We give a great deal of attention to technological advances and the beautiful cosmetic and reconstructive dentistry that can be accomplished but the golden standard in anything health care has to be prevention of disease.  Lets face it, dental caries (decay) is caused by bacteria and it ultimately impairs the ability to function normally which is the definition of disease.  So too is periodontal (gum) disease.  In fact something that most people don't understand is that an infant's first exposure to the bacteria that cause dental decay are mostly introduced by the mother.  This most often occurs when the person caring for the child shares a spoon or a piece of food in an effort to coax the child to eat.  There is a strong correlation between the decay experience of children and that of their caretakers, usually their mother and it's not necessarily the genetic connection.  So in that sense prevention begins very early in life.  We cannot control our genetic makeup which does play some role in disease experience.  But we do have complete control over several other factors which directly affect dental decay as well as periodontal disease.  These are fluoride exposure, sealants, diet and plaque removal.  The most for reaching preventive mechanism against tooth decay is without question fluoridation of water.  This has been a subject of contention for some but all of the scientific and epidemiological data supports the fact that fluoridation of public drinking water significantly reduces the incidence of decay on these populations.  It may be the single most cost effective and for reaching means of preventing disease in use.  Every child rich or poor, with or without access to other health care is benefited.  People who live in non-fluoridated communities or who use well water or bottled water for drinking and food preparation must supplement their childrens fluoride by taking prescribed daily supplements.  Your dentist  or often pediatrician can prescribe this for you and dosing is age dependent.  If you use well water you may want to have it tested for any naturally occurring fluoride it may have.  There are a few areas of the country that actually have an overabundance of fluoride in the water.  Too much fluoride is not good and can have some undesirable cosmetic affects so be certain not to overdo it.  More is not better as far as ingested fluoride is concerned, which benefits only developing teeth.  If you're not certain whether your municipal water is fluoridated you should call the local water authority, your dentist or you can get online to get the information you need. 

Once the teeth are erupted, and this includes adults who are experiencing higher rates of decay, topical fluoride application is the most beneficial.  This can be in the form of tray delivered fluoride treatments at your dental cleaning visits.  Fluoride varnishes are now very popular and have some very significant benefits for both young and old but also must be applied by your dentist or hygienist.  Probably the best topical fluoride exposure is with the daily use of fluoride containing mouthwashes, toothpastes and at home tray delivered gels.  Mouth rinses vary greatly in fluoride concentration from one product to another so they are not equal.  Generally speaking more is better in this case as long as the products are used properly.  The same is true for fluoride toothpastes.  Over the counter fluoridated toothpastes generally have 1000 to 1500ppm (parts per million) of fluoride.  Prescription strength ones have 5000ppm.  For people with extreme decay potential, such as head and neck irradiated patients, people with Sjogrens Syndrome or others with severely dry mouths because of their medications, at home tray delivered fluoride treatments are best.  These must be fabricated and prescribed by your dentist and patient compliance is often an issue since it takes extra effort and time to do this.

Another very affective means of preventing decay is with the use of pit and fissure sealants.  These are most often composite resin materials that are bonded onto the biting surfaces of teeth early in life and prevent  bacteria from getting into the grooves on the tooth.  Ninety percent of tooth decay starts in these grooves.  A recent study by the Centers for Disease Control and Prevention (CDC) in Atlanta, published in the American Dental Association Journal found that school based sealant programs reduced decay experience by 60%.  These school based programs often serve poverty level populations that experience almost twice the amount of tooth decay compared with more affluent populations.  Unfortunately only about half as many poverty level children ages 6-11 have received sealants in this study. 

Diet  also plays a tremendous role in decay experience.  It is not at all uncommon for us to have patients with great dental health that suddenly experience a great deal of decay and almost invariably it's because of a change in diet of some sort.  Something I have seen often is college students coming home with a mouth full of decay and find out that their soda consumption or junk food and snacking habits have changed significantly.  Almost everyone knows that "sweets cause decay."  But what is often not understood is that many foods including almost all processed foods and many so call "health foods" have significant decay potential.  I have a patient who suddenly experienced a number of new cavities and upon questioning discovered he had been using maple syrup in his coffee because he thought being a natural food it was better for him.  The fact is from a decay standpoint it's no better than refined sugar.  Foods that are high in carbohydrates, sweet or not, especially those that stick to your teeth like raisins or other dried fruits are worse for you than a piece of chocolate that you eat and it clears from your mouth relatively quickly with the natural flow of saliva.  This is also why sipping on soda, coffee or tea with sugar (or maple syrup!) in it or any other carbohydrate that you're constantly snacking on is bad for your teeth.  Avoid in between meal snacks!  The exception to this rule is certain nuts and hard yellow cheeses which can actually reduce your decay potential.  Chewing sugar free gum right after eating (or better yet brushing) is also very helpful because the stickiness of the gum and the saliva it stimulates helps remove and neutralize the harmful food particles.  Chewing gums containing Xylitol or Recaldent actually reduce decay.

Last but not least is thorough home care.  Brushing, flossing and the use of various other teeth cleaning aids are by far and away the most effective means of removing the food debris and plaque that lead to tooth decay and periodontal disease.  The problem here is that often patients do not effectively clean their teeth.  Quickly swishing a brush around with toothpaste on it may make your mouth feel clean (because of the minty toothpaste) but unless the plaque is physically removed it remains snugly attached to your teeth.  Electric tooth brushes can be helpful for people with diminished physical ability to clean their teeth but the brush must still physically remove the bacterial plaque.  If your not doing an affective job of brushing or flossing your dentist or dental hygienist should show you how to do it properly.  It only takes approximately three minutes to thoroughly brush and floss and even doing it properly once a day would be a vast improvement for many people.  I often tell people that brushing two, three or more times a day inadequately is not as good as doing it once properly before going to bed.

The bottom line is that tooth decay is for the most part entirely preventable with proper oral hygiene, diet and the use of fluorides and sealants. Much of  the same can be said for periodontal disease.  It's in your hands.

Dr. Peter Gold has been practicing general dentistry for over 30 years in the upstate New York capital region. He sees patients from the Schenectady, Albany, Troy,  Saratoga Springs and surrounding areas.