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Tooth Decay

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Also indexed as: Dental Caries, Dental Cavities

Illustration

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:

What you need to know

  • 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
3Stars

Fluoride

Lactobacillus GG

Xylitol

  
2Stars

Cod liver oil

Vitamin B6

Black tea

Green tea  (Camellia sinensis)

Neem
1Star

Sorbitol

Strontium

  
See also:  See also: Homeopathic Remedies for Tooth Decay
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star 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.

Medical options

Over-the-counter products containing fluoride (Gel-Tin, ACT) may help prevent tooth decay.

Prescription-strength fluoride toothpaste (Prevident) may be prescribed. Individuals living in communities without fluoridated water might be prescribed oral fluoride tablets or drops (Luride).

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.

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

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:

1. Harris NO, Garcia-Godoy F (eds.). Primary Preventive Dentistry, 5th ed. Stamford: Appleton & Lange, 1999, 93–5.

2. Harris NO, Garcia-Godoy F (eds.). Primary Preventive Dentistry, 5th ed. Stamford: Appleton & Lange, 1999, 93–5.

3. Ellwood RP, Blinkhorn AS, Davies RM. Fluoride: how to maximize the benefits and minimize the risks. Dent Update 1998;25:365–72.

4. Moss ME, Lanphear BP, Auinger P. Association of dental caries and blood lead levels. JAMA 199;281:2294–8.

5. Matte TD, Reducing blood lead levels: benefits and strategies. JAMA 1999;281:2340–1.

6. Price WA. Nutrition and Physical Degeneration. New York: Hoeber, 1939.

7. Jenkins GN, Forster MG, Speirs RL, et al. The influence of the refinement of carbohydrates on their cariogenicity. In vitro experiments on white and brown flour. Br Dent J 1959;106:195–208.

8. Cook HA. Phosphates and caries. Lancet 1968;i:1431.[letter]

9. Strean LP. The importance of pyridoxine in effecting a change in the microflora of the mouth and intestines. NY State Dent J 1957;23:85–7.

10. Makinen KK, Hujoel PP, Bennett CA, et al. Polyol chewing gums and caries rates in primary dentition: a 24-month cohort study. Caries Res 1996;30:408–17.

11. Makinen KK, Bennett CA, Hujoel PP, et al. Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res 1995;74:1904–13.

12. Hujoel PP, Makinen KK, Bennett CA, et al. The optimum time to initiate habitual xylitol gum-chewing for obtaining long-term caries prevention. J Dent Res 1999;78:797–803.

13. Makinen KK, Hujoel PP, Bennett CA, et al. A descriptive report of the effects of a 16-month xylitol chewing-gum programme subsequent to a 40-month sucrose gum programme. Caries Res 1998;32:107–12.

14. Kandelman D. Sugar, alternative sweeteners and meal frequency in relation to caries prevention: new perspectives. Br J Nutr 1997;77:S121–8 [review].

15. Hinman AR, Sterritt GR, Reeves TG. The US experience with fluoridation. Comm Dent Health 1996;13 (Suppl 2):5–9 [review].

16. Ellwood RP, Blinkhorn AS, Davies RM. Fluoride: how to maximize the benefits and minimize the risks. Dent Update 1998;25:365–72.

17. Hinman AR, Sterritt GR, Reeves TG. The US experience with fluoridation. Comm Dent Health 1996;13 (Suppl 2):5–9 [review].

18. Diesendorf M, Colquhoun J, Spittle BJ, et al. New evidence on fluoridation. Aust NZ J Public Health 1997;21:187–90 [review].

19. Ellwood RP, Blinkhorn AS, Davies RM. Fluoride: how to maximize the benefits and minimize the risks. Dent Update 1998;25:365–72 [review].

20. Driscoll WS, Heifetz SB, Korts DC. Effect of chewable fluoride tablets on dental caries in schoolchildren: results after six years of use. J Am Dent Assoc 1978;97:820–4.

21. DePaola PF, Lax M. The caries-inhibiting effect of acidulated phosphate-fluoride chewable tablets: a two-year double-blind study. J Am Dent Assoc 1968;76:554–7.

22. Ripa LW, Leske GS, Levinson A. Supervised weekly rinsing with a 0.2% neutral NaF solution: results from a demonstration program after two school years. J Am Dent Assoc 1978;97:793–8.

23. Kobayashi S, Kishi H, Yoshihara A, et al. Treatment and posttreatment effects of fluoride mouthrinsing after 17 years. J Public Health Dent 1995;55:229–33.

24. Fure S, Gahnberg L, Birkhed D. A comparison of four home-care fluoride programs on the caries incidence in the elderly. Gerodontology 1998;15(2):51–60.

25. Petersson LG, Svanholm I, Andersson H, Magnusson K. Approximal caries development following intensive fluoride mouthrinsing in teenagers. A 3-year radiographic study. Eur J Oral Sci 1998;106:1048–51.

26. Driscoll WS, Nowjack-Raymer R, Selwitz RH, et al. A comparison of the caries-preventive effects of fluoride mouthrinsing, fluoride tablets, and both procedures combined: final results after eight years. J Public Health Dent 1992;52:111–6.

27. Ellwood RP, Blinkhorn AS, Davies RM. Fluoride: how to maximize the benefits and minimize the risks. Dent Update 1998;25:365–72 [review].

28. DePaola DP, Faine MP, Palmer CA. Nutrition in relation to dental medicine. In: Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore: Williams & Wilkens, 1999, 1110–2.

29. Palazzo A, Cobe HM, Ploumis E. The effect of pyridoxine on the oral microbial populations. NY State Dent J 1959;25:303–7.

30. Hillman RW, Cabaud PG, Schenone RA. The effects of pyridoxine supplements on the dental caries experience of pregnant women. Am J Clin Nutr 1962;10:512–5.

31. Cohen A, Rubin C. Pyridoxine supplementation in the suppression of dental caries. Bull Phila County Dent Soc 1958;22:84.

32. Nase L, Hatakka K, Savilahti E, et al. Effect of long-term consumption of a probiotic bacterium, Lactobacillus rhamnosus GG, in milk on dental caries and caries risk in children. Caries Res 2001;35:412–420.

33. Harel-Raviv M, Laskaris M, Chu KS. Dental caries and sugar consumption into the 21st century. Am J Dent 1996;9:184–90 [review].

34. Harel-Raviv M, Laskaris M, Chu KS. Dental caries and sugar consumption into the 21st century. Am J Dent 1996;9:184–90 [review].

35. Trahan L. Xylitol: a review of its action on mutans streptococci and dental plaque—its clinical significance. Int Dent J 1995;45(1 Suppl 1):77–92 [review].

36. Touger-Decker R. Nutrition in dental health. In: Mahan LK, Escott-Stump S, eds. Food, Nutrition, and Diet Therapy. 9th ed. Philadelphia: Saunders, 1996, 585.

37. Touger-Decker R. Nutrition in dental health. In Mahan LK, Escott-Stump S, eds. Food, Nutrition, and Diet Therapy. 9th ed. Philadelphia: Saunders, 1996, 583.

38. Edgar WM. Sugar substitutes, chewing gum and dental caries—a review. Br Dent J 1998;184:29–32 [review].

39. Edgar WM. Sugar substitutes, chewing gum and dental caries—a review. Br Dent J 1998;184:29–32 [review].

40. Soderling E, Isokangas P, Pienihakkinen K, et al. Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6-year follow-up. Caries Res 2001;35:173–7.

41. Soderling E, Isokangas P, Pienihakkinen K, Tenovuo J. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res 2000;79:882–7.

42. Isokangas P, Soderling E, Pienihakkinen K, Alanen P. Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age. J Dent Res 2000;79:1885–9.

43. McBeath EC, Zucker TF. The role of vitamin D in the control of dental caries in children. J Nutr 1938;15:547–64.

44. Strontium and dental caries. Nutr Rev 1983;41:342–4 [review].

45. Strontium and dental caries. Nutr Rev 1983;41:342–4 [review].

46. Rasheed A, Haider M. Antibacterial activity of Camellia sinensis extracts against dental caries. Arch Pharm Res 1998;21:348–52.

47. Matsumoto M, Minami T, Sasaki H, et al. Inhibitory effects of oolong tea extract on caries-inducing properties of mutans streptococci. Caries Res 1999;33:441–5.

48. Otake S, Makimura M, Kuroki T, et al. Anticaries effects of polyphenolic compounds from Japanese green tea. Caries Res 1991;25:438–43.

49. Ooshima T, Minami T, Aono W, et al. Oolong tea polyphenols inhibit experimental dental caries in SPF rats infected with mutans streptococci. Caries Res 1993;27:124–9.

50. Ooshima T, Minami T, Matsumoto M, et al. Comparison of the cariostatic effects between regimens to administer oolong tea polyphenols in SPF rats. Caries Res 1998;32:75–80.

51. Ooshima T, Minami T, Aono W, et al. Reduction of dental plaque deposition in humans by oolong tea extract. Caries Res 1994;28:146–9.

52. Pai MR, Acharya LD, Udupa N. Evaluation of antiplaque activity of Azadirachta indica leaf extract gel—a 6-week clinical study. J Ethnopharmacol 2004;90:99–103.

53. Pai MR, Acharya LD, Udupa N. The effect of two different dental gels and a mouthwash on plaque and gingival scores: a six-week clinical study. Int Dent J 2004;54:219–23.
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