Tooth decay is on the rise and it's occuring at a worryingly young age. Here are the steps you and your family can take to improve the health of your mouth and protect your teeth.
"I had a three-year-old in the other day and she needed 12 fillings. That’s the most I’ve ever seen in a three-year-old. She was eating a lot of dried fruit and her mum wasn’t thinking that’s bad, but really, it’s just concentrated sugar.” Sydney dentist Dr Lawrence Stearn is a laidback man with a twinkle in his eye and a quip at the ready, but at this point he looks at me with a slightly exasperated expression. “I had to send her to a paediatric specialist, because she was too young to do any work on… and that was purely sugar-related.”
That might sound like an isolated horror story, but the more Healthy You talks to this experienced dentist from Forestville on the city’s leafy Northern Beaches, the more a pattern emerges. The people Lawrence sees each day in practice at Dentists on Starkey are worrying proof of this country’s increasingly poor dietary choices.
“Decay is still a big problem,” he says. “There’s so much sugar in processed food. If you go into the supermarket, I reckon 60 per cent of the food would be processed. A lot of that is added sugar… and a lot of things that people think are healthy have added sugar, like muesli bars. There’s a lot of sugar… and then kids are having sugar on top of that – like juices, which people don’t think about, because anything with fruit in it has to be healthy. Dried fruit is a big problem – so people having raisins and currants and cranberries, that’s all concentrated sugar and it’s sticky, and it sticks in the fissures.”
This part of Sydney, it should be pointed out, is affluent and educated, so the dental problems Lawrence sees every day aren’t representative of the rest of the NSW capital or the country. Statistics show that the less affluent an area, the more likely that population is to seek out cheaper, faster food options. That comes at a health cost but, as he explains, food manufacturers are more interested in swelling their profits than worrying about Australia’s swelling waistline. “There should be a massive focus now on eating healthy food, not crap that’s processed and comes in a packet. All manufacturers are doing is taking real food and putting in salt and fat and sugar. They’re the three things you add to stuff to make it more palatable,” he says.
“There’s something called ‘The Bliss Point’,” he explains. “When they make new products, say a new chocolate comes out, they’ll add different amounts of sugar, fat and salt until it gets to something called ‘The Bliss Point’ – they have tasters to confirm this – which is the ideal combination for that product.”
Australia has been a willing participant in this unhealthy food revolution. A 2017 survey ranked us the 31st heaviest nation out of the 192 nations sampled, with an obesity rate of 28.6 per cent. While this has serious implications for the incidence of diabetes, heart disease and stroke, it also takes a toll on your mouth. And the mouths of your kids, from an early age. “Sugar is the main problem and it has an onward effect, because if you’re losing teeth early because of decay, then that can cause major tooth-space problems, orthodontic problems,” says Lawrence. “Teeth drift into spaces where another tooth has been lost.”
It’s tempting to think that a little sugar now and then is easily rinsed or brushed away. The problem though, is more complex and unexpectedly, our conversation turns into a beginner’s guide to microbiology.
A biome, explains Lawrence, is a community of animals or plants living together in a certain environment. They exist in a rainforest or a desert. But they also exist in your body. “Your biome is your internal bacteria and microorganisms that live within your system. Now, research is starting to show that there are major health problems caused by a biome that’s not balanced,” he says. “Your mouth is part of your gut system, the start of your gut system. What you eat is a major determinant of what bacteria live in your mouth.
“It’s a bit like Darwin’s Theory of Evolution, in that, it’s survival of the fittest. You’ve got a wide variety of microorganisms living in your mouth – an average person would probably have 200 (types of) bacteria living in their mouth. “There’s only a certain amount of bacteria that can survive in a mouth that’s acidic. If you have too much sugar, what happens is that the bacteria that eat a lot of sugar and convert it to acid, they’re the only ones that can usually survive in that environment. All the good bacteria die off – they can’t survive that environment – and you end up selecting the bacteria that cause decay,” he says.
These challenges have ushered in a fundamental change in dentistry, explains Lawrence. “What we’re trying to do now as dentists is to avoid filling as much as we can,” he says. “There’s a whole move towards preventative measures, including rehabilitating the tooth before it needs a filling.”
To help in that mission, here are Lawrence’s suggestions for ways to restore your mouth to a healthy state and keep your teeth in tip-top shape.
Eat well
No surprises here. “You’ve got to get away from processed and packaged,” he says. “The only stuff you should be eating in a supermarket is the real food down the end – your fruit and vegetables.”
Don’t snack
Resist the temptation to have bags of lollies and chips lying around. Stick to three healthy meals a day and both your waistline and teeth will thank you. If you must snack, do it smartly: “If you want to limit decay, you want to decrease the frequency of sugar intake,” explains Lawrence. “It’s worse for you to have a bar of chocolate and eat a square every half an hour than it would be to have that bar of chocolate in one hit, because every time you have that sugar, the pH in your mouth drops. “If you imagine a little acid factory, every time you have a bit of sugar, that sugar is taken in by the bacteria and they release acid, be it between the teeth or in the pits and fissures,” he says. “If you have sugar frequently enough, that acid starts to dissolve the tooth.”
Get some fluoride
Australia has been adding fluoride to its water supply since the 1950s (Beaconsfield in Tasmania was first, in 1953) and this has had a significant effect on tooth decay, to the point that Australians born after 1970 have half the level of tooth decay of their parents’ generation. Given this, it’s not surprisingly that Lawrence’s recommendation as a drink of choice comes out of the tap, rather than the soft-drink bottle: “Water’s much better than anything. And you’re better off having tap water over bottled water, because bottled water’s got the fluoride (taken) out of it.” Eleven per cent of Australians don’t have access to fluoridated water, according to the Commonwealth Government’s National Health and Medical Research Council 2017 paper, Water Fluoridation and Human Health in Australia. If that’s you, discuss options with your dentist. “High strength fluoride is what you do in the dental chair, which is good at trying to protect the teeth from decay,” says Lawrence.
Get a check-up
For kids, Lawrence recommends a dentist first looks at your child’s mouth from the age of three. Beyond that, he says, “Definitely every six months, especially when they’re going through mixed dentition (a combination of both baby and adult teeth).” As they, get older, your kids’ teeth still require TLC. “In the early teenage years, kids get decay more easily because their teeth haven’t had that exposure to the fluoride, which makes the outside layer of the tooth stronger. It takes a while for that to take effect,” says Lawrence. “So you’ll find that a lot of people had fillings when they were young teenagers, then had hardly any fillings after that.” Longer in the tooth? Adults should head along every six months, too. As well as keeping an eye on possible decay, Lawrence says adults more commonly have gum issues: “If you’re not brilliant at cleaning and you’re getting tartar build-up, that can cause problems for your gums.”
Brush up on brushing
Lawrence is a fan of electric toothbrushes and says that, ideally, your child should brush morning and night for three to four minutes. He strongly recommends that parents brush their teeth at the same time as younger children to get them modelling correct behaviour. “If you brush your teeth for a decent length of time, the kids will copy that,” he says. Use kid toothpaste, even if you object to the superhero marketing on the tube: “There is a possible issue with having too much fluoride. Fluorosis (a condition where the enamel on developing teeth can get mottled through too much fluoride being ingested) was a concern for a while, so that’s why they brought out the lower fluoride toothpastes. Stick to the age-appropriate toothpaste unless the kid’s getting a real problem with decay, in which case you might increase the strength to an adult fluoride,” he says. Oh, and make sure that foamy, minty mouthful goes down the plughole, rather than their throat. “Some kids get a taste for it and start swallowing it and again, you can get a problem with fluorosis,” says Lawrence. Going old-school? For normal hand-held toothbrushes: “Soft is better – hard results in more likelihood of getting abrasion.” Abrasion usually occurs through lack of good brushing technique, where you brush back and forth near the gum line. This can cause the enamel to thin, as it’s already much thinner up at the part of the tooth near the gum anyway. With a soft brush, keep the motion circular, rather than side-to-side. And as soon as the brush ends start to fray, throw it out. Your gums will thank you.
Look mum, no tooth!
If your child manages to knock a tooth out, “the best place for the tooth is back in the socket. Obviously give it a bit of a rinse, preferably in milk,” says Lawrence. “If you can’t put it back in the socket, put it in some milk. It’s a time-related thing though: the sooner you get it back in the socket, the better. The sooner you get to a dentist, the better.”
Get your kids covered
A clear coating to protect your kids’ molars, “sealants usually get done in two tranches. The first, you tend to do on six-year-old molars. Then when the adult molars come out, you do it at 12. The risk of decay reduces by 300 per cent just by getting sealants put on.”
To floss or not to floss?
Be realistic, says Lawrence. “Most kids aren’t going to floss. If you can get them to floss, you can probably get them to cut down on the sugar, which is even better.” You, however, should floss. “Ideally, adults should floss every day; worst-case scenario, every other day. It takes about 48 hours for the worst bacteria to recolonise on your teeth after flossing,” he says.
Surviving sensitive teeth
“Imagine the tooth is like an egg,” says Lawrence. “You’ve got the shell, which is the enamel and the egg yolk, which is the nerve and the egg white is the dentine. Any time you expose the dentine, you can get sensitivity.” Luckily, there are products that can protect your teeth further. “Sensodine, Pronamel and fluoride all help to improve sensitivity. It won’t put the enamel back but it will help to protect the tooth a bit.”