Can you repair your teeth?

I am sure you have seen commercials for toothpastes that claim that they can "repair enamel". Or maybe someone at the local health store has recommended a product that is supposed to strengthen teeth. Is this true? Can enamel be repaired?

In order to answer this, we must go over a bit of tooth development. The outer layer of the teeth, the enamel, is a highly mineralized, non-living tissue that is created by cells called ameloblasts. These cells are shed after they perform their job and are not replaced by stem cells; the human body therefore can not regrow enamel!

This is why it is very important to protect your teeth from damage. Once the enamel is gone, it is gone.

So can enamel be repaired?

Yes and no.

If you lose a chunk of enamel biting on a fork, or taking a puck in the teeth, that damage is not repairable. A dentist will have to replace the missing enamel with a filling or a crown.

In terms of tooth decay, however, the answer is……..it depends.

"Demineralization"

Dental caries is the bacterial infection that causes tooth decay; this process is better described as demineralization. When bacteria in the mouth metabolize sugars present in the human diet, they create acid which dissolves the minerals in the enamel. The enamel does have the ability to take up minerals and to reverse this damage, but if the time in between these acid challenges is not long enough, there will be a net mineral loss and the tooth will begin to break down.

So yes, the enamel can "remineralize" itself…...to a point. It cannot "rebuild" itself.

“Cavities”

When the loss of minerals weakens the tooth sufficiently, a defect forms in the enamel and it becomes cratered and soft. This is what a dentist calls a “cavity”. Once the tooth gets to this point, the tooth needs a filling. Nothing on the market can repair cavities.

Demineralization can be seen on a radiograph (x-ray) BEFORE the surface becomes permanently damaged, so dentists can see where cavities are starting and can get an idea of the dental caries activity over time.

Can you strengthen enamel?

The only thing that actually STRENGTHENS enamel is fluoride. The main mineral of the tooth is hydroxyapatite, which usually dissolves at a pH of around 5-6. Adding fluoride to toothpaste, mouthwash, drinking water or even to the diet allows the tooth to absorb it and to chemically change this mineral to a much stronger version, fluorohydroxyapatite, or fluoroapatite. This new mineral dissolves at a pH of 4-5! This is a huge increase in the acid resistance of enamel!

Fluoride changes the mineral composition of your tooth to a stronger version! Nothing else does that.

What about the other stuff?

There are many products on the market that can help the tooth absorb minerals. They basically act as a reservoir of calcium or hydroxyapatite that come from different sources. You could also benefit from products that help reduce the activity of the bacteria, such a xylitol.

You may also find products such a vitamin K2 that claim to “strengthen” teeth and bones. The clinical evidence behind this is totally lacking and the support for this is theoretically based on bone metabolism pathways. Do not think that a product like this will help you fight tooth decay because they are not proven to do so, even though the person selling it to you may say so.

Products that can help repair demineralization and reduce bacterial load and activity are always great recommendations but nothing is as effective as fluoride, because it is simply the only product that strengthens the enamel. There are hundreds of studies supporting this.

Would you rather be good at bailing water, or have a stronger hull that is less prone to leaking?

What is the best thing to do?

Dental caries is very aggressive and anyone with teeth is susceptible to it. It is one of the most common communicable diseases in humans.

It is best to use a comprehensive approach of diet, hygiene and medicine.

Do not feed the bacteria! Avoid snacking on simple, sticky sugars and use sugar alternatives like xylitol.
Remove that bacteria! Brush and floss your teeth and go for regular professional cleanings.
Strengthen your teeth! Use fluoride.
Replace that lost mineral! Use products that contain nanohydroxyapatite and calcium.
Catch demineralization before it is too late! Go for dental checkups and do not decline x-rays because you think things look ok.