Additional factors affecting tooth decay
By Hong Kee-sang
The last article discussed how the teeth, the decay-causing bacteria, the sugar content of children’s diet and the amount of time the three are allowed to be together affect the development and progress of tooth decay.
But there are additional factors. Some of them play big roles, others small. By acting in combination, though, they influence the process in no small way. Let’s discuss them one by one.
Saliva
Everybody has it, but quality and quantity differ from person to person.
Some people have stickier saliva. Instead of acting to rinse away debris, it acts like syrup to retain the food particles in the vicinity of the teeth — leading to a heightened likelihood of tooth decay occurring.
Some people secret less saliva than others, leading to less capacity to coat/protect the surface of teeth and wash away debris. Of importance in children with regards to this is medication and mouth breathing. Lots of children these days have allergies, rhinitis, asthma, atopic dermatitis, you name it. Many of them take medication for extended periods. However, most medications, if taken for more than a couple of days, lead to decreased production of saliva. Even common cold syrups, not even taking into account their liberal sugar content, can lead to a dry mouth. Mouth breathing, be it from a chronic problem with nose breathing or from temporary infections, will also dry the mouth, take away the protective coating of saliva from the surface of the teeth and increase the risk of decay and gum disease.
What can you do? There are products out there that are meant to act as artificial saliva, but the best real life measure you can take is to give your children plenty of water to drink. They should not just gulp it down, but swish the water around just like they would with mouth rinse to wash away debris.
Buffering capacity of a person’s mouth
When a person eats something, the pH in the mouth drops below a critical level in three minutes or so and takes about thirty minutes to return to normal. While the pH is below that critical level, calcium and other minerals are lost from tooth surfaces. The thing is, some children have a healthier normal resting pH than others. For some, the pH never drops below the critical level (even after sugary snacks) or their pH recovers very quickly (faster than the mentioned 30 minutes); or vice-versa. Cheese and other snacks that act to buffer the pH are said to help in this regard. Also, your dentist can measure the pH in your child’s mouth and suggest things to do at home to counter lower-than-average pH values.
Fluoride
It’s almost ubiquitous nowadays, but regular use of fluoride in children’s oral hygiene regimen provides a real boost to preventing tooth decay. Children’s fluoride toothpaste, if a child doesn’t swallow it and can spit it out after brushing, is a must. If a child is too young and might swallow the toothpaste accidentally (or intentionally — it tastes pretty good), a non fluoridated toothpaste might be better — your dentist can discuss alternate ways of applying fluoride as dictated by the child’s decay risk profile.
Depending on a child’s overall risk of decay and whether your drinking water is fluoridated, fluoride mouthwash or other professional applications of fluoride might be necessary.
Shape of teeth and how they line up
Some kids have craggier teeth with deeper pits and fissures than others. Permanent teeth tend to be craggier and have more prominent grooves. These pits and fissures on the chewing surfaces of teeth are prone to food particles and debris-containing saliva seeping in and causing tooth decay there. Depending on a child’s tooth morphology and overall decay risk, sealants may be recommended to “caulk” those grooves.
The configuration in which children’s teeth line up and the presence of gaps between teeth or lack thereof can affect whether food particles and debris-containing saliva will cling between teeth and increase the risk of decay there. Your child’s dentist can take a look and advise appropriate at-home measures. Flossing always helps.
Diet
A child’s diet has a huge impact on his or her risk of developing tooth decay. There are three factors — sugar content, stickiness and frequency. Whether a meal or a snack contains lots of fermentable sugar dictates whether it is decay-causing or not. Sticky foods (or foods that leave a syrupy residue in the mouth — think cooked starch), even if they don’t have heaps of sugar in them, can cause tooth decay merely through their staying power. With regards to foods that might cause tooth decay, it’s not really about how much is eaten — it’s all about how often the kids eat them. From these three points, simple recommendations can follow. Cut down on the frequency of sugary snacks. For snacks, give children healthy stuff like fruits and whole meal items (think fiber and vitamins) with no added sugar instead of things that are made in factories.
Biofilm
It’s a fancy way of saying plaque. Theoretically, if a child’s teeth can be cleaned perfectly once a day, tooth decay scientifically cannot occur. Realistically, cleaning all areas of all the teeth in a child’s mouth is very, very difficult. A huge percentage of grownups, from a dentist’s point of view, can’t brush their own teeth proficiently. It’s unreasonable to expect children who can’t or have just learned to tie their shoelaces to be able to clean their teeth perfectly. As such, well into children’s early teen years, the parents need to supervise and provide feedback on the quality of their tooth brushing. For little children, it will need to be a hands-on effort for the parents. Regular checkups at a dentist’s are helpful in this regard — to check the quality of oral hygiene in addition to checking for decay.
The next topic will be about what the family can do at home and get their dentist to do for them to better protect their children’s oral health.
The writer is a dentist at Seoul Children’s Dental Center in Cheongdam-dong, southern Seoul, and has General Registration as a Dentist in Australia. For further questions, send an email to the writer at keesanghong@hotmail.com, or call the hospital at (02) 515-0926, or visit the hospital’s website, https://www.seoulchildrendentalcenter.com.