Preventive Care
It involves brushing and flossing your teeth regularly, seeing your dentist and/or dental hygienist for regular checkups and cleanings and eating a mouth-healthy diet, which means foods high in whole grains, vegetables and fruits and dairy products.
Preventive measures should be undertaken seriously for the following reasons:
Missing Teeth
As soon as a tooth is lost the bone will degenerate and the teeth on either side will shift or tip into the empty space. If there is a tooth directly above or below the space it will over erupt, as there will not be anything to prevent it from coming out of the gum tissue. The majority of bone degeneration will occur within the first 6 months but will slowly continue for years. The movement of the adjacent teeth will not occur immediately; rather it will become noticeable after 3 to 5 years. How fast it occurs will depend on the density of bone in the area, your bite and how well your teeth occlude or interlock with each other.
If you have missing teeth and you do not replace them, these movements will occur. These movements may create gum problems and/or decay and could lead to the loss of other teeth. As you lose more teeth, you will be forced to chew in other areas and this often leads to tooth fracture from overloading, excessive wear and/or TMJ (Jaw Joint) problems. Eventually more extensive and expensive dentistry may be required in the future.
There are several reasons that you want to replace a missing tooth or teeth. A tooth has many functions some being to chew, to speak, to keep the facial muscles and tissue in a proper position, to smile and to keep the other teeth from shifting. Once a tooth is lost this whole balance is disrupted and it leads to many other problems.
For certain teeth, such as wisdom teeth, it is unlikely that you will need to replace them. As adults we have 3 molar teeth and we do most (about 80 percentage) of our chewing from the first molar to the first premolar/canine area. About 20 percentage is done in the second molar area and very little is done in the wisdom teeth area. Therefore, we seldom miss or need our wisdom teeth if they are absent or removed. The second molar does at times need replacing, depending on each individual's situation.
In children, baby teeth maintain space for the developing permanent teeth. If baby teeth are lost early, crowding problems may be unnecessarily created and may require orthodontic treatment to correct. Baby teeth are generally not replaced with another teeth; however, an appliance (Space Maintainer) is often placed until the permanent tooth erupts.
Mouth Ulcers
A mouth ulcer is an open sore inside the oral cavity. 2 common mouth ulcer types are aphthous ulcers (Canker Sores) and cold sores(caused by the Herpes Simplex Virus).
The types of oral ulcers are diverse, with a multitude of associated causes including - physical or chemical trauma, infection from microorganisms or viruses, medical conditions or medications, cancerous and sometimes nonspecific reasons. Once formed, the ulcer may be followed by inflammation and/or secondary infection.
Symptoms:
- The symptoms preceding the ulcer may vary according to the cause of the ulcerative process.
- Some oral ulcers may begin with a sharp stinging or burning sensation at the site of the future mouth ulcer. In a few days, they often progress to form a red spot or bump, followed by an open ulcer. Sometimes this takes a little bit longer, depending on the cause of the ulcer.
- The oral ulcer appears as a white or yellow oval area/spot with an inflamed red border. Sometimes a white circle or halo around the lesion can be observed. The grey, white or yellow colored area within the red boundary is due to the formation of layers of fibrin, a protein involved in the clotting of blood. The ulcer, which itself is often extremely painful, especially when agitated, may be accompanied by a painful swelling of the lymph nodes below the jaw, which can be mistaken for toothache.
Causes:
- There are many reasons which can lead to ulceration of the oral tissues. In some cases they are caused by an overreaction by the body's own immune system.
- Factors that appear to provoke mouth ulcers include stress, fatigue, illness, injury from accidental biting, hormonal changes, menstruation, sudden weight loss, food allergies and deficiencies in vitamin B12, iron and folic acid, ill fitting dentures, etc.
Treatment:
- Your dentist may prescribe a local anaesthetic topical application gel along with multi vitamins course, for cases of multiple or severe oral ulcers.
- Treatments based on antibiotics and steroids are reserved for severe cases and should be used only under medical supervision.
Root Canal Therapy
A tooth is basically made up of 2 parts - the crown and the root.
The crown is what you see when you smile or open your mouth. It's the part that sits above your gumline. An outer enamel layer and the dentin inside protect the tooth's underlying structures and prevent bacteria from entering the tooth.
The root is below the gumline. It makes up about 2/3 of the tooth's total length. The root canals house the pulp and extend to the underlying bone. The pulp helps nourish the tooth and is made up of tiny blood vessels and nerves. The blood vessels carry nutrients to the tooth and the nerves give feeling to the tooth. The pulp tissue enters and exits through openings at the root tips.
Unhealthy Tooth:
Bacteria can invade your tooth through a loose filling, a cavity or a crack. In the initial stages the cavity can be cleaned and a tooth colored filling done to restore it. However, once the pulp becomes infected by the bacterial attack, a root canal treatment is necessary to restore it. If left untreated, the inflammation and infection will spread down the root canal, often causing sensitivity to hot or cold foods, throbbing, aching or pain when you chew. This may lead to the bone getting infected as the bacteria escape through the root openings. The bone breaks down and your ligament surrounding the root may swell and loosen the tooth.
Treatment:
- The goal of root canal therapy is to restore the health of your damaged tooth. During treatment, the pulp is removed from root canals through a small opening in the crown. Then the canals are cleaned and disinfected.
- Treatment may take 1 or more visits. The tooth is first numbed. An opening is made in your tooth and any existing fillings or decay is removed. Then dentist removes unhealthy pulp with tiny and flexible files. Using delicate, up and down motions, dentist gently cleans and smooths canals to disinfect them and prepares them for filling.
- The canals are then sealed with an inert material that occupies the space vacated by the removal of the pulp.
- After the inside of your tooth has been treated, the outside will be restored to protect tooth's underlying structures and to bring the tooth back into function. Your dentist will usually cover the tooth with a ceramic or metal crown.
- After root canal therapy your tooth should function and feel like your other teeth. Take care of your treated tooth the same way you would do for your other teeth. Brush after every meal and floss before going to bed. Also, have regular dental checkups, cleanings and any other dental work you may need so that your teeth last as long as you do!
Flossing
It is an essential part of the tooth cleaning process, because it breaks up and removes plaque from between teeth and at the gumline, where periodontal disease often begins. Most cavities and periodontal disease begin between the teeth. While brushing is important, the bristles of your brush simply can't reach between the teeth.
To keep your gums and teeth healthy, you must floss at least once a day.
Benefits:
- Decreased risk of gum disease.
- Better breath.
- Removes plaque in between teeth.
- Polishes tooth surfaces.
How to Floss?
- Break off about 18 inches of floss and wind most of it around the middle finger of one hand and the rest around the other middle finger. If the floss is hard to get between your teeth, try using dental tape, which is thinner.
- Holding the floss between your thumbs and forefingers, guide it between two teeth by gently rubbing it back and forth.
- When the floss reaches the gum line, curve it around one of the teeth and gently slide it back and forth in the crevice between the tooth and the gum.
- Holding the floss tightly against the side of the tooth, rub gently up and down.
- Repeat for each tooth, including the backside of your last teeth, changing to a different part of the floss as you go along.
Excuses for Not Flossing:
- My gums bleed: This is a sign you really need to start flossing because you have an infection in your gums.
- I get my teeth professionally cleaned twice a year, so I don't have to brush or floss: Plaque can turn to hard calculus in less than 2 days, daily cleaning is needed to keep your teeth clean.
- No time to floss: Floss your upper teeth in the morning, lower teeth in the evening.
- My teeth are too tight for the floss: Try a polymer floss that is ADA approved or use the flosser.
- I'm afraid of damaging my gums when I floss: The technique is so important, remember to slide the floss between the gum and teeth with light pressure.
Remember:
- Don't be discouraged with your first attempt at flossing, you will improve with time and practice!
- Your gums may bleed and be sore the first few days that you floss however they will heal and stop bleeding in a couple of days once the bacteria are removed.
- Flossing disturbs bacteria and stops it before it can create plaque and cause gum and bone disease. Floss once a day for a healthier set of teeth and gums.
Replacement of Natural Teeth with Implants
Until a few decades back when natural tooth was lost, it was replaced by a removable partial denture or a fixed prosthesis, each of these treatment options had their own disadvantages. With the advancement of technology and research, dentistry today has a better option for the replacement of a natural tooth - with dental implants.
Dental implant is an artificial substitute to replace the root portion of teeth and put into the bone and gums of mouth. Replacement teeth are then fixed on to these new roots. Dental implants allow people who are with missing teeth to be able to smile, speak and chew well and comfortably.
Types:
- Endosseous: They are usually shaped like a screw or cylinder. They are placed within the jaw bone.
- Subperiosteal: They consist of metal framework that attaches on top of the jaw bone but underneath the gum tissue.
- Transosteal: They are either a metal pin or a U shaped frame that passes through the jaw bone and the gum tissue, in to the mouth.
Implants are made from metals and alloys such as titanium, titanium aluminium vanadium alloy, chromium cobalt molybdenum alloy and ceramics.
Advantages:
- The goal of modern dentistry is to return patients to oral health in a predictable fashion. The partial and complete edentulous patient may be unable to recover normal function, esthetics, comfort or speech with a traditional removable prosthesis.
- The patient's function when wearing a denture may be reduced to 60 percentage compared with that formerly experienced with natural dentition, however, an implant prosthesis may return the function to near normal limits. The esthetics of the edentulous patient also is affected because of bone atrophy continued resorption leads to irreversible facial changes. An implant stimulates the bone and maintains its dimension in a manner similar to healthy natural teeth. As a result, the facial features are not compromised by lack of support. In addition, implant supported restorations are positioned in relation to esthetics, function and speech, not in neutral zones of soft tissue support. The soft tissues of the edentulous patient are tender form the effects of thinning mucosa decreased salivary flow and unstable or unretentive prosthesis.
- The implant retained restoration does not require soft tissue support and improves oral comfort. Speech and function are compromised with prosthesis form the supporting structures during use. The tongue and peri oral musculature may be compromised to limit the movement of the mandibular prosthesis. The implant prosthesis is stable and retentive without the efforts of the musculature.
Teeth and Gum Care
Teeth are meant to last a lifetime. By taking good care of your teeth and gums, you can preserve them for many years. No matter how old you are, you need to take care of your teeth and gums always.
Cavities, bad breath, bleeding gums and dental caries are almost household names due to poor oral hygiene practiced by most people. But there are ways to improve a person's dental condition, which can be followed by anyone in a relatively easy manner. Teeth and gum care involves 4 activities, which are brushing, flossing, eating the right kind of food and paying regular visits to the dentist.
Brushing is the simplest way of ensuring proper oral hygiene and should be done at least twice a day. If possible, the frequency of brushing can also be increased to every time a meal is had, however small it may be. Brushing teeth helps remove plaque, which is a thin coating of calcium compounds on the teeth. Plaque by itself does not harm the teeth in any way, but it is the bacteria residing within the plaque that pose threat towards teeth. These bacteria cause cavities by producing acids by reacting with food items. Brushing removes plaque and keeps the enamel clean.
Flossing is another important activity for ensuring proper dental hygiene. Flossing helps remove food and plaque that accumulates between teeth where toothbrushes cannot reach. This plaque, if allowed to remain there will harden into tartar, which can only be removed by a dentist using special equipment. Flossing should be done gently to avoid damage to the gums and instructions printed on the pack should be strictly followed.
Sugar and starch intake should be lowered to ensure good dental health. Starchy food like potato chips and sugary food like candies stick to the teeth and assist the bacteria in producing acids. Most of the problems can be avoided, however, if a person brushes the teeth after having food of these kinds.
Regular visits to the dentist can help a person keep the teeth in top shape. These visits ensure that the dentist can spot any problem with the patient's teeth at the onset of it. This can cure many ailments before they develop into serious problems.
Lastly, there is no substitute for maintaining proper oral hygiene. All that it takes is a little more effort and sensibility.
Dental Decay
Dental decay or cavities is the most common cause of loss of teeth affecting majority of the population. Still, most people tend to ignore dental decay till it reaches the stage, where the pain becomes unbearable causing infection of the tooth and the underlying bone.
How does it Happen?
Bacteria are constantly present in the mouth. Certain types of bacteria can attach themselves to hard surfaces like the enamel that cover the teeth. If they're not removed, they multiply and grow in number until a colony forms. Proteins that are present in the saliva also mix in and the bacteria colony becomes a whitish film (Plaque) on the tooth. These bacteria feed on sugars and starches from the foods (like Chocolates, Sticky Sweets, Ice Cream, Milk, Cakes and even Fruits, Vegetables and Juices), producing acid as a byproduct. This acid then eats into the tooth enamel (the Outer Hard Layer of the Tooth) gradually dissolving the tooth and a cavity is formed causing a hole in the tooth structure. If not taken care of at this stage, it further reaches the dentin (Inner Sensitive Second Layer) where it spreads more quickly. If still ignored, in some time, the decay spreads to the nerves and blood vessels in the centre of the tooth leading to tooth abscess. Unfortunately, the bacterial attack is so gradual that there may be no pain or sensitivity until the cavity becomes quite large.
Causes:
- Lack of correct oral hygiene habits.
- Baby bottle decay (Nursing Bottle Decay) happens in infants taking a bottle that contains milk or juices to bed with them. These liquids contain sugars that pool around the teeth and can cause decay.
- Root cavities can happen in advanced age as the gums recede, leaving parts of the tooth root exposed. Since there is no enamel covering the tooth roots, these areas can easily decay.
- Repeated decay can happen around existing fillings and crowns because these areas are not as smooth as a natural tooth surface.
- Cavities due to dry mouth or decreased salivation.
Prevention:
The key to preventing decay is removing plaque and bacteria before acid can eat away the tooth.
This can be achieved by:
- Good oral hygiene habits: Brushing carefully (Inside, Outside and Between your Teeth) at least twice a day, flossing daily and using fluoridated toothpaste.
- Food habits: Cutting down on sweets and between meal snacks, replacing fast food with raw vegetables and fruits in your diet.
- Regular dental checkups: Visiting your dentist at least every 6 months for checkups.
Your dentist can help you in following ways:
- May recommend fluoride gels, mouth rinses or dietary fluoride supplements if required.
- May use professional anti cavity varnish or sealants (Thin Plastic Coatings) providing an extra barrier against food and debris.
- Can repair the gaps or smooth the rough edges in existing fillings that could be areas for bacteria to grow.
- Can detect early decay on X rays and prevent it from spreading further. Can teach you the right way of brushing and flossing.
Oral health reflects a person's overall health. You can achieve a perfect oral health by taking good care of your teeth and oral cavity everyday and say goodbye to dental decay forever!
Receding Gums
The pink tissue that surrounds your teeth is called 'gums' which plays an important role in holding the teeth in the jaws. The color of this tissue is usually pink but it maybe black in some people. It is very important that these tissues remain in good health and care should be taken to see that the gums don't inflame and recede or shrink from their actual position.
Causes:
There are various causes of receding gums; the most common are:
- Accumulation of dental plaque: Dental plaque is a sticky, soft, colorless film of bacteria that constantly builds up on the surface of teeth and gums. Failure to remove this film causes formation of a layer which accumulates many bacteria that produce acids. These start causing irritation to the gums and thus produce gum inflammation where the gums become red, swollen and bleed easily.
- Tartar Formation: If oral hygiene is not maintained properly, the tooth plaque continues to build up and can become mineralized to form tartar or calculus. Thus, you can see it as a layer of yellow or brown hard mineral deposits on the teeth surface. It maybe present above and below the gums. It is full of bacteria and can cause severe irritation to the gums and in self defense, the gums become severely inflamed and start shrinking or 'receding' from their original position.
- Other Causes: There can be some other causes like thin gums, prominent frenum pulling the gums, if a restoration is impinging on the gums, trauma due to biting forces and toothbrush trauma.
Effects:
- Gums become inflamed, swollen and bleeding and pus discharge maybe seen.
- The root surface gets exposed which causes a lot of sensitivity, especially while having food of extreme temperatures like cold water or hot tea.
- It causes bad breath and it definitely looks unesthetic in case of anterior teeth.
- In extreme cases, if the tartar is accumulated for a very long time, there is loss of bone around the tooth that is present below the gums, this causes loosening of the teeth.
- Sometimes, due to neglect and lack of awareness, people think that tartar is a part of their tooth. In such cases, big tartar deposits remain, which cause gums to recede further. This is what we call 'gum disease' where pus discharge and loosening of teeth is prominently seen.
Prevention:
- Brush thoroughly at least twice a day, with a fluoride toothpaste to remove plaque from teeth.
- Use dental floss daily to remove plaque from between your teeth and under your gums.
- Rinse your mouth properly after every meal especially on having sticky food.
- Control your diet. Limit sugary or starch foods, especially sticky snacks.
- Check your teeth in the mirror to look for any stains or yellow brown tartar deposits.
- Visit your dentist regularly for professional dental cleanings and dental examinations.
Treatment:
Receding gums are treated by placing a 'soft tissue graft' over them and stitching or suturing it in place - this procedure is called grafting. Placing a soft tissue graft involves taking a soft tissue from the donor site - eg. the roof of mouth and moving it to the recipient site - eg. where the gums have receded. Different types of soft tissue grafts are performed to treat or prevent further gum recession or bone loss and for cosmetic reasons like making the gum line more even. In case of severe bone loss, bone grafts maybe performed to help rebuild an area of bone. A dressing is placed on the graft area which is removed after a week and then gentle cleaning of the area is allowed. Gums begin to look normal in 1 month and heal in 2 - 3 months.
Sports Dentistry
In the recent times, preventive dentistry has emerged as the main focus of dentistry. Awareness among sportsmen and various international sport organizations has recognized the need of dentistry in sports. Prevention of such injuries can be achieved through proper patient education, diagnosis, treatment of existing dental problems and designing custom made mouthguards.
Types of orofacial injuries commonly observed in athletes include injuries to the dentition, namely, fractured or knocked out teeth, loosened teeth or teeth forced out of position. Injuries resulting in dislocation or fracture of jaws may be incurred due to direct impact on jaws.
Contact sports like football, boxing, martial arts, hockey and non contact sports like basketball, baseball, bicycle riding, soccer, wrestling, racquetball, surfing and skateboarding should be supplemented with protective appliances like mouthguards.
Preventive Solutions for Orofacial Injuries can be Enlisted as:
- Regular check up for any undiagnosed problem that might cause an unexpected problem during athletic event.
- Completion of any ongoing dental treatment.
- Use of mouthguard under professional dental guidance.
Mouthguards:
They are readymade or custom made devices fabricated in a way to provide maximum coverage over all teeth. Usually they are adapted over maxillary teeth unless indicated on mandibular teeth. Material used for mouthguard must have shock absorbing properties. According to various international organizations for sports dentistry, material of choice for custom made mouthguards is ethylene vinyl acetate.
Types of Athletic Mouthguards:
- Stock: Has no individual fitting and is least desirable; available at local sports stores.
- Boil and bite: Individual fitting attempted by boiling material and adapting to individual teeth and is less desirable; available at local sports stores. Uneven distribution of material does not allow proper fit and protection.
- Custom made: The most preferred type. Fabricated under proper guidance of a dentist, they are either made in dental clinic or sent by the dentist to the dental lab for custom fabrication with proper guidelines. The advantage of a custom made mouthguard is its fit, adapatability to individual speech requirements, customized occlusion and no interference in breathing.
Custom Made Mouthguards:
They are designed according to the sport played, age of athlete and history of any previous trauma; eg. boxing and martial arts need mouthguards to be made keeping in mind maximum exchange of oxygen and adequate airway maintenance in unexpected events like nasal obstruction due to blow on nose.
Custom made mouthguards are further classified according to the method of fabrication as:
- Vaccum custom made by vaccum machines.
- Pressure laminated custom made by pressure machines.
Features of Mouthguard:
- Shock absorbing concussive forces to lower jaw.
- Protection against neck injury.
- Distributing force of blow all over surrounding teeth and gums.
- Adequate material thickness and maximum occlusal coverage.
A snugly fit customized mouthguard when in place causes forward and downward movement of the jaw, opening the space between the glenoid fossa and condylar head. Any impact to the lower jaw reduces the possibility of direct impact of head of condyle to the glenoid fossa, thereby decreasing impact and forces to the entire temporal region.
Maintenance for Mouthguards:
- Store in hard and perforated case.
- Replace when signs of wearing out are evident.
- Keep clean using toothbrush and water.
- Never keep in warm place or in hot water.
As a helmet will not hamper the ability to drive a bike, likewise athletes should understand that oral protection by way of properly fitted mouthguards will not hamper their ability to perform. "Prevention is better than cure", says an old adage. This holds true for orofacial injuries in sport events. Damage due to lack of proper measures may lead to a range of minor to major events having a long lasting impact on patient's oral as well as general health.
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