Tooth Decay: Hard Facts About Soft Teeth

Barbara Tritz
· June 14, 2020 ·

24 minutes

Moms are incredible. 

Moms want answers to help their children be healthy. When they do not know where to turn, they turn to the internet. In this case, Facebook. My oldest daughter is a new mom, and in her new mom group came the question: what can be done to help a youngster who has tooth decay under stainless steel crowns and needs root canals.  So, this one is for you Moms!  Here is the sequel to conquering decay with lots new information!  Time for some really hard truths about soft, mushy tooth decay. (We’ll deal with root canals another day.)

Worldwide Epidemic

Severe tooth decay in 12 year old child

The statistics tell a sad tale:

  • 3.9 billion people have untreated tooth decay [1] 
  • One out of 10 children in the U.S. will have a cavity by kindergarten
  • One in seven children suffered a tooth ache in the previous six months
  • Children reporting toothaches were four times more likely to have a lower grade point average than their pain-free peers [2]
  •  In 2014, England had nearly 26,000 children admitted to the hospital for tooth decay, up by 14% from 2011 [3]

This is a health crisis. WHY is your child is getting cavities? Let us explore decay in more depth and figure out why that is, how to treat it and then most importantly what to do to prevent it.   

Decay is relatively new to mankind. Our prehistoric ancestors had little decay.  What has changed?  Lots and lots!  Read on my friends and conquer tooth decay. Then we will cover all the tools and tricks I know to put a stop to this decay once and for all. You are about to be armed and dangerous to the decay bacteria!

Super Sleuthers

Tooth decay bacteria – dissolving the hardest substance in the body. Making the tooth soft and mushy.

Put your detective cap on and sleuth out the root cause. Dental disease does not just happen. Something, somewhere is out of balance.  You need to find the answer to “why”. Dental Diseases, both tooth decay as well as periodontal disease are due to an imbalance of bacteria and other pathogens.

You all know about sugar and plaque causing tooth decay.  And you’ve also gotten the “brush better” lecture too.  Yes, these are important, especially important, to address but not for the reasons you were taught.  Yup, you read that correctly. (Now, I am not giving you carte blanche to start eating candy but sugar is only a small part of the cause of tooth decay) More on this in a moment.

Tooth decay is very complex and needs a perfect storm to erupt.  Just putting a filling in a tooth, or even stainless-steel crowns on those precious baby teeth will not solve the problem, it just kicks the can down the road until new decay pops out on another tooth. 

The Perfect Dental Storm Erupts

Tooth decay, or as we in the dental world call it: caries, is a disease that dissolves the hardest substance in the body – your teeth.  Normally we need a diamond to cut tooth structure, so what and why and how do teeth literally dissolve, or really rot away?   

Aggressive tooth decay in toddlers and young children is called “Early Childhood Caries” or ECC [4], also called S-ECC for “severe early childhood caries”.  It has, pardon the jargon, multifactorial causes that come together in a perfect storm in your mouth.  And it will take a multifactorial team to help you and your loved ones to heal.

We Start with Facts     

Here is the most important part: we accept tooth decay as a part of life. We should not accept it as a part of growing up or growing old. And! It is NOT benign.  It infects other parts of our body.   Tooth decay is NOT inevitable.

#1. Tooth decay is a risk factor for heart attack [5] and strokes [6] and Alzheimer dementia .

The bacteria – mostly streptococcal mutans, streptococcal sobrinus, and lactobacilli are the main culprits, although there are many others.  

Strep mutans have been found in the thrombi (clots) of heart attack and stroke victims.  There is also a significant association with intracerebral hemorrhage and deep cerebral microbleeds (stroke) [8], as well as cognitive impairment (Alzheimer disease)[9]Leaky brain, anyone?

#2. Tooth decay bacteria are acquired from you, Mom (sorry).  It is contagious. [7] 

Yes, it is transmittable through saliva. We pass it by kissing, blowing on and tasting baby’s food to see if it is hot, and of course, licking that binky (because there’s no water to clean it and baby’s crying – and yes, even I have done this, and I know better).  Mother-to-child is the usual route – called vertical transmission- but children can also acquire these bugs from other children. This is called horizontal transmission.  There is a lot of saliva and drool going on.  They have done DNA tests on the bacteria and found that grandma, mom, and baby’s decay bacteria all share the same genetic code.

So, moms, no surprise when I say: to cure your baby or toddler, we need to address the bacteria in the ENTIRE family.  You may not have active decay, but someone in the family does and is sharing those pathogens with the rest of you. (And it could well be the family pet…) This is a family problem, not just the one person with decay, and it must be addressed by the entire family, aggressively. 

Oral hygiene – the toothbrush lecture and all things centering on plaque removal — are important to reducing the pathogens that are responsible for tooth decay. But, removal of the plaque is only part of the story. We need a mix of good and bad bacteria in our mouths.  We call that homeostasis. There is good plaque and then there is bad plaque. We brush and floss to reduce the bad plaque biofilm.

 #3.  Candida albicans [10]– fungus

Yes, fungus in the mouth.  It makes the strep mutans bacteria five times more virulent. [11] 

Also called oral thrush, it is a fungal infection of the mouth and tongue.  Fungus (candida) thrives on the high levels of sugar from folks with uncontrolled diabetes and result in what is often called burning mouth syndrome.[14] We all have some level of candida albicans in our mouths but a healthy immune system keeps them in check.

One study examined the maternal relatedness of C. albicans isolated from S-ECC children. They found that the mothers of S-ECC children were also highly infected with oral C. albicans (>80% detection in both saliva and plaque samples) and more than 60% of the S-ECC children were carrying the same C. albicans strains as their mothers[12]

What they do know is those with those with aggressive childhood tooth decay have much higher levels of candida, and that those moms did too.  Again, while everyone has some level of candida, those with tooth decay, have extra high levels. The pathogen growth is out of whack.  The good bacteria have been overrun by the bad guys. In my dental office we do salivary diagnostics to check for the decay pathogens as well as fungal overgrowth.

I feel we need to test for and lower/neutralize the candida overgrowth [13].  It affects not only the decay bacteria but also make diabetes 5xs more pronounced**

(Ozone, a super oxygen kills bacteria, fungi, and viruses, all pathogens that contribute to tooth decay.   At the end I will compile an instruction sheet and how to use all the products I recommend. Hint: I love ozone for a healthy mouth)

#3. All these pathogens live in an acidic environment. 

They are excreting acid and love living in this more acidic environment they created.  As the plaque biofilm matures it gets even more acidic.  The bad pathogens crowd out the “good guys”. Mouth breathing and acid reflux are the main culprits in encouraging this acid environment.  More on mouth breathing and reflux next. 

I recommend you purchase pHion strips and test the pH of everyone in the family first thing in the morning.  It should be neutral at a pH of 7.0, if it is below 6.5 then you have an acidic mouth.  

If you see your child mouth breathing during the day, test their pH and see it on the test strip. If they have juice or something acidic, it takes the mouth an hour to get the pH back up to 7.0.  So, if they are mouth breathing on top of the acid food or drink, it may never get back up to neutral.  Watch your child when they are watching television or playing. See what they naturally do. Mouth open, even a little means decreased quality of saliva. Which brings us to:

#4. Mouth breathing

Watch your child sleep, and not at 9:00PM, but at say, 2:00AM when they should be sleeping deeper.  Maybe even record it for a night or two.  Do they toss and turn a lot, sleep with their mouth open, or maybe even snore?  Do they sweat, get up a lot, sleepwalk, or have night terrors?  For adults, download the snore lab app and record yourself.  Test yourself, test your kids. See if the mouth stays closed.

And then, how about during the day? Do they walk around with their mouth open; do they chew with it open?  Does their nose run, or get plugged, or get a lot of colds?  Do they have allergies?

Mouth breathing is not healthy breathing.  It creates a very dry, acidic environment. Without saliva, teeth break down.  Saliva remineralizes teeth. They NEED to be bathed in healthy saliva.  And again, the pH of the mouth needs to be neutral. Mouth breathers get more tooth decay.

Mouth breathing due to allergies?  Dust, dander, and dairy are the place to start.  Remove the pets from the bedroom. Hand washing is all the rage right now so up your game there as well.  Then, and this may be hard, but stop all dairy for one month and see if the mucus clears up.  Find the cause! Once you do, you will have to teach your child how to close their lips and re-learn nasal breathing.  They will naturally still want to mouth breathe because it’s habit and easier for them.  An orofacial myofunctional therapist is specially trained to help with that. 

#5. Mouth Anatomy

Does your child have spaces between their baby teeth (hint: they should)?  Has anyone checked their mouth for tongue and lip ties?  If the tongue is tethered down or the lips have tissue holding them tight to the lips, then the child’s mouth and tongue may not be able to function properly in “self cleansing”. We use our tongue to remove food and clean teeth.

These tissues are called buccal, lip or tongue ties and these ties may instead be trapping food between the lips and the teeth. With limited mobility, the tongue cannot rub the teeth to cleanse them, reach between the upper lip and teeth, get behind the molars, or wherever else bits of food are hiding.  This may also cause improper development of the jaws. We call these myofunctional disorders. Again, a myofunctional therapist can assess for these and many other issues that might be contributing to decay.

Look beyond the tongue and into the throat.  What do the tonsils look like?  Two walnuts sticking out of the sides of the throat?  Can you even move the tongue out of the way to see back there?  If so, it may be time to see an allergist and/or an ear nose and throat specialist.  This is part of that multifactorial connection.  The nose needs to be clear and allow nasal breathing.

We need to go beyond just “brushing better” and instead, look for the causes of tooth decay.  The cavity is just the end result. There are deeper root issues going on, like perhaps two walnuts blocking proper breathing…

Tonsils this large make it hard to breathe, eat and sleep.

All decay has an orofacial myofunctional disorder component to it.  Look deeper.

#6. Acid Reflux 

When a child or adult is not breathing properly while sleeping, it can create a negative pressure on the diaphragm and bring up acidic gases from the stomach.  We call this silent reflux. They may not taste anything, but it does drop the pH.  Thus, the reason I suggest testing the pH of the mouth first thing in the morning.

Acid wear facets from silent acid reflux. These tiny divots are from stomach acid in the mouth.

This acid will create these divots in the teeth. I often see them on the lower first molar (dental peeps- look on the mesial buccal cusp of the first mandibular molars. You’ll see ’em) These can become sensitive, as they are dissolving enamel and heading into the next layer of tooth structure called the dentin. Dentin is not as hard or thick as enamel. If you see these acid wear facets know it is from acid either from reflux or possibly soda and other acidic drinks. My bet is reflux.

#7. Genes and gestation – the maternal link

First off, the good news: your genes are NOT your destiny.  

The bad news, there is a gene connected to tooth decay- the beta defensin 1 gene that can mutate – we call this a polymorphism, which can result in enamel defects in the developing fetus’s teeth that cause the enamel to be less hard and a less stable structure. [15]

And second, I found in my researching, that pregnant moms with low levels of vitamin D have children with a higher incidence of tooth decay.  Children with ECC had much lower levels of vitamin D as well as more enamel defects.[16]  If you are pregnant, I would recommend getting your D levels tested and up your D3 vitamins along with K2 (they work together).  

Adults – Vitamin deficiency affects your tooth decay development too.  Research links a vitamin D3, K2, C, and Niacin deficiencies to decay in adults. 

Adults levels should be:

  At least 1,000 to 2,000 IU per day of vitamin D in supplemental form is safe.

2,000 milligrams per day of vitamin C, and hundreds of milligrams per day of niacin, help prevent tooth and mouth troubles.

Sick individuals, and those who are prone to cavities, will typically benefit by starting with higher doses of vitamin D, vitamin C, and niacin under the supervision of an orthomolecular physician. [17]

Both children and adults would benefit from an evaluation from a functional medicine doctor with blood work and a physical evaluation to determine what else might be contributing to the destruction of teeth. Blood work will tell you the proper levels of supplementation.

#7. Nutrition and then Leaky Gut.

This is the real key to controlling decay. Bottom line: The tooth breaks down because there are not enough fat-soluble vitamins in the body.

A little sidestep into nutrition, and then we’ll come back to leaky gut again:  Sugar itself is not the bad guy per say – contrary to everything we have learned all these many years.  Sugar does cause the body’s microbiome to get out of balance, out of homeostasis, and feeds certain bad decay bacteria so of course we need to watch out for and eliminate sugar. Certain bacteria are “fast eaters” while others are “slow eaters”. Your fast eaters love simple sugar- they gobble them up quickly. Your slow eaters eat fiber, which takes longer to break down and eat. Those fast eaters are creating lots more acid in the mouth. We need to feed our “good” bacteria healthy food. More on that in a moment.

Also, be on the lookout for hidden sugars – I.E> granola, bagels, cereal, baby formula, liquid medicine, energy drinks, and the like.  Especially watch things like fish crackers (everybody’s favorite food snack, especially for little fingers), Cheerios, Kind bars, and snacky type foods that they munch on throughout the day. 

Baby formula has sugar as both the first ingredient and the fourth.  Yes, I was surprised too. (Yes, there are sugars in breastmilk. It’s difficult to replicate nature, but I think we need to work on something better for those moms and babies that are unable to nurse for whatever reason.)  No surprise then when we see children come down with diabetes. Sugar causes inflammation throughout the body.  Sugar goes by MANY names (at least 56 [18]) so it can be hidden.  Be a label reader.

This is the real reason to watch out for carbohydrates – they break down to simple sugars.  The stickier the food is, like fish crackers, the more cariogenic the food is.  Cariogenic means decay causing. (I’m just using all the jargon today.)  Simple carbs are already processed to breakdown more easily versus, say, an apple or a carrot which do not stick to your teeth. Feeding those “fast eaters” leads to tooth decay.

And then look at liquids- juice, energy drinks, flavored water, and Gatorade are all acidic fluids, as well as sugary.  Even some bottled waters are acidic so grab those pH strips and test your products.

Food diary- write down a three-day food diary of everything that goes in your or your child’s mouth, even toothpaste, mints, water, mouthwash, Kombucha, dried fruit.  Time to be that super sleuth detective.  Look at the labels, test the pH, and really analyze it.  For help it may be time to pull in a nutritional expert.  They can really assist in delving deeper into the nutritional aspect of your diet.

High time we feed the good, healthy bacteria with foods that contain Probiotics and Prebiotics.

Probiotics are in fermented foods such as Kefir, sauerkraut, yogurt, cheese, and pickled vegetables. The bacteria in these foods convert sugars into lactic acid, which then goes to work for you. It stunts the growth of harmful bacteria and increase or preserves enzymes and vitamins for better digestion. By feeding the good bacteria, we create harmony among the “bugs”, creating homeostasis. The good bacteria live with the bad bacteria all the time. We just need to get things in balance. These were the foods our forefathers ate but are not on our tables much anymore.

Prebiotics are non digestible carbohydrates that feed the friendly bacteria – think fiber. Top prebiotic foods include apples and their skins, raspberries, beets, seaweed, asparagus, and broccoli to name but a few.

Breast milk contains both prebiotics and probiotics. The perfect way to seed baby’s gut with good bacteria and jumpstart a healthy immune response. Contrary to popular myth, breast feeding does not contribute to tooth decay. It is the carbohydrates that baby consumes that starts the decay process, not the breast milk.

If decay or gum disease are a problem for someone you know, might be time to look at feeding the good bacteria and put things back in balance.

Chew it Well

Digestion starts in the mouth with properly chewing our food.  Our food should be chewed 20-30+ times BEFORE we swallow it.  It should be soupy.  (My family was astounded to know that yes, I count my chews to be sure I get that number. And yes, I realize I am a dental geek.)  If you only chew five to six times, how can your digestive system process all the nutrients out of your food? “Chunking” food down after six chews does not even start a healthy digestive process. By chewing thoroughly, you also stimulate the proper level of digestive enzymes needed for proper digestion.

We must get our children chewing real food. This grows the face and jaw properly.

Chew your food thoroughly. Chew on both sides of your mouth.  Develop your muscles evenly.  Swallow properly (a myofunctional therapist can help here as well.  And to think you never even knew about that specialty before, and now you need one!)

What is Leaky Gut?

Leaky gut may well be the true root of the problem. Leaky gut is something I previously had never even connected to tooth decay, let alone gum disease, but yes, it is the source and the start of chronic illness.  What we put into our bodies matter. 

Once the food is swallowed, it enters the rest of the digestive tract- this tube is lined with one-cell-layer-thick of epithelial cells and it is lined with mucus.  Normally, a healthy lining allows nutrients to enter your blood system and the mucous layer protects your immune system and reduces gut inflammation.  It keeps a healthy microbiome of bacteria in check.[19] 

When we damage this inner ecosystem with unhealthy foods and drinks, this layer then allows toxic gut bacteria and pathogens, and partially-eaten food particles into the blood system, and creates inflammation.  The body is trying to kill these bacteria but by eating these foods daily, our body is in constant crisis and inflammation.  This epithelial layer is chronically porous and thus starts chronic disease.  

What foods contribute to leaky gut? [20],[21],[22]  Bottom line – the SAD diet – our Standard American Diet:

  • Soy
  • Dairy
  • Cereal grains – gluten and processed refined foods
  • Oils (polyunsaturated fats)
  • Alcohol (ouch that one hurt)
  • Coffee (and this one is also on my ouch list)
  • Nightshades (peppers, eggplants, tomatoes, potatoes)
  • Sugar
  • Prepackaged foods (everything in the middle of the grocery store)
  • Fast foods
  • Antibiotics
  • Anti-inflammatories (NSAIDS too)
  • Everything in the middle of the grocery store should about cover that list…

Signs you might have a leaky gut include but are not limited to:

  • Unexplained migraines
  • Anxiety
  • Depression
  • Joint pain
  • Eczema
  • Celiac
  • Irritable bowel syndrome
  • Acne
  • Allergies

And, of course:

  • Gum disease
  • Tooth decay

How does your gut dysbiosis (leaky gut) influence tooth health causing tooth decay? 

Here’s the big unknown secret. Your tooth is alive and has a support system similar to a tree with sap running through it.

Your teeth have a natural built-in defense system called the dentinal fluid transport system. [23]   Your tooth is like a box of straws, we call these straws dentinal tubules and enamel rods.  They constantly have fluid flowing in them that pulsates from the pulp, or nerve center, of the tooth outward into the mouth.  This fluid protects the teeth.  It deflects acids and germs from entering the teeth, and with its pH of 7.4 acts as a buffer to neutralize acids. [24]  This fluid flow also brings nourishment to the teeth. 

Tooth decay starts when this fluid flow pump is interrupted or reversed. Instead of self-cleansing the tooth, it is now self-contaminating.   It is bringing acids and pathogens from the mouth into the tooth.  This fluid flow reverses due to problems within the endocrine system (the endocrine system is a network of glands that make hormones that help cells talk to each other), poor diet (See above- SAD),  or stress within the body which then negatively affects the hypothalamus (which connects your endocrine system to your nervous system) which is the regulatory gland of the dentinal tubule flow.    Biology class is over.

It is all connected – this tooth fluid flow is affected by the autoimmune reaction created by the foods you eat.  Tooth decay is an outward sign of an internal problem. (Leaky gut strikes again.) Most causes of death are due to chronic illness- and tooth decay, as well as gum disease, are some of the first signs this is occurring deep within our intestinal system.  So, leaky gut starts this cascade of inflammation throughout the body. Tooth decay is one end result.

So Much Information

The bottom line is how best to use it to stop tooth decay, heal teeth and even better, prevent future problems?

#1. Time to involve a medical professional to start the deep dig. A medical doctor, functional medicine doctor, or a naturopathic physician would be my suggestion. Have blood work done to look at your gut health as well as your mineral and vitamin levels.

Check your levels of:

Fat soluble vitamins- A, D3, K2, E,

Co Q 10,

B vitamins

Vitamin C


Zinc, Magnesium, Phosphorous, Collagen

And then supplement accordingly.

#2. Diet changes:

Stop drinking soda, sugar drinks, juice, and anything with high fructose corn syrup. Know the pH of the things you do drink. Swish with water periodically to raise the pH of your mouth. Do not sip on acidic drinks for hours at a time.

Anything white – bread, rice, potatoes, cereal… (it’s sticky)

Processed foods (more sticky stuff)

Phytic foods– lentils, wheat, beans, almonds, and soybeans. Phytic foods inhibit absorption of certain nutrients including minerals the teeth need for remineralization.

#3. Do consider an ancestral diet – natural foods, organ meats, farm-raised chickens and eggs, seasonal fruits and vegetables, as well as:

Omega 3 fatty acids (fish)

Vitamin C

Vitamin D and A (Fermented Cod liver oil (sorry))

Antioxidants (dark chocolate and berries (you’re welcome, finally!))


Probiotic food like Kefir, Sauerkraut, Kombucha ( but watch the sugars,) Kimchi

Healthy fats like butter and Ghee, lard, olive oil and coconut oil (some controversy here but for now, I’ll keep it on the good list.)

Drink water, lots of good clean healthy water.

Dark leafy greens- they feed the enzymes that make nitric oxide and that feeds the good bacteria* this is huge. I am learning more about Nitric oxide (NO) so plan a post this year on it. Trust me, you want more NO in your life!

#4. Add a probiotic to help feed the good gut bacteria

My favorite dental nutritional pro Dr Steven Lin recommends: GutPro [25]

Revitin toothpaste also contains prebiotics to feed the good guys.

#5. Sunlight, exercise and stress reduction

My favorite recommendation is get outside to soak up that Vitamin D, move and use your body – just be sure you are nasal breathing!

#6. Tricks of the Dental Hygiene Trade

Dental hygiene tools to help you and your family to have a healthy mouth. I have these tools listed on my Recommendations page! If you’d like to support this site, please purchase through there.

  1. An electric toothbrush – even for youngsters. 
    1. I would suggest you get two brushes and let your youngster pick which one to use. You use the other- he brushes, you brush for him and then he brushes again. 
    2. For kiddos I do like Dr. Fresh’s Firefly brushes. They light up and have timers. Perfect for little hands.
  2. Adults: I like the brush called Kyoui (pronounced “Q-ee”, it is French). It has an incredibly unique head that is angled so it cleans better. It also has a head called an end tuft brush that is a little bundle of bristles and fits in the nooks, crannies, crown margins, and even around implants so it cleans out the pathogenic plaque better.  [Said oldest daughter and editor’s note- I started using the Kyoui after being a diehard… other, Big Name Brand… user, and was impressed immediately. It does clean better.]
    1. Brush for at least two minutes, if not four.  And! This is important: BRUSH YOUR GUMS, then brush the roof of the mouth, cheeks and scrape your tongue. and put in my code for a 10% discount- BARBARATRITZsave10%

  • Clean in-between your teeth.
    • For kiddos try a tool called Gumchucks– perfect for your big hands in their little mouth
  • Of course, I love dental floss but let’s be real, most adults don’t floss. It is very technique sensitive and if you do not do it right, then it can be very ineffective and even damaging to the gums. Learn to do it correctly.
  • Consider an oral irrigation device like a Waterpik.  I also like a unit called a Hydroflosser. I do recommend adding a little baking soda to the water, but instructions will tell you not to add anything.  If you do, it voids the warranty.  FLUSH the tank after use and be aware it will shorten the lifespan of the product. Better to replace the irrigator than get a new cavity.
  • Other tools that clean in-between:
    • Interproximal brushes- tools that fit nicely in-between the teeth are great. TePe and Piksters are fabulous and great to keep in the coffee cup holder of the car to use on the way home.
    • Softpicks and other plastic tools- also good. Watch out for tools that are hard, such as toothpicks- I have seen damage to the roots by folks twilling them around in between the teeth.
  • Toothpaste- Every one of them claims to be the best at stopping decay, sensitivity, and whitening.  Really, let us keep it simple,
    • First, everyone should have their own tube.  I know I grew up with a communal tube of paste but think about it- what is at the top of that tube? Oral pathogens. No sharing. Might well be the way we infect our children.
    • The toothpaste should have an RDA number – I recommend that your toothpaste’s Relative Dentinal Abrasivity number be below 70.  If you have a favorite toothpaste, either look it up or call the company and ask. Most toothpastes are between 80 to 120.  We do not want to use pastes that are so abrasive.
    • My personal favorite pastes:
      • I personally like baking soda- it has an RDA # of seven. Yes, wet baking soda is very gentle, and it is not acidic.  Mix it with some coconut oil, a little ozone oil, and your favorite essential oil.  I also like Common Sense Teeth powder which has the baking soda, xylitol, and remineralizing minerals already in it. Available on Amazon or directly from Dr. Rainey- look online.
      • Boka Toothpaste- another remineralizing toothpaste
      • Revitin- contains prebiotics that feed the good bacteria
      • Dentalcidin- excellent herbal toothpaste that helps restore homeostasis.
  • Use a pea-sized amount on the brush, spit, and do not rinse. Let the minerals and other medicines within the toothpaste work.  Work the toothpaste in between the teeth with the Piksters or floss.
    • Brush BEFORE EATING to reduce the pathogenic bacteria on the teeth. Less plaque means less bacteria. The bacteria eat what you eat so reduce their numbers. They create mayhem within 20 minutes of your eating dinner, so don’t feed them too!  We brush to REMOVE PLAQUE.  NOT food debris. The irrigator removes the food debris.  Food for thought!
  • Tongue scraper – plaque on the tongue accounts for approximately 70% of the plaque in the mouth so cleaning the tongue is vital to controlling the bacteria.  I like tongue scrapers better than just brushing the tongue. 
  • Mouth wash- that gets a big NO from me- Most are acidic.  Again, test it or call the company to find out.  What research is now saying is that mouthwash raises blood pressure[26] [27] by killing the good bacteria. And, this reduces nitric oxide production in the mouth. We need all the nitric oxide we can produce. (Nitric oxide needs an entire blog post devoted just on this incredible molecule!) I do like a baking soda-water swish to raise the pH.
  • Xylitol- this is a good sugar. It is safe for diabetics and does not cause tooth decay.  It cooks like sugar and tastes good. It raises the pH of the mouth. All good things- and it tastes good to boot. Here is the short edited version of what xylitol does- the bacteria cannot digest it so they die- and then the good bacteria can repopulate.  Five servings of xylitol a day can change the oral microbiome to healthy.  I like all xylitol products.  They have sprays, mints, toothpaste, rinses, gum, and plain old straight xylitol. Find what you like and use them daily throughout the day. Too much xylitol too soon can cause “gastric distress” so do not go crazy.  Start slow and add a little each day.  The goal is five to 10 grams daily.
  • Remineralizing products:
    • Basic Bites- two a day- one am after brushing, and one pm before bed. Dissolved slowly in the mouth to remineralize teeth.
    • Prescription products called SalivaMAX or Neutrasal – swish twice a day. I actually like having my patients dip their toothbrushes in the swish first to work it into the teeth and gumline.
  • Ozone- My favorite war-chest tool. Make no mistake- this is a war and we must figure out how to outsmart the decay bacteria. (We certainly must also address the systemic and food connections, as well as the lack of quality saliva.)  But changing the decay microbiome is also a very important part of the equation. The decay bacteria poop acid making the mouth acidic, creating decay, and then they infect the entire body. More on ozone in a moment.


I use ozone in all I do. It is in the water I use while working. We use ozone water as our preprocedural swish before we work to reduce the dental bioburden. I use ozone oil on my dental tools to clean underneath the gumline, disinfecting as I work. Ozone gas helps heal diseased gum tissues by pumping gas through cannula to reach under the gumline.

I recommend my patients use ozone oil on their toothbrushes or on Piksters in between teeth.  Ozone oil is available on Amazon. It speeds healing and kills bacteria, fungi, parasites, and viruses (all discussed earlier as culprits in tooth decay). It is my personal first-aid ointment of choice. (Ozone in the body makes red blood cells slippery and able to get through the tiny capillaries more smoothly so better healing. Finding a doctor that understands ozone’s uses may be a challenge though.) Ozone oil can be used daily at home in numerous ways. I recommend mixing with baking soda, coconut oil, and Salivamax to use as toothpaste.  Yes, the taste is not as good as minty toothpaste, but it is more potent. And just so you know, sometimes patients tell me it tastes like a wet dog…

In office, we use ozone gas. We make custom trays that flow ozone gas (the strongest concentration of ozone) over the teeth for 15 minutes every three months. These are specially made trays that flow gas in and suction it out the other side. Ozone trays may cost more but bottom line –  if it reverses or eliminates even one cavity those trays are worth their weight in gold.

I can also gas individual teeth to pinpoint areas of decay more specifically.  Ozone kills bacteria, viruses, parasites and fungi so we are able to isolate ozone gas delivery to specific parts of teeth that have active decay. 

Ozone is AWESOME.

Disclosing solution shows where there is plaque

More Dental Hygiene Tools

  • Salivary diagnostics- while not a “tool” per say is an important part of my protocols. We can now check saliva for the bacteria level as well as the candida load.   Knowing what pathogens we need to deal with, as well as testing along the way to see how our treatments are proceeding is an important part of therapy.  Both Oral DNA and Fida Labs have salivary diagnostics to check for these decay pathogens.  Chairside, I have a Carifree swab that gives me a bacterial load with a simple cotton swab.  A quick test that tells me the bacterial load level to a point.  Good test and I use it often but not as thorough as a salivary sample by a lab.
  • Treatment- Air polishing teeth – another in-office protocol is using a erythritol in an air polisher weekly for four weeks. This helps change the pH of the mouth which kills the acidic loving anaerobic bacteria and fungi.
  • Disclosing tablets and gel- I love using a product that shows the remaining plaque different shades of pink and purple.  This helps me see where my treatment is most needed and allows the patient to see where they can brush and clean better.  Seeing is believing. It starts with better brushing and more efficient oral hygiene.
  • Nasal breathing is vital to oral health and systemic health for so many reasons. In order to breath properly, we MUST breathe through our nose at least  96% of the time.  Yes.  Even when exercising.  Watch your sweet munchkins while they sleep- look for mouth breathing.  
  • I personally use paper tape every night to ensure I only nasal breathe all night long, and daytime I have trained myself to nasal breathe. I use 3M Nexcare micropore paper tape for sensitive skin. Don’t tape those younger than five. There is a new tape for children called Myotape[29] by Patrick McKeown that goes around the lips encouraging them to close.  This is a biggie. Habits are hard to change so getting our children to nasal breathe from the start is important.  Working with a myofunctional therapist is important to establishing these critical life long habits.
  • Dry mouth contributes to decay.   Well over 400 medications also cause what we call xerostomia – which is dry mouth. These medications alter the quality and quantity of saliva so it is no longer a healthy saliva that can remineralize teeth.  It can be so gradual you don’t notice it.  Testing the quality of saliva is another good test that can be done in the dental office.
  • Nasal Hygiene- I encourage nasal cleaning twice a day with saline wash like Neilmed or xylitol spray by Xlear. If nasal breathing is still difficult then a trip to the ENT and/or allergist might be in order. Try eliminating dust, dander and dairy. Might just make a BIG difference.

The Bottom Line

Another large cavity in a permanent molar

Curing tooth decay is not the simple thing we had been led to believe. It is about more than brushing better, flossing and throwing more fluoride on teeth. Please note, I did not mention anything about fluoride treatments of any kind. Fluoride only hardens the outer six nanometers of the tooth. I call this lazy hygiene. We have better tools to remineralize teeth such as Salivamax, Boka, and our own wonderful saliva.

We must however look deeper at the root cause. Heal the tooth from the inside, change the pH in the mouth, create a healthy plaque biofilm, increase of fat soluble vitamins, and health our guts. Add five servings of xylitol daily to your routine. Fluoride does nothing to address any of this root cause.

This is a multifactorial problem with a multifactorial solution and a team of practitioners.  Dental professionals, myofunctional therapists, ear nose and throat doctors, allergists, naturopath or medical MD’s all need to look at the teeth, the airway and then up the nose, down the throat and at the gut.

We need to look beyond the teeth. We must look at our dirty food, dirty air and dirty water. We must inspect the food we ingest, reevaluate the way we breathe, and how we sleep.  The pathogen levels should be tested to know where we need to look. Tools need a major upgrade to completely remove ALL the pathogenic plaque but still feed the good pathogens.     

Tooth decay is not benign and should be treated aggressively. The goal is not to remove all the bacteria and pathogens, rather we want a balance, called homeostasis of all the bacteria so things stay healthy.  The mouth is the window to the soul. Be healthy, be well, and practice prevention.

Clean healthy teeth take lots of time, attention and work.

Thanks for taking the time to read all this. I know it was long. Treating tooth decay is a challenge and requires more than just better brushing. Now you know why it is there, how to repair it and how to prevent it. As I learn more I will let you know.

Til next time,

Keep smiling!

Barbara Tritz RDH

Queen of Tooth Decay Super Sleuther and Decay Preventer






























Hello, I'm Barbara Tritz

Unveiling the Stories Behind Dental Hygiene

Loving science, especially biology, from an early age, Barbara is a registered dental hygienist, certified biological hygienist, and orofacial myofunctional therapist. In 2019, she received the Hu-Friedy/ADHA Master Clinician Award from the American Dental Hygienist Association.

Share your thoughts below!


  1. Catherine

    My dentist says that Hydroxyapatite in toothpaste is abrasive. and doesn’t recommend that I use it. What do you think of that?

    • Barbara Tritz

      Good Morning Catherine,
      Thank you for reaching out, that’s a great question. All toothpastes contain some abrasives- that’s how the toothpaste cleans the teeth. Common abrasives you will see on the ingredient list include:dehydrated silica gels, hydrated aluminum oxides, magnesium carbonate, phosphate salts and silicates. Toothpastes are given an RDA number- relative dentin abrasion number. This says how abrasive a toothpaste is to dentin. Dentin is much softer than enamel. According to the American Dental Association, their position is that toothpastes with an RDA number under 250 are safe to use on a daily basis. Here’s the link to their page- Click on the pull down on “RDA” for more info. They say that there is limited wear to dentin and virtually no wear on enamel with toothpastes with RDA # under 250. My goal in using toothpaste with hydroxyapatite is in remineralizing the teeth. By using this you will strengthen the teeth, making them more resistant to acid attacks from food and reflux. Here’s the research that points to that: Hydroxyapatite is a natural product- it is what your tooth is made of. It is “biomimetic” meaning your body recognizes it. It belongs there. Hydroxyapatite will go into the pits and fissures of your teeth and make them stronger. Dr Mark Burhenne of Ask the Dentist has a great article on this so no need for me to rewrite all that he so eloquently says –
      I would like to read what research your dentist is quoting so I can better answer his concerns. I have full confidence in recommending products with remineralizing agents in them and have no worries of any kind that they will hurt your teeth. Instead, they will harden them! That is the ultimate goal.
      Thanks for reading and reaching out.
      Let me know if you need further information.

    • Stacey

      Hi, I am a dental hygienist and I am SO glad I stumbled across your site! I also have used a lot of products that you have recommended. But the one that has sparked my interest that I was not aware of is ozone oil. What brand do you get on Amazon? I would like to try it with a few of my more complex patients. Thank you, Stacey.

      • Barbara Tritz

        Hello Stacey,
        So happy you “stumbled” on to my blog! In my “favorite products” section I have a link to PurO3. I am working on a discount code so as soon as they send it, I will email it to you.
        I use ozone oil on everything – oral as well as body. It speeds healing, disinfects almost instantly, and is my go-to first and foremost. It just doesn’t carry the baggage that all the other products do. Test with salivary diagnostics and see how effective it is in healing your patients.
        All the best,

  2. Catherine

    Thank you so much for your speedy and thorough reply!

  3. DentalSave

    Great post!
    From my experience, I can say that Infant teeth are significant. In the event that child teeth are lost too soon, the teeth that are left may move and not leave any space for grown-up teeth to come in.


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