Tooth Decay: A Preventable Disease 
What is tooth decay, and what causes it?
Tooth decay is the disease known as caries. Unlike other diseases, however, caries is not life threatening and is highly preventable, though it affects most people to some degree during their lifetime.

Tooth decay occurs when your teeth are frequently exposed to food containing carbohydrates (starches and sugars) like soda pop, candy, ice cream, milk, cakes, and even fruits, vegetables and juices. Natural bacteria live in your mouth and form plaque. The plaque interacts with deposits left on your teeth from sugary and starchy foods to produce acids. These acids damage tooth enamel over time by dissolving, or demineralizing, the mineral structure of teeth, producing tooth decay and weakening the teeth.

How is caries prevented?
The acids formed by plaque can be counteracted by simple saliva in your mouth, which acts as a buffer and a remineralizing agent. Dentists often recommend chewing sugarless gum to stimulate the flow of saliva. However, though it is the body's natural defense against caries, saliva alone is not sufficient to combat tooth decay.

The best way to prevent caries is to brush and floss regularly. To rebuild the early damage cause by plaque bacteria, we use fluoride, a natural substance that helps to remineralize the tooth structure. Fluoride is added to toothpaste to fight cavities and clean teeth. The most common source of fluoride is in the water we drink. Fluoride is added to most community water supplies and to many bottled and canned beverages.

If you are at medium to high risk for caries, your dentist may recommend special high concentration fluoride gels, mouth rinses, or dietary fluoride supplements. Your dentist may also use professional strength anti-cavity varnish, or sealants - thin, plastic coatings that provide an extra barrier against food and debris.

Who is at risk for caries?
Because we all carry bacteria in our mouths, everyone is at risk for caries. Those with a diet high in carbohydrates and sugary foods and those who live in communities without fluoridated water are likely candidates for caries. And because the area around a restored portion of a tooth is a good breeding ground for bacteria, those with a lot of fillings have a higher chance of developing tooth decay. Children and senior citizens are the two groups at highest risk for caries. 
What can I do to help protect my teeth? 
The best way to combat caries and cavities is to follow three simple steps:
 
Brushing 
What is the best technique?
There are a number of effective brushing techniques. Patients are advised to check with their dentist or hygienist to determine which is the best one for them since tooth position and gum condition varies. One effective, easy-to-remember technique involves using a circular or elliptical motion to brush a couple of teeth at a time, gradually covering the entire mouth. Place a toothbrush beside your teeth at a 45-degree angle and gently brush teeth in an elliptical motion. Brush the outside of the teeth, inside the teeth, your tongue and the chewing surfaces and in between teeth. Using a back and forth motion causes the gum surface to recede, or can expose the root surface or make the root surface tender. You also risk wearing down the gum line.

Soft or hard bristles?
In general, a toothbrush head should be small (one inch by one-half inch) for easy access. It should have soft, nylon bristles with round ends. Some brushes are too abrasive and can wear down teeth. A soft, rounded, multi-tufted brush can clean teeth effectively. Press just firmly enough to reach the spaces between the teeth as well as the surface. Medium and hard bristles are not recommended.

How long should I brush?
It might be a good idea to brush with the radio on, since dentists generally recommend brushing 3-4 minutes - the length of an average song. Using an egg timer is another way to measure your brushing time. Patients generally think they're brushing longer, but most spend less than a minute brushing. To make sure you're doing a thorough job and not missing any spots, patients are advised to brush the full 3-4 minutes twice a day instead of brushing quickly five or more times through the day.

Should I brush at work?
Definitely, but mot Americans don't brush during the workday. Dentists say it's a good idea to keep a toothbrush in your desk, which increases the chances that you'll brush during the day by 65 percent, according to a survey released by Oral-B Laboratories and the Academy of General Dentistry. Getting the debris off teeth right away stops sugary snacks from turning to damaging acids, and catches starchy food like potato chips before they turn to cavity-causing sugar. If you brush with fluoride toothpaste in the morning and before going to bed, you don't even need to use toothpaste at work. You can just brush and rinse before heading back to the desk. If you don't have a toothbrush, rinsing your mouth with water for 30 seconds after lunch also helps.

The following tips may improve you work-time brushing habits: 
Five Ways To Protect Your Child's Oral Health At Home 
 
Diabetes and Oral Health 
What is periodontal disease?
Periodontal (gum) disease may result from gingivitis, an inflammation of the gums usually caused by the presence of bacteria in plaque. Plaque is the sticky film that accumulates on teeth both above and below the gum line. Without regular dental checkups, periodontal disease may result if gingivitis is left untreated. It also can cause inflammation and destruction of tissues surrounding and supporting teeth, gums (gingival), bone and fibers that hold the gums to the teeth.

A number of factors increase the probability of developing periodontal disease, including diabetes, smoking, poor oral hygiene, diet, and genetic makeup; and it is the primary cause of tooth loss in adults.

How are periodontal disease and diabetes related?
It is estimated that 12 to 14 million people, or one-third of the population in the United States, have diabetes, but only one-half of these individuals are diagnosed.
Studies have shown that diabetics are more susceptible to the development of oral infections and periodontal disease than those who do not have diabetes. Oral infections tend to be more severe in diabetic patients than non-diabetic patients. And, diabetics who do not have good control over their blood sugar levels tend to have more oral health problems. These infections occur more often after puberty and in aging patients.

What types of problems could I experience?
Diabetics may experience diminished salivary flow and burning mouth or tongue. Dry mouth (xerostomia) also may develop, causing an increased incidence of decay. Gum recession has been found to occur more frequently and more extensively in moderate and poorly controlled diabetic patients because plaque responds differently, creating more harmful proteins in the gums. To prevent problems with bacterial infections in the mouth, your dentist may prescribe antibiotics, medicated mouth rinses and more frequent cleanings.

How can I stay healthy?
Make sure to take extra good care of your mouth and have dental infections treated immediately. Diabetics who receive good dental care and have good insulin control typically have a better chance at avoiding gum disease.

Diet and exercise may be the most important changes that diabetics can make to improve their quality of life and their oral health. Diabetic patients should be sure both their medical and dental care providers are aware of their medical history and periodontal status. To keep teeth and gums strong, diabetic patients should be aware of their blood sugar levels in addition to having their triglycerides and cholesterol levels checked on a regular basis. These may have a direct correlation on your chances of obtaining periodontal disease.

What is the best time to receive dental care?
If your blood sugar is not under control, talk with both your dentist and physician about receiving elective dental care. Dental procedures should be as short and as stress free as possible. Also make morning appointments because blood glucose levels tend to be under better control at this time of day.

If you have a scheduled appointment, eat and take your medications as directed. See your dentist on a regular basis, keep him or her informed of your health status, and keep your mouth in good health. 
Pregnancy and Oral Health 
How does pregnancy affect my oral health?
It's a myth that calcium is lost from the mother's teeth and "one tooth is lost with every pregnancy." But you may experience some changes in your oral health during pregnancy. The primary change is a surge in hormones - particularly an increase in estrogen and protesterone, which is linked to an increase in the amount of plaque on your teeth.

How does a build-up of plaque affect me?
If the plaque isn't removed, it can cause gingivitis - red, swollen, tender gums that are more likely to bleed. So-called "pregnancy gingivitis" affects most pregnant women to some degree, and generally begins to surface in the second trimester. If you already have gingivitis, the condition is likely to worsen during pregnancy. If untreated, gingivitis can lead to periodontal disease, a more serious form of gum disease.

Pregnant women are also at risk for developing pregnancy tumors, inflammatory, benign growths that develop when swollen gums become irritated. Normally, the tumors are left alone and will usually shrink on their own. But if a tumor is very uncomfortable and interferes with chewing, brushing or other oral hygiene procedures, the dentist may decide to remove it.

How can I prevent these problems?
You can prevent gingivitis by keeping your teeth clean, especially near the gumline. You should brush with fluoride toothpaste at least twice a day and after each meal when possible. You should also floss thoroughly each day. If toothbrushing causes morning sickness, rinse your mouth with water or with anti-plaque and fluoride mouthwashes. Good nutrition - particularly plenty of vitamin C and B12 - help keep the oral cavity healthy and strong. More frequent cleanings from the dentist will help control plaque and prevent gingivitis. Controlling plaque also will reduce gum irritation and decrease the likelihood of pregnancy tumors.

When should I see my dentist?
If you're planning to become pregnant or suspect you're pregnant, you should see a dentist right away. Otherwise, you should schedule a check-up in your first trimester for a cleaning. Your dentist will assess your oral condition and map out a dental plan for the rest of your pregnancy. A visit to the dentist also is recommended in the second trimester for a cleaning, to monitor changes and to gauge the effectiveness of your oral hygiene. Depending on the patient, another appointment may be scheduled early in the third trimester, but these appointments should be kept as brief as possible.

Are there any procedures I should avoid?
Nonemergency procedures generally can be performed throughout pregnancy, but the best time for any dental treatment is the fourth through six month. Women with dental emergencies that create severe pain can be treated during any trimester, but your obstetrician should be consulted during emergencies that require anesthesia or when medication is being prescribed. Only X-rays that are needed for emergencies should be taken during pregnancy. Lastly, elective procedures that can be postponed should be delayed until after the baby's birth. 
Oral Health and Your Heart  
What should I be concerned about?
Researchers are finding possible links between periodontal infections and other diseases throughout the body. Current studies suggest that there may be a link between periodontal (gum) disease, heart disease and other health conditions. In fact, research suggests that gum disease may be a more serious risk factor for heart disease than hypertension, smoking, cholesterol, gender and age.

New studies suggest that people who have gum disease seem to be at a higher risk for heart attacks, although no one is certain how this relationship works. Your oral health affects your overall health, but the studies that will find exactly why these problems are linked are still underway.

How can gum disease affect my overall health?
The current theory is that bacteria present in infected gums can come loose and move throughout the body. The same bacteria that cause gum disease and irritate your gums might travel to your arteries. Researchers are unsure what causes the bacteria to become mobile, but it has been suggested that bacteria can be dislodged and enter the bloodstream during tasks as simple as brushing, flossing and even chewing.

Research shows that risk varies according to the level of gum infection. The worse the infection, the more likely the bacteria are to become blood-borne. Infected gums bleed, making it easier for bacteria to enter your bloodstream. If bacteria become dislodged, the bacteria enter through cuts or sores in your mouth and travel to other parts of the body through your bloodstream.

Once bacteria reach the arteries they can irritate them in the same way that they irritate gum tissue. This could cause arterial plaque to accumulate in the arteries, which can cause hardening and block blood-flow. Compromised blood-flow to your heart can cause a heart attack. Also, arterial plaque can come loose and travel to other parts of the body. If blockage occurs in the brain, it can cause a stroke.

Your dentist may use a special rinse immediately after dental procedures to neutralize these bacteria, but your best protection is to maintain a healthy mouth.

What should I do?
Keep your mouth healthy! See your dentist at least twice a year for periodic maintenance. Gum disease is a serious gum infection that should always be taken seriously. Although gum disease can often show few or no symptoms at all, watch for gums that are red and irritated, or gums that bleed easily. There are many new treatments available to control and help reverse gum disease.

Always remember that gum disease is caused by plaque buildup. Brush and floss regularly to remove plaque that you can't see below the gum line and remember to schedule regular check-ups. If you remove the plaque, you minimize the change for getting gum disease. 
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