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.