Preventing Dental Problems

In conversation with Hyderabad's leading pediatric dentist, Dr Tejas Melkote, Sakshi Post busts the myth associated with dental care and provides answers to frequently asked questions.
Q & A

Toothache and Cavities
If you have ever experienced toothache, or know someone who has had toothache before, you are aware that tooth pain is one of the most painful human conditions. Toothache is a result of cavities – the most common disease on the planet after the common cold. 

So how do we get cavities?
Cavities are a result of acid damage on tooth caused by plaque bacteria. 

What is plaque?
Our mouths have millions of bacteria. These are in form of a biofilm (a gel-like layer of different types of bacteria and germs) which is firmly stuck onto the tooth surface. This is called plaque. The acid from dental plaque causes cavities.

Acid!? Where does acid come from?
The plaque bacteria use the sugars that we eat and produce acid. Bacteria use sugars for their own nutrition and release acids. This acid gradually erodes away the tooth enamel and causes ‘holes’ in the teeth called cavities. 

The by-product of bacterial metabolism is lactic acid. Lactic acid when in contact with the tooth enamel, removes calcium from the tooth. This, over time, leads to a physical ‘hole’ on the tooth. This leads to more food staying on the tooth surface which leads to a vicious cycle of more acid production and more cavitation!

Does Sugar cause cavities?
YES! Sugar is the primary cause of cavities. This sugar can be direct sugar (that which we add to food) or indirect sugar (that which a manufacturer adds to processed foods). This is the root cause for cavities as it gives plaque bacteria a source of nutrition from which they produce acids.

Does brushing help?
Yes! Brushing removes most of the bacterial load from the teeth and thereby reduces the acid formation in the mouth. When we brush our teeth, the goal is to remove as much plaque from teeth as possible. This plaque then immediately starts to form back on the teeth. It takes about 10 – 12 hours for the plaque to build in sufficient quantity and complexity before which it can produce acids. This is why brushing twice is recommended – brushing every 10 to 12 hours disrupts plaque maturation and thereby reduces acid formation – and this reduces the formation of cavities.

So, If I brush, can I eat sugar?
It is not so simple! Brushing is not as easy as we assume it to be. It is estimated that our toothbrush can ONLY reach about 45% to 55% of tooth surfaces in our mouth! Which means that a lot of tooth surfaces cannot be cleaned by our toothbrush alone. This is why other cleaning methods are recommended such as – Floss, Interdental brushes and tongue cleaners are recommended by Dentists. Using additional brushing aids help reduce plaque and thereby, reduces cavities.

When do cavities form?
Cavities can form anytime when the conditions are favorable – When there is Sugar and mature bacterial Plaque on the teeth for a sufficient duration of time, cavities form. 
Saliva has an important role in buffering (diluting) this acid. During the daytime, we have a lot of saliva forming in the mouth. But at night, the saliva secretion is almost nil. This leads to a high cavity activity in the night time.

Therefore, night brushing is MORE IMPORTANT!

Ok. So, what happens to plaque when we eat sugar?
In 1943, Robert Stephan studied acid changes in the dental plaque. He found that once we eat sugar (in any form – table sugar, jaggery, honey, syrup etc.), the acid secretion of plaque is very high immediately. It remains so for about next 30 minutes after which the acid levels drop back to normal.

Imagine the scenario – If I were to give 5 candies to two children; the first child eats all the candies immediately whereas the second child eats one at a time over the next five hours – the first child’s teeth are exposed to acids only once. Whereas the second child has acid exposure five times!

Is there a safe time for sweets? 
As a general rule, minimize sugars as much as possible. However, if you MUST indulge, the following tips help –
•    Have the dessert in between the meal – for example - A typical south Indian traditional meal – the dessert is served in between the meal rather than at the end; after which, buttermilk or curd-rice is served. This helps buffer the plaque acids and reduce cavity risk.
•    Snacking – avoid snacking on sugary food/drinks. Choose fibrous foods like salad or fruit instead.
•    When craving for juice, eat a fruit rather than drinking fruit juice. 
•    Avoid frequent snacking.
•    Avoid sugars post dinner.
•    When sugar cravings occur, brush with a strong minty flavored toothpaste – it reduces sweet cravings.

Is sugar bad only for teeth?
Sugar has been linked to various other health issues. Significant among them in children are-    
1.    Mood issues/ Cranky behavior
2.    Hyperactive behavior
3.    Poor weight gain
4.    Inability to focus
5.    Increased blood pressure
6.    Addictive behavior – dependence/withdrawal 
7.    Resistance to natural insulin produced in the body
8.    Altered brain chemistry
9.    Delayed wound healing
10.  Faster ageing process

But don’t we need sugar for energy?
We need sugar for energy. BUT this sugar has to come from a digestive process. The food we eat (Rice, Dal, Pulses, Meat etc.) reaches our stomach; and is digested and broken down into sugar and then absorbed into the blood stream. This takes time and does not cause acid production in the mouth. This type of sugar maintains a stable, steady blood level and keeps the body healthy. 

But consumption of table sugar and other artificial sources of sugar give a sudden spike of sugar into the bloodstream eventually leading to lifestyle diseases and other metabolic issues. 

What other issues do cavities lead to in children?
- Loss of school time/ Inability to focus at school – due to pain/infection
- Disruption of jaw growth – due to infection
Disruption of general body growth - Cavities make chewing painful and therefore children prefer to swallow food with minimal chewing! This leads to poor digestion and absorption.

-Poor general Health – Oral Health is the gateway to overall Health. A healthy body begins with a healthy mouth. Often children with untreated dental infection, cavities and gum disease have more frequent cough, colds, stomach infections, Urinary infections. 

- Irregular Permanent Teeth – It is seen that children that have cavities in the milk teeth and lose milk teeth early, tend to have irregular permanent teeth which later needs correction with braces
-Speech Issues – Children who lose front teeth in early childhood, develop speech problems and are unable to pronounce certain words clearly
-Poor self-confidence – Children who lose teeth early often tend to be shy and timid when they are with other children of a similar age group

But won't the milk teeth fall anyway? Do they have to be treated?
Milk teeth will eventually shed and are replaced by permanent teeth. If milk teeth are lost early it can lead to –

• Crowded and irregular permanent teeth
• Poor facial growth leading to narrow crowded jaws
• Speech issues – pronunciation difficulty in certain sounds (word sounds with _s, _f is impacted)
• Psychological impact – low self-esteem and low self-confidence!