Tooth decay at the gum line – prevention versus restoration

Middle-aged woman smiling wearing a army green shirt.

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People over 50 get more cavities than children, and they get a different type of tooth decay. About one third of Canadians in their 50s get tooth decay at the gum line, and half of those in their 70s suffer from this chronic, infectious disease.

Tooth decay at the gum line, also called root decay, is more common than hypertension and arthritis. It is associated with receding gums, gum disease, a dry mouth and smoking.

So, what’s involved when you have a cavity at the gum line? First, it means you have a bacterial infection on the tooth surface. These bacteria produce acids to erode your soft part of the tooth at the gum line. You can’t often completely eliminate these bacteria through brushing and flossing. You need a professional cleaning plus some extra antimicrobial protection.

The traditional approach to gum line decay is to restore these cavities with mercury amalgam or often a white filling. Then both the patient and the dentist watch this filling fail over the next 2 or 3 years. Fillings at the gum line don’t last very long because the cavity is in a porous, moist area of the tooth which is often hard to access. So, most often, a cycle of fillings and new fillings begins at the gum line until the tooth requires a crown or an implant.

And there is more bad news. Typically, patients get one cavity after another at the gum line. This disease often re-occurs quickly on adjacent teeth.

But now the good news. Canadian dental offices are now being trained and are starting to use two new preventive tooth coatings to manage this recurring problem in the mouths of older patients. These coatings are topically applied to your teeth by your hygienist in a short appointment, and are invisible, painless and safe. This new preventive procedure is approved by Health Canada, has the Seal of Recognition of the Canadian Dental Association, and has been peer-reviewed by other regulatory and research agencies internationally. These antibacterial tooth coatings are a breakthrough in preventing cavities in adults.

How effective are these new coatings? And how much does this protection of my teeth cost?

These antibacterial coatings reduced ongoing root decay by 41% (versus placebo) in high risk older adults over one year. That’s far more effective than fluoride. Indeed, this preventive procedure is the most effective form of prevention against adult tooth decay.

The cost for this prevention is about $500 to $550 in the first year, and then about $225 in subsequent years. That may seem expensive to those free of tooth decay at the gum line, but it is a good deal for those experiencing this chronic disease. Most adult patients want to avoid the ongoing restorative expenses of filling after filling. It’s the old saying, pay me now or pay me later.