Sugar is Not Necessarily the Enemy in Tooth Decay:
When parents ask me what my best advice is for what they can do to keep their kids’ teeth and gums healthy, my response may be different from what you have heard before. We all know the common answers to this question; brush and floss daily and see the dentist regularly. The next most common answer that you will likely hear is to avoid sugar. While this is a good suggestion, it is incomplete.
You see, sugar does not have the chemical properties necessary to break down the enamel on your teeth. If you look at the demineralization and erosion process for your teeth, the key contributors are acid and abrasion. Considering each of these processes can help you be more successful with your own oral health as well as the oral health of your children.
Erosion in Nature:
Chemical erosion is the process of weakening a naturally hard substance and removing layers of the now weakened material. Acid rain causes a process called chemical weathering where CO2 from the air is absorbed by rain. This acid rain can then weaken some rock and stone and cause the formation of caves or cliffs to fall away. Ironically (or not), this same CO2 is present in the soda pop or carbonated/sparkling water we consume. The process of carbonation alone results in the beverage becoming acidic.
Physical erosion or abrasion is the manual process of particles rubbing together which can cause particles from a structure to be removed. In nature this happens primarily through wind and moving water, the Grand Canyon being a prime example. Continuous friction over time results in layer after layer being removed. So what does all of this science talk have to do with your teeth?
The Role of Acid in Tooth Decay:
Enamel is the hardest substance in the human body. In order for tooth decay to happen there needs to be a process of demineralization and erosion. The same two main factors that cause erosion in nature can cause erosion in your mouth. Chemical erosion can happen from acid breaking down the enamel on your teeth. The acid that comes in contact with your teeth comes from two places. Sometimes you place it in direct contact with your teeth through eating acidic foods and drinking acidic drinks. There are a surprising number of foods that are acidic that are in most of our daily diets. The other way that acid comes in contact with our teeth is as a byproduct metabolism. When the bacteria in our mouth break down sugars, one byproduct is acid on the surface of our teeth. This is why people recommend consuming less sugar!
The Role of Abrasion in Tooth Decay:
Many people don’t realize that one of the factors of tooth decay can be something that we all see as beneficial to our teeth. I am talking about brushing! If you brush too vigorously or with a hard toothbrush you can actually contribute to tooth decay. Aggressive and excessive brushing frequently leads to thinned enamel, recession of the gums and exposed tooth roots. These roots are not covered by hard enamel and are much more susceptible to decay. Additionally, aggressive and excessive brushing can thin the hard enamel layer.
How to Minimize Tooth Decay:
In an ideal world, acid would not come into contact with our teeth, however total avoidance really is not possible. We should be actively trying to minimize the amount of acid that comes in contact with our teeth and the length of time that it is in contact with our teeth. This can be done by eliminating highly acidic foods and especially highly acidic foods that are also sticky (increased contact time causes increased damage).
When acid does come into contact with your teeth (such a drinking soda, a sports drink or any other low pH foods), do not brush right away as the enamel is in a temporarily weakened state having had mineral removed by the acidic foods. Chemical demineralization combined with physical erosion is a lose-lose scenario. It is important to allow time for the enamel to re-harden. Work to bring the pH level of your mouth back to neutral. This can be done by swishing with fluoride mouthwash or toothpaste, or even by rinsing with water if neither of those are available. Chewing sugar-free gum will also stimulate saliva flow which will help oral pH to rebound more quickly to normal levels.
Acid food sources that weaken our teeth are all around us in beverages, sweets, vinegar salad dressings and elsewhere. When possible, work to minimize the consumption of these foods. When you do eat them, work to return your oral pH to neutral as quickly as possible and especially before brushing. As always, there is no substitute for regular evaluation by your dental professional. Regular professional evaluation combined with good habits is the best formula for excellent oral health!
Dr. Drew Bitter is a practicing dentist at Oxford Dental Care in Idaho Falls, ID.