Dental disease is an enormous health problem in the developed world. It causes pain, suffering and incon-venience to millions, and absorbs large sums of money from health service budgets. Yet at the level of the individual it is almost entirely preventable. Adopt a good programme of routine oral hygiene and you will maintain healthy teeth and gums or prolong the life of the teeth you still possess.
Gum inflammation (gingivitis) and, if this is un-checked, destruction of the firm rooting of the teeth in the jaw bone (periodontal disease). To keep teeth, gums and mouth healthy requires a three-part programme: eat the right food; protect teeth and gums; and attend to your teeth regularly to remove plaque and eliminate ‘susceptible sites’ where decay or gum disease can take hold.
Plaque and decay
The enemy of teeth is plaque, a collection of bacteria and other substances that continually forms on, and adheres to, the exposed tooth surfaces. The bacteria thrive on the food you eat, especially the sugars, and they make acid as a by-product of their life processes. It is this acid which softens the hard, outer enamel layer of the teeth and initiates dental decay (caries). Plaque is also responsible for initiating a complex process in which the delicate gums and supporting structures of the teeth are damaged.
First in the health programme is eating the correct foods. Refined sugars should have no place in our diet. The popularity of convenience foods has lead to increased sugar consumption, and regular sweet-eating has disastrous effects on the teeth. Reduce your intake of sweets and sticky foods, and particularly avoid those sweets, such as chewing gum, that are kept in the mouth for long periods. Chocolate is also dangerous but, being quickly washed away, is better than sucking boiled sweets, peppermints and toffees.
Fluoride and fissure sealing
Next comes tooth protection. If the chemical fluoride is incorporated into a tooth’s enamel layer, it greatly increases resistance to acid attack. Fluoride incorporated as teeth are forming in the gums is more effective in giving the enamel lasting strength and resistance than fluoride applied directly to already formed and erupted teeth. For fluorides to reach developing teeth they must be given systemically, that is into the bloodstream. This is done by consuming fluoride drops (for children between six months and two years) and then tablets (from two to eight years). Fluoride may already be present naturally – or added artificially – in drinking water, and it is wise to ask your dentist so that your children receive the correct dose of fluoride drops or tablets.
Fluoride put directly on the tooth surface after eruption is called topical fluoride. This can be in tooth-paste, a mouth rinse or a gel. Research has shown that regular brushing with a fluoride paste significantly reduces tooth decay. Most toothpastes are nowadays softer and less abrasive on enamel and the dentine underneath; the newest pastes claim to use enzyme action to break up the plaque and reduce its stickiness. But whatever the latest fashion, a good fluoride toothpaste is only one step on the road to oral hygiene.
Fluoride mouth rinses are a useful supplement for people with poorly-formed enamel. Fluoride gels are applied at the dental surgery; although effective they need to be used regularly and this is both time-con-suming and expensive.
Fissure sealing is another technique to protect teeth. The dentist coats a hard, adherent plastic material onto the fissured (cracked or furrowed) area of the tooth. Such areas are susceptible to decay because they harbour plaque deep in microscopic crevices in the tooth surface and are impossible to clean using a toothbrush. Teeth sealed in this way are usually the first and second molar (cheek) teeth. However there seems no reason at all why all fissured teeth should not be sealed, and encouraging results from recent studies with fissure sealants may cause this technique to become more common.
The tooth surfaces. This means brushing all tooth surfaces in as many directions as possible using a combination of movements. Horizontal scrubbing or a rotary motion is often taught but if done too hard and too repetitively may wear down the necks of the teeth, which can subsequently become temperature sensitive. Electric toothbrushes are mainly useful in making oral hygiene more ‘fun’ but they are recom-mended for people who find toothbrush manipulation difficult (the handicapped or arthritis sufferers, for example).
Denture-wearers need to take special care, not only in thoroughly cleaning their remaining natural teeth but also in their denture hygiene. Daily brushing of den-tures with a non-abrasive paste followed by an over-night soak eliminates plaque and debris and also prevents the denture material from drying out. Where the plate covers the gums and palate, the corresponding areas on the denture should be brushed as well, to prevent inflammation caused by fungal growths (’denture sore mouth’).
Children should be encouraged to brush their teeth as soon as they are able, and to regard oral hygiene as part of the daily routine. Supervise youngsters, though, to make sure they brush well and do not swallow too much paste. Just a little paste wiped on to a small brush is sufficient.
Dental floss is used to wipe teeth surfaces free from plaque. Flossing, more than most oral hygiene techni-ques, should be learned from a dentist or dental hygienist.
Dental sticks (toothpicks) are useful for some people such as the elderly whose gum recession has left a food-stagnation area, but sticks used incorrectly can damage gums and most dentists would not recom-mend them for everyone.
The water pick is a small electrical device that pro-duces a high-pressure water jet squirted around the mouth. The result is a stimulating oral irrigation that dislodges plaque and other debris. Water picks are more popular in some countries than others, but newer models used correctly seem to give good results and they are slowly catching on. When you clean your mouth and teeth, you can check how effective your oral hygiene is by chewing disclosing tablets that stain plaque and so reveal its presence in any unclean corners.
Brushing, flossing and picking
The third procedure is plaque removal – the main aim of routine oral hygiene. Plaque-removers include toothbrushes, dental floss, dental sticks and water picks. Toothbrushing, done properly, is an efficient and effective method of plaque removal. A brush with a small head and many nylon filaments seems to be most effective. There are as many toothbrush designs as there are ways of using them.
The final facet of oral hygiene is regular visits to the dentist for check-ups, X-rays to reveal hidden decay, scaling and polishing, updates on dental hygiene technique, and treatment of decay or gum disease. Every dentist would agree that prevention is better than remedial dentistry.
But the dentist cannot be with you twenty-four hours a day; the emphasis is therefore firmly on the individ-ual to maintain his or her own healthy teeth and gums.