Oops! Brushing twice a day doesn't keep cavities at bay anymore. Understanding the mysterious ways of tooth decay.

We've all heard the age-old advice from our dentists and parents: brush your teeth twice a day to keep cavities away. And for the longest time, it seemed to work like magic, giving us the confidence that our dental diligence was a fortress against tooth decay. But lately, something peculiar has been happening – despite our dedicated brushing routine, cavities seem to be sneaking in uninvited, leaving us scratching our heads and wondering, "What gives?"

In this article, we delve into the surprising reasons why brushing twice a day might not be the foolproof defense we once believed. From hidden sugars in unexpected places to the impact of our modern diets and lifestyle choices, we uncover the unsuspecting culprits behind tooth decay's covert operations.

But fear not, for armed with knowledge and a dash of dental savvy, we can reclaim our smiles and tackle tooth decay head-on. Along the way, we'll discover lesser-known brushing techniques, clever dental hacks, and oral hygiene superheroes to fortify our dental defenses.

1. YOU'RE BRUSHING THE WRONG WAY

As little kids, we used to be told that brushing hard and for a longer time will help keep our teeth white and the germs away. Turns out, there isn't much awareness among people about good brushing habits. Brushing should be done for 2-3 mins.

Amongst several methods of brushing techniques, the most commonly recommended technique is the Modified Bass method. In this, the toothbrush is held at 45 degrees to the gums so that the bristles contact both gums and the tooth. Then, the outer surfaces of 2-3 teeth are brushed at a time using short vibrating back, forth and rolling motion. Move to the next few teeth and repeat. For the inner surfaces of the back teeth, the same is done. When you approach the inner surfaces of the front teeth, the heel of the brush is positioned in a vertical, tilted angle to gently remove the debris away from the junction of the gum and the tooth in up and down strokes.

In addition to this, regular usage of floss and an effective mouthwash should be done.

2. CONSUMPTION OF SODA, SWEETENED BEVERAGES OR WINE

The pH of most commercialized soft drinks is less than the critical pH below which the demineralization of enamel occurs. These carbonated drinks contain high amounts of citric and ascorbic acids that increase the titrable acidity of the drinks. The significant alcohol and acidic content of wine have its own deleterious effects on teeth. These factors lead to the dissolution of enamel and the gradual erosion of the outermost layer of the teeth. This results in the exposure of the dentinal tubules and an easy access to the microorganisms. 

Sweetened beverages have loads of caloric sweeteners which bacteria and other microbes feed on and provide a suitable environment for them to grow and form colonies. 

3. GENETIC PREDISPOSITION

Studies have shown that there are several genetic factors that play a role in the development of dental caries. Researchers have discovered a list of genes that may increase the risk of decay and erosion of teeth. An individual may be more prone to tooth diseases in such a case despite taking sufficient care of teeth and making routine visits to the dentist.

4. DRUG ABUSE AND SMOKING

Be it cannabis or tobacco smoking, a strong association has been established with the development of caries. Smokers have repeatedly shown taste alteration that may increase their threshold for sweet taste and increased sugar consumption, low dental attendance, sporadic toothbrushing, stress and biological changes such as decreased salivary flow rate, variations in salivary lipid levels and reduced salivary buffer capacity. All these factors contribute to higher number of cariogenic bacteria in the oral cavity and eventually become of the reasons why the patient's tooth undergoes decay.

5. DRY MOUTH

Xerostomia or dry mouth is a condition where there is decreased salivary flow in the oral cavity. This brings in a lot of other problems such as impairment of speech, swallowing, burning sensation because of irritation of mucosa to name a few. A lack of saliva causes proliferation of acid producing bacteria thereby increasing the acidity in the oral cavity with the inadequate amount of ions to buffer the acidic pH. This leads to irreversible loss of minerals from the enamel and loss of lubrication.  A dry oral cavity gives rise to many opportunistic infections like candidiasis, etc making the teeth more prone to dental caries. 

6. MALALIGNED TEETH

Rotated or crowded teeth make it hard for the toothbrush bristles to reach the interdental areas. A dentist may perform routine scaling but that doesn't guarantee removal of food debris and microorganisms from between all the teeth. Flossing will help removing these debris but not plaque and calculus. Care has to be taken to maintain oral hygiene, even more during orthodontic therapy.

7. ACID REFLUX OR GERD

In people who have acid reflux disease, erosion of teeth is most commonly seen. This entirely destroys one or more surfaces of enamel. Enamel is an absolute factor in the protection of teeth against dental caries. Destruction is mostly seen on the palatal or lingual surfaces of teeth. This gives way to the microorganisms to reach the dentinal tubules and development of caries takes place. 

8. FAULTY OR OLD DENTAL RESTORATIONS

Faulty or old dental fillings may have an improper seal with tooth matter or leakage underneath them. This may lead to accumulation of bacterial colonies and secondary caries develops. Care needs to be taken to maintain these fillings by making a visit to the dentist once in every few months.

9. LACK OF FLUORIDES

Fluorides are essential minerals required to protect your enamel from damage. Lack or inadequate intake of fluorides may be a result of less than optimum fluoride levels in water supply, improper diet, wrong toothpaste, etc. Fluorides act by binding to the hydroxyapatite crystals in the enamel matrix and form a compound called fluorapatite that prevents bacteria from attacking the tooth. Deficiency of fluoride makes it easy for the development of dental caries.

10. EATING DISORDERS

Anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder are a few types of eating disorders that have an impact on the teeth. In the first two types, because of acid regurgitation associated with repeated vomiting, abnormal eating patterns, altered salivary composition and poor oral hygiene contribute to the development of tooth decay.