What causes cavities?

When a team of archaeologists recently discovered 15,000-year-old human remains, they made a fascinating find. The ancient humans had teeth riddled with cavities, caused by the same tiny microbes that affect us today. These microbes, which we typically acquire from our mothers soon after birth, form communities of bacteria on our teeth as they erupt. Depending on our diet, especially sugar intake, certain microbes can overpopulate and cause cavities.

High-sugar diets lead to an increase in mutans streptococci bacteria in our mouths. These bacteria love sugar, using it as an energy source and building block. As they consume sugar, they produce acids like lactic acid. While mutans streptococci are resistant to this acid, our teeth are not. The acid gradually wears down the protective enamel, leaching away calcium minerals and creating a pathway for bacteria into the tooth’s dentin layer. At this stage, cavities do not cause pain, but as the damage progresses and reaches the nerves, it can become excruciating. Without treatment, the infection can spread, potentially leading to tooth removal.

Ancient humans likely did not indulge in sugary treats, so what caused their cavities? Their diets included root vegetables, nuts, and grains, all of which contain carbohydrates. When broken down by saliva, these carbohydrates turn into simple sugars, feeding the mouth bacteria. Although ancient diets had less sugar compared to modern ones, their teeth were still exposed to sugars. Archaeological evidence shows that around 14,000 years ago, humans used sharpened flint to remove decayed tooth material. They even made rudimentary drills and used beeswax to fill cavities, similar to modern dental fillings.

Today, we have advanced techniques and tools to treat cavities, which is fortunate given our high sugar consumption. After the Industrial Revolution, the incidence of cavities surged due to the increased availability of refined sugar. Currently, 92% of American adults have had cavities. While some people are genetically more susceptible to cavities, high sugar intake is the primary cause for most.

To combat cavities, we use fluoride in toothpaste and water supplies to strengthen teeth and encourage enamel growth. When cavities do develop, fillings are used to prevent further damage. The best prevention methods include reducing sugar intake, maintaining good oral hygiene through regular brushing and flossing, and avoiding sugary, starchy, and sticky foods.

Unlike ancient humans, we have the knowledge and tools to prevent cavities. It is up to us to use them effectively.

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