Oral and Dental Care

Focuses on gingivitis and periodontal disease – the main reasons why people lose their teeth over time and age. We give you advice on keeping your teeth to your "old age".

Dr. Xxxxx : If you don't look after your teeth properly, you will lose them. The two main mechanisms being dental caries and periodontal disease.

Dr. Xxxxx : Dental caries is early and aggressive. It leads to holes in your teeth and then fractures. In the extreme case, teeth are broken down to the gum surfaces - only a number of rotting teeth remaining in the gum - causing pain and misery and introducing infection into your bloodstream at inopportune moments.

Periodontal disease is much more insidious and takes decades to develop. As a result of not brushing away the dental plaque in your mouth, plaque builds up at the gum margins. Then this build-up begins to nudge its way between the tooth and the gum - slowly expanding the space. It will eventually calcify - resulting in a hard mass of bacteria at the edges of the teeth and gums.

This chronic infection inflames the gums adjacent. This causes the gums
to fall away from the tooth. Over a long period of time, more and more of the root of the tooth becomes exposed, resulting in the appearance of "long teeth". As more of the root of the tooth becomes exposed and the membrane holding the teeth within their socket (periodontal membrane) becomes destroyed, the tooth becomes progressively looser within its socket. In the long term the tooth will simply "fall out".

Dr. Xxxxx : Periodontal disease is far more ubiquitous and far more serious than dental caries (holes) are for most adults.

Inflammation and calcified plaque
at the gum margins- look at the lower gums near the front teeth / incisors.

Kinkajou : Part of the problem is that most people are not taught what the key activities are to look after their teeth.

Kinkajou : Everyone is taught that you need to brush your teeth. But how much and how?

Dr. Xxxxx : I would say that brushing your teeth a minimum of twice a day, will largely result in your controlling dental caries.

This will not work to prevent periodontal disease.
It is simply not good enough.

To prevent periodontal disease, I believe brushing your teeth a minimum of 3 times a day - after every time you eat (after every meal) is essential. You also need to "floss" and / or "pick" your teeth approximately 3 times a day as well. In short, every time you brush, you need to floss/pick as well.

I would concede that flossing and picking once a day is a barely adequate start to your dental care.

Kinkajou : Why?

Dr. Xxxxx : The bulk of the damage to your teeth in terms of either dental caries or periodontal disease starts between the teeth. Brushing simply does not reach into this space. Only flossing your teeth or using a dental pick between your teeth can help to control the plaque in the space between your teeth.

And to keep the debris / plaque between your teeth to a minimum, you need to clean between your teeth every time you eat and perhaps even drink.

If you brush and floss/pick your teeth a minimum of 3 times a day (preferentially after every time you eat or drink), you can control dental caries and especially periodontal disease. There is no or minimal plaque between your teeth for most of the hours of a day.

Waxed dental floss is probably easier to use. You may need to use a couple of different sizes of dental pick because the gaps between the teeth do vary somewhat in
size.

And as a result of this you get to keep your teeth when you are older.

Dentures are helpful, but they are a long way short of the real thing. You can chew better with real teeth. You have more sensation with real teeth. You have better control of mastication with real teeth. But if you want to have real teeth, you have to look after them.

There really is nothing as good as having your own teeth. One friend of mine went to a party. He was having some hors d'oeuvres. Due to the lack of sensation with a denture, he did not realise that he swallowed a toothpick with his snack. This toothpick proceeded down into his intestines and perforated the intestine by punching a hole through it. The leaking debris caused a large severe abscess to develop which required surgery and months in hospital to settle down. All because you can't feel what you are chewing - because you have a denture, not real teeth.

Dental examination

Erasmus : Let's consider fluoride is the next issue.

Dr. Xxxxx : In our society, fluoride is essentially ubiquitous and unavoidable. It is supplemented into the water supply. This small intake over a long period of time results in harder teeth, much more resistant to dental caries. Studies have definitely shown that putting fluoride into the town water supply, definitely reduces dental decay in the population.

It is not hundred percent, but the reduction in dental caries damage is substantial.

There is much less effect on periodontal disease.

Dr. Xxxxx : There have been many concerns on the effects of fluoride on health. I would also have some similar concerns about the effects of fluoride on the activity of the human immune system. However, in the world in which we live, the beneficial effect of fluoride on dental caries definitely swamps any other unwanted effects of fluoride.

Many people think that modern science can replace diseased teeth. The main process for this is the creation of "dental implants". A metal post is anchored with "medical concrete" into a hole drilled into the bone under the gums. The gum then heals over this and a "prosthetic tooth" is placed onto the metallic post - creating a "tooth", in effect.

Dr. Xxxxx : However this artificial structure is prone to periodontal type infection as well. The problem becoming that if you have not looked after your 1st/2nd natural teeth - why would you look after your implanted artificial teeth. The damage process begins anew with the new target being the new artificial teeth.

If infection reaches the bone, bone infection results a.k.a. osteomyelitis. When severe, this can destroy the bone - a process called osteonecrosis. Some medications can accelerate this process (namely the bisphosphonate medications used to treat osteoporosis in women). The key issue here being lack of self-care being the main process causing dental damage, not the medication.

The best way to clean your teeth is with an electric toothbrush. The revolving head results in far more brush cycles than can be achieved using a manual toothbrush. The dental brush fibres are much finer in an electric toothbrush - resulting in much less abrasive dental damage - especially to the dentine at the gum margins.

Electric toothbrush brush fibres are much less stiff resulting in less abrasion of the dentine at the base of the tooth. (As the gums recess backwards with age, dentine becomes exposed as the gums drop below the enamel coating. This is much softer than the dental enamel at the top of the tooth and becomes damaged especially by manual brushing.( It's the big hard bristles on the toothbrush that do the damage - to soft dentine. Enamel is hard and immune to damage by toothbrushes).

 

Nice gums : a nice even flat pink colour. If you look after your dental hygiene, older people can have great gums too.

Kinkajou : Some other dental issues:
Dr. Xxxxx : Steroid containing asthma medications (puffers or turbihalers) result in steroid depositing at the back of the throat when these medications are breathed in. This causes a lot of throat irritation. Having your puffer or turbihaler before a meal, will result in the food you eat, washing the steroid off  your throat. Alternately , you can gargle some water to rinse the steroid off your throat. This is important resulting in  you experiencing a lot less throat infections.

Decongestant nasal sprays result in your throat becoming much more inflamed the next day after using them. I believe the reduction in blood flow caused by the decongestant enables infection / irritation to develop more easily.

Dr. Xxxxx : Use nasal decongestants when you really have no choice. Typically use them to prevent or treat the development of sinus infection. In this case, the relief obtained by reducing the sinus infection, outweighs the detrimental effect of the inflammation resulting from the use of decongestant medication.

Some doctors show some concern that high dose decongestants, especially in an older person, could result in reduction of middle ear blood flow, resulting in deterioration of hearing. This effect is uncertain and would be expected to be worse amongst older people using higher dose decongestants for longer.

Rinsing your throat is an excellent adjunct to brushing your teeth, especially if you are becoming ill with an upper respiratory tract infection - a cold or sore throat. Using Povidone-iodine as a mouthwash or even a commercial mouth wash (such as Listerine) can act very efficiently to kill germs on the throat.

One doctor I know relates how patients using Povidone-iodine mouthwash (Betadine 1in20 dilution) find it is as effective as antibiotics in controlling tonsillitis. The doctor found by using this preparation in patients with a sore throat and early tonsillitis, the need for medical treatment can be reduced from needing antibiotics once or twice a month to only needing antibiotics once every 6 months. It is very effective.

Dr. Xxxxx : There can be some small degrees of dental staining i.e. brown marking of the teeth with this medication.(Betadine = Povidone Iodine).