Does tooth brushing prevent dental decay? The answer might surprise you. — Dr. Kris Roling, CEO Virtual Dontics. Live, Online Continuing Dental Education.
By: Virtual Dontics
Tags: Dental Care, Dentistry, Dental Hygiene

As a dentist, I was trained to advise my patients on “good” oral hygiene practice to prevent tooth decay. Brush twice a day, floss daily, use a fluoride toothpaste, and see your dentist every six months for a checkup and cleaning. We tell our patients, if you do these things, “chances” are you won’t get a cavity. Recently there has been discussion amongst the public health dentistry world, “Does brushing your teeth really prevent dental decay?” Honestly, dentists don’t know this for sure. Yes, you read this correctly. Evidence Based Dentistry does not support the prevailing thought among dentists that brushing your teeth prevents dental cavities. If you are a dentist or a dental hygienist, raise your hand if you have witnessed a patient who has done everything right and still developed a cavity. What have we told this patient? Looks like you missed a spot with your toothbrush? Right? The fact is, there are areas of the tooth that a brush cannot reach, including pits and fissures. So why do some folks develop a cavity, and others don’t? Why are the poor twice as likely to be afflicted by dental decay? Why is there an assumption among dentists and the public, that poor people don’t brush their teeth, creating a greater prevalence of disease? Isn’t this a little like the notion of using leeches for 2000 years in the ancient practice of bloodletting? Sometimes the disease improved, and we credited the leeches, and sometimes the patient’s condition worsened. The tooth brush companies have made billions on the notion of creating a “better mousetrap” and while they may reduce plaque, the focus of a toothbrush as the silver bullet to eradicate an epidemic, is questionable, especially when EBD suggests that the plaque removed may be transient. Although CAMBRA was developed to assess risk of developing disease and assign appropriate treatment, what about other non-dental circumstances that have little to do with brushing and flossing that seem to drive this silent epidemic? Risk factors include poverty, not graduating from high school, low socioeconomic status, being part of an ethnic minority group, being developmentally disabled, geriatric, recent immigrants, tobacco users, and people infected with HIV/AIDS.

In my practice, I treat the poor. Historically, dentistry’s approach in treating the socioeconomically disadvantaged is to give them a free toothbrush and advise them that their catastrophic dental disease is a result of their own behavior, they just aren’t brushing to our (dentist’s) satisfaction. Not too long ago, I had a dentist tell me that they didn’t “buy the whole ‘poor’ thing”, and further stated, “We give them a toothbrush, it’s up to them to use it.” Now that dental decay is an epidemic of the poor, can we say this approach is working? We do know that plaque left on teeth may cause a breakdown in the enamel leading to decay. Tooth brushing can remove plaque, so it stands to reason this should prevent cavities, right? The answer is not necessarily, so what are we overlooking? The body’s reaction to stress and the environment. Like any chronic disease, dental decay is exacerbated by stress in the form of living in poverty, poor nutritional status, illness, isolation and disconnection from community. Studies measured cortisol levels as an indicator of stress in children and caries level. Children with higher levels of cortisol levels experienced more decay. Recently, research pointed the exposure to second hand cigarette smoke as an increased risk factor in developing caries in young children.

So do we stop giving away the free tooth brushes?

No. Although not evidence based, tooth brushing is shown to reduce plaque levels, especially in conjunction with fluoridated toothpaste. More evidence based practice must be introduced. The dental and medical profession however, must approach dental decay as a public health epidemic of the poor. Rather than focusing on the best way to brush, public health policy should be developed to address the inequity of access to care, healthy communities and the reduction of poverty �h��_(�