What Causes Cavities?

Let’s tackle a big controversy right now: What causes cavities?

You know the standard answer—Brush your teeth , stop eating sugar...
...and you won’t get cavities.

This isn’t wrong . . . but it’s not the WHOLE story. First, let’s talk about what a cavity is.

What is a cavity?

Your mouth is a veritable battlefield, with acid and bacteria as the enemies to strong teeth. If your mouth is acidic (from diet and overall health issues), that acid pulls minerals out of the enamel, leaving it weak and vulnerable.

If enough minerals are pulled out (called demineralization), bacteria can…

  1. Travel through the enamel to the dentin
  2. Dentin becomes infected 
  3. Once the infection starts, it is called dental caries or a “cavity”


There has been an upward trend in caries (cavities) since the 1990s.  An article from the Centers for Disease Control in 2016 states that…

 “Although dental caries are largely preventable, they remain the most common chronic disease of children aged 6 to 11 years and adolescents aged 12 to 19 years.

Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years. Dental caries also affects adults, with 9 out of 10 over the age of 20 having some degree of tooth-root decay.”

 There has been an increase in decay, while people in the US spend over $20 billion on dental care annually. Toothpaste commercials saturate the airwaves, and we have at least two generations of people who have been “educated” on what to do to prevent cavities.

Poor dental hygiene alone can’t be the cause for all of these cavities…

Despite more spending on dental care than any other time in history, dental health is as bad or worse than it has ever been. Something is missing.

What is a Dental Cavity

Decided by Vote

In the 1940s, at a meeting of the International Association of Dental Research, the attendees wanted to end the debate over what causes cavities. There were three heavily researched theories that were debated, along with others. These theories were:


Bacteria in your mouth are fond of sugar. When they eat sugar, they produce acid as a waste product. This acid dissolves the minerals in your tooth and you get a cavity.


Dr. Westin Price was a dentist that was frustrated with dental decay. He took 10 years to travel the world, looking for groups of people that had good dental health. He studied those people and found consistent, common nutritional reasons for healthy teeth and mouths.


Dr. Melvin Page also researched dental decay, and found that there is an internal fluid flow in teeth that naturally helps the tooth stay clean and healthy. This flow is controlled by hormones. When the hormones are not balanced, this fluid flow reverses and brings toxins into the tooth rather than out.

After evaluating the data from many research studies on the topic, the majority felt that the Acidogenic Theory (sugar + bacteria) was the most correct. This was adopted as fact, and that decision holds strong today…

…despite evidence to the contrary.

I don’t think they were wrong in 1940, but I don’t think they were completely right either. I believe there are multiple factors that contribute to tooth decay, and my years in practice have confirmed this.

I often examine the teeth of an entire family at the same time. I’ll see a wife that recently gave birth, and she has five new cavities. Her husband secretly confides that he hasn’t flossed a day in his life, and he’s never had a cavity. Their children are a mixed bag—some with cavities and some without. They eat the same food and have similar dental care.

Why the difference in decay?

There are volumes about this, but I’m going to give you a simple version that will help you know how to prevent cavities in the future.

what causes cavities

The Role Sugar Plays in Tooth Health

Sugar on the teeth is not what causes cavities. The sugar feeds certain damaging bacteria, and these bacteria create acid. It is this acid that dissolves and pulls the minerals out of the enamel, leading to cavities.

We all have bacteria in our mouths, and some live in that sticky plaque that makes your teeth feel “fuzzy.” We need bacteria to protect us…

…. but some also cause problems.

You can reduce the number of harmful bacteria (more on this later), but you can never get rid of all of them.

 If that plaque stays on your teeth, the bacteria multiply. If you feed them their favorite food–sugar–they will create acid which will dissolve your enamel. As you learned above, if enough minerals dissolve, you will get a cavity.

The Umbrella Effect and Cavity-Resistant Teeth

As I said, this is not wrong, but it isn’t the entire story. If it was, the husband in the previous example would have more tooth decay than his wife.

When you’re using an umbrella, the water beads up on the surface and doesn’t soak in because of the tightly woven fabric of the umbrella. It is water-resistant.


The Umbrella effect on cavities

If your tooth enamel is full of minerals, it becomes “cavity-resistant” in much the same way. 

In fact, if your tooth enamel is strong and healthy, what you put in your mouth–sugar or not–will not have as much effect.

My younger brother taught me the truth behind this. During his teenage years, he had new-fangled “white braces” put on his teeth.

He rarely brushed…

…So those white braces became orange braces, green braces–the color matched the meal.

Funny thing was, he never got cavities around those braces. If cavities are always caused by bacteria and plaque on your teeth, he would have had a mouthful.

dirty braces causing cavities

What protected his teeth?

His teeth were cavity-resistant. His enamel was healthy.

This has everything to do with those miles of tubes in your teeth. Your teeth are fed from the inside through blood vessels in the center pulp layer of the tooth. Those blood vessels send nutrients to the pumping cells, the odontoblasts, which pump them through the dentin tubules to the enamel above.

If you feed your body and teeth the right nutrients, your body will protect itself by using those nutrients to strengthen the teeth.

What are those nutrients?

 You will find this information in much more detail in Chapter Five– Nourish The Inside.

Hormones and Tooth Health

Lauren visited my office for a second opinion. While away at college, she saw a dentist for a cleaning and was told she had 16 cavities. Mom insisted she sees me—sure the other dentist was trying to get more money from her unsuspecting daughter. I took new dental x-rays and told her my findings. She didn’t have 16 cavities—she had 17.

Sharon never had a cavity until she had children. The first baby led to five cavities and fillings, the second to another four and a toothache, and she was nervous about what a third pregnancy would do to her dental health.

Despite taking meticulous care of her teeth, she continued to have dental problems until she visited my office.

Jerry always had great teeth, until he had a heart attack last year. Soon after that, he started noticing dark, sensitive areas along the gumline of his teeth. He came for a checkup and I diagnosed those dark areas as rapidly growing cavities.

All of these people have something in common—they have tooth decay that isn’t caused by sugar. 

Women who are expecting, growing teenagers and people that are suffering from chronic illness all share increased the risk for tooth decay. What is the connection? 


Dr. Melvin Page and other researchers found that when our hormone-secreting glands are out of balance, teeth start to decay.

Let me explain how this works…

 We already learned about the tubules inside your tooth and the cells (odontoblasts) that live at the end of each of those tubes. Those odontoblasts pump fluid up and through the dentin and enamel.

hormones lead to cavities

This fluid is like lymphatic fluid, and it cleans the tooth from the inside out. It repels plaque and bacteria, food and debris on the tooth. 

It’s like having a toothbrush on the inside. Amazing, isn’t it? 

This fluid flow is directed by the parotid gland, a saliva gland near your cheeks. This communicates with the hypothalamus, an area in your brain highly affected by hormones. When hormones are out of balance, this system reverses. The fluid draws the bacteria and debris into the tooth and…

…this leads to tooth decay.

There are natural causes for hormonal imbalance, including…

  • Pregnancy
  • Teenage puberty
  • Menopause

…and male hormone decline.

There are also unnatural causes like…

  • Prescription drugs
  • Environmental hormone disrupters (some foods, EMF wavelengths, etc.)
  • And having a diet high in white sugar and flour

Chronic disease also affects the balance of all the regulatory pathways in your body, including your hormones. If you are in one of these risk categories, you must do more to prevent cavities.

Summary: What Causes Cavities?

To summarize, there are many things that lead to tooth decay, but here are the three main players:

1. The bacteria on your teeth consume sugar and leave acid behind. This acid dissolves and weakens the enamel, letting more bacteria in.

2. If your tooth is weakened because of nutritional deficiencies, the tooth will be more susceptible to this acid attack.

3. If your hormones are out of balance, your tooth’s inner fluid flow reverses and it will be difficult to prevent decay.

Do not despair! 

If you have one or more of these tooth challenges, keep reading the upcoming chapters where we discuss:

  • How to predictably remove the bacteria off the teeth
  • How to strengthen the teeth through diet
  • How to balance your hormones to make your teeth resistant to this hormonal challenge.


Read Chapter 3 where we discuss how you can “heal your teeth” and protect your teeth through nutrition!

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