TOOTH DECAY: A PREVENTABLE DISEASE
What is tooth decay, and what causes it?
Tooth decay is the disease known as caries or cavities. Unlike other diseases, however, caries is not life threatening and is highly preventable, though it affects most people to some degree during their lifetime. Tooth decay occurs when your teeth are frequently exposed to foods containing carbohydrates (starches and sugars) like soda pop, candy, ice cream, milk, cakes, and even fruits, vegetables and juices. Natural bacteria live in your mouth and forms plaque. The plaque interacts with deposits left on your teeth from sugary and starchy foods to produce acids. These acids damage tooth enamel over time by dissolving, or demineralizing, the mineral structure of teeth, producing tooth decay and weakening the teeth.
How are cavities prevented?
The acids formed by plaque can be counteracted by simple saliva in your mouth, which acts as a buffer and re-mineralizing agent. Dentists often recommend chewing sugarless gum to stimulate your flow of saliva. However, though it is the body's natural defense against cavities, saliva alone is not sufficient to combat tooth decay. The best way to prevent caries is to brush and floss regularly. To rebuild the early damage caused by plaque bacteria, we use fluoride, a natural substance which helps to remineralize the tooth structure. Fluoride is added to toothpaste to fight cavities and clean teeth. The most common source of fluoride is in the water we drink. Fluoride is added to most community water supplies and too many bottled and canned beverages. If you are at medium to high risk for cavities, your dentist may recommend special high concentration fluoride gels, mouth rinses, or dietary fluoride supplements. Your dentist may also use professional strength anti-cavity varnish, or sealants plastic coatings that provide an extra barrier against food and debris.
Who is at risk for cavities?
Because we all carry bacteria in our mouths, everyone is at risk for cavities. Those with a diet high in carbohydrates and sugary foods and those who live in communities without fluoridated water are likely candidates for cavities. And because the area around a restored portion of a tooth is a good breeding ground for bacteria, those with a lot of fillings have a higher chance of developing tooth decay. Children and senior citizens are the two groups at highest risk for cavities.
What can I do to help protect my teeth?
The best way to combat cavities is to follow three simple steps:
Cut down on sweets and between-meal snacks. Remember, it's these sugary and starchy treats that put your teeth at extra risk.
Brush after every meal and floss daily. Cavities most often begin in hard-to-clean areas between teeth and in the fissures and pits the edges in the tooth crown and gaps between teeth. Hold the toothbrush at a 45-degree angle and brush inside, outside and between your teeth and on the top of your tongue. Be sure the bristles are firm, not bent, and replace the toothbrush after a few weeks to safeguard against re-infecting your mouth with old bacteria than can collect on the brush. Only buy toothpastes and rinses that contain fluoride (antiseptic rinses also help remove plaque) and that bear the American Dental Association seal of acceptance logo on the package. Children after three years old should only use a smear layer of fluoride toothpaste (about the size of a grain of rice) with assistance with brushing. Children the ages of three to six years that can spit out the toothpaste can use a small pea-sized dab of toothpaste on the brush and should spit out as much as possible because a child's developing teeth are sensitive to higher fluoride levels. Finally, because caries is a transmittable disease, toothbrushes should never be shared, especially with your children.
See your dentist at least every 12 months for checkups and professional cleanings. Because cavities can be difficult to detect a thorough dental examination is very important. If you get a painful toothache, if your teeth are very sensitive to hot or cold foods, or if you notice signs of decay like white spots, tooth discolorations or cavities, make an appointment right away. The longer you wait to treat infected teeth the more intensive and lengthy the treatment will be. Left neglected, cavities can lead to root canal infection, permanent deterioration of decayed tooth substance and even loss of the tooth itself.
What is dental amalgam?
Dental amalgams or silver fillings have reportedly been used as early as 659 A.D., France began using the materials in 1826 and the United States in 1833. Dental amalgam is made out of a mixture of metals such as silver, copper, tin and bound with mercury. The mercury makes up between 45-50 percent of the mixture and acts as a glue that binds the components into a hard stable and safe substance that is manipulated and adhered to your tooth. In fact, amalgam can be the least costly, quickest way to restore teeth, and is used in approximately 50 percent of all dental cases. Although this percentage is declining with the use of newer materials like composite resins.
Is dental amalgam safe?
Dental amalgam has been used for more than 150 years and can last in a patient's mouth for more than 12 years. No scientific studies have demonstrated that the mercury contained in dental amalgam is harmful. For example, studies show that the mercury found in a filling is less than a person's normal exposure to the mercury found in food, water and air. Therefore, dentists continue to place amalgams to preserve a tooth. The United States Public Health Service and the Food and Drug Administration Dental Products Panel are some of the many organizations that have determined amalgam is safe for preserving a tooth's structure. Amalgam has been claimed to cause some health problems, such as dizziness, headaches, fatigue, nervousness and sometimes compromised general health. The only people, however, who have been found to have a true reaction to amalgam are those who are allergic to mercury, which is approximately one percent of the population. If you think you have sensitivity to amalgam, ask your physician for a blood test.
How is my tooth prepared for a filling?
Once your dentist determines that you have decay, it is important to take care of it. Once the decay is removed, the amalgam is mixed and placed into the tooth. The final filling is then carved and adjusted to your bite. Once placed, it can take up to two weeks for your filling to harden completely. However, you may chew on the surface 24 hours later. If you have any prolonged discomfort with the tooth, contact your dentist for an evaluation.
Should I get my amalgams replaced?
With all the questions about amalgam, many people wonder whether they should have their silver fillings replaced. Removal of these fillings may cause structural damage to your teeth, depending on the filling's size, and may cause unnecessary expense. So unless you are allergic to amalgam, leave your teeth alone. You should be aware that in some jurisdictions it may be illegal for a dentist to advise you to remove your fillings without a proper medical diagnosis.
Are there other options to amalgams?
The decision in placing other restorative materials should be decided by you and your dentist depending on several factors, including esthetic concerns, cost, tooth location, your wishes and time demands. Other materials include gold, porcelain and composite resin. Each material has a specific use. You and your dentist should discuss what type of material would be best for your mouth.
DIABETES AND ORAL HEALTH
What is periodontal disease?
Periodontal (gum) disease may result from gingivitis, an inflammation of the gums usually caused by the presence of bacteria in plaque. Plaque is the sticky film that accumulates on teeth both above and below the gum line. Without regular dental checkups, periodontal disease may result if gingivitis is left untreated. It also can cause inflammation and destruction of tissues surrounding and supporting teeth, gums (gingiva), bone and fibers which hold the gums to the teeth. A number of factors increase the probability of developing periodontal disease, including diabetes, smoking, poor oral hygiene, diet, and genetic makeup; and it is the primary cause of tooth loss in adults.
How are periodontal disease and diabetes related?
It is estimated that 12 to 14 million people, or one-third of the population in the United States, have diabetes, but only one-half of these individuals are diagnosed. Studies have shown that diabetics are more susceptible to the development of oral infections and periodontal disease than those who do not have diabetes. Oral infections tend to be more severe in diabetic patients than non-diabetic patients. And, diabetics who do not have good control over their blood sugar levels tend to have more oral health problems. These infections occur more often after puberty and in aging patients.
What types of problems could I experience?
Diabetics may experience diminished salivary flow and burning mouth or tongue. Dry mouth (xerostomia) also may develop, causing an increased incidence of decay. Gum recession has been found to occur more frequently and more extensively in moderate and poorly controlled diabetic patients because plaque responds differently, creating more harmful proteins in -9the gums. To prevent problems with bacterial infections in the mouth, your dentist may prescribe antibiotics, medicated mouth rinses, and more frequent cleanings.
How can I stay healthy?
Make sure to take extra good care of your mouth and have dental infections treated immediately. Diabetics who receive good dental care and have good insulin control typically have a better chance at avoiding gum disease. Diet and exercise may be the most important changes that diabetics can make to improve their quality of life and their oral health. Diabetic patients should be sure both their medical and dental care providers are aware of their medical history and periodontal status. To keep teeth and gums strong, diabetic patients should be aware of their blood sugar levels in addition to having their triglycerides and cholesterol levels checked on a regular basis. These may have a direct correlation on your chances of obtaining periodontal disease.
What is the best time to receive dental care?
If your blood sugar is not under control, talk with both your dentist and physician about receiving elective dental care. Dental procedures should be as Short and as stress free as possible. Also make morning appointments because blood glucose levels tend to be under better control at this time of day. If you have a scheduled appointment, eat and take your medications as directed. See your dentist on a regular basis, keep him or her informed of your health status, and keep your mouth in good health.
PREGNANCY AND GINGIVITIS
Will pregnancy affect my oral health?
Expectant mothers (and women who take some oral contraceptives) experience elevated levels of the hormones estrogen and progesterone. These causes the gums to react differently to the bacteria found in plaque, and in many cases can cause a condition known as "pregnancy gingivitis." Symptoms include swollen, red gums and bleeding of the gums when you brush. Remember that the bacteria in plaque (not hormones) is what cause gingivitis. Brush twice a day and floss before you go to bed to help avoid plaque buildup.
What are "pregnancy tumors?"
Pregnancy tumors (pyogenic granuloma) are rare, usually painless lesions that may develop on your gums in response to plaque. Although they are not cancerous, they should be treated. Pregnancy tumors usually subside shortly after childbirth.
Could gingivitis affect my baby's health?
New research suggests a link between preterm, low birth weight babies and gingivitis. Excessive bacteria, which cause gingivitis, can enter the bloodstream through your mouth (gums). If this happens, the bacteria can travel to the uterus, triggering the production of chemicals called "prostaglandins," which are suspected to induce premature labor.
Should I receive dental treatment while I'm pregnant?
Good oral health care is vital during your pregnancy. Continue with your regular dental cleaning and checkups to avoid oral infections that can affect the fetus, such as gingivitis and periodontal disease. Dentists recommend that major dental treatments that aren't urgent be postponed until after your child is born. The first trimester, the stage of pregnancy in which most of the baby's organs are formed, is the most crucial to your baby's development, so it is best to have procedures performed during the second trimester to minimize any potential risk. Dental work is not recommended during the third trimester because the dental chair tends to be too uncomfortable for the mother. If you lie back, the chair may cut off circulation by placing pressure on the vein that returns blood to the heart from the lower part of your body.
If I do need treatment, what drugs are safe?
Be extremely cautious of all drugs during pregnancy. If you have gingivitis or periodontal disease, your dentist may want to treat you more often to achieve healthy gums and a healthy baby. Although dental anesthetics such as Novocain or Lidocaine can enter the placenta, which filters out most drugs, the doses used in most dental procedures are considered safe. If you need to have dental work done during your pregnancy, research has shown that some acceptable antibiotics include penicillin, amoxicillin, and clindamycin, but avoid tetracycline, which can cause discoloration of your child's temporary and permanent teeth. Products containing acetaminophen, such as Tylenol, are approved, but you should be wary of other over-the-counter medications such as aspirin or ibuprofen. Avoid using narcotics for dental pain until your child is carried to term.
Who can I talk to?
If you have any concerns about treatment or medications, make sure to ask your dentist or physician before receiving treatment. Most dental procedures are safe during pregnancy. Remember, the healthier your mouth is, the healthier and happier your pregnancy and baby will be
ORAL HEALTH FOR SENIORS
How can I take care of my teeth?
Proper oral care can keep you smiling well into retirement. Brushing at least twice a day with fluoride toothpaste and a soft-bristle brush are as important as ever. Flossing can help you save your teeth by removing plaque between teeth and below the gum line that your toothbrush cannot reach.
What are some problems I should watch for?
Gingivitis. Most people don't realize how important it is to take care of their gums. Gingivitis is caused by the bacteria found in plaque that attack the gums. Symptoms of gingivitis include red, swollen gums and possible bleeding when you brush. If you have any of these symptoms, see a dentist at once. Gingivitis can lead to gum disease if problems persist. Three out of four adults over age 35 are affected by some sort of gum (periodontal) disease. In gum disease, the infection becomes severe. Your gums begin to recede, pulling back from the teeth. In the worst cases, bacteria form pockets between the teeth and gums, weakening the bone. All this can lead to tooth loss if untreated, especially in patients with osteoporosis. If regular oral care is too difficult, your dentist can provide alternatives to aid in flossing and prescribe medication to keep the infection from getting worse.
What if it's too difficult to brush?
If you have arthritis, you may find it difficult to brush and floss for good oral health care and prevention of disease. Ask your dentist for ways to overcome this problem. Certain dental products are designed to make dental care less painful for arthritis sufferers. You may want to try strapping the toothbrush to a larger object, such as a ball, to make the brush more comfortable to handle, or electric toothbrushes can help by doing some of the work for you.
What are the signs of oral cancer?
Oral cancer most often occurs in people over 40 years of age. See a dentist immediately if you notice any red or white patches on your gums or tongue, and watch for sores that fail to heal within two weeks. Unfortunately, oral cancer is often difficult to detect in its early stages, when it can be cured easily. Your dentist can perform a head and neck exam to screen for signs of cancer. Since oral cancer is often painless in its early stages, many patients will not notice the signs until it is too late. In addition, many older people, especially those who wear dentures, do not visit their dentists enough and problems go unseen.
Should I be concerned about dry mouth?
Dry mouth (xerostomia) happens when salivary glands fail to work due to disease, certain medications or cancer treatment. This can make it hard to eat, swallow, taste and speak. In certain cases, such as radiation therapy, dry mouth can lead to severe complications, which is why it is important you see a dentist immediately before beginning any form of cancer treatment. Drinking lots of water and avoiding sweets, tobacco, alcohol and caffeine are some ways to fight dry mouth. Your dentist also can prescribe medications to fight severe dry mouth.
Maintaining your overall health
Studies have shown that maintaining a healthy mouth may keep your body healthier and help you avoid diabetes, heart disease and stroke. The best way to achieve good oral health is to visit your dentist for a cleaning at least twice a year.
YOUR CHILD'S DENTAL HEALTH CARE
Caring for baby's teeth
Caring for child's teeth is an important part of complete health care. When the first primary tooth appears at about 6 to 10 months, they are susceptible to decay. You should wipe the baby's teeth and gums clean after every feeding with a soft cloth. Allowing an infant to drink from a bottle of milk or juice during a nap or at night is the leading cause of tooth decay among young children. The acid formed by the juice or milk can damage teeth so badly that they cannot be restored. If your child takes a bottle to bed, it should only contain water.
The first visit to the dentist
Many pediatric dentists recommend that children have their first dental appointment when their first tooth comes in. This is to help prevent dental problems later. Your dentist may tell you when your child should begin brushing and flossing. By taking your child to a dentist early, your child will become comfortable visiting a dentist. You will be teaching your child good dental habits at an early age.
First permanent teeth
The first permanent tooth is usually one of the six year molars so named because they appear around age 6. Molars are important because they help shape the lower part of the child's face as well as effect the position of the other permanent teeth. Sealants are a plastic a plastic coating that protects teeth against decay.
Full set of permanent teeth
Permanent second molars usually appear around age 12. At that time, your child will have a complete set of teeth except for the wisdom teeth. Special attention should be paid to your child's teeth during the teen years, as it is during these years that most decay occurs. Wisdom teeth or third molars usually appear between age 17 and 21.
An ounce of prevention
Teaching your child to maintain good dental habits is the beginning of good dental health. It only takes a few minutes a day to ensure that your child is brushing and flossing properly. Proper personal care and regular visits to the dentist can keep dental problems to a minimum. With your help, tour child can have a lifetime of healthy smiles!