Oral Care

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By:	Healthwise Staff	Last Revised: January 22, 2009
Medical Review:	Kathleen Romito, MD - Family Medicine Steven K. Patterson, BS, DDS, MPH - Dentistry

 

What is oral care?

Oral care is the practice of keeping the mouth clean in order to prevent cavities, gingivitis, periodontitis, bad breath, and other dental disorders. Oral hygiene consists of both personal and professional care. Dental X-rays may be performed as part of routine professional examinations.

• Basic Dental Care
• Common Concerns
• Routine Checkups
• Gum Disease
• Orthodontics

Basic Dental Care

Overview

Is this topic for you?
This topic provides information on basic dental care. If you are looking for information on tooth decay or cavities, see the topic Tooth Decay. If you are looking for information on gum disease (periodontal disease), see the topic Gum Disease.

What is basic dental care?

Basic dental care involves brushing and flossing your teeth regularly, seeing your dentist and/or dental hygienist for regular checkups and cleanings, and eating a mouth-healthy diet, which means foods high in whole grains, vegetables and fruits, and dairy products.

Why is basic dental care important?

Practicing basic dental care:

• Prevents tooth decay.
• Prevents gum (periodontal) disease, which can damage gum tissue and the bones that support teeth, and in the long term can lead to the loss of teeth.
• Shortens time with the dentist and dental hygienist, and makes the trip more pleasant.
• Saves money. By preventing tooth decay and gum disease, you can reduce the need for fillings and other costly procedures.
• Helps prevent bad breath. Brushing and flossing rid your mouth of the bacteria that cause bad breath.
• Helps keep teeth white by preventing staining from food, drinks, and tobacco.
• Improves overall health.
• Makes it possible for your teeth to last a lifetime.

Are there ways to avoid dental problems?

Keeping your teeth and gums healthy requires good nutrition and regular brushing and flossing.

• Brush your teeth twice a day—in the morning and before bed—and floss once a day. This removes plaque, which can lead to damaged teeth, gums, and surrounding bone.
• Use a toothpaste that contains fluoride, which helps prevent tooth decay and cavities. Ask your dentist if you need a mouthwash that contains fluoride or one with ingredients that fight plaque. Look for toothpastes that have been approved by the American Dental Association.
• Avoid foods that contain a lot of sugar. Sugar helps plaque grow.
• Avoid using tobacco products, which can cause gum disease and oral cancer. Exposure to tobacco smoke (secondhand smoke) also may cause gum disease as well as other health problems.¹
• Practice tongue cleaning. You can use a tongue cleaner or a soft-bristle toothbrush, stroking in a back-to-front direction. Tongue cleaning is particularly important for people who smoke or whose tongues are coated or deeply grooved.
• Schedule regular trips to the dentist based on how often you need exams and cleaning.

When should my child start seeing a dentist?

By the time your child is 6 months of age, your doctor should assess the likelihood of your child having future dental problems. If he or she thinks your child will have dental problems, be sure your child sees a dentist before his or her first birthday or 6 months after the first primary teeth appear, whichever comes first. After your first visit, schedule regular visits every 6 months or as your dentist recommends.
Experts recommend that your child's dental care start at 12 months of age. If your baby has dental problems caused by injury, disease, or a developmental problem, see your pediatric dentist right away.

Common Concerns

The following are some concerns that many people have about going to the dentist and dental care.

• What can I do about being scared? Dental anxiety is being nervous before or during a dental visit. This can make going to the dentist a difficult experience. You can take steps to limit your anxiety, such as explaining your fears to the dentist and setting up a system of hand signals.
• Do I need teeth whitening? Teeth whitening uses a bleaching product or an abrasive to make teeth whiter. Teeth whitening is not a medical procedure—it does not result in healthier teeth—but it can result in a brighter smile. This in turn can make people feel better about themselves. Teeth whitening works better for some types of stains than others, so talk to your dentist about whether it is right for you and about the products and procedures available.
• Do older adults have any special concerns? Concerns of older adults include dentures and difficulty brushing.

Dental procedures

The following are some concerns about what might happen at the dentist's office:

• Will a routine visit hurt? If you go to the dentist regularly and take good care of your teeth, there will probably be no pain. If this is your first visit in a long time, or you do not take good care your teeth and gums, there may be some irritation as the dentist cleans the spaces between your teeth and between your teeth and gums.
• Will I need a filling? A filling is a substance that dentists use to replace a decayed or broken portion of a tooth. You often need a filling to fix a cavity. Whether you need a filling depends on how well you take care of your teeth. If you brush and floss on a regular basis and limit how much sugar you eat, chances are you won't need a filling.
• Will I need dental X-rays? Dental X-rays can identify cavities, bone disease, and infections and help in planning orthodontic treatment. In children, they can also identify when new teeth are coming in. X-rays can help your dentist find problems at an early stage, which can save you time, money, and unnecessary pain or discomfort. You and your dentist will set up an X-ray schedule based on your needs.

Children

The following are some concerns about dental care for children:

• How can I make a trip to the dentist enjoyable for my child? A visit to the dentist can be a scary thing for children. You can reduce this possibility by choosing your dentist carefully and preparing your child for his or her first visit. Most importantly, don't communicate your own fears to your child.
• Will my child need fluoride? Fluoride is a chemical that helps prevent tooth decay and cavities. It is often added to local water supplies, toothpastes, and other mouth care products. If your water supply does not contain enough fluoride, your dentist may recommend other sources of fluoride.
• How do I brush my child's teeth? It is important to start brushing your child's teeth when they first come in. This keeps your child's teeth and gums healthy and provides a good model for what he or she will do in the future.

Note:Fluoride is safe in the amounts provided in water supplies but can be toxic in large amounts. Toxic levels depend on your child's weight. A lethal dose of fluoride for a 3-year-old child is 500 mg and is even less for a younger child or infant. Keep all products containing fluoride, such as toothpastes and mouthwashes, away from children.

Routine Checkups

Our dentist will recommend how often to have routine checkups. Many people should see their dentists once or twice a year. Your dentist will examine your teeth and gums for signs of tooth decay, gum disease, and other health problems.

• Your dental hygienist will begin to clean your teeth by scraping hard mineral buildup (tartar) off of your teeth with a small metal tool. Then the hygienist will floss your teeth, use a polishing compound, and apply fluoride. Cleanings usually aren't painful.
• Occasionally your dentist will want to take X-rays. The X-rays take only a few minutes.
  • Your dentist or technician will have you put on a heavy apron to shield your body from X-rays. Everyone else in the room will either wear a protective apron or step behind a protective shield.
  • Your dentist or technician will have you bite down on a small piece of plastic. This will help align the teeth properly for the machine. Your dentist or technician will repeat this process several times to get pictures of all your teeth.
• If necessary, your dentist will put a sealant on the chewing surface of your back teeth to help prevent cavities. Sealants keep food and bacteria from getting stuck in the rough chewing surfaces or grooves of your teeth, and they protect your teeth from plaque.
• Your dentist or hygienist may apply a fluoride solution directly to your teeth to help prevent tooth decay. Your dentist may recommend a series of fluoride applications.
• If you are prone to infections, or if infections are particularly dangerous for you, you may need to take antibiotics before you have some types of dental work. You may need to take antibiotics if you:
  • Have certain heart problems that make it dangerous for you to get a heart infection called endocarditis.
  • Have an impaired immune system.
  • Had recent major surgeries or have man-made body parts, such as an artificial hip or heart valve.
• Your dentist or hygienist may ask you about the foods you eat. What you eat and whether you get enough vitamins and minerals can affect your dental health.
• If you have active tooth decay or gum disease, your dentist will talk to you about changing your brushing or flossing habits. In severe cases, he or she may recommend antibiotics or other dental treatments. If your teeth and gums appear healthy, your dentist will recommend that you continue your usual brushing and flossing. 

Gum Disease 

What is gum disease? 

Gum disease is an infection of the tissues and bones that surround and support the teeth. It is also called periodontal disease.

The two stages of gum disease are called gingivitis and periodontitis. Gingivitis (say “jin-juh-VY-tus”) is mild gum disease that affects only the gums, the tissue that surrounds the teeth. Periodontitis (say “pair-ee-oh-don-TY-tus”) is gum disease that gets worse and spreads below the gums to damage the tissues and bone that support the teeth.

• Gingivitis causes red, swollen gums that bleed easily when the teeth are brushed. Because gingivitis usually doesn't cause pain, many people don't get the treatment they need.
• Periodontitis develops if gum disease gets worse. The gums pull away from the teeth, leaving deep pockets where germs called bacteria can grow and damage the bone that supports the teeth. Gums can also shrink back from the teeth. This can make the teeth look longer. Teeth may become loose, fall out, or have to be pulled out by a dentist.

What causes gum disease?
Your mouth constantly makes a clear, sticky substance called plaque that contains bacteria. The bacteria in plaque make poisons, or toxins, that irritate the gums and cause the gum tissues to break down. If you don't do a good job of removing plaque from your teeth, it can spread below the gums and damage the bone that supports the teeth. With time, the plaque hardens into a substance called tartar that has to be removed by a dentist or dental hygienist.
You are more likely to get gum disease if you:

• Do not clean your teeth well.
• Smoke or chew tobacco.
• Have someone in your family who has gum disease.
• Have a condition that makes it harder for your body to fight infection, such as:
  • Uncontrolled diabetes, AIDS, or leukemia.
  • A high level of stress.
  • A poor diet that’s low in nutrients.

What are the symptoms?
It may be hard to tell if you have a mild case of gum disease. Healthy gums are pink and firm, fit snugly around the teeth, and do not bleed easily. But mild cases of gum disease (gingivitis) cause:

• Gums that are red, swollen, and tender.
• Gums that bleed easily during brushing or flossing.

As gum disease gets worse (periodontitis), the symptoms are easier to see, such as:

• Gums that pull away or shrink from the teeth.
• Bad breath that won't go away.
• Pus coming from the gums.
• A change in how your teeth fit together when you bite.
• Loose teeth.

How is gum disease diagnosed?
To find out if you have gum disease, your dentist will do an exam to look for:

• Bleeding gums.
• Hard buildups of plaque and tartar above and below the gums.
• Areas where your gums are pulling away or shrinking from your teeth.
• Pockets that have grown between your teeth and gums.

Your dentist or dental hygienist may take X-rays of your teeth to look for bone damage and other problems.
How is it treated?
If you have a mild case of gum disease, you will probably be able to take care of it by brushing and flossing your teeth every day and getting regular cleanings at your dentist's office.
If your gum disease has become worse and you have periodontitis, your dentist or dental hygienist will clean your teeth using a method called root planing and scaling. This removes the plaque and tartar buildup both above and below the gum line. You may also need to take antibiotics to help get rid of the infection in your mouth. If your gum disease is severe, you may need to have surgery.
How can you prevent gum disease?
Gum disease is most common in adults, but it can affect anyone, even children. So good dental habits are important throughout your life:

• Brush your teeth 2 times a day, in the morning and before bedtime, with a fluoride toothpaste.
• Floss your teeth once each day.
• Visit your dentist for regular checkups and teeth cleaning.
• Don't use tobacco products.

If you think you have a mild case of gum disease, make sure to take care of it before it gets worse. Keeping your teeth and gums healthy and getting regular checkups from your dentist can keep the disease from getting worse.
Having gum disease may increase a pregnant woman's risk of having a premature, low-birth-weight baby.¹ Also, studies have found a direct link between heart disease and the bacteria that cause gum disease.² So taking good care of your teeth and gums may have benefits beyond keeping your mouth healthy.

Malocclusion and Orthodontics

Treatment Overview

Orthodontic treatment uses appliances, tooth removal, or surgery to fix the way teeth and jaws are aligned. There are many ways to treat poor bite (malocclusion). Expert opinions differ about when to start treatment. Your dentist or orthodontist may give you a choice between early or later treatment or may prefer one specific approach.
The general categories of orthodontic devices (appliances) are functional and fixed.
Functional appliancesuse the muscle action from speaking, eating, and swallowing to create forces that move teeth and align the jaws. See a picture of a functional appliance.

• Some functional appliances are removable, while others are bonded to the teeth.
• A functional appliance may fit between the upper and lower teeth (a splint) or may span across the mouth between the molars, pressing the bone outward.

Fixed orthodontic appliances are sets of wires and brackets cemented to the teeth. These are commonly called braces. Over a period of about 24 to 28 months, the wires are tightened and adjusted, gradually applying enough force to move the teeth (bone remodeling).
Retainers are removable appliances made of molded plastic and wire. They hold the teeth in place after braces are taken off. If the teeth start to move back out of position, the orthodontist may bond a short retaining wire to the back of some teeth. This wire will hold the teeth in place.

Child and adolescent treatment

The aim of treatment in the childhood and teen years is to move permanent teeth into place. The orthodontist will time the treatments to match your child's natural growth spurts.
Treatment for crowding, the most common malocclusion problem, may mean removing (extracting) some permanent teeth. But orthodontists avoid removing permanent teeth when they can.
The malocclusion treatments for children and adolescents are:

• Extraction (serial removal). Removing some baby teeth may ease severe crowding.
• Growth modification. This involves wearing fixed or functional appliances during the day and night to move the jaw into a better position.
• Fixed appliances (braces) gradually move the teeth. For children and teens, this treatment phase usually lasts about 24 months; for adults, about 28 months.
• Retainers. Retainers hold the teeth in place after orthodontic treatment. Some orthodontists recommend that retainers be worn for many years, because teeth have a natural tendency to drift out of place.
• Space maintainers, made of metal or plastic. Spacers keep the surrounding teeth from moving (drifting) into open spaces created when teeth are pulled or lost in an accident.

Adult treatment

Orthodontic treatment for malocclusion is a popular option for adults, due in part to better technology. In the past, wide silver bands held braces in place. Today they are less obvious. Instead of the wide bands, a small metal or ceramic fastener is bonded to each tooth, and a narrow wire passes through the fasteners.
New options include:

• Clear plastic instead of silver wires.
• Lingual braces. These braces attach to the back of the front teeth.
• Removable clear plastic aligners (Invisalign). These are molded specifically for you.

Lingual braces and aligners don't work for everyone. They aren't options for children. Your orthodontist can tell you the best choices for your situation.
Orthodontic treatment for adults may also involve:

• Removal (extraction) of teeth to create more space.
• Orthognathic surgery of the jaw.
• A retainer, after braces are removed.
• Adjustments, such as grinding of high tips of teeth, to prevent continued or increased malocclusion for adults.

Most adults have little or no jaw growth. This means that surgery is the only way to correct jaw-related bite problems. Some adults may benefit from simply camouflaging, or hiding, a jaw-related problem. Using braces, the orthodontist can move the teeth so that they fit together, despite the jaw discrepancy. But surgery is the best way to treat more severe jaw problems.

What To Think About

Some cases of malocclusion clearly require orthodontic treatment to straighten teeth. In many cases, though, the decision is a matter of personal choice. Besides looking nice, straight teeth can improve how you bite, chew, and speak. They are also less prone to decay, gum disease, and injury.
The timing of treatment is ultimately up to you and your child or teen. Talk with your orthodontist about the pros and cons of treatment options.
Orthodontic treatment isn't an exact science. The average treatment time is about 2 years, but it can take longer than planned. Usually, adult treatment takes longer than a child's treatment. The treatment time can vary, so ask your dentist how long it may last for you.
After treatment ends, teeth often begin to shift. Molded plastic retainers, usually worn at night, help prevent this tooth movement. You may need a retainer for an indefinite amount of time.
Orthodontic treatment is costly. Most medical and dental insurance plans don't pay for orthodontics. Before deciding on treatment, ask about the projected cost, terms of payment, and terms of the treatment contract.
Orthodontic treatment doesn't pose risks to adults who have healthy teeth and gums. Adults who have gum (periodontal) disease, though, must first get treatment from a periodontist to avoid possible gum damage or tooth loss. Orthodontic treatment sometimes can make preexisting gum condition worse.