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On our Facebook page, we linked to an article that appeared two weeks ago in Medical News Today with that title: “Breathing through mouth during sleep may increase tooth decay risk.” Click here to read the original story. We got an interesting reaction from a follower: “My husband and I both sleep with mouth open. We wake up with dry mouth in the morning. I asked my dentist he replied just use duck tape all around. ??? lol” Which prompted me to do a critical analysis of this study. The bottom line—the title and the phrasing of the conclusions are overblown. The FactsThe first thing we need to understand is that the article from Medical News Today is not the original study but is a reporting of the study. The study itself was published in the Journal of Oral Rehabilitation, a scholarly journal. Medical News Today is merely reporting on the study, as are a number of other publications. Here is what the study demonstrated: Normal daytime oral pH is 7.3. Normal nighttime oral pH is 7.0. In those study subjects who were forced to breathe through their mouths during sleep, their average oral pH was 6.6. Now here’s what you need to know about oral pH. 7.0 is neutral. Anything lower than that is acidic. Acids in the mouth can damage enamel. But damage to enamel requires a pH below 5.5. But the average pH in mouth breathers in this study was 6.6, which is well above that threshold. It looks like there is nothing to worry about. But wait. The article states that the researcher discovered that, “at stages during the night, pH levels inside the mouth dropped to 3.6 in individuals who breathed through their mouths.” THAT is low enough to cause erosion of enamel. Did it ACTUALLY cause erosion of enamel? No, that wasn’t measured by the study. Did it cause tooth decay, as is suggested by the title? No, the study didn’t get into that either. All of that is conjecture, based on this little fact that “at stages” the pH dropped to 3.6. How long were those stages? It doesn’t say. The Whole Story is More Complicated Than ThisThere is a lot going on in your mouth that affects what happens to your teeth. There are buffers in saliva that counteract the acidity created when you eat and mouth bacteria feed on the carbohydrates you eat. There are minerals in your saliva and enzymes that repair the enamel. This idea that there is any decay or other damage to the teeth during the sleep of mouth breathers is a hypothesis based on this one tiny observation. And while the article correctly phrased this hypothesis as “may increase tooth decay risk,” the “may” is lost on too many people. It’s a guess that “may” warrant further study. So in mouth breathers, “at stages” the pH dropped to 3.6. I’d be interested to know how low the pH dropped “at stages” in the non-mouth breathers. We’re not told. My cynical side leads me to think that little tidbit was left out because the author wanted to sensationalize the findings. But that is only a hypothesis that would need further study to corroborate. – Dr. David Hall Do you have a comment? We’d love to hear from you. Enter your comment below. Click here to ask Dr. Hall a question of your own. |
Search Results for: tooth decay
Another question about tooth decay from weightlifting
Dr. Hall –
I saw your note to the effect that weightlifting will not affect tooth decay. But let me ask the question a different way. I have been lifting weights (squats) for a few months now and am beginning to get up to moderately sizeable weights. I am doing this to preserve/increase bone mass to avoid osteo problems ten or twenty years from now.
If I am building extra bone as a result of this exercise, the raw materials must come from somewhere. Obviously, preferably diet. But is it possible that it may take some calcium from the teeth to build the extra bone mass?
I have just found I have problems with two teeth after not having any material problems for some years. It just seems like a curious coincidence, that it has occurred a few months after starting some fairly serious weights exercises.
– Rodney in Ontario
Rodney,
Your body can’t extract calcium or anything else from your teeth. Once they’re formed, they’re done. Your body can and does take calcium from bones when they fall into disuse, but not teeth.
It’s conceivable that, if your diet isn’t providing enough calcium to build up these bones that your saliva could be deficient in calcium, and if that’s the case, you’re weakening one of your defenses against tooth decay. There is a constant repair process that goes on where your teeth have little acid attacks every day and your saliva provides the repair every day to rebuild the site of the attack.
– Dr. Hall
Related pages in the www.mynewsmile.com web site:
Bone loss from gum disease
What to look for in dental floss and flossing
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Can you catch tooth decay from kissing?
Dr. Hall,
I noticed that someone I had kissed had a tooth that looked like it was decaying. Can I get sick from kissing that person if they had a decayed tooth in their mouth? This is a serious question not a joke, thank you so much.
– Jamie from California
Jamie,
Tooth decay isn’t contagious. The decayed tooth won’t hurt you at all, no matter how much you kissed this person.
Everyone has the same tooth decay bacteria (lactobacillus) in their mouth. The way the bacteria cause you trouble is when you feed them often or don’t clean them off daily. So brush, floss, don’t snack all day long, and you’ll be fine.
For more information, read our page about tooth decay. Also read about the myth of soft teeth.
– Dr. Hall
Thank you Dr. Hall I feel much better now, I hope he gets his teeth fixed soon.
– Jamie
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Tooth decay from weightlifting.
Dr. Hall,
When I weightlift, I feel a lot of pressure on my jaw and my molar teeth. I recently had a molar pulled because of a huge cavity far below the gumline, and am starting to feel similar pains in the molar on the other side. Is there anything I can do to protect my teeth and jaw while I do these sorts of strenuous exercises? Or am I doomed to lose all my molars?
Alan in Alberta
Alan,
While weightlifting can cause pressure on your teeth, and possibly even pain, it won’t cause tooth decay. So no, you aren’t doomed to lose your molars from weightlifting.
I’d suggest taking a look at your eating habits. Do you snack frequently or drink soda frequently? My guess is that’s what you’re doing.
If you eat or drink anything with carbohydrates in it frequently, there is no way to brush your teeth or floss enough to counteract the acid attacks that you are experiencing on your teeth. If you limit yourself to your regular three meals and maybe a couple of snacks, and then brush your teeth at the gumline, you should pretty well eliminate almost all tooth decay.
– Dr. Hall
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Tooth decay under a crown
Question:
I have dental crowns and there is decay under them. I have several root canals and need another one. Can the crowns I have be reused after the root canal and decay are taken care of. I cannot afford to have all new crowns done and I have been told due to a sensitive gag reflex I would have a hard time wearing dentures. I am a 70 yr old who thought my dental problems were solved 7 years ago when I had the crowns done. I am so frustrated with dentists and the poor care and advice I have gotten in the past that I find it hard to trust what any of them tell me.
Christine from Florida
Christine,
If you have decay around or under a dental crown, sometimes the crown can be patched. It depends on how extensive the decay is. If it gets too deep inside the crown, the crown will have to be removed, which may require cutting the crown off, making it impossible to use it again. But, even if there is extensive decay, if the crown can be removed intact and money is an issue, sometimes it can be relined with a buildup material and placed into service again.
As far as your general problems, you can help yourself a great deal, if you are still tending to get a lot of decay, by reducing your frequency of eating. Some people are under the false impression that the best way to fight tooth decay is to brush well and floss. But if you snack repeatedly during the day, no amount of brushing and flossing will be enough. See our page on tooth decay for a discussion of this issue.
– Dr. Hall
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Decay on a tooth with a crown after only seven years
Dr. Hall
I have a 7 year old porcelain crown with a cavity underneath. What would cause this to happen? And could you recommend a good cosmetic dentist for me?
Thank you.
Judi from Ohio
Judi,
Seven years isn’t very long for a crown to last. When any crown is done, regardless of the material that is used, the dentist needs to be sure that the margin, which is the place where the crown meets your tooth, has no gaps in it, and that it is smooth. If there is any roughness at the margin or if there is a gap, even a very tiny gap there, it will attract plaque and will be a place that will be extra vulnerable to recurrent decay.
Insurance companies will generally have a standard that they expect a dental crown to last a minimum of five years and won’t pay for a replacement anytime sooner than that. But most dentists would feel that the crown should last much longer than that and would be embarrassed if it got new decay in seven years, unless the patient were particularly prone to cavities.
And I see that we do not have a recommended cosmetic dentist close enough to you. If you are serious about this request and it wasn’t just an offhand question, get back to me, and we will research this and find you a great cosmetic dentist. Please see my separate post, how we choose a cosmetic dentist.
Dr. Hall
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Can there be a cavity in a tooth without any outward signs?
Dr. Hall,
My right lateral incisor (#7) has been diagnosed with a cavity inside it, and dentist claims it needs a root canal. Interestingly, she has referred me to a root canal specialist who has the same very uncommon last name as hers. My previous dentist of last year’s x-rays didn’t indicate any issues with this tooth. And the outside of the tooth has never had work done on it and no surface cavity is showing. This tooth does stick ‘out’ at an angle in the front of my mouth a bit, thus is not receiving pressure from the lower teeth when chewing. I can’t find on the net any answer to is it possible to have a cavity inside of a tooth that has no outward signs of holes or wear?
– Theresa
(See Dr. Hall’s answer below.)
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Theresa,
You don’t have to go to the root canal specialist that your dentist recommends. Given the possible conflict of interest with your dentist and with this diagnosis you are questioning, I’d get another opinion from another specialist or general dentist.
About having a cavity in a tooth without having any external point of entry, no, that can’t happen. Decay has to start on the surface and eat its way into your tooth. When it goes deep enough, the bacteria causing the decay will infect the tooth, which will require a root canal treatment.
However, it’s possible that your dentist is using different language to describe a problem called internal resorption. Internal resorption is a rare condition where the pulp of the tooth begins to eat away at the tooth from the inside. The cause isn’t known, but this is an inflammatory reaction, so it seems that there needs to be something that begins irritating the pulp. Since there is no history of decay in the tooth, the only way I can imagine this happening is if there was some trauma to the tooth from its sticking out further than your other teeth. But again, this is unlikely, since this is very rare, so my advice would be to find an endodontist for a blind second opinion to confirm the diagnosis. Check my post on how to seek a second opinion:- Ask for a copy of the x-ray to take to the other dentist.
- Don’t let the second dentist know the name of any other dentist involved.
- Don’t even share the first diagnosis.
You could also send me a copy of the x-ray and I would be happy to render an opinion.
– Dr. David Hall
(There is also a pathology called external root resorption, which happens on the outside of the tooth. This could have the same x-ray appearance as internal resorption. Taking two x-rays at significantly different angles would help pin down whether the resorption is occurring inside the root or outside.)
Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.
Wisdom tooth is growing in brown
Hello Dr. Hall,
My wisdom tooth is growing in brown? It’s only begun to peek out but that seems to be the case.
I’m really confused as to why/how this is happening.
For context, there is some minor darkening at the bottom of my back teeth.
I believe my enamel (for all my teeth) has been destroyed by acid as well, and I may have a few cavities.
…I read that enamel can’t be restored once it’s completely gone. I’ve scheduled a dentist appointment for next week (the soonest time available), but I can’t get my mind off of the matter.
Is there any way I can restore my teeth’s health & appearance? 🙁
– Polly
(See Dr. Hall’s answer below.)
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Polly,
There’s a lot I don’t know about your situation, so I’ll just give you my best guess based on what you’re telling me. It sounds like you have defective enamel on your wisdom tooth. Enamel can turn brown if there is decay that starts and then is arrested, but if is brown right when the tooth erupts, that wouldn’t be the case. The fact that you have darkening at the bottom of your back teeth leads me to believe that something happened to you, health-wise, at the time the enamel on those teeth was finishing forming, which would be at about the time the enamel on your wisdom teeth was forming.
If that is the case, you have defective enamel, the tooth will be very susceptible to decay and would likely end up needing a crown. But it is worth it, trying to save a wisdom tooth, especially since it would be difficult to do a quality crown on a wisdom tooth? That’s a judgment call you would have to make after consulting with a trusted dentist, and considering other cavities you may have.
– Dr. Hall
Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.
I have a cavity on a porcelain veneer tooth
I have a cavity on a tooth that has a veneer and my dentist wants to take the veneer off and replace it with a crown. This seems strange to me. What would you suggest?
Connie from Littleton, CO.
(See Dr. Hall’s answer below.)
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Connie,
There are several things to consider here. I wish I knew a little more about your case, this cavity, and your dentist, but my gut reaction is not to let this dentist replace your porcelain veneer with a crown. I would get a second opinion, and I will explain how to go about that and why. And I would like to explain a couple of other things about your situation.
First, the chances that this dentist and his dental laboratory will be able to match the crown to the veneers on the rest of the teeth are slim. Maybe 2% of dentists would be able to do this. I have a number of emails from frustrated patients whose dentists tried to match a crown to a porcelain veneer with poor results.
Second, you don’t say how big this cavity is, but it would need to be pretty big before a crown would be needed. While a porcelain veneer is very conservative, with only a small amount of enamel needing to be shaved on the front of the tooth, a crown on a front tooth is a very aggressive treatment, requiring the tooth be ground to a stub. You would need to have a substantial portion of the tooth decayed before a crown would be justified, like at least 20% of the tooth or more. While I don’t know the specifics, my suspicion is that this dentist is very unfamiliar with porcelain veneers and feels much more comfortable doing crowns, and that is what is driving this preference. Also, the cavity may be on the edge of the porcelain veneer (that’s the most susceptible place on a porcelain veneer tooth for a cavity), and your dentist may not have the training or the equipment needed to bond the composite filling to the veneer, which will need to be done to get this filling to last.
If you have or want porcelain veneers, it is very important to understand the difference between a general family dentist and an expert cosmetic dentist. I won’t try to give much advice about that in this post. I discuss that on the home page of this website, linked in the previous sentence. If you have a smile makeover with veneers and your regular maintenance dentistry is done by a family dentist, when you have some maintenance work on your veneers, I would ask for a polite leave of absence from the family dentist and have an expert cosmetic dentist help you with that need. If it required substantial travel, it would be worth it. Most family dentists will claim to be able to do cosmetic dentistry because they don’t want to lose that business. But it takes a rare artistic inclination and a certain passion to be able to do it well. I have a file full of emails from patients who had beautiful work done by a previous dentist that was ruined by a subsequent dentist who simply didn’t have the artistic inclination and training needed. Find a dentist recommended on this website, or find one who proudly displays beautiful work on his or her website, with a clear indication that the dentist actually did that work.
Note that I am not flatly saying that this dentist is wrong. While unlikely, it is possible that he or she is an expert cosmetic dentist and that this cavity is large enough to justify going to a crown. I am just strongly recommending that you get a second opinion.
Finally, just a comment on how to avoid this situation. When you’ve got porcelain veneers, your teeth become particularly vulnerable to new decay right at the margin where the porcelain meets the tooth. The good news is that it is not difficult to prevent this decay. Limit your frequency of eating, because each meal or snack launches a separate decay attack. It’s not how many sweets you eat—it’s how often you snack. And floss faithfully every day. Flossing will clean that margin.
Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.
I can’t afford to have my wisdom tooth extracted
Hi Dr. Hall,
About a year ago my lower wisdom tooth cracked and a corner fell off. Over the course of the past year little pieces have been falling out leaving me with just the back wall left and the inner pulp. Now the pulp is disappearing fairly rapidly and the tooth is super sensitive. Will it eventually just fall out or should I go in to the dentist? Since I’m dirt broke it’s kinda a hard choice.
– Tanner B.
(See Dr. Hall’s answer below.)
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Tanner,
Yes, your decaying wisdom tooth will eventually decay away completely and fall out. But of course it’s best to have the dentist take out the tooth. There is a chance that infection could get into the bone and cause a serious abscess, and to avoid that you should have the tooth taken out.
But then there’s your money circumstances, and my sympathies for that begin to kick in, so I need to tell you some of the mitigating factors in your situation. I’m going to have to make some assumptions here, because it’s a little fuzzy to me what is going on with your tooth. I’m not sure what you mean by the pulp disappearing. If the pulp of your tooth has been exposed, then it became infected and is pulp no longer. Is that what you mean? And then I’m unsure what you mean by your tooth being super sensitive. Sensitive to what? If the pulp is infected, it is dead, and your tooth could only be sensitive to biting. But when people say their tooth is sensitive, they usually mean sensitive to cold or air. In that case the pulp would have to still be alive. So there’s some confusion in my mind about how far along the damage is to your tooth.
Here’s my advice, given the uncertainties about the condition of your tooth, and out of sympathy to your financial situation. As long as there is no swelling around your jaw, this isn’t an emergency, you could just wait this out and hope that the tooth just decays away. But if you start to have swelling, you need to get to a dentist.
With this being a lower tooth, it makes things a little easier because once infection starts, that won’t get in the way of getting the tooth numb. The nerves to the lower teeth are accessible in the back of your mouth, so novocain can be administered without having to inject into infected tissue. For upper teeth, that isn’t the case. If this were an upper wisdom tooth, it’s much more risky to wait until it’s infected.
Another option you might consider, though, is calling around to find a free dental clinic for emergencies. In many cities there are such charity clinics where they will do extractions or other simple dental emergencies for free for people with no money. You could call around to local charities or dental offices to see if anyone knows of such a clinic in your area.
Oh, and I should add for the sake of other people who may want to extrapolate what I am advising to apply to other teeth. If this tooth were a first molar, say, my advice would be totally different. For a first molar, you have a potential complication of the surrounding teeth tipping into the space and ruining your bite. But that won’t happen with a wisdom tooth.
– Dr. Hall
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