Separating myths from facts about cavities.
“The Only Good Bacteria is a Dead Bacteria” Is Kinda Wrong
It's common knowledge that bacteria, more specifically the proliferation of certain “bad” bacteria, is a fundamental cause of cavities. Even from a young age, we are taught to brush and floss our teeth, preferably with minty toothpaste, to kill the bacteria in our mouths. Through a combination of education and the ever-present background hum of advertising, we are taught to extol the virtues of dental hygiene and demonize our oral bacteria.
Toothpaste and brushes, mouthwashes and rinses, even some gums and flosses, all claim to “destroy,” ”kill,” “eliminate,” “eradicate,” and “wipe out” the microbes in our mouths. They conjure up images of some microscopic holocaust that happens in our mouths twice a day every day. However, perhaps in our zeal to destroy the germs in our mouths, we missed a more significant point. Despite decades of developing all kinds of germ-destroying and bacteria-fighting chemicals, pastes, rinses, washes, and appliances, dental caries remains one of the most ubiquitous dental diseases in the United States. Although dental caries is mostly preventable, cavities are the most common chronic disease of children aged 6 to 11 years and adolescents aged 12 to 19 years. Cavities are also the most common chronic diseases amongst all age groups.
"The real causes behind cavities can be divided into three general categories: demineralization, diet, and genetics."
--- DR. REZA KHAZAIE, DDS. PROSTHODONTIST
If the marketing and the early dental education in many primary schools are to be believed, we should have solved this problem long ago. Our bacteria-killing prowess is unmatched, yet dental caries remains a considerable dental health concern for most people.
While the proliferation of bacteria in the mouth indeed plays a crucial role in the development of dental caries, they are but one of many significant factors that determine the severity, scope, and likelihood of getting cavities.
Putting the Bacteria Myth to Bed
It is important to remember, bacteria does play an essential role in the development of cavities in both children and adults. However, it is not the bacteria itself that is destructive but rather the complex interaction of the bacterial waste products of a small subsection of oral bacteria, namely gram-negative bacteria, and the minerals in enamel.
Furthermore, recent research has shown us that wantonly destroying all the microbes in our oral cavity is not only not helpful for dental health; it can be detrimental. To understand bacteria and its role in our oral health, it is essential to know why bacteria got such a bad name.
Scientist have known for a long time that certain strains of bacteria in the mouth produce acidic wastes as a byproduct of metabolizing sugars. These acids leach the protective minerals out of the enamel of teeth in a process known as demineralization.
It is the demineralization of teeth and the subsequent weakening of the protective enamel that leads to the creation of cavities. Cavities are merely holes in the dental enamel. As a result of this discovery, the next logical step is to eliminate the bacteria.
No bacteria, no acidic waste byproducts, no demineralization of dental enamel, and therefore, no cavities. Unfortunately, our dental health is not that simple.
By focusing on only one necessary but not all-encompassing link in the creation of cavities, traditional notions of dental hygiene that focus solely on eliminating bacteria and biofilm failed to address other causes of demineralization or directly combat demineralization itself.
Research shows that killing all bacteria isn’t helpful. Instead, we should focus on cultivating our oral microbiomes. The total number of harmful bacterial species is incredibly limited. Yet our mouths contain an enormous diversity of other either harmless or even helpful species that do everything from aiding in digestion to fighting off harmful bacteria. Some estimates put the number of different bacteria species in any given mouth between 500 and 1,00 different species all vying for space and nutrients. The idea is that by cultivating “good” bacteria and removing “bad bacteria” people can create a more resilient oral microbiome that is better at resisting the creation of cavities.
The Real Big 3: Demineralization, Diet, & Genes
The demonization of oral bacteria needs to be addressed. Not all bacteria in the mouth is terrible. Destructive bacteria occupy only a tiny slice of the total share of space in the mouth. Even so, these relatively few bacterial strains do not directly attack enamel as they are often depicted too. Instead, it is the demineralizing effects of their waste products that produce the most damage.
With this in mind, the focus of dental hygiene shifts from a never-ending war against bacteria to a mindset of maintaining balance whether it is a balanced oral ecology, balanced mineral content in teeth, or a balanced diet. The real dangers to dental health, and the practical reasons behind cavities, then, have to do with the imbalances that result from our choices or pure genetics.
The real causes behind cavities can be divided into three general categories: demineralization, diet, and genetics. The first two underlying causes of cavities can be actively controlled with a variety of techniques and methods. The last, genetics, is out of our control yet plays an overwhelming role in determining a person’s overall oral health and susceptibility to developing dental caries.
Demineralization is primarily the result of bacteria. However, combatting demineralization doesn’t necessarily mean removing harmful bacteria only. By remineralizing teeth and ensuring a net positive inflow of minerals into the enamel compared to outflow as a result of acid leaching cavities can be prevented.
Likewise, eating a diet that is rich in the minerals necessary for dental health, such as calcium and potassium, can significantly improve a person’s oral and dental health. Consuming fluoridated water is also a proven and effective way to rapidly remineralize teeth and prevent cavities.
Avoiding simple sugars which fuel acid-spewing bacteria is another effective way to promote strong enamel.
Finally, the food we eat plays a vital role in determining the composition of our oral ecology. Diets high in meats and fats tend to encourage the growth of halitosis-causing microbes that produce sulfur and toxic byproducts while diets high in vegetable tend to cultivate more benign strains of oral bacteria. If you want to address the real reasons behind cavities, you’ll want to address demineralization and avoid a poor diet.
Lifestyle & Holistic Strategies for Fighting Cavities
Most dentists would recommend a balanced combination of extrinsic, intrinsic, and holistic strategies to help maintain, preserve, and actively brighten up your smile and protect your teeth from demineralization.
Lifestyle changes can be one of the easiest, most cost-effective ways to whiten your teeth or protect your whitening investment. Avoiding staining beverages such as coffee and wine can go a long way towards preserving your teeth as well. When drinking beverages, especially acidic beverages that can erode and demineralize teeth such as fruit juices and sodas, using a straw does wonder for your teeth.
Other simple lifestyle changes include eating a healthy diet, getting enough sleep, and exercising daily. In general, a healthy body means healthy teeth. Our teeth are intimately connected to and affected by the rest of our body. Maintaining good health means that our teeth will have the nutrients they need to build enamel, fight off bacterial infections, and keep healthy bone density.
Watching what you eat and maintaining good health is, by far, the most economical, most effective, most holistic, way to improve your teeth and smile. When combined with a rigorous routine of removing harmful plaque and bacterial biofilm you and your family can have beautiful, white teeth for a long time.