For years the main approach to treating tooth decay (or caries) could best be described as “drill and fill” — remove the decayed tooth material and fill the resulting cavity. But a new approach has come to prominence that addresses not only the results of decay, but seeks to identify and treat the underlying conditions that caused the decay in the first place, and may continue to infect other teeth.

This approach is known as Caries Management By Risk Assessment or CAMBRA. Rather than a “One Size Fits All” approach, CAMBRA individualizes treatment and prevention options by first assessing your own individual risk for tooth decay.

We base this assessment on what might be called the Caries Balance. On one side are factors that increase your risk of tooth decay, easily remembered by the acronym BAD: Bad bacteria that produces acid; Absence of healthy, functional saliva that neutralizes the effects of acid; and Dietary habits that are heavy with sugars, acids and between meal snacking. On the other side are protective factors that reduce your risk, known as SAFE — Saliva and sealants that protect the surfaces of teeth; Antimicrobials that help rid the mouth of bad bacteria; Fluoride, which strengthens teeth against de-mineralization caused by acid; and an Effective diet.

The assessment first involves a survey of questions about your hygiene habits, dental history and lifestyle: Do you brush twice and floss once daily? Do you live in a fluoridated area or use fluoride mouth rinse? Do you smoke? Have you had frequent cavities in the past? These and other questions, along with a complete dental exam and acid level testing, can give us a more accurate understanding of your risk and how best to incorporate treatment that reduces it even further.

Using CAMBRA, you and our dental team develop a true partnership that actually transforms your dental health from simply treating existing caries, to preventing future occurrences.

If you would like more information on the CAMBRA approach to caries prevention, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Decay: How to assess your risk.”

Did you know that tooth decay (dental caries) is the second most frequently occurring disease — surpassed only by the common cold? It can start as soon as toddlers sprout their first teeth and by middle age, more than 90% of adults are affected by the problem! Fortunately, you can significantly lower your risk for decay. The key is to nurture health-promoting (protective) factors in your mouth while discouraging those that are disease causing (pathologic).

The top two traditional steps can't be stressed enough:

Good Oral Hygiene. Diligent brushing and flossing, along with routine professional cleanings, help limit a buildup of bacterial plaque (biofilm). This whitish film is attractive to decay-producing bacteria (among the many types of bacteria — including beneficial ones — that normally live in the mouth). These microbes like to snack on sugars and carbohydrates (perhaps part of that bagel you had for breakfast or the midafternoon candy bar), and in the process they produce acid. A healthy oral environment has a neutral pH — a perfect balance between acids and bases. But in a more acidic environment, minerals in the protective enamel of your teeth start to dissolve, exposing the dentin and root surfaces underneath that are even more vulnerable.

Sensible Diet. Keep decay-producing bacteria in check by limiting your intake of sugars and carbohydrates; the bacteria need these nutrients to grow and reproduce. Choose products containing natural sugars, such as those in fruits and vegetables, over those containing added sugars, such as sodas and candy. Be aware that Xylitol, an “alcohol sugar” used in some chewing gums and dental products, can actually help reduce pathogenic bacteria. And don't forget that frequent consumption of acidic foods and beverages, such as sipping coffee during the day, can create an acidic environment in your mouth that can contribute to decay by eroding tooth enamel and weakening its defenses.

Individual Risk Factors

You also may have individual risk factors as well that our office can help you identify and address. For example, the shape of everyone's teeth varies and some of us have more valleys, tiny grooves and pits than others. These likely places for bacteria to congregate can be the most difficult to reach with a toothbrush, but invisible sealants can be applied to prevent bacteria from reaching those areas.

If you would like more information about tooth decay and prevention, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Tooth Decay” and “Tooth Decay — How To Assess Your Risk.”

Parenthood comes with no manual — if it did it would surely include many essential tips to make your job easier while improving your children's lives. One important fact that surprises many people, is the age you should take your children to the dentist for their first dental appointment, age one. The reason that the age one dental visit is so important is that it establishes the foundation of oral healthcare for the rest of their lives. Unfortunately, some parents wrongly assume that because primary teeth “fall out anyway,” they do not need to worry about them. Nothing could be further from the truth!

One problem children may face is Early Childhood Caries (ECC) tooth decay. This is a type of tooth decay that occurs from sucking on a bottle filled with sugary liquids such as formula, juices and fruity drinks for extended periods of time and from a sleep-time bottle. ECC can affect all the primary (baby) teeth in infants soon after they come into the mouth.

Bringing your children into our office for their age one dental visit enables us to establish a friendly, trusting relationship with the whole family while we assess your children's oral health. During this consultation we will identify if the teeth and jaws are developing correctly, whether habits such as sucking on baby bottles are causing tooth decay or if there are other underlying issues that may indicate future problems. And this ounce of prevention often enables us to stop an anticipated problem before it even starts.

Protecting your children is one of your most important roles as a parent or caregiver. Dental sealants are one way you can protect your children's teeth from the ravages of tooth decay, drilling and fillings — and they can be applied simply, comfortably and quickly right here in our office.

What is a dental sealant?

A dental sealant is a thin, plastic film that is painted onto the tiny grooves on the chewing surfaces of the back teeth (usually the premolars and molars) to prevent caries (cavities) and tooth decay. And by allowing us to use sealants to seal these little nooks and crannies where your child's toothbrush can't reach, you will dramatically reduce their chances for developing tooth decay. This one, simple and quick office visit could save you both money and time with fewer dental visits and healthier, cavity-free teeth.

So will sealants guarantee no (or no more) cavities?

No, just like life, there are few guarantees. Your child's oral hygiene, regular dental visits, fluoride, sugar consumption and genetics are the other important factors that will determine to what degree your child experiences tooth decay. However, research shows that pit and fissure (chewing surface) decay accounts for approximately 43% of all decayed surfaces in children aged 6 to 7, even though the chewing surfaces (of the back or posterior teeth) constitute only 14% of the tooth surfaces at risk. This demonstrates the vulnerability of the chewing surfaces of the posterior teeth to decay. By placing a protective seal over the areas of teeth at risk, you can effectively and proactively protect your children's teeth.

How long do sealants last?

Research has shown that some sealants can last up to 10 years. However, if you opt for sealants for your children's teeth, we will closely monitor them with each office visit to ensure that they are still doing their job. As needed, we can apply more sealant.

A number of factors can lead to dental caries (tooth decay). To find out if you are at high risk, ask yourself these questions.

Is plaque visible in my mouth?
Dental plaque is a whitish film of bacteria that collects on your teeth. If it is clearly visible, it means that there is a lot of it. Among the bacteria in the plaque are those that produce tooth decay, particularly in an acidic environment. (A normal mouth is neutral, measured on the pH scale, midway between the extreme acidic and basic ends of the scale.)

Do I have a dry mouth?
Saliva protects your teeth against decay by neutralizing an acidic environment and adding minerals back to the outer surface of enamel of your teeth, so reduced saliva is a high risk for caries. Many medications can cause dry mouth as a side effect.

Do I eat a lot of snacks, particularly unhealthy ones?
Frequently eating sugars, refined carbohydrates, and acidic foods promotes the growth of decay-producing bacteria. The more frequently you eat, the longer your teeth are bathed in sugars and acids. Acidic foods not only promote bacterial growth, they also directly cause erosion of the tooth's hard surface by softening and dissolving the minerals in the enamel.

Do I wear retainers, orthodontic appliances, bite guards or night guards?
These appliances are recommended for various conditions, but they tend to restrict the flow of saliva over your teeth, cutting down on the benefits of saliva mentioned above.

Do my teeth have deep pits and fissures?
The shape of your teeth is determined by your heredity. If your teeth grew in with deep grooves (fissures) and pits in them, you are at higher risk for bacterial growth and resulting decay.

Do I have conditions that expose my teeth to acids?
If you have bulimia (a psychological condition in which individuals induce vomiting), or GERD (Gastro-Esophageal Reflux Disease), your teeth may be frequently exposed to stomach acids that can cause severe erosion to your teeth.

Do I already have cavities?
Visible cavities can range from those only visible with laser technology or x-ray examination to those a dentist can see with a naked eye. If you already have small cavities, you are at high risk for developing more.

Do I have white spots on my teeth?
White spots are often the first sign of decay in a tooth's enamel. At this point, the condition is often reversible with fluorides.

Have I had a cavity within the last three years?
Recent cavities point to a high risk of more cavities in the future, unless conditions in your mouth have significantly changed.

If you have any of these indications of high risk, contact us today and ask us for suggestions for changing the conditions in your mouth. You can also learn more by reading the Dear Doctor magazine article “Tooth Decay.”