Dental professionals and students of dental technologies  who want a more detailed understanding of the anatomy of the teeth and their supporting structures may wish to proceed to the two pages I have written and illustrated especially for them.  Click the icon on the right.

The image on the right is a schematic of a tooth as it sits in the gums.  The tooth consists of a crown (which is that part of the tooth that is visible above the gums), and the root(s) (7).   In a state of health the roots are surrounded by the gingiva (4), and the bone (5).  Deep inside of the tooth is the nerve (3) (also called the dental pulp) which is composed of soft tissue like that in your finger tip.  It contains blood vessels and connective tissue as well as nerve tissue. (For more on the structure of nerves as they relate to the teeth, click here.)   The nerve is surrounded by a yellow, bony substance called dentin (2).  The dentin contains millions of parallel microscopic tubules which hold tiny projections of living nerve tissue. The dentin is covered above the gum line by a hard white shell called enamel (1).  The enamel acts like armor, protecting the sensitive dentin underneath.  If the integrity of the enamel is breached by decay or traumatic injury, the dentinal tubules become exposed to the air and caustic chemical attack.  This causes movement of fluid in the dentinal tubules and is the reason that broken or decayed teeth are sensitive when touched or dried out.  If the decay actually penetrates to the level of the nerve itself, then the nerve becomes inflamed and becomes extremely sensitive or painful even if there is no immediate stimulus. For more information on the anatomy of the oral cavity, click on the diagram or here to visit my page on oral/dental anatomy.

Notice that the gingiva (4) not only covers the bone, but also narrows down to a very thin soft tissue sheath which attaches to and surrounds the entire root of the tooth, separating it from the surrounding bone like a sock separates a foot from its shoe.  This thin soft tissue sheath is called the periodontal ligament (6) and is an extremely important part of the structure of the dental apparatus.  It acts as both a biological barrier separating the germ filled oral cavity from the sterile bone and blood supply underneath, as well as a shock absorber allowing a small amount of movement of the tooth in response to forces from above.

The 5 major factors that effect the health of the teeth

There are five major factors which effect the health of your teeth.  Each is explained in the numbered sections below:

1. Sugar

2. Oral hygiene

3. Grinding and clenching the teeth (bruxing)

4. Dry mouth

5. Habits that cause severe tooth wear

Just about everyone is born with strong, healthy teeth! I mean it! You may think you have soft teeth or bad gums, but you don't! You just have some bad habits that have lead you to have difficulty with your teeth. These habits cause the disease processes which make make your teeth look and feel bad. Correct these habits and the problems stop in their tracks. Once the disease processes stop, then you can begin the process of repairing the damage that has occurred, and you can have not only healthy teeth, but "Nice Teeth" too.

1. SUGAR.....causes decay!

Click on the image to see the disposition of this case

Believe it or not, even if you never brushed your teeth, you would never get a single cavity if there were no sugar in your diet. No sugar, No decay....period! Even if you NEVER brushed your teeth! (If you want proof of this, go to a museum of natural history sometime and look at the skeletons of ancient humans. You will find their teeth quite worn, and some may be missing from gum disease, but you will see NO cavities!  These people did not have dentists, and they did not brush their teeth, but they had limited access to concentrated sugar which is the reason that they had no tooth decay.) 

This does not mean that sugar is evil. If you eat sugars only with meals, it does relatively little harm. 95% of all cavities are caused by specific sugar habits which people usually develop during adolescence or early adulthood as a result of a change in lifestyle. Suppose you get a job in an office where everyone gathers around a soda machine during breaks. You begin drinking soda, canned juice or sweetened ice tea, at first as a social habit, then because you get used to it. The sugar is metabolized by the germs in your mouth and turns to a dilute acid which decalcifies the enamel and dentin and causes decay. The more you drink, the more decay you get. For a more thorough discussion of this phenomenon and the specific sugar habits that may be involved, click here.

Q. But even diet soda contains acid from the carbonation (carbonic acid) as well as citric acid and even other forms of acid added to enhance the flavor.  Why is it that diet soda doesn't cause decay??

A. All the non sugar related acids in soda (including diet soda) are so soluble in water that they are washed off the teeth almost immediately before they can cause much decalcification of the tooth structure.  On the other hand, the sugar in regular soda is very sticky and remains on the teeth for a long time.  In addition, the bacteria in plaque use sugar as a raw material to create dextrans which is the viscous sticky stuff that makes plaque adhere to the teeth.  The dextrans have the property of absorbing more sugar which is turned into acid by the plaque bacteria causing the plaque to remain acidic for twenty minutes or more after each exposure to sugar.
 
2. Oral hygiene---Failure to clean your teeth thoroughly at least once a day!

The soft sticky white stuff that builds up on the necks of your teeth is not food debris. It is made of germs that accumulate in a sticky mass called plaque. Plaque is very toxic because it is a mass of living organisms which produce (along with acid made when you eat sugar) collagenase and  endotoxins which tend to eat away at the gums, the periodontal ligament and the underlying bone that supports the teeth.  This disease process is known as gum disease, or periodontal disease. This disease is painless, but does cause bleeding of the gums which may be the only indication that you have periodontitis . Eventually, it causes the loss of so much supporting bone, that the teeth become mobile and painful to touch.  In general, when teeth lose so much bone that they become mobile, they must be extracted.

The images above illustrate a real case of periodontal disease that presented in my office.  The two central teeth had become mobile and painful and were removed as part of the patient's treatment plan.  By the end of the treatment plan, the remaining teeth were free from disease and the missing teeth were replaced with a removable partial denture.  For a discussion of this case and the meaning of the colored, extracted tooth in the bottom image, click here.

This process can be stopped where it is at any time simply by removing the plaque from ALL surfaces of the teeth, but the bone, once lost, never comes back. In order to arrest the disease (which can go on painlessly for many years with bleeding as the only outward sign that you have it), you must brush and clean between the teeth at least once a day. It is difficult to convince people how easy it is to clean between the teeth. Dental floss is considered the gold standard, but I have found that toothpicks (Stimudents or similar aids bought in a drug store) work exceptionally well and are very easy to use, especially because they can be manipulated with one hand.  

3. Clenching or grinding your teeth. (bruxing)

Of all the self inflicted problems people face on a daily basis, the most pervasive and misunderstood is the habit of grinding or clenching the teeth.  Grinding of the teeth with side to side motion is known as bruxing.  You DO clench and brux your teeth. Everyone does at one time or another, particularly when under stress or in deep concentration. These habits are almost entirely unconscious. No one realizes that they do it until it is pointed out to them. You may do it while working on your computer, while driving your car, while vacuuming the rug, while concentrating on a problem, or when you are mad at your spouse or the kids. In addition, you may be doing it while you sleep. For most people, the problems associated with bruxing are temporary and minor, but if you are one of the many people who does it to excess, it is probably one of the most self destructive habits in existence. It causes headaches, jaw aches, ear aches, stiff neck and is frequently associated with other stress related pain. For a more complete discussion of Bruxing and its associated woes, see my page on TMJ.

In addition, clenching and bruxing contributes to almost everything else that can go wrong with your teeth:

*Bruxing and clenching contribute to the severity of decay.

The constant pressure of your teeth against each other places enormous forces on your fillings and other man made repairs that dentists have done in your mouth. This pressure on these rigid structures tends to cause tiny stress fractures in the teeth where they meet the filling or crown. These tiny cracks allow leakage of sugar and germs under the margins of the restorations and extend the decay into these areas where it can damage the tooth structures without being disturbed by toothbrushes or the detersive action of foods. Note that if you are not using sugar, these tiny cracks are of little clinical importance. We say that the grinding and clenching are codestructive and accelerates and intensifies the damage done by sugar.

*Bruxing and clenching contribute to Periodontal disease.

The constant pressure of the teeth against each other causes the teeth to rock back and forth in their sockets. This effects the blood supply to the periodontal ligament and lowers the ability of the structures that support the teeth to resist the advance of the plaque organisms in the sulcus that surrounds the tooth. This accelerates the bone loss seen in periodontal disease.  Note that if the teeth are kept clean by brushing and flossing, the movement of the teeth within the socket is of little clinical significance. We say that the grinding and clenching are codestructive and accelerates the damage done in periodontal disease by plaque.

*Bruxing and clenching cause sensitive teeth.

Generalized sensitivity of the teeth to cold foods is a very common symptom of clenching and grinding the teeth. Grinding and clenching is probably the second most common reason for sensitive teeth after toothpaste abuse.  The reason for this phenomenon is not yet understood. It may involve the pressure placed on the dentinal tubules by the stretching of the periodontal ligament.  More or less constant problems with tooth sensitivity imply toothpaste abuse, while if the sensitivity is more episodic (comes and goes) the sensitivity probably corresponds to times when you are under stress and likely to be bruxing.

The most frequent cause of sensitive teeth is "toothpaste abuse"!  If you suffer from overly sensitive teeth you should read this link.

*Bruxing and clenching are the major causes of phantom tooth pain.

Grinding on one tooth in particular can cause that tooth to be painful and very sensitive to cold. This problem can mimic a severe toothache and is frequently misdiagnosed as inflammation of the dental pulp (nerve) prompting an unnecessary root canal.

*Bruxing and clenching can cause teeth to develop invisible cracks. 

These cracks can cause severe pain when pressure is applied to the cracked tooth.  This problem is called cracked tooth syndrome.

*Bruxing and clenching can destroy even the best dental work.

Early failure of fillings, crowns, implants and almost anything manmade is frequently caused by grinding and clenching the teeth.  

Grinding and clenching are difficult to stop since the habits are unconscious and frequently happen during sleep. They can often be controlled with a bruxing guard, which is a horseshoe shaped plastic wafer made to fit over the biting surfaces of (usually) the top teeth.  The guard has a flat lower biting surface and prevents the lower teeth from locking together with the upper teeth thus reducing the forces that can be placed upon the ligaments that hold the teeth in the bone. For a more thorough discussion of this phenomenon, please see my page on TMJ.

4. Dry mouth

Dry mouth (xerostomia) effects the health of teeth mostly in elderly patients and drug addicts.  This is because both of these populations use drugs which depress the production of natural saliva.  The elderly are also prone to disease states that cause dry mouth.  For those especially interested in learning the causes and treatments for dry mouth syndrome, please see my dedicated page on xerostomia.

A number of conditions and drugs tend to cause chronic dry mouth.  They include the normal ageing process, Sjorgren's syndrome, and numerous prescription and non prescription drugs such as antihistamines and decongestants (used for colds), numerous psychiatric drugs including Lithium and Thorazine and drugs used to produce drowsiness and assist in falling asleep.  Numerous illegal recreational drugs such as those mentioned here also cause dry mouth.  

Plaque is composed of a range of species of bacteria, and the relative number of each species of plaque organisms is highly dependent on the exact chemical and physical composition of the saliva in the mouth.  Dry mouth causes a drastic change in the composition of the plaque reducing the populations of some species and increasing the populations of others.  Unfortunately, this shift in floral composition tends to cause an overgrowth of organisms which produce acidic waste products, especially when sugar is abundant.  Of course, the acid in plaque is the actual agent that produces tooth decay.  This generally means that people with chronically dry mouths tend to get rampant decay in their teeth.  

Compounding this problem is the natural tendency of persons who suffer from dry mouth to sip sweet drinks and suck on hard candy all day.  The combination of dry mouth plus copious amounts of sugar throughout the day causes serious decay in these people, especially the elderly.  This combination of dry mouth and excessive sugar usage causing rampant decay is called "dry mouth syndrome"

The greatest advance in dentistry concerning dry mouth syndrome has been the discovery that hard candies and chewing gum sweetened with xylitol instead of sugar can actually inhibit tooth decay.   Since the presence of sweet things in the mouth can help promote the production of saliva, sucking on hard candies artificially sweetened with xylitol can be a real lifesaver for these people. 

5. Habits that cause serious wear of the teeth (attrition)

There are five specific habits which cause serious tooth wear not connected with tooth decay.  They are discussed in depth in a new eight page course geared for dental professionals:  Recognizing tooth wear.

The five habits fall under two broad categories; Habits that cause abrasion of tooth structure, and those that cause erosion.  Pathological tooth wear from abrasion and/or erosion is called attrition.

Abrasion is the mechanical removal of tooth structure due to rubbing of the teeth, either over each other (bruxism) or with toothpaste on a brush (toothpaste abuse). 

Erosion is defined as the chemical dissolving of tooth structure with acidic solutions.  Each type of habit leaves wear patterns on the teeth which are unique to the habit, and diagnosis of the habit can be made by careful inspection of plaster models of the teeth.

• Abrasion
  • Bruxism--This is the habit of grinding of the lower teeth against the upper teeth when not eating.  This causes wear on the chewing surfaces of both top and bottom teeth.  Bruxing is mostly a reaction to life stresses, and since everyone becomes stressed at numerous points in their lives, EVERYONE bruxes, at least occasionally.  But some persons (Type A personalities?) carry the stress so far that they cause massive damage to the teeth.
  • Toothpaste abuse--Interestingly, a number of studies in the literature have demonstrated that toothpaste is more abrasive than the toothbrush , regardless of the hardness of the bristles.   It is the toothpaste, and not the toothbrush that causes toothbrush abrasion. 

    I know that this is heresy from the viewpoint of hygienists and most dentists, however research in this area goes back to 1917.  (Miller WD. Experiments and observations on the wasting of tooth tissue variously designated as erosion, abrasion, chemical abrasion, denudation, etc. Dent Cosmos 1907;XLIX(1):1–23; XLIX(2):109–24; XLIX(3):225–47.)  Recent studies done by Thomas C. Abrahamsen, DDS have shown that modern toothbrushes without toothpaste do not create cervical lesions, while the same toothbrushes using toothpaste do.

    If this assertion is true, then most of the cervical lesions that dentists and hygienists have been calling "toothbrush abrasion" are in fact caused by toothpaste abuse.  This still means that the patient is being too aggressive with his or her toothbrush, however, it is not the toothbrush that causes the damage, but the abrasives in the toothpaste.  In order to avoid this type of problem,  patients who like to vigorously "scrub" their teeth may wish to use mouthwash instead of toothpaste on their brush, and learn to use a more correct method of brushing the teeth.   Good choices of mouthwash would be a fluoride containing mouthwash such as Act®, or Listerine® which has been shown to kill plaque organisms.

    Toothpaste is not really necessary in order to thoroughly clean the teeth.  Most dentists, when cornered, will admit that toothpaste serves more of an esthetic purpose than a practical one, adding a bit of a zippy taste to the tooth brushing process, but not much to the process of removing plaque.  The abrasive in toothpaste will help to remove serious stain from drinking large amounts of coffee or tea, but it will not remove the yellowness from your teeth since the yellow color comes from the dentin which is UNDER the outer layer of the enamel.  Overbrushing with toothpaste will make your teeth even yellower.

     

    Sensitive teeth Toothpaste abuse is probably the most frequent cause of tooth hypersensitivity.   By overbrushing with abrasive toothpastes in order to try to make your teeth brighter, you are removing much of the tooth structure around the necks of your teeth that used to protect the nerves from cold sensitivity.  Only a dentist can repair the damage already done, but you can prevent further damage to the teeth by brushing your teeth with mouthwash instead of using abrasive toothpastes.

     

• Erosion--The chemical dissolution of tooth structure.
  • Regurgitation--This classification of non-carious loss of tooth structure includes Bulimia (an eating disorder involving binge eating followed by vomiting to avoid weight gain) and GERD (Gastro-Esophogeal Reflux Disease), now commonly called ARD (Acid Reflux Disease).  This type of erosion of tooth structure is caused by frequent vomiting (in the case of bulimia) and regurgitation of stomach contents into the mouth with subsequent swallowing (in the case of ARD).  Each of these disorders creates a different pattern of tooth erosion and can be differentiated by looking at plaster models of the teeth.
  • Soda-Swishing--Carbonated sodas contain three acids: citric acid, phosphoric acid and carbonic acid.  If the soda contains sugar, then it will contribute to the production of decay, but diet sodas will not.  Ordinarily the acids in sodas pass by the teeth too quickly to cause much tooth erosion, however if a patient develops the habit of "swishing" the soda around in his or her mouth before swallowing it (in order to remove the carbonation which may hurt their throat), then the acids in the soda (diet or regular) will, over time, cause considerable erosion to the enamel on the teeth.  This damage is habit specific and can be diagnosed by looking at plaster models of the teeth.
  • Fruit mulling--This habit, commonly engaged in by health conscious patients (often vegetarians) is a combination of bruxism and acid erosion caused by fruit which is kept in the mouth and "mulled" for considerable time before it is swallowed. 

    All of the above habits can cause serious damage to the tooth structure, and may eventually necessitate extensive restoration of the dentition.

Click here to read about the various products and prescriptions used to treat dry mouth syndrome.  

Click the button above to email Doctor Spiller.

If the email button does not work, or if you use webmail instead of an email client, click here.

Dentists
 You are always welcome to email me using the email button above.  I have written a separate page for you here.

Patients
Please make your questions short and precise.  Avoid rambling, multiple questionnaires. 

Remember that I cannot diagnose something I cannot see. I probably won't be able to tell you what that sore in your mouth is.  See a dentist.

referrals to a dentist near you
This is a new page,  and will grow as more dentists come on board.

Please do not inquire about fees. (See this page instead.).

I DO appreciate your help in correcting typos and broken links.
 

No dental insurance?
 What is dental
  insurance and how
  does it work?

Are your fillings
killing you?
 Is mercury ruining your
 life??

Is Fluoride poison?
 Should it be illegal?

Do Root Canals cause
multiple sclerosis or
other diseases?
 Click here to find out.

Are dentures better
than real teeth?
 Should you have all your
 teeth pulled and get
 false teeth?

Bad breath?
 What is causing your bad
 breath, and how can you
 treat it?

Cure your dry mouth for
Free
 Click here to find out how.
 

Copyright 2000 by Doctor Martin S. Spiller, DMD
Please click here to see the terms of fair use.

Check out another family website! 
San Francisco Desktop Guy. 
Free BIG desktop images for multiple monitors.