PlayWell Publications

A cavity is defined as an empty space within a solid object. You have the oral cavity as well as 5 major body cavities (thoracic, abdominal, etc.) that outline and define the areas of your body's insides. But a dental cavity is an empty space (hole) in your tooth! To explain how this occurs, we must dive into the process known as caries. Caries is the process; cavity is the result.

The special cavity-causing bacteria that I like to call "sugar bugs" eat the sugars and carbs and "poop" their waste product, which is lactic acid, onto our teeth. This is what dissolves away at our teeth. At first, this caries process results in an area which is becoming softer, hypo-mineralized, and less crystalline (almost gelatinous), before the area finally gets so big and soft that it literally "cavitates" and dissolves away, leaving a hole.

What can we do to stop this from happening? Contrary to what a lot of people think, genetics has very little to do with it compared to hygiene and diet.

Hygiene (brushing and flossing) is the portion you probably hear about most. The bacteria coalesce into a plaque, and they create a biofilm of slime around themselves that protect them from chemical attack. Translation: you cannot mouthwash them away. Fortunately, they are very easy to remove physically, which is where the classic remedy of brushing twice a day for 2 minutes each time comes into play.

If you've ever had the experience of forgetting to brush for a day, feeling the textured film on your front teeth with your tongue, then scraped at your tooth with a fingernail and got to see the schmutz, then noticed your tooth felt smooth afterwards (like after brushing), THAT'S the stuff we're looking to eliminate. Cavities do not form if there are no bacteria to make the acid that cause them. 

For littles under 3, brushing can be challenging! Usually by 3 I see parents having more success getting kids to be cooperative (rather than combative). Find a way to make it a game! Brushing even once a day but brushing really well can be so important; even if kids are being fussy, it doesn’t mean we don’t change diapers, get dressed, or get buckled into car seats. 

For littles under 8, it’s still important for parents to be helping! We want to hand off the responsibility (and so do the kids!) but we need to be helping and checking at least once a day. I like to say that the bare minimum benchmark is for kids to be able to tie their own shoes. If they can’t do this, I don’t trust that they are as dexterous and capable as mom or dad, and I see many kids brushing solo too soon with very predictable areas being missed and cavities forming in the same areas.

Don’t forget flossing once a day! That bacterial plaque is on the side of the tooth as much as it is on the front where your fingernail can get it; if you’re not flossing, it’s about a 1/3 of your tooth that you’re NEVER cleaning. This can lead to having beautiful teeth where the sun shines (i.e., where the toothbrush reaches) but having many cavities tucked away in between the teeth. As soon as teeth start to touch each other, especially the back teeth usually around 3-4 years of age and older, we need to incorporate flossing. I see all too often kids referred to me who have never had cavities before, now coming in with cavities in both molars (2), in all 4 corners of the mouth, which makes 8 teeth with cavities and 2 unhappy parents.

If hygiene is first, then diet is the second half of the battle, but actually, I usually refer to it as the other 51% of the battle, for I truly think it to be the bigger half of the cavity causing process. Sugar Bugs like what we call fermentable carbohydrates. Candies and dried fruits are common culprits, but it’s often the processed-flour, dry carbohydrates that surprise parents and get us in trouble: animal crackers, goldfish crackers, pretzels, potato chips, dried cereal, granola bars. These foods are VERY snacky and are usually enjoyed over a long period of time. They get stuck in the teeth and broken down directly into simple sugars for the sugar bugs to use to make lactic which they poop right back onto the teeth.

So what’s wrong with snacking? Every time you eat, you feed the sugar bugs, too. Once fed, they digest and make acid for about 30 minutes. If you were to drink something (that's not plain water) or eat anything in the fermentable carbohydrate category every 30 minutes, then all you're doing is restarting the bacteria over and over again ALL DAY LONG and your teeth are being acid-attacked without reprieve. 

Goldfish crackers are such an easy snack to pack and to have on the go – I know, my kids have them, too, sometimes – but the goal is for crackers to not be a daily thing, and for kids to not have free pantry access to go hunting for them whenever they want to graze (kids LOVE to graze), or when they want to play picky eater at dinner time and then raid the pantry for crackers 30 minutes later (kids LOVE doing this, too). As much as possible, get rid of them, and have rules in the house about eating together at mealtimes. Daycare and school do a really good job at eating times and non-eating times – do this at home, too. We are seeing a lot of “COVID-cavities” from kids who were at home eating whenever they wanted (which means all day long without many breaks).

The goal is to eat 3-5 meals in a day with a 2–3-hour water-only break in between meals to give the teeth time to heal after the acid attack. Help your 8-year-olds and younger with brushing their teeth, twice a day, ideally, and flossing once a day if those teeth are touching! For foods, remember that it's mostly the frequency that I'm concerned about. When it comes to the crackers and juices – know that the battle against cavities STARTS in the grocery store.