Ask the Dentist: Dilemma – brush and floss but still get cavities

Dental offices hear many explanations and complaints daily. Educating all patients is a perennial task for any dental team, and if we had issues with that we would be in the wrong business. We’re hearing from more families now who insist they brush and floss, and still get cavities. They simply don’t miss a day. Still, cavities develop and this is both frustrating and mystifying. We’ve been asked whether there is some ‘superbug’ out there that is impervious to good oral care?

We inquire about the family daily routine, from early morning until bedtime. We inquire about timing on brushing, eating breakfast, the composition of school lunches, mid-morning snacks, etc. What occurs at school, outside of normal classes? Any celebrations of birthdays in the classroom? After school, is there any shopping with parents? To which stores – grocery, Big Box, or what? Any visits to movie theatres? After dinner at home, does the family consume any food or beverages before bedtime? The manner of this ‘discussion’ is important for accuracy. We are not interrogating anyone, and really just chatting about events of the day. This virtually always provides the “Smoking Gun”.

We’ll hope the children and parents brush after breakfast, and depart for their day. Many tell us they brush upon waking up, and then proceed with their day putting food into their mouths. When the child goes to school, with lunch in hand and perhaps snacks, who knows when they get consumed? Often at recess, between periods, or actually at lunch. Virtually nobody sends a toothbrush and paste to school, and the compliance ratio would be slim.

Sometimes in class a birthday is celebrated, often with cake. Dinner at home, and eventual brushing and flossing at what may be 8:00 PM – 10:00 PM at night, largely unsupervised. The parent or care giver provides (or instructs) this final oral hygiene exercise for the day, and their task is theoretically complete.

What has just been outlined is a period of approx. 12 hours of rampant decay development time. Has this always been the case, or is this some new situation? Let’s look at what has been called ‘The Olden Days’ – or the 1960’s. Most meals were eaten at home. Fast Food was Kraft Dinner. Yes, oral care was still limited to ‘maybe’ brushing daily, and doubtful flossing. Shopping trips to the store didn’t include ‘Grazing Stands’ at the end of each aisle with free samples. If anyone consumes just one potato chip or even one string of spaghetti, it sets up the process of starch converted to glucose by salivary amylase and the decay process renews itself. The only healthy alternative is to brush and floss it away. The consumption of soft drinks, energy drinks, smoothies, and flavoured water is rampant. Even diet sodas still contain acid, which leads to oral breakdown. Look through the window of any family minivan in a parking lot, and observe chips, cheezies, candy wrappers, drink containers, cheerios, and other food stuffs. Just about everything that clogs up the industrial vacuum at the car wash deteriorates teeth.

What to do? We’ve just described real life today. Nobody has any sinister intent, or negligent attitude. It is simply what ‘happens’. Ask your dentist about preventative treatment, and inhibit decay effectively. These may include special resins done by the dentist. The Solea laser preps these teeth without needles, and prevents what can become a lifetime memory of a ‘dental bad experience’. Most such memories are nothing but a normal appointment with perhaps a needle and extraction. The simplest single rule we advocate is that if ANYTHING but water passes your lips – you should brush and floss. This literally means any chip, cookie, birthday cake, or cough drop. At the very least, those convenient little plastic containers of floss sticks are a game saver. Make a quick stop in the restroom, use a floss stick, and rinse your mouth out. This interrupts the cycle. Keep some in your purse, glove compartment, lunchbox, and everywhere. One family who visit our clinic have made it a game, where the small children get involved with reminding everyone it is time for a floss stick. There could be much worse habits! Help to modify your family oral health routine, and particularly the frequency of snacks. You’ll all be rewarded on checkup day.

Dr. Michael Dolynchuk is a General Dentist practicing in Caroline and Red Deer. Forward inquiries to: DentalQuestions@shaw.ca.

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