I've been in the process of writing a paper highlighting my beliefs of the state of our nation's oral health for a few months now. It started when I was learning about the big push for mid-level providers in the state of Kansas. And now, PBS will be airing an episode of Frontline titled "Dollars and Dentists" on June 26th. While I'm all for informing the masses on true state of things, I get pretty annoyed when these pieces point the finger at the "rich and greedy" dentists and not at the real causes; lack of hygiene and high consumption of sugar (and other crap foods).
The sad fact is that 90% of what I do is totally preventable in the first place. Sure, there is the occasional trauma (sports, car accidents, etc) and genetic anomalies (the actual incidence of "soft teeth" is a pretty darn rare condition known as enamelo/dentinogenesis imperfecta, and unless you were born with your teeth being brown, blue, or see-through that are easily worn from day 1, you don't have it). All of these special-interest groups, media outlets, and politicians rant and rave about "access to care". I don't disagree that there is a great need for care. Where we disagree on is that they like to blame dentists, where I put the blame on diet. I don't see cardiologists getting blamed for the rampant heart and cardiovascular disease in our nation, but for some reason dentists get blamed for oral disease.
I would LOVE if I never had to do another filling a day in my life. Will that ever happen? Not likely. But maybe this paper will help people understand how cavities work, and what they can do to prevent them. So without further ado....
This
Country Needs a Better Diet, Not More Dentists
Make no mistake; dental caries
(aka cavities) is a disease. It is a
degenerative disease of the teeth caused by bacteria. The 2000 Surgeon
General’s report on “Oral Health in America” identified tooth decay as the most
common chronic disease of children in the U.S. Dental caries is most prevalent
in lower income households. When folks
read this, they usually throw their hands in the air and blame it as an “access
to care” issue. Because of these reports, there has been a push by lobbyists
and politicians (both state and federal alike) for a “mid-level provider” to
increase this “access to care”. The
purpose of this article is to shed some light on the issue, to advise where
attention should really be given, and to give some suggestions on where to go
from here.
First, a short science lesson
is in order. We’ll call it “Cavity-ology
101”. The first lesson is a simple
formula on which we’ll expand:
Teeth +
Bacteria + Sugar +Time= Cavities
The mouth contains a wide
variety of bacteria, but only a few specific types of bacteria have been found
to cause cavities. It’s because of these
select strands of bacteria that we have thousands upon thousands of kids with
tooth decay. But how do these bacteria,
which I like to call “bugs” due to better imagery, cause cavities exactly? Well, bacteria are constantly creating a
layer, or biofilm, on your teeth. This
biofilm becomes a sticky, creamy-colored mass most commonly known as
plaque. In other words, that fuzzy stuff
that collects on our teeth is a network of millions of bugs lining an
assault. Their means of attack is by the
production of acid. And the fuel source
for these bugs to pump out acid is none other than sugar.
The harmful bacteria in our
mouths convert sugars into acids through a process called fermentation. If allowed to sit on the teeth, these acids
can cause the teeth to lose their strength by robbing them of minerals through
a process cleverly called demineralization.
With enough demineralization over time, the tooth “disintegrates” and is
left with a hole, or cavity. The scientific study of how sugars can affect
the progression of cavities is called cariogenictiy. Without getting too jargon logged, let’s keep
it simple. Different types of sugars are
worse than others (i.e. table sugar is worse than sugar from fruit), but given
enough time, most of these common sugars (sucrose, glucose, lactose and
fructose) can cause cavities. So it doesn’t matter if the sugar is from candy,
pop, bread, milk, potato chips, juice, fruit, etc; they all will lead to
cavities given enough time.
The next step on the road to
cavities is time. How often teeth are exposed to sugar and acid
plays a big role in the formation of cavities.
After meals, snacks, or anytime you put fermentable sugar in your mouth,
bacteria produce acid. Each exposure can
dissolve your teeth for up to 2 hours.
To help get this point across, let’s use an example. Jack and Jill don’t brush their teeth all
day. Jill eats 3 times throughout the
day: Breakfast, Lunch, and Dinner. Each
one of these meals has a good amount of carbohydrate (sugar) content. This means that her teeth can be subject to
acid attack for six hours in just that day alone. Now to make things worse, here comes
Jack. Jack eats the same meals as Jill,
but also has some potato chips for a mid-morning snack, and has a can of Coke a
couple hours after lunch. This means his teeth could be left dissolving for 10
hours (5 meals x 2 hours of acid)! And I won’t even go into what would happen if
Jack were to nurse his Coke all day long.
There are other factors that
can lead to cavities. These can include
the quality of mineral content in your saliva, tobacco use, and rare
developmental disorders of tooth formation.
But for the vast majority of the population, cavities are the result from
the combination of bacteria, sugar, and time.
So where do we go from here?
Well, the answer is painfully simple.
Cut down on sugar and brush and floss more.
The End... for now
I have a lot more to write about the subject, and the paper is far from over. But the here is a launching pad if you want to know how to protect your teeth for life-long service. As always, if you have any questions whatsoever, feel free to ask.
Down with Tooth Decay!
