Hard Facts on Soft Teeth

Over my many years in private practice as a dentist, I’ve heard numerous things. Many times patients will say:

I only have these cavities because I have soft teeth.

On a similar note, I’ve talked to many dentists who have either said or written:

There’s no such thing as soft teeth.

Well, I’m here to tell you that, generally speaking, both of the above comments are correct. You won’t hear other dentists saying this. Let’s look at the whole “soft teeth” issue in greater detail to understand this apparent contradiction.

Soft Teeth is Not a Valid Dental Term

The term “soft teeth” is not a true medical or dental term the way “Type II Diabetes” and “COPD” are. If I pick up one of my textbooks from dental school, there is no mention of the term “soft teeth.” So that’s why many dentists dispute the notion.

decayed teethphoto - not because they were soft

These teeth decayed not because they were “soft” – but because of lack of proper hygiene.

Dentists will also discard this notion because many patients will try to use the “soft teeth excuse” for their cavities when in reality it is due to oral hygiene and/or sugar intake. If you drink 5 cans of Mountain Dew a day and brush your teeth once a week, don’t try to claim your cavities are from your teeth being soft!

But Some Teeth Can Be “Softer” Than Others

So, even though the dental term soft teeth does not exist, some teeth are more susceptible to developing decay than others. Let’s look at one specific example:

soft teeth photo due to trauma leading to cavities

This patient’s left tooth is weaker due to a history of trauma and infection when it was developing. The brown area is much more likely to get a cavity.

In the above case, the tooth on the patient’s left is weaker and “softer” than the right one. It is intrinsically weaker.

How did this happen? When the patient was younger, he suffered trauma which damaged a baby tooth. The trauma led to an infection of the baby tooth which then traveled directly up to affect the developing adult tooth. The tooth came in like this – and is clearly weaker than the one on the right.

So What Makes Teeth “Soft?”

A tooth can be “soft” if some unusual event occurs to disrupt normal development. The development of a tooth is a complex and coordinated process any many things can disrupt it. Examples include:

  1. Trauma, dental decay, or other factor leading to an infection of the baby tooth preceding the adult tooth.
  2. Fever, even for a short period of time.
  3. Malnutrition leading to vitamin deficiencies.
  4. Hormonal imbalances.
  5. Certain rare genetic conditions.
  6. Systemic consumption of fluoride at extremely high levels (> 5 ppm).
  7. And other factors (usually quite rare).

The key point here is that for any of these events to have an effect on the softness/hardness of the teeth – the disturbance must occur WHILE the teeth are developing.

Here is another photo of teeth which are weaker due to an unusual event which occurred during development:

teeth with fluorosis photo showing soft teeth

These teeth are “softer” or higher risk for decay due to excessive fluoride consumption when the teeth were developing.

The above photo illustrates one example of what can make teeth weaker or “soft.” In this case, an unusual occurrence (excessive systemic fluoride consumption) during tooth development led to mottled and pitted enamel – which is much more likely to develop decay.

The Hard Facts

So, many of you now might be wondering: am I getting all these cavities because I have “soft” teeth?

The answer is: probably not.

Why, you may ask?

  • First, as mentioned above, for teeth to be “soft” or weaker, something needs to have happened when the teeth were developing. Except for wisdom teeth, your teeth are done developing around age 14. So, unless one of the above things occurred before age 14, your teeth are not intrinsically weaker.
  • Second, in nearly all cases, your teeth will appear different. The teeth may have brown spots, chalky spots, banding, or other unusual appearances. If your teeth look normal – and your dentist has never mentioned any unusual findings – your teeth are most likely not “soft.”

Many people incorrectly believe that certain events can cause their teeth to become “soft.”  These include pregnancy, breastfeeding, a diagnosis of diabetes as an adult, new allergies, and many other occurrences.

So, if you’re developing cavities, they are most likely from diet and/or hygiene. Developing “soft teeth” later in life is a myth.

Graphic Effects of Sucking Fentanyl Patches

As a dentist, I have seen many patients over the years who have abused heavy drugs. In many of those cases, their oral hygiene took a back seat to their addiction, and their teeth and gum tissue suffered as a result. Nearly all dentists have seen cases like this:

Photograph of decayed teeth from a drug addict of opiates percocet and vicodin

This patient suffered from narcotic addiction for many years. This led to extreme teeth decay as seen above.

Graphic photo of rotten teeth from years of narcotic and opiate drug abuse

The same patient as above.

I had a very long and candid conversation with this patient who opened up to me about his past. In addition to abusing prescription painkillers such as Vicodin, Lortab, and Percocet, he also admitted to sucking fentanyl patches. He said that he would feel the effects almost immediately upon putting the patches in his mouth.

On exam, the broken down, rotted teeth did not surprise me – I had seen that many times before. What was surprising were the linear lesions all across his palate (the roof of his mouth) as seen here:

Photo and picture on gums from sucking fentanyl patches

Linear patches on his palate on one side only. This is where he used to suck the fentanyl patches. Clicking on the image will yield a larger, high resolution version.

I had never seen anything like this before over my entire career. Are these lesions scar tissue from the constant placement of fentanyl patches against the soft tissue in the mouth? It is hard to tell. I have shown these photos to several colleagues and no one has seen anything like this before.

Regardless of the origin, it is safe to say that chronic abuse of narcotic painkillers – consumed orally or by sucking on them – can have disastrous results for both the teeth and the soft tissue of the oral cavity.

7 Habits of Highly Effective Brushers

I get tooth brushing questions all the time from my patients in private practice in Orange, CT. What toothpaste should I use? Should I listen to Dr. Oz? Am I brushing too hard? Should I brush after every meal?

After many years of observations, the following was born: The Seven Habits of Highly Effective Brushers.

1.  They use a Power Toothbrush

Power toothbrush used by highly effective brushers as observed by Orange, CT dentist Nicholas Calcaterra DDS

Oral-B Toothbrush with a timer

Electric toothbrushes, if properly used, are far more effective in removing plaque and other debris than a manual toothbrush. Regardless of the brand used, the vibrations and movements produce cleansing actions that cannot be reproduced manually. Removal of more plaque and tartar reduces the likelihood of gum disease and dental decay. The most effective brushers I have encountered always use power toothbrushes.

Besides cleaning the teeth more effectively, power toothbrushes also can have other important features. One is a timer indicating you should move to another area of the mouth. Another feature tells you when you are brushing too hard. This is especially important as brushing too hard is addressed in Habit #5.

2. They ask for personalized feedback from their dentist or hygienist

I spent 9 years after high school training to become a dentist with 5 years focusing primarily on the oral cavity. Dental hygienists spend a minimum of 2 years after high school studying the gum tissue and supporting structures. Your dentist and hygienist know more about the oral cavity than your physician, Dr. Oz (see Habit #3), WebMD, or any other resource.

Highly effective brushers always ask me or one of my hygienists for feedback.  Certain power toothbrushes are better for some than for others. Some toothpastes are better for decay (cavities) than gum disease and vice versa. We are there to give you information and advice.  Just ask. Your teeth and gums will thank you for it!

3. They do NOT listen to Dr. Oz for dental advice

Dr. Mehmet Oz is a great surgeon but gives bad dental advice

Dr. Mehmet Oz. Image courtesy wikipedia

Dr. Oz is an accomplished cardiothoracic surgeon and TV personality. His training in the dental field is likely limited to the 2 hour lecture on teeth and gums he received as a second year medical student back in the 1980s. But that has not stopped him from presenting some questionable and even frightening solutions regarding oral health.

In his post on home teeth whitening, he suggests mixing lemon juice (an acid) and baking soda (an abrasive). You apply it to your teeth, let it sit for a minute, and then brush it off. In doing so, your teeth will become whiter. But you will be actively wearing away your teeth! This is the equivalent to swishing with Mountain Dew for 2 minutes and then rubbing your teeth with sandpaper!

Highly effective brushers do not turn to Dr. Oz for dental advice. They rely on their dentist and hygienist for professional advice.

4. They don’t brush immediately after every meal

Some people rush to the bathroom after every meal to brush. This is either ineffective or in some cases counterproductive. After an acidic meal, such as one with orange juice, the acids in the juice will have temporarily weakened the enamel. If you rush to the bathroom to brush, you will be slowly brushing away the weakened enamel!  Do this over a period of years and you will have lost enough enamel for the teeth to be permanently weakened.

Highly effective brushers typically brush 2 to 3 times per day, and never immediately after a meal. After an acidic snack, they are more likely to rinse their mouth with water than to brush.

5. They don’t brush too hard

Photo of receded gums from brushing too hard teeth and recession

Gum Recession and abrasions from an overzealous tootbrusher!

Some people think that the harder they brush, the better. Wrong! Brushing too hard can lead to recession of the gum tissue, as seen in the photo to the right. Over time, the tooth loses the critical gum and bone tissue supporting it.

Another side effect from brushing too hard is that you can wear away the outer layer of the tooth. The beginning of this can be seen in the photo on the right. I’ve had patients brush so hard that they wore all the way into the nerve of the tooth so that they needed a root canal!

Highly effective brushers do not brush too hard. This is because they have been properly instructed by their dentist or hygienist (see Habit #2) or they have a power toothbrush which tells them when they are brushing too hard (Habit #1).

6. They use a fluoridated toothpaste

Fluoride has been proven by hundreds of studies to reduce dental decay. The CDC called fluoridation of public water supplies one of the 10 greatest public health achievements of the 20th century. But some still attempt to link fluoridation to a Communist Plot.

A fluoridated toothpaste is much less controversial than public water fluoridation. I can say from my personal experience that people who use a non-fluoridated toothpaste get more cavities. I’ve seen this hundreds of times. Fluoride works. Highly effective brushers use fluoridated toothpastes sensibly.

7. They Floss

Dental floss used by highly effective tooth brushers

Effective Brushers also floss!

The seventh and final habit of highly effective brushers does not deal with brushing teeth. It address flossing.

Highly effective brushers also floss. They know that brushing only cleans 60% of the tooth surface. The other 40% of the tooth can only be reached and cleaned by dental floss or similar device. Without flossing, even the best brusher in the world will still be susceptible to getting cavities (dental decay) as well as gum disease.

Other Habits?

Do you have other ideas on the habits of highly effective brushers? If so, leave a comment!