Cavities: A Basic Guide to Healthy Teeth
(Plain Text Version)
By: Marlow Doyle
Smashwords Edition
Copyright: Marlow Doyle 2010
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~~~~MD~~~~
Table of Contents (Hyper Linked)
Dental Checkups (Regular Dental Visits)
Signs of A Trustworthy Dentist and Office
I wrote this paper with the intent to inform people of oral health. However, there may be experts who disagree with what I state. Always consult a dentist regarding any concerns you have about your teeth. I am not responsible for any actions you do or do not take as a result of reading this article.
My name is Marlow Doyle. For the last year, I have been a dental assistant. In this document, I discuss the following: how cavities occur; how to properly brush and floss; explanations of dental terminology; descriptions of all routine dental procedures; signs of good and bad doctors; and other important information regarding teeth and dentistry.
I'd say about 98% of the patients I work with don't know what causes tooth decay (cavities). When I ask, the typical answer is usually "sugar," or a blank stare. Bacteria (plaque) are responsible for tooth decay. They occur in the mouth naturally and produce an acid that softens teeth. They reproduce in very large numbers, and throughout the course of a day will eventually stick to teeth. After eating and drinking, the bacteria feed off the remaining particles of food or beverage in the mouth. They digest the particles, and the result is an acid that causes tooth decay, or cavities. Proper cleaning habits will slow the rate of decay.
Severe toothaches usually indicate nerve damage. If a tooth is split in half, the nerve would be exactly in the middle. It runs from the crown, or portion of tooth seen by looking into a mirror, to the end of each root of the tooth (the portion under gums that anchors teeth into the jaw-bone). The plaque, or bacteria, have created a cavity reaching the tooth's nerve. This usually results in an infection. The pain is from the inflamed gum tissue and pressure created by the infection, and it is also from the nerve being exposed to food, liquid, and air. Root canals are needed to restore, or fix, the tooth(SEE DENTAL PROCEDURES).
Mild toothaches may be a result of several different factors. Most often, mild toothaches are a result of gum recession. As a person ages, gums tend to recede, or pull away. This results in sensitive portions of teeth being exposed to food, liquid, and air. Consult a dentist regarding any pain being experienced with your teeth.
Dental Checkups (Regular Dental Visits)
It is important to visit the dentist office twice a year, especially if you don't have insurance. Every six months, dentists will take x-rays and examine patients' teeth. They will determine the number of cavities present as well as other problems. Check-ups can cost about $200 depending on the office. Some may be cheaper while others may be more expensive. Also, the initial first exam may be more in price because about 18 x-rays are taken. The following checkups usually require only four x-rays. If teeth are properly monitored, then the extent of cavities or decay will usually be minimal. Therefore, the price to restore, or fix, problems with teeth should be reasonable (there are some people who experience a large amount of continuous decay regardless of how well they take care of their teeth or how often their teeth are monitored). Patients who neglect the dentist for several years at a time usually have to pay about $3,000 to $5,000 if not more to restore, or fix, all the problems with their teeth. I've worked with patients who needed $14,000 worth of dental work. In my experience, those patients who attend regular checkups and take care of their teeth properly usually have less decay and therefore smaller dental bills.
Sugar is a dangerous catalyst for cavities; that is, it drastically increases the rate at which decay occurs. As mentioned previously, bacteria produce an acid that causes decay. However, it takes time for plaque to stick to teeth in numbers large enough to cause substantial decay. Because sugar is so sticky, it decrease that time needed for bacteria to stick to teeth. In fact, once a person eats or drinks sugar, the plaque can INSTANTLY stick to teeth. Also, the sugar provides an abundance of food for bacteria. One sweet snack or soda will last the germs a very long time, and it provides ample opportunity to reproduce and cause decay. The other dangerous aspect of sugar is that it blends with saliva; therefore, it can reach many tiny crevices within the structure of teeth and underneath gums that are impossible to clean.
Fluoride helps strengthen teeth. It is in most brands of toothpaste and can also be in public drinking water. Fluoride can be ingested (food or drink) or absorbed by teeth (toothpaste or rinse). The correct amount of fluoride reduces the decay teeth experience. Consult with a dentist regarding the amount of fluoride needed to prevent cavities; too much can have negative consequences. Also, depending on the location, people might not have access to fluoridated water such as those who have wells as a source of drinking-water.
To reduce the rate at which cavities occur, bacteria must be mechanically removed from teeth and gums. Brushing and flossing are the best methods. Mouth-rinse alone isn't very effective. There are some rinses that kill bacteria on contact; however, this does not remove the sticky film produced by plaque. Thus, when bacteria eventually reproduce, a sticky environment will already be in place. Brushing and flossing will remove bacteria and the sticky film, but it must be done habitually for any chance at slowing decay. While brushing usually removes about 70% of plaque, or bacteria, roughly 30% remains between teeth UNDER THE GUM-LINE. The purpose of flossing is to remove plaque in these areas.
Floss first, then brush.
FLOSSING: I like CREST GLIDE DEEP CLEAN floss. Tear off a ribbon (floss) about 18 inches long (or a piece of floss stretched from shoulder to shoulder). It's important to use a long piece of floss; otherwise, it will shift and move while attempting to floss resulting in an ineffective technique. Wrap each end around each pointer finger simultaneously. Put the floss near your teeth and gently slide it between them. Use your thumbs for leverage and positioning. Pull your hands apart to tighten the floss. Rub the floss up and down each tooth. Be sure to use slight pressure. Slide the floss PAST the gums. ABOVE THE GUMLINE is the most important area to clean; it can't be reached with a toothbrush. You should see part of the floss disappear as it cleans under the gums. Floss between every tooth including all four teeth in the back of the mouth.
BRUSHING: I use the CREST SPIN BRUSH; it's an electrical toothbrush that is inexpensive. Always use soft bristles. Gently brush all visible tooth structure. Pay extra attention to where the gums meet the teeth - on both sides of the teeth (tongue side and cheek side). Put a slight angle on the brush where the gums meet the teeth. On the cheek-side of the teeth, move the brush gently in circles from one side of the mouth to the other. Then, do the same for the tongue side. Then, start the process over for the bottom teeth. You need not spend more than five minutes brushing; three to four minutes will do. I feel the electrical toothbrush does a better job removing bacteria on the tongue side of teeth than does a regular toothbrush. Consult with a dentist for a professional opinion.
CHEWING SUGARLESS GUM after each meal is a great way to dislodge pieces of food caught between teeth that a toothbrush and floss may not be able to clean. It also freshens breath, and most brands have an ingredient that kills bacteria. However, I believe that there may be certain brands with ingredients linked to cancer. Consult with a dentist to be certain.
Brush and floss after each meal – especially before going to bed.
Mouth-rinses: As stated previously, mouth-rinse alone is not an effective method of preventing cavities or decay. However, it can be effective when combined with brushing and flossing. It is important to use a rinse with fluoride. Be sure to read the directions. Most rinses require 30 minutes without eating or drinking after rinsing. This is because fluoride needs time to be absorbed by teeth. Any food or drink will wash away the fluoride (SEE FLUORIDE). It would be best to use a brand that kills plaque as well as provides fluoride.
At the point where the gums meet teeth, there is a crevice commonly referred to as a periodontal pocket, and each tooth has one. The pocket between your gums and teeth; you cannot see it in the mirror. When flossing, you can see the floss enter the pocket as you slide it past the gum-line. It is three dimensional and surrounds the entire tooth. Bacteria like to colonize (reproduce) there. Furthermore, if that area is neglected from flossing and brushing, the pockets will grow deeper. This is a result of the bacteria "eating" away at the bone structure that holds teeth in place. Consequently, as the pockets become deeper, more bacteria will be able to reproduce there. The plaque will continue to "eat away" the bone structure that anchors and hold teeth in place until teeth become loose and mobile.
There are two kinds of bad breath, in my opinion. One type of bad breath results from not brushing and flossing after eating a meal. This bad breath will go away after brushing and flossing. The other type is due to an abundance of plaque, or bacteria, in the mouth. The scent is difficult to describe, but it is similar to a dying animal. This breath is not uncommon, and these mouths often have serious amounts of decay. Usually, extensive dental procedures are needed to "fix" the breath and teeth of these mouths. Brushing, flossing, chewing sugarless gum, using a fluoride mouth-rinse, and regular visits to the dentist will help prevent bad breath. Also, if you are unsure how your breath smells, ask someone.
ABSCESS – Puss from a bacterial infection. If visible, it looks like a pimple on the gums.
RESTORE - This means to fix teeth. Some teeth may not be restorable; therefore, they must be extracted, or pulled. Others may be restored by extensive procedures such as a root canal and then a crown.
PLAQUE - Another word for bacteria.
TARTER – Plaque or bacteria that have hardened. After 24-hours, bacteria turn to tartar. The tartar must be scraped off teeth by certain dental procedures.
CROWN – Generally speaking, the crown refers to the visible portion of the tooth as opposed to the roots of teeth under the gums. What a person can see in the mirror is the crown potion of teeth. A crown may also be a prosthetic tooth.
PARTIALS – A Partial set of dentures. They are removable.
DENTURES – A full set of 14 to 16 prosthetic, or fake, teeth.
MOBILE – A loose tooth.
FLIPPER – A partial denture consisting of one to three prosthetic, or fake, teeth that are next to each other. For instance, if a patient was missing their two front teeth, a flipper is usually recommended. However, if they are missing a tooth on both side of their top jaw, then usually a partial would be recommended. Flippers are usually recommended to be used temporarily; a patient may need to save money for implants or dentures etc. Flippers are removable.
AMALGAM FILLINGS – SEE SILVER FILLING.
BRIDGE – Three or more crowns fabricated together – a three-unit-bridge. SEE BRIDGE PREP
BRIDGE PREP – This is recommended when a patient is missing one tooth but has two teeth on opposite sides of the missing tooth, or it is recommended when a tooth has to be extracted. The purpose of a bridge is to fill the void from the missing tooth. A crown prep is performed on both teeth opposite from the missing tooth (SEE CROWN PREP THIS SECTION). Impressions, or molds, are taken of the prepared teeth and sent to a laboratory. When the bridge, or prosthetic teeth, is cemented to the prepared teeth, it will appear as though there is no longer a missing tooth. Bridges can be made for more than one missing tooth. There can be a three, four, or five-unit-bridges etc. I have seen a 12-unit-bridge. Ask your dentist about the different types of bridges. If it is affordable, consider the higher quality material being used for the bridge - especially when dealing with the front teeth (SEE CROWN PREP).
COMPOSITE FILLING – SEE WHITE FILLING.
CROWN PREP – Crown preparation procedure. When the dentist recommends a crown prep, it means the majority of tooth is decayed, or it means that a filling will not be able to restore, or fix, a tooth. During this procedure, the tooth is shaved down to a nub. After drilling, the tooth usually looks like a small thimble. The portion of tooth that was weak from decay will be drilled away, and all that will remain is healthy strong tooth structure. Impressions, or molds, are taken of the tooth and sent to a laboratory. A prosthetic "cap" or crown is made at the lab. A standard prosthetic crown is referred to as a porcelain fused to metal crown. It has a metal base that is covered with white porcelain. The dentist will make a temporary crown, or cap, to wear while the permanent is being made. Once the permanent is made, it will be cemented to the prepared tooth. There are several different qualities of prosthetic crowns. If you have the money, I would always ask for the highest quality. The basic crown often chips and flakes; therefore, the metal shows through. For the front teeth, always ask for an all porcelain crown. Otherwise, in a year or two, a metal line will be visible at the gum line of the tooth.
CROWN INSERT – Procedure to cement the permanent crown to a prepared tooth (SEE CROWN PREP).
CROWN LENGTHINING – Basically, this procedure is necessary to make more tooth structure on a tooth with very little tooth structure. It may be done by cutting or drilling away millimeters of gum around a tooth. By decreasing the height of the gums, this lengthens the remaining tooth and allows for a crown that will hold properly (SEE CROWN PREP). If there isn't enough tooth, a prosthetic crown will fail, or fall off. Another reason for crown lengthening is when decay extends along the root of the tooth past the jaw-bone. In this situation, jaw-bone along with decay is drilled. As the height of the jaw-bone decreases, the tooth becomes longer. There is also a crown lengthening procedure done by a periodontist (gum specialist). This is a more advanced surgery that involves many teeth.
DENTURES – A full set of 14 to 16 prosthetic, or fake, teeth. There are two sets for a mouth – one for the top, and one for the bottom. A denture is recommended when a patient has no remaining teeth on the top or bottom jaw-bone, or the remaining teeth are non-restorable, or not able to be fixed. Molds of a patient’s mouth are taken and sent to a lab. The Lab then fabricates the dentures. This process may take up to 3 months. Always remove the denture at night and clean it unless directed otherwise. Dentures can attract bacteria.
EXTRACTION – Pulling a tooth.
FILLINGS – Decay or cavity is drilled out of a tooth. The hole that was drilled is replaced with a filling material – usually either metal or plastic.
FLIPPER – A flipper is a removable prosthetic tooth or teeth consisting of usually no more than three teeth. They are ordered usually as a temporary solution. For instance, a patient may have two teeth extracted and a flipper made while he or she saves money for a bridge or partial denture.
FULL MOUTH DIBRIDEMENT (DIH-BRY-MENT) – Removal of tartar from crown portion of teeth. An instrument is used to scrap the hardened tartar off teeth. Usually this procedure is performed by a hygienist.
IMPLANT – This is when a prosthetic, or fake, tooth is screwed into the jaw-bone. The implant refers to the female part of the prosthetic tooth. Impressions are made and sent to a laboratory whereby a crown, or cap, is made. The cap (male piece) is screwed into the implant.
PARTIALS – Partial dentures. A partial denture is recommended when a patient is missing several but not all teeth on either the top or bottom jaw-bone. For instance, a patient may have 10 upper teeth. A partial denture would be recommended to replace the four missing teeth. Partials are removable prosthetic teeth. Impressions, or molds, are taken of a patient's mouth. The molds are sent to a laboratory whereby the partials are fabricated. Always take the partial out at night and clean it unless directed otherwise. Partial dentures attract bacteria.
POST AND CORE – Post procedure. Core buildup procedure. A post procedure usually takes place after a root canal treatment. It is when a small screw is placed into the remaining tooth. From there, a material is placed around the screw; this is the core buildup. The core material is then hardened. The purpose of a post and core is to provide additional strength to a tooth. After a root canal procedure, a tooth has lost a majority of its structure. The post and core adds additional support. Some teeth need only a core buildup and not a post. After the post and core procedure, a crown prep procedure is performed (SEE CROWN PREP).
PULPECTOMY – Sometimes root canal procedures need to be completed in steps. A pulpectomy is the removal of the tooth's nerve. Usually, a pulpectomy is ordered when a patient is in severe pain. The procedure will eliminate any discomfort. The infection will be given time to heal, and the patient will come back at a later time to finish the root canal. See Root Canal for an understanding of the nerves within teeth.
ROOT CANAL – Each tooth has a root or roots. The roots are behind the gums buried under the jaw-bone; you cannot see them by looking in a mirror. Some roots are straight while others are curved. The root is anchored in the jaw bone to provide the tooth with stability. Inside each root is a canal where the tooth’s nerve is located. The nerve supplies the tooth with blood and oxygen, and it runs from the end of the root nearest the jaw-bone to the crown, or the portion of tooth above the gums. Each canal is extremely tiny – ranging from about .08 to .40 millimeters thick. A root canal is usually recommended when nerve-damage occurs. When bacteria penetrate the tooth to the nerve, the result is usually an infection (abscess). There are various reasons for nerve damage occurring; however, the only way to restore, or fix, this is by removing the nerve by a root canal procedure. During this procedure, a hole is drilled to the nerve. Once the canals are located, the dentist will remove the nerve inside the canals with tiny files. After all the nerve is removed, the canals are filled with a rubber substance and then sealed. Usually the tooth will need a crown prep in order to be fully restored, or fixed (SEE CROWN PREP IN THIS SECTION). Sometimes patients are sent to a specialist for root canal procedures.
ROOT SCALING – This procedure is usually done by a hygienist. This is when an instrument is used to scrape the bacteria and tartar off a tooth far underneath the gum line. Usually this is recommended when patients are suffering from severe gum disease. Another reason for a root canal is often due to teeth being fractured. After a fracture, a post and buildup may be required in order to restore the tooth. Unfortunately, posts cannot be placed without the nerve being extracted, or removed.
SILVER FILLING – A combination of metals mixed together. Once the metals are mixed, they become soft. The metal is placed in the area of the tooth where decay has been drilled away. The soft metal is then shaped to the tooth.
WHITE FILLINGS – This is a plastic-like material. It starts off as a liquid or paste-like substance. Decay or cavities are drilled out of a tooth. The hole that was drilled is replaced with filling material. It is then hardened with a special light.
Signs of A Trustworthy Dentist and Office
There are many horrible dentists. There are dentists who tell patients who have holes in their teeth that no decay is present. There are dentists who will diagnose a tooth that has a hole in it without taking an x-ray. There are dentists who fall asleep during procedures. There are dentists who are alcoholics and drug addicts. There are dentists who lie to patients. There are doctors who continue to practice dentistry despite the fact that their procedures fail 70% of the time. That means 70% of their root canals fail, and patients have to go see a specialist to have the tooth retreated as a result. There are dentists who will accidently poke themselves with a needle prior to numbing a patient and then numb the patient without changing that needle. The fact that a dentist is a doctor means absolutely nothing.
Being a successful dentist is not easy. It takes a lot of patience and precise movements to perform a dental procedure correctly. For instance, when a dentist is drilling a cavity, they are drilling away millimeters of a tooth. It is difficult to remain in a chair with proper posture for an entire career – especially on a person's back. It's a difficult job, and that is why there are so few great dentists.
The following are characteristics of great dentists I have worked with:
EXCELLENT POSTURE – the dentist is sitting straight up and not bending over looking upside down, standing up, or leaning over the patient. Also, the patient should almost always be lying down. There are times when a dentist has to arch there back while drilling. However, it shouldn’t be happening consistently while the drill is running.
SLOW MOVEMENTS – movements of the drill and other instruments are very slow, especially around the patient's face and mouth. Movements aren't sporadic. A patient shouldn’t feel the drill bumping into other teeth.
LITTLE CHATTING – dentists aren't talking much while working on a patient, especially when in the mouth.
STEADY HANDS – a good dentist has extremely steady hands.
PATIENCE – a doctor should never rush through a procedure. Remember, they are working in millimeters. It is one thing to move at a fast pace; however, objects shouldn’t bee thrown around, and the doctor should have a hurried attitude.
HIGH SUCCESS RATE– a good doctor rarely has to redo a procedure. Occasionally, this will happen to the best of dentists, but it should not happen on a continuous basis.
INFORMATIVE PERSONALITY– A great dentist is extremely informative and answers patients' questions whole heartedly.
CLEAN OFFICE - If the office is dirty, there is a higher chance that germs are being spread. A dirty office usually means that proper disinfecting methods aren't taking place. A dental office should be spotless for the most part. It is extremely easy to spread blood from one side of a room to the other.
The majority of patients don’t understand that a tooth is still susceptible to decay even after crown, bridge, and root canal procedures. In other words, teeth can still get cavities after these procedures. Any natural tooth structure in a person’s mouth is always able to get cavities.
Crowns must be brushed and flossed as normal teeth. Bridges need what is called a “floss threader.” A “floss threader” is basically a plastic needle. The floss is threaded through the eye of the threader. Then it is placed between the gums and bridge where the missing tooth or teeth are. The purpose of the threader is to get one end of the floss between the bridge and gums so that the area can be properly flossed. The area where teeth are missing must be flossed, especially the teeth that hold the bridge in place. If you were to picture a bridge extending from one surface of land to another, the most important part to clean is the area between the two surfaces of land. However, there is no place on the bridge to slide floss between; therefore, a floss threader is needed to pull the floss between the gums and bridge where the missing teeth are located. That entire area must be cleaned with floss, especially the teeth that hold the bridge in place.
A well made crown can potentially last 30 years, but most patients replace them in less than five due to decay within the remaining tooth structure. Bridges become loose more often because there is much more surface area being exposed to grinding and chewing forces. However, most bridges have to be REDONE due to improper cleaning techniques.
~~~~MD~~~~