Tooth Decay: Symptoms, Stages, Causes, and Prevention

Tooth decay is a pressing topic across all ages. 

42% of children ages 2 to 11 have cavities in their baby teeth, and 21% of children in that age range already have developed them in their permanent teeth. 

For adults, 92% of us have experienced tooth decay.

Here’s the good news: even if you have a history of dental issues, you can skip the headache (and the toothache) moving forward, stopping cavities before they start. 

Let’s take a look at the symptoms, stages, causes, and prevention techniques you need to know to send away tooth decay.

What is tooth decay?

Tooth decay refers to small spots where tooth enamel or dentin has been eaten away by acid, eventually growing and spreading throughout the tooth. Advanced tooth decay, also called cavities or dental caries, is the number one preventable disease in the world.

This decay process can happen on any part of the tooth: on the smooth surface of the sides, at the root, between teeth (interdental spaces), or on the ridges at the top.

Tooth decay damages and eventually begins to break down the teeth if left untreated. Even a small cavity or spot is worth taking seriously.

If you’re caring for your children’s teeth, it’s crucial to be proactive about cavities. The Centers for Disease Control and Prevention (CDC) calls it “the most common chronic disease in children ages 6 to 11.”

Everyone from nursing children to dentists ourselves can develop tooth decay. It’s essential to understand how a cavity can develop so you can catch and prevent its spread.

 
 
 
 
 
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How does a cavity develop?

To understand how a cavity can develop and make its way through your tooth, we need to know how a tooth operates. Let’s talk about the four layers of teeth, according to the American Dental Association (ADA):

  • Enamel. This is the hard outer layer that you can see on the surface of your tooth. It is the hardest substance in your body, made up of several minerals.
  • Dentin. This second layer of the tooth contains the tiny tubules and living tissues that communicate with the nerves located farther inside the tooth. 
  • Cementum. The cementum is also quite hard, covering the bottom half of the tooth’s root and anchoring the tooth in the gum.
  • Pulp. The pulp is softer than the other layers and is found in the middle of the tooth. It acts as a casing for the nerves, blood vessels, and connective tissue.

In the beginning stage of tooth decay, a layer of clear, sticky film called dental plaque builds up and coats the tooth. Plaque is teeming with pathogenic (disease-causing) bacteria that produce acids that can damage your teeth and cause gum disease.

Unfortunately, this acid that comes from plaque eats away at the minerals that make up the enamel. Over time, it can begin to demineralize and eventually break down the enamel layer, continuing to cause damage deeper into the tooth.

Symptoms of Tooth Decay

It’s relatively easy to see or feel dental cavities forming once they progress throughout the tooth. But your best bet is to catch this decay as early as you can before tartar build up and damage become irreversible.

Knowing the symptoms of tooth decay and catching it in the early stages can save you from more intensive procedures, possible infection, and bigger dental bills. 

The signs and symptoms of tooth decay include:

  • White spots or a chalky appearance on the surface of the tooth
  • Small holes on the surface of the tooth
  • Tan, brown, or black spots 
  • Sensitivity to hot or cold food and beverages
  • Pain and swelling at a tooth
  • Bleeding or swollen gums
  • Discomfort when chewing
  • Persistent bad breath
  • Unpleasant taste in the mouth

So, knowing the symptoms, how is tooth decay diagnosed? 

Tooth decay can only be accurately diagnosed by a dental professional. While you may see the symptoms, it’s tough for an untrained eye to tell the extent of the damage and the best treatment plan. Your dentist will use a physical examination and, in many cases, x-rays to diagnose cavities and determine the appropriate treatment.

Head to the dentist if you notice any of these symptoms. The sooner you can catch tooth decay, the better. This is one of the many reasons it’s wise to keep your dental checkups scheduled every 6 months. 

Plus, we like seeing you!

Tooth Decay Stages (with Pictures)

What are the stages of tooth decay? Tooth decay has 5 stages, growing more severe as it progresses. Here’s how it develops, from the initial stages to the end result, if left untreated:

  1. Demineralization. In the first stage of tooth decay, acid produced by the bacteria in plaque begins to break down the minerals that make up tooth enamel.
  2. Decaying enamel. Once the enamel has lost its minerals, it is left weakened, and bacteria can eat through the enamel of the tooth, causing a hole that will need to be filled.
  3. Decaying dentin. The bacteria has passed through enamel and now begins to damage the dentin layer. In this stage, increased sensitivity in the tooth may occur since it is linked to the tooth’s nerves.
  4. Damage to the pulp. After the bacteria has penetrated through the dentin layer, it has now reached the sensitive pulp. This may cause swelling and more acute pain as the bacteria irritate the nerves inside the tooth.
  5. Abscess. At this stage of tooth decay, the pulp is infected. A pocket of pus can form at the base of the tooth, called an abscess, and pain may spread into the jaw, swollen lymph nodes, or fever. If you have an abscess, do not wait. Go see your dentist immediately to keep the infection from spreading.

While advancing tooth decay can cause significant pain and trouble, a tooth abscess is dangerous to your overall health. Untreated abscesses can cause life-threatening complications.

Causes

There are many possible contributors to decay in the teeth, or dental caries. These include, but are not limited to:

  • Consistent snacking. Food can cling to the teeth between meals, especially on sugary foods and carbohydrates that break down into food for oral bacteria.
  • Poor oral hygiene. It’s important to brush and floss regularly and for your kids to do the same. I recommend brushing 3 times a day and flossing at least once.
  • A consistently dry mouth. This can be caused by mouth breathing at night, stress, or even overusing mouthwash.
  • Acid reflux disease. Stomach acid can enter the mouth and cause wear and tear on the enamel.
  • Medical conditions. Some forms of treatment for cancer in the head and neck can increase the likelihood of dental caries.
  • Improper nutrition. You need a healthy intake of vitamin D3, vitamin K2, and calcium to build healthy enamel. For children, these nutrients also support jaw development and can help reduce the risk of orthodontic problems.

As you can see, many of these causes of tooth decay are preventable with intentional oral care. 

Risk Factors

Interestingly, not all mouths, or even all teeth, are at the same risk for decay. 

These factors make teeth more susceptible to bacteria:

  • Location. Your molars are often harder to reach when brushing. They also have many grooves and places for food to hide. The back teeth are more likely to experience decay.
  • Age. Young children under 12 and older adults are more likely to have tooth decay than other groups.
  • Brushing and flossing. Not brushing 3 times a day after meals or flossing regularly raises the risk of tooth decay. 
  • Old dental fillings or devices. If fillings and crowns are not looked after, they can become weaker and create a place for decay to build underneath.

What are the long-term effects of tooth decay?

The long-term effects of tooth decay include abscesses, potential root canals, and even tooth loss. Gum disease can also occur when plaque and tartar go unchecked — cavities and gum disease run hand in hand.

What happens if tooth decay is left untreated? Tooth decay that is left untreated has the potential to continue to spread throughout the whole tooth. It can continue its movement to infect the mouth and head, or even the jawbone in the late stages. These later stages pose a risk to both your dental and whole-body health.

Treatments

Can you fix tooth decay? Yes, there is a treatment for each stage of tooth decay. No matter what stage of tooth decay you are experiencing, let a dentist help. We can alleviate discomfort, find solutions, and put your mind at ease. 

From fillings to extractions, you or your child will be numbed and comfortable through the procedure. Don’t let fear of pain stop you from treatment. Here are the most common treatments for tooth decay.

1. Reversal

When tooth decay is caught early on, it is possible to reverse it. My top recommendations are diet changes to incorporate more vitamins like D3 and K2 and minerals like calcium for strong teeth.

In addition to a diet overhaul, oral probiotics, tongue scraping, and nasal breathing  help reverse tooth decay. I also recommend oil pulling and certain dietary supplements, depending on the situation.

Another great option to rebuild enamel is hydroxyapatite toothpaste. Hydroxyapatite is the primary mineral that teeth are made of, and brushing it on can help to restore the structure of your teeth. 

What is the best toothpaste? The best toothpastes to restore enamel are Risewell (use code: DOCTORSTACI for 10% off) or Boka (use code: DOCTORSTACI for 20% off); I highly recommend both for their hydroxyapatite content and fantastic flavors.

Fluoride toothpaste is associated with more systemic risks to children than HAp toothpaste, but it can also support remineralization of the teeth to support cavity reversal in certain high risk situations, although I find hydroxyapatite to be superior and without the worry..

2. Fillings

Once bacteria have broken a more significant hole into the enamel, fillings will be necessary. Your dentist will clear out the area of decay and then place a composite material into the tooth to fill the gap.

3. Pulpotomy/Root Canal

What is a root canal? A root canal is a procedure that removes infected pulp from within the tooth before cleaning and filling the cavity inside the tooth. After this is complete, a crown is placed on top of the tooth.

A root canaled tooth is essentially “mummified.” It is no longer living, changeable tissue but cut off from the body’s blood supply. 

In baby teeth, this procedure is called a pulpotomy and removes less pulp than a root canal to avoid excessive damage to the tooth.

4. Extraction with Implant

In more severe tooth decay cases, it may be necessary to extract the tooth if the infection has spread or irreparably damaged the tooth. After removing a permanent tooth, it’s possible to have a new, false tooth implanted into the jaw, maintaining the health of the mouth.  Primary, or baby, teeth do not need replacement but may need a space maintainer.

However, if a child loses a permanent tooth, kids generally cannot have dental implants until they turn 17-18 yo (because the jaw and palates continue to grow). Instead, talk to your dentist about a spacer to prevent orthodontic issues.

How to Prevent Cavities

We’ve talked about diet and brushing directly after meals, but there’s much more you can do to be proactive against cavities.

You may be wondering how to prevent cavities, or more practically, “How can I prevent tooth pain?” You can prevent tooth pain with the following tips to avoid cavities and minimize tooth decay:

Managing Mouth Breathing

Breathing through the mouth can cause tooth decay, not to mention facial development issues in children. In fact, chronic nighttime mouth breathing can present in children similar to ADHD.

Try mouth taping overnight for adults. Bring a child who breathes through the mouth regularly into their pediatric dentist to check for underlying issues and discuss treatment with your pediatric dentist. A visit to other specialists like an ENT or myofunctional therapist may be indicated.

Floss

Flossing daily removes bacteria that your toothbrush can’t reach, preventing hardened plaque called tartar from attaching to the teeth.

Tongue Scraping

Tongue scraping can help remove the aggressive bacteria from the mouth and balance out the oral microbiome. I’ve found that kids love the silliness of tongue scraping, which is a bonus!

Oral Probiotics

There are good bacteria in your mouth, not just bad ones, and they help fight off tooth decay. Taking oral probiotics can increase the ratio of good bacteria in your mouth, aiding in the battle against cavities.

Other Approaches

Many dentists will recommend dental sealants or fluoride treatments (fluoride varnish) to prevent cavities. However, studies have shown that hydroxyapatite is as effective as fluoride but with fewer side effects. 

Dental sealants are an option for some families but merit an in-depth conversation about what materials they’re made of and what technique is used to ensure bacteria or early cavities are not getting trapped underneath as these sealants are sitting in your child’s mouth indefinitely and should be taken very seriously.

 

 
 
 
 
 
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When to See Your Dentist

How can I remove tooth decay myself? Unfortunately, you can’t remove tooth decay yourself. Come see your dentist, and some x-rays and a quick conversation will give you a plan you can smile about.

The best way to prevent tooth decay is to practice prevention and see your dentist every 6 months. We’re here to help, and we can catch demineralization before it progresses. We want to see you empowered, not afraid, so you can live without tooth decay.

Sources

  1. Colard, T., Falgayrac, G., Bertrand, B., Naji, S., Devos, O., Balsack, C., … & Penel, G. (2016). New insights on the composition and the structure of the acellular extrinsic fiber cementum by Raman analysis. PLoS One, 11(12), e0167316. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5147880/ 
  2. Ghannam, M. G., Alameddine, H., & Bordoni, B. (2020). Anatomy, Head and Neck, Pulp (Tooth). StatPearls [Internet]. Full text: https://www.ncbi.nlm.nih.gov/books/NBK537112/#:~:text=The%20pulp%20is%20a%20mass,each%20other%27s%20development%20and%20survival
  3. Ratcliff, P. A., & Johnson, P. W. (1999). The relationship between oral malodor, gingivitis, and periodontitis. A review. Journal of Periodontology, 70(5), 485-489. Full text: https://www.ncbi.nlm.nih.gov/books/NBK279593/ 
  4. Hicks, J., Garcia-Godoy, F., & Flaitz, C. (2004). Biological factors in dental caries: role of saliva and dental plaque in the dynamic process of demineralization and remineralization (part 1). Journal of Clinical Pediatric Dentistry, 28(1), 47-52. Abstract: https://pubmed.ncbi.nlm.nih.gov/14604142/ 
  5. Selwitz, R. H., Ismail, A. I., & Pitts, N. B. (2007). Dental caries. The Lancet, 369(9555), 51-59. Abstract: https://pubmed.ncbi.nlm.nih.gov/17208642/ 
  6. Robertson, D., & Smith, A. J. (2009). The microbiology of the acute dental abscess. Journal of medical microbiology, 58(2), 155-162. Abstract: https://pubmed.ncbi.nlm.nih.gov/19141730/ 
  7. Erazo, D., & Whetstone, D. R. (2020). Dental Infections. StatPearls [Internet]. Full text: https://www.ncbi.nlm.nih.gov/books/NBK542165/ 
  8. Islam, B., Khan, S. N., & Khan, A. U. (2007). Dental caries: from infection to prevention. Medical Science Monitor, 13(11), RA196-RA203. Abstract: https://pubmed.ncbi.nlm.nih.gov/17968308/ 
  9. Estrela, C., Holland, R., Estrela, C. R. D. A., Alencar, A. H. G., Sousa-Neto, M. D., & Pécora, J. D. (2014). Characterization of successful root canal treatment. Brazilian dental journal, 25(1), 3-11. Abstract: https://pubmed.ncbi.nlm.nih.gov/24789284/ 
  10. Surtel, A., Klepacz, R., & Wysokińska-Miszczuk, J. (2015). The influence of breathing mode on the oral cavity. Polski merkuriusz lekarski: Organ Polskiego Towarzystwa Lekarskiego, 39(234), 405-407. Abstract: https://pubmed.ncbi.nlm.nih.gov/26802697/ 
  11. Bordas, A., McNab, R., Staples, A. M., Bowman, J., Kanapka, J., & Bosma, M. P. (2008). Impact of different tongue cleaning methods on the bacterial load of the tongue dorsum. Archives of oral biology, 53, S13-S18. Abstract: https://pubmed.ncbi.nlm.nih.gov/18460399/ 
  12. Shakib, P., Rouhi, S., & Zolfaghari, M. R. (2020). The role of probiotics in preventing dental caries. Plant Biotechnology Persa, 2(1), 55-58. Full text: http://pbp.medilam.ac.ir/article-1-40-en.pdf 
  13. Amaechi, B. T., AbdulAzees, P. A., Okoye, L. O., Meyer, F., & Enax, J. (2020). Comparison of hydroxyapatite and fluoride oral care gels for remineralization of initial caries: a pH-cycling study. BDJ open, 6(1), 1-7. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376056/

Children’s Oral Health: Hygiene, Diet, Sealants, & Fluoride

Helping your children to have a lifetime of healthy teeth is an important part of basic health care, and it is possible… if you have accurate information and tools to help you on your way. 

When it comes to children’s dental health, you may already know that diet plays a role in cavity formation. But did you also know that what your child eats (or doesn’t eat) can even help to prevent or reverse dental decay? 

The American Dental Association’s National Children’s Dental Health Month is right around the corner in February. So, let’s talk about the key nutrients to include in your child’s diet to boost dental health and also some major things to avoid (like cavity-encouraging snacks, questionable sealant ingredients, and more!).

You’re probably wondering: How do I teach my child dental health? Teaching your child good dental hygiene begins with establishing a healthy routine as soon as their first tooth erupts. You can even start wiping their gums daily prior to tooth eruption.

As children get older, the work of brushing a child’s teeth transfers hands, literally, from caregivers to child. If the importance of pediatric dental health is established at a young age, children will see it as a non-negotiable part of their day. They’re also likely to take pride in their own ability to care for the health of their teeth and mouth.

Why is good oral health important for children?

How does a child’s oral health impact their overall health? Your child’s oral health has a significant impact on their overall health — if the teeth and gums are healthy, it’s more likely the rest of the body will be, too. 

When pediatric oral health is not optimal, it can cause problems throughout the entire body. There is a direct link between the health of our mouths and the health of our entire bodies (often called the mouth-body connection or the oral-systemic connection).

How can children’s poor dental health affect their health? The mouth is a gateway or “mirror” to the entire body. Cavities and gingivitis aren’t just oral health issues — they point to a compromised immune system, an unhealthy microbiome, and problems in the diet.

Deep, untreated cavities can eventually cause pain, infection, or more dangerous systemic complications. These complications can range from dental abscesses to perpetuating painful periodontal disease. 

Periodontal (gum) disease is associated with chronic health conditions including diabetes, Alzheimer’s, heart disease, and obesity.

Taking care of your child’s teeth and gums is not only a preventive measure when it comes to cavities and gum disease, but it can also ward off other major health concerns.

My Favorite Things for Great Oral Health in Kids

Flossing

Once a child has baby teeth that are touching, flossing should become a daily habit. The number one place I find cavities in kiddos (adults, too!) is in between the back molars.

Not only does flossing help to prevent dental caries (tooth decay), it also helps to keep our gums healthy, which leads to better systemic health. As I like to say: Floss is 100% boss!

Vitamin D3 and K2

How can you strengthen your child’s teeth? To strengthen your child’s teeth (both the baby teeth and the permanent teeth!), try to incorporate the dynamic duo of D3 and K2 into their diet on a regular basis. 

D3 and K2 (along with calcium) prevent cavities, benefiting remineralization of teeth, and can keep the oral microbiome in check.

Limit processed foods

Refined sugars and flours are not ideal for our teeth. They’re sticky and highly processed nature break down into sugars and acids quickly, increasing cavity risk. If they do that to your teeth, imagine what these sugary foods might be doing to the rest of your body?!

Many people think crackers, Goldfish, and similar foods are healthier for their kiddos than candy and sweets. 

In reality, crackers and other foods that contain processed carbohydrates are about the same for your child’s teeth as a pack of candy. In other words… they’re not good for strong teeth.

Hydration

Water is helpful to every system in our bodies, including our mouths. Not only does water help rinse off food debris and leftover sugars and help to neutralize the mouth, but it also helps to keep our saliva healthy and enzyme-rich, protecting our teeth and oral structures. 

If your child drinks some fruit juice, encourage a few sips of water afterward to clear away the sugar and acids. Also, make sure to only give plain water as a beverage after brushing and flossing before bed.

Nasal Breathing

Nasal breathing is a hot topic right now, and for good reason! Getting back to nasal breathing is critical for the well-being of the entire body. 

Mouth breathing leads to dry mouth and lowered pH (think dysbiosis or imbalances in the bacteria in the mouth) and can cause major issues. 

Often, when families are doing “everything right” and their child is still getting cavities, it is due to mouth breathing during the day and/or during sleep.

Oral Probiotics

Strains of probiotics specifically designed to support oral health are called oral probiotics or dental probiotics. 

These chewable supplements are loaded with commensal bacteria that your mouth’s mini-immune system uses to fight decay, bad breath, gingivitis, and even respiratory infections!

Children’s Oral Health Statistics

Tooth decay is the most prevalent chronic disease in children even though it is preventable, according to the National Institute of Dental and Craniofacial Research.  

Some interesting children’s oral health facts in the United States from the Centers for Disease Control and Prevention (CDC):

  • About 20% of children aged 5 to 11 years have at least one untreated decayed tooth.
  • Around 13% of adolescents aged 12 to 19 years have at least one untreated decayed tooth.
  • Children aged 5 to 19 years from low-income families are twice as likely to have cavities, compared with children from higher-income households.
  • Cavities left untreated can lead to pain and infections that cause problems with eating, speaking, playing, and learning. 
  • Children with poor oral health often miss more days of school and get lower grades compared to children with good oral health.

Tooth Decay in Kids

Why does tooth decay happen? In simple terms, tooth decay happens when your teeth are demineralized (broken down) more than they are remineralized (built and strengthened). The primary cause of demineralization is acid excretion by pathogenic bacteria in the mouth. 

When cavity-causing bacteria in your mouth find sugar molecules to eat, they gobble them up and “poop” out acid. The acid eats away at your teeth. When bacteria are allowed to gather on concentrated areas of your teeth, these acid excretions cause tooth decay.

Mouth breathing and diet (specifically, a diet high in carbs and processed foods, not just sugar) are 2 of the overlooked reasons why these bad bacteria flourish and children develop tooth decay. Those are also 2 of the big factors behind bad breath in children. 

What are the factors that may lead or contribute to tooth decay?

  • Poor dental hygiene
  • Dry mouth/mouth breathing
  • A diet high in sugar, acid, and highly processed foods 
  • A diet low in vitamins and minerals
  • Poor hydration
  • An unbalanced oral microbiome
  • Certain medications 
  • Genetic or developmental predisposition

What does a cavity look like? While cavities are not always visible with the naked eye, signs of a cavity include tooth discoloration, black spots, or holes. Toothache or tooth sensitivity can also be a sign of a cavity. Regular dental visits are a very important way to catch cavities early and possibly even reverse them. 

A Tooth-Friendly Diet

To promote children’s oral health and prevent dental decay, limit processed foods as much as you can. 

I know this can be tough, but many packaged foods marketed to kids are truly terrible for their teeth. They are highly processed with many artificial flavors, coloring, refined flours, and sugar. And unfortunately, even many organic packaged foods are not ideal. Aim to eat unpackaged, whole foods as much as you can.

To encourage children’s oral health, there are also some specific nutrients you’ll want to make sure they get enough of, including vitamin D3, vitamin K2, calcium, and probiotics.  

Vitamin D is one of the nutrients responsible for delivering calcium to your teeth (along with vitamins A and K2). Many people are deficient in vitamin D, even in developed nations! Foods high in vitamin D3 are excellent for supporting tooth remineralization and protecting against cavities.

Some of my favorite vitamin D3 foods are:

  • Cod liver oil
  • Egg yolks
  • Sardines

The next lesser-known nutrient key to pediatric dental health is vitamin K2, which is vital to building tooth structure. Vitamin K2 is not the same as K1 (or just “K”), is found in very different foods, and has a dramatically different function in the body.

If you’re K2-deficient, your teeth and bones will become weaker over time. Plus, your risk of most chronic diseases goes up (not just cavities).

Foods highest in vitamin K2 include:

  • Natto
  • Cheese
  • Grass-fed butter
  • Egg yolks

Calcium is a nutrient your teeth need from the inside out. Plus, more calcium intake reduces your risk of gum disease.

Try incorporating these calcium foods into your child’s diet:

  • Chia seeds
  • Beans/lentils
  • Collard greens
  • Edamame

Next up is probiotics, which support both your oral and gut microbiome. Healthy bacteria are necessary for crowding out the bad stuff that leads to cavities and gum disease. They even keep your breath fresh! 

Start with probiotic foods like:

  • Fermented pickles
  • Kefir
  • Sauerkraut

I also recommend supplementing with an oral probiotic like Hyperbiotics Pro-Kids ENT. These mouth-friendly bacteria are great for supporting oral health.

Things like crackers, pretzels, cheese puffs, granola bars, dried cereals, and fruit snacks should be limited as best as you can. They stick in teeth and break down into sugars and acids very quickly, causing lots of dental problems.

What are some pro-dental health foods for kids? Try veggie sticks and hummus or guacamole, seeds and nuts, olives and pickles, cheese, seaweed snacks, fresh berries and fruit, or hard-boiled eggs.  

I try to meal prep on the weekends, including cutting veggies and fruits for ready-to-go snacks for the week ahead. It’s a pay-it-forward trick that I have found helps my family tremendously!

Dental Sealants

Dental sealants are thin, plastic coatings that seal over the narrow grooves found on the chewing surfaces of the back teeth.  When placed perfectly on these deep pits, sealants can prevent a significant amount of tooth decay (cavities) by protecting sensitive tooth enamel from the acid that causes cavities.

Children who benefit most from dental sealants include those:

  • With very deep grooves in their molars
  • At high risk for cavities
  • Who eat a diet high in processed foods, refined flours and sugars, and sugary drinks
  • With special needs that make dental hygiene and/or a healthy diet more challenging

Ideally, sealants should be placed immediately after the eruption of the first molars (around age 6) and second molars (around age 12). Sooner is better to ensure the grooves have not been affected by bacteria or early cavities.

Many parents are concerned about the possible negative effects of dental sealant material on their children’s overall health. Most dental sealants do contain BPA and/or bis-GMA. Both of these established endocrine disruptors should generally be avoided in developing children.

To avoid toxic sealant materials (even in very small amounts), ask your dentist what materials they are using for their sealants. Ceramic-based materials, rather than those with BPA, Bis-DMA, or bis-GMA materials, are associated with the smallest level of risk to overall health.

Should my child get fluoride treatments?

When it comes to the importance of pediatric dental care, fluoride is a controversial topic. 

Should you give your child fluoride treatments? My short answer: No. 

My long answer: Preferably not. However, if your child has special needs or can’t really eat a healthy diet and correct mouth breathing, then fluoride treatments may be a stopgap measure worth the risk.

Rather than fluoride toothpaste, I recommend hydroxyapatite toothpaste. Research demonstrates that hydroxyapatite toothpaste helps to remineralize teeth and also prevent demineralization. Additionally, it’s been shown to work just as well to prevent cavities as fluoride toothpaste.

When should my child see a pediatric dentist?

Around the time of your child’s first eruption of baby teeth is a good time to begin regular dental checkups with a pediatric dentist. Some dentists suggest waiting until their first birthday or even 2 years of age.

If you find that teaching dental hygiene to preschoolers is challenging, your pediatric dentistry of choice is likely to have some great tips. Thankfully, there are a lot of playful, yet non-toxic toothbrushes on the market today. Making dental care fun is one of the easy ways to make your child look forward to maintaining a healthy smile and mouth. It also makes your life easier, too! 

Sources

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  6. Rubin, B. S. (2011). Bisphenol A: an endocrine disruptor with widespread exposure and multiple effects. The Journal of steroid biochemistry and molecular biology, 127(1-2), 27-34. Abstract: https://pubmed.ncbi.nlm.nih.gov/21605673/ 
  7. Pulgar, R., Olea-Serrano, M. F., Novillo-Fertrell, A., Rivas, A., Pazos, P., Pedraza, V., … & Olea, N. (2000). Determination of bisphenol A and related aromatic compounds released from bis-GMA-based composites and sealants by high performance liquid chromatography. Environmental health perspectives, 108(1), 21-27. Full text: https://ehp.niehs.nih.gov/doi/pdf/10.1289/ehp.0010821 
  8. Amaechi, B.T., AbdulAzees, P.A., Alshareif, D.O, Shehata, M.A., et al. (2019). Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children. BDJ Open, 5 (18). Full text: https://www.nature.com/articles/s41405-019-0026-8

Hyperdontia: Causes, Symptoms, Diagnosis, Treatment, & more

How many teeth is too many? In typical cases, adults grow 32 permanent teeth, and children have only 20 primary teeth.

What does it mean if you or your child develop more than usual? Are you becoming one of the X-Men? 

Nope! You are simply one of the many Americans with hyperdontia, and there are many explanations and solutions available to your family.

What is hyperdontia?

Hyperdontia is a condition that causes extra teeth to grow in both children and adults. These are also referred to as supernumerary teeth.

These extra teeth grow within your dental arches and are most likely to develop near the incisors or in the molar area.

Is hyperdontia bad? No, hyperdontia is not “bad,” and there are many options available in cases of extra teeth — in fact, not every patient needs treatment. 

Nevertheless, it’s vital to get your, or your child’s, mouth checked if you notice an abnormally high number of teeth to avoid potential issues.

Risk Factors for Hyperdontia

Not everyone has the same odds of developing additional teeth. Here are some of the risk factors for hyperdontia.

Hyperdontia in Children 

Hyperdontia is much less common in pediatric dentistry, with only 0.3% to 0.8% of kids experiencing the condition in their “baby teeth,” also known as deciduous teeth.

Despite its rarity, it’s still quite important to chat with your pediatric dentist about the condition, as supernumerary teeth can cause overcrowding and other issues in some cases. While you’re waiting for your appointment, try these tips.

Hyperdontia in Adults

Studies show that adults are more likely to develop additional teeth than children. 

Is hyperdontia rare? Hyperdontia is relatively rare, with the prevalence of adult hyperdontia ranging anywhere from 0.1% up to 3.8% in permanent dentition.

Adult men are also significantly more likely to develop this condition than women, at a 2:1 ratio in some studies.

Causes of Hyperdontia

What causes hyperdontia? There are many potential causes of hyperdontia, mainly hereditary genetic disorders. These may include: 

  • Cleidocranial dysplasia: This causes abnormalities in skull and collarbone development. 
  • Cleft lip or cleft palate: These conditions create openings in the roof of the mouth or upper lip, which can cause ear infections and/or trouble breathing, eating, or speaking.
  • Fabry disease: Fabry creates the inability to sweat, skin rashes that appear red or blue, and hand, foot, and abdominal pain. 
  • Ehlers-Danlos syndrome: This disease affects joints and makes dislocation easier, causes pain around joints and muscles, scoliosis, and easy bruising.
  • Gardner’s syndrome: Gardner’s leads to growths on the colon and skull and cysts in the skin.
  • Down syndrome: Down syndrome is associated with intellectual disabilities, delayed development, and distinctive facial features.

These genetic conditions are some of the most likely causes of hyperdontia.

What happens inside the mouth when an extra tooth is growing? For answers, look inside the dental arch containing the lamina and buds where new teeth form. 

The dental lamina grows within the jaws, giving rise to the enamel as teeth form in the tooth bud. This process begins before birth, which is why we recommend bringing your baby in for their first checkup at one year old.

Early treatment allows us to spot symptoms of hyperdontia and other potential issues early, helping us plan the best treatment options for your child and guiding their dental development. Plus, we can give tips on how to get their oral microbiome thriving early for lifelong health.

Hyperdontia Symptoms

Symptoms of hyperdontia are usually relatively easy to notice and may include: 

  • Visible extra teeth, most commonly found close to the incisors
  • Pain and swelling around the tooth, in the gums, or the surrounding jaw
  • Malocclusion, as extra teeth can push their way in and take up space, crowding other teeth in the mouth (this can also happen in cases of impaction, where the tooth doesn’t fully break the gumline)

Shapes of Teeth

Not all supernumerary teeth are the same, and many shapes and types may occur. Here are how the shapes of teeth associated with hyperdontia are classified:

  • Supplemental: Supplemental teeth have the same shape and anatomy as the teeth near which they grow. Other tooth shapes that do not match the adjacent teeth are classified as rudimentary teeth.
  • Conical or peg-shaped teeth: These are characterized by a broader base and grow narrower at the top of the tooth. They may look or feel sharp.
  • Tuberculate: This shape of tooth is shaped like a tube or barrel.
  • Compound odontoma: This tooth shape is characterized by several smaller, tooth-like growths clustered near one another.
  • Complex odontoma: This shape of hyperdontia is a bit different, as it is comprised of an area of tooth-like tissue that grows in a disordered fashion.

These shapes vary, as do the locations in the mouth that hyperdontia is likely to happen.

Placement of Teeth

The placement of teeth in hyperdontia can vary. Hyperdontia is more common in certain parts of the mouth.

  • Mesioden. The mesioden is the most common type of supernumerary tooth, and it grows around one of the 4 front teeth. The mesioden is sometimes referred to as a central incisor, growing on the roof of the mouth centered between and just behind maxillary anterior incisors.
  • Distomolar. This extra tooth grows in line with the molars in the back of the mouth.
  • Paramolar. This additional tooth grows next to a molar rather than inline.

Up to 98% of supernumerary teeth grow in the roof of the mouth, and less than 24% of cases involve more than one extra tooth.

However, only a dentist can let you know exactly what you’re dealing with in cases of hyperdontia. How do they get to the bottom of diagnosing and treating these cases?

How is hyperdontia diagnosed?

Hyperdontia is usually straightforward to diagnose, especially if the tooth has already grown in. If the tooth has not erupted yet, an x-ray will reveal their presence, or your dentist may ask for a CT scan to get a better picture of what’s going on in your mouth and jaw.

Treatment for Hyperdontia 

The recommended treatment options for hyperdontia vary by each case. In many cases of hyperdontia, treatment may not be necessary. Many additional teeth cause no pain or other symptoms and are perfectly fine to leave as they are.

In some cases of hyperdontia, surgery to extract the tooth may be necessary, for example, when it causes:

  • Overcrowded, crooked teeth
  • Damage to teeth that haven’t erupted yet
  • Delayed eruption of permanent teeth in children
  • Difficulty or damage when chewing
  • Difficulty when trying to brush or floss, which may result in gum disease or cavities forming
  • Self-consciousness about your personal appearance

In some cases, orthodontic treatment may be appropriate to shift the adjacent teeth back into place.

Moving Forward

Does hyperdontia go away? No, hyperdontia does not go away on its own. You will need a dentist’s professional opinion to determine the best course of action for you.

When addressed properly, hyperdontia can be corrected or even left in place, but the peace of mind that comes with a dental visit is the best prescription to help you move forward.

Sources

  1. Rathee, M., & Jain, P. (2020). Embryology, Teeth. StatPearls [Internet]. Full text: https://www.ncbi.nlm.nih.gov/books/NBK560515/ 
  2. Nayak, G., Shetty, S., Singh, I., & Pitalia, D. (2012). Paramolar–A supernumerary molar: A case report and an overview. Dental Research Journal, 9(6), 797. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612233/ 
  3. Parolia, A., Kundabala, M., Dahal, M., Mohan, M., & Thomas, M. S. (2011). Management of supernumerary teeth. Journal of conservative dentistry: JCD, 14(3), 221. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198547/ 
  4. Ata-Ali, F., Ata-Ali, J., Peñarrocha-Oltra, D., & Peñarrocha-Diago, M. (2014). Prevalence, etiology, diagnosis, treatment and complications of supernumerary teeth. Journal of clinical and experimental dentistry, 6(4), e414. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282911/ 
  5. Diaz, A., Orozco, J., & Fonseca, M. (2009). Multiple hyperodontia: report of a case with 17 supernumerary teeth with non syndromic association. Med Oral Patol Oral Cir Bucal, 14(5), E229-31. Abstract: https://pubmed.ncbi.nlm.nih.gov/19218904/ 
  6. Subasioglu, A., Savas, S., Kucukyilmaz, E., Kesim, S., Yagci, A., & Dundar, M. (2015). Genetic background of supernumerary teeth. European journal of dentistry, 9(1), 153. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319293/ 
  7. Sekerci, A. E., Cantekin, K., Aydinbelge, M., & Ucar, F. İ. (2014). Prevalence of dental anomalies in the permanent dentition of children with Down syndrome. Journal of Dentistry for Children, 81(2), 78-83. Abstract: https://pubmed.ncbi.nlm.nih.gov/25198950/ 
  8. Kumar, A., Namdev, R., Bakshi, L., & Dutta, S. (2012). Supernumerary teeth: Report of four unusual cases. Contemporary clinical dentistry, 3(Suppl1), S71. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354792/ 
  9. Khambete, N., & Kumar, R. (2012). Genetics and presence of non-syndromic supernumerary teeth: A mystery case report and review of literature. Contemporary clinical dentistry, 3(4), 499. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636847/ 
  10. Meighani, G., & Pakdaman, A. (2010). Diagnosis and management of supernumerary (mesiodens): a review of the literature. Journal of dentistry (Tehran, Iran), 7(1), 41. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184724/ 
  11. Singhvi, V., Nambiar, S., & Shetty, S. (2013). Orthodontic management of non-syndromic multiple supernumerary teeth. Contemporary clinical dentistry, 4(4), 540. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883341/

Oral Thrush in Your Baby: Signs, Treatment, & Prevention

Has your baby been extra fussy lately and weird when you’re nursing? Peek inside your baby’s mouth and see if there are any white spots… 

If you see these telltale white spots, you may have a case of oral thrush on your hands. 

Don’t panic! Thrush is a very common health problem in babies, and there are many natural ways to treat and prevent this fungal overgrowth. 

What is oral thrush?

Thrush is the overgrowth of a fungus called Candida albicans in the mouth.

Oral thrush, also known as candidiasis, is a common yeast infection that can affect the mouth, especially in babies and elderly people. 

Is thrush contagious?

Thrush can spread from a baby’s mouth to a mother’s breast through nursing.  It can also spread from a mother’s nipple to a baby’s mouth in the reverse fashion. Thrush can go back and forth between mother and child until the issue is addressed naturally or with medical treatment. 

Signs of Thrush in Babies

The most common signs of oral thrush in babies are:

  • Excessive fussiness
  • Problems with breastfeeding
  • White and/or yellow lesions on the tongue and inside of the mouth
  • Signs of pain centralized to the mouth

How do you know if your baby has thrush? Your baby may have thrush if they suddenly have trouble nursing and are more fussy than usual. 

Is thrush painful for babies? Unfortunately, thrush lesions can be uncomfortable or even painful, which leads to difficulty eating and fussiness. 

Causes of Thrush in Babies

Oral thrush is caused by an overgrowth of the Candida albicans fungus within the mouth. Often, little ones develop thrush when the baby’s tongue is exposed to a yeast infection in the vaginal canal.

An overgrowth of Candida in the body can result in oral thrush, diaper rash, and vaginal yeast infections. Oral thrush in babies can often be accompanied by a diaper rash.

It’s natural for both babies and adults to have Candida yeast present in their digestive tracts and mouths. When it’s a normal level of Candida, there are typically no unwanted symptoms or health concerns. However, when the body’s microbiome becomes out of balance, an overgrowth of Candida albicans fungus can occur and lead to oral thrush in babies or adults. 

In adults, thrush can occur due to a weakened immune system. In babies, thrush can happen because they do not yet have fully developed immune systems. 

Oral thrush is also often seen in babies (and adults) after a round of antibiotics since antibiotics kill both the good and bad bacteria, which results in a suboptimal microbiome.

Thrush Symptoms

Symptoms of thrush can include:

  • Creamy white lesions on the tongue, inner cheeks, and sometimes on the roof of the mouth, gums, and/or tonsils
  • Slightly raised lesions with a cottage cheese-like appearance
  • Redness, burning, or soreness that may be severe enough to cause difficulty eating or swallowing
  • Slight bleeding if the lesions are rubbed or scraped
  • Cracking and redness at the mouth corners 
  • Thrush in babies diaper area (diaper rash)

Moms experiencing a Candida infection of the breast may experience:

  • Unusually sensitive, red, cracked, or itchy nipples
  • Shiny or flaky skin on the areola
  • Unusual pain while nursing 
  • Nipple pain between feedings
  • Shooting pains deep within the breast

Treatments for Thrush 

How do you get rid of thrush in babies? To get rid of oral thrush in babies, you may have to wait out the infection; but some thrush infections require medical intervention. A conventional healthcare provider may recommend a prescription or over-the-counter medication.

Medical Treatment

Medical treatment for oral thrush in babies often includes an antifungal solution (such as nystatin or fluconazole) to apply to your baby’s mouth multiple times a day for 10 days. Your doctor may also recommend an antifungal ointment for mom to apply to her nipples.

If your baby also has a diaper rash that is the result of a yeast infection, your provider will likely recommend prescription antifungal medication for the diaper rash as well. 

Over-the-Counter Medications 

There are a few options for over-the-counter baby thrush treatment, but make sure to check with your pediatrician before using any of these options.

Conventional antifungal medicines (both prescription and OTC) can come with some unwanted side effects such as diarrhea, irritation, and more, which is why you may want to consider home remedies for oral thrush in babies as your first line of attack.

Home Remedies for Thrush 

How can I treat my baby’s thrush at home? Home remedies for oral thrush in babies may include items you may already have around your house, like baking soda, coconut oil, and salt water. 

These are some gentle yet effective remedies that are especially likely to work if your baby has a mild case of oral thrush. 

Baking Soda

To use baking soda (sodium bicarbonate) for your baby’s thrush: 

  1. Dissolve a half teaspoon of baking soda in a cup of warm water. 
  2. Using a cotton ball, apply this diluted baking soda to the inside of your baby’s mouth. 

The mix can also be used on the nipples by mom between feeding sessions.  

Coconut Oil

Coconut oil isn’t just a tasty ingredient and a fantastic natural moisturizer; it also contains an anti-inflammatory and anti-fungal agent called caprylic acid. Research demonstrates that caprylic acid can successfully kill off the Candida albicans yeast that causes oral thrush. 

Use a cotton swab to dab coconut oil on the white patches in your baby’s mouth. You can also apply it to your nipples if you’re a nursing mom. 

A warning for using coconut oil for oral thrush in babies: It is possible to be allergic to coconut oil. Discontinue use if you notice any type of allergic reaction in your baby. 

Salt Water

Before you turn to prescription antifungal medication for your baby’s lesions, you may want to try good old salt water instead. 

To use salt water as a home remedy for oral thrush:

  1. Dissolve a half teaspoon of good quality sea salt in warm water.
  2. Apply it to the lesions using a small, clean sponge or cotton swab. 

The salty water is a soothing natural antiseptic that, applied regularly, might make those lesions disappear. 

Yogurt and Probiotics

If your baby is eating regular food, unsweetened milk yogurt or kefir is a great choice right about now. The high probiotic content of these foods can help to balance out your baby’s microbiome. 

Just make sure to avoid a sugary yogurt or kefir — the Candida yeast feeds on sugar. 

If yogurt isn’t an option, look for an infant-appropriate probiotic supplement. 

Gentian Violet

Gentian violet is a popular home remedy for thrush in babies. Although this natural treatment may be useful, it easily stains and carries risks (especially if it’s overused), including irritating the sensitive oral mucous membranes of a baby’s mouth. 

Talk with your provider before trying this remedy and consider it as your last natural option. 

Can you breastfeed if your baby has thrush?

You can continue to breastfeed if you and/or your baby has thrush. Some babies will nurse just fine, while others may struggle a bit. 

Can you prevent thrush?

Since thrush is caused by fungal overgrowth, it’s crucial to maintain a nourishing, whole foods-based diet and other habits that encourage a healthy microbiome. A fungal infection like thrush may still occur, but these are definitely ways to prevent one in the first place. 

Good Oral Hygiene

Your baby may not have teeth yet, but daily wiping their gums and tongue with a wet washcloth is the start of a good dental health regimen. 

Once baby teeth erupt, brush them twice a day to reduce not only plaque that can cause cavities but also to prevent an overgrowth of yeast that can cause oral thrush. 

Smart Breastfeeding Habits

Whenever possible, let your nipples dry thoroughly in between feedings to avoid bacterial overgrowth. Changing nursing pads after each feeding can help, too.

Cotton bras can also support ventilation.  Wash bras often in hot water, especially if you or your baby has an active thrush infection. 

Emphasis on a Healthy Diet

Your diet and your baby’s diet (if he or she is old enough) can go a long way to discourage or encourage a thrush infection. 

Candida loves to feed on sugary and starchy foods, so if you’re going to reduce or cut out anything from your diet, this is definitely the place to start. Avoid high sugar beverages,  processed foods, and starchy items like cakes, cookies, muffins, etc.

Instead, focus on high-fiber veggies that feed healthy (commensal) bacteria in the mouth and gut. Aim for your little one to consume nutrient-dense whole foods whenever possible.

Support Your Microbiome

To support your baby’s microbiome, I recommend that you take probiotics as a nursing mom. This allows you to pass that good bacteria on to your baby and strengthen both mom and baby’s immune systems. 

Breastfeeding, in general, is also a great way to bolster your baby’s immune system. Human milk is known to encourage a healthier microbiome and a healthier immune system in babies. 

Supplementing with probiotics is especially important after mom or baby has taken antibiotics. Research demonstrates that Lactobacillus strains of probiotics are most helpful in fighting Candida infections.

If you’re bottle-feeding, you can also look for options via formula or supplements to provide them with more probiotics in their diet daily. 

Other Tips to Prevent Thrush

Here are some other great ways to prevent thrush (in both baby and mom):

  • Wash your baby’s hands, pacifiers, and toys regularly to prevent bacterial growth that can get into your baby’s mouth and disrupt their microbiome (making yeast overgrowth more likely).
  • If you use a breast pump, sterilize it regularly.
  • Always refrigerate breast milk until right before you give it to your baby to discourage yeast growth. 
  • When you or your baby have thrush, it’s extra essential to wash bras, clothing, burp cloths, etc., in hot water. 

Key Takeaways

Whatever you do, try not to freak out if you realize your baby has oral thrush. It’s a widespread occurrence, and it responds well to treatment. It even goes away on its own sometimes! Thrush can also be prevented in both mom and baby, and now you know those prevention tips.

When to Call a Doctor

Oral thrush is typically not a problem for healthy children and adults. However, it can spread from the mouth to the tonsils or back of the throat. 

Once you notice that your baby has signs of oral thrush, it’s a good idea to give your pediatrician and/or pediatric dental provider a call to get professional medical advice and discuss the best course of action. 

Cases of oral thrush can clear up without medical treatment after a week or two, but you or your doctor may not want to wait that long. I highly recommend trying home remedies, especially if you get the green light from your doctor.

Going forward, don’t forget that cutting out sugars and adding probiotics to your diet can go a long way to prevent thrush in both you and your nursing baby. 

Sources

  1. Bae, Y.S. & Rhee, M.S. (2019). Short-Term Antifungal Treatments of Caprylic Acid with Carvacrol or Thymol Induce Synergistic 6-Log Reduction of Pathogenic Candida albicans by Cell Membrane Disruption and Efflux Pump Inhibition. Cell Physiol Biochem, 53(2), 285-300. Abstract: https://pubmed.ncbi.nlm.nih.gov/31334617/
  2. Mundula, T., Ricci, F., Barbetta, B., Baccini, M. & Amedei, A. (2019). Effect of Probiotics on Oral Candidiasis: A Systematic Review and Meta-Analysis. Nutrients, 11(10), 2449. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836010/