October 19, 2017
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Taking the bite out of cavities

By: George Malkemus
October 6, 2017
The Wealth Of Health


Cavities. They hurt, they look bad and they are not fun to fix. What's the best way to deal with a cavity? Try not to get one in the first place. A cavity doesn't happen overnight and it's not caused by a single event. A series of events have to line up to create that painful hole in your tooth. Knowing how cavities start may give you some insight into how to stop them.

STEP ONE: Plaque Build up

A multitude of bacteria live in your mouth. The ones that produce the acids (mutant streptococci and lactobacilli) live in the plaque on your teeth. Plaque is a sticky, colorless biofilm, filled with bacteria that can cover your teeth. Enamel, the protective, thin coating around the tooth is extremely hard, actually the second hardest substance in nature behind diamonds. Dentists use diamond impregnated burs to drill through enamel when treating teeth for cavities. But acids secreted by bacteria can eat through enamel, a process called demineralization. Once through the outer enamel, decay can advance rapidly through the soft internal parts of a tooth. 

Every time you eat or drink you leave a little food behind on your teeth for the bacteria to dine on; they secrete acid, which eats away the enamel producing a cavity. The bacteria especially like it if you're eating sugary or starchy foods. Sticky sugary foods are particularly bad, like candy or raisins. Acidic drinks and food add to the demineralization of enamel.  With the first bite or sip, the clock is ticking. Within minutes, the bacteria convert these sugars and starches to acids. Saliva is designed to neutralize the acids and protect the teeth, but it takes in the neighborhood of twenty minutes to do its job. So, the more often you eat the less time your saliva has to repair the damage. If you have a hamburger at noon, cookies at one, then a cola at 1:30, you're not giving your mouth enough time to recover from the acid attack. 

Leave plaque alone and it will build up on your teeth. Bacteria doubles their population every 20 minutes forming more and more plague until you brush and floss again. That is why, it is best to brush after every meal, since bacteria just ‘party on,’ using new food debris to grow, secrete acid and make plaque. Plaque essentially forms a shield that prevents the saliva from rinsing away the acids while holding them directly against the teeth's surfaces, allowing the acids to seep into your teeth. That's the beginning of the end.

STEP TWO: Demineralization

The older the plaque, the more acids it holds in place and the more demineralization it can inflict. The acid-filled plaque that has now found a comfortable spot on your teeth, if left undisturbed, will begin to dissolve the teeth's mineral layer, essentially turning it from a solid to a liquid. Over time, that demineralization leads to the formation of a cavity.

Recently, a 17-year-old boy, who had been a patient of mine for many years with no cavities, came in for his 6-month dental examination.  Amazingly, he had gum line black cavities on every tooth. It turns out he had been working, flipping burgers at a fast-food restaurant for the last three months. Due to the heat while cooking, he had been sipping continually on coke. The acid and sugar from the coke, constantly bathing his teeth, had caused the decay to occur in a short time.  Many ‘health’ drinks contain high concentrations of sugar and acid as well as soft drinks, so be careful. 

Sometimes you can tell the demineralization process has begun. If you  see a white or brown spot on your tooth, or you have an area that is sensitive, you probably have demineralized enamel and an early cavity.  Sometimes if caught early enough your body can repair the enamel through process called remineralization. 

STEP THREE: Remineralization

 Just like when you break your leg or cut your finger, your body kicks into action to try and heal the damage. When demineralization begins, your body immediately tries to shore up the weakened spot. If you continually add fuel to the fire with constant eating, you create a standoff situation. Your body is trying to repair the damage but your eating is adding more sugars that create more acids that increase the damage that you body is trying to repair. And because the acids work faster than your saliva does, the acids have the unfair advantage.

The most important time to brush and floss is after your last meal before bedtime. Salvia flow stops during sleep, so bacteria continue to grow with the food debris left on the teeth during the night. Some people only brush their teeth in the morning. They wake up with a nasty taste in their mouth in the morning and brush their teeth to remove the bad taste.  Then they have breakfast and start the whole bacteria growing cycle again.  By the time they brush again the next morning, after numerous meals and snacking, there are billions of bacteria forming a thick plaque. This continual process forms an ever-deeper cavity.

STEP FOUR: Reversing the Process

Ironically, one of the things you can do to rebuild the damage done from eating is…eating. But this time, choose foods rich in minerals. Unprocessed, organic spinach and squash high in calcium, tuna and 

eggs loaded with iron, bananas and broccoli full of potassium; all of these will add to the mineral supply 


your body needs to rebuild your teeth's enamel. 

Of course the most important thing is good brushing and flossing techniques done frequently with regular dental check ups and cleanings.

To be your dentist's star patient, you would only eat three meals a day, with no snacks and brush and floss after every meal. But that's unrealistic for most people. What you can do is reduce sugary, acidic foods and drink and rinse your mouth with water after eating - or use any device, such as a toothpick or a brush without toothpaste to remove food debris after eating.

One day, cavities may be a thing of the past. If you combat demineralization now, you will be on the leading edge of dental health and on your way to keeping your healthy smile for a lifetime.


Enjoy life and keep smiling!


George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at