How does tooth decay start and what does it say about your overall health? What are the most effective treatments? To mark National Dental Health Month, an expert in the field answers your most common questions about this condition...
What causes teeth to rot? Believe it or not, that answer remained elusive until the 1970s.
Now, we know, of course, that plaque – tough, filmy bacteria that adhere to teeth – is the culprit. This knowledge and better oral hygiene means that most of us, thankfully, are keeping our teeth longer, according to the National Institute of Dental and Craniofacial Research.
Still, there's plenty to clear up when it comes to dental health.
“People don’t always believe it when they’re told they have a dental problem,” says Marjorie Jeffcoat, D.M.D., professor of dentistry and dean emeritus at the University of Pennsylvania School of Dental Medicine.
“But it’s important to know what’s going on with your mouth. If damage is happening to the teeth, damage is being done to rest of the body.”
How much do you know about your mouth? Lifescript spoke with Jeffcoat for tips to keep teeth in top shape and dental problems at bay.
Why are so many people in denial about dental problems?
Often, the issue is silent and doesn’t hurt until it’s serious – when a tooth breaks, for example.
Yet, cavities and gum disease are chronic infections, which can worsen many systemic diseases, such as diabetes and HIV.
In pregnancy, they can even contribute to preterm delivery.
So our teeth are linked to our general health?
That’s right. Like other body parts, oral tissue can even get cancer.
That’s why your dentist needs to do an exam, even if you have full dentures.
Do dentists automatically check for oral cancer?
They should, but patients should also ask to be sure.
I always tell my patients, “I’m taking a moment to look for lumps or bumps that shouldn’t be there that are more important than a cavity."
If your dentist doesn’t mention anything like this, ask for an oral cancer check.
Do you recommend brushing twice a day and flossing at night to prevent dental problems?
You should brush at least twice a day – or after meals and sugary snacks. But I make recommendations based on the individual patient’s problem areas — where [in the mouth he or she] isn’t brushing, what he or she is currently doing and how often he or she is doing it.
We have lots of devices – different types of toothbrushes, flosses, little brushes, things with rubber tips and more.
So, for example, if you have a big bridge, I may suggest using a small brush to get under the bridge and clean the plaque.
Do you have a toothbrush preference?
Some patients do well with a manual brush, but most do better with a rotary electric brush. That’s what’s sitting on my bathroom counter. Some high-end electric brushes even control if you’re brushing too hard, a problem if your gums are thin.
A dentist or hygienist can help you select a proper brush. If a patient has a grip problem, for example, the dentist may recommend a brush with big, soft handles.
What are the most common brushing mistakes?
Brushing too hard with a hard brush is No. 1. Use a soft brush so bristles can go between teeth and so you don’t brush away your gums.
Also, patients tend to miss the same spots over and over again. If you’re right-handed, you tend to brush better on the left.
So, often I’ll tell the patient to spend a little more time thinking about the right side if she’s right-handed.
Brushing long enough is also sometimes difficult. Electric toothbrushes often have a timer.
If patients use a manual brush, I recommend a timer [for] 3 minutes.
And flossing is essential to preventing dental problems, right?
Well, you absolutely need something that cleans between your teeth. But many patients don’t floss or do it incorrectly. It’s hard for a lot of people to maneuver. Some patients sort of use it like a cheese slicer – they go straight up and cut their gums.
So if you don’t have the dexterity to floss correctly, ask your dentist or hygienist about other options.
And if you are going to use floss, first train yourself in front of a mirror. Once you know your teeth and where the spaces are, you can do it while you watch the news before bed. If you have something to watch while you floss, you tend to do it more regularly.
People who have big spaces between their teeth can use little brushes or rubber tips. Some patients like Stim-u-dents, which are little triangles that come in a box that fits in a pocket. Men seem to like these, but women usually don’t.
What makes getting between teeth so important?
Gum disease often starts between the teeth. So if you aren’t doing something to get at that surface, you’ll have problems.
If done correctly, flossing can also get under the gum line. Ask your dentist or hygienist to give you a quick lesson on how to do it.
Your toothbrush also helps get the between-teeth surfaces. Remember, soft brushes are the ticket. Hard brushes can’t mold easily and get in there.
What’s the story behind mouthwashes? Do they help avoid dental problems or are they purely for masking odor?
It depends on the rinse. Many – probably most – are purely cosmetic, but certainly not all are.
In fact, a recent study showed that use of a certain over-the-counter mouth rinse – Crest Pro-Health, which contains a controlled-release antimicrobial called cetylpyridinium chloride, or CPC – among pregnant women with periodontal disease cut the number of preemie births by more than half.
Many women develop periodontal disease in pregnancy. The rinse also helped stabilize or decrease gum inflammation, bleeding and swelling.
It is easy to use and inexpensive. You don’t need a prescription, and it contains no alcohol.
Do you have to be careful about alcohol in mouth rinse?
From 9%-14% of mouth rinse is ingested. Some goes through the cheek and some is swallowed.
We don’t recommend anything with alcohol to a pregnant woman. Other people may not like to have alcohol, either; recovering alcoholics, for example, or just people who don’t like the bite of alcohol in a mouth rinse.
What should we look for in a mouth rinse if we want something other than a cosmetic freshener?
If cavities are your big problem, look for an over-the-counter fluoride rinse. If periodontal disease is your current problem or biggest risk, I might prescribe a mouth rinse with the antiseptic chlorhexidine.
Or I’d recommend something over the counter with an antimicrobial ingredient such as CPC.
There have been reports that alcohol in mouth rinses may contribute to oral cancer risk. Do you worry about alcohol in mouth rinse for this reason?
No. I don’t think those studies were well designed. So I wouldn’t tell my patients that rinses with alcohol are dangerous.
However, we know that if you smoke and/or drink alcohol, your risk for certain cancers escalates. So, frankly, I’d rather avoid mouth rinses with alcohol for my patients.
To prevent dental problems, is it necessary to get your teeth professionally cleaned or can super-vigilant people do a good enough job at home?
A professional hygienist or dentist cleans plaque off of your teeth. Plaque calcifies because your saliva is saturated with calcium.
Because of this, you get stuff – sort of like hard rocks – on your teeth, which you just can’t remove at home.
If you have a lot of plaque, you end up with periodontal disease. So, yes, professional cleaning is truly needed.
And the rule of getting your teeth cleaned every six months is valid?
Your dentist should make the call how often you need it.
Six months is a good average, but if you do an impeccable job cleaning your teeth, if you don’t have any periodontal disease, and you have few or no "caries" [tooth decay], maybe he or she will recommend you come back in nine months.
On the other hand, I have some patients who need to come back much sooner than six months. I try to see some of my pregnant patients every six weeks because pregnancy hormones contribute to gum disease.
It really depends on the patient.
Does diet influence oral health?
Diet directly affects your oral health. Sugar or sucrose is the No. 1 thing that bacteria feed on to make cavities. So it’s important not to have a lot of sugar or, if you do, clean your teeth afterward.
Teach kids to brush their teeth after they eat lollipops, for example.
Calcium is also very important, especially for women. Osteoporosis, a bone loss disease, also affects the bone around teeth.
Calcium is especially important for kids. The most important bone-building years happen by the time someone is 20. If you decide to start taking calcium supplements when you’re 50, you’re not getting the same major benefit you would have gotten before age 20.
Also, vitamin D inadequacy is rampant in this country. If you don’t have vitamin D, you can’t build bone. You get vitamin D from sunshine, but most of us use sunblock.
Ask your doctor to check your vitamin D levels and see if you could benefit from a supplement.
Are discolored teeth inevitable?
As we age, our teeth naturally become a darker shade of whatever they were. If your teeth had a yellow tinge when you were 15, they will be more so when you’re 70.
It happens because we inflict tiny amounts of trauma on our teeth over time — little things, like hitting them with a fork. As these little traumas occur, the tooth lays down more tooth to protect the nerve.
As more and more good tooth is laid down, you see the color more. So a progression of color intensity is normal and natural.
But that’s different from extrinsic staining. Things like coffee or red wine tend to stain teeth, so you just have to do a very good job cleaning your teeth after you eat or drink these things.
If you do, you won’t get a lot of staining. I drink a lot of coffee and have very little staining. Unfortunately, for many people the stains build up, and it gets much harder to get them off.
That’s where bleaching comes in, right?
Yes, you can do it at home or in the dental office. Bleaching in the dental office is fast and effective. You can get maximum bleaching in very little time.
But there are usually temporary side effects such as some tooth sensitivity.
At home, you can use strips or other agents that you put on your teeth for various lengths of time. They don’t work as quickly, but they offer some advantages.
If a patient experiences sensitivity, they can just take them off and stop. I like patients to be able to be in control.
But I recommend a dental exam before doing any home whitening to make sure there are no signs of dental problems that would give them difficulty.
Can bleaching products be harmful to teeth?
If you use fluoride toothpaste afterward, there’s no evidence that they negatively influence the health of the teeth.
If too much bleach comes in contact with the gums and you have thin gums or certain special problems, though, you can make them sore or do injury to them.
Any last words of teeth wisdom?
If you want your teeth to look as white as a sheet, think twice. Teeth aren’t supposed to be this color. Also, ask your dentist for advice on taking care of your teeth. And listen to this advice!
You will never get another set of teeth. You want them to stick around.
For more information and expert advice, visit our Dental Health Center.
What's Your Dental Health IQ?
Thanks to more knowledge and better oral hygiene, we’re keeping our teeth much longer these days. Yet, how much do you really know about preventing cavities and gum disease?
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