Healthy teeth portray healthy lifestyle according to the folklore: Take care of vour teeth on a daily basis and they will take care of you. However, despite increasing awareness about dental/oral healthcare, most of us are not accustomed to visiting a dentist for routine checkup. We show up only when a serious problem, not cured by folklore treatments or self or suggested medication(s), gets out of enduring limits. This article provides basic information on some common dental problems and dental/oral healthcare.
- What are the most common dental/oral problems?
Common dental oral problems, some of which may be preventable by practising good oral hygiene, include:
* Calculus or tartar-Yellowish/ brownish hard crusty deposit buildup on teeth near/below the gum line due to inadequate regular removal of dental plaque -a sticky colourless biofilm of bacteria. Acids produced by these bacteria destroy tooth enamel resulting in bad breath, tooth decay (caries), and gum disease. Calculus is quite hard and so firmly attached that it cannot be removed with a brushing or flossing and can be removed onlv with ultrasonic tools or dental hand instruments such as periodontal scaler.
* Caries-Commonly referred to as dental cavities or tooth decay, it is caused mainly by plaque buildup on teeth, which produces acid that destroys the tooth enamel requiring root canal treatment (RCT) and proper filling of the cavity.
* Tooth erosion-Loss of tooth structure caused by acid attacking the enamel. It is irreversible loss of tooth structure due to chemical dissolution by acids not of bacterial origin; most common cause being excessive consumption of acidic foods and drinks.
* Tooth sensitivity, toothache- Discomfort or pain felt in the teeth from sweets, hot drinks, cold air/drinks or ice cream, and even while brushing and flossing is usually the result of worn tooth enamel or exposed tooth roots. However, it may be caused by other factors, such as a cavity, a cracked or chipped tooth, a worn filling, or gum disease.
* Tooth abscess - A pocket of pus caused by bacterial infection. It occurs when bacteria invade the dental pulp or the innermost part of the tooth that contains blood vessels, nerves and connective tissue. It may occur at the tip of the root (periapical) or in the gums at the side of a tooth root (periodontal). It mav cause severe, persistent, throbbing toothache radiating to jawbone, neck or ear, sensitivity to hot and cold beverages/ foods, sensitivity to chewing or biting, fever, swelling in the face or cheek, swollen lymph nodes, and sudden rush of foul-smelling/tasting, salty fluid in the mouth. If untreated, infection may spread deeper into the jaw and surrounding areas of head and neck or even other parts of the body.
† Wrongly spaced, crooked, misplaced or prominent teeth - Irregularities of teeth, bite and jaws (e.g., malalignment, crowding, spacing, diastema, overjet, underbite, crossbite, overbite) requiring corrections using bands, wires, braces and other fixed or removable corrective and supportive appliances or retainers.
* Supernumerary teeth or hyperdontia
-Occurrence of teeth that appear in addition to the regular number of teeth requiring extraction.
* Halitosis- Bad breath caused primarily by gum disease, cavities, oral cancer, dry mouth and bacteria on the tongue.
* Gingivitis, Periodontitis-Gum disease varying from mildly swollen to bleeding gums to painful chewing and complete tooth loss.
* Canker sores-Small, shallow lesions with red inflamed soft tissue that develop on the tongue, inside of cheeks, lips, gum line and throat, and may be caused by injury from vigorous tooth brushing, dental work, braces or dentures, or a sports accident. They can be painful and can make eating and talking difficult.
Acidic foods, including citrus fruits, may trigger a canker sore or make it worse. These sores are non-contagious and usually disappear on their own but could be sign of something more serious (including HIV if they do not go away within two weeks.
* Fever blisters or cold sores-Caused I by Herpes simplex virus (HSV-1), these appear as clusters of red, raised blisters outside the mouth, typically around lips, under the nose or chin causing itching, burning or tingling sensation. They are considered highly contagious and will come and go in 2-4 weeks without leaving a scar but are not completely curable.
* Oral submucous fibrosis (OSMF) - A premalignant condition and cripplig disease characterised by inflammation and progressive fibrosis and stiffening of oral mucosa, restriction in opening of the mouth and tongue movement, and dryness of mouth. Believed to be caused by sustained area nut or betel quid chewing, besides other factors. OSMF has a significant mortality rate because it can transform into oral cancer, particularly squamous cell carcinoma at a rate of 7.5%-9.5%.
* Dental fluorosis - Common disorder characterised by hypomineralisation - a softening and discoloration - of tooth enamel due to ingestion of excessive fluoride during enamel formation of permanent teeth in childhood (up to 8 years of age).
Early use of fluoride toothpastes in young children too can lead to fluorosis in permanent teeth. It is primarily a cosmetic condition characterised by white spots/patches/lines/ streaks, cloudy spotches, brown stains or pitting on the teeth, but the damage to the enamel is permanent.
- What is dental plaque and how is it formed?
Dental plaque or biofilm is a sticky, colourless film of bacteria that forms on our teeth. Often undetected, it develops when traces of food containing carbohydrates are frequently left on the teeth. Bacteria in our mouth thrive on these foods, producing acids, which if not removed by daily brushing and flossing, destroy tooth enamel resulting in dental caries and gum diseases.
Brushing within 30 minutes of eating slows down bacterial colonisation of teeth. Brushing dilutes inflammatory acid and helps rid the mouth of bacteria that produce it. Gum disease begins with gingivitis caused by plaque irritating soft tissues along the gum line that gradually gets worse as the population of bacteria increase. Plaque can also develop on tooth roots under the gums and cause breakdown of bone supporting the tooth. This causes gums to recede from the teeth and may result in tooth loss or further gum infection. Inadequate removal of plaque causes built up of calculus or tartar (vellow or brownish hard crusty deposit) on the teeth near the gums, which cannot be removed by brushing or flossing.
- Which toothbrush should be use?
Most dentists recommend use of a 'Soft' or 'Super-soft' toothbrush, since firmer bristled (Medium, Hard) toothbrushes can damage tooth enamel and irritate the gums. Use of brushes with flexible ribbed neck designed to prevent excessive force to teeth, enamel and gums is advisable. Electric or power brushes have been designed to provide adequate force while brushing and to get to tough areas better than manual brushes. Toothbrush bristles wear out over time, lose their shape, flexibility and effectiveness, and may even become sharp due to friction and can cause gums to bleed, when it is the time to change your brush. Proper care is also needed to keep the toothbrush clean and hygienic.
To keep it free of airborne or hand-held contamination, store it upright so that it can dry before next use, but do not leave it open on washroom counter as flushing toilets and spraying showers can spread millions of germs over all surfaces including your toothbrush.
- How to brush teeth?
It is recommended to rinse mouth with clean fresh water first thing in the morning to get rid of any leftover taste.
Apply pea-sized amount of toothpaste to the toothbrush and gently rub it in circular fashion over each tooth (front, back and chewing surfaces) and along the gum line. According to the American Dental Association, for proper brushing, place your toothbrush at 450 angle to outer gum line and gently move the brush back and forth in short tooth-wide strokes. Similarly, brush inner surface of each tooth. Then brush chewing surfaces of teeth using backward and forward motion. Do not brush across your teeth.
- Spend two to three minutes brushing.
At the end of the day, repeat the entire brushing procedure. Ideally, brushing teeth while standing in front of a mirror helps to observe movements of the brush/floss and the teeth that require attention.
Over brushing (brushing harshly, too much or for too long) or using medium- or hard-bristled toothbrush to achieve shiny teeth may overdo a good thing and cause 'toothbrush abrasion' leading to sensitive teeth and receding gums.
- Does fluoride-containing toothpaste provide additional safety?
Toothpaste is a paste or gel dentifrice used with a toothbrush to clean and maintain health and aesthetics of the teeth. Basically, toothpastes are complex formulations with often more than 20 ingredients aimed to combat dental caries, gum disease, malodour, calculus, erosion and dentin hypersensitivity.
Toothpastes also contain abrasives to clean and whiten teeth, flavours for breath freshening and dyes for better visual appeal. Recently, a few herbal/
Avurveda-based toothpastes have also been marketed. Use of fluoride-containing toothpaste and flossing between teeth at least once a day to remove food particles and bacteria can prevent plaque buildup. In fact, widespread use of fluoride has been the major factor in the decline in prevalence and severity of dental caries. However, since high fluoride concentration may increase risk of enamel fluorosis (discoloration or mottling) and tooth damage, especially in children and those living in areas with high fluoride levels in drinking water, it is important to regulate exposure to fluoride to avoid its adverse effects. It is also advisable not to stick to any brand of toothpaste over prolonged periods.
- How is use of dental floss helpful?
A variety of devices such as wooden and plastic toothpicks, interdental brushes and dental floss of variable thickness made from biodegradable materials is now available. Flossing is recommended to remove hidden crumbs, debris or dento-bacterial plaque from spots in between the teeth where toothbrush cannot easily reach. Flossing in combination with brushing daily prevents gum disease, bad breath and dental cavities.
- Why is it useful to clean the tongue after brushing?
A tongue cleaner/scraper is an oral hygiene device designed to remove some of the millions of microorganisms (up to 500 different types of bacteria and fungi), decaying food debris and dead cells from the rear surface of the tongue. Microorganisms colonise and multiply on protein-rich areas of tongue and eventually, through saliva, reach all areas of mouth. These microorganisms contribute to periodontal problems, plaque on teeth, tooth decay, gum infections, gum recession and tooth loss.
These bacteria produce malodorous compounds that account for most cases of bad breath. Toothbrushes meant for brushing teeth are not effective to clean spongy tongue tissue. Ergonomic tongue cleaners are designed in accordance with tongue anatomy and are optimised to lift and trap plaque coating, clean and massage tongue surface, prevent bad breath, improve sense of taste and stimulate secretion of digestive enzymes.
It is best to scrape the tongue before using mouthwash to get most germs out of the mouth.
- Is regular use of mouthwash helpful?
Nothing is more offensive and embarrassing than bad breath. Bad breath mav be because of certain reasons other than bad dental health such as sinus, nose/throat infection, tonsils, allergies, smoking, constipation, indigestion, liver-malfunction, acid reflux disease, ulcers, breathing disorders, etc. It is crucial to understand exact cause of bad breath for effective treatment. Use of mouthwashes and sprays to freshen breath is recommended between meals and brushings. A variety of mouthwash preparations such as all-natural, alcohol-free, tartar/plaque control, whitening rinses, etc., are available over the counter.
It is advisable to talk to a dentist who is familiar with the condition of your teeth and gums to recommend products) best suited to your oral hygiene needs and lifestyle. Preferably, one should useseparate mouthwash in place of the two-in-one toothpaste with built-in mouthwash.
Besides, certain homemade/folklore remedies to help treat bad breath include taking clove tea or herbal teas containing peppermint oil, sucking
lemon sprinkled with a little salt, myrrh or cinnamon bark, chewing sugarless gum that also stimulates salivary glands keeping mouth moist and drinking enough water as dry mouth is the most common reason for bad breath.
- Is tooth bleaching and whitening essential?
Teeth darken over time for a variety of reasons such as consumption of coffee, tea, red wine, dark colas or tobacco, antibiotic use, excessive fluoride intake, etc. Tooth bleaching and whitening is a fast-growing cosmetic trend. However, since careless use of bleaching products may damage gums, tooth enamel, dentin, pulp and other areas of the mouth, their use only under a dentist's supervision is advised.