Your teeth are perpetually shifting dynamically between the states of demineralization and remineralization. The former is when the tooth loses minerals and the latter is when it regains them.
Demineralization of teeth happens when the acidity in the mouth drops below the critical pH value of 5.5Â such as when you're eating or drinking. Remineralization occurs when you partake in activities which raises the pH above the critical threshold such as doing your oral hygiene regime.
What we are trying to tell you is that you can directly exert an influence over the state that your teeth are in. You can do things that shift the dynamics towards remineralization and away from demineralization.
How to remineralize teeth:
Rinse with baking soda immediately after your meal for 2 minutes.
Wait 30 minutes for your mouth to further deacidify.
Chew xylitol gum while you wait.
Drink water while waiting.
In addition to the remineralizing protocol above, there are other factors which can influence remineralization. There are certain things that you can do to help it along and also other things that you should avoid. Knowing what to do may help prevent tooth decay.
Rinsing with baking soda
The first and most important step in getting your teeth to stop demineralizing and start remineralizing is rinsing with baking soda immediately after your meal.
How to make/use a baking soda mouth rinse:
Add 4 oz of water to a cup.
Add a teaspoon of baking soda.
Stir the mixture.
Rinse for two minutes
Spit it back out.
What determines the state that your teeth are in depends on the overall acidity in your mouth. Immediately after a meal the pH in your mouth will drop and turn acidic. In order for remineralization to begin, you need to first deacidify it and rinsing with baking soda rinse is highly effective. It is also very inexpensive.
Acid neutralization with baking soda
Studies have shown that baking soda (sodium bicarbonate) will neutralize acid by raising salivary pH. In fact it will increase it beyond the threshold which is needed to prevent demineralization and to enhance remineralization.
It is due to its potent acid neutralization that The American College of Obstetricians and Gynecologists recommend it as the mouthwash of choice for morning sickness. Pregnant women are often stricken with this condition which is accompanied by vomiting. The stomach acids that are coming back up are acidic enough to cause enamel erosion.
The sodium bicarbonate is potent enough to neutralize it. Studies have shown that using it will prevent erosive challenges and reduce surface enamel loss.
Last but not least, according to a study by JADAÂ it also has the potential for increasing the pH in plaque. That means it may even have direct anti-cavity effects as well.
Wait 30 minutes prior to brushing
After rinsing, you should wait at least 30 minutes before you brush your teeth to give your mouth time to fully deacidify.
According to Columbia University, those 30 minutes are crucial because it allows the teeth to naturally start remineralizing. It is actually harmful to brush immediately afterwards while the acids are still on your teeth. You don't want to brush the acids directly onto your enamel and spread it intentionally.
It may seem like a waste of time sitting around for 30 minutes while you wait to brush but there are things you can do in the meantime. Chewing xylitol gum and getting in your daily water intake while you're waiting can promote remineralization.
Chew xylitol gum
Chewing sugar-free gum with xylitol can help with remineralizing teeth because it can reduce bacteria and stimulate saliva flow. You can chew gum with this artificial sweetener for 5-20 minutes depending on your preference.
A systematic review and meta analysis showed that chewing sugar free gum significantly reduced the bacterial load of Streptococcus mutans. These bacteria are one of the primary driving forces of carious lesions. Having less bacteria will result in less demineralization since its their acid byproducts which dissolve teeth.
Chewing xylitol gum will also stimulate the flow of saliva by up to 10-12 times the unstimulated rate of 0.3-0.4 mL/min. Having an increase in saliva is important because it washes away bacteria from the tooth surface and it buffers oral acidity.
An important function of saliva is its buffering mechanism which promotes remineralization. In fact, the primary buffering system is the bicarbonate system, then followed by phosphates and proteins. The increase in saliva will bring the pH of the mouth back up so that the teeth can repair itself. This little fact also supports the use of baking soda for deacidifying the mouth since they both use bicarbonate!
Drink enough water
The recommendation by Harvard is to drink 13 cups of water for men and 9 cups for women. Most people don't drink enough water so while you're waiting it would be the perfect time to do so.
Aside from meeting your water quota for the day, there are remineralization benefits as well:
Fluoridated tap water promotes enamel remineralization.
Water can wash away bacteria and acid from the surfaces of your teeth.
Studies have shown that when teeth are bathed in low levels of fluoride, enamel dissolution slowed but repair of it increased. Therefore drinking fluoridated water will provide a protective effect for your teeth.
Dry mouth - Xerostomia
It is important to drink enough water so you don't end up with dry mouth, which is a deficiency of water intake. The saliva is very important in preventing your teeth from dissolving and helping them repair itself. It can do this because it contains a lot of calcium and phosphate which are the minerals that are used for repair.
The saliva will also assist in washing away bacteria and acids in your mouth. The bacteria cleansing effect is most notably such as when you wake up with morning breath. Your breath smells upon waking because saliva stops flowing and bacteria is permitted to flourish. The smell is a consequence of sulfur production by the bacteria.
Floss
Flossing is the primary means of removing plaque and food debris from in between your teeth. That is crucial for preventing cavities from forming in between your dentition.
How to floss properly:
Wrap floss around both fingers.
Floss through in between your teeth.
Pull the floss and wrap it around one tooth.
Floss the tooth up and down.
Pull the floss and wrap it around the other tooth.
Floss it up and down.
Pull the floss out from in between and move to the next spot.
You can rinse and brush all you want but they'll never be as effective as flossing when it comes to keeping the in between your teeth clean. Therefore you really can't skip out on the floss if you want any chance at remineralizing the in between portions of your teeth.
Brush with a remineralizing toothpaste
Brushing with a remineralizing toothpaste can shift the dynamics away from demineralization. The two ingredients which can do this are fluoride and nano-hydroxyapatite.
How to use remineralization toothpastes:
Wet toothbrush under running water.
Wet your mouth with a quick rinse.
Apply toothpaste and brush for 2 minutes.
Spit out and rinse.
Both types of toothpastes will assist in repairing the enamel and help strengthen them. Although they do so via different mechanisms. The fluoride is inexpensive and effective but if you wanted a fluoride-free option, the hydroxyapatite is equally comparable in preventing cavities.
How fluoride toothpaste remineralizes teeth
Brushing with a fluoride toothpaste will enhance remineralization and inhibit demineralization. There is also an additional effect of having a protective calcium fluoride-like layer that serves as a mineral reservoir if you've been brushing with it regularly.
Studies have shown that demineralized tooth structure is more reactive to fluoride than an intact one. Teeth that are being dissolved by acid will take in and incorporate fluoride more readily than enamel. The significance of that is the fluoride will attract the minerals calcium and phosphate to help remineralize the tooth. Therefore it enhances tooth repair.
Demineralization has also been shown to be inhibited in the presence of fluoride. Researchers found that the net mineral loss was shown to be negatively related to the logarithm of the fluoride concentration. Thus brushing with a fluoridated toothpaste will increase the concentration and consequently halt the dissolution.
Calcium fluoride-like layer
An often glossed over benefit is the formation of a calcium fluoride-like layer when you brush regularly with fluoride. This is a layer that covers over the exterior surface of the tooth, which contains fluoride, calcium, and phosphates.
Under acidic challenges, this layer will dissolve first thus protecting the tooth. When it dissolves it releases all of the bound minerals which can then be used to remineralize the tooth as well as buffer the mouth acidity.
The buffering system in saliva is not just composed of bicarbonate because phosphates also play a role. These released phosphates can remineralize the tooth directly or deacidify the mouth by removing protons (H+) from the solution.
The benefit of this additional protective layer is only there if you've been brushing with fluoride regularly. If this is your first time using it then you won't have this extra effect.
How nano-hydroxyapatite toothpaste remineralizes teeth
Brushing with a nano-hydroxyapatite toothpaste will enhance remineralization and inhibit demineralization. Studies have shown that its cavity prevention effects were comparable to fluoride, thus making it a valid fluoride-free option.
Examples of hydroxyapatite toothpastes:
Davids Sensitive+Whitening nano-hydroxyapatite toothpaste
Risewell mineral toothpaste
Boka Nano toothpaste
Nano-hydroxyapatite is able to assist in remineralizing the teeth because it is literally what your teeth are made of. Your enamel consists of 97% hydroxyapatite by weight which is essentially a mixture of calcium and phosphate.
How it remineralizes is by inserting itself directly into demineralized porosities in the enamel. Since it is made of the exact same mineral as your tooth, it can serve as a replacement. The advantage of this over fluoride is that the fluoride still needs to attract calcium and phosphate while this does not. The entire substance already contains both minerals so you can think of it as "pre-made". It doesn't get any easier than that!
Brushing with hydroxyapatite is also advantageous in that it can inhibit demineralization. When it is present in an acidic environment, it can dissolve and release the minerals calcium and phosphate. Once again, the phosphates are part of the buffering system in your mouth to help decrease the acidity so that it can shift the equilibrium towards repair instead of disrepair.
Other factors affecting remineralization dynamics
Aside from the remineralization protocol above which is what you should be doing immediately after a meal, there are other important factors as well. These can influence the dynamics when an acid attack occurs.
What helps teeth remineralize
You should strive to consume a diet that is sufficient in minerals that strengthen and repair teeth. This is important because you could be ready for remineralization but if you don't have the required minerals, nothing will happen.
Studies have shown that even if you brush with a lot of fluoride, the limiting factor is often calcium and phosphate. What that implies is you should eat foods that are rich in calcium and phosphorus.
Aside from those two minerals, it is also helpful to get a lot of vitamin A, C, D, K, and potassium in. These don't directly repair the enamel but they help keep your teeth healthy indirectly.
How to avoid demineralization
The number one rule for preventing demineralization is to minimize or abstain from foods that are acidic in nature. These foods directly cause the enamel to demineralize.
Sweets - desserts such as cookies and cakes; carbohydrate rich meals
Sour - salad dressings or candies; lemons and limes
Spicy - the acidity from these foods can erode your enamel
Alcoholic beverages such as wine and beer
Consuming excessive amounts of these will shift the dynamics towards enamel dissolution because they directly cause it. Ultimately that will only make your remineralization efforts more difficult.
Anti-nutrients
There's been an increasing awareness in the rise of "anti-nutrients" which interfere with our body in absorbing essential nutrients. These can be detrimental to how teeth remineralize if they affect the absorption of calcium or phosphorus.
Phytates (phytic acid). Found in whole grains, nuts, and legumes which can decrease the absorption of calcium.
Oxalates. Found in leafy green vegetables, tea, nuts, beets, and beans which can prevent absorption of calcium by binding to it.
Lectins. Found in beans, peanuts, soybeans, and whole grains which can affect absorption of phosphorus and calcium.
Based upon these effects, the implications are that you should avoid a diet which is high in these three substances. They could potentially be harmful for the health of your teeth
According to Harvard University, you can minimize their effects by eating a balanced diet. You can also space out some of these foods into different meals to minimize it.
Nonetheless, completely cutting these anti-nutrients out of your diet could be harmful as well because they do provide other benefits. For example, phytic acid can lower cholesterol and prevent high blood pressure.
How to tell if your teeth are remineralizing
It may be a little difficult but there are some subtle signs that can let you know you're on the right track.
Decrease in teeth sensitivity
Decreasing size of white spots
Smoother looking teeth
Healthier looking teeth
However the only definitive way to tell is by getting a dental check up. Unchecked and uncontrolled demineralization will eventually lead to a cavity. Therefore if your dentist can't find any cavities, your efforts were probably not in vain.
Takeaway
Raising the pH in the mouth and avoiding demineralizing activities is how you remineralize your teeth.
The oral environment is constantly shifting back and forth between both states. The net effect would be whichever one that you do more of. Therefore if you partake in more remineralizing activities, your teeth will ultimately end up repairing themselves. The vice versa is also true in that you keep attacking your teeth with acid, it will eventually form a cavity or erode the enamel.
Our dentists in Long Island City wish you the best of luck in remineralizing your teeth. If you succeed you'll have essentially conquered the very first stage of tooth decay, demineralization.
