Preventing Tooth Decay
Tooth Decay
Tooth decay is a preventable disease, but it is one of the most common diseases of man. Decay can have a serious impact on one’s life, fortunately is a very treatable disease. Imagine not being able to chew your favorite food, or smiling without teeth! Remember how you had to feed your child “baby food” until his or her teeth were present – now think about doing that for a lifetime – YUK!
Tooth decay is caused by fermentable foods and juices being left in your mouth. Bacteria, which are present in the mouth, can reproduce rapidly when they utilize the sugars from these fermentable foods and juices as a food source. When bacteria proliferate they produce acids and gases as byproduct. The acid will break down the tooth enamel causing cavities, and the gases will cause bad breath. Some young children do not always have the manual dexterity and others do not realize the importance of proper daily brushing and flossing routines and, therefore, they are at a high risk for tooth decay. The process of tooth decay is cumulative and progressive – daily oral hygiene is essential. It is recommended that you wait 15 - 20 minutes to brush your teeth after meals or partaking in food or drink that can lead to tooth decay to allow the oral fluids to neutralize the acids the bacteria produce. For school age children it is not always possible for them to brush after lunch at school; for this reason we recommend a vigorous rinsing with water. There is no need to make a mess at the water fountain, just vigorously swish several times and swallow the water.
We encourage patients to consider their diet carefully, being aware the food they eat can be broken down into fermentable carbohydrates and sugars which can harm your teeth. When teeth are continuously exposed to the acids produced by the bacteria naturally occurring in your mouth, the enamel of the teeth can be weakened. For this reason the American Academy of Pediatric Dentistry recommends avoiding excessive fruit juice (especially in a baby bottle or sippy cup) and soft drinks. The Academy strongly suggests water as the beverage of choice.
Tooth Decay is Preventable!
Why do Teeth Decay
Tooth Decay a progressive disease initiated by the interaction of a bacterium known as Streptococcus Mutans. This bacteria is found in the mouth and interacts with sugars and fermentable carbohydrates in the everyday diet. Bacteria utilize these sugars and carbohydrates as food sources to produce acids and gases. The gases make your mouth stink. With prolonged exposure to these acids the tooth enamel breaks down leading to decay – the tooth has a cavity. To avoid decay, the patient must brush and floss their teeth – we recommend brushing and flossing after meals. Because many of our patients are in school, we recommend a forceful gargle and rinse after lunch because they probably do not take a toothbrush to school, nor do they have time to complete an after lunch brushing. Practicing good oral hygiene, controlling their diet, and regular periodic oral health exams with application of fluoride will help to maintain healthy teeth and hopefully avoid costly dental treatment.
How Do I Prevent Cavities?
Be “proactive” in your child’s dental health by examining and monitoring their teeth as they erupt. Be sure you or your child brushes his/ her teeth twice a day with a toothpaste containing fluoride. As the back teeth start to touch you will need to help your child floss until they are old enough to do this on their own – usually until about age ten (10). Good oral hygiene removes bacteria and left over food particles that combine to create cavities. For infants, use a wet gauze or clean washcloth to wipe the plaque from the teeth and gums. Avoid putting your child to bed with a bottle filled with anything other than water.
See Baby Bottle Tooth Decay for more information.
For older children, their teeth should be brushed at least twice a day. Also watch the number of sugar containing snacks and drinks they consume.
Just as adults should have regular dental oral health examinations approximately every six (6) months, the American Academy of Pediatric Dentistry recommends children receive a periodic oral evaluation every six (6) months beginning with the child’s first birthday. Routine and regular visits will start your child on a lifetime of good dental health. During the periodic visits Dr. West may recommend the application of fluoride in the form of a gel or varnish, additional he may suggest home fluoride products, and protective sealants.
Good Diets Aid in the Development of Healthy Teeth
Healthy eating habits lead to healthy teeth. Like the rest of the body, the teeth, bones and the soft tissues of the mouth need a well-balanced diet. Children should eat a variety of foods from the five major food groups. Most sugary snacks that children eat can lead to cavity formation.
The more frequently a child snacks on sweets, the greater the chance for tooth decay. How long food remains in the mouth also plays a role. For example, starchy foods like rice and pasta, hard candy and breath mints can stick to teeth and stay in the mouth a long time, which cause longer acid attacks on tooth enamel. If your child must snack, choose nutritious foods such as vegetables, low-fat yogurt, and low-fat cheese, which are healthier and better for children’s teeth.
How Often Should I see the Dentist?
The guidelines established by The American Dental Association, The American Medical Association and the American Academy of Pediatric Dentistry recommend a minimum of two (2) dental visits a year approximately six (6) months apart. More frequent visits may be recommended due to specific circumstances an individual patient may be experiencing. Patients exhibiting a high risk for dental disease and those undergoing orthodontic treatment may be encouraged to visit more often.
New Patient appointments take between 45 minutes to an hour. Preventive recare appointments are suggested approximately every six (6) months and these appointments take between twenty (20) to thirty (30) minutes per patient.
Dental Treatment appointment times vary depending on the procedure needed (fillings, crowns and extractions).
What Can My Dentist Do to Help Prevent Decay?
Preventive Recare
Preventive dental care is important throughout your life, no matter how old you are. By practicing good oral hygiene at home and scheduling regular oral health/oral cancer screening examinations with Dr. West, you can help keep your smile healthy. Dr. West prefers to call these examinations “Preventive Recare” visits rather than a recall visit. Recalls are usually associated with a defective product; recare implies conscientious continuous care to prevent dental problems.
During these visits Dr. West will review the patient’s current medical history, complete a comprehensive oral examination, visually checking for tooth decay, study facial and jaw development including the relationship of the upper and lower jaws to each other, and take radiographs (x-rays) when indicated. Most visits will include a thorough dental cleaning with age appropriate oral hygiene instructions and an application of fluoride. Upon completion Dr. West will advise you of his clinical findings and recommendations for further visits as necessary and answer any dental care questions you have.
We encourage our patients to brush their teeth at least twice a day to remove food particles and plaque from the tooth surfaces (cheek side, tongue side and chewing surface) using an ADA approved toothpaste and a soft bristled toothbrush.
We also encourage the use of floss and mouthwash. Flossing will remove food particles from the surfaces between the teeth and below the gum line where a toothbrush cannot reach and a mouthwash helps to remove bacteria from all the soft tissue in the mouth.
Dental Prophylaxis, or Cleaning with the Use of Fluoride
The purpose of a professional dental cleaning is to remove the pellicle and stains that form on the enamel surface of teeth. The pellicle is a biofilm composed of several different kinds of bacteria and their products. This pellicle is known as plaque! The prescription toothpaste used by the dentist during a cleaning is abrasive; it microscopically removes this pellicle from the teeth. Following the removal of the enamel pellicle, a prescription fluoride treatment is applied. The fluoride applied after a thorough dental cleaning is a stronger concentration than found in toothpaste. Following a dental prophylaxis, the surface readily absorbs fluoride; the fluoride binds to the surface, making the tooth harder and more resistant to decay. The advantage of the “fluoride treatment” is that in addition to making the tooth harder and more resistant to decay, it also makes it more difficult for the decay-causing bacteria to stick to the tooth surface. Long term benefits of fluoride treatment can last three to six (3 – 6) months. Clinical trials confirm the anti-caries effect (prevention of decay) of professional topical fluoride treatments is highly effective. Fluoride can prevent or reverse enamel demineralization (beginning of a cavity).
A dental cleaning without the application of fluoride does not aid your child in prevention of decay.
Fluoride
Fluoride is a mineral that helps teeth become stronger and resistant to decay. Although many refer to Fluoride as a vitamin it really is not a vitamin. Fluoride is a naturally occurring mineral, which has been shown to prevent tooth decay by as much as 50%-70%. Despite the advantages, too little or too much fluoride can be detrimental to the teeth. With little or no fluoride, the teeth are not strengthened to help them resist cavities. Excessive fluoride ingestion by young children can lead to dental fluorosis, which is typically a chalky white discoloration (brown in advanced cases) of the permanent teeth. Be sure to follow the instructions given by Dr. West on suggested fluoride use and possible supplements, if needed.
You can help by using a fluoride toothpaste and only a smear of toothpaste (the size of a grain of rice) to brush the teeth of a child less than three (3) years of age. For children three to six (3 to 6) years old, use a "pea-size" amount of toothpaste and perform or assist your child’s tooth brushing. Remember that young children do not have the ability to brush their teeth effectively on their own. Children should spit out and not swallow excess toothpaste after brushing, in order to avoid fluorosis.
Fluoride occurs naturally in water, however, in our area of Houston the amount of fluoride in the municipal water supply can vary greatly during the year because our water is from wells throughout the city. Additionally, you must read the label on any sink or refrigerator filters to see if they remove fluorine, chlorine, bromine or iodine. Water delivered through a filtered source may have had the fluoride removed. Most bottled waters do not contain fluoride. If you wish to purchase bottled water with fluoride, look for gallon bottles which will be have a label noting they contain fluoride.
Fluoride Varnish
Dental decay, when caught early, can be reversible. Decay is an ongoing process which, if not altered, will result in cavities. Until the point of cavitations, dental intervention is possible. Antimicrobial treatment (similar to an antibiotic for the mouth) is used to reduce the amount of toxic bacteria present. Currently, the drug of choice is prescription fluoride in gel or varnish form. Fluoride varnish was first used in Germany in 1964 and was introduced to the U.S. in 1991. Studies done in the past 30 years have proven as much as a 70% reduction in dental decay when fluoride varnish is used.
Fluoride Varnish Application
The teeth are first cleaned to remove the “pellicle” which forms on the teeth. The varnish is then applied to the tooth surface with a small paintbrush. After the application patients can eat almost immediately, however, they should wait a minimum of four (4) hours before brushing their teeth. The desired result is a decrease in the rate of new cavities and/or cavity reversal.
Post Application Instructions
After the application of Fluoride Varnish, your child will feel the coating and may notice a thick sticky substance while the varnish remains on the teeth. To obtain the maximum benefit during the four to six (4-6) hour treatment period; we ask that you take the following care when you leave the office.
- If possible, wait until the next morning to resume normal oral hygiene
- Eat a soft food diet during the treatment period
- Avoid hot drinks and products containing alcohol
- A thorough brushing and flossing will easily remove any remaining fluoride varnish. Your teeth will return to the same shine and brightness as before treatment.
Orthodontics and Fluoride Varnish
Orthodontic patients are at an increased risk of demineralization (the first step of the decay process). When the acid in plaque strips the calcium from the teeth, white spot lesions are the result. 50% of all patients with orthodontics have some permanent white spotting on their teeth that are more obvious when braces are removed. Fluoride varnish can prevent spotting of the teeth for those patients and reduce their overall susceptibility for decay.
Seal Out Decay
A sealant is a protective coating that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars), where four out of five cavities in children are found. This sealant acts as a barrier keeping food, plaque, and acid from collecting on the decay-prone areas of the teeth. In most instances the bristles on a toothbrush are larger than the grooves they need to clean and some plaque can remain in the grooves even after a thorough brushing. The bacteria that remain then break down the tooth enamel causing cavities. Recent studies indicate that 88% of the total cavities of American school children are caused this way. Nutrition and good oral hygiene are still important to prevent decay because the placement of sealant is only successful on the pits and fissures of molar teeth; it is not applied to the smooth surfaces on the sides and between teeth. The recommended ideal timing for the placement of sealants is within the first year after a tooth erupts. Therefore, to place sealants on primary molars, the procedure should be done about the age of three (3). The tooth has to be erupted enough that the chewing surface can be kept completely dry so the sealant material can adhere to the enamel of the tooth. Just as fingernail polish would not stick to wet nails, sealants do not adhere to the tooth when it is wet.
Permanent molars and premolars can be sealed as they erupt, again, once the surface to be sealed can be kept dry the tooth is a candidate for sealing.
Although sealants can provide protection from the development of cavities in the occlusal grooves of the teeth, there is not a guarantee for NO decay. Their protective effect can be compromised by “crunching ice”, eating hard and sticky candies, and chewing gum. Placement of sealants does not replace the need for regular dental visits, daily brushing and flossing, or good dietary habits. Sealants should be inspected at periodic dental check-ups and replaced if found to be partially or totally missing, or failing due to fractures.
