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Winter Park Dentistry- Dental Decay and Dental Cavities

Dr. Ramzi Matar:

Hello, welcome. Today’s topic is dental decay, a pretty common problem. Dental decay is cavities or caries or what we all know as fillings, for example. I’m just going to give a little bit of a brief background and some information about what is dental decay and we can do to prevent it, and some of the same true and tried methods out there. Dental decay is a bacterial infection, it can be transmitted person to person, obviously using some sort of mouth interaction, kissing. Mostly, we have a few different ways to treat decay. We can alter the bacteria, we can alter the structure of the tooth, and we can try to alter behavior. Let me get into those.

Altering the bacteria is basically breaking up the bacteria. That’s your brushing, your flossing, your water pick. What that basically does is try to remove the biofilm. Biofilm is what forms from the bacteria. It’s basically that layer on your teeth. Biofilm hardens up into plaque and tartar. This is what you read about. What the ideal scenario is, you break up the bacteria prior to it hardening up, when it’s still at the stage called the biofilm. We try to break up the bacteria mechanically. We can try to kill the bacteria, that’s why we use fluoride. We have a medication called chlorhexidine. We also have things called Tylenol, or sodium basically bleach. We have low concentrations of bleach that people use to try to rinse with. I don’t recommend people rinsing with bleach or chlorine, or hydrogen peroxide. I’ve heard all these being done, these have to be monitored and done properly with certain formulations of that, but these are all ways we have to try to kill the bacteria.

We can also try to change the environment that’s in the mouth. Basically we’re trying to make the mouth more basic, less acidic. We have medications, we have some called xylitol, which is mostly found in gum. We also have probiotics, this is a sort of an up and coming part of dentistry. Actually, not far from here, in Gainesville, Florida, there is a researcher, I forget his name, he’s a PHD researcher, he has a company called EvoraPro, or I think his product is called EvoraPro, his company is called Oragenics, if I’m correct. Basically what EvoraPro is, it’s a probiotic, it’s a good bacteria, that you chew up a tablet and the idea is that if you put good bacteria in your mouth, it overpopulates, it doesn’t let the bad bacteria cause cavities. This is similar to probiotics when people eat yogurt or things like that, that change the bacteria in their gut or in their stomach.

We talked about how we can try to alter the bacteria. We can also try to alter the structure of the tooth. This is something we do pretty commonly. Most of what you know about is fluoride. Again, I mentioned fluoride earlier because it can kill bacteria, but fluoride has another advantage and it’s that it hardens tooth structure. There’s lot of different opinions about fluoride, I’m not going to get into that kind of conversation, I’m just telling you fluoride does harden teeth. We can try to remineralize teeth. So we have a tooth that’s started to break down, the bacteria, the acidity from the bacteria has started to soften the tooth. We can try to remineralize it, again, using fluoride, another product called MI-paste, which has a product called re-caldant, and this is something that goes in and try to remineralize the tooth. I’ve also heard of things called ozone therapy, I don’t know much about it. And this is another method of trying to harden the tooth back up. I will tell you from practical experience, I have not seen this to be very effective. I’m talking about MI-paste or ozone therapy. I’ve heard of it, I know some people do claim that it works, especially around orthodontic brackets. I think there are some areas that MI-paste does work, but to see a lesion and put some paste on there and see that lesion disappear, I have not yet witnessed that, so maybe I need to see that, but I have not yet. We can also coat the surface of the tooth. We all know this as sealants. It’s still kind of the gold standard, with children we like a sealed teeth, I encourage it for all my kids that have newly erupted adult teeth, at around 6 years old, that’s when that starts.

So let’s summarize what I had to say. Really, the best that we have to prevent cavities are still diets, avoiding sugary foods, sodas, acidic foods, fluoride, home care, brushing, sealants. The next step down in the good category is going to be xylitol, chlorhexidine, there’s a new product called cervitec+, this is a varnish, made with chlorhexidine and thymol, showing some positive research. I don’t know too much about the product. Everything else that’s out there is still in its explorative phase, when it comes to probiotics or the ozone therapy and stuff like that. So ultimately when I have a high-caries patients, we try to change their behavior, that’s very difficult, it’s tough to change people. We have high fluoride toothpaste, we use clean pro, there’s also another product called fluoridex, there’s lots of products out there that have high fluoride content, usually high fluoride toothpaste has 5thousand ppm, on the tube, which is about 5 times more. Most toothpastes have 1 thousand to 1500 ppm. Prescription toothpastes have 5 thousand ppm. We can apply fluoride varnish on these patients when we see them every 3 or 4 or 6 months. And then we encourage them to consider some kind of adjunct at home, maybe xylitol gum would be my next advice. Usually xylitol gum you want to get 5 grams a day, usually chewing 5 one gram pieces of chewing gum throughout the day. You don’t want to get more than 5 grams, I’ve heard that xylitol might cause some stomach upset, so you’d have to research exactly how to get it. Most of the time the xylitol gum has to be purchased online. I think EPIC is probably the most common brand that I see. I’m not sure if you can get it at a local health food store, but online they’re very readily available. Thank you, good luck.