Many people know the most common cause for cavities, also known as tooth decay. Sugar, candy, sodas, sticky fruit like raisins, fruit snacks, cough drops and other sweets are all well-known cavity causing foods. Starchy foods like bread, crackers, and chips can also cause cavities because starches are broken down into sugars by digestive enzymes found in saliva.
Cavities are caused by germs (Streptococcus mutans, Lactobacillus) in the mouth which metabolize sugar from food or drinks and produce acid as a by product. This acid removes the minerals from the teeth through the process of erosion, causing a hole or cavity in the tooth. So the basic "cavity equation" is TEETH + SUGAR + GERMS = ACID -> CAVITY. Our goal is to keep the teeth, it is difficult to get rid of the germs, therefore the item to eliminate in the cavity equation to prevent cavities is sugar.
Next I will review some lesser known sources of tooth decay, which are as follows:
- Diet soda- Diet soda does not contain sugar, instead it contains artificial sweetners. Although the sweeteners used in diet sodas generally do not cause cavities; diet soda contains acid as a preservative which erodes teeth. I like to say that diet soda "skips the middle man," sugar and goes straight to putting acid on the teeth, causing decay.
- Fruit juice- Fruit juice is high in sugars (fructose, sucrose and glucose). Certain juices such as orange juice and grapefruit juice contain high concentrations of citric acid as well as a lot of sugar and this combination can rapidly cause tooth decay.
- Sports drinks- Many sports drinks are advertised as being healthy for active people because they "hydrate", replace minerals, and electrolytes lost through perspiration. However many sports drinks contain sugar and even diet versions contain acid as a preservative which can cause tooth decay.
- Chronic dry mouth (xerostomia)- Dry mouth or xerostomia may be caused by various health conditions, or as a side effect of certain prescription medications. Decreased saliva flow allows cavity causing bacteria to stick to the teeth longer, affects the pH of the mouth, and can contribute to tooth decay. Also patients with dry mouth may use hard candy or drink cavity-causing beverages to relieve discomfort from dry mouth.
- Acid reflux (Gastroesophagal Reflux Disease or GERD)- Acid reflux or GERD is a condition that causes stomach acids to escape the stomach and flow up through a patient's esophagus into their mouth. This may be accompanied by frequent heart burn, and nausea. The regular flow of acid in the mouth may also erode teeth and cause cavities.
- Asthma inhalers- Please note: This observation is anecdotal, meaning I have seen increased occurrence of cavities with some of my patients who use inhalers, however I do not have specific scientific studies to verify this process. Some theories as to why inhalers may cause cavities are: beta2 agonists, such as salbutamol, and corticosteroids, such as fluticasone propionate, decrease the pH of the dental plaque (high acidity in the mouth leads to erosion and decay). Beta2-adrenoceptor agonists in inhalers cause decreased saliva secretion by 20 – 35%. The lactobacilli (cavity causing bacteria) count will increase producing more acid by production. The combination of these factors may explain why there can be a higher cavity rate in patients using these types of inhalers.
- Diet sodas- decrease or eliminate diet soda from your diet. A healthier beverage choice is water.
- Fruit juice- Better choices to prevent decay are less acidic juices such as 100 % apple, grape, and cranberry juice. These should be consumed in moderation and can even be diluted with water to decrease the amount of sugar per serving. I occasionally get creative and mix 2/3 of a cup of no-sodium seltzer water with 1/3 of a cup of one of the less acidic, 100 % fruit juices for a lower sugar "soda".
- Sports drinks- According to the report, “Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate ?" in the June 2011 issue of Pediatrics ), water is the best drink for routine physical activity.
- Chronic dry mouth/ xerostomia- Consult your physician about your dry mouth symptoms especially if it is a side effect of a presciption medication. Use products specifically formulated to help with dry mouth such as Biotene, or Oasis. There are toothpastes, mouthrinses and saliva replacement sprays on the market that can give relief. Avoid oral care products containing alcohol which can cause dry mouth. Use sugar free candies, gum, or cough drops to stimulate saliva flow. Sip water frequently through out the day.
- Acid reflux/ GERD- Consult your physician about controlling this condition. Reflux can cause other serious health problems as well.
- Asthma inhalers- I would never advise patients to stop using their inhalers. Asthma can be life threatening, as opposed to cavities which are treatable. Instead, I advise patients who use inhalers to decrease consumption of sugary foods and drinks, brush teeth after meals, and use alcohol free oral care products to prevent dry mouth.
