mouth and dental disorders
Cavities
Prevention of Cavities
Several general strategies are key to preventing cavities: Good oral hygiene and regular dental care Healthy diet Fluoride (in water, toothpaste, or both) Sometimes fluoride, treatments sealants, and antibacterial therapy Good oral hygiene, which involves brushing before or after breakfast and before bedtime and flossing daily to remove plaque, can effectively control smooth surface decay. Brushing helps prevent cavities from forming on the top and sides of the teeth, and flossing gets between the teeth where a brush cannot reach. Electric and ultrasonic toothbrushes are excellent, but an ordinary toothbrush, used properly, is quite sufficient. Normally, proper brushing takes only about 3 to 4 minutes. People should avoid using too much toothpaste, especially abrasive types, which may erode the teeth (particularly if brushing occurs immediately after exposure to acidic drinks). Floss is gently moved between the teeth, then wrapped around the tooth and root surfaces in a “C” shape at the gum line. When the floss is moved up and down 3 times, it can remove plaque and food debris. There are many small, toothpick-like devices (called interproximal brushes) with bristles or plastic projections on the ends that can be used to clean between teeth. These devices are effective but can be used only if there is enough space between the teeth to accommodate them. They come in many sizes and shapes and can be used alone or with different toothpastes or rinses. Water-flossing devices may prove helpful for patients who have difficulty manipulating dental floss. These types of devices are considered an adjunct, not a replacement for conventional dental floss. Initially, plaque is quite soft, and removing it with a soft-bristled toothbrush and dental floss at least once every 24 hours makes decay unlikely. Once plaque begins to harden, a process that begins after about 72 hours, removing it becomes more difficult. Although all carbohydrates can cause tooth decay to some degree, the biggest culprits are sugars. All simple sugars, including table sugar (sucrose) and the sugars in honey (levulose anddextrose), fruit (fructose), and milk (lactose), have the same effect on the teeth. Whenever sugar comes in contact with plaque,Streptococcus mutansbacteria in the plaque produce acid. The amount of sugar eaten is less important than how often people eat sugar because what matters is the amount of time sugar is in contact with the teeth. Thus, sipping a sugary soft drink over an hour is more damaging than eating a candy bar in 5 minutes, even though the candy bar may contain more sugar. Infants who go to bed with a bottle, even if it contains only milk or formula, are also at risk of cavities. Bedtime bottles should contain only water. People who tend to develop cavities should eat sweet snacks less often. Rinsing the mouth with water after eating a snack removes some of the sugar, but brushing the teeth is more effective. Drinking artificially sweetened soft drinks also helps, although diet colas contain acid that can promote tooth decay. Drinking tea or coffee without sugar also can help people avoid cavities, particularly on exposed root surfaces. Fluoride can make the teeth, particularly the enamel, more resistant to the acid that helps cause cavities. Fluoride taken internally is effective while the teeth are growing and hardening. Water fluoridation is the most efficient way to supply children with fluoride, and over half of the population of the United States now has drinking water that contains fluoride. However, many people may not consume enough of this water to significantly reduce tooth decay. Conversely, if a water supply has too much fluoride, the teeth can become spotted or discolored ( Fluoride Excess ). The discoloration may range from mild to severe. If a child’s water supply does not have enough fluoride, doctors or dentists can prescribesodium fluoridein drops, gels, toothpastes, or tablets. Children begin taking the drops or tablets at about 6 months and can take them through age 16. For people of any age who are prone to tooth decay, dentists may apply fluoride directly to the teeth or have them wear, at night, a custom-made mouth guard that holds fluoride. Fluoridated toothpaste is beneficial for adults as well as children. Tablets should be chewed or allowed to dissolve in the mouth before swallowing. Dentists sometimes apply sealants to protect hard-to-reach pits and fissures, particularly on the back teeth. After thoroughly cleaning the area to be sealed, dentists roughen the enamel with an acid solution to help the sealant adhere to the teeth. Dentists then place a liquid plastic in and over the pits and fissures of the teeth. When the liquid hardens, it forms such an effective barrier that any bacteria inside a pit or fissure stop producing acid because food can no longer reach them. About 90% of the sealant remains after 1 year and 60% remains after 10 years. The occasional need for repair or replacement of sealants can be assessed at periodic dental examinations. People who are very prone to tooth decay may need antibacterial therapy. Dentists first remove cavities and seal all pits and fissures in the teeth. Then dentists may prescribe a powerful antiseptic mouth rinse (chlorhexidine) that is used for 2 weeks to kill off the cavity-causing bacteria that remain in plaque. A long-acting form ofchlorhexidinecan also be applied by a dentist. The hope is that less harmful bacteria will replace the cavity-causing bacteria. However, the effectiveness ofchlorhexidinein preventing caries in adults is inconsistent. Another way to keep bacteria under control is to have people who are prone to cavities chew gum or hard candy containingxylitol(a sweetener that inhibits the cavity-causing bacteria in plaque). Antibacterial therapy can be used by pregnant women who have a history of severe cavities. Pregnant women who cannot tolerate antibacterial therapy can usexylitolas mentioned above.Xylitolis used from the time the child is born until the age at which the mother no longer samples the child’s food.Xylitolmay help prevent the mother's bacteria from being passed to the child. 