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THE ART OF DENTISTRY
While genetics (and on occasion some good fortune) have a significant role in our dentition and its health, our own personal development to include good habits and oral hygiene is the other big player. Regarding the formation of the teeth during our childhood there is nothing more important than maintaining systemic health, keeping fevers down, and eating a healthy diet. A diet rich in protein and dairy products to help those growing tissues develop with the nutrients they need is very important. Then, during and after the development of our teeth, maintaining what we were born with is truly the key, and that continues with a healthy (and not cariogenic) diet. Also since following our daily meals all food stuffs eventually break down into plaque which is a home, and a grocery store for the bacteria that live in your mouth, we need to remove their home and food source by brushing 2-3 times (and flossing) daily. You’ve heard it before but it is the truth. Generally speaking, once this is achieved, the teeth and their supporting structure have a much greater chance to make it throughout life without too much tooth trouble.
As you know, you have to brush and floss daily to be thorough. If you possess teeth with good arch form and alignment, you should have an easier time gaining success with your efforts. If you are not blessed with that good arch form and alignment (generally, that great smile) you can often times correct it through orthodontic treatment. I generally recommend that a person have orthodontic treatment, (not to necessarily give them that great smile), but to obtain alignment so they can better keep their teeth clean. Good alignment allows your tools to do a better job for every tooth! Furthermore, if they need restorative service it is easier and better for me to restore, and with a good restorative result, you can keep everything clean long term! Finally, if orthodontic treatment improves your smile, that is icing on the cake! By the way, the three functions that teeth provide are; speaking, mastication, and to smile with. Esthetics, with a great looking smile is that function that everyone wants and for some, will sometimes require greater effort to achieve. I do consider esthetics and your smile equally valuable with the other two, but it should never supersede their function. Through maintaining health in your oral cavity you can maintain their function. And through maintaining a healthy and normal “masticatory apparatus”, you can keep a great smile!
Besides that alignment and function issue, now, let’s keep it clean with good oral hygiene! You should begin by having an assessment of the health of your periodontium (gingiva and bone) and knowing what it is. Your dentist and hygienist should generally due an annual assessment with periodontal probing which maps out the topography of your supporting structure. If you already possess and maintain a healthy periodontium, some people may not require it as often, but it’s a good idea to keep an eye on it. Periodontal disease is a progressive disease and is generally very quiet, until it gets big! With the periodontal charting (topographical map) that has been obtained, flat plains and gentle rolling hills are best with probing depths ideally of 3 mm or less. Generally speaking, steep hills and valleys are not good and tend to exhibit chronic disease with bleeding which is a sign of gingivitis and inflammation. Also, as studies have come to evidence, there is a correlation between people who have chronic oral inflammation as having a greater prevalence to develop coronary artery and other heart disease.
Once your team knows you, they will make recommendations regarding how, and how often. I will say that if you like and trust your hygienist, I will always encourage you to follow their recommendations. That is because they generally know, between their knowledge and training they have gained through education, and the experience they have gained from the opportunity to see what goes on in a lot of people’s mouths. Plus, if you stay with one person they can get to know your habits and abilities. If you don’t like or trust your team, then find a team that you do, because remember, these are your teeth. Since there are areas that are difficult for you to maintain on your daily basis, your hygienist will recommend a frequency of professional cleanings based upon your tendency toward formation of plaque and calculus, and your ability to remove it. I personally believe it would be hard to get your teeth cleaned professionally too often, and if you do have a tendency to form more deposit of plaque and calculus than normal, you might do better with 3-4 cleanings per year. I would listen to your hygienist, and if you don’t agree, maybe compromise. Sometimes the care of a specialist (Periodontist) is desired or needed depending upon your history, or if irreversible damage to your supporting structure has occurred.
When you have your teeth professionally cleaned, the purpose is to clean all areas and getting to some of those hard to get to areas and it should not necessarily be painful. If it is, that can generally be more a sign of disease, and an area that perhaps needs cleaning more than other areas, and not necessarily a sign of a bad cleaning. Some areas can be more tender/sensitive than others and if there is something about your cleaning that makes it unbearable, or keeps you from coming in, you should talk to your dentist/hygienist about pain management during your cleaning. It could be as simple as using warm water for your cleaning or taking a pre-treatment dose of ibuprofen. Whatever it takes, and remember that a cleaning that you don’t feel or is too fast does not mean it is a good cleaning. And, while you want to get to know your hygienist and develop a relationship and trust, it should not be social time either because you’ll never get anything done. Now that your teeth are clean, your assessment has been made, and perhaps recommendations on techniques or specific tools, do your best daily!
When the hard tissue of your tooth becomes affected from decay, some sort of filling or restoration is usually necessary. What happens to teeth can sometimes be mechanical and trauma related, but generally is due to decay which is in part a microbial disease, and is basically a chemical process. When the hydroxyapatite crystals of your enamel are exposed to a low chemical pH in the acid range, the crystals that make up your tooth are affected (“softening the tooth”) from the area of acid contact. Since plaque is loaded with acid, when it is allowed to stay on the tooth for too long/too often it will generally lead to the formation of a cavity or “white spot lesion” underneath that area. Another way our teeth will be exposed to acid is with certain foods and beverages. All carbonated beverages are usually in a pH range of 3.7-4.0 and if not a diet beverage, they can be loaded with sugar. Therefor frequent consumption of carbonated beverages keeps the pH or your oral cavity into an acidic range which is very detrimental to the enamel and root structure.
Since most of the carious process is due to acid exposure through diet and lack of proper hygiene it is important to develop good habits early in life. Habits are usually learned through family and social upbringing/diet, and if decay “runs in a family” it has more to do with living under the same roof. If there is a genetic prevalence toward the development of decay it would have more to do with the size and shape of the teeth perhaps, as well as being due to the nature and pH of your own body’s saliva. Some peoples' saliva will be more basic (not acidic) than others. When the saliva is kept in its normal basic range it is more able to neutralize acid exposure. Those same people will also be more likely to form tarter because of that basic pH and resultant tendency toward mineralizing the plaque into tarter. As a common observation, with the pH necessary to mineralize the plaque, tarter formers are less prone to develop tooth decay. Therefore, I believe the formation of tarter is not all bad, as long as you have it removed regularly. Pop drinkers and people with a lower pH will tend to exhibit more plaque and less tartar, and also exhibit a higher prevalence of decay. Finally, this “pH” and oral environment is not always in our control because age and sometimes medications can have their effect on the quality of the saliva. Some (necessary) medications can have negative effects on the salivary glands therefor it is not always entirely due to diet and hygiene. When the benefits of a medication exceed the negative side effects, that person will need to be even more careful with their diet and hygiene, and consider supplemental fluoride treatment. I guess you just can’t get away from certain facts, that in order to keep your teeth in good order, for your lifetime, you need to take care of them.
If you are susceptible to tooth decay (regardless of the cause), you should consult with your providers about fluoride treatment programs available to assist you in your cavity fighting efforts besides diet, and oral hygiene.
During your pregnancy, get information from your oral health care providers as well as your obstetrician regarding dos and don’ts during your pregnancy. You generally would avoid any unnecessary medications, and keep with excellent nutrition. Remember, some of your child’s teeth are forming while in utero. Keeping up your normal good hygiene is also very important, not necessarily for your baby (although it can’t hurt) but more for you. More for you, because during your pregnancy, with all your hormonal changes, you are more at risk to the effects of plaque and calculus and its associated periodontal disease. An exam and cleaning (without x-rays) should be done during your first or second trimester, as long as you are comfortable in the chair. It’s good to maintain your regular visit for hygiene purposes and educational purposes, but also to make sure there is nothing that perhaps should be treated prior to your delivery.
Regarding your infant and child’s development, listen to your instincts, and your mother’s advice, but don’t be afraid to confirm those ideas with your dentist/hygienist. On occasion there can be opinions (“that a parent thought that’s what you were supposed to do”) that are just not good for your child’s teeth. Meeting a dentist for the first time with a toothache or just needing a filling can be a tough way for your child to meet the dentist! There is a lot of good information out there, and education can help you be a friend to your child’s teeth. Baby teeth will begin erupting between ages 4-7 mo. and they serve a very important function! We want parents to implement early oral hygiene for their child. Not only can you help keep their teeth clean and begin to teach and practice good habits, but just in case there is something bad going on in there, you can see it! Also, perhaps equally important is not exposing young children to cariogenic foods, in part because of their effects on the teeth, but because they like it and psychologically and developmentally it can be hard to reverse.
At Centric, we recommend bringing your child to their first dental visit at age three, unless you see something sooner. While you will hear from other sources that you should take your child sooner, I like age three. I find at age three, they are cognitively developed enough to understand they are going to the “tooth doctor” and therefore cooperative, but also because you can generally catch them before they might have a problem. Good Luck!
In Dentistry, besides the biological materials of the body that we work with, (both hard and soft tissues), there are too many different materials to address. What most people are interested in are the restorative materials they can choose from when needing some type of restoration or crown. While old fashioned, gold is still perhaps the best material for posterior teeth when they are requiring some type of crown, even if on an implant. When gold has so many qualities that just fit for what is best for a tooth (and opposing tooth), and if it doesn’t show I believe it can be a good idea. Other metal colored restorations will either be a casting using a less precious metal or an amalgam. By definition, an amalgam is an alloy of mercury and another metal or metals. This in itself is a heated topic of opinion, with its use in the oral cavity. I do know that the new amalgams are of very low mercury, and at times they provide a very serviceable restoration for that patient who needs it. Nowadays however there are so many other good materials to choose from that you certainly should never have to use it if you do not wish. In my personal experience of 30 years, the thing that I have seen change the most in dentistry is the development of materials (particularly tooth colored), and the bonding of those materials to enamel and dentin. The “delivery of care” I believe is the other thing that has also changed a fair amount.
On permanent first molars and teeth exposed with your smile, I prefer using tooth colored restorations and crowns. They will either be made of some composite material (plastic) which is bonded to your tooth, or porcelain. Porcelain is more like “glass” and can be bonded or cemented depending upon its application. Porcelain certainly has the advantage and ability to maintain its color and “look” better than the composites, although improvements have been made in the color stability of composites. On the other hand composites sometimes have an advantage of reversibility, whereas most porcelain restorations require preparation of the tooth and are therefore irreversible. Both choices will have their advantages and disadvantages, and generally be sometimes site specific or result specific. If you need something done, don’t be afraid to ask about your restorative material choices.