Why do I keep getting cavities?
March 9, 2015 8:13 PM   Subscribe

I brush, floss, and rinse with fluoride twice daily. Why do I always get cavities?

I am asking a question for which it seems science has no answer. All my life I have had a problem with cavities. Most of my family has this problem (both immediate and extended) so it seems like it has to be at least a little bit genetic. However dentists always want to interrogate me on the lifestyle factors, so I always feel like I have to bring a character witness with me to affirm:

*I brush twice daily with the Sonicare toothbrush. I use Pronamel toothpaste. I know the proper "technique" for brushing. I have a subscription for new toothbrush heads so they are changed on schedule.
*I use ACT fluoride rinse twice daily. I do not eat or drink for at least 30 minutes thereafter, but usually longer.
*I floss with the Reach wand each evening. Like most people, if I eat something where things conspicuously get stuck in my teeth, I will floss additionally.
*I drink a can of soda probably about 3 times a week. Otherwise I drink water and unsweetened herbal and black teas (the latter of which leads to a lot of staining, but that is a different issue). I don't drink juice on any kind of routine basis.
*I do not smoke or drink coffee.
*My diet is diverse, but skews toward Mediterranean due to my heritage. So I eat a lot of vegetables, salad, fish, pasta, etc. I also like Asian and Indian food, and will indulge in the occasional hotdog or unhealthy snack. But overall most would characterize me as a healthy eater. I do not generally eat very crunchy foods.

I have been on this regimen for at least over a decade. I have always brushed my teeth and taken basic care, but at the same time have always gotten cavities. This would result in the dentist giving me The Lecture and saying, "Now, I understand you are already using an electric toothbrush, but CLEARLY it is not as good as the Sonicare otherwise you would not be getting all these cavities..." So I kept ramping up my efforts until I landed where I am, to no positive effect. Six months ago I was at the dentist. They didn't do an x-ray and said my teeth looked okay. This time, though, they did the x-ray and found that I have SEVEN cavities in between my teeth and one may need a crown. This is the worst diagnosis I have ever gotten. They said they will probably want to do x-rays on me every six months now in order to keep a track of things.

This is my third dentist. I like him, but he has no compelling ideas of why this happens or how to prevent it. I was quoted $1500 to fix all the cavities (more if I do need the crown), but he mentioned that I might just need all of this work again in no time since we cannot ascertain why this continues to happen. Pretty much any time I go to the dentist they report that I have at least one or two cavities. I consider those "good" trips to the dentist.

Once the dentist works his way to the bottom of the interrogation list then we get to diet, and suggestions skew towards "Well, instead of 3 cans of pop a week, how about you never drink soda again?" My diet is great in terms of my health, so if it is to the point where I have to change it just for my teeth, then who even needs teeth? It's not like I'm eating bags of Jolly Ranchers or anything crazy. I feel like they get hung up on this because there is nothing left to try. I am not sure what else to do. It seems like I must just stop using my mouth for eating and drinking and go on an intravenous diet and see what happens.

As far as I can tell there are no compelling theories for this phenomenon. This latest dentist even thought of a few off the script questions to ask me (i.e. "Did you ever live anywhere else [in case the tap water there was horrible]?"). He says saliva that is intrinsically too acidic is not a possibility. Has anyone ever had this problem and come up with a miracle solution? Are there emerging scientific theories and treatments? I feel so disinclined to spend all that money for something that just seems to be a chronic condition.
posted by Angel de Lune to Health & Fitness (65 answers total) 15 users marked this as a favorite
Xylitol is clinically proven to reduce cavities - try sugar free gum after meals?
posted by bq at 8:22 PM on March 9, 2015 [5 favorites]

A huge part of it is genetic. If you have crappy teeth, good oral hygiene will only minimise the effects of that :(
posted by DarlingBri at 8:22 PM on March 9, 2015 [39 favorites]

Do you happen to be on hormonal birth control? I had constant cavity issues that resolved when I went off the pill and came back during pregnancy. My dentist at the time, a dental school professor, said it wasn't an unusual side effect of increased female hormones.

Another thing that seems to have helped is that my insurance now pays for three cleanings per year instead of two. Might be worth an extra $100 per year to pay for an additional cleaning out of pocket.
posted by Cecilia Rose at 8:23 PM on March 9, 2015

Man I'm sorry your dentists have been so lecturey. Here are things that have contributed to cavities in my family:

1) Genetics. My brother & sister are both genetically disposed to excess buildup (I want to say tartar buildup but I don't think that's right). Their dentist often commented on the fact that they were just plain genetically predisposed to lots of cavities, and they both have to be extra careful

2) Bad previous dental care. I had a bad dentist who did a bad job putting sealants on my teeth as a child and I got cavities under every single one. I have also gotten several cavities under existing fillings, just because they were badly done (future dentists were pissed about this).

What to do: Only thing I can recommend is post-lunch brushing (or post-any meal). And get a dentist who's not a jerk.
posted by brainmouse at 8:24 PM on March 9, 2015 [5 favorites]

Did you grow up in a place without flouridated water? I did and my teeth are cavity-prone. My sister, however, grew up with me and has very few cavities. Also dental technology has improved over the past decade so that dentists can see mini-cavities that didn't even show up before and they're getting more proactive about handling them sooner. So a combination of

- genetics maybe
- upbringing maybe
- proactive dentists maybe

And it may be also that you are sensitive to the dentist's questions because at some level when you're doing everything you can you just have to laugh and say "Yeah, teeth, huh?" Some dental offices are more judgey than others.
posted by jessamyn at 8:24 PM on March 9, 2015 [2 favorites]

I've gotten cavities even though I brush at least twice a day and floss at least once a day (usually more). I don't smoke or drink soda. My dentist told me I'm doing the right things, and it's probably just genetic.
posted by John Cohen at 8:25 PM on March 9, 2015

I agree with brainmouse. It couldn't hurt to start brushing after lunch.
posted by Kevtaro at 8:27 PM on March 9, 2015

How old are you ?

I had tons of cavities and such when I was younger - and level of hygiene just never seemed to matter. As I got into my 30s, I started getting problem teeth replaced with crowns and it's made a world of difference. It's expensive, so start saving now, but those man made teeth hold up way better than my natural ones ever did - and as a bonus they are nowhere near as temperature sensitive.
posted by Pogo_Fuzzybutt at 8:27 PM on March 9, 2015

I got cavities until I stopped flossing and started using the water-pik things. Not a single cavity since. YMMV.
posted by H. Roark at 8:36 PM on March 9, 2015

Pasta, bread, rice and other carbs will cause cavities.
posted by Nevin at 8:37 PM on March 9, 2015 [4 favorites]

Response by poster: I am 29 years old. I have lived in Chicago my whole life so always had fluoride in the water. I went to the same dentist until I was in my 20s and they were always accusatory jerks, so the take home message was always "this will hurt and be expensive and YOU could have prevented this if only..." I then went to a different dentist who was crazy expensive, they wanted like $800 just for a consultation and told me that marks left by my long-removed braces were cavities that needed to be filled. We didn't even get as far as x-rays. Finally I went to my latest dentist who dispelled the notion that my braces marks were anything to worry about, but he did give me all of this other bad news. He did suggest that my first dentist might have given me low quality fillings, resulting in many recurrences.

The thing about the "start brushing after lunch" idea is it is just another way to ramp up my efforts when it seems like it is just a teardrop in the ocean of all the changes I've already made that created no difference. It's not like that's the divide between me and people that don't get cavities. I am feeling really cynical about further lifestyle changes at this point, when I've been so compliant for years and gotten nothing out of it.
posted by Angel de Lune at 8:40 PM on March 9, 2015 [3 favorites]

Do you sip your soda over a long time period? I know that a continuous wash of sugar can be hard on your teeth. This would be true of fruit juices, too. Also, carbs, like bread, that stay in contact with your teeth for a long time (as they get stuck in the crevices of your teeth) are also more like to cause cavities. Brushing more often after meals could help.
posted by dawg-proud at 8:40 PM on March 9, 2015

Okay, I posted after your update, and I know you are frustrated with changes that don't seem to help, but I really recommend that you not give up. It is absolutely true that you can be genetically prone to cavities. I am sure that my mother was. However, she gave up and made the situation for her teeth so much worse, and so much more expensive. Brushing after lunch for six months and evaluating then is so much less costly than crowns and root canals. I am absolutely not preaching, I am very sympathetic, and hope you find something that works.
posted by dawg-proud at 8:45 PM on March 9, 2015 [4 favorites]

Could it be an issue with saliva production/dry mouth? Has any dentist suggested daily flouride trays? I wonder if they are seeing tartar buildup in addition to cavities, which is why they're asking about lifestyle stuff. But yes, my understanding, as someone with lots of fillings, is that badly done fillings can leave places for bacteria to collect that brushing can't reach.
posted by muddgirl at 8:46 PM on March 9, 2015 [1 favorite]

I DON'T floss and I don't do a fluoride rinse, but I have literally never had a cavity. Literally never! I'm 34. I grew up super poor and had pretty inconsistent dental care in the first 20-ish years of my life.

Your problem (and my tremendous good fortune) is 100% genetic.

I do agree that your dentist sounds like kind of a jerk.
posted by kate blank at 8:47 PM on March 9, 2015 [17 favorites]

I've had similar issues with my teeth, and the culprit turned out to be a bad case of dry mouth (caused by a combination of nightly CPAP use and various prescription medications). Might be something to look into. Xylitol mints and Biotene mouth spray have helped, and I have far fewer cavities these days.
posted by Vervain at 8:47 PM on March 9, 2015 [1 favorite]

Are you getting enough calcium?
posted by brujita at 8:51 PM on March 9, 2015

Response by poster: Not sure what you mean by fluoride tray? I do rinse with the ACT fluoride rinse twice daily. This latest dentist did ask about dry mouth, but it's not really a problem I've noticed. I told him I've had sinus problems and asked if the post nasal drip could be related, but he said no. I've been told that I don't have a tartar problem, my enamel is not thin, and my gums are good. In fact it is extra infuriating because at first glance hygienists and dentists have given me compliments on how good my teeth and gums look but then when they get into it and find all the cavities they change their tune.
posted by Angel de Lune at 8:51 PM on March 9, 2015

I've pretty much been you. I do most of what you already do--the Sonicare, mouthwash, etc. Two things occur to me:

(a) How often do you go to your dentist for a cleaning? Because in addition to all of what you're doing, I go four times a year because I have to get the plaque/whatever cleaned off more frequently. And I've managed to go years without a cavity now.

(b) GET ANOTHER DENTIST. I've seen a lot of dentists who had no effing idea what to do with me and my problem mouth, and it sounds like yours is the same way. Try to find someone else who doesn't just nag you to get another Sonicare and throws up his hands.
posted by jenfullmoon at 8:55 PM on March 9, 2015 [4 favorites]

I also have genetically bad teeth and my latest hygienist strongly encouraged me to at least rinse my mouth with water after lunch. I haven't gotten up the fortitude to make it a habit yet, but I do see women brushing their teeth and rinsing with mouthwash in the bathroom after lunch.

If you do start brushing midday though, keep in mind that you can't have anything acidic (e.g. soda) in the 30 minutes beforehand. That will destroy your already weak enamel.
posted by serelliya at 8:55 PM on March 9, 2015

Do you/could you drink your sodas through a straw?
posted by tomboko at 8:57 PM on March 9, 2015

It can definitely be genetic. I am kind of the opposite of you in that I am not very careful with my teeth at all, ate tons of sugar for most of my life, and never flossed until I was in my late twenties. I have never had a cavity at all. Same with all my genetic relatives.

I think you just got unlucky, and should do what you can, and then tell your dentist to stop lecturing or you'll change practices.
posted by lollusc at 9:08 PM on March 9, 2015

(Dentist practices, that is, not your tooth-brushing practices.)
posted by lollusc at 9:08 PM on March 9, 2015

I don't know if I would brush any more than you already are. My mom used to be a 3-a-day brusher until the dentist pointed out it was wearing down her enamel and making her more prone to cavities.
posted by Anonymous at 9:09 PM on March 9, 2015

Response by poster: Well I have changed dental practices at last. I am hoping since this new dentist was talking smack about my last dentist's filling capabilities that he will do a much better job and maybe this will make a difference to my life (and be worth the money).

And yes, that is another reason I am skeptical about brushing more than twice daily (wearing down the enamel). My mom tried that route and was told that it was making things worse for her. She also goes in for cleanings every 3 months but still has a mouth full of crowns and cavities. However she is a chain smoker and a chain coffee drinker, so I am not sure how much comparison between us is relevant. ;)
posted by Angel de Lune at 9:15 PM on March 9, 2015

Another religious brusher/flosser with terrible mouth genetics here. Sometimes it's just the luck of the draw. My teeth are actually not cavity-prone--it's that my gums just hate my teeth, and vice versa, and therefore want to die. No matter what. All of my relatives are the same.

Honestly? We all just get dentures at alarmingly young ages. Full-mouth implants eventually became MORE cost-effective for my mother than the endless root canal/gum grafting/bone grafting circus that was otherwise going to be the entire rest of her life. It's still really really expensive, but I imagine that will change in the next couple of decades.
posted by We put our faith in Blast Hardcheese at 9:16 PM on March 9, 2015 [2 favorites]

I'm sorta like you... If I do *All The Things* I can decrease (but not eliminate) cavities. My super nice dentist said my teeth and gums look great, some people are just prone.

I'm with Jessamyn though... My siblings and husband were all exposed to fluoride as infants (oral drops, water supply) and none of them have ever had a cavity. I didn't get fluoride until I was a toddler.
posted by jrobin276 at 9:19 PM on March 9, 2015

I took my three kids to the dentist today and he recommended a prescription flouride toothpaste for one of them. Maybe when you get a non-asshole dentist you could ask them about it?

Also want to add to the pile that it's way more genetics than you thought. My husband takes care of his teeth so well and always gets a 'so-so' at the dentist. I have horrible, horrible, horrible habits and the same dentist says 'looks good!'. Genes.
posted by 58 at 9:20 PM on March 9, 2015

Get another dentist. Ask older folks you know (50s/60s, who take care of their teeth) for recommendations. I love going to the dentist. It's like a spa treatment to me. But dentists do have to sell the services to you more than other health care providers, and one of their sales tactics is to make you feel bad about yourself. If you are left questioning your hygiene, you might not be thinking too critically about all the treatments being pushed. And I say this as a person who loves dentistry. Find a new dentist whom you trust and like.

Also - all your efforts are not for nothing - you sound very kissable! Keep it up!
posted by stowaway at 9:23 PM on March 9, 2015 [1 favorite]

Mod note: Hey there, Angel de Lune, just to let you know, AskMe isn't a venue for a back-and-forth discussion. You've asked your question; now people will answer, and you can mark the ones you find most helpful. Thanks.
posted by LobsterMitten (staff) at 9:30 PM on March 9, 2015

While genetics probably play a part in it, there's truth in what Nevin says above.

This is an e-book, but you don't need to read it, just scroll down to the pictures of people and you'll get the idea. Keep scrolling, there's a lot of them. The basic point, though, is that eating "modern" foods, like processed carbs and sugar, is what causes dental problems. There's case after case offered as examples.

If you seriously want to keep from getting cavities, why not avoid processed food for 6 months and see what happens?
posted by MexicanYenta at 9:31 PM on March 9, 2015 [1 favorite]

I've never been a sweets person, I'm a bread person. Seconding bread, pasta, and other carbs, per my dentist. All those carbs stuck in you teeth until the next time you brush break down into sugars pretty quickly.
posted by Room 641-A at 9:37 PM on March 9, 2015 [1 favorite]

I mentioned upthread that pasta, bread, rice and other carbs can cause cavities. Also how frequently you eat will cause cavitieisas well. If you are snacking (rather than eating 2 or 3 meals a day) you may be more prone to cavities.

Brushing one's teeth and flossing kind of helps, but what you eat, and when you eat is more important.
posted by Nevin at 9:48 PM on March 9, 2015

2nding brainmouse that if you had bad work done in the past, it can have a knock-on effect. A dentist might not recognize this because they're not thinking too deeply or because they're not experienced enough to have seen this pattern over a number of patients. (Or more uncharitably, they might be loathe to undermine a colleague's work/their profession.) Keep looking for a dentist; agree with getting a dentist at least in mid-career. Ask for recs.
posted by cotton dress sock at 10:01 PM on March 9, 2015

Oh sorry. Seconding your current dentist also.
posted by cotton dress sock at 10:06 PM on March 9, 2015

Do you have a dry mouth? Some medications will have a dry mouth as a side effect and some people just have a dry mouth naturally, but I've been told by two dentists now and a vet that a dry mouth is the #1 cause of cavities in humans and animals.

I'm on high-flow oxygen and even though it's blowing into my nose and not into my mouth, it hits the inside of my mouth continously and my teeth are just about gone now; in fact, I'm getting what's left of them extracted in the next few weeks and dentures to replace them, which is not exactly thrilling me. But when I wailed to the dentist that I work SO hard to keep my teeth in good repair and they just disintegrate anyway, he said it's because of the dry mouth caused by the oxygen. And he said that many people are on meds that cause the same problem.

I'm sorry - I feel your pain.
posted by aryma at 10:07 PM on March 9, 2015 [2 favorites]

Oh, and I forgot to mention that GERD - acid reflux - can be a quiet source of tooth decay also.
posted by aryma at 10:08 PM on March 9, 2015 [1 favorite]

Best answer: My partners mom is a dental hygienist with moving up on several decades of experience. Any question like this, she'll instantly shut down the discussion saying it's just genetics and luck of the draw. Some people never get cavities and are more prone to gum disease, and some people get cavities but almost never get gum disease. It's a give and take. All the dentists she's worked with agreed with that.

Two siblings can grow up in the same family, in exact the same conditions, eating the same food and everything and one will get tons of cavities and the other wont. I've seen it happen in several families, and she's seen it happen in hundreds. I've even seen it move to the sibling that constantly has problems getting really methodical and having a regimented care routine and still just having endless decay, while the other sibling stops brushing their teeth more than once a week and never has any problems despite that.

I have a feeling this is one of those things like the gut bacteria-obesity link where in 20 years or less it'll have just been definitively proven.

It sucks, but it really seems like for a non zero number of people you can do everything right and still just have endless problems with this.
posted by emptythought at 10:37 PM on March 9, 2015 [7 favorites]

I have pretty poor oral hygiene, and only recently have brushed more often than not at night. there was a period when I would wake up from hunger in the middle of the night for a sugary snack and go back to bed without brushing. I'm pretty sure I don't have cavities.

The one thing that sets me apart is that I drink a ton of water, key element: sipping throughout the day. Water neutralizes acidity to a certain extent, and drinking is like rinsing, which is a poor substitute for brushing. So, get used to drinking water and my favorite -sipping on cups of artificially sweetened tea. Hope this helps!
posted by kinoeye at 10:44 PM on March 9, 2015

Best answer: I hear you, this is frustrating. I have crappy teeth and take more diligent care of them than anyone I know. Now my 13-month-old daughter, who we hold down to brush her teeth every night, and who has never had juice or a bottle in her life, is getting cavities, too. It's maddening. I think it's a combination of different things:
  • To a certain extent, cavities are subjective. In my experience, dentists with digital x-rays pick up more and earlier cavities. Some dentists are more conservative, willing to wait and see if a cavity progresses to something. Others are more aggressive and want to fill and drill everything. I drive 2 hours to see my childhood dentist, who is extremely old school and conservative and doesn't want to put in fillings if it's not absolutely necessary because that can cause problems down the line.
  • Dental work can lead to more dental work. Fillings--both composite and amalgam--fail over time, necessitating drilling deeper to repair. Composite fillings can mess up your bite. Sometimes food gets trapped under a poorly-smoothed filling and causes decay. And any time you go in there and drill, you risk inflaming the nerve, which is how I ended up with two abscesses and two root canals right after I got fillings in teeth that had never bothered me before.
  • This nasty asshole. S. mutans is an infectious disease. Not everyone has the right bacteria in their mouth to cause cavities in the first place.
  • Bruxism/grinding. This is a big one for me. I've had dentists casually mention that my wear on my back teeth looked like it was from grinding but no one ever suggested that it might be the cause of my decay, which has only ever been in my molars, often over and over again in the same teeth. I recently did some research and it turns out that bruxism can cause cavities. Whoops. I don't grind my teeth to my knowledge, but I do clench and it's only recently, after a period of stress and an aching jaw, that I've realized how bad it is.
  • Diet. You can go down a long rabbit hole of the Weston A. Price diet/holistic dentistry and curing tooth decay naturally. Vitamins K2 and D are especially important. I'm adding fermented cod liver oil and grass fed butter to my diet and my daughter's diet, because I figure it can't hurt. I've definitely been d-deficient during times in my life and apparently people who don't eat a lot of animal proteins (vegans) sometimes have worse teeth.
There are things you can do for some of this: finding a conservative dentist who you trust is key, you can get a custom mouthguard off amazon for pretty cheap if you grind your teeth, you can take supplements, make dietary changes, get prescription toothpastes like gel kam and try something like mi paste to remineralize your teeth. But it's a balance, I think. I wouldn't be happy if I were going to never eat another clementine or handful of jelly beans as a snack, if I were to brush 4x a day instead of two, and I doubt it would help that much, anyway.
posted by PhoBWanKenobi at 10:45 PM on March 9, 2015 [7 favorites]

Oh! Also, look into your diet. I think it's pretty conclusive that diets rich in animal fat and protein prevent cavities, while diets rich in refined carbs promote them. IIRC, they did a study on a a traditional style hunter gatherer population, and the people didn't brush their teeth yet had amazing teeth. It was only the introduction of refined carbs to these societies (including a population in Japan I think?) that coincided with cavities.
posted by kinoeye at 10:49 PM on March 9, 2015

Find a dentist who trusts you about home care.

Look into the hormonal issue if you are a woman; I too have chronically bad teeth and when I was pregnant I was getting cavities and infections EVERYWHERE and especially along the gumline. My hygienist said this is absolutely typical for pregnant woman who I guess get all kinds of swelling and for some people this causes serious problems.

Get cleanings every 3 months instead of 6.

You're doing enough. Keep at it. A lot of people are like this and you're not alone. I have great home care too and every tooth in my mouth has a cavity. I've even lost a tooth. It sucks, but it's what I got. I just have to keep up with my home care and let the dentist fix what gets through the cracks.
posted by annekate at 11:00 PM on March 9, 2015

Looks like they're still working on the caries vaccine, but keep your eye out for it!
posted by aniola at 12:29 AM on March 10, 2015

Hello, fellow cavity sufferer.

Like you, I take religious care of my teeth, and I still get cavities on a fairly frequent basis. It wasn't until I moved to the UK and talked to a private (and awesome!) dentist there that I got the following information:

Cavities can be very genetic. It might have to do with the pH of you saliva or the composition of bacteria in your mouth. You can brush your teeth three times a day, floss, and not eat any sweets and still get cavities. This doesn't mean that you might as well give up, but it does mean that some people, like us, just have to be a Perfect 10 on dental hygiene if we want to keep our teeth.

I use a special prescription toothpaste. If you're in the US, it's likely that your toothpaste has a lower concentration of fluoride than the average that you find in the UK. To really prevent cavities in those of us who are high risk, you have to get a super-fluorided toothpaste. I get Colgate's Duraphat 5000 (that's 5000ppm of fluoride). It's pricier than normal toothpaste, but I've been on it for a year now and I think it's kept the level of cavity decay down.

I've also changed my brushing and flossing habits. I used to rinse my mouth with water after brushing, then floss, then rinse with a fluoride mouthwash. It turns out that all this rinsing was washing out all the fluoride from my toothpaste, thus making my hygienic routine useless. Nowadays I rinse first with water (to get out the chunks of food between my teeth), then I floss, then finally I brush with Duraphat. I don't rinse with anything (no more fluoride mouthwash, because the fluoride concentration is lower than that of my toothpaste) , and I try to make sure the toothpaste doesn't bubble or foam in my mouth at all when I brush. That means no wetting your toothbrush pre-brushing. I just spit out the toothpaste afterward, so I can feel a thin film of toothpaste on my teeth when I'm done.

I also brush with regular toothpaste right after lunch, and floss if I feel that there is food stuck. If I can't reach a toothbrush, I chew Xylitol gum for about half and hour.

I drink my coffee without sugar and artificial sweeteners, so it's just milk and coffee (the milk makes it less acidic). I don't have any soda at all, and I try to minimize snacking. Snacking without brushing is one of those things that also puts you into a higher risk category for cavities.
Apparently fruits are also high acid and can cause enamel erosion, so it's recommended that you wait for 20 mins after eating fruits or drinking acidic drinks (like soda, wine and coffee) before you brush. Otherwise, you're actually brushing when your enamel is being softened by the acid, which can exacerbate your cavity-prone situation.

Anyways, that's what I do, and that's what I was told. I know it seems unfair, my wife can eat and snack on whatever she wants and she's only ever had one cavity in her life, whereas I get about one per year now. Some of us just have to deal with the fact that we're naturally a higher risk category, and we have to keep up or change our routines.

Maybe try a better toothpaste and changing your ritual? If you are a foamy brusher or if you rinse afterward, don't! Making those changes has made a difference in the amount of cavities I have.
posted by the_wintry_mizzenmast at 2:39 AM on March 10, 2015

I hope your current dentist is less judgy and lecturey! Dentists, of all people, ought to know that whether you have perfect teeth or a mouthful of cavities has a lot to do with the luck of the genetic draw. Don't give up on finding a dentist who believes in customer service!

Have you been checked for GERD/acid reflux? My dad had a lot of problems with gum disease and tooth decay, and once he got his severe GERD and ulcers treated, his teeth became much healthier too. The acid backwash in his mouth was eating away at his teeth.
posted by Rosie M. Banks at 4:38 AM on March 10, 2015

I didn't notice any posts while skimming mention this... Calcium bicarbonate. A toothpaste with a decent amount added(arm & hammer maximum baking soda is what i use) will bond to the calcium in your teeth and even repair minor cavities. It's miracle stuff. Toms makes a baking soda mouth wash too.
Also flourosis. This is what happens when too much flouride is put on the enamel on teeth. It actually starts to eat it away and will significantly reduce the shine of enamel and leave you prone to cavities. Google it. Also flouride was originally used after the discovery of "Texas teeth" which was caused by Calcium-Flouride. If you check the ingredients on your toothpaste and mouthwash you will see it is not this chemical compound and is either sodium flouride or the other long name one i forget. I do not doubt that flouride bonds to enamel and helps. The effectiveness of the chemicals used today in water and toothpaste i do doubt how effective they are.

Also genetics is huge. Also my mom said she started taking vitamin d3 and this helped her teeth. It helps with the absorption of calcium immensely. The same as the suns Rays which also contain the true vitamin d we need for this process. 50% of organ failure is caused by calcium build up in organs caused by the lack of vitamin d.. just a side note.

I do use fluoridated toothpaste and alcohol based rinses. I switch them up daily with more natural products as well, like Toms baking soda wash and neem toothpaste(sans-flouride). Please use baking soda somewhere in your regimens. Good luck with your teeth!. Flouride rinse twice a day is probably over kill with regular toothpaste use. Those little new floss tooth picks are awesome and water picks are cool too. Get the softer picks also, not the hard plastic ones.
posted by bfease at 4:40 AM on March 10, 2015

Novamin is a compound that helps remineralize and rebuild enamel. It's in toothpastes in Europe but hasn't made it through for approval in the US yet. It's available imported from Europe via Amazon.

I got it for my husband who is very prone to cavities and grew up just east of where you are now, along with a Sonicare he is religious about using at least once per day. He's been cavity free for a year now. We also moved to the eastern seaboard so the water etc. are different, but it might help you too.
posted by bookdragoness at 6:38 AM on March 10, 2015 [1 favorite]

There is a theory espoused by Dr. Gerald Judd that there is a continuous cycle of demineralization and remineralization of teeth. He believes that the glycerine in toothpaste blocks the remineralization. He recommends brushing with soap, not toothpaste. Also, he thinks flouride is terrible.

For decades I had terrible tooth sensitivity. Even though I used sensitivity toothpaste, if I ate anything acidic (fruit, pickles) I could not even brush my teeth because of the intense pain.

I heard about tooth soap and after 3 weeks I can eat fruit, pickles, sauerkraut.

I do not know if it would help with your cavities, but it seems like more remineralization might mean fewer cavities. I have not had any cavities in the 5 years that I have been using soap (just deteriorating existing fillings and crowns). Also, my gums seem to be getting better.

This is a tooth soap I like. I like the mint and hate the clove.
posted by H21 at 7:21 AM on March 10, 2015 [1 favorite]

Just wanted to offer my sympathies. I am also 29 and while I have excellent dental hygiene, I also constantly get new cavities. It's so unfair.

Things I've been told to do: sip water while eating ANYTHING sweet, EVEN FRUIT. Brush after lunch. Use prescription fluoride toothpaste. Use "MI PASTE" calcium and fluoride paste. Never, ever eat sweets or drink soda.
posted by Cygnet at 7:34 AM on March 10, 2015 [1 favorite]

Do you have your wisdom teeth? I have three wisdom teeth and decided not to get them removed because they all came in pretty much without a problem. I am now finding that they are causing my other teeth to move a bit, mostly closer together. I eat healthy and while I haven't always been the best about flossing, I never developed a cavity until my wisdom teeth came in. My dentist, whom I trust and who has not led me astray before, says the cavities are caused by my teeth cracking due to the pressure of the wisdom teeth shoving them around.
posted by Urban Winter at 7:49 AM on March 10, 2015

I also sympathize.

Things that have reduced my cavity train from 5 in a visit to 1 in 10 years:
- bite guard for night - I have a custom one because it's more comfortable to me, but a cheapo one you kind of mold to your mouth works, too
- very, very little soda
- very little fruit outside of meals
- lots of water
- prescription toothpaste - this has worked better than act fluoride rinse did
posted by Ms Vegetable at 7:55 AM on March 10, 2015

Here's how to choose a dentist: are there big, glossy ads for them all over town/TV with headshots showing their perfect white teeth and taglines like "We're in the SMILES business!"...? They are not your dentist. When you go in does the lobby look like a set in a Kubrick film? They are not your dentist. Do they discover that they need to do another crown every single time you go in there? THEY ARE NOT YOUR DENTIST. I lost one tooth to a crown-happy freakshow like this and fled after she discovered another molar in dire need of crowning. Never again. This was like five years ago and the needful molar is still in my head, unmolested, because I switched to university faculty practice. They operate out of a secret lair deep in the dental school that nobody knows about. They don't advertise. They don't have a massive office staff that gives you an appointment card and then mails out reminders--you have to remember, yourself, because they aren't paying anybody to remember for you. The lobby is a room with some unassuming lobby chairs in it and a poster or two from 1986 and 10-year-old carpet. They don't need to flog teethwhitening or do unnecessary crowns in order to pay for billboards. Consequently, I spend a whole lot less money, I have many more of the teeth I was born with, and my dentists are the same people teaching dentistry to the next crop of dentists to come out of the school, so I'm pretty sure they're on top of any new dentistry developments. If you don't happen to live in a community with a big university dental school, visit several dentists before you let anybody drill. Find the most conservative one in town.
posted by Don Pepino at 7:56 AM on March 10, 2015 [6 favorites]

Adding my sympathies. Nthing perhaps it is genetic. I have never had a cavity at 46 years old. Believe me, it's not super oral care -- sure I brush (with a regular brush) and floss (most of the time) but I am not super careful about it. My dentist has told me I am just lucky and it's my genetics. (I do have a major crown -- since I chipped a tooth in half -- so not super lucky.) My partner -- who is a much better flosser -- and uses a Sonicare all the time -- gets cavities.
posted by Lescha at 7:59 AM on March 10, 2015

Happens to me too. I have soft teeth, always have, always will. I do all those things you talk about.
posted by Jewel98 at 8:46 AM on March 10, 2015

Best answer: nth-ing genetics. Not your fault.
Also, another vote here for MI Paste Plus fluoridated toothpaste. It's like a mini-fluoride treatment at every brushing, plus correctly balanced bio-available calcium/phosphate for your tooth enamel. It's been incredibly helpful to me, I get it from my dentist. Even available on Amazon.
posted by k8oglyph at 9:06 AM on March 10, 2015

My sister and I never, ever got cavities but my little brother gets them all the time. Our dentist guessed that it was because he had had a fever at some certain age when he was a baby (my mom confirmed.). Apparently a badly timed fever can spoil your enamel for life.
posted by BusyBusyBusy at 9:28 AM on March 10, 2015

oh man, seconding Don Pepino's advice on choosing a dentist. I tend to go to dentists whose degrees are from impressive programs but whose offices are, like, a couple of rooms above a CVS. Sure, I'm still probably paying for the dentist's boat, or their kids' college funds, but somehow those don't necessitate the high-intervention hard sell that recurring ad costs and skyrocketing rent seem to.

The first thing I say to any dentist: I have never had cosmetic dentistry, and I don't want it; I just want my teeth to chew food and not hurt. If they seem even the slightest bit grumpy about that, I bail.

My current dentist and I joke about how we both grew up poor, and she readily admits that while she does a lot of adult braces, they would likely be a pointless intervention at my age (whereas every. other. dentist. I've been to has tried to sell me on cosmetic braces). I don't even think she does veneers or any of that stuff. And my teeth and gums are doing better under her care than they ever have before...not least because I actually GO to see her.
posted by We put our faith in Blast Hardcheese at 10:05 AM on March 10, 2015 [2 favorites]

I haven't had a chance to read all of the responses, but I wanted to suggest something that has completely changed my life (well, my dental life anyway): the gum stimulator.

My dentist gave me one of these about a year ago, to clean a specific section of one of my molars where there was some recession (and therefore a tiny hole that food was getting into). After a few weeks, I started using it after flossing/brushing to gently wipe along the gum line of all my teeth. My dentist hadn't suggested this use, but I just started doing it one day. I couldn't believe how much thick sticky clear gunk was coming up as I used it. I just run the tap and rinse this stuff off of the stimulator after it accumulates a bit on the tip.

At any rate, when I went for my first dental cleaning after starting this regimen, the hygienist couldn't believe how clean my teeth were. I guess using this thing before your plaque hardens makes a huge difference. I didn't really have a problem with cavities before, but there used to be a bunch of hardened plaque for the hygienist to clean off..... now there is hardly anything. So it could help you if you tried using it.

It usually only takes me about 2-3 minutes extra in the evening. I actually find it really satisfying to get all that gross stuff off my teeth. I thought I was getting my teeth clean before, since I floss and brush properly every night. But I was surprised at how much gunk is still left on the teeth afterwards.
posted by barnoley at 10:36 AM on March 10, 2015

Best answer: Some ideas.

Do you have sinus problems or mouth breath when you sleep? Your mouth drying out at night can increase cavities?

Do you grind your teeth at all? Are you sure? I would have sworn black & blue I didn't tooth grind but it turns out when I'm stressed I do in my sleep. While it hasn't done huge direct amounts of damage with direct grinding wear and tear it does weaken/crack the enamel so I am more prone to cavities.

You can get at home fluoride treatments & also sealers put on your teeth which may help.
posted by wwax at 10:41 AM on March 10, 2015 [1 favorite]

Best answer: Has anyone mentioned Sjogren's Syndrome to you, yet? It's a not exactly rare autoimmune disease in young women (Venus Williams has it) -- your body attacks moisture producing glands, usually saliva and tears are what people notice (in my case I didn't feel like I had a dry mouth but my saliva had turned acidic). The road to my diagnosis was bumpy because of shaming about oral health care. I went from having no cavities at age 27 to what my dentist called (not to my face!) "meth mouth" at 28. It was totally insane; my teeth began sort of slow motion crumbling and my dentist just smirked and smirked and smirked. I only got to the root of the problem when I went to my rheumatologist (MD). They do blood tests and salivary gland biopsies to diagnose this. The Sjogren's Foundation has a list of friendly dentists available via their hotline - I bet that would be a resource to you regardless. Those dentists tend to be health focused.

What helps Sjogren's people is toothpaste, mouth wash and artificial saliva for dry mouth (dentist words: Xerostemia or Sicca Syndrome -- but don't quote me on that). Plus deep (periodontal) cleanings every three months. Lately I've been going in ~once a week to try to stay ahead, after avoiding stuff for a long time. I hope this isn't your problem but a nurse telling me about it probably saved my teeth!
posted by sweltering at 11:16 AM on March 10, 2015 [1 favorite]

I would also like to suggest xylitol. It actually inhibits bacteria growth by staving it, which cuts down on plaque. When I use it regularly it keeps my mouth feeling so much cleaner.

I use a toothpaste with xylitol and fluoride and eat xylitol mints after meals. Sometimes I also add a tablespoon of granulated xylitol to a big jug of water which I drink through out the day. 6-10 grams per day is the suggested amount for dental uses.

posted by Shanda at 11:28 AM on March 10, 2015

Oh and there are absolutely medications to help! I take Salagen which does exactly what it sounds like. My now-dentist is really impressed by how it's improved my dry mouth as well as keeping the saliva better balanced. The first week you drool but this is a small tradeoff. I have been told it works for anybody with dry mouth, saliva not right somehow or Sjogren's. I know there are two others but they interact with my medications somehow undesirable. I'd really suggest going to an MD, re: sicca syndrome, dry mouth (xerostemia - Also? I denied that my eyes were dry when they tested me for that and it turned out I had no tear production) or Sjogren's. Mine got so bad I got a jaw infection and lost three teeth. Don't be avoidant like me. This could be your whole system.

Oh, and the oral surgeon I ended up with, a specialist in these things, was able to bill my medical insurance because it was systemic. That was huge and I got better care.
posted by sweltering at 11:33 AM on March 10, 2015 [1 favorite]

Have you tried drinking more water? Since I was a baby, I've always required much more than average drinking water, which in turn keeps my teeth strong. Drinking more water keeps the saliva flowing, and saliva has calcium and other minerals that keep teeth strong.
Can't hurt to try. Keep a water bottle next to you and make sure you are sipping it in addition to your normal liquid consumption.
posted by Neekee at 12:50 PM on March 10, 2015 [1 favorite]

Just nthing what emptythought said - my sister and I grew up in the same household, eating the same things, brushing/flossing/mouthwashing consistently, and I've never had a cavity in my life. She came back from the dentist two weeks ago with twelve cavities. That's the worst it's ever gotten for her, but she almost always has at least one cavity if not several at her six month dental check ups.

She and I both also have issues with drymouth, due to medications we take. And we both use drymouth-specific dental hygiene products to combat it. So, no guarantee that even if you have dry mouth (as an explanation for the continued cavities) it can be 100% resolved with something like Biotene or Therabreath.

My recommendation would be, if you can afford it or if you have dental insurance that covers it, go to the dentist 3 times a year. My dentist has recommended this for me and has said it really should be the standard of care. In addition to everything else you're doing, a little extra monitoring from the dentist may go the distance in keeping this at bay. (Oh, and shop around for another dentist, of course, because yours sounds a little too judgmental - and unhelpful - to be seeing three times a year!).
posted by nightrecordings at 7:31 PM on March 10, 2015

Mostly here to sympathize. I have excellent teeth but my gums have been inexplicably melting away for the past decade, starting in my mid-30s. So I may eventually have no teeth anyway. My dentist extolls the virtues of the proxibrush, which is part of my daily routine along with flossing, of course, and the sonicare (sensitive brush!) I also use the MI Paste mentioned above, as recommended by my dentist and periodontist. And the Pronamel, not the whitening kind of course. Waterpik with salt water to rinse. My bedtime brushing routine takes about 20 minutes, morning is faster, just brushing and waterpik. I go for professional cleanings every three months. Good diet, I exercise, I'm in good shape. Your basic boring healthy lifestyle. This is keeping my gums healthy-ish for the moment, though the recession marches on and the gaps between my teeth are pretty horrendous.

I, like you, spent lots of time feeling really bad and judged and like I wasn't doing anything right. No one in my family but me has these shitty gums. But at this point, after almost a decade where I have never once missed a day flossing or brushing, where I have semi-routine scaling and root planing and I've experienced the delights of gum grafts I have mostly given up and realized that if my teeth fall out I've done all I can. I'll probably be happy to move on to dentures even at a relatively young age. You can only do so much. Hang in there.
posted by Cuke at 7:42 PM on March 10, 2015

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