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Dental health



Related terms
Background
Treatment
Author information
Bibliography
Prevention and self-management
Common dental problems, causes, and risk factors

Related Terms
  • Acquired immunodeficiency syndrome, AIDS, aphthous stomatitis, calculus, cancer, candida esophagitus, candidiasis, canker sore, cavities, chemotherapy, cold sore, dental caries, denture aid, erythroplakia, gingivitis, gingival bleeding, hairy leukoplakia, halitosis, hemorrhage, herpes simplex, herpes virus, HIV, human immunodeficiency syndrome, jaw clenching, leukoplakia, mucositis, oral cancer, oral leukoplakia, oral thrush, osteomyelitis, periodontitis, phenytoin-induced gingival hyperplasia, plaque, pregnancy-related gingivitis, stomatitis, Streptococus mutans, teething, tooth clenching, xerostomia.

Background
  • Dental health refers to the care of the mouth, which includes the teeth and gums. Taking good care of dental health can help prevent disease in the mouth and throughout the body.
  • The health of the mouth can be an indicator of the individual's overall health. Many serious diseases, such as diabetes, human immunodeficiency syndrome (HIV), and some eating disorders (such as bulimia), show their first signs as symptoms in the mouth, such as oral thrush (an overgrowth of yeast in the mouth). It is for these reasons that healthcare professionals recommend complete, yearly oral exams.
  • Dental problems include dental cavities, gum diseases (such as gingivitis and periodontitis), canker sores (aphthous stomatitis), mucositis, fungal infections, oral leukoplakia, and oral cancer. The most common oral health problems are cavities and gum disease (including gingivitis and periodontitis).
  • Most adults show signs of gum disease during their lifetime. According to the Centers for Disease Control (CDC), gum disease affects about 14% of adults aged 45-54 years.
  • Signs and symptoms of soft tissue diseases such as cold sores are common in adults and affect about 19% of those aged 25-44 years.
  • For every adult 19 years or older without medical insurance, there are three without dental insurance. Dental insurance is important, as the cost of dental procedures keep many individuals from seeking dental care, leading to problems such as tooth decay and gingivitis.
  • Approximately 70% of adults in the United States reported visiting a dentist in the past 12 months. Those with incomes at or above the poverty level are much more likely to report a visit to a dentist in the past 12 months than those with lower incomes.
  • During the past several decades, the percentage of older adults in the United States who have retained their natural teeth has increased steadily due to advances in dental healthcare.

Treatment
  • Dental caries: A tooth that has been destroyed cannot regenerate. However, using appropriate treatment, the progression of cavities can be stopped. The goal of treatment of dental caries is to preserve the tooth and prevent complications, such as pain and gum disease.
  • A dentist will remove decayed tooth material by drilling and replacing with a restorative material (called a filling) such as silver alloy, gold, porcelain, or composite resin. Anesthetics are usually used, such as novocaine. Nitrous oxide (laughing gas) may also be used. Pain medications, such as ibuprofen (Motrin®, Advil®), or opiates, such as codeine (Tylenol #3®), may be prescribed when needed. For those individuals who fear dental work, sedation with anti-anxiety agents, such as alprazolam (Xanax®) may be used. It is advisable in these individuals to have someone to drive them to and from the dentist due to the drowsiness caused by the anti-anxiety drug. Antibiotics, such as ampicillin, may be prescribed for any infection or the prevention of an infection.
  • Crowns are used if decay is extensive and there is limited tooth structure, which may cause weakened teeth. Large fillings and weak teeth increase the risk of the tooth breaking. The decayed or weakened area is removed and repaired using a covering jacket or "cap" (crown) fitted over the remainder of the tooth. Crowns are often made of gold, porcelain, or porcelain fused to metal.
  • A root canal is recommended if the nerve in a tooth dies from decay or from a traumatic blow. The center of the tooth, including the nerve and blood vessel tissue (pulp), is removed along with decayed portions of the tooth. The roots are filled with a sealing material. The tooth is filled and a crown may be placed over the tooth if needed.
  • Gum disease: The goal of treatment for gum disease is to thoroughly clean the pockets of bacteria around the gums and to prevent more damage. Many individuals with gum disease can be successfully treated with noninvasive therapies, such as scaling. If pockets between the gums and teeth are 5 millimeters or less in depth, the individual is a good candidate for scaling and root planning, sometimes in conjunction with antibiotic therapy. If the individual consistently practices good oral hygiene at home, this may be the only treatment necessary.
  • Scaling removes tartar and bacteria from tooth surfaces and beneath the gums. Scaling may be performed using instruments or an ultrasonic device. Root planning smoothes the root surfaces, discouraging further accumulation of tartar. In addition to these procedures, a periodontist may prescribe antibiotics, such as doxycycline (Periostat®) or penicillin (V-cillin K®), to help control bacterial infection.
  • Some dentists, for example, recommend antibiotic mouth rinses, such as chlorhexidene (Peridex® or PerioChip®). Others may insert threads and gels containing antibiotics into the space between the teeth and gums or into pockets after deep cleaning. These products appear to lower bacteria levels and may help prevent future problems.
  • However, in advanced periodontitis, where the depth of the pockets between the gums and teeth is more than 5 millimeters, gum tissue may not respond to non-surgical treatments. Surgery may be required in these cases. Deep pockets may need to be opened and cleaned. Loose teeth may need to be supported. Extraction (removal) of a tooth may be necessary for advanced periodontitis so destruction does not spread to adjacent teeth.
  • Canker sores: Canker sores usually heal by themselves in 14 days without any treatment. Various treatments are only useful to relieve the pain of the sores. People with canker sores can rinse their mouth with salt water. Salt water has antibacterial properties and may aid in healing the canker sore. Avoiding hot and spicy foods also helps to minimize pain. Pain relievers used for canker sores include viscous lidocaine (Xylocaine viscous®), an anesthetic that can be applied to the sore or used to rinse the mouth to numb the pain. However, although it relieves pain, it may interfere with an individual's sense of taste. Benzydamine mouthwash (Difflam®) can provide temporary relief from the pain of canker sores, but it does not speed up healing. Silver nitrate can also be applied to the sore to relieve pain. Severe canker sores may be treated with corticosteroid medications, such as dexamethasone (Decadron®) in a mouth rinse or prednisone (Deltasone®) taken as tablets. A doctor may give those with chronic (long-term) problems with canker sores vitamin B12, iron, or folate for nutrient deficiencies.
  • Leukoplakia: The usual treatment for leukoplakia is to remove the source of the irritation. For most people, quitting smoking or eliminating alcohol consumption clears the condition. When this is not effective or if the lesions show early signs of cancer, a dentist may choose to remove leukoplakic patches using a scalpel, a laser, or an extremely cold probe that freezes and destroys cancer cells (cryoprobe). These procedures are performed using anesthetics to numb any pain or discomfort. Recurrences of leukoplakia are frequent, so healthcare professionals recommend yearly checkups.
  • Oral thrush: It is essential to get treatment for thrush if there are any signs of the illness, such as white patches on the tongue. Oral thrush can persist for months, becoming extremely painful. A healthcare provider can prescribe medicated treatments to help restore the balance of yeast in the body. Prescription treatment generally involves taking a course of oral antifungal tablets, such as fluconazole (Diflucan®). Other drugs include nystatin (Nystatin® oral suspension), amphotericin (Fungilin® lozenges), or miconazole (Daktarin® oral gel).
  • Mucositis: Treatment of mucositis is mainly supportive, helping to alleviate redness and pain. Oral hygiene is the mainstay of treatment; individuals are encouraged to clean their mouth every four hours and at bedtime, more often if the mucositis becomes worse. Water-soluble jellies can be used to lubricate the mouth. Salt mouthwash can soothe the pain and keep food particles clear so as to avoid infection. Individuals are also encouraged to drink plenty of liquids, at least three liters a day, and avoid alcohol. Citrus fruits, alcohol, and foods that are hot are all known to aggravate mucositis lesions. Medicinal mouthwashes may be used such as chlorhexidine (Peridex®) and viscous lidocaine (Xylocaine viscous®) for the relief of pain. Palifermin (Kepivance®), is a human KGF (keratinocyte growth factor) that has been shown to enhance epithelial cell proliferation, differentiation, and migration. Experimental therapies have been reported, including the use of cytokines and other modifiers of inflammation (such as interleukin-1 and tissue growth factor-beta3), amino acid supplementation (such as glutamine), vitamins (vitamins E, A, and C), colony-stimulating factors, cryotherapy (freezing), and laser therapy. Symptomatic relief of the pain of oral mucositis is provided by barrier protection agents such as Gelclair®. This viscous oral gel can be diluted and used as an oral rinse. The film-forming agents within Gelclair® coat the oral mucosa shielding ulcerated tissues and protecting exposed nerve endings.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Academy of Family Physicians. .
  2. Academy of General Dentistry. .
  3. American Dental Association. .
  4. Centers for Disease Control and Prevention. .
  5. Dye BA, Thornton-Evans G. A brief history of national surveillance efforts for periodontal disease in the United States. J Periodontol. 2007 Jul;78(7 Suppl):1373-9.
  6. Heijnsbroek M, Paraskevas S, Van der Weijden GA. Fluoride interventions for root caries: a review. Oral Health Prev Dent. 2007;5(2):145-52.
  7. Naidoo S, Myburgh N. Nutrition, oral health and the young child. Matern Child Nutr. 2007 Oct;3(4):312-21.
  8. National Institute of Dental and Craniofacial Research. .
  9. Natural Standard: The Authority on Integrative Medicine. .
  10. Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet. 2007 Jan 6;369(9555):51-9.
  11. Worthington H, Clarkson J, Eden O. Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD000978.

Prevention and self-management
  • Management of dental problems begins at home. Taking care of the teeth and gums is very important.
  • Brushing and flossing: Thorough tooth brushing and flossing to reduce dental plaque can prevent dental caries and gum disease. Healthcare professionals recommend drinking fluoridated water and using a fluoride toothpaste. Fluoride's protection against tooth decay works at all ages.
  • Brushing the teeth after each meal and snack is recommended. Brushing after meals helps remove any food particles from the teeth. Food particles lodged in the teeth may lead to dental caries. Also, a soft toothbrush is best. Turn the bristles against the gum line and brush gently. Use small, circular motions. Brush the front, back, and top of each tooth.
  • Using dental floss at least once a day is recommended. Flossing helps prevent the buildup of plaque on the teeth. Plaque can harden and grow under the gums and cause problems. Using a sawing motion, gently bring the floss between the teeth, scraping from bottom to top several times.
  • Mouthwashes can also be helpful to remove dental plaque.
  • Keep dentures clean and comfortable.
  • Limit tobacco use: In addition to the general health risks posed by tobacco, smokers have four times the risk of developing gum disease compared to non-smokers. Tobacco use in any form, such as cigarettes, pipes, and smokeless (chewing) tobacco, increases the risk for gum disease, oral and throat cancers, and oral fungal infection (candidiasis). Chewing tobacco containing sugar increases the risk of tooth decay.
  • Limit alcohol use: Heavy use of alcohol is also a risk factor for oral and throat cancers. When used alone, alcohol and tobacco are risk factors for oral cancers, but when used in combination, the effects of alcohol and tobacco are even greater.
  • Diet modification: Adults and children should avoid snacks full of sugars and starches as well as limit the number of snacks eaten throughout the day. The recommended five-a-day helping of fiber-rich fruits and vegetables stimulates salivary flow to aid in decreasing tooth decay.
  • Regular dental checkups: It is recommended by healthcare professionals to visit the dentist regularly, preferably every six months for cleaning. Check-ups can detect early signs of oral health problems and can lead to treatments that will prevent further damage, and in some cases, reverse the problem. Professional tooth cleaning (prophylaxis) is also important for preventing oral problems, especially when self-care is difficult.
  • Other: If medications produce a dry mouth, drinking plenty of water, chewing sugarless gum, and avoiding tobacco and alcohol can be helpful in reducing the problem.
  • Have an oral health check-up before beginning cancer treatment. Radiation to the head or neck and/or chemotherapy may cause problems for the teeth and gums. Treating existing oral health problems before cancer therapy may help prevent or limit oral complications or tissue damage.
  • It is recommended by healthcare professionals to call a dentist right away if there are problems with the teeth, gums, and oral cavity.

Common dental problems, causes, and risk factors
  • Dental caries: Dental caries is an infectious disease that damages the structures of teeth. Tooth decay or cavities are consequences of caries. All individuals are at risk for getting cavities throughout their lifetime. By the time most people are adults, 85% of people will have had a cavity. Cavities are caused by the bacteria Streptococcus mutans, which can attach themselves to hard surfaces like the enamel that covers the teeth. If the bacteria are not removed, they multiply and grow in number until a colony forms. More bacteria of different types attach to the colony already growing on the tooth enamel. Proteins that are present in the saliva (spit) also mix in and the bacteria colony becomes a whitish film on the tooth. This film, called dental plaque, damages and decays the teeth and causes cavities.
  • Plaque begins to accumulate on teeth within 20 minutes after eating (the time when most bacterial activity occurs). If this plaque is not removed thoroughly and routinely, tooth decay will not only begin, but flourish. The acids in plaque dissolve the enamel surface of the tooth and create holes in the tooth (cavities). Cavities are usually painless until they grow very large inside the tooth and destroy the nerve and blood vessels in the tooth. If left untreated, a tooth abscess (pus enclosed in the tissues of the jaw bone at the tip of an infected tooth) can develop. Untreated tooth decay also destroys the internal structures of the tooth (pulp) and ultimately causes the loss of the tooth. Pulp refers to the softest part of the tooth that lies in its root and extends all of the way to the top part of the tooth (the crown). The pulp contains the blood vessels, the nerves, and connective tissue inside a tooth and provides the tooth's blood and nutrients.
  • Gum disease: Gum diseases include gingivitis and periodontitis. Gingivitis is inflammation of the gums that causes the gums to bleed and swell. Gum diseases are more often seen as people age, with most people showing signs of them by their mid-30s. Gingivitis is caused by infection or plaque around the teeth and is a common cause of tooth loss after age 35. The most common type of gum disease is gingivitis.
  • Periodontitis is a more serious type of gum disease. Periodontitis is a dental disorder that results from progression of gingivitis, involving inflammation and infection of the ligaments and bones that support the teeth. Plaque, formed from bacteria, hardens into calculus (tartar) when left on the teeth. As plaque and calculus continue to build up, the gums begin to pull away, or recede, from the teeth, and pockets form between the teeth and gums. As the gums recede, more bone and the periodontal ligament are damaged. Teeth - even healthy teeth - may become loose and need to be extracted.
  • Gum diseases such as gingivitis and periodontitis can be caused by numerous factors, including: smoking/tobacco use; genetics - up to 30% of the population may be genetically susceptible to gum disease; pregnancy, puberty, and menopause (hormonal changes can make individuals more susceptible to gum diseases); stress; medications, such as oral contraceptives, the anti-seizure drug phenytoin (Dilantin®), the immune system drug cyclosporin (Sandimmune®), and some heart medicines including nifedipine (Procardia®); clenching or grinding the teeth - clenching or grinding the teeth can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed; diabetes - diabetes makes the individual more susceptible to developing infections, including gum diseases; poor nutrition - vitamin deficiencies can impair the immune system, leading to periodontitis; and disease such as human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and cancer can impair immunity and lead to gum diseases.
  • It has been estimated that 50%-75% of women experience gingivitis during pregnancy. Pregnancy-related gingivitis is caused by increased hormone levels and is most common between the second and eighth month of pregnancy. The increased hormones result in more overall fluid retention throughout the body, which can cause swollen, red, and tender gums. Hormonal changes in pregnancy have also been found to reduce resistance to infection in gum tissue and to promote growth of certain bacteria and plaque (particularly increased levels of progesterone), which causes inflammation. Swelling and tenderness in the gums may be severe and cause bleeding. Untreated gingivitis may lead to periodontitis. Research has found an association between chronic gum disease and premature delivery. One well-known study reported that compared to mothers with healthy gums, pregnant women with chronic gum disease were four to seven times more likely to deliver prematurely. Experts suggest that pregnancy gingivitis can be prevented by proper oral hygiene both prior to and during pregnancy, including brushing at least twice a day (with a fluoride-containing toothpaste), flossing once a day, using an antimicrobial mouth rinse, and regularly scheduled professional dental cleanings. Following delivery, gums usually return to normal. If symptoms such as bleeding, sensitivity, swelling, and irritation persist after delivery or get worse, it is advised to contact a dentist.
  • Phenytoin-induced gingival hyperplasia is an enlargement of the gums. The gums can grow along the sides of, or over the teeth. Phenytoin (Dilantin®) causes gingival hyperplasia in approximately 50% of those who take it within two weeks to three months after initiation of therapy. This may progress to the point that the teeth are virtually submerged. Phenytoin is commonly used for seizure control.
  • Canker sores: Canker sores, also known as aphthous stomatitis or mouth ulcers, are common, but mostly harmless, sores. Stomatitis means inflammation of the mouth. Canker sores appear as ulcers (an eroded area of the oral cavity, marked by tissue disintegration) that are white or gray with a red border inside the mouth. They occur in women more often than men, often during menstrual periods. The reason why they appear is unknown but some experts believe that problems with the immune system, the body system that fights disease, bacteria, or viruses, may be involved. Fatigue, stress, or allergies can increase the chances of getting a canker sore. Canker sores tend to heal by themselves in one to three weeks. If an individual gets a large sore (larger than 1 centimeter), it may need to be treated. Canker sores are vulnerable to infection by bacteria in the mouth.
  • Canker sores are usually seen in children and adolescents from the ages of 10 - 19 years. For about one-third of the children affected, lesions continue to reappear for years after the initial outbreak. These ulcers are not contagious and cannot be spread from one child to another.
  • Oral thrush: Oral thrush is a fungal or yeast infection (candidiasis) in the mouth caused by an overgrowth of Candida albicans. Oral thrush appears as red or white lesions, flat or slightly raised, in the mouth. When severe, this fungus can spread down the esophagus, making chewing and swallowing very painful. They are common among denture wearers and occur most often in those who are very young, in the elderly, or in those who have a problem with their immune system, such as in cancer and HIV/AIDS patients. Individuals who have dry mouth syndrome (xerostomia) and those taking antibiotics may also get oral yeast infections. These yeast infections can be prevented with good oral hygiene, such as cleaning dentures appropriately and brushing the teeth.
  • Oral leukoplakia: Oral leukoplakia is a condition in which thickened, white patches form on the gums, on the inside of the cheeks, and sometimes on the tongue. The cause of leukoplakia is unknown, but it is considered to result from chronic irritation. Tobacco, either smoked or chewed, is the main cause, but irritation can also come from other sources, such as long-term alcohol use.
  • Leukoplakia is the most common of all chronic mouth lesions. Although anyone can develop leukoplakia, it's most common in older men. People with compromised immune systems sometimes develop an unusual form of the disorder called hairy leukoplakia. Hairy leukoplakia of the mouth is an unusual form of leukoplakia that is seen only in people who are infected with human immunodeficiency virus (HIV), have acquired immunodeficiency syndrome (AIDS), or AIDS-related complex. Hairy leukoplakia consists of corrugated, fuzzy, hence the name "hairy," white patches on the lateral borders of the tongue and less frequently elsewhere in the mouth. It may resemble thrush, an infection caused by the fungus
  • In general, leukoplakia is not painful, but the patches may be sensitive when the individual touches them or eats spicy foods. Although the disorder usually is not dangerous, a small percentage of leukoplakic patches show early signs of cancer. Many cancers of the mouth occur next to areas of leukoplakia. For that reason, it is best to see a dentist if there are unusual changes in the mouth lasting longer than a week.
  • The cause of leukoplakia is unknown. Many possible causes have been linked to leukoplakia, including tobacco, long-term alcohol use, and other chronic irritants. Tobacco use appears to be responsible for most cases of leukoplakia. The majority of individuals who develop leukoplakia are smokers, and most leukoplakic patches either improve or disappear within a year after stopping smoking. Chewing tobacco and snuff also play a key role. As many as three out of four regular users of "smokeless tobacco" products eventually develop leukoplakia where they hold the tobacco against their cheeks. Other factors contributing to leukoplakia include the fungus Candida albicans, which causes oral thrush, and human papillomavirus (HPV), the virus that causes genital warts.
  • Oral cancer is the most advanced stage of leukoplakia. Oral cancer most often occurs in people over the age of 40. It is often found at late stages when it is harder to treat. This is because oral cancer is not usually painful so individuals may not recognize the problem early. Also, many people do not visit their dentists often enough to find the cancer early. The most common sites of oral cancer are on the tongue, lips, and floor of the mouth. Use of tobacco, especially with alcohol, is the main cause for these cancers.
  • Chemotherapy or radiation treatments to the head and neck can cause dry mouth, tooth decay, painful mouth sores, leukoplakia, and cracked, peeling lips.
  • Mucositis: Mucositis, or stomatitis, is inflammation of the mucous membranes lining the digestive tract from the mouth on down to the anus. Mucositis is a common side effect of chemotherapy and of radiotherapy that involves any part of the digestive tract. Mucositis affects the rapidly dividing mucosal cells lining the mouth, throat, stomach, and intestines. These cells normally have a short life span. Chemotherapy or radiation therapy can destroy the cells quickly and they are not replaced right away. Destruction of mucosal cells in the oral cavity leads to ulcers or sores. Mucositis is painful, can interfere with eating, and may require pain medication for a week or two until the tissues recover.
  • Mucositis is also the primary cause of pain for patients undergoing bone marrow transplants due to chemotherapy and/or radiation therapies. Good mouth care is essential. Infection calls for prompt antibiotic treatment.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.



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