Oral Health
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Dental health

Prevention and self-management
Common dental problems, causes, and risk factors

Prevention and self-management
  • Management of dental problems begins at home. Taking care of the teeth and gums is very important.
  • Brushing and flossing: Thorough tooth brushing and flossing to reduce dental plaque can prevent dental caries and gum disease. Healthcare professionals recommend drinking fluoridated water and using a fluoride toothpaste. Fluoride's protection against tooth decay works at all ages.
  • Brushing the teeth after each meal and snack is recommended. Brushing after meals helps remove any food particles from the teeth. Food particles lodged in the teeth may lead to dental caries. Also, a soft toothbrush is best. Turn the bristles against the gum line and brush gently. Use small, circular motions. Brush the front, back, and top of each tooth.
  • Using dental floss at least once a day is recommended. Flossing helps prevent the buildup of plaque on the teeth. Plaque can harden and grow under the gums and cause problems. Using a sawing motion, gently bring the floss between the teeth, scraping from bottom to top several times.
  • Mouthwashes can also be helpful to remove dental plaque.
  • Keep dentures clean and comfortable.
  • Limit tobacco use: In addition to the general health risks posed by tobacco, smokers have four times the risk of developing gum disease compared to non-smokers. Tobacco use in any form, such as cigarettes, pipes, and smokeless (chewing) tobacco, increases the risk for gum disease, oral and throat cancers, and oral fungal infection (candidiasis). Chewing tobacco containing sugar increases the risk of tooth decay.
  • Limit alcohol use: Heavy use of alcohol is also a risk factor for oral and throat cancers. When used alone, alcohol and tobacco are risk factors for oral cancers, but when used in combination, the effects of alcohol and tobacco are even greater.
  • Diet modification: Adults and children should avoid snacks full of sugars and starches as well as limit the number of snacks eaten throughout the day. The recommended five-a-day helping of fiber-rich fruits and vegetables stimulates salivary flow to aid in decreasing tooth decay.
  • Regular dental checkups: It is recommended by healthcare professionals to visit the dentist regularly, preferably every six months for cleaning. Check-ups can detect early signs of oral health problems and can lead to treatments that will prevent further damage, and in some cases, reverse the problem. Professional tooth cleaning (prophylaxis) is also important for preventing oral problems, especially when self-care is difficult.
  • Other: If medications produce a dry mouth, drinking plenty of water, chewing sugarless gum, and avoiding tobacco and alcohol can be helpful in reducing the problem.
  • Have an oral health check-up before beginning cancer treatment. Radiation to the head or neck and/or chemotherapy may cause problems for the teeth and gums. Treating existing oral health problems before cancer therapy may help prevent or limit oral complications or tissue damage.
  • It is recommended by healthcare professionals to call a dentist right away if there are problems with the teeth, gums, and oral cavity.

Common dental problems, causes, and risk factors
  • Dental caries: Dental caries is an infectious disease that damages the structures of teeth. Tooth decay or cavities are consequences of caries. All individuals are at risk for getting cavities throughout their lifetime. By the time most people are adults, 85% of people will have had a cavity. Cavities are caused by the bacteria Streptococcus mutans, which can attach themselves to hard surfaces like the enamel that covers the teeth. If the bacteria are not removed, they multiply and grow in number until a colony forms. More bacteria of different types attach to the colony already growing on the tooth enamel. Proteins that are present in the saliva (spit) also mix in and the bacteria colony becomes a whitish film on the tooth. This film, called dental plaque, damages and decays the teeth and causes cavities.
  • Plaque begins to accumulate on teeth within 20 minutes after eating (the time when most bacterial activity occurs). If this plaque is not removed thoroughly and routinely, tooth decay will not only begin, but flourish. The acids in plaque dissolve the enamel surface of the tooth and create holes in the tooth (cavities). Cavities are usually painless until they grow very large inside the tooth and destroy the nerve and blood vessels in the tooth. If left untreated, a tooth abscess (pus enclosed in the tissues of the jaw bone at the tip of an infected tooth) can develop. Untreated tooth decay also destroys the internal structures of the tooth (pulp) and ultimately causes the loss of the tooth. Pulp refers to the softest part of the tooth that lies in its root and extends all of the way to the top part of the tooth (the crown). The pulp contains the blood vessels, the nerves, and connective tissue inside a tooth and provides the tooth's blood and nutrients.
  • Gum disease: Gum diseases include gingivitis and periodontitis. Gingivitis is inflammation of the gums that causes the gums to bleed and swell. Gum diseases are more often seen as people age, with most people showing signs of them by their mid-30s. Gingivitis is caused by infection or plaque around the teeth and is a common cause of tooth loss after age 35. The most common type of gum disease is gingivitis.
  • Periodontitis is a more serious type of gum disease. Periodontitis is a dental disorder that results from progression of gingivitis, involving inflammation and infection of the ligaments and bones that support the teeth. Plaque, formed from bacteria, hardens into calculus (tartar) when left on the teeth. As plaque and calculus continue to build up, the gums begin to pull away, or recede, from the teeth, and pockets form between the teeth and gums. As the gums recede, more bone and the periodontal ligament are damaged. Teeth - even healthy teeth - may become loose and need to be extracted.
  • Gum diseases such as gingivitis and periodontitis can be caused by numerous factors, including: smoking/tobacco use; genetics - up to 30% of the population may be genetically susceptible to gum disease; pregnancy, puberty, and menopause (hormonal changes can make individuals more susceptible to gum diseases); stress; medications, such as oral contraceptives, the anti-seizure drug phenytoin (Dilantin®), the immune system drug cyclosporin (Sandimmune®), and some heart medicines including nifedipine (Procardia®); clenching or grinding the teeth - clenching or grinding the teeth can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed; diabetes - diabetes makes the individual more susceptible to developing infections, including gum diseases; poor nutrition - vitamin deficiencies can impair the immune system, leading to periodontitis; and disease such as human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and cancer can impair immunity and lead to gum diseases.
  • It has been estimated that 50%-75% of women experience gingivitis during pregnancy. Pregnancy-related gingivitis is caused by increased hormone levels and is most common between the second and eighth month of pregnancy. The increased hormones result in more overall fluid retention throughout the body, which can cause swollen, red, and tender gums. Hormonal changes in pregnancy have also been found to reduce resistance to infection in gum tissue and to promote growth of certain bacteria and plaque (particularly increased levels of progesterone), which causes inflammation. Swelling and tenderness in the gums may be severe and cause bleeding. Untreated gingivitis may lead to periodontitis. Research has found an association between chronic gum disease and premature delivery. One well-known study reported that compared to mothers with healthy gums, pregnant women with chronic gum disease were four to seven times more likely to deliver prematurely. Experts suggest that pregnancy gingivitis can be prevented by proper oral hygiene both prior to and during pregnancy, including brushing at least twice a day (with a fluoride-containing toothpaste), flossing once a day, using an antimicrobial mouth rinse, and regularly scheduled professional dental cleanings. Following delivery, gums usually return to normal. If symptoms such as bleeding, sensitivity, swelling, and irritation persist after delivery or get worse, it is advised to contact a dentist.
  • Phenytoin-induced gingival hyperplasia is an enlargement of the gums. The gums can grow along the sides of, or over the teeth. Phenytoin (Dilantin®) causes gingival hyperplasia in approximately 50% of those who take it within two weeks to three months after initiation of therapy. This may progress to the point that the teeth are virtually submerged. Phenytoin is commonly used for seizure control.
  • Canker sores: Canker sores, also known as aphthous stomatitis or mouth ulcers, are common, but mostly harmless, sores. Stomatitis means inflammation of the mouth. Canker sores appear as ulcers (an eroded area of the oral cavity, marked by tissue disintegration) that are white or gray with a red border inside the mouth. They occur in women more often than men, often during menstrual periods. The reason why they appear is unknown but some experts believe that problems with the immune system, the body system that fights disease, bacteria, or viruses, may be involved. Fatigue, stress, or allergies can increase the chances of getting a canker sore. Canker sores tend to heal by themselves in one to three weeks. If an individual gets a large sore (larger than 1 centimeter), it may need to be treated. Canker sores are vulnerable to infection by bacteria in the mouth.
  • Canker sores are usually seen in children and adolescents from the ages of 10 - 19 years. For about one-third of the children affected, lesions continue to reappear for years after the initial outbreak. These ulcers are not contagious and cannot be spread from one child to another.
  • Oral thrush: Oral thrush is a fungal or yeast infection (candidiasis) in the mouth caused by an overgrowth of Candida albicans. Oral thrush appears as red or white lesions, flat or slightly raised, in the mouth. When severe, this fungus can spread down the esophagus, making chewing and swallowing very painful. They are common among denture wearers and occur most often in those who are very young, in the elderly, or in those who have a problem with their immune system, such as in cancer and HIV/AIDS patients. Individuals who have dry mouth syndrome (xerostomia) and those taking antibiotics may also get oral yeast infections. These yeast infections can be prevented with good oral hygiene, such as cleaning dentures appropriately and brushing the teeth.
  • Oral leukoplakia: Oral leukoplakia is a condition in which thickened, white patches form on the gums, on the inside of the cheeks, and sometimes on the tongue. The cause of leukoplakia is unknown, but it is considered to result from chronic irritation. Tobacco, either smoked or chewed, is the main cause, but irritation can also come from other sources, such as long-term alcohol use.
  • Leukoplakia is the most common of all chronic mouth lesions. Although anyone can develop leukoplakia, it's most common in older men. People with compromised immune systems sometimes develop an unusual form of the disorder called hairy leukoplakia. Hairy leukoplakia of the mouth is an unusual form of leukoplakia that is seen only in people who are infected with human immunodeficiency virus (HIV), have acquired immunodeficiency syndrome (AIDS), or AIDS-related complex. Hairy leukoplakia consists of corrugated, fuzzy, hence the name "hairy," white patches on the lateral borders of the tongue and less frequently elsewhere in the mouth. It may resemble thrush, an infection caused by the fungus
  • In general, leukoplakia is not painful, but the patches may be sensitive when the individual touches them or eats spicy foods. Although the disorder usually is not dangerous, a small percentage of leukoplakic patches show early signs of cancer. Many cancers of the mouth occur next to areas of leukoplakia. For that reason, it is best to see a dentist if there are unusual changes in the mouth lasting longer than a week.
  • The cause of leukoplakia is unknown. Many possible causes have been linked to leukoplakia, including tobacco, long-term alcohol use, and other chronic irritants. Tobacco use appears to be responsible for most cases of leukoplakia. The majority of individuals who develop leukoplakia are smokers, and most leukoplakic patches either improve or disappear within a year after stopping smoking. Chewing tobacco and snuff also play a key role. As many as three out of four regular users of "smokeless tobacco" products eventually develop leukoplakia where they hold the tobacco against their cheeks. Other factors contributing to leukoplakia include the fungus Candida albicans, which causes oral thrush, and human papillomavirus (HPV), the virus that causes genital warts.
  • Oral cancer is the most advanced stage of leukoplakia. Oral cancer most often occurs in people over the age of 40. It is often found at late stages when it is harder to treat. This is because oral cancer is not usually painful so individuals may not recognize the problem early. Also, many people do not visit their dentists often enough to find the cancer early. The most common sites of oral cancer are on the tongue, lips, and floor of the mouth. Use of tobacco, especially with alcohol, is the main cause for these cancers.
  • Chemotherapy or radiation treatments to the head and neck can cause dry mouth, tooth decay, painful mouth sores, leukoplakia, and cracked, peeling lips.
  • Mucositis: Mucositis, or stomatitis, is inflammation of the mucous membranes lining the digestive tract from the mouth on down to the anus. Mucositis is a common side effect of chemotherapy and of radiotherapy that involves any part of the digestive tract. Mucositis affects the rapidly dividing mucosal cells lining the mouth, throat, stomach, and intestines. These cells normally have a short life span. Chemotherapy or radiation therapy can destroy the cells quickly and they are not replaced right away. Destruction of mucosal cells in the oral cavity leads to ulcers or sores. Mucositis is painful, can interfere with eating, and may require pain medication for a week or two until the tissues recover.
  • Mucositis is also the primary cause of pain for patients undergoing bone marrow transplants due to chemotherapy and/or radiation therapies. Good mouth care is essential. Infection calls for prompt antibiotic treatment.

Copyright © 2011 Natural Standard (www.naturalstandard.com)

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.