Tooth decay is the gradual breakdown of the tooth, beginning with the enamel surface and eventually progressing to the inner pulp.
Tooth decay is caused by acids produced by certain mouth bacteria in dental plaque. Factors that affect this process include oral hygiene, diet, meal frequency, saliva production, and heredity. Teeth with significant decay are said to have caries, or cavities.
Checklist for Tooth Decay
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Green tea (Camellia sinensis) |
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| See also: See also: Homeopathic Remedies for Tooth Decay | ||
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Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary
studies suggesting a health benefit or minimal health benefit. An herb is primarily supported by traditional use,
or the herb or supplement has little scientific support and/or minimal health benefit. |
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People with tooth decay may have tooth pain, including sensitivity to cold food and drinks.
Over the counter products containing fluoride (Gel Kam®, ACT®) may help prevent tooth decay.
Prescription strength fluoride toothpaste (Prevident®) may be prescribed. Individuals living in communities without fluoridated water might be prescribed oral fluoride tablets or drops (Luride®).
Treatment includes daily brushing of teeth with toothpaste (especially after meals), flossing, limiting sugar in the diet, and regular professional teeth cleanings by a dental hygienist. Dentists commonly apply fillings to dental cavities. Topical fluoride applications or sealants (plastic coatings that form a barrier between bacteria and the chewing surfaces of the teeth) may be recommended.
It has been noted for over 50 years that the incidence of tooth decay is low in people of traditional rural societies, such as Eskimos and African Bantus. However, However, the incidence of cavities increases as their diets begin to include more “westernized” processed foods.1 Although many different factors have been implicated in this observation, including refined flours,2 3 inactivation of vitamins by heating foods,4 and sugar intake,5 no single agent has been found responsible. Nevertheless, a diet high in whole grains and low in processed foods is a healthful choice that probably helps defend against tooth decay.
Sugar, especially sucrose (table sugar), appears to be required by the oral bacteria for the production of tooth decay. This finding has caused sugar to be widely blamed in the popular press as the primary cause of dental caries. However, caries incidence has recently declined in a time of increasing sugar intake.6 This has led to a reevaluation of caries causation, and sugar is now understood to be only one of the factors in the development of tooth decay.7 Nearly as important as the total amount of sugar intake seems to be the consistency of the sugary foods and the length of time they are in contact with the teeth. Dry and sticky foods tend to stay in contact longer, causing more plaque formation.8 Still, reduction of total dietary sugar is probably the most accepted dietary recommendation for the prevention of dental caries.9
Certain sugar substitutes appear to have anti-caries benefits beyond that of reducing sugar intake. Xylitol is not fermented by the oral bacteria, and it inhibits bacterial growth.10 Sorbitol is only slowly used by oral bacteria, and it produces less caries than does sucrose.11 Children chewing gum containing either xylitol or sorbitol for five minutes five times daily for two years had large reductions in caries risk compared with those not chewing gum. Xylitol gum was associated with a slightly greater risk reduction than sorbitol gum.12 A double-blind study found 100% xylitol gum was superior to gum containing lesser amounts or no xylitol.13 Another study found xylitol-containing gums gave long-term protection against caries while sorbitol-only gum did not.14 Other research has confirmed the anti-caries benefits of xylitol in various forms, including gum,15 chewable lozenges, toothpastes, mouthwashes, and syrups.16
Drinking fluoridated water (1 mg fluoride per liter) has led to an estimated 40 to 60% reduction in dental caries in many cities in the United States and worldwide.17 18 While most experts believe water fluoridation to be associated with minimal risk,19 others disagree. A minority of scientists believes fluoridation to be associated with an unacceptable risk of skeletal damage, including osteoporotic fractures and bone tumors, in exchange for a modest dental benefit.20 Fluoride has topical action as well as whole-body effects,21 suggesting that those who do not have access to fluoridated water can achieve some benefit with fluoride-containing toothpastes and mouthwashes. In areas without fluoridated water, a number of controlled trials have found oral use of chewable fluoride tablets (1 to 2 mg per day of fluoride)22 23 or fluoride mouthrinses (0.05% to 0.2% fluoride content)24 25 also reduce caries risk in children. Fluoride tablets26 and mouthwash27 have been found to be effective for caries prevention in young adults and the elderly. Tablets are slightly more effective than a mouthrinse for caries protection.28 These products should not be used by young children (under three years of age), who might accidentally swallow dangerous amounts of fluoride.29 The American Dental Association (ADA) recommends supplementing children in areas without fluoridated water with liquid fluoride drops,30 but this should be done with the guidance of a dentist.
The ADA recommends regular tooth brushing—daily brushing, ideally after each meal.31 Although thorough brushing varies from person to person, five to ten strokes in each area should be adequate.32 Toothpastes containing 1,000 to 2,500 ppm (1 to 2.5 mg per gram) of fluoride have been shown to reduce caries risk.33
A recent population survey found blood lead levels were associated with the amount of dental caries in children and adults. The authors estimated that lead exposure is responsible for roughly 10% of dental caries in young Americans.34 For this and other health reasons, known and potential sources of lead exposure should be avoided. Common sources of lead exposure may include paint, foods grown near roadways, and water from lead pipes.35
Test tube studies show that vitamin B6 increases growth of beneficial mouth bacteria and decreases growth of cavity-causing bacteria.36 A double-blind study found that pregnant women who supplemented with 20 mg per day of vitamin B6 had significantly fewer new caries and fillings during pregnancy.37 Lozenges containing vitamin B6 were more effective than capsules in this study, suggesting an important topical effect. Another double-blind study gave children oral lozenges containing 3 mg of vitamin B6 three times per day for eight months, but reported only insignificant reductions in new cavities.38
In a double-blind study of children aged 1 to 6 years, supplementation with Lactobacillus GG five days a week in milk for seven months reduced the incidence of cavities by 49%, compared with unsupplemented milk.39 The amount of Lactobacillus added to the milk was 5 to 10 x 10e5 CFU per ml.
One older controlled trial found that children given 3 teaspoons of cod liver oil per day (containing roughly 800 IU of vitamin D) for an entire school year had over 50% fewer new cavities.40 These promising results have not been followed up with modern placebo-controlled trials.
Levels of strontium in the water supply have been shown to correlate with the risk of dental caries in communities with similar fluoride levels.41 Compared with children with fewer cavities, enamel samples from children with high numbers of caries have been found to contain significantly less strontium.42 However, supplementation with strontium has not yet been studied as tooth decay prevention.
Compounds present in both green tea and black tea have been shown to inhibit the growth and activity of bacteria associated with tooth decay.43 44 Animals given tea compounds in their drinking water develop fewer dental caries than do those drinking plain water.45 46 47 Human volunteers rinsing with an alcohol extract of tea leaves before bed each night for four days had significantly less plaque formation but similar amounts of plaque-causing bacteria compared with those with no treatment.48 Tea drinking has not yet been tested as a tooth decay preventative in humans.
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2. Harris NO, Garcia-Godoy F (eds.). Primary Preventive Dentistry, 5th ed. Stamford: Appleton & Lange, 1999, 93–5.
3. Ellwood RP, Blinkhorn AS, Davies RM. Fluoride: how to maximize the benefits and minimize the risks. Dent Update 1998;25:365–72.
4. Moss ME, Lanphear BP, Auinger P. Association of dental caries and blood lead levels. JAMA 199;281:2294–8.
5. Matte TD, Reducing blood lead levels: benefits and strategies. JAMA 1999;281:2340–1.
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14. Touger-Decker R. Nutrition in dental health. In Mahan LK, Escott-Stump S, eds. Food, Nutrition, and Diet Therapy. 9th ed. Philadelphia: Saunders, 1996, 583.
15. Edgar WM. Sugar substitutes, chewing gum and dental caries—a review. Br Dent J 1998;184:29–32 [review].
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17. Makinen KK, Hujoel PP, Bennett CA, et al. Polyol chewing gums and caries rates in primary dentition: a 24-month cohort study. Caries Res 1996;30:408–17.
18. Makinen KK, Bennett CA, Hujoel PP, et al. Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res 1995;74:1904–13.
19. Hujoel PP, Makinen KK, Bennett CA, et al. The optimum time to initiate habitual xylitol gum-chewing for obtaining long-term caries prevention. J Dent Res 1999;78:797–803.
20. Makinen KK, Hujoel PP, Bennett CA, et al. A descriptive report of the effects of a 16-month xylitol chewing-gum programme subsequent to a 40-month sucrose gum programme. Caries Res 1998;32:107–12.
21. Kandelman D. Sugar, alternative sweeteners and meal frequency in relation to caries prevention: new perspectives. Br J Nutr 1997;77:S121–8 [review].
22. Hinman AR, Sterritt GR, Reeves TG. The US experience with fluoridation. Comm Dent Health 1996;13 (Suppl 2):5–9 [review].
23. Ellwood RP, Blinkhorn AS, Davies RM. Fluoride: how to maximize the benefits and minimize the risks. Dent Update 1998;25:365–72.
24. Hinman AR, Sterritt GR, Reeves TG. The US experience with fluoridation. Comm Dent Health 1996;13 (Suppl 2):5–9 [review].
25. Diesendorf M, Colquhoun J, Spittle BJ, et al. New evidence on fluoridation. Aust NZ J Public Health 1997;21:187–90 [review].
26. Ellwood RP, Blinkhorn AS, Davies RM. Fluoride: how to maximize the benefits and minimize the risks. Dent Update 1998;25:365–72 [review].
27. Driscoll WS, Heifetz SB, Korts DC. Effect of chewable fluoride tablets on dental caries in schoolchildren: results after six years of use. J Am Dent Assoc 1978;97:820–4.
28. DePaola PF, Lax M. The caries-inhibiting effect of acidulated phosphate-fluoride chewable tablets: a two-year double-blind study. J Am Dent Assoc 1968;76:554–7.
29. Ripa LW, Leske GS, Levinson A. Supervised weekly rinsing with a 0.2% neutral NaF solution: results from a demonstration program after two school years. J Am Dent Assoc 1978;97:793–8.
30. Kobayashi S, Kishi H, Yoshihara A, et al. Treatment and posttreatment effects of fluoride mouthrinsing after 17 years. J Public Health Dent 1995;55:229–33.
31. Fure S, Gahnberg L, Birkhed D. A comparison of four home-care fluoride programs on the caries incidence in the elderly. Gerodontology 1998;15(2):51–60.
32. Petersson LG, Svanholm I, Andersson H, Magnusson K. Approximal caries development following intensive fluoride mouthrinsing in teenagers. A 3-year radiographic study. Eur J Oral Sci 1998;106:1048–51.
33. Driscoll WS, Nowjack-Raymer R, Selwitz RH, et al. A comparison of the caries-preventive effects of fluoride mouthrinsing, fluoride tablets, and both procedures combined: final results after eight years. J Public Health Dent 1992;52:111–6.
34. Ellwood RP, Blinkhorn AS, Davies RM. Fluoride: how to maximize the benefits and minimize the risks. Dent Update 1998;25:365–72 [review].
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36. Palazzo A, Cobe HM, Ploumis E. The effect of pyridoxine on the oral microbial populations. NY State Dent J 1959;25:303–7.
37. Hillman RW, Cabaud PG, Schenone RA. The effects of pyridoxine supplements on the dental caries experience of pregnant women. Am J Clin Nutr 1962;10:512–5.
38. Cohen A, Rubin C. Pyridoxine supplementation in the suppression of dental caries. Bull Phila County Dent Soc 1958;22:84.
39. Nase L, Hatakka K, Savilahti E, et al. Effect of long-term consumption of a probiotic bacterium, Lactobacillus rhamnosus GG, in milk on dental caries and caries risk in children. Caries Res 2001;35:412–420.
40. McBeath EC, Zucker TF. The role of vitamin D in the control of dental caries in children. J Nutr 1938;15:547–64.
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44. Matsumoto M, Minami T, Sasaki H, et al. Inhibitory effects of oolong tea extract on caries-inducing properties of mutans streptococci. Caries Res 1999;33:441–5.
45. Otake S, Makimura M, Kuroki T, et al. Anticaries effects of polyphenolic compounds from Japanese green tea. Caries Res 1991;25:438–43.
46. Ooshima T, Minami T, Aono W, et al. Oolong tea polyphenols inhibit experimental dental caries in SPF rats infected with mutans streptococci. Caries Res 1993;27:124–9.
47. Ooshima T, Minami T, Matsumoto M, et al. Comparison of the cariostatic effects between regimens to administer oolong tea polyphenols in SPF rats. Caries Res 1998;32:75–80.
48. Ooshima T, Minami T, Aono W, et al. Reduction of dental plaque deposition in humans by oolong tea extract. Caries Res 1994;28:146–9.
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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires July 2004.