Cedar County Public Health
Caring For Your Teeth
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We need teeth to chew food and speak clearly. They also affect the appearance of your face and smile. It's important to look after them.

Maintaining good oral hygiene, including toothbrushing and visiting your dentist or hygienist regularly, is a crucial part of caring for your teeth.

Tooth decay (dental caries), gum disease (periodontal disease) and dental erosion are common dental problems that can be avoided. These are described in more detail below.

Tooth decay

Soon after toothbrushing, a thin, sticky layer of bacteria forms on the surface of all the teeth. This layer of bacteria is called plaque.

When we eat anything sugary, the plaque bacteria turn the sugar into the energy they need, producing acid at the same time. The acid removes minerals from the hard tooth surface (enamel) in a process called demineralisation. This softens the enamel, and may lead to tooth decay.

Saliva is a watery fluid that helps to wash away and neutralise the acid. It also contains minerals to replace those lost from the enamel during acid attack (remineralisation).

Demineralisation and remineralisation are repeated every time we eat or drink something sugary. It is an ongoing battle between the acid and our saliva. If sugary food or drinks are consumed too often, the saliva doesn't get long enough to fully remineralise the teeth. The enamel gradually weakens, and eventually a decayed hole (cavity) forms. This can be painful.

Gum disease

Also known as periodontal disease, gum disease is very common, affecting most adults.

When plaque is allowed to remain on the teeth for too long, it collects close to the gums and turns into a hard substance called tartar (or calculus). The gums become irritated, red and swollen. This early stage of the disease is called gingivitis.

If gingivitis is left untreated, the gums tend to pull away from the teeth creating a gap called a periodontal pocket, which traps even more plaque and tartar. Teeth affected by periodontal disease can become infected and wobbly, and may need to be taken out.

Preventing gum disease involves controlling the amount of plaque and tartar that build up on your teeth.

Dental erosion

Dental erosion is gradual wear of the surfaces of the teeth. It is caused by acid attacking the surfaces of the teeth, but this time the acids are not made by bacteria. Instead, the acids usually come from drinks such as fruit juices, fizzy drinks and squashes - even the sugar-free varieties.

These drinks are so popular that nearly half of the children in the have some dental erosion by the age of six.1

Dental erosion is irreversible and can result in sensitivity and pain.

Erosion can be prevented by drinking acidic drinks less often. Babies and toddlers should not drink juice or fizzy drinks from bottles, as this can lead to severe erosion. Older children and adults may be able to reduce the amount of contact acidic drinks have with their teeth by drinking through a straw, placed towards the back of the mouth.

How to look after your teeth

Maintaining good oral hygiene is an important part of preventing tooth decay and gum disease. This means cleaning your teeth twice a day with fluoride toothpaste, visiting the dentist and hygienist regularly and controlling how often you consume sugar.

Brush your teeth

Brushing is the most effective way of removing plaque. Here are some tips for getting the most benefit out of toothbrushing:

  • brush at least twice a day
  • use fluoride toothpaste to protect against decay
  • use a toothbrush with a small head and soft or medium synthetic bristles
  • start at one side of your mouth and move round to the other side, brushing all the tooth surfaces thoroughly
  • use a gentle circular action
  • pay particular attention to the gumline, angling the bristles into the crevice where the gums meet the teeth
  • don't rinse your mouth with water after brushing
  • replace your toothbrush at least every three months

Children's teeth should be brushed by their parents from the time their teeth come through until they are able to do it properly by themselves (usually at about seven years of age).

If your child is less than two years old, only use a smear of toothpaste. Then, use an amount about the size of a small pea until they are seven years old. You must make sure that they spit the toothpaste out after brushing. However, fluoride needs to be in contact with the teeth in order to have an effect, so you should not ask your child to rinse their mouth out with water after toothbrushing.

Some people prefer an electric toothbrush. There is some evidence that certain types of electric toothbrush are more efficient at removing plaque than brushing by hand.2

Clean between your teeth

Dental floss or inter-dental brushes remove plaque and particles of food from between the teeth and under the gumline. These are areas that a toothbrush cannot reach. Correct technique is important, so ask for advice from your dentist or hygienist.

Use mouthwash

Fluoride mouthwashes can help to remineralise the enamel. Some antiseptic mouthwashes reduce the number of plaque bacteria. Those containing chlorhexidine (eg Corsodyl) are very effective, but can stain the teeth and affect the sense of taste in the long-term. Always follow your dentist's advice and read the instructions on the box or bottle.

Try disclosing tablets

These are small pills that, if crunched for 30 seconds, turn plaque a bright colour - usually pink. This can help you to see any areas that you have missed.

Chew gum

Chewing sugar-free gum after a meal stimulates the production of saliva, which helps to neutralise plaque acid. Some chewing gums contain a sugar-free sweetener called xylitol, which suppresses certain types of plaque bacteria. Research is currently looking at whether this prevents decay.3

Control sugar in your diet

There is a clear link between sugary food and drinks and tooth decay. Some types of sugar are worse than others. The biggest offenders are those added to food during manufacturing (refined sugars).

It is how often these sugars are eaten - rather than the amount - that is important. Avoiding refined sugars between meals gives your teeth a chance to be remineralised by saliva.

Fruit, vegetables, cheese and milk all contain natural sugars that are much less likely to cause decay. This makes them good alternatives to sweets, and suitable for snacks between meals.

Alcohol and tobacco

Smoking stains the teeth and increases the risk of gum disease and tooth loss.4 Alcoholic drinks, and the mixers used with them, often contain lots of sugar, increasing the risk of tooth decay.

Drinking alcohol and smoking or chewing tobacco are also associated with an increased risk of developing mouth cancer.4

Visiting the dentist and hygienist

Dentists and hygienists play an important role in preventing problems such as tooth decay, gum disease and erosion. At check-ups, they will be able to detect any problems early, and provide advice and treatment.

Your dentist will give you advice about how often you should have a check-up. For adults, this will vary from every three months to every two years.5

Children, and adults who are at high risk of developing dental disease, need to see a dentist more often. You may be at high risk if you smoke, have a diet high in sugar, or have had lots of dental treatment in the past.

Scaling and polishing

Even thorough brushing and flossing cannot remove every trace of plaque. Most people have irregularities in their teeth where plaque can accumulate out of reach and harden into tartar. This can only be removed by a dentist or hygienist using a special scaling instrument. Polishing, using a rotating brush and abrasive paste, removes stains from teeth.

Fissure sealants

Some children have very deep crevices (fissures) in their back teeth. These can be difficult to keep clean. These fissures can be sealed with a resin film that stops plaque and acids reaching the enamel and prevents decay.

Children who are likely to develop decay (for example, those with decayed milk teeth) should have fissure sealants placed as soon as the first permanent molar teeth come through. This is usually at about six years old.

Fissure sealants can last for several years, but regular visits to the dentist are necessary to check that they have not worn through. Children with fissure sealants still need to brush their teeth with fluoride toothpaste.

Further information

References

1.       Report of the oral health survey. Commissioned by the Department of Health & MAFF, 1997.

2.       Heanue M, Deacon SA, Deery C, Robinson PG, Walmsley AD, Worthington HV, Shaw WC. Manual versus powered toothbrushing for oral health. The Cochrane Database of Systematic Reviews 2003, Issue 1.
www.cochrane.org

3.       Xylitol containing oral products for preventing dental caries (Cochrane protocol - at the time of writing the Cochrane oral health group are preparing to review this subject).

4.       Johnson NW, Bain CA, and co-authors of the EU-working group on tobacco and oral health. Tobacco and oral disease. Br Dent J 2000; 189:200-206.

5.       Dental recall. Recall interval between routine dental examinations. National Institute for Health and Clinical Excellence, 2004, clinical guideline 19.
www.nice.org.uk

Published by BUPA's health information team, healthinfo@bupa.com, May 2005

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