Cure_Article March 2020

Are you doing enough?

Dr Michelle McLean

Did you know, dental caries (cavities) is the most prevalent disease in the world? How are you trying to prevent getting sick?

We all know that oral hygiene needs to be an incredibly important part of our daily lives, but do we know exactly why?

Here are some scary facts:

  • Between 60-90% of school-going children have at least one cavity
  • Between 15-20% of adults aged 35-44 have severe gum disease
  • Around 30% of people in the world, aged 65-74 have no natural teeth left
  • 1-10 people out of every 100000 have oral cancer

Poor oral hygiene has been linked to diabetes, heart disease, cancers, endocarditis, premature birth and low birth weight.

What causes dental caries?

We all have commensal bacteria in our oral cavity – this is the bacteria that make up our oral flora. With good oral hygiene habits, a good diet, and no other contributing factors, this bacteria can remain in the mouth without causing any harm. However, this bacteria thrives when the oral environment has a low pH (acidic). Any time we put food/drinks into our mouths, our pH immediately drops. This happens more severely with food containing simple carbohydrates (glucose, fructose, sucrose) such as sugars, fruits/fruit juices, bread, pasta, chocolates, fizzy drinks, etc.

When the pH drops, this causes demineralization of the tooth structure, weakening the tooth and allowing bacteria to cause further damage.

This bacteria can also cause gum disease, which can result in halitosis (bad breath), inflamed and bleeding gums (gingivitis) and bone loss (periodontitis) This can eventually lead to the loss of teeth, as there is no longer anything supporting the teeth in the mouth.

Dental caries in Children

Dental caries are a huge concern in children and a lot of adults believe that the primary/ milk teeth will fall out, so there is no need to worry about them. This is not the case and it is extremely important to care for them. Yes, all 20 primary teeth will fall out, but this usually happens between 6-12 years of age. During this time, children are learning about food textures, tastes and what a healthy, balanced diet is. Tooth decay causes toothache and severe infection, resulting in fewer foods eaten. If teeth are extracted at an early age, chewing becomes more difficult and inevitably, children will opt for softer foods, usually without sufficient fats and proteins, which could hinder muscle and brain development.

By retaining primary teeth until they are ready to exfoliate, we also help maintain sufficient space for the eruption of permanent teeth, possibly decreasing the need for drastic orthodontic treatment.

Unfortunately, dental care is the parent’s responsibility until the child can understand the need for good oral hygiene and the consequences if not followed correctly, as well as the dexterity/physical ability to clean properly themselves.

  • We need to ensure a child’s teeth are brushed twice daily. The evening brush must be done AFTER dinner and no more food/drink, except water, should go in the mouth, until breakfast the next morning.
  • Use a toothpaste appropriate to the child’s age. Do not use fluoride-free toothpaste, as they cannot contribute to the health of your child’s teeth.
  • Young children who are still drinking from a bottle at night – this bottle may contain plain water or rooibos tea only. There must not be any sugar/milk in the bottle. Anything else added to the bottle will cause rampant cavities and will result in the need for extensive dental treatment at a young age.
  • Teeth need to be flossed every day.
  • Bring your child to the dentist every 6 months, starting between ages 2-3. It is rarely a full checkup, but more of a chance for the child to get used to the environment, see how the lights work, how the chair moves and maybe count their teeth. The last thing you want is for your first dental visit to be an emergency due to pain and then this is all the child remembers when seeing then dentist.
  • If you think you see an issue when brushing their teeth, possibly try take a photo with your cellphone to show the dentist. It’s usually not a very accurate picture but will sometimes help the dentist see what is going on, especially is the child refuses to open their mouth at their appointment.

Dental caries in Adults

  • Brush twice a day, with a fluoridated toothpaste
  • FLOSS daily
  • If you have braces or bridges and are unable to floss correctly due to these, invest in a water pick/flosser to reduce bacterial load and plaque
  • Reduce the amount and frequency of ingesting simple carbohydrates
  • Rinse your mouth with water during the workday, after food, if you are not able to brush
  • Visit the dentist EVERY 6 MONTHS for a check-up and clean, even if you have no pain. At these appointments, x-rays should be taken to ensure there are no cavities starting between your teeth (where you would not be able to see them with the naked eye) as well as check your bone levels, to ensure you are not starting to have bone loss.
  • Bone loss is especially prevalent in smokers, as the ‘warning signs’ such as bleeding or swollen gums and pain, are usually nonexistent. Smoking causes vasoconstriction, decreasing blood supply to the oral environment, which negates the warning signs of gingivitis and periodontitis. This also decreases the healing capacity of the oral environment.
  • Mouthwashes can be used as an adjunct to the above hygiene measures but should never replace them.

Please consult your family dentist if you are unsure of your oral hygiene routine or are starting to feel sensitivity or pain in your mouth. See you in the next 6 months!

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