Dental Health
What causes cavities?
Are there other causes of cavities?
How long does it take for a cavity to develop?
How can so much damage occur before you feel the
slightest twinge of pain?
Does fluoride prevent tooth decay?
Are there warning signs of a cavity?
What is the best way to deal with a toothache?
Where is a cavity most likely to develop?
Why does a cavity have to be filled?
What is root canal work?
Why not just pull a tooth that's badly decayed,
especially if it's in the back, where it doesn't show?
What's a crown?
Why is brushing so important?
What is the best tooth-brushing regimen?
Why is it necessary to floss as well as brush?
Is it necessary to floss after every meal?
What's the right way to floss?
What is the best way to prevent bad breath?
What causes bleeding gums?
What is gingivitis?
Are there any other conditions that might cause bleeding
gums?
What is periodontitis?
What is the treatment for periodontal disease?
What is orthodontics?
Why is it so important to have straight teeth?
What are wisdom teeth?
What does it mean if my jaw pops when I chew?
What can I do if I have TMJ pain?
How often is it necessary to see a dentist?
Your smile is one of your most wonderful assets, and your
teeth are essential tools that should serve you for a lifetime. But they can do
that only with consistent, proper care. You'll find that the time and energy you
devote to maintaining healthy teeth and gums are well worth' the effort. On the
other hand, the alternative can be painful and expensive.
The pain of an infected tooth can make your whole head
ache. And even worse than the pain, at times, is the inconvenience. It can spoil
a vacation or a special party you've been looking forward to, interfere with
your sports activities, disrupt your study schedule, or keep you from doing your
best on an exam.
Repairing neglected teeth and gums can be a financial pain
as well. While keeping your mouth healthy doesn't usually cost much, restoring
it after it's been neglected can be expensive.
If your college is far from home, find a local dentist to
perform your regular checkups and periodic cleanings. You will be less likely to
neglect your teeth, and you will have someone to turn to if a problem does
arise. Don't count on vacation time for your routine dental exams.
This section answers the questions many people have about
dental health and hygiene. Use it as a guide to establish good daily mouth care
habits. Those habits coupled with a visit to the dentist every 6 months can
protect you from future dental problems.
Read through the chapter to be sure you understand what
the best course of action is. That will help you avoid the mistakes that some
students unwittingly make. For example, one student we know who was very
conscientious about brushing his teeth even carried a toothbrush and toothpaste
in his day-pack so that he could brush after every meal. But because he brushed
regularly, he thought he didn't need to see a dentist quite so often. He let two
years go by and then, to his surprise, he woke up one morning with a toothache.
A visit to the dentist revealed that he had four cavities. What he discovered is
that brushing alone won't prevent cavities and gum problems.
Cavities are areas of tooth decay (dental caries)
resulting from the combined action of three factors. Bacteria (agents) that live
in the mouth attack the teeth (host) when they are supplied with the appropriate
foods (environment). Dental enamel, the outside covering of the crown of the
tooth is a hard, calcium-containing material that is difficult for the bacteria
to break down.
Sugar is one of the worst culprits in the process because
it is readily usable by the bacteria that destroy tooth enamel. More important
than the quantity of sugar consumed is the time the sugar remains in the mouth.
A chewy caramel, for instance, eaten during a morning break will provide food
all day long for bacteria, until the sticky material is worn or brushed and
flossed away. The sugar in a can of soda can quickly be cleared from the mouth
by drinking or rinsing with fresh water.
Chipped teeth are more susceptible to decay than are whole
teeth. Avoid using your teeth to open such things as bottles or hair clips, and
if you do accidentally chip a tooth, have it treated as soon as possible.
Vomiting from self-induced purging is now recognized as a
serious health consequence of bulimia, an eating disorder (see
Eating Disorders). The acid
from the stomach's digestive juices mixed with highly concentrated food
particles can rapidly stain and erode the tooth enamel. If you are suffering
from an eating disorder, see your dentist. It's important to brush and rinse
after vomiting to limit the teeth's exposure to the corrosive effects of the
acid.
Because dental enamel is a very hard material that does
not break down quickly, it can take considerable time under the appropriate
conditions for bacteria to break through this barrier. The process may take as
long as 2 years or, in the total absence of oral hygiene, only 3 weeks.
The tooth enamel has no nerve endings. If it did, chewing
on food would be agony. So the early stages of a cavity are painless. Only after
slowly penetrating through the hard enamel do the bacteria reach the next layer,
the dentin, a softer material that forms the major part of the tooth. At that
point the cavity progresses more quickly and soon reaches the dental pulp, where
the nerve is located.
Fluoride has been shown to be effective in reducing tooth
decay. It is a micronutrient that works as a deterrent by crystallizing minerals
in the tooth enamel. The crystals make it more difficult for acids produced by
bacteria in the mouth to erode the enamel.
Sensitivity to hot or cold food may be a warning sign of
tooth decay. It is not until the pulp, in the root of the tooth, becomes
involved that a toothache develops. By then a very serious condition exists that
will require dental work.
You should see a dentist as soon as possible. A toothache
indicates that the protective barrier of the tooth enamel has been broken and
that a cavity needs to be repaired. The condition may rapidly deteriorate,
leaving you in excruciating pain. You may have to take antibiotics to cure the
infection before the tooth itself can be worked on.
Taking a painkiller and putting some oil of clove directly
on the infected tooth may help to reduce the pain until you can get to a
dentist's office for treatment. When you call for an appointment, be sure to let
the dentist know that you have a toothache and that you are not just coming in
for a regular checkup.
Cavities are most likely to develop in the areas between
the teeth and in the crevices on the surface, or chewing area, of the molars.
Because these areas are difficult to clean, food particles are often trapped
there-a perfect place for bacteria to live and grow for extended periods.
Once a tooth develops a. cavity, the hole is there
forever. If the dentist merely cleaned out the cavity without filling it,
bacteria and food would soon accumulate and begin to eat away at the tooth
again.
Therefore, all the decayed portion of the tooth must be
drilled away and the cavity filled to abort the decaying process. If the
infection has reached the nerve of the tooth, a root canal procedure is usually
required.
A root canal procedure is used to replace the pulp, or
nerve area, of a tooth that has become infected. With a drill, the dentist
removes all of the nerve from the tooth and then fills the spaces with a
material that will not decay. This complicated process sometimes requires two or
three trips to the dentist, followed by further dental work to crown the tooth.
When a tooth is pulled, the space must be filled with a
bridge, an artificial crown anchored to the natural teeth. If the space were not
filled, the remaining teeth would slowly collapse into the area and eventually
fall out.
A missing tooth can cause problems in the jaw, as well as
in the alignment of all the teeth. Because the space must be filled anyway, it
is better to do it with a crown and keep the tooth intact in the jawbone.
A crown is a tooth-shaped covering made of porcelain,
gold, or platinum that is placed over a damaged tooth to protect it from further
decay. When the nerve of a tooth has been removed by root canal work or a cavity
is too large for a tooth to hold a filling, the dentist will shape the remaining
tooth structure so that a crown can be cemented to it.
Having a tooth crowned, or capped, as it is sometimes
called, is an expensive and time-consuming procedure for saving a tooth. It is
necessary under certain circumstances, and almost always preferable to
extraction, but it can usually be avoided by consistently practicing good dental
hygiene. Regular brushing and flossing are the first lines of defense.
Bacteria can act to deteriorate tooth enamel only when
food is present, which is the reason frequent brushing and flossing are
essential. The bacteria use the carbohydrates in refined flour and sugar to form
a gummy substance called plaque. If the plaque is not regularly removed, it
penetrates the enamel and eventually creates a cavity.
Use a soft-bristled toothbrush at least twice a day.
Brushing before going to bed or after you have finished eating at night is best.
Ideally, you should brush your teeth after every meal and snack. Remember to
replace your toothbrush when the bristles become worn or bent. A worn-out
toothbrush will not clean the teeth properly, and a hard-bristled toothbrush may
injure the gums.
To brush correctly, place the brush against one or two
teeth at a time, angle the bristles at 45 degrees into the gum, and move the
brush with short circular strokes. This technique gets the tips of the bristles
under the gum to loosen the plaque. On the inner aspect of the teeth (the tongue
side), use the tip of the brush to get between the gum and the teeth.
To prevent trauma to the gums, avoid scrubbing. Instead,
work the brush in a gentle circular motion against the inner and outer sides of
each tooth and then brush the chewing surfaces of the molars. After thoroughly
brushing all surfaces of every tooth, gently brush the tongue and insides of the
cheeks as well.
There are now electric toothbrushes on the market that can
clean teeth better than most dentists can clean their own teeth with
conventional brushing. If you buy an electric toothbrush, make sure it has
individually rotating bristles.
Flossing is an excellent mechanical method to break up and
remove the plaque that builds up in those hard-to-reach areas between the teeth.
Usually your toothbrush will not reach these areas, which are a perfect
environment for decay to begin.
If you do not regularly floss, you will be amazed at the
debris that can build up between your teeth. Even after brushing, the amount of
food matter trapped between the teeth can be considerable. It is a major source
of bad breath, even in those who conscientiously brush their teeth.
It would be good for your teeth and gums to floss after
every meal and snack, but for many people that would be too inconvenient to be
practical. If you floss only once a day, do so after your nighttime brushing.
Take about 18 inches of floss and wrap the ends around the
middle fingers. Hold a small section between the thumbs and forefingers. Slide
the floss into the crevice between each tooth and gently rub up and down three
or four times against the sides of adjoining teeth, being sure the floss rubs
against each tooth all the way to the area of the gum line, where plaque
develops. Curve the floss around the tooth, scraping as much of the side of the
tooth as possible before moving on to the next tooth.
Pull the floss through from one side to the other after
you have cleaned each crevice. This will remove debris from between the teeth.
After you are finished, rinse your mouth with plain water or give the teeth a
quick brushing to freshen your breath. (See Figure 4.3 for the correct flossing
technique.)
Bad breath, or halitosis, usually originates from the
odors of food in the stomach. Certain foods, such as garlic and onions as well
as alcohol, leave behind their telltale aromas, as does smoking. Frequent
brushing and using a mouthwash can help remove, or at least mask, these odors.
Halitosis can usually be controlled by daily brushing and flossing, using a
mouthwash, and avoiding certain foods.
Sometimes bad breath is a symptom of a serious disease,
such as diabetes or kidney failure, or of an infection in the lungs or sinuses.
If you are following good dental hygiene and watching your diet for the kinds of
food that cause bad breath, but the halitosis continues, seek medical care to
evaluate possible causes
Bleeding gums are the first sign of periodontal disease, a
general term for two related diseases-gingivitis and periodontitis-that destroy
the gum area and bony structures that support the teeth (Figure 4.4).
Gingivitis is an inflammation of the gingiva. Healthy
gingiva is the firm, resilient, fleshy coral pink part of the gum that comes in
contact with the base of the tooth. The gingiva becomes inflamed when plaque is
allowed to build up on the face of the tooth, especially along the base. The
inflamed gingiva, which is puffy and bright red, bleeds when you brush your
teeth or eat certain foods that are abrasive to the sensitive tissue.
The production of plaque is affected by diet. Foods with a
high fiber content, like raw fruits and vegetables, have a natural brushing
action when eaten. Processed foods, soft foods, and sweets stick to the teeth
more easily and provide nourishment for bacteria, which cause plaque to form.
If the plaque is allowed to remain, it eventually
mineralizes, or hardens, and becomes calculus, or tartar. Calculus begins
forming between 1 and 14 days after bacterial plaque is allowed to remain
undisturbed on the tooth. It can be removed only by a dentist or by a dental
hygienist. Special tools are used to scrape it off.
A lack of vitamin C in the diet can cause swollen and
bleeding gums. The condition can also be a side effect of certain medications,
such as oral contraceptives or antiseizure drugs. Stress can also be a major
factor. Gum health can be an indicator of overall health and stress management.
Periodontitis is a major complication of untreated
gingivitis. The inflammation spreads to include the bony structures that support
the teeth. Bone loss can occur, and the teeth eventually become loose in their
sockets and fall out.
Unless an infection develops, there may be little or no
pain to warn that bone loss is occurring. Usually, both periodontitis and
gingivitis can be treated successfully, unless too much alveolar bone loss has
taken place.
All the plaque and calculus buildup must be removed by a
hygienist or a dentist. Advanced periodontal disease may need to be treated by a
periodontist (a dentist specializing in periodontal care). The procedure
sometimes requires gum surgery as well as scaling the teeth. Then it is the
patient's responsibility to brush and floss thoroughly every day to prevent the
recurrence of the condition. In addition, it is essential to have regular
periodontal checkups to remove any further plaque and calculus buildup.
Orthodontics is the branch of dentistry that is concerned
with the prevention and treatment of malocclusion, the term used for any
deviation from the normal contact of teeth. Orthodontists may prescribe braces
to correct misaligned or crooked teeth.
The purpose of straightening teeth is not just cosmetic.
Improper alignment can affect the growth of surrounding teeth. Malocclusion, the
failure of the upper and lower teeth to come together normally, can cause eating
and digestion problems as well as dental problems. Crooked teeth can also be
responsible for speech difficulties and premature tooth loss. Although wearing
braces can be uncomfortable, the results are well worth it.
Wisdom teeth are the third set of molars and usually the
last teeth to erupt. They usually appear between the ages of 15 and 25. By that
time there often is little room left for them and they may be forced sideways,
which can cause them to become impacted and infected. This condition can require
oral surgery.
The first signs that something may be wrong are pain and
swelling at the very back of the jaw, where it meets the neck. The pain may
spread to the throat and jaw and even up toward the ear. If you have these
symptoms, you should see a dentist for an evaluation before a major infection
sets in.
The infection occurs between the emerging tooth and the
flap of gum covering it. Food particles easily become trapped under the gum
flap. The infection may spread, causing pain in the jaw and on swallowing, as
well as swollen lymph nodes.
Seeing a dentist before your wisdom teeth are due to come
in may prevent this problem. X rays will reveal the direction of the wisdom
teeth. If there is enough room for them, removing the flap of gum tissue at the
right time can prevent infection. Also, if there is the likelihood of a problem,
you may be able to receive treatment at a time convenient for you rather than be
subjected to an unexpected toothache in the middle of finals week.
The popping sound may be coming from the temporomandibular
joint (TMJ). This joint is located between the jaw and the side of the skull,
about half an inch in front of your ears. Overuse of this joint can cause pain,
and the popping sound you hear may mean the joint is being overused or is
partially slipping out of the socket. This slippage, called subluxation, may be
more common in people with a dental misalignment such as an overbite or an
underbite.
Grinding the teeth at times of stress or during sleep,
called bruxism, can also place excess stress on the TMJ and wear down the
surface of the teeth.
The most common symptom is an aching in the area of the
joint, sometimes mistaken for an earache or a headache. In rare cases the jaw
can actually dislocate and requires medical attention to put it back in
alignment. Put the tips of your little fingers inside the ear canal and gently
press forward. You will be pressing directly on the TMJ. If this causes pain,
you probably have TMJ overuse.
Decrease your use of the jaw muscle. Stop chewing gum,
eating hard candy and thick-crusted sourdough bread, and breaking nuts with your
teeth. To rest the joint, try a soft diet for a few days, and use massage and a
warm pack over the muscles to reduce the pain. Mild analgesics or
anti-inflammatory drugs like aspirin or ibuprofen taken over several days may
reduce the inflammation.
Check to see if during times of concentration or stress
you unconsciously clench your jaw or grind your teeth. If you are aware of this,
you may be able to break the habit.
If these measures don't help, see your dentist to check on
your jaw alignment. Sometimes wearing a soft mouthpiece at night can help. In
rare cases injections and dental work may be needed, but conservative treatment
usually resolves the problem in 5 to 14 days.
You should see your dentist every 6 months for an
examination and a cleaning. A dental hygienist has the tools and training to
remove plaque and calculus buildup, which you cannot possibly remove even by
regular brushing and flossing. A semiannual visit gives your dentist the
opportunity to spot easily correctable minor problems before they become major
problems that could result in expensive dental work or loss of teeth. Regular
checkups can reduce traumatic dental work and can keep your mouth in top-notch
condition.
| 
