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Look after Your Teeth

Teeth have many functions and it's important to your quality of life to look after them. Their main job is to chew, or masticate, food before swallowing, in order to aid the digestive processes. Teeth do, however, have other functions. They are intimately involved in speech, and are, of course, vital to our appearance, not only for a healthy, attractive smile, but also to support the cheeks and lips.

With proper care and attention, we should all keep our own natural teeth for a whole lifetime. This page gives some background to potential problems and advice on how best to look after them. A normal tooth is made up of a central pulp which is alive, consisting of blood vessels, nerves and other soft tissues.

Surrounding the pulp is the major part of the tooth, consisting of a hard tissue called dentine. Because of association with the nerves of the pulp, the dentine is a sensitive tissue. The part of a tooth above gum level is termed 'crown' and covered by enamel (the hardest tissue produced by the human body and totally insensitive). Below gum level is the tooth root covered by cementum. This is attached to the bony socket of the jaw by the periodontal ligament.

There are 4 basic types of teeth:
Molars
Large strong teeth, found at back of mouth, used for grinding and chewing food.
Premolars (bi-cuspids) Smaller, but also used for grinding and mashing food to a suitable consistency for swallowing.
Canines (cuspids) Sharp pointed teeth with long strong roots, ideal for tearing food. The uppers develop high in the upper jaw below the eyes and are often referred to as 'eye teeth', made famous by vampire movies!!
Incisors Very sharp edges and ideal for biting and cutting food.They are found at the front of the mouth.

Baby Teeth

Humans have 2 sets of teeth. The baby teeth begin to form before the baby is born and push through the gum at 6mths.

In some unusual cases, babies can be born with an extra set of 1 or 2 teeth already erupted in their mouths. These are known as neonatal teeth and make breast feeding very uncomfortable for mother.

20 baby teeth make up a full set which will all have erupted by 2-3yrs. In each corner of the mouth 2 incisors, 1 canine and 2 molars. There are no premolars in the baby teeth.

Mixed Dentition

At 6yrs children have 20 baby teeth. At this stage they usually start to acquire some permanent, or adult teeth. This transition from baby to adult teeth happens in a definite sequence.

During this period children are said to be in the 'mixed dentition' stage.

Teeth 6-7 Years

By 6-7yrs most children have lost 1st baby teeth (the 1st lower incisor teeth). These are replaced by adult successors. Adult molar teeth erupt, behind the last baby teeth, into space made available by growth of the jaws.

Teeth 7-8 Years

By 7-8yrs the 2nd lower incisors and 1st upper incisors have replaced baby predecessors.

Teeth 8-9 Years

During the 9th yr the 2nd upper incisors erupt followed by lower adult canine teeth.

Teeth 9-10 Years

Adult teeth are both larger and more numerous than baby teeth. During this transition the jaws are growing along with the rest of the child. Often, however, the growth of jaws is not enough to make room for all adult teeth. This leads to overcrowding and irregularity of teeth, which may require extractions and orthodontic treatment.

Teeth 10-11 Years

By this age 1st baby molars have usually been lost and replaced by 1st adult premolars.

Teeth 11-12 Years

By this age most children have lost all remaining baby teeth and adult 2nd premolars and upper canine teeth erupt.

Teeth 17-21 Years

By 12-13yrs children have usually had 2nd molar teeth erupt at the back of the mouth and between 17 and 21yrs the final teeth, the 3rd molars or wisdom teeth erupt.

Dental Care

Adult Teeth

There are 32 teeth in the complete adult, permanent or secondary dentition. However, following extraction s to alleviate overcrowding and impacted wisdom teeth, many adults do not have a full complement of 32.

How To Prevent Tooth Decay And Gum Disease

To protect teeth and gums from tooth decay and gum disease you should:

* Control plaque

* Control your diet

* Increase resistance of your teeth to decay by using fluoride products

Controlling plaque is essential to decrease risk of gum disease. However, since plaque starts to form again immediately after it has been removed, it is not as important as dietary control and the use of fluoride products to increase resistance of teeth to decay.

Your dentist can give personal advice on how to look after your mouth. He can advise on oral hygiene, diet and fluoride supplements. Your dentist can also repair damage that has been done to your teeth and try to stabilise and prevent further gum disease.

Remember, prevention is better than cure and prevention is largely up to YOU.

Mouths are all different and so there is no single correct way to brush teeth. The  aim of brushing is to remove plaque from teeth, gums and spaces between, without damaging them. The 1st stage in achieving successful oral hygiene is getting to know your own mouth and where the worst plaque deposits accumulate, so that you can pay special attention to those areas.

By chewing a disclosing tablet you can stain the plaque in your mouth. You can then see plaque and develop your own personal technique of brushing which is most effective. A small mouth mirror is useful to see the backs of teeth inside the mouth. Your dentist or hygienist can help to advise on the correct technique.

Tooth Brushing

The best method is whatever is effective in removing plaque for you. As a general guide, remember to brush the outsides, insides and biting surfaces of all teeth using a combination of upward and downward, backward and forward and round and round actions, keeping the bristles of the brush pointing at 45 degrees to the axis of the tooth.

You should brush thoroughly twice a day. It takes at least 1 minute to brush teeth effectively. Check your technique regularly using disclosing tablets. Your dentist will be able to give specific advice for your mouth.

There is a confusing array of different shapes and sizes of toothbrush available from chemists. Most dentists agree that you should use a brush which you find comfortable to hold. However, larger brushes are not as effective in gaining access to the smaller nooks and crannies in your mouth.

The neck of the brush should be slim enough for easy access to your back teeth and the brush itself should be made from medium texture nylon filaments with rounded ends.

There are a huge number of toothpaste's, gels, polishes and powders available today. Always use a toothpaste or gel containing fluoride. There is little to choose between most toothpaste's and gels, so use one with the best taste and price.

Generally, gels are the most kind as they have the least added abrasive, but may not be as effective in preventing build up of staining if you are a smoker or avid tea or coffee drinker. Some of the tooth powders and polishes are very abrasive and will scratch the surface of your teeth.

Should you be susceptible to staining, it makes sense to see your dentist rather than damage your own teeth by regular use of abrasive materials.

Flossing

Once you have mastered tooth brushing correctly, the next step in plaque control is flossing. However thoroughly you brush your teeth, you can't remove the plaque from spaces between teeth with a brush. It is important to remove this plaque daily with floss.

Most dentists agree it is not necessary for children to floss until they have lost all baby teeth, at 12-13yrs.

Taking about 20 inches (50cm) of floss you can either tie it in a loop, or wind the ends around your middle fingers, leaving a short distance of floss between them.

Insert the floss carefully between your teeth and clean the side of each tooth by moving the floss gently up and down. Be careful not to damage your gums by being too vigorous. This should be repeated between each of your teeth.

Flossing takes time and practice. Perseverance and patience will be rewarded by maintained health of your gums.

Some flosses are now available with added fluoride which can help increase the resistance of your teeth to decay.

Should you have awkward spaces between teeth, other cleaning aids are available. Interproximal, interspace brushes and woodsticks may be used.

The interspace brushes are particularly useful if you have had some gum recession leaving larger spaces between teeth.

'Anti-plaque' mouth rinses may aid effective plaque control, and should be used prior to tooth brushing.

Dental Care

When sugar is taken into the mouth, it is metabolised by bacteria in the plaque. This produces acid, which causes tooth demineralisation and decay. Following eating or drinking something sweet, the acid remains in the plaque for approximately 30 minutes. If sugar is taken 2-3 times/day, the effect is not significant.

However, if you eat sweet things or take sweet drinks between meals, the period during which acid is present is increased and eventually a cavity will result. It is the frequency, not the quantity of consumption of sweet things which is important.

You should try to avoid a daily diet which contains too many sugary foods and drinks. Try to restrict sugar consumption to 3 times per day, at meal times. If you're hungry between meals, eat a safe snack containing no sugar.

Some dentists believe that chewing certain types of gum immediately following a meal can reduce the risk of dental decay!

Fluoride helps to make teeth more resistant to the acid which causes decay. There are several ways of introducing fluoride to teeth. The best resistance is by incorporating fluoride into teeth as they develop. As teeth are already developing at birth, this means taking fluoride into the body from a very early age.

Some areas have naturally occurring fluoride in the water supply while others add fluoride (1 part to 1,000,000 parts water).

This is the best method as fluoride is taken up into developing teeth and also has a localised action on the surface of teeth which have already erupted.

Areas that have fluoride in their water supply show a substantial decrease in the cases of tooth decay. Alternatively, fluoride drops and tablets are available from drug stores and should be given to children aged 0-12yrs in areas where there is no natural or added fluoride in the water.

Consult your dentist prior to giving your children fluoride supplements (too much fluoride may cause problems, e.g. tooth staining).

The surface layer of teeth can be made more resistant to decay with topical, or surface applied fluoride. This can be in the form of toothpaste, mouthwashes, gels or varnishes, and floss containing fluoride (a USA study, at the University of Iowa, found that fluoride toothpaste cut seniors' root cavities by 67%).

Areas of the teeth most likely to decay are the pits, grooves and fissures on the biting surface of the teeth. These can be protected by your dentist by application of a protective layer of a sealing resin.

The surface of the tooth is cleaned thoroughly and then etched by application of a phosphoric acid conditioner for a short period.

This is then washed away and the sealing resin applied. Sometimes a material is used which requires the use of a blue light for a short period to encourage setting.

Common Problems

Teething

During the eruption of new teeth, a baby is said to be cutting new teeth or teething. Whilst teething, children are often irritable, fretful, they may develop flushed cheeks, dribble and want to gnaw on hard objects.

The lower middle or front incisor teeth are the 1st to appear, usually at 6mths. The last baby teeth have erupted usually by 3yrs.

Most dentists agree it's not teething causing problems. At 6mths, when front teeth appear, a baby loses infection immunity received from mother prior to birth.

For a short time (coinciding with teething), a baby is prone to minor infections, until its own immunity develops. Babies rarely suffer teething problems when back teeth erupt, as their immune system has started operating.

Teething can be painful, and gums and oral cavities may become inflamed. However, teething gels are available which contain an antiseptic and local anaesthetic which can provide rapid relief. It's important to ensure such gels are free from sugar.

Your dentist will advise on a suitable product. Solid teething rings can also provide relief for a teething baby. If in doubt seek medical advice.

Wisdom Teeth

Approximately 75% of western people have 3rd molar or wisdom teeth. They usually erupt at the very back of the mouth between 17-21yrs.

As mankind descended from his evolutionary ancestors, the brain increased in size, at the expense of space available for face and jaws. It is the reduction in the size of jaws which creates problems for the 3rd molar tooth.

Being the last tooth to erupt, there is often not enough room for them. When teeth are stopped from fully erupting, they are referred to as being impacted. This can lead to problems with infection around the teeth known as pericoronitis, and often leads to the need for extraction.

Plaque

Plaque is a soft deposit of certain constituents of saliva (glycoproteins) into which bacteria become trapped. Plaque forms on all surfaces of all teeth throughout the day and night. It accumulates particularly in spaces between teeth and around margins of gums.

Dental Care

Plaque can be made visible by staining with vegetable dyes contained in disclosing tablets. The bacteria in plaque are responsible for both tooth decay and gum disease, which are the most common and damaging of dental diseases. It is essential for dental health to control the build up of plaque.

Calculus

Should you fail to remove plaque thoroughly and regularly, calcium salts from saliva may be precipitated into the plaque.

This will cause the plaque to harden and become like the scale in a kettle. This hardened plaque is known as calculus or tartar.

Some toothpastes are designed specifically to reduce the build up of calculus. You will need to visit your dentist for removal of calculus. They may use a selection of hand or ultrasonic instruments to do this.

Gum Disease

Gingivitis is the 1st sign of gum disease and happens if plaque is not removed regularly and effectively. The bacteria in plaque produce toxic substances which attack gums. The gums become swollen, red in colour and tend to bleed. Gingivitis is, however, usually not painful.

At this stage gum disease is completely reversible, providing an intensive oral hygiene program is adopted. You should consult your dentist for advice on the appropriate measures if you think you have gingivitis.

If gingivitis is ignored, or its existence is not recognised and it is allowed to persist, then it will progress to periodontitis.

Like gingivitis, periodontitis is usually not painful, but unlike gingivitis, it is not reversible and causes permanent damage to gums.

Periodontitis is the term applied to the destruction of the periodontal ligament as the result of long term inflammation.

Destruction of the ligament is followed quickly by resorbtion (shrinking) of the supporting bone, recession of the gums or pocketing, leading to loosening and eventual loss of teeth.

Gum disease accounts for the loss of more teeth than any other cause, yet is often completely preventable.

Tooth Decay

Bacteria in plaque metabolise sugars (natural and refined) producing acid, causing demineralisation (calcium loss) of crystalline tooth tissue and decay.

Common areas of tooth decay are where plaque can hide, pits and grooves on biting surfaces of back teeth, and tooth surfaces next to spaces between teeth. Teeth can be made more resistant to decay by using fluoride products.

Sensitive Teeth

Teeth are usually sensitive because there is some dentine exposed in the mouth. This can be the result of decay and development of a cavity, or as a result of gum recession, exposing the tooth root.

In case of an exposed root as a result of gum disease, toothpaste's for treatment of sensitive teeth can be useful. If you suffer from sensitive teeth, you should see your dentist for advice.

Bad Breath

Bad breath, or halitosis, can arise from many causes:

* Poor oral hygiene (by far the most common cause).

* Dental decay/gum disease.

* Diet - consumption of garlic, spices, onion, etc., will inevitably taint your breath.

* Infections of mouth.

* Eructation, belching or burping (brings noxious smelly gases up from stomach).

* Consuming excess alcohol.

* Smoking.

* Gastrointestinal or stomach problems.

Should oral hygiene measures not cure a bad breath problem, consult your dentist.

Dental Anxiety

It is natural to feel a certain anxiety at the thought of visiting your dentist. For many people it used to be an unpleasant  experience years ago. Beware of subconsciously passing outdated anxiety to your children. Today, dentistry is a much less unpleasant experience than in the past.

Anaesthetics are very effective and relatively painless to administer. Your dentist may be able to offer some sedation technique if you are very nervous. If you cannot face treatment, then a general anaesthetic is a possibility.

Dental Care

Dental First Aid

If you are travelling for long periods to places where dentistry is not easily available, it makes sense to take a dental 1st aid kit. These are readily available from drug stores and consist of a dental mouth mirror, temporary filling material and temporary material for recementing displaced crowns.

Fillings

Should you develop a cavity as a result of tooth decay, then your dentist will remove the decayed area of tooth (usually with a drill using local anaesthetic) and restore the tooth to its original size and shape with filling material.

Depending on depth of decay, your dentist will place a lining (insulating layer) to protect sensitive nerve and pulp tissue inside the cavity.

For well over 100yrs, dentists have filled cavities with silver amalgam. It is still very widely used for restorations in back teeth.

However, tooth coloured materials have improved remarkably in recent years.

Great advances in filling techniques have been made since the advent of adhesive materials. These materials can actually bond to enamel and dentine, this enables fillings to be placed with the minimum removal of sound tooth material.

Rootcanal Therapy

Should decay penetrate deep into a tooth, pulp within the tooth may die or become irreversibly diseased.

Dead pulp tissue can become infected and infection can spread down root canals into the jaw, to produce a dental abscess.

Root canal therapy is a procedure undertaken by your dentist whereby dead or diseased tissue within the tooth is removed.

The cavity is then cleansed and sterilised and eventually filled with a root filling material. This can sometimes be a lengthy and involved procedure which often requires several visits to your dentist.

Tooth Crown

Your dentist may suggest providing a crown for a tooth in order to either restore a badly damaged tooth, to improve appearance of a tooth, or to build up the biting surface of a tooth.

The natural tooth needs to be reduced by about 1-2mm to accommodate the crown, which fits over the top of the tooth (like a thimble) to strengthen and support the remaining tooth.

Crowns can be made of porcelain, precious metal or a combination of porcelain thermally fused to precious metal, a bonded crown. Very occasionally, an acrylic (plastic) crown may be made.

Tooth Veneer

One of the major developments in recent years has been the advances in adhesives. It is now possible to use materials to restore teeth which actually stick or bond to the natural tooth.

Veneers are thin porcelain facings which are stuck onto the front of natural teeth to improve appearance (like false finger nails).

Some reduction of the natural tooth is usually necessary, but the advantage of veneers is there is much less removal of sound natural tooth needed than required to make a crown.

False Teeth

These can be made of metal (cobalt chromium alloy), or a methyl methacrylate acrylic material. Dentures are retained in the mouth by suction and/or use of clasps which grip natural teeth.

Occasionally, precision attachments can be used which help to attach partial dentures to crowns via a special linkage.

Bridges

A bridge replaces 1 or more missing teeth by attaching artificial teeth to remaining natural teeth in the mouth.

This often involves crowning teeth either side of the missing tooth and attaching a false tooth to the crowns.

Artificial teeth can sometimes be attached to natural teeth by cementing a false tooth with wings to the backs of 2 adjacent natural teeth.

The advantage of this method is that it involves no destruction of natural teeth. This is called a rochette, or maryland bridge.

Dental Care

Implants

Insertion of metal (usually titanium), or ceramic or artificial bone (hydroxyappatitie materials), units into jaws, which act as a foundation for supporting artificial teeth.

This is a specialised field which is growing very rapidly. 10yrs from now, implantology may well be a common method of replacing lost teeth. Currently, it is both expensive and time consuming.

Orthodontics

The study of the development of face and jaw, and how irregularities in development may lead to malocclusion (an abnormal relationship between upper and lower teeth, or between teeth in same jaw).

The most commonly occurring problem is overcrowding, which may cause teeth to splay outward or inward, or twist out of alignment with each other.

This in turn, apart from looking unattractive, can lead to an increased susceptibility to decay and gum disease, because irregular teeth are more difficult to clean effectively.

Correction of such irregularity may require extraction of some teeth and wearing of a brace to realign the remaining teeth.

Braces

Braces are most commonly fitted during childhood and adolescence. However, occasionally treatment in adults is both possible and desirable.

Braces may be fixed to teeth or removable. Both types work by exerting a very gentle, but continual force upon a tooth. It encourages the tooth to move, whilst using other teeth as anchor points.

Removable appliances are easier to keep clean and often less obvious, but may interfere with speech. They can only move teeth by tilting them.

Fixed appliances are more versatile, since a tooth can be moved in any direction into a desired position. However, they take longer to fit and adjust.

6 Rules For Continued Dental Health

* Brush thoroughly twice/day using fluoride toothpaste.

* Floss spaces between teeth daily.

* Use disclosing tablets regularly to check brushing effectiveness.

* Avoid eating/drinking sugary snacks/drinks between meals.

* Make sure you and your family visit the dentist at least every 6 months.

* If you play contact sports, always wear a mouthguard.

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