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Caring for your teeth

Prevention is always the best medicine, although a healthy routine is sometimes difficult to adopt. Here's a quick review of good preventive dental habits:

Brush at least twice a day with a fluoride toothpaste

Floss daily or use an inter-dental cleaner.

Eat nutritious and balanced meals and limit snacking.

Visit your dentist every six months for professional cleanings and dental exams.

Check with your dentist about using supplemental fluoride to strengthen your teeth. Also ask about dental sealants (a protective plastic coating), which are applied to the chewing surfaces of the back teeth to protect them from decay.

 

What are teeth made of?

Teeth consist of enamel, dentin, cementum, and pulp tissue.

Enamel is the hardest substance in the body. It covers the outer layer of the tooth in a protective shell. It contains no nerve endings and is not sensitive to a dentist's drill.

Dentin forms the next layer of the tooth. Dentin makes up about 75% of a normal adult tooth. It has about the same density as bone, but contains special cells, called odontoblasts, that are sensitive to temperature and touch. These threadlike cells extend throughout the dentin in the tooth. Their job is to regenerate new dentin from the nutrients delivered by the blood cells. When the dentin is damaged (when it loses a portion of the protective enamel, for example) the odontoblasts relay responses to the nerves, which usually register feelings from mild discomfort to severe pain.

The center of the tooth and its soft tissues are known as the pulp, which extends to the bottom of the root. The pulp is made up of blood vessels, which carry oxygen and nutrients back and forth from the heart. These help keep the tooth in top working condition and protect it from infection. Extremely sensitive nerves also line the inside of the tooth. These nerves respond to multiple stimuli such as heat, cold and pressure.

Cementum covers the entire surface of the root. It is very thin—about the thickness of a fingernail. The main purpose of the cementum is to connect the tooth's root to the bone of the jaw. By forming a bond, it acts like a shock absorber for the tooth.

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Brushing Your Teeth

It is extremely important that you brush after every meal to prevent the build-up of plaque. Plaque is a sticky bacterial substance that forms on the teeth. Plaque mixes with the sugars inside the mouth, forming strong acids that cause tooth decay.

When teeth are not properly brushed, plaque builds up on the surfaces of the teeth and irritates the gums. If this condition is left untreated, the gums will respond by pulling away from the teeth, leaving pockets that contain bacteria and pus that irritate and destroy the bone that hold the teeth in place. Eventually, the bone loss can become severe and no longer support the teeth.

Tooth decay and gum disease are easily preventable by brushing, flossing, proper nutrition and visiting your dentist once every six months for a professional cleaning and examination.

How to brush correctly:

1.  Begin with a good quality toothbrush. Generally, an angled brush with soft bristles is most likely to be recommended by dentists.

2.  Remember that you must brush each tooth inside and out. Start by using some of your favorite toothpaste and brush in an organized pattern.

3.  The back teeth are most often missed, so start there on the outside surfaces of the teeth and work forward around to the opposite side of the mouth. Use a short circular motion making sure the brush makes contact with both the teeth and the gum line.

4.  For the front teeth, position the bristles at a 45-degree angle and brush in a small circular motion.

5.  Make sure you brush the top surface of your tongue. This helps in fighting bad breath bacteria. A tongue-scraper may also be used to remove oral bacteria.

6.  Finally, rinse with water or your favorite mouthwash.

 

Choosing the right toothbrush

toothbrushes

Choosing an effective toothbrush is the first step in obtaining maximum brushing results. There are many shapes and styles of brushes, from the standard manual toothbrush to electric toothbrushes.

Regardless of the type of toothbrush you choose, the general rule of thumb is to choose a toothbrush that has an angled head and soft bristles.

The toothbrush should be replaced every three to four months. In the case of the electric toothbrush, you can simply replace the head, which contains the soft bristles.

Electric toothbrush Please keep in mind that simply brushing your teeth is not as effective at removing plaque and tartar as the brushing and flossing combination.

Additionally, it is essential that you have a professional cleaning and checkup every six months.

 

Flossing Your Teeth

Brushing simply doesn't reach all of the tooth surfaces. Specifically, it misses the proximal surfaces (between the teeth) and the V-shaped sulcus (where the teeth and gums meet).

 

flossing This is why daily flossing is crucial to maintaining healthy teeth and gums. If you are a bit out of practice or are just learning to floss for the first time, here are a few flossing tips that will get you going in the right direction:

1.  Tear off a piece of dental floss about 18 inches long.

2.  Wrap the floss a few times around your fingers and leave about three or four inches between the fingers and thumbs.

3.  Start in the back of the mouth, either on the top or bottom. Insert the floss between the teeth and move the floss up and down. Work between the teeth and the gum line scraping away food particles and plaque.

4.  As the floss begins to fray or build up with plaque, unwind another piece of floss.

5.  After you have flossed between every tooth you should vigorously rinse with water or your favorite mouthwash.

It is important to keep in mind that visiting your dentist every six months for a professional cleaning and examination is as important as regular brushing and flossing.

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Mouthwashes

Using mouthwash, in conjunction with brushing and flossing, may help reduce buildup of plaque and tartar and therefore reduce your chances of tooth decay.

There are many types of mouthwashes that kill bacteria in the mouth, while others actually loosen plaque so it can be removed more easily while brushing and flossing.

Regardless of which type of mouthwash you choose, it is important to remember that nothing substitutes for regular brushing and flossing. You should ask which mouthwash, if any, is recommended when you visit your dentist for your six-month cleaning and checkup.

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Nutrition

Proper nutrition plays a key role in your general overall health. It also has an obvious and direct effect on your teeth and mouth.

The fuel that allows plaque to form is sugar. Eating foods that have high concentrations of sugar may put you at a higher risk for developing tooth decay and gum disease than other types of healthier foods.

If you limit your intake of foods like cookies, pastries, candy, soft drinks and chewing gum, and replace them with snacks like fresh fruit (which is lower in sugar), you will significantly reduce your risk for tooth decay and gum disease.

It is also very important to have your teeth professionally cleaned and examined by your dentist every six months.

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Dental Exams

Regular dental exams are critical to the prevention of tooth decay, gum disease and other dental disorders that can lead to serious oral problems. Once tooth decay or gum disease begins, it will continue to spread to other areas in the mouth. Quite often people won't even realize that they have a problem until a painful symptom is present.

Prevention of many common dental disorders is easy as long as you have a good oral regimen and visit your dentist every six months for professional cleanings and evaluations.

If you are a first time patient or haven't been to the dentist in a while, here is what you can expect when you visit the dentist for an examination.

Before your dental exam begins the dentist will need to know your medical and dental history. This is usually accomplished by filling out a questionnaire. Once the dentist is familiar with any special conditions or allergic reactions that may affect your exam, he/she can then proceed.

The dental examination seeks to explore your current dental condition. It will focus on the teeth, gums and the other tissues in the mouth. By identifying which teeth are healthy and which teeth need treatment the dentist will offer the best procedural options.

The Teeth

 Using special instruments, the dentist will look for any evidence of tooth decay. The dentist will also check for any abnormalities in your bite (the way the teeth come together when your mouth is fully closed). An irregular bite can lead to uneven or excessive wear on the affected teeth and may lead to other dental problems in the future.

The Gums

The dentist will examine the condition of the gums, making sure they aren't inflamed or soft. The tool used for this is called a "periodontal probe," which measures the depth of the sulcus (the area where the gum and tooth meet). Large pockets in the sulcus are signs of early gum disease.

The Tissues Inside the Mouth

The dentist will examine any irregularities on the tongue, cheeks and lips. Many times a dentist is the first to diagnosis certain types of oral cancer. Many types of oral cancer that are caught in the early stages can be treated and eventually eradicated.

X-rays

X-rays help the dentist see any abnormalities in the mouth that cannot be seen by the naked eye. The dentist is able to see the extent of any tooth decay, or minute fractures in the teeth.

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Professional Cleaning

Visiting your dentist every six months for a professional cleaning and checkup is crucial to maintaining a healthy smile. Regardless of how diligent you are at brushing and flossing your teeth, you will still need a professional cleaning every six months to clean those areas that are impossible to clean at home.

Most people do not understand that early stages of serious dental problems are rarely accompanied by symptoms. Quite often, a person will not realize there is a problem until a dentist diagnoses it, or until the problem has advanced to the point where it is causing serious dental pain. There are many problems that can only be diagnosed by a dental professional.

If you limit your intake of foods like cookies, pastries, candy, soft drinks and chewing gum, and replace them with snacks like fresh fruit (which is lower in sugar), you will significantly reduce your risk for tooth decay and gum disease.

The Procedure

The techniques used in dental cleaning have changed significantly over the past 20 years. Today's dental techniques have made the professional cleaning procedure relatively quick and painless.

A cleaning may be performed by a dentist or a dental hygienist (a specially trained dental professional). The cleaning consists of scraping off the hard material buildup with a dental scaler or an ultrasonic machine, which uses sound waves to remove the plaque. The plaque is then rinsed off.

After the teeth are cleaned, they are then polished using a special material and a cup-shaped instrument. After the cleaning, your teeth will feel smooth and fresh.

Restore or Extract?

Today, modern dentistry and better nutrition have reduced the necessity of tooth loss. It is easily possible to preserve and maintain your teeth for a lifetime.

When a tooth is extracted, it leaves a space that can cause other teeth to shift and become crooked, affecting your ability to chew properly. Thus, the loss of a single tooth can have a major impact upon your dental health and appearance.

Although an extraction is less expensive, the missing tooth will need to be replaced with a bridge or implant, which can cost more than a root canal or other restorative treatment.

Overall, the benefits of natural teeth outnumber the benefits of prosthetic, or replacement, teeth.

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Dental Technologies

Just as new technology has improved other areas of healthcare, new developments in dental care have brought incredible patient benefits. From the development of tooth-colored filling materials to the perfection of dental implants as a means of replacing missing teeth, today's dentist is able to help patients in ways that simply were not possible even just a few years ago.
Modern dental care also allows dentists to detect and correct minor problems before they become more significant. Patient comfort is another characteristic of modern dental care. Thanks to modern developments, a visit to the dentist today is a comfortable and pleasant experience. The end result is that through the wonders of modern dentistry, everyone can have a healthy, attractive smile and enjoy the benefits of excellent oral health throughout their lifetime. Following are examples of modern dental technology. Because these are emerging technologies, they are not yet available in all dental offices.

Dental Lasers

Laser dentistry employs a new and exciting technology. Dental lasers are a family of instruments, some used for surgery, some to cure (harden) restorative tooth materials and enhance tooth bleaching, and others to remove tooth structure to eliminate disease. Dental lasers are used for a variety of treatment procedures. Depending on treatment needs, the dentist may use the laser for a long period of time or for only brief moments. All laser treatment requires eye protection, so safety glasses with special lenses will be provided.

Laser therapy may require a reduced need for local anesthesia, and has been found to enhance the effect of tooth bleaching agents for a fast and effective result. When used on gum tissues in the treatment of periodontal disease, bleeding is minimized and swelling is controlled.

Because this is a developing technology, which requires additional training, relatively few dentists provide laser treatment at this time. Dentists who use lasers have devoted training time and expense to be able to offer this new technology in their dental offices.

Air Abrasion

Air abrasion cavity preparation allows the dentist to remove the decay from a tooth without using a drill.  This is done with micro-fine abrasive particles that remove any decay and prepare the tooth for the filling material.
Because the abrasive particles can be controlled very precisely, anesthesia is not needed in most cases. Another benefit of air abrasion is that the precision provided by the micro-fine particles allows the dentist to remove only the decay, resulting in the preservation of tooth structure. While air abrasion is best limited to small areas of decay, when appropriate, this method of treatment can provide attractive benefits.

 

Digital Radiology

New digital technology allows dentists to take and store diagnostic pictures with the computer. Benefits include instant viewing capability and the ability to easily enlarge images for greater clarification. In addition, digital radiography allows for the electronic transmission of images to colleagues such as dental specialists or to insurance companies. While digital radiography is not yet a total replacement for traditional film x-rays, improvements in this technology are progressing rapidly and it’s likely that digital pictures will become common in the dental office.

Intra-Oral Camera

Smile, you’re on TV! Advances in modern video camera equipment have allowed dental manufacturers to develop very small video cameras for use in the dental office. With a camera about the size of a pen, the dentist can film the mouth and present it as an image on a monitor that is magnified 10-40 times natural size. This technology allows the patient to see exactly what the dentist sees and is a tremendous aid in diagnosis and patient education. The intra-oral camera allows the dentist to see things that may not appear with a traditional x-ray and can help the dentist detect minor problems before they become more significant. The camera is also very effective at helping the patient "see" how they are doing with their home hygiene care which often results in more effective brushing and flossing.

 

 

Pain-Free Dental Visits

The truth is that modern dentistry can be a pain-free experience. New developments in injection techniques and technology allow the dentist to deliver anesthesia without pain. The modern dental office strives to make every visit a comfortable and pleasant experience. From a toddler’s first visit to the dental office to a more experienced patient who may have not visited the dentist in a while, most dental offices are well-trained in dealing with patients with special needs and are prepared to make the visit a positive experience.

Cosmetic Dentistry and Video Imaging

A beautiful smile is not limited to the Hollywood set! Cosmetic dentistry refers to dental treatment that helps patients look their best. With the wonderful advances in dental materials that look amazingly natural, you can now have the smile of your dreams. Cosmetic dentistry can provide a brighter smile, fix crooked or stained teeth, fill in spaces between teeth and correct other appearance issues. Some dental offices now have new video imaging technology that can allow you to see how you would look with your new smile (with before and "after" images), which can help the dentist design a smile that is perfectly suited to you.

Microscopes and Other Vision-Enhancing Tools

Many dentists today wear little surgical telescopes that look like funny eyeglasses. These usually have a small light source attached and allow the dentist to see things in your mouth magnified many times natural size. The use of very powerful microscopes is also a technology available in some dental offices today. These microscopes and other vision-enhancing tools allow the dentist to see things that are not possible with the naked eye and result in even earlier diagnosis of dental problems.

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Women's Oral Health


According to a study published in the January 1999 issue of the Journal of Periodontology, approximately 23 percent of women ages 30 to 54 suffer from periodontitis, the advanced stage of gum disease. In addition, a survey from the California Dental Association revealed that 48 percent of female dentists questioned felt that periodontal disease was the biggest oral health concern for their women patients.

Gum disease is a problem for both men and women. But for women, gum disease poses a more serious threat because of the many physical changes experienced during a lifetime, such as puberty, menstruation, pregnancy, and menopause. Taking oral contraceptives can also contribute to gum disease as well as anti-depressants, diuretics, diet pills, and anti-allergy medications, which all can decrease the amount of saliva in the mouth, creating an optimal environment for disease to grow. Eating disorders, such as bulimia and anorexia can also cause harm to the teeth. 

Click on the topics below for details on how they influence women's oral health:

Puberty

During puberty, young women may experience gum disease as a result of increased levels of hormones (progesterone and estrogen) that cause more blood to circulate to the gums, according to the American Academy of Periodontology. This increase in hormones, in combination with the plaque and food particles, can contribute to red, swollen, and tender gums. However, symptoms usually diminish as puberty passes. Your dentist may recommend periodontal treatment to prevent damage to the tissues and bone surrounding the teeth.

Be sure to visit your dentist regularly in order to keep potential gum disease from progressing, and follow a good oral hygiene routine at home that includes brushing and flossing daily.

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Menstruation

Some women may experience several changes in their mouth during menstruation, such as swollen gums and salivary glands, lesions, canker sores and cold sores, according to the American Dental Association. For some, there may not be any noticeable changes, but for others, who already have a history of gum disease, the gums may bleed a few days prior to menstruation as a result of increased levels of hormones, progesterone, and estrogen. Symptoms often dissipate after your period begins. However, it’s very important to visit a dentist as soon as possible. Your dentist can prescribe special cleanings, gum treatment, or topical anesthetics to help ease discomfort.

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Pregnancy

Women often experience many physical changes in their bodies during pregnancy, including their teeth and gums. As a result of increased levels of progesterone and estrogen, the bacteria found in plaque reacts differently causing a condition known as “pregnancy gingivitis.” Symptoms include swelling, bleeding, redness, or tenderness in gum tissue. Pregnancy gingivitis may begin in the second or third month of pregnancy and increase in severity throughout the eighth month. Sometimes, the gums may react to irritants, such as food particles, and form lumps. These lumps, known as pregnancy tumors, are not cancerous and usually painless. The lumps usually diminish toward the end of your pregnancy or after giving birth. However, if the tumor persists, it may need to be removed by a periodontist. In addition, studies have also suggested that pregnancy gingivitis can cause pre-term or low-birth-weight babies. The bacteria that causes gingivitis can enter the bloodstream through your mouth and travel to the uterus, stimulating the production of prostaglandins, which may be responsible for inducing labor.

To assess your oral health, dental cleanings are recommended in the first trimester. Another cleaning may be suggested during the second trimester to monitor any changes and to assess your oral hygiene routine. Many dentists suggest postponing elective dental treatment during the first and third trimesters of pregnancy. The first trimester is a crucial time for baby’s development because most of the organs are formed during this phase and the fetus could be susceptible to environmental influences. In addition, some women in the third trimester may be at risk for premature delivery and many find sitting in the dental chair for extended periods of time uncomfortable. Non-emergency procedures generally can be performed, but the fourth through sixth month is the most optimal time for treatment. However, if you have a history of miscarriage, are a risk to miscarry, or have another medical condition, your dentist may recommend postponing treatment until after pregnancy.

If dental work is necessary during pregnancy, most forms of drugs are safe to take, including dental anesthetics such as novocaine or lidocaine. If antibiotics are necessary, research has also shown that penicillin, amoxicillin, and clindamycin are acceptable during pregnancy. Avoid narcotics for dental pain until after the baby is born as well as tetracycline because it can cause discoloration of your baby’s temporary and permanent teeth. Also avoid aspirin. Over the counter products that contain acetaminophen, such as Tylenol, are approved during pregnancy. However, be cautious of drugs containing ibuprofen. Dental x-rays during pregnancy should only be taken in emergency situations. Consult your obstetrician if you require any anesthesia or if medication is prescribed.

For women experiencing morning sickness, it’s important to neutralize the acid caused by vomiting in order to prevent tooth decay. The Academy of General Dentistry recommends using paste made of baking soda and water, rubbing it on the teeth for thirty seconds, rinsing, then brushing and flossing. If you’re unable to do this routine, rinse with water instead.

Keep in mind that if your gums are healthy before pregnancy, they are more likely to stay healthy during pregnancy. If you are thinking about becoming pregnant, or are pregnant and experiencing any of the above symptoms, visit your dentist as soon as possible. Also, don’t forget to brush and floss daily and don’t skip dental cleanings. If you have gingivitis or periodontal disease, you may need to spend a little more time with your dentist during your pregnancy, but the results will be worth the time and effort.

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Menopause and Post-Menopause

Between 20 and 90 percent of menopausal and postmenopausal women experience pain, burning sensations, altered taste perceptions (salty, peppery, or sour), dry mouth, and sensitivity to hot and cold food or drinks, according to the American Dental Association (ADA). Some women may experience a condition known as menopausal gingivostomatisis which is characterized by gums that are dry, shiny, bleed easily and range in color from pale to deep red.

However, these symptoms could be lessened by hormone replacement therapy (HRT), according to a study from the Journal of Periodontology. The research suggests that postmenopausal women taking estrogen supplementation within five years of menopause may slow the progression of periodontal disease. According to the study, estrogen supplementation may reduce gingival inflammation and the rate of attachment loss (destruction of the fibers and bone that support the teeth) in women with symptoms of osteoporosis, which in turn may help protect the teeth. Be sure to check with your doctor to see if HRT is right for you.

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Oral Contraceptives

According to research conducted in Great Britain and Sri Lanka, women taking oral contraceptives were more likely to experience gum disease than women not taking the pill. As this study suggests, birth control pills can affect a woman’s oral health, especially since many take them for extended periods of time. Hormones found in oral contraceptives (which mimic the symptoms of pregnancy) increase the levels of progesterone in the body, causing the gums to react differently to the bacteria found in plaque. This can contribute to inflamed, bleeding, and swollen gums.

In addition, oral contraceptives can affect gum health after a tooth extraction. In a study published in General Dentistry, women taking birth control pills were twice as likely to develop a dry socket, a localized inflammation, after extraction. Why? A dry socket forms when the blood clot, which helps facilitate healing around the extraction site, is lost or does not form properly as a result of increased estrogen. The ADA recommends scheduling tooth extractions on days when you are taking the placebo pills in your birth control packet.

According to the American Dental Hygiene Association, women taking oral contraceptives have also a 20 percent greater risk of having temporomandibular joint disorder (TMD), a painful jaw disorder involving the ball-and-socket joint.

If you are taking birth control pills and are experiencing any jaw or periodontal problems, visit your dentist as soon as possible. A good oral hygiene routine at home that includes brushing and flossing daily can help stave off potential, or more severe, gum disease.

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Eating Disorders

Bulimia Nervosa and Anorexia Nervosa can cause serious damage to your oral health. The American Anorexia Bulimia Association Inc (AABA) describes Bulimia Nervosa as a disorder “in which frequent episodes of binge eating (rapid consumption of food in one sitting) are almost always followed by purging (ridding the body of food).” Bulimia nervosa is often discovered by the dentist through regular dental exams.

Purging, or vomiting, episodes cause acids from the stomach to come up through the mouth resulting in enamel erosion on the backside of the upper front teeth, sometimes within days of the first vomiting. The acids also contribute to sensitivity, thinning, and chipping of teeth. Dentists can also detect a possible eating disorder by sores that often appear at the corners of the mouth.


Preventive measures can be taken to help protect teeth. Patients with eating disorders are advised to not brush right away after vomiting because it can accelerate tooth enamel erosion. According to the Academy of General Dentistry (AGD), the most effective treatment is to rinse with a fluoride rinse, then use a counter-acting paste, such as baking soda and water, and rub it on the teeth after vomiting to neutralize the acid. After 30 seconds, rinse the paste off, brush, floss, and use a mouthwash to freshen the mouth. If this routine is not possible, rinse the mouth with warm water after purging. If you have already suffered damage to your teeth as a result of bulimia, your dentist can restore them with bonding materials once the purging episodes have stopped.

Anorexia can also cause damage to teeth. According to the AABA, anorexia is a disorder in which “…preoccupation with dieting and thinness leads to excessive weight loss.” According to the AGD, anorexia can lead to bad breath, periodontal disease and eventual tooth loss, in addition to vitamin, mineral, and calcium deficiencies, osteoporosis, and a rise in blood pressure. The AGD suggests eating crunchy foods to help scrape plaque off the teeth (crunchy foods acts as a detergent), in addition to taking a multivitamin daily including a calcium supplement.

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