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.

What Does a Cavity Under a Crown Look Like?

As this blog approaches nearly 3 years of age and well over 150,000 views, I am able to see what the more popular dental topics are out there. Currently, the fourth most popular post on this site, clocking in with a little more than 19,000 views (as of July 2015), is Dental MythBuster #9: You can’t get a cavity under a crown.

In analyzing what people search for online, many readers – hundreds that is – searched for some variation of: what does a cavity under a dental crown look like?

I had just finished compiling this information when a long time patient of mine – one who I had been telling for several months now about decay under one of her crowns – called to finally schedule her extraction.

Photos and X-rays of Cavities Under a Crown

In this particular case, the decay was so deep that her only option was extraction (see below for why extraction was her only options). Below is a bitewing x-ray:

dental bitewing x-ray showing decay under a crown

The x-ray shows the definite shadow of decay underneath a crown.

I had first diagnosed this nearly a year ago primarily based on the x-ray. In this area of the mouth – the last tooth on the lower left – the cheek drapes up against the tooth – making it very difficult to see – and very difficult to brush!.

I then removed the tooth. And no, I did not put my knee on her chest! The decay was unmistakable. Upon completing the procedure and having the patient go home, the first thing I thought was: “this will make a great photo for my blog!” So here it is:

high quality detailed photo of extracted tooth with decayed cavity under a dental crown

The extracted tooth in all its glory. If you dare, you can click on it to see a larger version!

You can clearly see the decay on this crown when it is out of the mouth. However, when it was in her mouth, it was nearly impossible to see. It could only be “felt” with a dental instrument. But the x-ray showed it.

Why was the tooth extracted?

If you get decay underneath a crown, it doesn’t always mean that the tooth has to be extracted. Before I explain why this was extracted, let’s look at one where the tooth was able to be fixed:

high quality photo of a cavity under an incisor crown

The decay underneath this crown was predictably fixed with a new crown.

The tooth directly above could be saved because the decay was easily accessible and only extended slightly underneath the gum tissue. The tooth had already had a root canal.

For the first tooth, the decay extended deep underneath the gum tissue and went into the furcation (the furcation is where the two roots of two-rooted tooth meet). No amount of modern dental procedures could have saved the tooth. So we extracted it and placed a dental implant.

Please note that I have greatly simplified the criteria for when a tooth can be saved vs. extracted. There are dozens of other factors – all beyond the scope of this post.

So, to summarize:

  • You can get decay or cavities underneath a crown.
  • The extent and location of the decay as well as other factors will dictate the treatment needed to correct the problem.

As always, your dentist should answer all your questions. If he/she doesn’t, it’s time to look for a new one.

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.

A Divorce over Bad Breath?

Picture of person with bad breath aka halitosis

Halitosis or Brad Breath. Image courtesy Flickr Commons.

Bad Breath, more formally known as halitosis, is a condition that affects tens of millions of people worldwide. It is defined as a persistent malodor coming from the mouth. Bad breath is primarily caused by conditions affecting the teeth or gums but other anatomical areas such as the nose, throat, and GI system can also be causes.

The annoyance of bad breath has been noticed for centuries – it is not just a recent development. But did you know that in some cultures, you could divorce your partner over it?

Bad Breath in the Talmud

The Talmud is an important text in Judaism and dates back to more than two thousand years. This text serves as the basis for Jewish law and customs.  Surprisingly, halitosis is discussed in great detail in more than one part of the Talmud.

In this great summary by Shira Goldstein, she outlines the details of halitosis and how it was addressed in the Talmud:

  • According to the Talmud, halitosis is considered a “serious disability.”
  • In Jewish marriage, the ketuba is the marriage contract between the husband and wife. If a husband discovers his wife has bad breath, he has the ability to cancel the ketuba over it.
  • Women were able to divorce their husbands over halitosis too. The smell from bad breath was even comparable to the smell from collecting dog dung!
  • There was significant discussion in the Talmud over whether nasal odor and oral odor were equivalent. They were later deemed to be comparable.

So this means that over 2000 years ago, people were gravely concerned about bad breath!

Bad Breath and the Dentist

Photo of teeth with gum disease showing halitosis or bad breath

Would you divorce your spouse if his/her teeth looked like this and the odor was comparable to dog dung?

As a dentist in Orange, CT, patients typically look to me to help them with their real or perceived halitosis. Many people actually suffer from a perception and/or fear that they have bad breath. This is referred to as halitophobia.

But most cases of perceived halitosis are legitimate. Research shows that 85 to 90% of cases of bad breath are oral in origin with the remaining 10 to 15% originating elsewhere. So that means I can help the vast majority of patients with real (or perceived) cases of halitosis. The techniques for treating bad breath are beyond the scope of this post but in general we focus on improving oral hygiene. For the other 10 to 15%, I typically refer to the correct physician specialist for evaluation and diagnosis.

What NOT to do if you have halitosis

I’ve had a great number of patients come to me for assistance and advice on many dental and non-dental issues. These have ranged from whether the Tooth Fairy should come for Wisdom Teeth (no!) to whether used dental floss can be flushed down the toilet (no!) to how do I tell my significant other they should see the dentist (firmly but delicately).

I have yet to field a question regarding bad breath and the status of a patient’s marriage. But I can confidently say:

Do not divorce you partner if he/she has bad breath!

Your dentist and hygienist can help. Just call them.