During most of my lifetime the dental profession witnessed a steady decrease in the cavity rate. Now we are seeing an alarming increase in the cavity rate. This is most distressing!! It appears it is the result of a cultural shift in a lot of habits. Young people, especially our teenagers and toddlers, seem to be getting the worst end of it. However, poor oral health will haunt us for a lifetime, contributing to multiple chronic diseases including heart disease and diabetes. Has the reduction in cavities brought on by fluoride over 60 years lulled us into a false sense of dental security? We have a generation of parents now with relatively few dental problems. Are our habits shifting in a dentally dangerous direction?
The ones hardest hit are the toddlers being introduced to new foods (50% have cavities by pre-school age, yikes!) and the teenagers who never had a cavity in their life and suddenly in the period of one check up are showing multiple beginning cavities. As you can imagine, the shock leads to disbelief and is very hard for them to understand. And unfortunately it is on teenager's permanent teeth so the problem will exist for their lifetime. I would like to share some of the startling observations and discussions I have had in recent years that I think are germane to this problem.
Have we forsaken water? Soft drinks, juices and carbonated water/juice alternatives seem to have replaced water as the standard drink. Studies are indicating the average American teen is drinking 4 carbonated beverages a day. Since I don’t drink them, does that mean you are drinking 8? Well the bottom line of the sweet beverage problem includes:
- Carbonic acid (which provides the fizz) in sodas dissolves enamel off the teeth,
- The bacteria that cause cavities flourish in an acid environment and the beverages provide that,
- The sugar in the beverages gives the bacteria what they need to thrive and cause cavities.
How about juice as a healthy alternative? Sorry, NO. Unfortunately, juice has been promoted for two generations as a health food. Juice actually has very little more than soda in nutrients. However, the acids are organic acids, which are far more active than the acids found in soda. As an example, the acid in apple juice is about 9 times more difficult to neutralize than a cola. Toddlers who are weaned off milk to juice are facing huge problems with cavities.
For those of you who still drink water, have you switched to bottled or filtered water that no longer has fluoride in it? We think this is part of the problem too. If you are in a fluoridated water area, chose a filter that does not remove fluoride. Most do not.
Is Candy the culprit? Until now my answer was no. It was not in most diets in a significant amount. That has changed. Look at these issues:
- Candy as a reward. A bad joke in dentistry was the dentist who offered candy as reward for a good dental visit. Now I see candy rewards for good behavior from teachers and counselors and as a passing ‘good will’ gesture from business owners or nearly anyone who comes in contact with children. My daughter was recently given candy as a thank you for sitting quietly for some academic tests!
- Candy as a treat or favor. Holidays have always been a time of indulgence. Recently, however, there is a marked increase in the candy I see around. More alarming to me is the general use of candy as a "snack," if that is the right word. Or party favor bags being primarily filled with sweets. The sheer volume of candy I see around Halloween and Easter has skyrocketed. Now I am confronted with large candy offers as I enter my supermarket as well as when I check out.
- Sour Power! The sour flavor of candies (the rage the last couple decades) comes from 3 acids added to the candy. The acids literally dissolve enamel off the teeth. The bacteria that cause cavities flourish in an acid environment. Additionally the sugar in the mix feeds those bacteria. These particular candies are usually designed for sucking and slow dissolving so the exposure risk to teeth is prolonged. A colleague in Santa Rosa recently shared with me a case history in which a 14 year old in his practice who had never had a cavity and was a meticulous kid got hooked on sucking sour candies after school and during the evening. Despite good brushing habits, the acids dissolved so much enamel off his teeth, allowing cavities to start, that in one year a perfect mouth suddenly needed full crowns on twelve teeth. Twelve!
- Eating on the run: Our society has changed. We eat more and more prepared foods because we don’t have the time to cook. Well take a look at those prepared foods. They all taste better because of the little additions of sweetener here and there. The Ketchup industry taught the food preparers a lesson. Years ago one ketchup maker discovered more people liked their ketchup with more sugar in it. They gained an increasing share of the ketchup market until the competitors discovered they had as much as 40% sugar in their ketchup! The others changed quickly.
- Lunch for school. The average home packed school lunch bag has at least 1 candy bar in it!
The prepared foods are also more processed which means they will form great gooey pastes that cling between your teeth. That paste between your teeth will absorb sugar from any source you provide and hold it between your teeth for hours.
Adults, take a look at yourself. When I grew up, the fabulous dessert at a fine restaurant was a slice of "home made" (and it really was home made) pie a la mode with maybe a drizzle of chocolate. Now look at the decedant desserts at any restaurant. Also look at simple daily habits like regular meetings at the local coffee house with the associated pastries. And the "coffee" has become a coffee milkshake with endless varieties. Remember, the kids are mimicking the adults around them. And the adult population's increase in obesity is now showing up in the children at an alarming rate. Ditto for the associated high blood pressure and diabetes, now epidemic in children.
We are living in a society that has too much too easily. I am afraid we are forgetting that it takes clear decisions supported by strong determination to guide our path in this life. There is now an alarming trend in Oral Health as well as General Health. We have the knowledge if we are willing to make the choice. Dental disease can be prevented. The choices you make to improve oral health will also improve your general health.