An Ounce of Prevention and A Pound of Cure

I am recycling – recycling my articles; the important ones.  We have often heard the phrase, “Practice makes perfect,” and we understand that practice is simply the repetition of something over and over.  This process moves us from unconscious incompetence – we don’t know what we don’t know – to unconscious competence, the capacity to perform a certain task or skill at a high level without really even thinking about it.

And so I am going to explain the basics of dental cavities and periodontal disease – two maladies that are almost universal among us.  My hope is that by understanding the disease processes involved in each of these problems, we will be better able to avoid them.

The first thing to understand about teeth is that they are crystals and that crystals dissolve in acid.  There are a variety of things that will create or introduce acid into our mouths.  Sugar most commonly comes to mind, but sugar is not acid so why is it bad for our teeth?  Among the multitude of bacteria in our mouths, there are some (most notably Streptococcus Mutans) that use sugar as a food source.  Bacteria metabolize sugar and a byproduct of that process is acid.  So, sugar goes into bacteria, acid comes out.

We can compare the bacteria in our mouths to weeds in our lawns.  There are many different weed varieties that populate our lawns and the manner in which we tend and manage our lawns will determine what the ratios of those weeds are.  Similarly, we have many different bacteria in our mouths and the way we care for our mouths will impact what the ratios of those bacteria will be.  Diligent and detailed homecare habits such as brushing for a full two minutes 2-3 times/day, flossing with proper technique at least once/day, and making non-cavity causing food choices will reduce the numbers of pathogenic bacteria and boost the populations of helpful bacteria.

The next thing to understand is what plaque is.  Most would say it is a sticky, white substance that is found on teeth.  But what IS plaque?  Think of algae on a lake – a big sheet of algae is nothing more than hundreds of thousands of individual algae organisms all grouped together, making them visible.  Plaque is simply hundreds of thousands of individual bacteria that have clustered together.  When bacteria are collected together into plaque, their effect on teeth is much more damaging.  More acid is produced and, because the plaque forms a barrier, the acid is held against the tooth rather than being washed away by saliva.  In this way, the crystals that comprise the tooth structure are exposed to a concentrated acid in a focused application, thereby causing greater damage.

Third is the Stephan Curve.  This is a graphical representation of acid levels in our mouths following the introduction of a sugar substrate.  Let’s say I eat a chocolate chip cookie.  The sugar in the cookie will result in increased acid levels in my mouth for approximately 20 minutes following consumption of the cookie.  Now, let’s say I snack throughout the day on chocolate chip cookies, eating one every hour for eight hours.  That means I have exposed my teeth to 160 minutes (2 hours 40 minutes) of elevated acid levels throughout the day.  Now, you may not like chocolate chip cookies, but you are probably exposing your teeth to more acid than you realize.  Try keeping a food diary for one week and identify ALL sugar containing foods and beverages you consume.  Then, figure out how much time your teeth have been exposed to elevated acid levels.

These three concepts – teeth are crystals and acid dissolves crystals; plaque is just a large cluster of bacteria that create and hold acid against your teeth; and that for every sugar containing food or drink you consume, the acid levels in your mouth spike upwards – help us understand why it is so important to keep plaque cleaned off of our teeth and to monitor the frequency as well as the volume of sugar consumption.  If we engage in behaviors that create elevated acid levels in our mouths, we can expect to experience tooth decay.  If we respect these concepts and take steps to reduce the acid exposure that our teeth endure, we can expect minimal or no tooth decay.

Now, these are the basics as far as cavities are concerned.  There are many other factors involved, but a mastery of these concepts both intellectually and behaviorally will yield great dividends for the individual in search of cavity free dental check ups.

Let’s turn our attention to periodontal disease.  Periodontal disease is defined as loss of supporting bone and attachment apparatus surrounding a tooth or teeth.  It can begin as a mechanical process (i.e., stress overload on the supporting bone due to clenching and/or grinding resulting in bone loss and pocket formation) or a bacterial process (clusters of bacteria causing inflammation in gingival tissues).  Regardless of the initiating factors, periodontal disease will always become a bacterial problem.  This is because when a periodontal pocket forms and reaches a depth of 5mm or greater, the pocket cannot be cleaned by conventional homecare techniques (brushing, flossing, toothpicks, dental picks, etc.).  As a result, pathogenic bacteria inhabit these “corners” in our mouths and create microenvironments that damage the surrounding attachment apparatus (bone and ligament) that support our teeth.

One of the great problems with periodontal disease is that it is non-painful until its later stages.  Unfortunately, most of us tend to ignore problems until they are staring us right in the face.  So, when someone comes in and complains of gums that bleed easily, of bad breath, and/or a feeling that his or her bite is shifting around, the time for a simple cleaning has past.  These are symptoms associated with moderate periodontal disease, which needs to be treated appropriately (scaling and root planing or Laser Assisted New Attachment Procedure).

With both cavities and periodontal disease, it is much easier to prevent these problems than it is to treat them.  Regular visits to your dental office for professional cleanings and examination and evaluation of your teeth, gums, and bone are essential to maintaining excellent oral health and preventing these common maladies.  If you are concerned about your dental health, please contact your dentist today.  If you do not have a dentist, please consider Today’s Dentistry – we’ll take great care of you!