Tooth Decay - Care of the teeth and gums

Years ago, loss of teeth really was unavoidable. Today, thanks to modern practices of preventive dentistry, it is possible for nearly everyone to enjoy the benefits of natural teeth for a lifetime. But natural teeth can be preserved only by daily oral-hygiene habits and regular dental checkups.

The Dental Examination

Dental checkups should begin in early childhood and continue throughout adult life. A child should see a dentist at the age of two or two-and-a-half, once all the primary teeth have emerged. Children who require special attention in treating dental problems can benefit from seeing a pedodontist, a dentist who specializes in the care of children. After the permanent teeth have become established, the dentist should be visited every six months, or at whatever intervals the dentist recommends for an individual patient who may need more or less care than the typical patient.

The dentist, like the family physician, usually maintains a general health history of each patient, in addition to a dental health history. He examines each tooth, the gums and other oral tissues, and the occlusion , or bite. A complete set of X-ray pictures may be taken on the first visit and again at intervals of perhaps five to seven years. During routine visits, the dentist may take only a couple of X-ray pictures of teeth on either side of the mouth; a complete set of X rays may result in a file of 18 or 20 pictures covering every tooth in the mouth.

X rays constitute a vital part of the dental examination. Without them the dentist cannot examine the surfaces between the teeth or the portion of the tooth beneath the gum, a part that represents about 60 percent of the total length of the tooth. The X rays will reveal the condition of the enamel, dentin, and pulp; any impacted wisdom teeth; and the alveolar bone, or tooth sockets. Caps, fillings, abscessed roots, and bone loss resulting from gum disease also are clearly visible on a set of X rays.

Other diagnostic tests may be made, such as a test of nerve response. Sometimes the dentist will make an impression of the teeth, an accurate and detailed reverse reproduction, in plaster of paris, plastic impression compound, or other material. Models made from these impressions are used to study the way the teeth meet. Such knowledge is often crucial in deciding the selection of treatment and materials.

After the examination, the dentist will present and explain any proposed treatment. After oral restoration is completed, the dentist will ask the patient to return at regular intervals for a checkup and prophylaxis , which includes cleaning and polishing the teeth. Regular checkups and prophylaxis help prevent periodontal diseases affecting the gum tissue and underlying bone. Professional cleaning removes hard deposits that trap bacteria, especially at the gum line, and polishing removes stains and soft deposits.

Dental Care in Middle Age

Although periodontal disease and cavities—called dental caries by dentists—continue to threaten oral health, two other problems may assume prominence for people of middle age: replacing worn-out restorations, or fillings, and replacing missing teeth. No filling material will last forever. The whitish restorations in front teeth eventually wear away. Silver restorations tend to crack and chip with age because they contract and expand slightly when cold or hot food and drinks come in contact with them. Even gold restorations, the most permanent kind, are subject to decay around the edges, and the decay may spread underneath.

If a needed restoration is not made or a worn-out restoration is not replaced, a deep cavity may result. When the decay reaches the inner layer of the tooth—the dentin—temporary warning twinges of pain may occur. If the tooth still is not restored, the decay will spread into the pulp that fills the inner chamber of the tooth. A toothache can result from inflammation of the pulp, and although the pain may eventually subside, the pulp tissue dies and an abscess can form at the root of the tooth.

Dental Care During Pregnancy

It may be advisable for a pregnant woman to arrange for extra dental checkups. Many changes take place during pregnancy, among them increased hormone production. Some pregnant women develop gingivitis (inflammation of the gums) as an indirect consequence of hormonal changes. A checkup by the dentist during the first three months of pregnancy is needed to assess the oral effects of such changes, and to make sure all dental problems are examined and corrected. Pregnant women should take special care to brush and floss their teeth to minimize these problems.


To avoid the problem of toxic substances or poisons circulating in the mother's bloodstream, all sources of infection must be removed. Some of these sources can be in the mouth. An abscessed tooth, for example, may not be severe enough to signal its presence with pain, but because it is directly connected to the bloodstream it can send toxic substances and bacteria through the mother's body, with possible harmful effects to the embryo.

It is during pregnancy that tooth buds for both the deciduous and permanent teeth begin to form in the unborn child. If the mother neglects her diet or general health care during this period, the effects may be seen in the teeth of her child.

Maintaining Good Oral Hygiene


Among general rules to follow between dental checkups are using fluorides, maintaining a proper diet, and removing debris from the teeth by brushing and by the use of dental floss. Fluorides are particularly important for strengthening the enamel of teeth in persons under the age of 15. Many communities add fluorides to the water supply, but if the substance is not available in the drinking water, the dentist can advise the patient about prescription fluoride rinses and treatments. Studies show that fluoride keeps teeth and gums healthy for older adults as well as for children and teenagers.

Dental sealants are also used in the prevention of tooth decay. The dentist brushes a plastic protective coating on the chewing surfaces of the back teeth, creating a barrier against food particles and bacteria. Since sealants can prevent up to 80 percent of all cavities, the American Dental Association recommends this treatment for all children.


Although a good diet for total health should provide all of the elements needed for dental health, several precautions on sugars and starches should be added. Hard or sticky sweets should be avoided. Such highly refined sweets as soft drinks, candies, cakes, cookies, pies, syrups, jams, jellies, and pastries should be limited, especially between meals. One's intake of starchy foods, such as bread, potatoes, and pastas, should also be controlled. Natural sugars contained in fresh fruits can provide sweet flavors with less risk of contributing to decay if the teeth are brushed regularly after eating such foods. Regular chewing gum may help remove food particles after eating, but it deposits sugar; if you chew gum, use sugarless gum.

Because decay is promoted each time sugars and other refined carbohydrates are eaten, between-meals snacks of sweets should be curtailed to lessen the chances of new or additional caries. Snack foods can be raw vegetables, such as carrots or celery, apples, cheese, peanuts, or other items that are not likely to introduce refined carbohydrates into the mouth between meals.


Brushing the teeth is an essential of personal oral hygiene. Such brushing rids the mouth of most of the food debris that encourages bacterial growth. Brush with a fluoride toothpaste at least twice a day, more often if your dentist recommends it. A complete cleaning of brushing and flossing should take three to five minutes.

There is no one kind of toothbrush that is best for every person. Most dentists, however, recommend a brush with soft end-rounded or polished bristles. The size and shape of the brush should allow you to reach every tooth. Replace your toothbrush every three or four months, sooner if the bristles become worn, frayed or splayed. A hard, brittle brush can injure the gums. An interdental brush, a small brush tip at the end of a handle, is useful for cleaning between widely spaced teeth, between a tooth and an artificial crown or a bridge, or any tooth surface that is hard to reach.

Although several different methods may be used effectively, the following is the technique most often recommended. Brush the outside, inside, and chewing surfaces of the teeth with short, gentle strokes. Hold the brush with the bristle tips angled against the gum line at 45 degrees. Use a slight side-to-side motion. Brush the outside surface of each tooth before proceeding to the next tooth. Use the same technique on the inside surface of each tooth as well. For the hard-to-brush inside surfaces of the front teeth hold the handle of the brush in front of the mouth and apply the tip in an up-and-down motion. Next, carefully brush the chewing surfaces, or tops, of the back upper and lower teeth. Then brush the tongue to remove food particles and bacteria.

Some people prefer electric toothbrushes, which require less effort to use than ordinary toothbrushes. These are available with two basic motions—up and down and back and forth. Your dentist may advise which kind best serves an individual's needs and proper use of equipment. Some dentists point out that back-and-forth brushing applied with too much pressure can have an abrasive effect on tooth enamel because it works against the grain of the mineral deposits. The American Dental Association also evaluates electric toothbrushes and issues reports on the safety and effectiveness of various types.

Removing Debris with Dental Floss

Brushing often does not clean debris from between the teeth. But plaque and food particles that stick between the teeth usually can be removed with dental floss. A generous length of floss, about 18 inches, is needed to do an effective job. The ends can be wrapped several times around the first joint of the middle finger of each hand. Using the thumbs or index fingers, the floss is inserted between the teeth with a gentle, sawing, back-and-forth motion. Then it is slid gently around part of a tooth in the space at the gum line and gently pulled out; snapping the floss in and out may irritate the gums. After brushing and flossing, the mouth should be rinsed with water. A mouthwash is unnecessary, but it may be used for the good taste it leaves in the mouth.


The dentist may recommend the use of an oral irrigating device as part of dental home care. These units produce a pulsating stream of water that flushes food debris from between teeth. They are particularly useful for patients wearing orthodontic braces or for those who have had recession of the gums, creating larger spaces between the teeth.

People who want to see the areas of plaque on their teeth can chew a disclosing tablet , available at most pharmacies, which leaves a harmless temporary stain on plaque surfaces. Some dentists recommend the use of disclosing tablets about once a week so that patients can check on the effectiveness of their tooth-cleaning techniques.

Dental Care in Emergencies

If a tooth is knocked out, you should immediately rinse the tooth gently in water to remove dirt or debris. Then place the tooth back in its socket. If reinsertion isn't possible, place the tooth in a cup of milk or water since it is important not to let the tooth dry out. Then see a dentist or go to a hospital emergency room immediately. Studies show that if a tooth is placed back into its socket within 30 minutes of being knocked out, there is a 50 percent chance of saving the tooth.

If a tooth is pushed out of place (inward or outward) but not knocked out of its socket, gently clean any dirt or debris from the injured area with warm water. Push (but do not force) the tooth back into place and hold it in the socket with a moist tissue or gauze. Go to a dentist or emergency room immediately.

When you have a toothache, rinse your mouth thoroughly with warm water to clean out food particles. Use dental floss to remove any food that might be wedged between the teeth. Take an aspirin or other pain reliever to help dull the ache. An over-the-counter medication containing benzocaine can be applied to the tooth. See your dentist as soon as possible.

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