Teeth and Gums

18 May

You can keep your teeth and gums healthy by brushing and flossing every day. And be sure to visit your dentist regularly for examinations and cleanings. Good oral healthcare will help ensure strong teeth and good overall health for years to come.

Keeping Your Teeth and Gums Healthy

Having a clean mouth is good for you in many ways. Not only does it give you fresh breath and a nice smile, but it also gives your self-esteem a lift. Thorough daily cleaning of your teeth and gums helps prevent tooth decay and periodontal disease (gum disease). Keeping your teeth and gums healthy also can improve your overall health. Periodontal disease may be a factor in the development of chronic conditions such as heart disease.

Your Teeth

Most of us have 32 permanent teeth.Teeth start the digestive process when we eat food.Incisors have a sharp edge for cutting food, the canines tear food, and the premolars and molars grind food.

The best way to ensure oral health is to brush your teeth at least twice a day and to floss them daily. Brushing and floss- ing remove the thin sticky layer of bacteria that grows daily on your teeth. This layer of bacteria is called plaque, and it is responsible for both tooth decay and periodontal disease. When you eat, the bacteria in plaque produce acids that attack the teeth and irritate the gums, making them inflamed. Over time, the gums may bleed and pull away from the teeth. Bacteria and pus accumulate in the pockets that form in the

Structure of a Tooth

A tooth is living tissue.The crown is the part of the tooth that shows above the gums. Dentin, a tissue that is harder than bone but sensitive if its enamel covering is broken, makes up most of the tooth.Teeth contain one to three roots, which are embedded in bone.The pulp cavity at the core of a tooth contains nerves, connective tissue, and blood vessels and lymphatic vessels (which provide nourishment and disease protection).

spaces between the gums and the teeth. Eventually the bone around the teeth deteriorates, and the teeth loosen and fall out.

Flossing your teeth every day helps to remove the plaque that accumulates between your teeth, where your toothbrush cannot reach. It is also important to see your dentist for a thorough teeth cleaning twice a year, assuming that your gums are healthy. A professional cleaning helps to remove calculus (commonly known as tartar), a hard mineral deposit that forms on the teeth, providing an additional surface to which plaque can adhere. If you have periodontal disease or tend to accumulate calculus faster than normal, your dentist may recommend more frequent cleaning.

When you brush your teeth, be sure to use a soft-bristled brush. Brushes with medium or hard bristles are too abrasive and can make your gums recede from your teeth. Your teeth can then become sensitive to cold liquids because the roots of the teeth, which are normally covered by the gums, have been partially exposed. Place the toothbrush against your teeth at an angle and brush back and forth gently in short strokes. Brush the outer and inner tooth surfaces and the chewing areas of the teeth. Be sure to brush your tongue to remove bacteria and to freshen your breath.

To floss your teeth properly, use about 18 inches of floss and wind some of it around one of the middle fingers on each hand. Hold the floss between the thumb of one hand and the index finger of the other hand, or use both index fingers, or

whatever feels most comfortable to you. Gently slide the floss between your teeth, up to the gum line. Do not snap the floss into your gums. Move the floss up and down between your teeth, and repeat this procedure on the rest of your teeth. If you find dental floss to be too unwieldy, try using another kind of den- tal cleaner, such as a pick, to clean between your teeth. Ask your dentist to show you how to use the device properly so you do not injure your teeth or gums.

Sugary and starchy foods—such as sweets, bread, crackers, and cereal—are more likely to cause plaque buildup than other foods. Try to limit your intake of these foods between meals, or brush your teeth soon after eating them. Better yet, snack on fresh fruit, raw vegetables, or plain yogurt. It will be better for your overall health as well.

Corrective Dentistry

To treat damage caused by tooth decay and gum disease, your dentist has a wide array of techniques available. He or she also can replace or repair teeth lost or damaged because of an injury to the mouth or the jaw. Extraction (pulling) of a tooth is now a last resort. Sometimes the line between corrective and cosmetic dentistry blurs when cosmetic techniques are used to repair or replace lost or damaged teeth. Remember to see your dentist twice a year for a thorough clean- ing and checkup so that he or she can detect and treat any tooth or gum problems early. Common corrective dental techniques include:

Silver amalgam fillings. Silver fillings consist of an alloy of several metals—such as silver, zinc, or tin— and mercury. Dentists use silver fillings to fill a tooth after all of the decayed material has been removed. Although it is a matter of some controversy, no proof exists that dental amalgam containing mercury poses any threat to your health.

Crowns. Sometimes called caps, crowns are placed over a tooth that does not have enough tooth structure left for more conservative treatment, such as a veneer.

Bridges. Dentists use replacement teeth called bridges to fill in the spaces left by one or more missing teeth to prevent the teeth adjacent to the space from shifting out of their normal position. The bridge is cemented to the adjacent teeth, which are fitted with crowns or caps.

Implants. Implants are also used to replace missing teeth by placing a “substitute” root form into the jaw- bone. Crowns, caps, or bridges can then be attached to the implants without involving adjacent teeth.

Fitting a Crown

For a crown, your dentist first makes an impression of the natural shape of your damaged tooth.He or she then files the tooth down to a stub in preparation for fitting the crown.The crown has a hollow core that fits precisely over the filed-down tooth.The crown is cemented in place over the tooth.

•  Root canal therapy. During root canal treatment, the dentist or oral surgeon first administers a local anesthetic and removes the infected nerve tissue from the tooth. Then he or she prepares the root canal to accept the filling material. At the next visit, the dentist will fill and seal the root canal with a plastic material that prevents future infection. The tooth may then require a crown or a cap.

Cosmetic Dentistry
T
oday there are a number of techniques that can improve the appearance of your teeth and brighten your smile. These cosmetic dental techniques vary in price. Some are simple and others are complex. Your dentist can advise you about the best cosmetic den-
tal procedures for your situation. The most common cosmetic dental procedures are:

•   Tooth whitening or bleaching. Bleaching is simple and effective and has few side effects. The dentist makes a mold of your teeth, from which rubber mouth guards are made. At home, you place the tooth-whitening solution into the mouth guards and wear the guards for an hour each day, for 2 to 4 weeks.

•   Cosmetic contouring. In this process, the dentist reshapes the front teeth, using a hand- held instrument, to create a more pleasing appearance.

•   Veneers. A veneer is a porcelain laminate shell used to make a new front surface for a tooth that is misshapen, darkened, or spaced too far from a neighboring tooth.

•   White fillings. These white plastic fillings, called inlays or onlays, are used instead of silver fillings to treat dental cavities in a more aesthetically pleasing way.

•   Crowns. Sometimes called caps, crowns are placed over a tooth that does not have enough tooth structure left for more conservative treatment, such as a veneer.

•   Braces. Orthodontic appliances, commonly called braces, straighten teeth that are crowded or crooked. Braces can be made with metal or plastic brackets and wires.

•   Aligners. Aligners are clear, removable pieces of plastic molded to fit over the teeth to straighten them without wires and brackets. An aligner is worn day and night for about

2 weeks and is then replaced with the next one in the series. Unlike braces, aligners can be removed for eating, brushing, and flossing.

Periodontal Disease

Periodontal disease, also known as gum disease, is inflammation of the gums and other tissues surrounding the teeth that is caused by a bacterial infection. The disorder affects as many as 75 percent of adults over age 35. It is the main cause of tooth loss in adults.

The earliest stage of periodontal disease is called gingivitis. The main symp- tom of gingivitis is gums that bleed when you brush or floss your teeth. At this stage, gum disease is both preventable and reversible because the plaque buildup has not yet extended below the gum line to the roots. Brushing your teeth daily is not enough to prevent gingivitis. The only way to stop gingivitis and to prevent further inflammation is to brush your teeth consistently twice a day, floss your teeth daily, and have a professional tooth cleaning at least twice a year. You should also maintain a balanced diet and avoid smoking or chewing tobacco.

Left untreated, the gums begin to pull away from the teeth, and pockets form between the teeth and the gums. The pockets may become filled with pus, and the gums may recede farther. Plaque spreads to the roots of the teeth, and the infec- tion begins to damage the bone and other supporting tissue. The teeth begin to shift and loosen and either fall out or have to be extracted (pulled) by the dentist.

Warning Signs of Periodontal Disease
P
eriodontal disease, also known as gum disease, is the number one cause of tooth loss in American adults. It may also be a risk factor for heart disease or other medical con- ditions. An estimated 75 percent of adults over age 35 in the United States have some form of periodontal disease, but the disorder is easily reversed in its early stages by con- sistent, daily toothbrushing and flossing. Because periodontal disease is painless, you may not know that you have it. If you notice any of the following signs of periodontal disease, see your dentist right away:

•   gums that bleed when you brush or floss your teeth

•   red, swollen, or tender gums

•   gums that have pulled away from your teeth

•   bad breath or a bad taste in your mouth that does not go away

•   pockets of pus around your teeth and gums

•   loose teeth

•   pain when chewing

Not only is periodontal disease damaging to your teeth and gums, it also may adversely affect your overall health. Periodontal disease may contribute to the development of heart disease, the number one cause of death in the United States. Doctors are still not sure why there appears to be a connection between periodontal disease and heart disease, but research has shown that the bacteria responsible for periodontal disease can enter the bloodstream and cause plaque buildup in the arteries leading to the heart. Periodontal disease also has been implicated in the development of stroke, pneumonia, and peptic ulcers.

It is important to have regular dental checkups to prevent and detect peri- odontal disease. If you think you have the condition, see your dentist right away. He or she will perform a thorough examination of your mouth, teeth, and gums. If the condition is present, the dentist will probably assess the sever-

ity of the disorder by checking for bleeding with a probe, measuring the depth of any pockets, assessing how well each affected tooth is still attached, and evaluating bone loss through dental X rays. He or she will develop a treatment plan that is tailored to your needs, depending on the extent of the periodontal disease.

Dentists use a variety of therapies to treat periodontal disease, but all focus on the removal and control of the infectious bacterial plaque. In a process known as scaling, the dentist uses handheld instruments to remove the hardened plaque and calculus from above and below the gum line. During root planing, the den- tist smoothes out the surface of the root by removing the bacteria and toxins that lead to periodontal disease. Ultrasonic scaling involves use of an instrument that converts a high-frequency electrical current into mechanical vibrations, which remove plaque and calculus. The dentist may also use a technique called subgin- gival debridement to remove tooth surface irritants from below the gums so that infection will not occur at the treated site.

If periodontal disease has progressed to an advanced stage, the dentist may have to treat it with one of two surgical techniques. Both procedures attempt to remove diseased tissue so that new replacement tissue can grow. The first tech- nique is called resective surgery, in which the dentist lifts the gum away from the tooth and bone to remove diseased tissue and reshape infected bone. The dentist then repositions the gum and stitches it back into place. Another type of surgery, known as regenerative surgery, attempts to actually regrow the jawbone and supporting tissue by using special inserts that help new tissue grow.

Dentists are beginning to use some new therapies to fight periodontal disease. Inserts containing antibiotics or anti-inflammatory drugs are available that can be placed directly into infected pockets to destroy bacteria. Mouth rinses or toothpastes containing drugs or antimicrobial agents that can destroy the microorganisms responsible for periodontal disease also have been developed. Ask your dentist to recommend one.

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