Our lives have changed due to advances in technology and new discoveries. Advances in our health care have made our lives very different than the lives of our ancestors. This is extremely evident in dental health care. Imagine what it must have been like prior to the 1900’s when the vast majority of people had decayed and abscessed teeth, which required extraction without any local anesthetic.  Or what it must have been like for our great grandparents to discover that they had gum disease and needed to have all of their teeth extracted and wear full dentures for the rest of their lives, never knowing what caused the disease or how to prevent it.  Today we know what causes the dental diseases of decay and gum disease so that we can cure and prevent them from occurring in our mouths and in the mouths of our children.  The advances in dental materials and techniques allow us to save and rebuild teeth like we never could have imagined.

Unfortunately, this message has not been delivered to the majority of the general public.  Knowledge about the cause and prevention of these diseases is woefully inadequate.  Most people do not know what causes decay and gum disease or what steps they can take to stop and prevent them from occurring.  Hopefully what follows will teach you what you need to know and what to do to have a healthy mouth. 

There are two main dental diseases: decay and gum disease.  Please read on to discover what causes them and how to eliminate and prevent them.  

Decay

Three things are necessary for tooth decay: teeth, bacteria and sugar. If we eliminate bacteria, we could eliminate the decay. The problem is that no matter how much we brush and floss, and no matter what mouth rinses we use, we still cannot eliminate decay-producing bacteria from our mouths.  If you have a problem with decay and you try to control it solely with better oral hygiene, you are going to become frustrated when you continue to develop new cavities.

Although practicing proper dental hygiene is essential to decay prevention, it is not enough.  We need to consider our intake of sugar.  By controlling our intake of sugar, we stop feeding the bacteria that decay our teeth. To get a better understanding of how to do this, it helps to get a better understanding of how the sugar causes the decay.

When we ingest sugar, bacteria immediately absorb the sugar and produce an acid that dissolves calcium ions from our enamel. This continues until we stop eating the sugar and we swallow it. The bacteria will then continue to produce the acid for an additional 20-30 minutes after consumption, which dissolves more calcium. During this time, our saliva, which is loaded with calcium ions, puts this calcium back into our enamel. Without this remineralization, our teeth would dissolve within weeks after being exposed repeatedly to the sugars we eat. So when we eat sugar, the acid takes calcium out of our teeth and thankfully our saliva puts the calcium back. When we do this in moderation, the damage sugar does is completely repaired. So the damage that occurs when we eat a dessert, a candy bar, sugared cereal, or even drink an occasional soda pop is reversed thanks to our saliva.

The problem with decay occurs when we ingest sugar at a frequency where our teeth are almost constantly exposed to sugar. This occurs when you have a sugar habit. Our teeth have sugar on them most of the morning, afternoon and evening, day after day. Some examples of sugar habits are chewing gum with sugar in it all day long, constantly sucking on hard candies such as lifesavers, tic tacs, or breath mints, or sipping soda pop or other sugary drinks all day.  This exposure from a sugar habit results in constantly removing the calcium from our enamel and doesn’t allow our saliva to put this lost calcium back. As more and more calcium is lost, cavitation or a cavity will occur.

Eating sugar in moderation will not cause decay. However, ingesting sugar as a habit all day will. Every person with a decay problem has some form of a sugar habit. Stopping these habits will stop new decay from occurring.

When the back teeth are developing, depressions and grooves form in the chewing surfaces of the enamel. These irregularities are called pits and fissures. These crevices can be a very weak and trap sugars for long periods. Over time, these grooves can become decayed even with moderate sugar intake. Fortunately, it’s possible for dentists to seal these grooves with a bonded plastic before the decay occurs. Therefore, I highly recommend that children have these areas sealed. Sealants can play an important role in the prevention of tooth decay.

Fluoride has for many years strengthened tooth enamel to resist decay. It is best incorporated into the enamel structure by drinking fluoridated water while children’s teeth develop or by taking a prescribed fluoride supplement in areas with non-fluoridated water. The amount of fluoride ingested these ways is precisely controlled because too much fluoride can actually cause damage to the teeth. Too much fluoride can be ingested if a young child is using fluoridated toothpaste and they don’t spit out the toothpaste out after brushing. Many manufactures make children’s toothpaste taste good to encourage them to brush, and as a result many of them will swallow it rather than spitting it out. Therefore, I recommend using non-fluoridated toothpastes for young children and making sure that older children spit out all the fluoridated toothpaste after brushing.

One final note regarding decay: take a good look at the nutritional guides of the foods you eat. You will be amazed at how much sugar is added to foods. The recommended sugar intake for men and women is less than or equal to 15 grams daily. Most people drastically exceed this recommendation.  Although sugar habits are the main cooperates of decay, the sugar added to every day foods contribute to the problem and are terrible for your overall health..  

Gum Disease

Gum disease is caused by plaque, a soft food and bacteria film that form on your teeth every 24 hours. The bacteria in plaque produce a toxin, which causes an inflammation of the gums called gingivitis.  When this happens, your gums become red swollen.  They will become tender and will bleed easily when they are touched.  This becomes especially evident when you begin to floss properly.  At first, your gums may hurt and bleed.  But as you continue to remove the plaque everyday, your gums will start to heal.  After a week or two, the pain and bleeding stop, and your gums will heal.  The gingivitis will go away and your gums will be healthy.

Occasionally, the gingivitis will continue and the inflammation will persist.  After a number of years, the jawbone underneath your gums that hold your teeth in place will begin to dissolve. When the bone is lost but the swollen gums don’t shrink along with it, a gap or “pocket” forms between the gum and the tooth’s root. You can’t clean the plaque that accumulates down in these pockets because the toothbrush bristles and floss can’t reach down there, and the disease becomes worse and worse. Fortunately, your dentist has ways to reduce the pocket depth. You’ll then be able to clean all the plaque laden surfaces, stop the gingivitis and stop the bone loss before it becomes less and less supportive of the tooth. However, left unchecked and untreated, more and more bone is lost, the tooth loses its support, becomes loose, and when the bone can no longer properly support the tooth, the tooth will need to be extracted. 

Gingivitis has also been linked to a number of other diseases.  People with gingivitis are much more likely to develop blockages of the arteries leading to heart attacks and strokes, develop adult diabetes, and suffer from osteoporosis, kidney failure, and pancreatic cancer. 

To prevent gingivitis, you need to remove plaque from your teeth.  Plaque can be removed from teeth with proper brushing and flossing. When it is not removed, calcium in our saliva can harden plaque and form tartar on your teeth. This causes the surface of the tooth to be rough, which makes it easier for plaque to adhere to the teeth and makes it more difficult to clean. Professional dental cleanings eliminate tartar, making it easier to keep plaque off your teeth. However, since plaque forms on teeth every day, you would need 365 cleanings a year to keep the gum disease causing plaque off of your teeth as opposed to the recommended two.  So although professional cleanings are a great first step towards healthy gums, they alone will note stop gum disease.  The only way to eliminate and prevent gum disease is daily cleaning.

With proper brushing and flossing, we can eliminate plaque and stop and prevent gum disease from occurring.  Brushing removes plaque from the front or facial surface and from the inside surface of your teeth.  Scrub these surfaces with a toothbrush two to threes times a day.  Make sure to scrub them with the tips of the bristles in a circular scrubbing motion.  There is also a small space under the gum line where plaque hides, so it is important that the outside row of bristles swipe underneath this crevice to clean the plaque from there.

Most people do a decent job of brushing their teeth.  However, brushing only removes the plaque on the front and back of your teeth and fails to remove the plaque growing on the surfaces between your teeth.  Only proper daily flossing can remove this plaque.  Since many people do not floss or do not floss properly, this plaque tends to be the main culprit of gum disease.

To floss, start with an adequate length of floss, approximately the length of your arm.  Lightly wrap the floss a number of times around your middle fingers.  This will leave your index finger and thumb free to hold and maneuver the floss around your teeth. Bridge a short length of the floss between your two index fingers (or between your thumbs, whatever works best for the particular tooth that you are flossing).  Using a short length will keep your fingers close to the teeth while you floss. By applying tension to the floss with your fingertips, you will form a crease or groove in the tip, which allows you to floss using only two fingers in your mouth. After getting the floss between your teeth, use your fingers to wrap the floss around the tooth, and then scrape up and down the side of the tooth as far under the gum line as you can get. The crucial part is getting all the way under the gums. While our toothbrush only has to brush under a shallow space in front and inside of the gum line, there is a large area of the tooth covered by gum tissue between our teeth. This gum tissue is triangular shaped and called the papillae. The plaque grows and hides beneath this tissue, so you have to scrape the inside of the tooth as far up under the gum as you can reach with the floss.  Watch yourself flossing in the bathroom mirror.  If you have any questions or concerns about your flossing method, consult your dental professional.

No matter what technique you use, these important steps are necessary for proper flossing: 1. Get the floss between your teeth. 2. Wrap the floss around the tooth, fingers close to the front and inside of the tooth. 3. Floss/scrape the entire length of the tooth, reaching as far under the papillae as possible.

When you first start to floss this way, it is very likely that it will hurt and that your gums will bleed.  This pain is bleeding is caused by gingivitis already present in your mouth, and is not the result of injury from cutting your gums with the floss.  You will need to endure some pain and bleeding to remove the gingivitis.  If you continue to floss correctly every day, your gums will heal and the pain and bleeding will stop.

It may take up to 20 minutes to floss your teeth at first, but as you continue to floss every day, you will get better and eventually it will only take a minute to properly floss all of your teeth.  By flossing, you will prevent gum disease and you will be amazed by how much cleaner and fresher your mouth feels.

While gum disease can only be eliminated by keeping the plaque off the teeth, certain mouthwashes, such as Listerine, or prescribed mouthwashes containing chlorhexidine can help reduce the inflammation. These can be a good supplement to your brushing and flossing.

There are a number of excellent videos on YouTube that demonstrate both proper brushing and flossing. I also encourage you to visit a dentist and get a complete examination to determine your overall dental health status. He can diagnose any existing decay and gum disease and help you eliminate them, getting your mouth healthy again and back to square one.  But ultimately your dental health is up to you. Only your daily care can keep your mouth healthy. Avoiding excessive sugar habits, and brushing and flossing properly every day are the only way to achieve and keep it that way. You’ll also prevent new problems from occurring. That means lots less time in the dental chair.

Best of all, you’ll have a healthy mouth and be able to keep and enjoy your teeth for your entire life.

            Good Luck.