By: Dr. Scott R. Harden
With the holidays in full swing, people across the country have been faced with the annual challenge of what gifts to buy for their friends and family. At the top of the list is sweet treats that go hand-in-hand with the holiday season. Holiday chocolates, candy canes, cookies, cakes, and pies all add up to immense amount of sugar intake. While you have been savoring those delicious goodies throughout the holiday season, remember you’re not the only one who loves sugar. That’s right. The bacteria in your mouth, which reside in and on your teeth, love it just as much as you do. So, as part of a New Year’s resolution, you might just consider picking up a few toothbrushes and toothpaste as an added bonus.
In the past 20 years, the consumption of sugar has grown from 26 pounds to 135 pounds per person. Stop and think about that statistic. That is astounding. And raise your hand if the word diet has come across your lips some time in the last year. Sugar consumption is one of the leading factors in cavities and in a time when bottled water is decreasing our intake of fluoride, sugar consumption is up five times since 1987, about the time I graduated from dental school at Emory.
What are the effects of all these sweets on teeth? Statistically, kids will miss 52 million school hours and adults will miss164 million work hours due to dental related issues, many of which are cavities caused by sweets. It’s no surprise to you that the American Dental Association recommends brushing, flossing and eating healthy – in addition to visiting your dentist at least twice a year.
The anatomy of our teeth is a major factor in the relationship between sweets and cavities. By anatomy, I more specifically refer to how the surfaces of our teeth formed. Some teeth have very smooth surfaces, and because of this smooth anatomy, they rarely or never get cavities. Some teeth have rough surfaces with grooves, which dentists refer to as pit and fissures. Grooves serve the purpose of enhancing the ability for us to chew our food more efficiently. The only problem with groovy teeth is that bacteria take up residence in those grooves and patiently wait with the ability to go to battle and perform significant damage when armed with the right ammunition — carbohydrates — and among the best of them are sweets.
There are several common questions that come up from here. Do all teeth that have grooves get cavities? Why do people get cavities in their 80’s? Why do some teeth appear perfectly fine by clinical evaluation and yet have a large brown cavity below the surface occupying 50% or more of the tooth as seen on x-ray?
Let’s take these questions one at a time and apply them to grooves and sweets. Not all teeth with grooves get cavities, but groovy teeth are more far more likely to get cavities than not get cavities. This is why dentists recommend sealants to fill in the grooves with a plastic like coating that prevents bacteria from entering into the grooves. Brushing is then much more efficient with sealants since the tooth brush bristles can never get down into the fine grooves and remove the bacteria. Early on in dentistry it troubled me that people got cavities, even in their eighties. Why would a tooth form a cavity after resisting decay over 70 years? I created an analogy, called the “crack-in-the-sidewalk” principle, to help me explain this occurrence. Why does grass grow in some of the cracks (expansion joints) of a concrete sidewalk and not others? Expansion joints are depression lines scratched into wet concrete (forming rectangular patterns) to influence any cracks that might form when concrete settles to occur in these expansion joints. When the sidewalk settles and a crack forms in the expansion joint, grass seeds reside in the crack, germinate, and grass appears. If no crack forms, grass seeds are washed away from the depression, do not germinate, and no grass is present.
Cavities in groovy teeth happen the same way. Some grooves are open and susceptible to bacteria, while other grooves are closed and resistant to bacteria. Some grooves are wide, some are shallow. Some grooves are narrow, some are deep. This is the details of dental anatomy. Grooves that are open and deep trap bacteria easily and form cavities in our early childhood. Grooves that are open (not fused together) and narrow make it difficult for bacteria to penetrate and it may take over 70 years of continuous exposure for bacteria to finally form a cavity.
This same combination of open narrow grooves also creates the deceptive condition of undetectable cavities when clinically looking at your tooth. How? The bacteria meander down the tight groove and start forming a cavity below the surface which then causes elusive decay only detectable by x-rays. A large percentage of dental cavities follow this process. New diagnostic equipment, called a Diagnodent, provide wonderful new means to detect cavities of this nature and to simply detect cavities early before they destroy a lot of tooth structure.
Visit you dentist regularly, at least twice a year. Eat healthy. Reduce your intake of sweets since you might be consuming 135 pounds per year. Brush and floss at least twice a day to prevent the bacteria looming in the grooves of your teeth from getting the carbohydrates they need to form cavities.