Fillings | Delmarva Dental Services


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Cavities And Their Prevention About 150 million fillings are placed in the teeth of Americans every year. Many of these fillings could have been avoided. Understanding how cavities are caused and what can be done to prevent them could save millions of dollars as well as needless time in the dental chair. Cavities or caries are caused by bacterial plaque. This is a soft sticky biofilm (see “Biofilms and Oral Health“) composed of bacteria and bacterial products that adhere to the tooth. The bacteria use sugar for food and produce acid as a waste product. It takes 20 minutes for the acid to be made. The acid dissolves the tooth surface by removing the calcium. Initially it will look opaque or chalky on the outer surface of the tooth. This area is porous and many times stains will actually penetrate the surface. If plaque continues to be present, the acid will remove more calcium, the tooth will become softer, eventually caving in and creating a cavity. Cavities are influenced by the following factors: The amount and type of plaque formed, acid produced and the resistance of the tooth surface. The more sugar present and the longer it remains in the mouth the more cavity causing bacteria making acid. Processed foods that contain the following items are high in sugar: dextrose, sucrose, lactose, high fructose corn syrup, brown sugar, honey, and molasses. When reading a list of ingredients on a label, remember items at the beginning of the list are in greater concentrations than items at the end of the list. Also stickier foods remain in the mouth longer. It was once thought that only sugar caused cavities; we now realize that starches can cause cavities as well. Starches are long chains of sugar molecules connected together. An enzyme in the mouth called amylase can break these connections. If the starch remains in the mouth, sugar will be formed. Starchy foods like cereal, bread, potato chips, and pretzels once believed to be innocent are now known to contribute to cavity formation. Avoid foods high in sugar and rinse your mouth, brush and floss after starchy foods. Various devices (See “Home Care Instructions“) such as toothbrushes and floss can remove plaque. Toothbrushing removes plaque from the cheek side, tongue side, and most of the chewing surfaces of the teeth. Electric toothbrushes are usually more effective than conventional toothbrushes. Flossing removes plaque from the side of the tooth that contacts the adjacent tooth where a toothbrush can’t reach. The only areas that cannot be cleaned effectively by brushing and flossing are the tiny pits and grooves on the chewing surfaces of the back teeth. These areas can be sealed with a plastic barrier called a sealant (See “Sealants”) that is bonded to the tooth covering the pits and grooves. This prevents bacteria, plaque acid and sugar from penetrating into these tiny pits and grooves causing damage. The longer acid remains in contact with the tooth the more calcium loss. After the ingestion of sugar, it takes 20 minutes for bacteria to release acid. Over the next hour, the saliva in the mouth neutralizes the acid. If sugar is continually ingested, the saliva never gets a chance to neutralize the acid. This happens when sipping drinks containing sugar throughout the day or when sticky starches or sugars remain around the teeth for hours. When brushing and flossing are not possible, much of the acid can be removed before it begins to dissolve the tooth by rinsing with water or by chewing gum. The gum causes you to produce more saliva. In both cases, the acid is diluted, neutralized and washed off the tooth. Chewing gum with Xylitol is the most beneficial. (See “Chewing Gum“) When the mouth is dry, sugar and starch will cause greater destruction. The mouth is drier during sleep and in people who take certain medications like decongestants and diuretics. (See “Medications Causing Dry Mouth“) Oral probiotics will reduce the number of sugar producing bacteria by increasing the number of good bacteria. (See “Cavity prevention with Oral Probiotics“). When fluoride is present in the mouth, it causes calcium from the saliva to enter the tooth, reversing the process where acid removes the calcium. This is how a beginning white spot cavity can become hard again. Fluoride can be obtained in various ways: Fluoridated water, toothpaste, rinses, drops, tablets, vitamins and in office treatments. (See “Fluoride“). The more fillings, crown, and bridges in a person’s mouth, the easier it is to get cavities. That’s because filling and crowns have junction points where the restoration meets tooth structure. When viewed from a microscopic level, there is no such thing as a leak free junction. Since bacteria are microscopic, they can enter the tooth here. It is easier for bacteria and acid to penetrate these areas than solid tooth. The more dental work present the more junction points, therefore the more potential for cavities. People who have extensive dental work should take special preventive measures such as the ones noted above. Adhering to this advice will help you achieve a cavity free mouth.