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Remineralization of Teeth

When the mouth has a healthy balance, saliva crushes starches, and keeps calcium and phosphates flowing around so teeth can remineralize.
When the mouth has a healthy balance, saliva crushes starches, and keeps calcium and phosphates flowing around so teeth can remineralize.
iStockphoto/Thinkstock

Saliva heals. Animals tend to wounds by licking them, and in recent years, studies have shown that human saliva speeds up healing in people, too [source: JADA]. Naturally occurring proteins, enzymes and cellular compounds in saliva can fight infection and slow tissue loss as they penetrate open or broken layers of skin. These same compounds help heal hard teeth, too, as they work to re-harden or remineralize the enamel. Enamel itself can't be re-grown or harden to its original state, but it can self-repair and stay strong if remineralization keeps in step with mineral breakdown -- or demineralization.

Teeth are tough on the outside because of the tight mineral bonds of enamel -- the strongest substance in the human body. And although it seems watery, bland and even weak, saliva is strong enough to help keep teeth hard. As acids and carbohydrates from food and drink -- and the bacteria that thrive off of them -- combine and assault teeth, they corrode the enamel and break down the mineral fibers almost constantly. This process is part of demineralization. When the mouth contains healthy levels of saliva, though, it not only crushes starches, it also keeps calcium and phosphates flowing around so teeth can remineralize to combat the demineralization.

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If saliva didn't help rebuild minerals and strengthen the crystalline bonds, teeth would lose their hard-coated enamel covering, and bacteria and acids would get below the enamel to the dentin. Without remineralization, teeth would become soft and chewing would be difficult. Soft teeth would be no match for food that needs to be broken down before getting digested in the stomach, and the very nutrients needed to keep the body and the teeth healthy would be hard to absorb [source: Madrigal].

In a regular or normal mouth, teeth will stay tough and protected but sometimes bacteria and acids win the battle and overtake the saliva balance, leading to plaque, tooth decay and cavities. Poor hygiene, a high-sugar or acidic diet, and tooth damage increase demineralization, as can illness and medication, so knowing how remineralization works can help you keep your enamel and teeth strong.

The hard work of saliva in this process is nothing to spit at. We'll look at how teeth remineralize naturally with the help of salivation, next.

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Before going on about remineralization, just what is the mineral part of teeth and how does it get demineralized?

Teeth are made up of four kinds of tissues: pulp, cementum, enamel and dentin. Pulp is the softest, deepest part of the tooth and contains the nerves and blood vessels that bring nutrients to the tooth. Cementum is a hard covering around the pulp down into the roots, and dentin is an inner covering that is also very hard but fills most of the inside rather than outside of the tooth. Enamel crowns the tooth, making up the visible part and adding strength for chewing. Three of the four tooth tissues are hard, but all can be compromised and become worn down or soft and weak. Pulp is already soft, but as long as it's covered, it serves its purpose painlessly and efficiently beneath the harder coatings. Once exposed, however, the network of nerve endings throughout and surrounding the pulp are open to air, liquid and bacteria contact, all of which can cause significant pain.

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Cells in the body multiply to form teeth tissues, and the hard parts are made up mostly of minerals. Crystals of calcium phosphates grow close together in a network to form the enamel, and although it is stronger even than bone or concrete, once it starts to break down through acid erosion or injury, it doesn't grow back in its original, hardest enamel form. But in the short term, and as part of the ongoing process mentioned earlier, enamel can retain strength if remineralization keeps happening to neutralize acids and bacteria [source: Madrigal].

Our bodies support remineralizing teeth as long as there are minerals available to send as needed. Saliva carries calcium and phosphates to the sites of demineralization naturally, but the mouth can only compensate so much when it's overcome with bacteria and plaque for too long. Plaque can start to harden on teeth if it's not removed after eating, and when this hardening starts, enamel begins breaking down from the overactive bacteria in the plaque growth. Demineralization then wins out and cavities can run rampant.

When plaque gets out of control, remineralization of the hard tissues below the gum line is affected too, and the risk of gum inflammation and disease increases. Saliva needs to be present and circulating, often through moving the jaw or chewing. Diet, hygiene and overall physical health also impact how well teeth can remineralize and protect themselves naturally. Dry mouth from medications and tooth decay from over-consumption of soda and starchy and sugary foods are just two enemies of remineralization [source: ADA].

If teeth can't remineralize enough to outpace the loss of minerals, can anything be done to regain balance, or do the bad guys in your mouth win? We'll look at some artificial means of remineralizing, next.

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Scientists are still working on ways to re-create natural remineralization, and in the not-too-distant-future, technologies for regrowing teeth themselves may even be realized [source: Madrigal]. In the meantime, however, most methods of remineralizing teeth involve enhancing the natural process. Some of these mineral regrowth boosters include:

  • Chewing gum -- Exercising the teeth and jaws by chewing on a piece of sugarless gum after eating increases saliva flow in the mouth and helps speed up the process of washing away acid and swishing around the good stuff in saliva: calcium and phosphates. About 20 minutes of gum chewing helps measurably, and some types of gum now contain agents to help specifically with remineralizing, too [source: ADA].
  • Fluoride -- Topical applications of fluoride in toothpastes and mouth rinses, as well as in dentist office treatments, increase the protective power of enamel against demineralization and have been shown to even increase remineralization.
  • CPP-ACP -- Casein phosphopeptides-amorphous calcium phosphate (CPP-ACP) is a chemical compound made up in part of milk proteins. CPP-ACP has the ability to penetrate enamel at the right time to aid in remineralization of teeth. It delivers the calcium phosphates when and where needed.

These three types of products help with remineralization individually or when used together. CPP-ACP, for instance, is used in chewing gums, toothpastes, rinses, dental work compounds (such as those used for filling cavities) and even in milk products.

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As with practicing good oral hygiene to prevent tooth and gum problems before they begin, most artificial remineralizing efforts will work best before significant demineralization occurs. Enamel can't be regrown -- yet -- but it can heal itself in moderation if it isn't overwhelmed by bacteria. As much as products can help improve the natural process of remineralization, they can't get very far if damage and wear has turned to decay.

Remineralization can be a lifelong, balanced process with some early intervention and regular maintenance. We'll look remineralization from childhood to old age, next.

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As we grow, regular dental visits and conscientious oral care with topical, or applied fluoride, help keep mouth bacteria at bay and the remineralization process of saliva normalized enough to neutralize day-to-day demineralization.
As we grow, regular dental visits and conscientious oral care with topical, or applied fluoride, help keep mouth bacteria at bay and the remineralization process of saliva normalized enough to neutralize day-to-day demineralization.
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Even before a child is born, he can receive stores of calcium and fluoride for tooth health from a mother's diet, or systemically. Although some advocate avoiding fluoride for health reasons, the American Dental Association (ADA) and others promote its use for healthy teeth and gums [source: ADA]. As we grow, regular dental visits and conscientious oral care with topical, or applied fluoride, help keep mouth bacteria at bay and the remineralization process of saliva normalized enough to neutralize day-to-day demineralization. Poor dietary choices, such as consuming a lot of soda, sugary and starchy foods, and sticky teeth-hugging candies and fruits work fast to break down the mineral integrity of enamel. Snacking throughout the day is particularly damaging to teeth, whereas brushing soon after meals and avoiding corrosive foods in between is a good lifelong habit.

Short-term, or acute, illnesses and long-term, or chronic, diseases also affect oral health a great deal, and medications used to combat germs and disease progression often rob the mouth of moisture needed to fight bacteria around the teeth and gums. Whenever dry mouth sets in, saliva can't keep up with bacterial growth and enamel and dentin can break down quickly.

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Dry mouth also occurs in some people naturally, and treating this condition with oral or topical treatments may be necessary. Treating it in the short-term may be as simple as chewing sugarless gum, but checking with a dentist no matter the cause or frequency is advisable.

A healthy body is capable of fighting off infection and bacteria, and it keeps body processes in balance in a condition called homeostasis. Our mouths have their own balance of demineralization and remineralization, and keeping this ongoing process in check and neutralized will help keep teeth strong enough to break down foods that benefit the body from the toes up.

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Sources

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  • El-Sayad, I.I., et al. " Combining CPP-ACP with Fluoride: A Synergistic Remineralization Potential of Artificially Demineralized Enamel or Not?" The Smithsonian/NASA Astrophysics Data System, Harvard.edu. 2008. (Dec. 22, 2011) http://adsabs.harvard.edu/abs/2008SPIE.7065E..31E
  • Gorman, Jessica. "The New Cavity Fighters." Science News, TheFreeLibrary.com. Aug. 19, 2000. (Dec. 22, 2011) http://www.thefreelibrary.com/The+New+Cavity+Fighters.-a065301573
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  • Journal of the American Dental Association (JADA). "Saliva May Help Wound Healing." ADA.org. March 1, 2001. (Dec. 26, 2011) http://jada.ada.org/content/132/3/282.2.full
  • Madrigal, Alexis. "Tooth Regeneration May Replace Drill-and-Fill." Wired.com. April 2, 2008. (Dec. 19, 2011) http://www.wired.com/medtech/health/news/2008/04/tooth_regeneration
  • Merriam-Webster. "Saliva." Merriam-Webster.com. 2011. (Dec. 26, 2011) http://www.merriam-webster.com/dictionary/saliva
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