Cavities, Bacteria, Acid Saliva or Reflux

Dear Dr. Brooksby

I went to the dentist the other day and he found several of my molars had decayed. He told me that I needed to take better care of my teeth. I brush after every meal and even floss every day. What more can I do? Down in the Mouth.

Dear Down in the Mouth,

When we were in Dental school every dentist was taught that the only cause of decay was bacteria. We were told that brushing and flossing and elimination of sweets was the solution to preventing decay.

I have found that there is a large percentage of people that, like you brush and floss regularly and conscientiously try and take care of their teeth. When I examine there teeth there is no plaque or tartar and they do not have bleeding gums, yet they still have decay. On the other hand I know people that do not seem to take care of their teeth, they have tons of buildup on their teeth and they have no cavities.

About 8 years ago my daughter was working on a science fair project in which we were trying to determine if some denture adhesives were acidic and could cause teeth to decay. We found that the test kit for a swimming pool worked best. We decided to try the test kit to see if some patients had acid saliva and some had basic saliva. We began a year long study in which we sampled and tested the saliva of every patient that came into our practice. We found that 70% of the cavities in our practice occurred in people with saliva that tested with a pH of 7.0 or less. On the test kit the testing solution was deep red, but when the saliva was acid it turned the solution yellow. We also found that those patients that had a pH above 7.6 had lots of tartar buildup and no cavities.

We also found that a certain percentage of the patients that had normal saliva that tested about pH 7.4 still had decay, but it was usually on the posterior teeth. These people had a history of heart burn and took a lot of Tums or medications for ulcers and heart burn. It seems that as the stomach acid surges from the stomach to the back of the mouth it causes heartburn, but it also decays the back teeth that are bathed in the acid.

In your situation, you may get a swimming pool tester and see if you have acid saliva. If you do not, but do have heartburn, this could be the cause of your problem. Your doctor could put you on Prilosec or Pepcid A/C. You may already be using Tums or Rolaids. If you do get the acid reflux into your mouth rinse it out immediately and do not brush. You can get a prescription for a fluoride gel toothpaste from your dentist that can help reverse some of the damage.

Unfortunately, if you have acid saliva the teeth are bathed in the acid 24 hours a day. The best solution is to find ways to make your saliva turn more basic. A urologist may have a medication that can do this, or you may try altering your diet to see if you can find a way to make the saliva more basic. Some purport that green leafy vegetables help make the saliva more basic. This is a very individual thing and you have to try to make the changes by trial and error. Thank goodness the cost of a pool test kit is really low.

One other cause of decay is acid reflux. If you get heart burn, the acid from your stomach may eat your teeth. If you do get reflux, medications like Prevacid can help. If you get the acid in your mouth, rinse quickly. Some even suggest rinsing with baking soda water.

The good new is that candy and sugar are not the big culprits we were taught, so while you are looking for ways to reduce the acidity have a candy bar. It may help and if it doesn’t, at least it will taste good.

For more information on cavities, implants or bridges call Dr. Brooksby at or if you have questions you would like answered you can e-mail Dr. Brooksby at scott@lvimplant.com.