinary way, the carbonic
acid caused by carbonation does NOT spend enough time in the mouth to damage the

teeth. However if a patient habitually engages in soda-swishing, which is the habit of

swishing the soda around in the mouth for prolonged periods before swallowing in order
to remove the carbonation (because the carbonation hurts the throat), then over many
years, the acids in even diet soda can cause serious erosion of the enamel and exposed
dentin. Note that this form of erosion is NOT the same as decay. Decay is caused by
bacterial action while erosion is caused by direct acid attack. Of course, soda swishing
with regular sugared soda causes rampant decay as well as serious tooth erosion.
Brushing your teeth DOES help prevent tooth decay! In order for the sugar to have the
negative effect it does on the teeth, the bacteria (germs) that live in plaque must metabolize
(digest) it to produce a dilute ACID which is the agent that does the real damage to the teeth.
These germs live in your mouth and double their number about every 20 minutes. By brushing
your teeth, you are reducing their number, and hence the amount of acid produced. This in turn
reduces the rate of decay. Unfortunately, even if your oral hygiene is very good, millions of
germs remain behind, and continue to reproduce throughout the day leaving plenty of them
around to turn the multiple swigs of sugar into acid. In the presence of reasonable oral hygiene,
multiple exposures of the teeth to sugar still produces decay, but much more slowly than if the
teeth are not kept clean.

5. Tooth decay is a major contributor to chronic bad breath!

It is essential to control your tooth decay in order to get your bad breath
under control. However, tooth decay is not the only contributor to
halitosis. Click here to learn about all the forms of bad breath, and how you
can treat them

The sugar habits and sugar myths

If you seem to get a lot of cavities, then you almost certainly have a sugar habit. By that I
mean that you tend to expose your teeth to something sweet numerous times
throughout the day. The key here is the frequency of exposure, not the actual amount of
sugar in the foods eaten or drunk.
Say you buy one can of (sugared) soda (or even natural fruit juice) and then
sip it throughout the day, taking a sip, putting it down, then picking it up for
another sip twenty minutes later.
Each sip allows the sugar to coat your teeth.
The bacteria in your mouth metabolize the sugar turning it into acid.
This acid remains active for about twenty minutes at which time you take another
sip starting the whole sugar/acid cycle over again.
One bottle, or can may last a whole day, but that bottle contains enough sugar to
cause huge damage to your teeth.
Note that even if you drank an entire case of Coke in the space of 20 minutes, that
case of soda would constitute only one discrete exposure and would do minimal
damage to your teeth.

Drinking Diet Coke, Diet Mountain Dew, Diet Pepsi, Diet Kool-Aid or any other
artificially sweetened drink does not cause any decay at all, because artificial sweeteners
are not metabolized into acid by the germs in your mouth.
Finally, it is not just soda that is involved in the sugar habit/tooth decay
syndrome. Below is a short list of some of the surprising habits that I have run into
over the years, and every one of them was the reason that the patient needed a lot of
dental work.
1. Unsweetened fruit juices used in the same way as Coke described above does the
same thing to your teeth. Fruit juices contain natural sugar which is just as
fermentable as table sugar. Many of our patients work in a local juice bottling factory.
They can drink all the juice they want as a perk of the job. Many of them begin to
develop major tooth decay only after beginning work there because of the simple
availability of all that sugar.
2. One woman prided herself on never using sugar, but she needed three very carious
teeth extracted, three root canals and numerous fillings. I kept asking her what type of
foods she ate. "Fresh fruit, vegetables, and other wholesome things. Oh yes, and herbal
tea. " I sweeten it with a tablespoon of HONEY". How often did she drink her tea? "All
day long" she told me. Honey is just concentrated sugar made by bees.
3. Another vegetarian patient came to me with rampant decay. After much indignant
denial about eating or drinking sugared foods, I discovered that she ate RAISINS
throughout the day. Fresh fruit does not stick to the teeth and rarely is involved in the
sugar habit syndrome, but raisins and other dried fruit are very much like gumdrops as
far as the teeth are concerned. The sticky raisin paste remains on the teeth long after the
raisin is eaten, and releases sugar into the saliva for quite a long time.
4. Another older man who I had been treating for years came into the office one day with
cavities starting in almost all of his teeth. He had never had a single cavity for years, but
now he had lots of them. It turns out that he had recently retired and had been spending
a lot of time at the VFW with a bunch of guys who all drank copious amounts of
Mountain Dew. They had all long ago lost their teeth and were wearing dentures. But
my patient had acquired the habit by associating with his new friends, and almost
acquired their dentures as well.
5. A pair of identical twins was brought into Tufts dental clinic while I was there. One
twin had perfect teeth without a single cavity. The other had rampant decay all over his
mouth. Being from the same family, they both ate the same things at each meal (mom
was adamant that she gave them almost no sweets) and being identical twins, they were
genetically identical, so neither one should have been any more susceptible to cavities
than the other. No one could pry out of the twins any differences in their eating habits.
Finally, one of my older professors cornered the two of them and after much prodding
finally discovered that the cavity prone one liked to suck on bread balls. "Bread balls??

What are bread balls?" "Well you take the soft middle out of a slice of bread, ball it up
real tight and suck on it!" Bread is not sweet. How could that cause cavities? Actually,
bread is made of starch which normally does not cause decay, but when kept in the
mouth for a long time, an enzyme in the saliva called amylase begins to break down the
starches into their constituent parts, and those parts are simply sugar. Try it sometime.
If you keep a piece of bread in your mouth for a while it begins to taste sweet. This is not
to imply that bread, potato chips or other starchy foods are major causes of tooth decay.
The sugar is released if the starch is kept in the mouth for a long time without being
swallowed.
6. One elderly woman had a dry mouth, so she began sucking on cough drops all day
long and discovered that within a year of beginning the habit, her teeth, which had
always been a prized possession began turning black and breaking out.
7. One patient liked to reward herself at the end of a long day with a little Claret, a
sweet brandy. She would pour her little shot glass and sip on it all evening until bedtime.
After two years, her formerly good teeth were in need of total reconstruction
8. Nursing bottle syndrome (most recently called early childhood caries) is
characterized by children, generally under the age of 3 who are put to bed with a baby
bottle filled, usually with fruit juice (all natural juices contain lots of fermentable sugars)
or sweetened milk. The pattern is severe decay of the front top teeth. If the bottle
contained only water, or an artificially sweetened drink such as Crystal Lite or artificially
sweetened Kool-Aid, the teeth would not be affected. No mom does this on purpose to
her child, but it is quite common because mom simply doesn't know that the sugar in
the bottle would do this.

Chewing tobacco is cured in sugar! People who chew a lot of tobacco generally
have rampant decay! In areas where chewing tobacco is popular, there is not only a
great deal of decay, but also a lot of badly stained teeth. Chewing tobacco is quite acidic
and tends to etch the surface of the teeth in the same way that the dentist does when he
puts dilute acid on a tooth to etch the surface in preparation for bonding a filling. The
etching process causes a microscopically rough surface on the enamel ideal for allowing
stains to hide out from toothbrushes. Since the tobacco juice is also dark brown, the
stain not only coats the surface of the enamel on the teeth, but it also penetrates into the
nooks and crannies etched into the surface by the acid. This means that the staining
becomes permanent.
10. Honey does cause tooth decay! Honey is considered a refined sugar because
96% of the dry matter in honey is composed of fructose, glucose and sucrose. Honey
also has the highest calorie content of all sugars with 65 calories/tablespoon, compared
to the 48 calories tablespoon found in table sugar. Honey actually decays teeth faster
than table sugar, partly because it is very sweet, and partly because it is sticky and
remains on the teeth longer than other refined sugars.

Recently, however, scientific evidence has come to light showing that

some types of raw honey contain enzymes which kill bacteria. Indeed,
some studies have shown that certain types of honey, when applied
directly to wounds, can reduce the risk that the wound will become
infected. In other words, honey can have antiseptic properties which
could affect its cariogenicity (decay producing properties). In fact, I
have received one letter from a fellow who spent a number of summers
processing honeycomb. He tells me that he has chewed pieces of
honeycomb throughout the day for years without getting cavities. This
is probably true, but only for certain types of honey.
Honey contains an enzyme that produces hydrogen peroxide, and
which is believed to be the main reason for its antimicrobial activity.
Unfortunately, the antimicrobial activity of various types of honey may
differ as much as a hundred fold depending on the specific substrate
(flowers) from which the bees make their honey. Manuka honey seems
to be especially high in the appropriate enzyme. The Manuka shrub is
native to New Zeeland, so if you live "Down Under" you are more likely
to find this type of honey available in stores. The type of commercial
honey you buy in North American and European supermarkets is made
up from mixed batches collected from multiple sources and the
concentration of the appropriate enzyme is likely to be fairly dilute. My
correspondent who had been chewing honeycomb over the course of
years without ill effects for his teeth happened to live in New Zeeland
and had been processing Manuka honey.
One anecdote may help to dispel the myth that honey will not harm the
teeth. The term "honey bear" refers to two species of bear which prefer
to raid beehives for honeycomb. Bears who habitually feast on honey
are the only wild animals which have the dubious distinction of
suffering from tooth decay when NOT in captivity.