tooth decay / cavities / dental caries

There are two time periods in life when humans, as a group, seem to have their greatest difficulty with the occurrence of tooth decay. They are:

• Childhood: Both children and adolescents.
  
  
• Adulthood: Senior citizens and also those adults who have had, or have been treated for, periodontal disease (gum disease).

Children and Adolescents: The cavity prone years.

As you probably know, it is very common that the years corresponding with childhood and adolescence prove to be a time period when tooth decay can be a problem for an individual. It seems likely that these "cavity prone years" are at least partially associated with the fact that young people often maintain diets that are high in sugar consumption (candy, sodas, etc...). Additionally, some young people tend to be less diligent with their brushing and flossing habits than they should be.

Beyond these factors, the contents of this page describe other problems associated with the formation of tooth decay that often occur and are fairly unique to children. They are:

• Using dental sealants as a means of helping to prevent tooth decay.
  
  
• Baby bottle caries / Baby bottle tooth decay.
  
  
• Braces and the risk for developing white spot lesions.

Preventing tooth decay with dental sealants.

Some portions of a tooth can be more at risk for the formation of tooth decay than others. This increased susceptibility is often related to the anatomy (shape features) of the tooth. And in these instances dental sealants can prove a valuable aid in helping to prevent the decay process from starting.

Some back teeth, especially molars, can be difficult for a person to clean because the grooves in the chewing portion of these teeth (the "pits and fissures") are deep and narrow. Even though the person brushes they are not able to clean dental plaque off effectively because the bristles of their toothbrush are literally too large to scrub the depths of these pits and grooves. Because some plaque perpetually remains, tooth decay can form.

A solution for this situation can be the placement of dental sealants. When a dentist bonds plastic sealant into and over the grooves of a tooth the net result is that the surface of the tooth is somewhat flatter and smoother. There are no longer any places on the chewing portion of the tooth that the bristles of a toothbrush can't reach and clean. Since plaque can be removed more easily and effectively, there is much less chance that decay will start.  [ Click this link to be forwarded to our discussion about dental sealants. ]

What is "baby bottle caries?"

"Baby bottle caries" (or "nursing bottle caries") refers to a pattern of tooth decay that occurs in the teeth of infants and preschoolers who are allowed to nurse from a bottle containing a sugary beverage, either frequently or for prolonged periods of time (such as while napping or sleeping at night) or both.

The decay pattern is typically one where the child's front upper teeth are affected the most. Many time these teeth will have very extensive decay. The child's bottom front teeth will typically be spared from decay due to the fact that these teeth are somewhat protected from exposure to the sugary drink by the nursing positioning of the tongue. Teeth in other locations in the child's mouth are placed at greater risk for the formation of cavities also and may be found to have extensive decay.

There is nothing special or unique about baby bottle caries syndrome. It is simply a case of a sugar supply being present as a food source for oral bacteria (over a prolonged time period) and therefore tipping the balance between demineralization and remineralization greatly in favor of tooth decay formation.

What can you do to minimize the risk of baby bottle caries?

Here are some things you can do to minimize your child's risk for developing the rampant decay associated with baby bottle caries:

• Anticipate that anything you place in a child's bottle except water is a source of sugars, unless you specifically know otherwise. Breast milk, milk, formula, and fruit juices are all sources of dietary sugars.
  
  
• Never allow your child to nurse for prolonged periods or fall asleep with a bottle containing a beverage that contains sugars.
  
  
• Never give your child a pacifier that has been dipped in honey or any sugary liquid.
  
  
• Breast feeding an infant frequently throughout the night can lead to baby bottle caries syndrome.

Braces and the risk of developing "white spot lesions."

It just doesn't seem possible that anything could ever be designed that would make it harder for someone to effectively brush and floss their teeth than braces. And because of this increased difficulty with plaque removal, it is extremely important for anyone with braces (and their parents) to realize during that time frame when the braces are in place that there will be at increased risk for tooth decay formation.

A special complication associated with not removing dental plaque effectively when braces are in place has to do with the formation of "white spot lesions." As you know from our text, tooth decay is caused by a demineralization of a tooth's enamel. Acids produced by oral bacteria found in dental plaque actually dissolve away the mineral content in teeth.

Because this demineralization process changes the quantity and quality of the tooth's mineral, the appearance of the tooth's enamel will change. In fact, dentists term the earliest stage of tooth decay formation a "white spot lesion," because the tooth's enamel takes on an opaque whitish color in the area where the demineralization is taking place.

So, if dental plaque is allowed to persistently accumulate around a person's braces, white spot lesions will form in the tooth's enamel. The portion of the tooth that lies underneath the orthodontic brackets, however, will have been protected from the plaque and therefore this portion of the tooth's enamel will not change in appearance. When the person's orthodontic treatment has been completed and the braces are removed, a white spot lesion outlining the original position of the orthodontic bracket will be obvious and spoil the cosmetic appearance of the tooth.