Heath Notes

Tooth Decay

Also indexed as: Dental Caries, Dental Cavities

Keep that smile on your face by protecting and strengthening your teeth and gums. According to research or other evidence, the following self-care steps may reduce the number of trips to the dentist:

Protect your pearly whites
Try over-the-counter toothpastes (Gel-Tin, Stop) and mouthwashes (ACT, Fluorigard) to help protect your teeth and make them stronger

Discover xylitol
Chew gum containing xylitol to reduce the activity of cavity-causing bacteria

Battle the bad bugs
Inhibit cavity-causing bacteria by adding lactobacillus GG to children’s milk

Pass up sticky sweets
Cut down on cavity-causing bacteria by avoiding sugary foods that stick to your teeth or stay in the mouth for a long time

Keep an eye on hygiene
Prevent tooth decay by brushing and flossing regularly, and visiting your dentist's office for fluoride treatments and periodic cleanings

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full tooth decay article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About tooth decay

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.

Product ratings for tooth decay

Science Ratings	Nutritional Supplements	Herbs
	Fluoride Lactobacillus GG Xylitol
	Cod liver oil Vitamin B6	Black tea Green tea (Camellia sinensis) Neem
	Sorbitol Strontium
See also: See also: Homeopathic Remedies for Tooth Decay
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

People with tooth decay may have tooth pain, including sensitivity to cold food and drinks.

Dietary changes that may be helpful

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, 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

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.¹⁰ ¹¹ While most experts believe water fluoridation to be associated with minimal risk,¹² 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.¹³ Fluoride has topical action as well as whole-body effects,¹⁴ 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)¹⁵ ¹⁶ or fluoride mouthrinses (0.05% to 0.2% fluoride content)¹⁷ ¹⁸ also reduce caries risk in children. Fluoride tablets¹⁹ and mouthwash²⁰ 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.²¹ These products should not be used by young children (under three years of age), who might accidentally swallow dangerous amounts of fluoride.²² The American Dental Association (ADA) recommends supplementing children in areas without fluoridated water with liquid fluoride drops,²³ but this should be done with the guidance of a dentist.

Lifestyle changes that may be helpful

The ADA recommends regular tooth brushing—daily brushing, ideally after each meal.²⁴ Although thorough brushing varies from person to person, five to ten strokes in each area should be adequate.²⁵ Toothpastes containing 1,000 to 2,500 ppm (1 to 2.5 mg per gram) of fluoride have been shown to reduce caries risk.²⁶

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.²⁷ 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.²⁸

Other therapies

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.

Vitamins that may be helpful

Test tube studies show that vitamin B6 increases growth of beneficial mouth bacteria and decreases growth of cavity-causing bacteria.²⁹ 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.³⁰ 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.³¹

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.³² The amount of Lactobacillus added to the milk was 5 to 10 x 10e5 CFU per ml.

Certain sugar substitutes appear to have anti-caries benefits beyond that of reducing sugar intake. 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. Sorbitol is only slowly used by oral bacteria, and it produces less caries than sucrose.³³ Xylitol gum was associated with a slightly greater risk reduction than sorbitol gum.³⁴ Bacteria in the mouth do not ferment xylitol, so they cannot produce the acids that cause tooth decay from xylitol.³⁵ A double-blind study found 100% xylitol-sweetened gum was superior to gum containing lesser amounts or no xylitol.³⁶ Another study found xylitol-containing gums gave long-term protection against caries while sorbitol-only gum did not.³⁷ Other research has confirmed the anti-caries benefits of xylitol in various forms, including gum,³⁸ chewable lozenges, toothpastes, mouthwashes, and syrups.³⁹ Mothers typically transmit one of the decay-causing bacteria to their infant children, but a double-blind trial found that the children of mothers who regularly chewed xylitol-containing gum for 21 months, starting 3 months after delivery, had a greatly reduced risk of acquiring these bacteria,⁴⁰ ⁴¹ and also had 70% less tooth decay.⁴²

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.⁴³ 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.⁴⁴ Compared with children with fewer cavities, enamel samples from children with high numbers of caries have been found to contain significantly less strontium.⁴⁵ However, supplementation with strontium has not yet been studied as tooth decay prevention.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Compounds present in both green tea and black tea have been shown to inhibit the growth and activity of bacteria associated with tooth decay.⁴⁶ ⁴⁷ Animals given tea compounds in their drinking water develop fewer dental caries than do those drinking plain water.⁴⁸ ⁴⁹ ⁵⁰ 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.⁵¹ Tea drinking has not yet been tested as a tooth decay preventative in humans.

In a double-blind trial, 1 gram of neem leaf extract in gel twice per day was more effective than chlorhexidine or placebo gel at reducing plaque and bacteria levels in the mouth in 36 Indian adults.⁵² A similar trial found neem gel superior to placebo and equally effective as chlorhexidine at reducing plaque and bacteria levels in the mouth.⁵³ These promising early studies should be followed by studies regarding prevention of cavities and relief from gingivitis or periodontal disease.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

References
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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 June 2009.

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