Apart from cost of treatment, avoiding tooth decay is also important for the reason that any dental intervention weakens the tooth. Once a filling is placed, it will no longer be as strong as before. Here the principle of “prevention is better than cure” is particularly relevant.
I’ll skip the things that everyone knows about, such as brushing your teeth or avoiding sweets. I’ll move on to those less known, but also effective.
As always, the synergistic effect will be important. The use of two “tricks”, each of which reduces the risk of caries by 30%, will reduce the risk to almost zero. This works on a similar principle to how two weak poisons, each of which kills only 5% of victims, given at the same time will kill almost everyone.
First, a surprise. Flossing is not as effective as commonly believed. The only studies in which it was shown to be effective involved children who had little contact with fluoride (did not use toothpaste regularly), and the flossing treatment was combined with enamel fluoridation. Studies in adults and children who regularly brush their teeth have shown no clear effect.
https://pubmed.ncbi.nlm.nih.gov/16567548/
Of the non-dietary things, reflux can severely aggravate the destruction of enamel and thus open the way for tooth decay. It works similarly to eating citrus or other highly acidic fruits. However, there is no simple “cure” here.
Vitamin D3 supplementation, unsurprisingly, reduced the risk of caries by almost twice:
https://pubmed.ncbi.nlm.nih.gov/23356636/
Xylitol. There is a great deal to be gained by replacing sugar with this sweetener. Controversy surrounds it, some scientists believe that xylitol harms the intestinal flora, some on the contrary, that it helps regulate it. How it really is, we will probably find out in a dozen years or so, provided someone does extensive research. There is one problem with the research, namely, it is hard to find a solid methodology here. Using xylitol as a coffee sweetener? A completely different effect will be in a person who drinks 1 coffee a day, and another in one who drinks these coffees 7. Eating candy has a different effect, chewing gum has a different effect. One study compared two groups of children, one of whom was given xylitol candy regularly. Cases of tooth decay were only half as frequent in this group as in the control group.
https://pubmed.ncbi.nlm.nih.gov/3422062/
Strontium. Toothpastes with this element are emerging, as preliminary studies suggest a strong positive effect, but interestingly, it can also be supplemented. Even more, you should supplement it, because strontium has a very strong positive effect on bones. However, it is not entirely certain what the effect of such supplementation will be on teeth in adulthood. In one study, children who lived in regions where water is rich in strontium had a dozen to tens of percent lower risk of tooth decay:
https://pubmed.ncbi.nlm.nih.gov/6576005/
It is not known what future studies will show, for now one has to rely on preliminary ones, and these present strontium in a very nice light. However, there is one very old study in which strontium showed negative effects in rats. The results are quite suspicious, as the same negative effect was shown by other elements, seemingly having nothing to do with teeth or body function in general, for all of them the results were very similar, which calls into question the integrity of the scientists conducting this. What’s more, in this old study molybdenum very strongly increased susceptibility to tooth decay, while all subsequent studies have shown it to have a protective effect, in some studies comparable to the effect of fluoride. Nevertheless, the study exists and it is appropriate to mention it.
The results of the probiotic are interesting. In one study, the use of Lactobacillus rhamnosus GG bacteria reduced the risk of caries by as much as half. This, of course, refers to products in which the bacteria come into contact with the teeth, not capsules.
https://pubmed.ncbi.nlm.nih.gov/11799281/
You can buy a probiotic that contains them and just pop it in your mouth every so often, spreading it over your teeth, without swallowing.
There is a lot of talk about the role of vitamin K2, but it is just that, talk, and it should be researched. It is not known what the effect of supplementation will be, but it certainly can’t hurt to try.
There is one very interesting study on the use of iodine.
https://pubmed.ncbi.nlm.nih.gov/20578661/
A 10% solution of iodopovidone, 0.2 ml during one “session”, was applied to the teeth and left for about 5 minutes. The procedure was repeated once every three months. The study group was too small to clearly assess the effect on caries itself (only 2 people had cavities in the control group and 0 in the group that got the iodine), but the number of bacteria that are responsible for carious lesions dropped as much as tenfold, no mistake or coincidence here.
Note – iodine is NOT indifferent to health, in some people it can cause an allergic reaction, in others it can accelerate the development of Hashimoto’s disease or even cause temporary hyperthyroidism. On the other hand, quite a few studies suggest that regular higher intake of iodine can significantly reduce the risk of breast or prostate cancer, cancers that kill 1 in 30 people. Not 1 in 30 patients, but 1 in 30 in general.
It is time for purely hypothetical things, here I will rely on animal studies.
Chronic vitamin A deficiency makes animals very susceptible to tooth decay. In humans, this deficiency is quite rare, but people who abuse alcohol or are on diets devoid of animal products may have a problem if their bodies do not synthesize strongly enough from plant sources. In hamsters, the deficiency increased tooth decay by as much as three times:
https://journals.sagepub.com/doi/abs/10.1177/00220345590380050501?journalCode=jdrb
People who have been deficient in zinc, or iron, should especially pay attention to it, as this is associated with lower levels of vitamin A.
Copper is closely linked to bone health, so much so that supplementation has completely halted the progression of osteoporosis in elderly women. People with weak teeth have only half of copper concentration in their enamel compared to those with strong teeth:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3906556/
Long-term supplementation with either zinc or iron can severely reduce copper levels in the body, increasing susceptibility to tooth decay. It’s hard to say whether supplementation with this element should be recommended to everyone; some studies suggest that copper deficiency is one of the most serious health problems behind the epidemic of heart disease, some that excess copper can cause neurotic problems.
Speaking of zinc, its deficiency also increased the risk of dental caries in animals, but only by a few or so percent, compared to copper, where deficiency increased the risk threefold.
https://pubmed.ncbi.nlm.nih.gov/7373428/
Vitamin A, zinc and copper are in a relationship. Zinc deficiency causes vitamin A levels to drop. Zinc supplementation, in turn, makes copper levels drop. Ideally, supplementation should alternate, some days just zinc, some days just copper.
There has been a great deal of talk about vitamin B6, and there was even a clinical trial in the past where supplementation clearly reduced the risk of dental caries in women. However, there is a lack of further research, and as it has been 60 years since that initial one, it doesn’t look like anyone will ever look into it. There is a lot of evidence that this vitamin will mainly help people with a deficiency; in practice, this would be people who abuse alcohol, as well as those suffering from depression or anxiety disorders.
Finally, it is worth emphasizing that fluoride is the best thing you can do for your teeth. It is harmful in drinking water, but giving up fluoride toothpastes is a very, very stupid idea.