Dental Caries Prevention

Too many dental professionals are giving inaccurate advice about the prevention of dental caries. Dentists often have this scenario in their office - a family comes in for checkups and daughter Jan has several carious lesions, while son Jim has none. The parent says, "I don't understand. Jan brushes her teeth all the time and Jim doesn't ever brush."

If all we tell our patients is this simplistic notion, "brushing prevents dental caries," then we aren't giving them the full story and aren't equipping them to deal with dental caries. Here's the fuller explanation:

Brushing prevents dental caries on the surfaces that are brushed, which are the broad, smooth surfaces of the teeth. Brushing can't prevent pit and fissure dental caries, because brushing doesn't reach the depth of those pits. Neither can brushing prevent interproximal dental caries. Flossing helps there. People who brush don't get smooth surface dental caries - there is no magic in preventing dental caries in other places.

The biggest factor in preventing dental caries:

And, here is the big one - neither brushing nor flossing can prevent dental caries in a patient who is eating multiple times a day.

Try this next time you have a patient with this quizzical expression after you have told her she has twenty cavities and she insists she brushes twice a day and flosses every night. Ask, "How often do you eat?" When I have asked this question of such a patient with a high rate of dental caries, almost without exception I see a dropping of the jaw and a somber expression come over the patient's face as the patient says something like, "Oh, is that what causes it?" Practically all of these people are big snackers. They will have a bag of pretzels or a can of soda that they will nibble on or sip all day long.

Studies about the causes of dental caries:

There are several studies about preventing dental caries that, in my opinion, aren't spoken of enough. These studies, one from the South Seas, and one from Scandinavia, establish two facts. First, people who eat a lot of sugary foods don't get a lot of dental caries as long as that sugar consumption is confined to normal daily meals.

Second, from the Scandinavian study, the quickest way to get a lot of dental caries is to consume sticky, sugary foods continually throughout the day.

The logic of the prevention of dental caries is inescapable. Every time a person consumes carbohydrates, there is an acid attack and dental caries formation on the teeth. If the carbohydrate sticks to the teeth, that dental caries attack continues as long as it is stuck. Combined with this you have normal body defenses against dental caries. Our saliva has antibodies and, besides tending to neutralize the acid, it has minerals in it that help remineralize an early carious lesion. If the dental caries lesion is confined to the enamel, your saliva can repair it. However, when the frequency of attack overwhelms the ability to repair, dental caries progresses into the dentin where natural repair becomes impossible and professional intervention is required. So it is frequency of dental caries attack, not the quantity of sugar or whether or not a person has brushed sometime during the day that has the greatest effect on the rate of dental caries.

We need to better teach our patients the relationship between frequency of eating and dental caries.

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