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What is Dental Health?
Dental health is an absence of disease.
What are the main types of dental disease?
The main types of dental diseases are decay and gum diseases.
What is dental decay?
Dental decay is a slow gradual disease process caused by repetitive acid attack on teeth, resulting in the destruction of tooth structure. This acid commonly comes from bacteria in the mouth; which is held onto the tooth surface by plaque. Bacteria basically turns sugar; from things we eat and drink; into acid which then attacks and dissolve teeth. As all teeth have a protective hard outer enamel shell (shown below), it often takes years before this layer is breached. However, once the acid attack penetrates through the enamel and into the inner dentine layer, it is known as “decay” . Progress from this stage onwards is often swift and may only take months to spread and involve the “nerve and blood vessels” of the tooth; commonly known as the “pulp”.
Does decay cause me pain?
Decay may or may not cause pain. In some cases, decay can spread and “eat away” at the tooth and yet remain asymptomatic. It is not until the advanced stages does the destruction undermine the enamel, causing a cavitation overnight. Therefore relying on pain as a guide to seeking professional treatment can sometimes lead to a false sense of security. It is recommended that regular dental checkups and X-rays be carried out to help detect and arrest decay at the early stages.
If I do experience symptoms from decay what would they be?
The most common symptoms of decay are pain or sensitivity to sweet, cold and sometimes hot. If left untreated, in the advanced stages where the pulp is involved, bacteria can enter the pulp and spread down the root canals. The most common outcome is a tooth abscess often seen as a gum boil with pus discharge. By this stage, there is often tenderness to biting/chewing, pain to hot food/drinks and even disturbed sleep. Pain killers also tend not to work too well either. As well as this, the entering and spread of bacteria from the root canals into the blood stream can result in facial swelling, which can become life threatening.
Why is early intervention of decay important?
Early detection and intervention of decay minimises the need for extensive restorative treatment and eliminates the need for costly Root Canal treatment or premature loss of teeth. It also reduces the chance of experiencing dental pain or developing life threatening conditions.
Can decay be prevented?
Yes, in the initial stage of decay development; when acid attack is still confined to the enamel layer (often seen by chalkiness to the outer tooth surface); it is often possible to remineralise and reverse the effect. This is achieved by having a professionally applied, concentrated fluoride treatment at the dentist in conjunction with regular brushing, flossing and use of fluoridated water and toothpaste. Remember the old saying, “prevention is always better than cure.”
What is the best type of brush to use?
It is recommended that a small head, soft bristled brush be used. This is so that it can reach all confines of the mouth; especially the back molar teeth. The soft bristles again should be applied gently onto the surfaces of the teeth at the gum margins. The reason for this is to enable effective cleaning without any damage to the tooth or gum. Typical damage from heavy handed brushing includes permanent abrasion to the tooth’s surface and even “stripping” of the gum, resulting in exposed root surface. All of these may lead to teeth sensitivity, especially to hot and cold temperatures.
How many times should I brush and floss each day?
With respect to brushing and flossing, it is better to brush once or twice a day, but do a thorough proper clean, than to do it 5 or 6 times but not properly. A typical thorough job should last anywhere between 5-10 minutes.
What is the best time to clean my teeth?
There is no particular time that is best to clean your teeth other than a time that is convenient to you. Try and find a moment or two throughout the day where you can spend a good 5 to 10 minutes. This can be in the shower, or during the lunch break, or before bedtime. In general, most people like to freshen up and so brushing in the morning and again before bedtime to remove all the plaque that has built up during the day.
Is an electric toothbrush recommended over a normal brush?
The answer to this depends on whether you have any disabilities and what your attitude is to brushing. If you are able to brush with a normal toothbrush and can do it well, then an electric toothbrush will not be of much advantage to you. Whereas a person with a disability or handicap may find that an electric toothbrush improves their brushing considerably and in this group of patients, it is most advantageous.
How does diet and dietary behaviour affect decay development?
As discussed previously, bacteria require sugar to produce acid, and an absent of sugar from our diet basically means an absent of decay. However, this is not practical in the world which we live in; as most foods contains some form of sugar or carbohydrate. For example, bread, fruit, potato chips all carry a form of sugar (in the form of carbohydrate), as do the obvious such as soft drinks and sweets. It is therefore not practical to just concentrate on this when it comes to control of decay. We must look at the other important factor which is dietary frequency. To understand this, we must look at what happens in the mouth whenever food or drink with sugary substrates are consumed. Again, whenever sugar is introduced into the mouth, bacteria uses this to produce acids. This acid attack starts to dissolve small amounts of tooth structure. Fortunately, our mouth produces saliva which helps in a big way by neutralising the acid attack. However, this whole neutralising process requires time (up to 30-60 minutes) before the pH in the oral cavity is restored back to normal. This is a major reason why constant snacking is not recommended as it interferes and prevents saliva from carrying out it’s protective function. Frequent snacking basically introduces multiple episodes of acid attacks before saliva has had a chance to neutralise the acid and in effect turns the oral cavity into an “acid bath”. This has serious repercussions in that the outer enamel shell is constantly under acid attack and hence prone to dental decay.
Does chewing of sugarless gums help with decay prevention?
It has been shown that the chewing of sugar less gums in between meals helps reduce decay. This is because the chewing action (whether it be gum or something else) stimulates saliva flow, which in turns help neutralise any acid present. Sugarless gums commonly substitutes sugar with artificial sweeteners; which bacteria cannot use to produce acids and hence cannot cause dental decay.
Are there any disadvantages in chewing sugarless gums?
Continuous chewing may cause side effects such as stressed jaw joints leading to joint pains. Chewing also tends to promote the flow of saliva which is good in terms of decay prevention but may lead to a faster build up of tartar (discussed in more detail below). Some artificial sweeteners in high concentration may cause side effects such as stomach upsets and diarrhoea.
Can anything else affect my susceptibility to decay?
There is a significant percentage of the population; who by no faults of their own, are born with teeth which have narrow grooves and pits. In these situations, plaque which collect in these narrow crevices cannot be removed, even with thorough brushing. Fortunately, preventive treatment is available whereby the deep narrow pits and grooves are opened, cleaned and sealed over. This is done so that future plaque deposits collect above these preventive sealants and are therefore accessible to the toothbrush. This in turns help facilitates effective cleaning and maintenance; thereby minimising decay formation.
Children with newly erupted permanent molars, who because of their age tend not to be able to brush too well. In this group of individuals, their lack of dexterity means that plaque left behind on the grooved surfaces of the teeth can promote decay. And as adult/permanent teeth are required to serve us throughout our lifetime, their preservation is of utmost importance. It is therefore commonly advised in children over 6 years of age that a protective sealant be applied over deep pits and grooves of their adult molar teeth, as a preventative measure against decay.
With age, saliva flow tends to decrease and saliva quality reduced, and hence in the elderly age group, root decay is quite common. It is therefore suggested that those who fall into this group visit their dentist more regularly for follow up maintenance and fluoride treatments. Home use of fluoridated gels or rinse may also help, as does chewing of sugarless gums.
What is gum disease?
Gum disease is a disease process which arise from inadequate removal of plaque and often leads to bleeding, receding and/or swollen gums as well as bad breath. Although painless at the early stage, in advanced stages, there is usually significant loss of surrounding bone (which are the supporting structures for the tooth). This often results in tooth loosening, and can cause considerable pain when chewing. By this stage, extraction of the tooth is more often than not, the only treatment available, as dental bone loss is permanent and cannot regenerate.
What is gingivitis?
Gingivitis or “inflammation of the gum” is basically gum disease in the early stage. This is often characterised by bleeding and/or swollen gums without any active bone loss. The main cause is poor oral hygiene. However hormonal factors (such as the hormonal changes during puberty and in pregnancy) and certain drugs can also cause a different form of gingivitis.
What is periodontitis?
Periodontitis or “inflammation of the gum and surrounding bone” is basically gum disease at the advanced stage. It exhibits all traits of gingivitis but also characterised by deep pocketing in the gum and bone loss. There is often a lot of tartar below the gum and deep scaling and root planing treatment is required.
How can I prevent gum disease?
The removal of plaque via thorough brushing and flossing on a daily basis, is mandatory in the prevention of gum disease. However, it is also essential that tartar be removed. This is achieved by having a professional clean at the dentist at least once every six to twelve months.
Do mouthwashes help in preventing gum disease?
Although mouthwashes help in reducing bacteria, it should only be considered an adjunct to those wanting a “perfect” clean or a fresh breath afterwards. If thorough brushing and flossing removes 98% of plaque in the mouth, mouthwashes will only help destroy the remaining 2% of bacteria to give that “perfect” clean. The use of mouthwash by itself, to replace brushing and flossing altogether is therefore not recommended.
What is plaque?
Plaque is basically a gel like invisible film; containing bacteria; which clings strongly to the surfaces of teeth.
What is tartar?
Tartar, also known as calculus; are hard deposits formed from the hardening/calcification of plaque. It is commonly found attached to teeth close to the gum line and range in colour from light yellow to black.
What are the different types of tartar and how are they formed?
The light yellow coloured types are formed by plaque which have been calcified by saliva. It therefore is found mainly at the saliva duct openings; at the cheeks near the upper molar teeth and on the tongue side of the lower front teeth. These types of tartar also tend to be located at or above the gum line; where plaque is in constant contact with saliva. Tartar which are brown in colour are basically the light yellow types but have been stained by food pigments or from smoking. Lastly, the black variety of tartar are those formed by plaque which have been calcified by blood pigments. They are therefore commonly seen under the gum line or if the gum shrinks, it may expose this type of tartar and make it seem like it is above the gum line. This type of tartar is often found in those with gum disease; and bleeding gum is often associated.
Why must tartar be removed?
The significance of tartar is that on a microscopic level, it is quite porous meaning that it attracts and allows plaque to adhere to it. As more plaque adheres to the tartar surface, it again can calcify and allow the tartar deposit to continue growing in size, synonymous with a snowball rolling down a mountainside. And as bacteria in plaque produce toxins, acids and other by products , these can cause detrimental affects in humans. Such adverse affects include bad breath, tooth decay, swollen and bleeding gums, and eventually, loosening and loss of teeth. It therefore makes sense to remove tartar, so as to reduce the amount of bacteria accumulating in the mouth and restore health to the gum and supporting tissues. This highlights the need to have your teeth and gums professionally cleaned periodically ( usually every six months ).
What are the effects of tooth loss?
Tooth loss means fewer teeth, and this may lead to reduced chewing efficiency and comfort. It can also become an aesthetic and phonetic problem if it involves a front tooth and this can impact on one’s confidence and lead to reduced self esteem.
In some cases it may lead to jaw problems as teeth adjacent to the gap, tips or moves and opposing teeth may over extrude. This can upset the “harmony” of the bite and may also result in jaw joint pain.
It can thus be summarised that fewer teeth often leads to a lower quality of life.
Why is quality care of paramount importance?
In order to achieve healthy, strong and long lasting teeth it is important that any treatment carried out be of the highest standard using the best material and technical services available.
Quality dental treatment is therefore an investment aimed at achieving greater health so that less treatment and expense is required in the future.
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