Cavities and cavity progression

[yappy]

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Hey guys,

I was wondering if some DDS/dental students could point me in the direction of some good dental journals or provide me with some information reguarding dental caries.

Recently I have read online about how one may "heal" a cavity through diet. Note, i'm not saying prevent but rather, be diagnosed with a real cavity and then heal it so that it no longer exists. Is this possible?

I have found that the "paleo diet" is tauting this and I have had patients ask me about at a free clinic that I work at (I dont comment b/c I'm only a predent). To me it sounds not right but wanted to post it here. Anyone have any dealings with this croud before?

Here is a link:

http://paleodietlifestyle.com/preventing-and-healing-tooth-decay/

ALOT of people I know and have interacted with seem to buy this...

 

[Doc Smile]

Hey guys,

I was wondering if some DDS/dental students could point me in the direction of some good dental journals or provide me with some information reguarding dental caries.

Recently I have read online about how one may "heal" a cavity through diet. Note, i'm not saying prevent but rather, be diagnosed with a real cavity and then heal it so that it no longer exists. Is this possible?

I have found that the "paleo diet" is tauting this and I have had patients ask me about at a free clinic that I work at (I dont comment b/c I'm only a predent). To me it sounds not right but wanted to post it here. Anyone have any dealings with this croud before?

Here is a link:

http://paleodietlifestyle.com/preventing-and-healing-tooth-decay/

ALOT of people I know and have interacted with seem to buy this...

A cavity, "caries," is a disease process from an infection of bacteria. You cannot 'cure' caries unless you remove the underlying cause - not something you can eat your way out of.

I think what paleo peeps are talking about is that their diet has, for all intensive purposes, ZERO refined/processed sugar - which wouldn't allow the disease process to become over-reactive and allow caries to begin formation.

Once you have a cavity - you need it to be 'drilled and filled' to remove the bacteria, decayed tooth structure, and restore the hole to prevent bacteria from recolonizing that structurally unsound area.

 

[Streetwolf]

A cavity, "caries," is a disease process from an infection of bacteria. You cannot 'cure' caries unless you remove the underlying cause - not something you can eat your way out of.

I think what paleo peeps are talking about is that their diet has, for all intensive purposes, ZERO refined/processed sugar - which wouldn't allow the disease process to become over-reactive and allow caries to begin formation.

Once you have a cavity - you need it to be 'drilled and filled' to remove the bacteria, decayed tooth structure, and restore the hole to prevent bacteria from recolonizing that structurally unsound area.

Almost.

If you have a cavity that hasn't reached the DEJ and the outer shell of enamel is still intact (there's no hole or communication between the mouth and the inside of the cavity) then it's possible with proper diet, OH, and *fluoride* use to stimulate remineralization and get rid of the cavity.

But this whole miracle diet thing is a bunch of BS. Tell people to stop eating like crap and pick up a toothbrush more than zero times a day.

 

[yappy]

What is the long term result if the cavity has passed through the DEJ and it is not treated?

Almost.

If you have a cavity that hasn't reached the DEJ and the outer shell of enamel is still intact (there's no hole or communication between the mouth and the inside of the cavity) then it's possible with proper diet, OH, and *fluoride* use to stimulate remineralization and get rid of the cavity.

But this whole miracle diet thing is a bunch of BS. Tell people to stop eating like crap and pick up a toothbrush more than zero times a day.

 

[PreDent08]

What is the long term result if the cavity has passed through the DEJ and it is not treated?

the cavity or decay will spread more rapidly since dentin is softer than enamel. it'll then hit the pulp, and if it is still not treated with endo, periapical abscess will probably develop and infection could spread throughout the body.

 

[Lattelove]

what about cod liver oil ?

 

[yappy]

LOL my point exactly. I dont get it either. Thanks for your reply. I look forward to studying this in more detail once I get to dental school!


EDIT: Okay, I see what you're getting at. I have read about fish oil as a cure too.

http://www.thehealthyhomeeconomist.com/2011/05/how-i-healed-my-childs-cavity/

Does anyone have any idea as to why someone would think fish oil would cure a cavity?

what about cod liver oil ?

 

[Streetwolf]

Either they were wrong about the tooth having a cavity in the first place (are they dentists? no!) or they were wrong about the tooth not having a cavity a month later. Such a large cavity as the one they described not only takes months to form, if it were even ABLE to heal it would probably take more than a month to do that. Additionally it wouldn't magically look like normal tooth again. Remineralized enamel is not as organized as enamel that hasn't had a carious insult to it and as such would have more of a brown appearance.

I call BS on this story. If a dentist saw this child for a before/after visit WITHOUT filling the teeth I'd be slightly less skeptical, though I'd still doubt the fish oil played a role.

 

[DrJeff]

Dental Caries is really quite simple, as this is how we should be explaining it to our patients. The more frequent you consume solid OR liquid carbohydrates over and extended period of time, the more likely you are to need to spend time in the chair having work done.

If someone the start of decay, and then "sees the light" and changes their ways in the form of DECREASING their carbohydrate exposure and maintaining impecable oral hygiene with targeted topical flouride application, then yes it is possible to 1st arrest and then reverse the spread of active, fully enamel contained, decay.

This is an area, where especially when one encounters a new patient where some subjectivity is needed. You can very well be seeing a new patient, who radiographically might have multiple enamel only incipient lesions that are INACTIVE and may have been there exactly like that for years. In a situation like that, one could easily argue that if you treat those lesion (typically interproximal ones) that by removing the lesion and hence removing a portion of the exterior wall of that tooth, that longterm you might very well be doing more harm than good. That is if that patient appears to have excellent oral hygiene! In a case like that, I'm likely to NOT treat those small lesions immediately and re-asses radiographically those same areas 6 to 12 months later. If they're unchanged, i'm watching them, If they've gotten larger (i.e. the decay is active) then i'm treating them while they're still small. If that new patient has a number of through the DEJ lesions and some enamel only lesions and not as good a level of oral hygiene, then i'm much more likely to treat ALL of the radiographic lesions immediately since the reality is that they are active.

While we have some great, scientifically proven methods to stop and in some cases "cure" caries without having to remove tooth structure, the reality is that the food and beverage industry is far too good at providing many of our patients with too many carbohydrate containing foods and drinks than they can resist and as such, operative dentistry will be around for a long time to come! 😀

 

[ogopogodude]

decay and cavity are NOT synonymous.

Decay LEADS TO a cavity or cavitation (or hole).

Think of a 2 X 4 chunk of wood.

the wood rots, ... then the decayed chunks of wood flake away causing a defect in the two by four wood, ... ie "a hole:... or cavity...

It is SO SIMPLE, ....

I have one bjillion analogies like this one that i use every day with patients.

I take the mystery out of dentistry.

 

[yappy]

While your explanation is nice (for patients)... as a pre-dental student, biochem student, and undergrad researcher I prefer the scientific explanation which is not always so simple.

Thanks for your contrabution.

decay and cavity are NOT synonymous.

Decay LEADS TO a cavity or cavitation (or hole).

Think of a 2 X 4 chunk of wood.

the wood rots, ... then the decayed chunks of wood flake away causing a defect in the two by four wood, ... ie "a hole:... or cavity...

It is SO SIMPLE, ....

I have one bjillion analogies like this one that i use every day with patients.

I take the mystery out of dentistry.

 

[DrJeff]

While your explanation is nice (for patients)... as a pre-dental student, biochem student, and undergrad researcher I prefer the scientific explanation which is not always so simple.

Thanks for your contrabution.

My theory is that you know that you really know something when you can both explain it in a technical way that your professors will be happy and also in a way that a person with say an 8th grade education will understand it. Obviously the words used will be different, but having the ability to explain basically any aspect of dentistry in both of those ways will pay off for you as a practitioner in the future

 

[peg lateral]

decay and cavity are NOT synonymous.

Decay LEADS TO a cavity or cavitation (or hole).

Think of a 2 X 4 chunk of wood.

the wood rots, ... then the decayed chunks of wood flake away causing a defect in the two by four wood, ... ie "a hole:... or cavity...

It is SO SIMPLE, ....

I have one bjillion analogies like this one that i use every day with patients.

I take the mystery out of dentistry.

I like the wood analogy... not sure why I never thought of that. What other analogies do you use, if you don't mind sharing?

 

[ogopogodude]

Wow, ... I like that another dentist appreciates analogies. I DO USE MANY analogies each and every day.

I talk about rust in a car at the body seams etc, and that can be compared to decay in a tooth..... and how some rust starts and then stops (arrested decay, ...as in minor occlusal decay that can be watched and monitored instead of filling) and some rust just gets out of hand very quickly (rampant decay as in class II interproximal decay)...

I will start a new thread shortly on dental analogies to use on patients for education purposes.

Here is another: When a patient wonders why his/her crown came off/filling came loose (or any other dental work that may have failed) and that patient is ALREADY missing several teeth thru-out the dentition, ... I say to that patient:

"Imagine your mouth as an 18 wheeler Semi-Truck/Trailer, ... and my mouth has all eighteen wheels. YOUR mouth, on the other hand, has five flat tires and you are still driving on the road.... this would actually be illegal in real life to drive on several flat tires. Now, ... with missing tires , this puts overdue stress on all the other tires, such that other tires will end up blowing up or going flat. So there is no-one to blame for that filling falling out/crown coming off EXCEPT YOU, the patient, not taking control of YOUR OWN PROBLEM.... take ownership of that problem, ... as I sure as heck won't"....

I actually talk to patients EXACTLY like that..... REALLY I DO, ...

 

[ogopogodude]

I have come to realize that most --not all-- patients are stupid, ... they really are.

For example, .. I have two brothers that are physicians and they are very smart except when it comes to teeth... but they are smarter than the average doctor because I teach them the basics that every doctor should know... but don't because dental knowledge is seemingly only a one-hour lecture given in med school.

 

[ogopogodude]

While your explanation is nice (for patients)... as a pre-dental student, biochem student, and undergrad researcher I prefer the scientific explanation which is not always so simple.

Thanks for your contrabution.

I could go into the whole etiology of the bacteria called Strep. Mutans and how they thrive on undisturbed source of carbohydrate-substrates (longterm-left-alone-plaque-from-non-flossing/brushing) along with an ideal micro-environment that is acidic (low on the pH scale) that ALL bacteria thrive on (not just Streptococcal Mutans) and the story can go on to tell how the enamel rods/prisms first becomes decalcified by these bacterial strains and the enamel breaks down (EXACTLY like putting repeatedly drops of vinegar on a certain area on an eggshell ---as a grade four scientific experiment), ... and leaving it there and in a few days that area that has the vinegar and then finally being able to poke thru this area with a feather..... (seriously)...

The vinegar is acidic, ... it causes the eggshell to break down in that area that the vinegar is placed. I did this experiment in grade school, ... and it was so memorable for me that i had my son do the exact same thing for his grade five science project. Everybody was so amazed that this happens, ... when it is so obvious what is going to happen.... It is all simple chemistry.

 

[ogopogodude]

Think of a paint job on a car:

Then along comes a bird above and craps a huge load on the centre of the hood.

The owner of that car NEVER washes this acidic crap off the hood, ... but just leaves it there undisturbed for a very long time... and i do mean a very long time.

When that bird-crap is finally washed off, ... the paint right underneath the bird-crap is CERTAINLY not like the surrounding paint, ... is it? (it is typically a little faded, ... or even so bad that the paint actually can come right off to the metal)

 

[ogopogodude]

Almost.

If you have a cavity that hasn't reached the DEJ and the outer shell of enamel is still intact (there's no hole or communication between the mouth and the inside of the cavity) then it's possible with proper diet, OH, and *fluoride* use to stimulate remineralization and get rid of the cavity.

But this whole miracle diet thing is a bunch of BS. Tell people to stop eating like crap and pick up a toothbrush more than zero times a day.

Ditto, ...
(... this Streetwolf guy speaks truths...)

 

[Lidopaine82]

"Imagine your mouth as an 18 wheeler Semi-Truck/Trailer, ... and my mouth has all eighteen wheels. YOUR mouth, on the other hand, has five flat tires and you are still driving on the road.... this would actually be illegal in real life to drive on several flat tires. Now, ... with missing tires , this puts overdue stress on all the other tires, such that other tires will end up blowing up or going flat. So there is no-one to blame for that filling falling out/crown coming off EXCEPT YOU, the patient, not taking control of YOUR OWN PROBLEM.... take ownership of that problem, ... as I sure as heck won't"....

I actually talk to patients EXACTLY like that..... REALLY I DO, ...

You probably loose a lot of patients. While your message is good, you come off as an ass.

 

[yappy]

One time I heard a ER physician tell a guy: "Listen, you're FAT, you're LAZY, and you're going to DIE. CHANGE D*MNIT" .

The patient was like this ... dead silence.

LOL

looks like some dentists share the same bedside manner.

You probably loose a lot of patients. While your message is good, you come off as an ass.