Episode 93: A Survival Guide to Dental Health for Teens

(0:03 – 0:36) Eon Engelbrecht: Welcome back to Save Your Money, Save Your Teeth. I’m Eon from eRadio SA and today we are tackling a critical stage of life, the teenage years. Joining us is Dr. Clifford Yudelman from OptiSmile to discuss why even the most cavity-free kids can suddenly face dental drama once they hit high school. So we’re diving into the teenager’s survival guide to oral health. Dr. Yudelman, welcome back.
(0:37 – 0:44) Dr. Clifford Yudelman: Thanks Eon, great to be back and I can’t believe January is already finished. Wow, we’re into February now.
(0:44 – 0:48) Eon Engelbrecht: Yeah and that means two years of Save Your Money, Save Your Teeth. Is that correct?
(0:48 – 0:56) Dr. Clifford Yudelman: Yeah, 100%. I think next week or Valentine’s Day will be our two-year mark.
(0:57 – 1:05) Eon Engelbrecht: Unbelievable and here we are 93 episodes already. That’s quite an achievement.
(1:04 – 1:05) Dr. Clifford Yudelman: Amazing, well done to you.
(1:06 – 1:14) Eon Engelbrecht: Well done to you. So interesting.
(1:11 – 1:14) Dr. Clifford Yudelman: Another 50 or so up my sleeve.
Why Cavities Spike in Teenagers
(1:16 – 1:30) Eon Engelbrecht: Okay, awesome. Dr. Yudelman, this is a very interesting topic. I want to start off right away and ask you why do teenagers suddenly get a spike in cavities after years of actually being cavity-free?
(1:30 – 4:15) Dr. Clifford Yudelman: So a lot of the stuff we’re going to speak about today we’ve spoken about in various episodes but I thought since we did the 0 to 3, 3 to 6, 6 to 12, let’s do one for teenagers and then next week we’ll do one especially for men or males as specific things. So if you’re a teenager, you have a teenager, this one’s for you.
So the spike in cavities, yeah, that’s really something we see a lot. It’s very frustrating and it’s common especially as a parent. You got a few kids and then they get away with no cavities and then suddenly at 16, 17, there’s cavities. So children with excellent teeth in primary school getting cavities when they’re teenagers coming out of nowhere but it’s really a number of risk factors that converge all at the same time.
The main thing what happens with teenagers is the behaviour changes. They become more independent as you know especially over food choices. It’s impossible sometimes to get them to brush their teeth. Trying to speak to a 10-year-old versus a 16-year-old is a bit different. Brushing becomes rushed. Often, they stop flossing if they were flossing.
Late nights, they miss bedtime brushing. The diet is shifted. They eat a lot more sugar. They start with sports drinks, energy drinks, Red Bull, all of those things, all very acidic types of things, juices and they spread it out throughout the day and each time you have something sugary or acidic, it triggers an acid attack that softens the enamel for up to an hour. So they’re doing this every couple of hours. The enamel is just being softened all the time.
The third thing is the saliva changes which is quite interesting. The hormonal fluctuations during adolescence can affect saliva flow and composition and can actually reduce the buffering effect and the saliva is the mouth’s natural defence system. These studies have shown that this is because of diets and behaviour. It’s not just a sudden biological weakness of the teeth and the take-home message really is that teenage cavities are predictable and preventable and maintaining structure, making sure they keep using fluoride toothpaste or hydroxyapatite toothpaste that we mentioned if somebody’s trying to avoid fluoride.
The regular monitoring during this life stage can save a huge amount of future dental costs and damage. A lot of people start missing that six-monthly or annual exam and it catches up. Finally, they come in when they’re 20 and they haven’t had an exam in four years and there’s always cavities.
The Impact of Energy Drinks on Enamel
(4:16 – 4:26) Eon Engelbrecht: Exactly and you know the kids love their energy drinks and sports drinks but I mean what is the real impact of these drinks on your enamel as a teenager?
(4:26 – 6:22) Dr. Clifford Yudelman: So it’s much worse than what parents realise. To add to what we’re saying earlier, it’s not just about the sugar. A lot of these are very highly acidic which means that they have a low pH and anything with a pH lower than 5.5 will actually melt or erode the enamel. When the enamel is exposed to the acid, it softens and they don’t get enough time to remineralise.
If you add sugar to that, that just makes it worse and they often will sip on these drinks slowly, have two or three of these drinks that make them last the whole day and so their teeth are just being bathed in acid. It’s really quite crazy how we see this severe erosion on a young patient, 18, 19, 20 years old. The enamel doesn’t grow back. We only used to see that type of erosion on 50 and 60-year-olds and now we’re seeing it on youngsters like that.
From a practical standpoint, these drinks shouldn’t be drunk every day or I shouldn’t consume them every day. Water is the default. Personally, I have now switched from a plastic bottle to a glass bottle, whatever that is. I just fill it up at the tap. I have a filter. I don’t even use that. I just drink tap water myself. I think depending where you live, tap water is probably the best thing and it’s much better than drinking cold drinks or juice.
Make sure that if you do have something acidic that you have it with a meal and you follow it with water. Brushing should always be delayed for at least 30 to 60 minutes after you have an acidic beverage. You don’t want to drink one of these and go and brush. That’s even worse because your enamel gets soft and then you’re going to go and brush it away.
Vaping vs. Smoking
(6:23 – 6:35) Eon Engelbrecht: Exactly. Apart from the energy drinks, very popular is vaping nowadays. Is vaping safer for your teeth than smoking? Any hidden dangers for teenagers?
(6:36 – 8:42) Dr. Clifford Yudelman: Vaping is often marketed as a safer alternative to smoking, but from an oral health perspective, it’s far from harmless. While it eliminates the combustion products, it introduces other risks that are particularly relevant to teenagers. Most vaping products contain nicotine and other chemicals that reduce blood flow to the gums. This can mask early signs of gum disease such as bleeding and allows damage to progress silently.
Vaping is also associated with dry mouth. We’ve spoken about saliva a lot. Reduced saliva increases the risk of cavities, can give you bad breath and also cause gum inflammation. Now, new research shows that vaping changes your oral microbiome, the bacteria in your mouth and that favours bacteria linked to gum disease. Although it’s newer than smoking and the long-term data is still developing, the evidence so far suggests that it’s not harmless to your oral tissues.
For teenagers, the additional concern is addiction because nicotine dependence affects behaviour, attention and long-term health choices. My advice is clear and I’m quite conservative on this. Vaping is not safe for teeth or gums or your overall health. It shouldn’t be viewed as a harmless habit simply because it’s not cigarettes. My personal opinion is that I think they’re going to find that it’s way worse than cigarettes because it depends. There used to be maybe 20 or 30 cigarette manufacturers and they were all doing the same thing, growing the plants, drying it, rolling it up, putting it in a little paper thing with a filter. With vaping, you don’t know what chemical is in that thing. You don’t know what you’re breathing. Some of it smells like apples and peaches and who knows what, cinnamon. I mean, that’s all going in your body, in your lungs.
(8:43 – 9:01) Eon Engelbrecht: Yeah, you already have teenagers battling with conditions like popcorn lung and all that stuff at a very young age. Yeah, I’m young. Caused by? Popcorn. Yeah, you know about popcorn lung, I’m sure, and caused by vaping and what’s the other one, hubbly-bubbly.
(9:01 – 9:13) Dr. Clifford Yudelman: Oh yeah, I mean those things, how can they be good for you? Sometimes you got to just grow up and listen to the grown-ups, I guess.
Oral Piercings
(9:13 – 9:30) Eon Engelbrecht: And you know, it’s not a teenager if there’s not a piercing. There has to be a piercing somewhere. So can we talk about oral piercings like tongue or lip studs? Do they actually affect your gum health and your tooth structure?
(9:30 – 11:23) Dr. Clifford Yudelman: Well, lately I haven’t seen too many, too much of this, but actually when it first started, I was in California and I actually had a young Filipino male patient that bit on his tongue stud very hard by mistake actually, and he split his tooth right down the middle. It was terrible. I was able to save his tooth, but we didn’t really even have injection moulding or anything back then. I remember I think he got two veneers or two crowns, but it was early, early, early days.
And I’ve seen quite a number of patients when they have like a lip ring or something that rubs on the gum and it causes recession. I mean, if you do have that, it’s not too late to take it out and the gum can grow back or you can get minor grafting, but long-term those things do mess up the gums. They rub on them thousands of times a day. I’ve had patients break back teeth. I’ve had patients, you know, they keep playing with their tongue bar or tongue ring. I mean, that’s just generally annoying. Maybe it’s meant to annoy adults, but people get into funny habits.
As I say, you can get surgery if your gum does recede, but you really don’t want to break a tooth. And then also doing these piercings right in the middle of the tongue, there’s a lot of nerves there. There’s people that have had permanent nerve damage. You can get infections, but there’s lots and lots of literature too, where they’ve studied all of this and the cost to repair the damage, you know, far exceeds the prevention. And from a long-term perspective, oral piercings are high risk and a low reward decision for dental health.
Brushing with Braces
(11:24 – 11:34) Eon Engelbrecht: Okay. And let’s say they’ve got braces. What is the best way to clean around those braces if the teenager is not too fond of flossing?
(11:34 – 13:39) Dr. Clifford Yudelman: Yeah, look, flossing, I mean, that’s why we do only Invisalign at OptiSmile. I’ve got two dentists that know how to and can do braces as well, but they much prefer Invisalign because patients can brush and floss as normal. You know, orthodontic braces cause block traps. It becomes difficult. Flossing with braces is very difficult.
You know, you want to reduce harm. So if someone does have traditional braces, you can get these tiny little brushes, not the little toothpick things. They’re interdental brushes that you can use around and between the teeth and under the wires. A water pick or water flosser can help get food out. There’s some really good electric toothbrushes now. Some of them have orthodontic brush heads or a sonic brush will get around and in between works really well. We’ve got some really good ones at OptiSmile. Some of them are super expensive. You don’t need a super expensive one, but you need something with nice soft bristles. We have done podcasts about electric and manual brushes and yeah, look, it’s not an excuse.
You’ve got to keep them clean. My brother had braces when he was young, my older brother, and he also used to drink a fair bit of Coca-Cola and I fixed his teeth. He’s my family member and he’s had years and years of suffering from not keeping his teeth clean when he had braces. We’re talking in the 70s or 80s, but braces haven’t changed since then. I mean, Invisalign has come along, but braces are still braces and getting regular professional cleaning during orthodontic treatment is very important. Some orthodontists recommend that the patient go every three months to the hygienist. That’s not only so much for us to clean your teeth, but to actually motivate you and show you where you’re missing and to prevent what’s called white spot lesions, which is damage to your enamel from plaque sitting on the braces and on the teeth.
Teeth Whitening: Appropriate Age
(13:39 – 13:45) Eon Engelbrecht: And doctor, at what age is it safe for a teenager to start professional teeth whitening?
(13:45 – 15:46) Dr. Clifford Yudelman: A great question there because it comes up all the time. So teeth whitening should generally wait until all the permanent teeth are in and the enamel is fully matured. Usually, we like to wait till the late teenage years, 18, 19. Whitening earlier can increase the risk of sensitivity, but we will and we have done whitening. I’ve done whitening even quite a while back on patients as young as 13 or 14, if they’re being teased at school or don’t want to go out, if they have significant brown marks.
In fact, I remember a particular case even when I was back in California. I moved to Australia in 2002. So in the late 90s, I did whitening on some very young patients. It was unheard of then, but nothing happened. Their teeth got whiter, their confidence improved. Generally, it’s not a fashion thing we’re talking about teenagers or the younger ones where they have severe brown stains and fluorosis. You can’t do it if there’s cavities or gum disease or bleeding gums or significant erosion. They’re recommended for younger patients safe if it is under supervision when they’re 14 or 15. All these really bad marks is a very weak carbamide peroxide overnight, but you definitely don’t want to be doing anything over the counter or like off the internet or social media, all of these DIY products or whitening strips. The safest approach is to actually get it done with a dentist. I wouldn’t go to a beauty salon or anything like that. We did six podcasts on whitening. So yeah, I think this question about what age can you start is very important. If someone has a question, they can set up a free video consult and I’ll give them advice tailored to their own situation.
Puberty and Gum Health
(15:47 – 15:57) Eon Engelbrecht: Irene, how do puberty and hormonal changes specifically affect gum health? I mean, there’s something called puberty gingivitis, I think?
(15:57 – 17:26) Dr. Clifford Yudelman: Yes. So the puberty brings a big surge in hormones. It increases blood flow to the gums and it changes the inflammatory response. It can make gum tissue more reactive to plaque even when oral hygiene hasn’t really changed or gotten worse. The gums look red and swollen, they bleed easily. They just got to improve their oral hygiene and the research has clearly shown a correlation between puberty and this gingival inflammation independent of plaque levels.
The solution isn’t aggressive brushing, it’s gentle plaque control. And education is important when teenagers understand that the bleeding gums are a warning sign rather than something to ignore. They’re more likely to improve oral hygiene habits. And flossing is really important at that stage, as well as tongue scraping. If your gums are bleeding, then you could also have bad breath. That was our very first broadcast on bad breath. Scraping your tongue will help. We do sometimes give teenagers special mouthwash and toothpaste that’s got a tiny bit of chlorhexidine in it. Not the normal chlorhexidine that you buy over the counter that can stain your teeth, but the chlorhexidine that it’s a non-staining, it’s called Curasept, Curaden. Products are really good from Switzerland, just a small tiny amount of chlorhexidine, but not all the time, just to get things under control.
Wisdom Teeth
(17:26 – 17:50) Eon Engelbrecht: And you know when you’re a teenager, all of a sudden you’re going through so many changes, and then that’s also when you get to meet your wisdom teeth. And it’s either going to be wonderful and they’re going to come in nicely, or they’re going to cause problems like they did for me. Not pleasant. So what are the early warning signs of wisdom teeth coming through in your late teens, doctor?
(17:51 – 19:22) Dr. Clifford Yudelman: So we did, as you remember, a full podcast just on wisdom teeth quite early on. That is a common subject. We get a lot of people googling that and finding our podcasts and our blog pages and our wisdom tooth page. So they usually begin to erupt in late teenage years, although timing varies. Some early signs can be intermittent pain at the back of the mouth, especially on the lower ones. You get some swelling of the gum tissue. Sometimes it can be hard to open your mouth and you can get a bad taste if food is trapping in that area.
A partially erupted wisdom tooth, one that’s just like a halfway in or quarter way in, is prone to infection because bacteria accumulates under that little gum flap, and this is called pericoronitis. It can become painful and it can happen over and over. Clinical examination with a dentist and x-rays are essential to assess whether there’s enough space for the eruption or whether the tooth is actually stuck or impacted, it’s called, where it’s impacting on the tooth next to it, like jammed in there. Early assessment allows for planned management rather than emergency treatment during exams. Sometimes they’ll flare up during exams or when you’re on holiday or over Christmas or stressful periods. And monitoring the wisdom teeth early helps to avoid pain, infections and last minute extractions when it’s not convenient.
Retainers and Aligners
(19:23 – 19:42) Eon Engelbrecht: And you know, children can be quite nasty in school, especially if you’re wearing something that they can see, you know, like braces or whatever. They’ll call you brace face or whatever. So how can we encourage the teens to wear their retainers or aligners when they feel self-conscious about it, maybe?
(19:42 – 20:56) Dr. Clifford Yudelman: Yeah, so obviously if you’ve got braces, then there’s no getting away from that. They’re stuck on there for 18 months or two years or three years. So what we’re talking about here, because more and more, you know, Invisalign and retainers are more common, is the teenagers need to understand that the parents spent a lot of money on getting their teeth straight and the teeth can move back or relapse, we call it, very quickly after orthodontic treatment. And the relapse often leads to the need for re-treatment, which again is costly and it’s frustrating for the parents.
You know, normalising appliance wear is important and many teens assume they’re the ones wearing retainers or aligners. And these days, there’s quite a few people with them, you know, clear aligners or discreet retainers help. But I think, you know, we show patients what it looks like if you don’t wear your retainers and your teeth move back to where they were. And usually the parents, because they spent a lot of money, are the ones that make sure that the kids are listening. And, you know, retainers are insurance. You wear them now or you pay for it later.
(20:57 – 21:05) Eon Engelbrecht: That’s a good one. It’s just so fascinating how your teeth can move. I mean, it takes time, but it’s incredible how they can move.
(21:05 – 21:18) Dr. Clifford Yudelman: Yeah, they move your whole life. If you develop a habit like chewing on your pen, that tooth will start moving forward. So if you bite your nails and, you know, the teeth will move inwards.
Bad Breath in Teenagers
(21:18 – 21:28) Eon Engelbrecht: That’s amazing. Also, just one more question, doctor, is bad breath in teens usually hygiene related or could it be even tied to their diet?
(21:28 – 23:10) Dr. Clifford Yudelman: In the vast majority of teenagers, bad breath is due to oral causes, something going on in their mouth. It’s very rare that it’s the stomach, unless they’re burping all the time, or some kind of abscess or infection in their nose. It’s generally the plaque buildup on the tongue coating, dry mouth from not drinking enough water or having too many energy drinks and not enough water. And then also like oral hygiene, trapped food in between their teeth.
Diet also plays a role, especially high protein foods. I mentioned, you know, biltong, but even like a protein shake, then also sugary snacks and energy drinks. These can cause bad breath. Dehydration, we mentioned, especially if the teenagers are playing a lot of sports and not drinking enough water. Like I said, systemic causes or like general health causes of bad breath are very rare in this group. So good brushing, tongue scraping, hydration, drinking lots of water, making sure you floss, getting rid of gum inflammation, that usually sorts out the problem. And persistent bad breath should be assessed professionally and not masked with mints or sprays.
There is something called the tic-tac cavity. I don’t know if you remember, you’ve tried those tic-tac mints, the little sort of, yeah, they’re tiny little mints and you normally stick them up next to your upper molar at the back there and you can get a cavity right there on that tooth. We call it a tic-tac cavity. I haven’t seen one in a while.
(23:10 – 23:11) Eon Engelbrecht: Wow, okay.
(23:12 – 23:35) Dr. Clifford Yudelman: I just look in someone’s mouth and sometimes they have a bit of a greenish look to them and I’ll say, oh, so you like to keep your tic-tacs on the upper right, yeah. And they go, how do you know? Wow, that’s so cool. Yeah. And treating, yeah, getting rid of the actual whatever’s causing the bad smell is way better than trying to cover it up with a tic-tac or a breath mint or mouthwash.
Conclusion
(23:36 – 23:46) Eon Engelbrecht: Exactly. Okay, well, that was so interesting and that also wraps up our survival guide for the teens in your life for today. Dr. Yudelman, thank you so much for joining us again.
(23:47 – 23:51) Dr. Clifford Yudelman: Thank you and looking forward to speaking to you next time.
(23:52 – 23:58) Eon Engelbrecht: Absolutely. Next week, talking about men’s oral health, the silent crisis, that’s bound to be very interesting as well.
(23:58 – 24:01) Dr. Clifford Yudelman: Yes, and have a good week until next week.
(24:01 – 24:16) Eon Engelbrecht: Thank you, you too. And remember, teenage cavities are predictable and preventable with the right structure and monitoring. To our listeners, protect that enamel now. It’s the best way to save your money and your teeth. Until next time.
(24:36 – 25:21) Speaker 3: Discover the world of dental excellence with OptiSmile. Join us for a weekly podcast featuring Dr. Clifford Yudelman, a seasoned expert with 40 years of dental experience across four continents. Gain unique insights and expert dental advice by visiting optismile.co.za for free. OptiSmile, where global expertise meets local care.