Teeth may be damaged by dental decay (caries), trauma, erosion, attrition or lost through gum (periodontal) disease.
Caries and periodontal disease are the most common oral diseases, both occur as a result of the activity of dental bacterial plaque. Plaque is a complex structure containing various microorganisms that forms mainly on teeth and particularly between them, along the gum margin, and in the pits and fissures of teeth. If plaque is not regularly removed the bacteria multiply, and plaque may also calcify, forming calculus (tartar).
Fermentation of sucrose and other sugars by plaque bacteria results in the production of acid causing tooth decalcification resulting in caries.
Accumulation of plaque also causes gingival (gum) inflammation (gingivitis). If conditions are appropriate this may progress to damage the periodontal membrane (chronic periodontitis) and lead to tooth loss.
Tooth erosion is an increasing problem from consumption of carbonated and fruit drinks and occasionally from gastric regurgitation or repeated vomiting (as in bulimia, alcoholism, and reflux). In most cases it results in little more than a loss of normal enamel contour, but in severe cases teeth may be severely damaged.
Tooth wear - Attrition, wearing of the biting surfaces, is usually due to tooth grinding or an abrasive diet. Abrasion, wearing at the margin where the tooth meets the gum, is mainly caused by brushing with a hard brush or abrasive dentifrice. It can lead to exposure of dentine and therefore sensitivity to hot and cold in particular. Desensitising toothpastes are available, but professional dental care will be needed.
Diet and lifestyle
Sugars, particularly sucrose, are the major dietary causes of caries. Frequency of intake is more important than the amount. Dietary advice should start with recommending appropriate infant feeding and weaning practice. Drinks other than milk and water should not be given in feeding bottles and should be confined to main meals. Children should be introduced to a cup at about 6 months of age and should have ceased using bottles by about 1 year. Weaning foods should be free of or very low in sugars other than those present in fresh milk and raw fruits or vegetables.
For older children and adults, snack foods and drinks especially should be free of sugars. Because of the risk of erosion as well as of caries, frequent consumption of carbonated and cola type drinks should be discouraged. Fruit juices can also cause tooth erosion. Water and milk are the preferred options for children.
The production of saliva may counter plaque acids, and thus chewing sugar-free gum or cheese after meals may be of value. Fresh fruit and vegetables can also confer some protection against oral cancer. However, smoking or chewing tobacco and some other habits may contribute to periodontal disease and oral malignancy.
Fluorides protect against caries by inhibiting mineral loss, promoting remineralisation of decalcified enamel, and reducing formation of plaque acids. Water fluoridation has consistently been shown to be the most effective, safe, and equitable means of preventing caries and can reduce the prevalence of caries by about half.Children under about 6 years old may swallow toothpaste, so only a pea sized amount of toothpaste should be used and the brushing supervised in order to reduce the risk of fluorosis (excess fluoride in developing teeth).
Plastic coatings placed by a dental professional in the pits and fissures of the permanent teeth can help reduce caries.
Good oral hygiene can prevent periodontal disease and bad breath (halitosis). The most important means of maintaining oral hygiene is using a toothbrush: many types are available, and most are effective at removing plaque. Electric brushes, particularly the rotary kind, are strongly recommended. Tooth brushing at least twice daily with a small headed, medium hardness brush will also help reduce caries if a fluoride toothpaste is used.
However, tooth brushing removes plaque only from smooth outer dental surfaces. More effective interdental removal requires regular flossing (some flosses also contain fluoride), interdental woodsticks or interdental brushes.
Soft plastic mouth guards, or occlusal splints, may be needed to prevent damage from trauma, as in sports injuries, or tooth grinding.
Our dentists and hygienist will discuss all aspects of dental health with you if you are concerned about your teeth and gums. Our well stocked shop sells an excellent range of products which you need for the prevention of dental disease and to maintain oral hygiene.
Four main ways to maintain oral health
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