Tooth decay syndromes.

How tooth decay can affect child and adult populations. | Baby-bottle tooth decay, Root caries, Gum-line cavities, Chronic dry mouth (xerostomia).

At different points in their life a person may struggle with experiencing various tooth decay syndromes (a cavity rate or pattern that's shared with other members of their population group).

This page provides descriptions of some of the more common ones, and solutions for combatting them.

A) Syndromes affecting children and adolescents.
B) Syndromes affecting adults (especially seniors).

Animation illustrating the tooth decay pattern usually displayed with baby-bottle caries syndrome.

The decay pattern typically displayed by baby-bottle caries syndrome.

Baby-bottle tooth decay.

Baby-bottle caries refers to a pattern of tooth decay that occurs in infants and preschoolers who are allowed to nurse from a bottle containing a sugary beverage, either frequently, or else for prolonged periods of time (i.e. napping, sleeping), or both.

Other names for this syndrome are: Early Childhood Caries (ECC), nursing bottle caries, or just nursing caries.

a) Only specific teeth are affected.

In most cases, this condition displays a characteristic decay pattern.

  • The upper front teeth are affected the most. These teeth may have very extensive decay.
  • The child's back teeth are frequently affected too.
  • The lower front teeth are usually spared from cavity formation. That's because they are protected somewhat from exposure to the sugary drink by the nursing position of the child's tongue.

cavities using:

b) Why does the decay form?

There is nothing special or unique about baby-bottle syndrome. It's simply a case of cause and effect.

  • A sugar supply (the drink) is available to the child's oral bacteria frequently, or else over extended time periods.
  • This excessive exposure simply tips the tug of war between demineralization and remineralization in favor of the former, and therefore a syndrome of cavity formation.

c) What can you do to prevent baby-bottle tooth decay?

Here are some of the things that you can do to reduce your child's risk for experiencing this problem:

  • Anticipate (unless you specifically know otherwise) that anything you place in a child's bottle could be a sugar source. Breast milk, milk, formula, and fruit juices are all sources of dietary sugars.
  • Never allow your child to nurse for long periods of time, or fall asleep with, a bottle that contains a sugary beverage.
  • Never give your child a pacifier that has been dipped in honey or any other type of sugary liquid.
  • Frequent breast feeding can lead to baby bottle caries syndrome too.

Root caries / Gum-line tooth decay.

Root caries is a decay syndrome that takes place in situations where a person has a receded gum line (involving one or even most of their teeth), and thus exposed root surfaces.

The enamel-covered portion of a tooth is its "crown."

Animation showing that tooth crowns are covered with enamel. Tooth roots are made up of dentin.

Exposed root surfaces are composed of dentin.

a) Dental anatomy as it pertains to this problem.

You may not be aware of this fact but a tooth's enamel covering ends right at its gum line. This portion of the tooth is termed its "crown."

The remaining aspect of a tooth, the part that lies below the gum line, is its root.

b) A tooth's root is "softer" than its crown.

The root portion of a tooth is not covered by enamel. Instead, it's primarily composed of another mineralized tissue called dentin.

Since dentin contains less mineral content than enamel (it's less "hard"), it's more easily and more quickly damaged by tooth demineralization (cavity formation).

c) How gum recession can increase your risk for decay.

When gum recession occurs, a tooth's root becomes "exposed." (It's no longer fully covered over by a protective layer of gum tissue and bone. It's newly at risk for decay formation).

The recession may occur due to abrasion (over aggressive tooth brushing), relatively normal event related to aging or periodontal conditions (gum disease).

Gum recession exposes root surfaces.

Animation illustrating how gum recession places a tooth's root at risk for cavities.

As a result, the roots are placed at greater risk for developing cavities.

A new set of cavity risks.

This change can result in a person going through a second set of cavity-prone years (the first ones being during their childhood and teenage years). Here's why:

  • Root surfaces are relatively "soft," at least when compared to enamel, and therefore decay more readily.
  • Teeth with receded gums can be a challenge to clean thoroughly. As a result, dental plaque (a major factor in the formation of tooth decay) may remain on their surface for extended periods of time.

d) Seniors are especially at risk for this syndrome.

Gum recession frequently accompanies advanced age, which means that seniors are especially likely to experience root caries.

  • It's been estimated that roughly half of all people over the age of 50 have had at least one root surface cavity, two for those age 70, and three for ages 75 and beyond. (Jensen 2013)

As an added factors, seniors often experience a decrease in oral moisture, which also increases their risk for decay. (See next section.) They also frequently have diminished dexterity, which makes brushing and flossing effectively more difficult. (The use of an electric toothbrush may be beneficial.)

e) The treatment of root caries can be difficult.

Successfully treating this syndrome can be a challenge.

  • Just as cleaning a tooth's nooks and crannies that have become exposed when its gum tissue recedes, your dentist will have difficulty in identifying, accessing and treating the cavities that have formed on these surfaces too.
  • To make matters worse, the decay involves comparatively softer tooth dentin, as opposed to enamel. That means the rate at which cavities start and advance is accelerated.

All of these factors combined lead to an outcome where experiencing this syndrome frequently results in tooth loss.

f) What can you do to minimize your potential for gum recession?

  • Brushing incorrectly (like too forcefully or brushing back and forth in a "sawing" motion) can cause gum tissue to recede. So can brushing with a toothbrush whose bristles are too stiff.
  • Gum disease (periodontal disease), as well as those procedures required for its treatment, typically result in some amount of gum recession. Be diligent with your oral home care so you don't develop this condition.
  • Bruxism (a habit of tooth clenching and grinding) can create changes with teeth that result in gum-line recession.

g) What can you do to help prevent root caries?

  • If dental plaque doesn't accumulate on your root surfaces, cavities can't form. And towards this goal the use of an electric toothbrush may help to make your brushing efforts more effective.

    Our page "The best power toothbrushes for senior citizens" discusses this issue.

  • Ask your dentist about the use of fluoride tooth varnish. This type of product is painted onto your teeth and root surfaces (twice-a-year application is common). It helps to insure that fluoride, and therefore the anticavity benefit it provides, is available precisely where it's needed.
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Xerostomia / Chronic dry mouth.

Hyposalivation refers to the situation where a person has diminished salivary flow (a reduced amount of saliva in their mouth). In situations where this condition is a chronic (long-standing) one, the term xerostomia is used.

One problem associated with this condition is that a lack of saliva can tip the balance between demineralization and remineralization in favor of the former, and therefore create a syndrome of cavity formation.

a) What role does saliva play in cavity prevention?

Saliva plays a very important role in fighting tooth decay. Here is a list of some of the benefits that it provides:

As these protections are lost, the decay rate of the person can be expected to rise, possibly significantly.

b) What causes xerostomia?

Advanced age.

A person's salivary glands tend to work less effectively as they age. And as a result, the quantity (and composition) of their saliva may change.


Oral dryness is a side effect of some types of medications. In fact, more than 400 drugs are known to have an inhibitory effect on salivary flow. (Jensen 2013)

This includes items such as: Antihistamines (allergy and cold medications), blood pressure agents, diuretics, urinary incontinance drugs, narcotics as wellas antidepressant, antipsychotic and anti-anxiety drugs.

This cause of xerostomia can be especially likely for seniors since it's so common for them to be taking a regimen of multiple medications.

Tips for preventing tooth decay -

Fact - Having a chronically dry mouth can increase a person's risk for cavities.

Cavity prevention suggestions :

  • Since salivary flow decreases when we sleep, be certain to brush and floss thoroughly before going to bed so to insure that your mouth is as plaque-free as possible.
  • Drink and rinse with water frequently throughout the day, or when up at night.
  • Salivary flow increases when we chew food, so chewing sugarless gum can be a good way to boost a person's output of saliva.

    The sugar substitutes found in sugarless gum are not readily fermented by the bacteria that cause cavities and therefore will not promote the formation of acids that cause decay. Xylitol-sweetened products have the advantage that it provides an anti-cavity effect on its own (see button link above).