March 5, 2021
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Taking the bite out of cavities in 2021

By: George Malkemus
January 8, 2021

2021. Wow.  Time marches on.  So glad 2020 is behind us.  Between extreme fires, angry polarizing politics, and deadly Covid-19, 2020 was an infamous period in our history.  Though not out of the woods yet, hope is here and hopefully normalcy around the corner.  But we still need to be smart, stay safe, wear masks and social distance and also hope for more rain. 

Now is a good time for a positive New Year’s resolution.  How about stopping decay in your mouth?

Cavities. They hurt, they look bad and they are not fun to have fixed. 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 mouth is a great environment for bacteria, being warm, moist and filled with food debris.  The bacteria that cause decay 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, enamel is 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 foods 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 time to do its job. The more often you eat the less time your saliva has to repair the damage.  So, snacking increases the decay process.  If you have a hamburger at noon, cookies at one, and a cola at 1:30, you're not giving your mouth enough time to recover from the acid bacteria attack. 

Leaving plaque alone by not rinsing, brushing and flossing and the plaque continually builds up on your teeth.  Bacteria double their populations every 20 minutes forming more and more plaque until the next time you brush and floss.  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. Plaque is the beginning of the decay process.


STEP TWO: Demineralization

The older the plaque is, 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.

Two falls ago before the pandemic, a 17-year-old boy, who had been a patient 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 previous three months over the hot summer.  Due to the heat, he had been continually sipping on soda while cooking.  The acid and sugar from the soda was constantly bathing his teeth and 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 weakening 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 by the continual food source more acids is created that increases the damage that your 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.  Saliva 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; brush their teeth to remove the bad taste.  Then they have breakfast and start the whole bacteria growth 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.  

If left unchecked, this process can cause deep decay, pain, bacterial abscess and the need for root canal therapy or even extraction.  If caught at an earlier stage, the teeth can be repaired with a dental filling.


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 foods are best.  Spinach and squash are high in calcium, tuna and eggs are loaded with iron, bananas and broccoli are 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 checkups 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.  Have A Great 2021!



 George Malkemus has had 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