Nice Teeth (page 2)

The 4 major factors that affect the health of the teeth

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

Oral hygiene
Dry mouth
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!

caries_thumbClick 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. Poor Oral hygiene

perio_probeIf you don’t properly clean your teeth 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.

Perio-titleperio-toothThe 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. 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.

4. Factors that wear your teeth away

1. Bruxing (Grinding your teeth)

Grinding your teeth can cause major pain, such as chronic headaches, chronic ear aches, neck pain, jaw pain, and damage to the jaw joints, (covered in the TMJ pages), but it also causes major damage to the teeth themselves. Click on the icon below to see how it happens:

Attrition2_thumb2. Damage done with a toothbrush and toothpaste; Click on the image below to see how it happens:

ToothBrushAbrasionThumb3. Damage done with acids; click on the images below to see more on the subject

I. Acid Reflux and Bulimia

GERD_thumb2II. Soda Swishing and Fruit Mulling


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Click here to read about the various products and prescriptions used to treat dry mouth syndrome.
Gum Disease
Tooth Decay
Do you have bad breath?

Bad breath is more complicated than you think.  You can beat Halitosis, but first you have to understand it.  Click here to go to a page on this site to learn everything there is to learn about Bad Breath.