Cavities in teeth do not develop overnight. 

Tooth decay formation takes place due to a process called demineralisation. The term "demineralisation" simply describes the fact that minerals (like calcium compounds) are leached (dissolved away) from a tooth's hard tissues (enamel, dentin, cementum).  It typically takes months or even years for a cavity to form. This is because conditions aren't always right for the tooth demineralisation process.

Tooth decay forms underneath dental plaque. A cavity forms as a result of repeated acid attacks. There has to be both dental plaque and dietary sugars present for tooth decay formation to occur. These conditions don't always exist but each time they do some tooth demineralisation will occur.

Over time there can be a point where the cumulative effect of each episode of demineralisation has resulted in the formation of a cavity.

The demineralisation / remineralisation tug of war.

There is another important dynamic that takes place related to tooth decay formation besides just the demineralisation of the tooth. If conditions are right, a tooth can undergo a remineralisation process. Remineralisation helps to counteract the damage done during demineralisation. Remineralisation in effect is somewhat like tooth decay in reverse.

What is the remineralisation process and how does it attempt to reverse tooth decay formation?

Remineralisation attempts to repair the damage caused by demineralisation.

When conditions at a tooth's surface are non-acidic a remineralisation process can take place. During this event minerals found in the oral environment can be re-incorporated into a tooth, thus reversing, or at least minimising, the damage that was done to the tooth during the demineralisation process (tooth decay formation). This repair process will continue until the repair has been completed, or until the next attack by bacterial acids has begun.

This tug of war action between the demineralisation and remineralisation processes, each of which can occur many times a day, is one reason why cavities can take many months to form. In some cases a tooth's remineralisation can balance out the damage done during the demineralissation stage. However, in those cases where there is heavy dental plaque accumulation or the person has a high sugar intake, the balance will tip to the side of tooth decay formation.

What can be done to promote Remineralisation?

We need to decrease the acidity of your saliva - we will do a pH test of your saliva and based on the results recommend a course of action.

We may recommend topical agents to apply to the teeth to promote remineralisation - such as Tooth Mousse (CCP-ACPF), high flouride containing tooth pastes or mouthrinses.

We may recommend the use of chewing gum - Recaldent (the same active ingredient that is in Tooth Mousse) Chewing Gum helps to stimulate saliva flow and coats the teeth with remineralisation promoting biofilm.

Of course, decreasing the number of times sugar is consumed throughout the day and brushing with a flouride containing toothpaste and flossing the teeth regularly will help as well!!

Fluoride promotes tooth remineralisation.

Researchers have discovered that fluoride enhances the tooth remineralisation process. Fluoride found in a person's saliva will adsorb onto the surface of a tooth where demineralisation (tooth decay formation) has occurred. The presence of this fluoride then in turn actually attracts other minerals (such as calcium), thus helping to speed up the rate or degree to which remineralisation (reformation of tooth mineral) will occur.

To receive the benefit of this process fluoride must be present in a person's saliva. This is why drinking fluoridated tap water throughout the day would be a better choice (in regards to cavity prevention) than unfluoridated bottled water. This is also a reason why brushing with a fluoride toothpaste three times a day would be better than brushing just once a day.

The new tooth mineral that is created by the remineralisation process when fluoride is present is actually a "harder" mineral compound than the one that was present when the tooth initially formed.

Teeth are generally composed of the minerals hydroxyapatite and carbonated hydroxyapatite. The tooth mineral that is created during the remineralisation process when fluoride is present is fluorapatite. Fluorapatite is "harder" than other tooth minerals in the sense that it is more resistant to damage caused by acids (demineralisation). Not only does fluoride promote the tooth's remineralisation but it also helps to create a tooth surface that is even more resistant to the formation of tooth decay.

Fluoride can inhibit oral bacteria's ability to create acids. Dental researchers have found that fluoride can decrease the rate at which the bacteria that live in dental plaque can produce acids. This is because fluoride disrupts the bacteria's ability to metabolise sugars. The less quantity of sugar that the bacteria can consume, the less acidic tooth demineralising waste products they will produce.

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