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So I get this question a lot and people go on to ask whether it's genetic related? Is it because I have bad teeth?


Whilst there are some conditions that make it easier to get tooth decay (Demineralisation related to Enamel hypoplasia I do not put in the same category as tooth Decay/Caries) they will not be the root cause of tooth decay.


If we look at what causes tooth decay caries we consider 4 factors:

  1. Tooth surface - Caries only happens on teeth, not on crowns or other materials in the mouth like denture or orthodontic appliances.

  2. Sugar - The bacteria requires carbohydrate food source - this can be any carbohydrate and nowadays (especially in China) there is pretty much carbs in every kind of snack.

  3. Time - It takes time to develop tooth decay

  4. Streptococcus Mutans - The bacteria that causes decay by producing acid


1. Frequency of sugar vs Amount of sugar - This is the most important part of this article, you can skip other sections of this article but must read this part.


We mentioned “Time" being one of the factors and to cut straight to the chase, but looking at this graph:


Stephan's curve in tooth decay

  • It can take only 5 minutes for decay to start occurring after sugar intake (different sugars different times). It then takes 20 - 60 minutes for that decay stop only after stopping that sugary intake!

  • You only need a very small amount of sugar to start this decay process (A bite of fruit will start this)

  • Frequent sugar attacks will cause tooth decay and cavities as the tooth doesn't have a chance to re-mineralise and "repair"


2. The Diet Sheet I strongly encourage - Ideally before the dental appointment if possible:


This can give use objective information as to what foods and habits are causing the decay and looks something like this:


Example diet sheet for caries

The diet sheet must contain the times of when there is food intake otherwise will be pretty useless. The idea is after we see this diet sheet, is to cut certain snack times or shorten meal times so we limit the "sugar attacks" as much as possible



3. Medical history


There are other situations where the medical history can directly affect the decay process and indirectly affect. Here are some examples: Diabetes -The diabetes does not make it medically easier to get decay, the habits associated with keeping the diabetes under control may do however, as this can involve sporadic eating times


Sjogren's or any other condition with limited Saliva - The Salivary changes will mean that the "sugar attacks" last longer as the Saliva is unable to buffer/remove the sugar.


There can be a whole host of other medical history issues but the best is to come in so we can assess you appropriately.


4. Flouride Application for prevention


It's essential we try to counteract and prevent any more decay happening, and one thing we can do is administer high concentration flouride at the clinic every 3 months. At our clinic we have 5000-1000ppm Flouride (in comparison to OTC toothpaste which is 1500). This has strong preventative effects.



If there are any other questions relating to this, please get In touch. This Article was written by Dr. Oscar Sum



Dr. Oscar Sum Dentist at Aidencare

Dr. Oscar Sum is a dentist in Shanghai practicing in central Shanghai who performs Implant surgery, Orthodontics, and other advanced dental procedures. Please call scan the QR code to enquire about an appointment with Dr. Sum




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