Good oral hygiene for all the family!

Early tooth development occurs in the jaw bone away from the mouth. Once the tooth is 90% developed it emerges into the mouth. At this stage the tooth is not fully formed and is immature. The last stage of maturation occurs whilst the tooth is bathed in natural neutral saliva.

The deciduous “milk teeth” emerge into the mouth from the age of 6 months to 36 months and are slowly replaced by the permanent “adult” teeth from the age of 6 years to approximately 16 years. During this time the teeth need to be bathed in natural neutral saliva to achieve final maturation.

Tooth decay is a complex multi factorial process and there are only a few features that we can control. Research shows that individuals with diets that are rich in refined carbohydrates and acids coupled with poor oral hygiene demonstrate more tooth break down.

What we believe happens is that at a stage of tooth development when teeth need to be bathed in neutral saliva, they are actually bathed in sugar rich acidic saliva. This prevents the teeth from achieving their final maturation.

The natural state of the saliva is neutral, which acts to protect the teeth. Once food of any type is placed into the mouth acidic saliva is produced from different glands. This acidity is to aid the initial breakdown of the food and the commencement of digestion. The acidity in the mouth remains for 45 minutes before it returns to the neutral protective state. Teeth can become soft and decayed in the absence of any added sugars or acids. However, we see more decay in those individuals who demonstrate a sugar / acid rich diet.

Tooth Decay

It is difficult to identify a single component of the diet that causes tooth decay because it is more to do with eating habits and frequency with which items of food are placed into the mouth. Caution needs to be exercised around the frequency of use of Re-fined carbohydrates to include natural and added sugars. Caution also needs to be applied to the use of acids to include natural fruit acids.

The dental examination does not prevent tooth decay. It is a means of identifying problems as they arise. As teeth decay from the inside outwards the examination fails to identify problems until they are relatively well developed. The same applies to dental X-rays early tooth decay is almost impossible to diagnose. The lesions have to be of a significant size to be visualised and by that time the damage has been done. The greater importance of the dental visit is to learn how to best avoid tooth and gum problems. It is the implementation of this information that realises healthier teeth.

It is my greatest experience that the underling eating habits influence tooth and gum health. Whilst the early stages of damage are occurring these do not become apparent at dental check ups, as these changes occur in the deeper structure of the tooth. The lack of negative feedback fails to persuade patients to change their eating habits. The teeth, in the goodness of time, reflect their history by demonstrating cavity after cavity. By this stage the damage has been done and reversal or changes to eating habits do not prevent further damage as the teeth have become relatively weak and the decay process become self propagating.

Dr Hafeez Ahmed’s Recommendations:

  1. A balanced diet adhering to fixed eating times that avoids “grazing” during the day.
  2. Consult with nutrition text to identify which foods are sugar / acid rich. Maybe identify calorific values for food so as to address the need for “grazing”. Understand that our bodies are far more addictive to all the foods that result in tooth damage. Hence the cliché “if it tastes good it must be bad”.
  3. If sugars and acids are consumed they are best consumed at the end of meal times in one go. Prolonged “grazing” is less desirable.
  4. A firm and prolonged “Scrub” of the biting surfaces of teeth at least 2 times daily with the use of a traditional tooth brush. This surface of the tooth is undulated like a “mountain” to aid the crushing of food. The food can remain trapped here for lengthy periods of time. A firm scrub here does not damage the tooth.
  5. A gentle clean of the tooth surface where it emerges from the gum. The brush to be used here is a single tufted “interspace” brush. This area is best cleaned with a gentle action with the brush angled at 45 degrees to the gum line. Scrubbing with a traditional brush is best avoided as this can result in abrasion damage.
  6. The spaces in between teeth are best cleaned using dental floss. This habit is best promoted and developed early so that it becomes second nature.
  7. The use of Fluoride toothpaste during tooth cleaning.

The dental examination

The Dental examination is of great value if used as an adjunct to good homecare practices and care. The interval between visits should be governed by the risk factors such as diet, cleaning habits, previous decay, and family history of tooth decay. The average visit interval is 6 months. Dental Examinations without good homecare practices are essentially far more important and recommended more frequently, as problem teeth can be identified and treated earlier. However, in the longer term one needs to consider the value of such work if the underlying aetiology is not addressed.