15 Feb
Close up image of two dental cavities on a single tooth

Why Do I Keep Getting Cavities

If you've ever asked yourself, "Why do I keep getting cavities and what can I do about it?", you are not alone. Cavities can start as a minor inconvenience but may lead to significant oral health issues if left unchecked. It's a common concern that comes across our dental practice, indicating a gap in many people's understanding of tooth decay. The intent of this blog post is to bridge this gap, providing you with comprehensive insights into the why and how of cavities. You'll find the answers to key questions, such as what a cavity is, the risk factors for getting cavities, whether certain individuals are more prone to develop cavities, and why prevention is not as daunting as it appears.

What Is a Cavity?

Cavities are holes in the tooth surface that form due to tooth decay. Bacteria and plaque on the teeth create an acidic environment that causes this decay. The process involves eroding the protective layer of the tooth, known as enamel. Once the decay spreads into the inner tooth, aka dentin, the decaying process moves at a faster rate because the dentin is softer than the enamel.

Let’s simplify this process for illustration purposes: Think of enamel as the hardest substance in the body, akin to glass or ceramic. It is about 96-98 % inorganic in composition. Dentin, on the other hand, is softer. With a mineralization of 70-72 %, the dentin is slightly harder than bone, which is only 60 % mineralized.

To destroy the enamel, bacteria need acid, which melts it away when in contact for a sufficient period of time. So, where do bacteria find this acid? The answer lies in your meals. Every time you eat sugar, the bacteria feast on it and metabolize it into acidic waste products that destroy your tooth. And quite worryingly, they do it all very inconspicuously, so much so that you might not even be aware. Most cavities do not hurt until it’s too late.

Over time, this continuous cycle of acid production chisels away at your enamel, leading to the formation of tiny holes. Initially, these are shallow and superficial. However, if left untreated, they can grow deeper and larger, eventually reaching into the inner layers of your teeth where the nerves lie. At this point, what started as a seemingly minor issue can become a detrimental, painful problem. This, in short, is how cavities form.

Progression of Decay

See how plaque and bacteria that build up on your teeth can progress and ultimately cause decay that places the tooth at risk if left untreated.

What Factors Increase Your Risk of Developing a Cavity?

There are several risk factors for cavities:

  • Poor Oral Hygiene - The more plaque buildup on your tooth, the more bad bacteria available to destroy it.
  • Dry Mouth - Saliva is protective of the teeth and oral tissues. It contains antibacterials and antibodies, as well as buffering (neutralizing) capabilities when the acid load of the mouth has increased.
  • Diet - As you may now understand, any acidic food can erode the teeth, and any sugary food can be broken down into acidic end products. When it comes to diet, the frequency of exposure matters most. So, the next time you have a sugary drink, remember that it’s better to consume it during meals, versus sipping on it for hours between meals.
  • Lack of Fluoride Exposure - There is a lot of controversy around this topic, but fluoride has been praised for having anti-cavity and re-mineralizing effects on your enamel.
  • Dental Restorations - It's no wonder that a mouth full of dental restorations will be more prone to plaque retention and may suffer from more cavities than a mouth with no fillings at all. The more restorations, the longer it takes to clean!
  • Gum Recession and Exposed Root Surfaces - Root surface decay is a completely different issue. If you thought dentin was soft, then the root surface cementum is even softer. It’s only 45-55% calcified. Root surface caries is more prevalent in adults and the elderly.
  • Irregular Visits to the Dentist's Office - Your dentist can pick up on the smallest of cavities on X-rays and recommend ways to reverse them.
  • Orthodontic Appliances such as Braces - It is challenging to brush properly and thoroughly when your teeth are bonded with brackets. A water flosser comes handy in this case.
  • Decreased Dexterity - This factor is associated with the effectiveness of plaque and biofilm removal.
  • Alcohol and Drug use - These habits can impact dental health in multiple ways, one of them being dry mouth.
Model teeth - patient education on tooth decay progression

Am I Prone to Getting Cavities?

One of the most frequently asked questions we encounter is, "Am I at risk for getting cavities?" . The answer is, compellingly, not straightforward as it is contingent on a multitude of factors. Your dentist can help you predict your cavity risk level at your next exam. And he or she can make recommendations on how to best prevent cavities and maintain optimal oral health. Let's dive into this question more thoroughly.

According to the American Dental Association's Caries Risk Assessment Tool , you are at a high risk of developing cavities if you have severe or moderately severe dry mouth (also known as xerostomia), if you frequently consume sugary foods or drinks during and in between meals, if you’ve recently had radiation therapy to the head and neck area, or if you’ve had 3 or more cavities in the last 3 years.

You are at an increased (moderate) risk if you have poor oral hygiene, do not visit the dental office regularly, have a lot of previous dental restorations such as fillings or crowns, wear braces or a partial denture, have a gum recession with root surface exposure, take a lot of medications that may have reduced saliva flow as a side effect, have an eating disorder, and do not have adequate exposure to fluoride through drinking water, supplements, professional application, toothpaste etc.

You are at a low risk if you brush and floss your teeth daily, have regular dental cleanings and exams, use fluoridated toothpaste, eat a well-balanced diet (consume sugar and acidic foods primarily at mealtimes vs throughout the whole day).

Preventing Cavities: It's Easier Than You Think

The good news is that you can easily lower your caries risk from high to low by following your dentist recommendations. Here are the top tips that we provide our patients to help minimize the chances of getting cavities:

  • The first advice you will get from us is to maintain impeccable oral hygiene, and no, there is no way around this. This means brushing your teeth at least twice a day, and flossing daily.
  • Diet modifications: limit your sugar intake and opt for healthier choices when possible.
  • Regular dental check-ups and cleanings are vital. At these appointments, we can identify early signs of cavities and provide necessary treatment to prevent further damage. Moreover, professional cleanings can remove tartar, which is hardened plaque that's especially tough to clean with regular brushing and flossing. For extremely high-risk patients closer monitoring is recommended: bitewing x-rays may be needed more frequently, sometimes every 6 months, and dental exam and cleaning every 4 months. Combating dry mouth, should also be part of any cavity prevention plan.
  • For moderate to high-risk patients, fluoride varnish should be applied at every routine visit. It is advisable to use prescription strength fluoride toothpaste twice a day, in place of the standard over-the-counter fluoride toothpaste.
  • Xylitol candies or gum four times a day will be helpful, as well as prescription calcium-phosphate topical dentifrice, 1-2 times daily. Acid neutralizing rinses such as baking soda rinse (2 tsp in 8 oz water), 4x6 times daily are optional for extreme risk patients.

Cavities can be a nuisance - but they don't have to be. With these tips in mind, you can gear up to fight against cavities and maintain a healthy, sparkling smile.

Your Route to a Cavity-Free Smile

In summary, striving to keep your teeth healthy and cavity-free necessitates a joint effort that includes regular brushing and flossing, balanced diet choices, scheduled dental check-ups and cleaning with your dental team. Yet, the reality of oral health is that almost everyone is at risk of developing cavities in their lifetime. Recognizing your personal risk factors and addressing them promptly and effectively is a crucial component of your dental health journey.

While we all want to wave a magic wand and prevent the emergence of cavities overnight, it's clear that diligent oral care and understanding the role of each risk factor are needed for effective cavity prevention. Remember, your dentist is not just there to treat prevalent oral health issues; they can also provide you with personalized advice and preventive care strategies. If you often find yourself asking why you keep getting cavities, talk with a trusted dental professional about it.

Are you finding yourself frequently dealing with cavities despite your best efforts to maintain oral hygiene?

Wondering if you're naturally more prone to these dental issues? Hopefully this blog post helps demystify the reasons behind cavities and reveal strategies for prevention. If you still have questions or would like to have a check-up and assessment done for cavities, give us a call or schedule a dental appointment online with  Dr. Tufa. Get expert insights from a dental professional that could guide you towards a healthier, cavity-free smile. Don't just ignore the problem— learn, understand, and take control of your dental health today!


Heni Tufa

Dr. Tufa is a general dentist in Acton, MA who is also an Invisalign Provider and certified Botox dentist.