Dental Disease: A 21st Century View

Article submitted by Terry Batliner, DDS, MBA., Vice President at Delta Dental of Colorado.
For more information, they can be reached at 800-455-0573, or visit their website: www.DeltaDentalCo.com.

Years ago, people did not expect to keep their teeth for a lifetime. It was considered a normal part of aging to loose your teeth and spend your later years using dentures. Those times are gone. Most people with teeth now can expect to keep their teeth for the rest of their life. Why? What has changed?

We learned a few things over the last 50 years. It is now understood that dental disease is caused by bacteria. In other words, dental disease is caused by an infection. Dental disease can be divided into two main categories: Caries, more commonly known as decay and Periodontal or gum disease. Dental decay is caused primarily by one form of Strep bacteria. Periodontal disease is caused by a variety of bacteria. The type seems to change and vary as the disease progresses.

Dental decay starts when bacteria are allowed to adhere to the teeth in plaque. When we eat fermentable carbohydrates, which means bread, crackers, milk and not just sweets, the bacteria produces acid that removes minerals from the teeth. As the minerals dissolve out, the spot on the tooth gets weaker. If it gets very weak, it will collapse or cavitate, forming a "cavity". However, we now know that demineralized areas of the tooth can heal. If there is enough fluoride present in the environment the tooth lives in, the tooth can remineralize and repair itself. This can only happen in the early stages of the disease and cannot occur once cavitation has happened. Once a cavity has formed a filling must be placed to restore the tooth to its normal shape. So, there are a couple of things you can do to reduce your risk of future decay. Keep the frequency of carbohydrate ingestion low. If you are going to eat sweets or breads or other carbohydrates, do it only at meal times and not throughout the day. A lot of carbohydrates eaten three times per day are much easier on your teeth than a few carbohydrates eaten all through the day. The frequency of carbohydrate intake is more important than the amount when you are concerned about dental decay. Also, use fluoridated tooth paste and, if you have had recent fillings, fluoridated mouth wash. The fluoride can help demineralized areas heal.

Periodontal disease is the most important dental problem for people in their 30s and beyond. It starts when bacteria are left on the teeth near the gum line. The bacteria cause the body to respond with inflammation of the gums. This is obvious when you see red puffy gums that bleed easily. This early form of gum disease is called gingivitis. If gingivitis is left untreated, it becomes chronic. Your body then starts to destroy itself. Cells in the body that remove bone are activated. The bone around the teeth is removed and a pocket is formed. These pockets are spaces between the gums and the teeth. Once a pocket gets to be 5 or 6 millimeters deep, you cannot clean it and the disease can more easily progress. The bacteria that live in the pocket become more destructive and the body attacks itself more vigorously causing bone loss. Teeth can become loose or even come out if the disease is not stopped.

Gingivitis can be stopped by brushing, flossing and using mouth rinses that kill bacteria such as Listerine. Once 5 to 6 millimeter pockets have formed, professional help is needed. A deep aggressive cleaning may be needed or a small surgical procedure may be required to eliminate the pockets so the disease can't progress.

In the last ten years, studies have shown a relationship between gum disease and other diseases in the body. Your risk of having a heart attack or stroke appears to be higher if you have significant gum disease. This may be due to bacteria and the toxins they produce contributing to inflammation in the arteries that supply blood to the heart and brain. Gum disease also appears to make it harder to control blood sugar levels in diabetics. There also seems to be a relationship between inflammation in the gums and the risk of pre-term birth. If pregnant women control the inflammation in their gums they may be able to significantly reduce the chance of giving birth to a premature baby.

These relationships now demonstrate the importance of good oral health. In fact, your life may depend on it.