Put simply, the equation looks like this:
Prolonged/intense low pH in the mouth = death of healthy bacteria/overgrowth of cavity-causing bacteria = caries infection = CAVITIES
Dental plaque that is kept at a pH of 7.0 or greater does not experience this shift in the bacterial species to aciduric and acidogenic (cavity-causing) bacteria even during exposure to sugar. If the pH in the mouth can be maintained at a neutral or alkaline pH, regardless of sugar, food, or acidic drink consumption, the healthy bacteria within the dental plaque biofilm will not die and the shift to cavity-causing bacteria will not occur.2
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A healthy pH balance in the mouth can explain why many people—family members, coworkers, friends, etc.—can consume lots of sugary food and drink, seemingly take little care of their mouth, and yet do not have cavities. At the same time, many people who are extremely diligent about their diet and home care continue to get cavities because the bacteria in their biofilm are primarily cavity-causing bacteria. These people continue to be very susceptible to small changes in pH.
The good news is that this microbial shift from healthy bacteria to cavity-causing bacteria can be reversed using alkaline pH dental therapies (such as CTx4 Treatment Rinse, CTx3 Rinse, and CTx4 Gel 1100). This pH neutralization (alkaline) therapy can be used in a few different ways.
For those patients who are experiencing dental decay, alkaline dental products with pH ranges from 8 to 11 (such as CTx3 Rinse) can be used daily to reverse the bacterial shift from cavity-causing bacteria to healthy bacteria. In addition, daily uses of a pH neutralizing oral spray, gel, or gum after meals, snacks, and drinks can quickly elevate acidic oral conditions caused by diet. This method of pH neutralization can shorten acid attacks caused by foods/sugars and keep the acid attack from dropping to intensely low pH levels.
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Finally, for patients that have risk factors leading to a bacterial imbalance, targeted pH neutralization dental products used daily can greatly aid in preventing a bacterial shift in their oral biofilm. This is especially important for individuals with unmodifiable risk factors such as a restricted diet, saliva issues, prescription medications, and children at risk. It is preferable to prevent the bacterial shift from healthy to unhealthy (cavity-causing) than to reverse an acidic biofilm back to a healthy balance.
In a clinical trial conducted by the authors to examine the potential of pH neutralization as a caries treatment strategy, ten high caries risk adults were instructed to wear oral trays containing a gel with a pH of 9.0 for 8 hours at night for a period of 30 days. Mixed samples of their plaque were taken prior and after the 30-day period. The plaque samples from each individual were then checker-boarded using PCR and 16S gene sequencing DNA identification to identify the individual bacteria and the changes the bacterial species and concentration based on the neutralizing strategy. The results demonstrated an elimination of caries-causing bacteria like Selenomonas, slight reduction of Streptococcus mutans/sobrinus, Lactobacillus species, and a concurrent growth of healthy bacteria including Prevotella, Campylobacter, and Veillonella. These limited results demonstrate that it is possible to reduce/shift the cariogenic microbes from the oral biofilm while replacing them with healthy organisms by regular maintenance of a neutral pH with a tray/gel system.
The method of pH neutralization is a safe and effective way of reversing the bacterial shift or preventing the bacterial shift toward cavity-causing bacteria and can be used for all age groups, including infants. Patients are encouraged to identify the pH of dental products they use in order to identify if the products are pH neutralizing. The ideal pH range for prevention is 8-9, and the ideal pH range for treatment of an unhealthy biofilm is 9-11.