The tooth and nothing but

From speaking and eating to kissing or smiling, your mouth is perhaps the most multifunctional part of the human body. Of the mouth’s many functions, the most obvious are biting, chewing and swallowing food. The foremost tools in this process are your teeth.

Teeth And Gum Primer

Each of your teeth – most develop 32 of them – can be divided into two parts (see illustration). The visible portion is the crown. The portion hidden below the gumline is the root. The surface of a healthy crown is covered with enamel, a thin layer of calcified material which is the hardest substance in the human body. The outer surface of the root is covered by cementum, which isn’t as hard as enamel. Periodontal ligament, a connective tissue, binds the root cementum to the bone that forms the tooth socket.

Beneath the enamel and cementum lies the body of the inner tooth (dentin). Dentin is softer than enamel and cementum, but harder than bone. It surrounds the hollow tooth core (called the pulp canal or root canal), an area where nerve endings and blood vessels sensitize and nourish the tooth. Nerves and vessels feed into the pulp canal through an opening at the root tip.

A healthy tooth is surrounded by firm, pink gums (gingiva). At the edge of your gumline, your gum tissue folds back underneath itself before connecting to your teeth. This creates a snug, 1- to 3- millimeter groove around each tooth. This groove is called the gingival sulcus.

Healthy teeth and gums wouldn’t remain healthy for long without saliva. It’s secreted from glands throughout your mouth. One of saliva’s main functions is to protect your mouth from decay and disease. It does this by flushing food from your mouth, helping neutralize acids that can eat away at your teeth, directly killing or inhibiting numerous microbes, remineralizing tooth enamel and helping to heal wounds.

Plaque Attack

There are about 500 species of bacteria thriving in your mouth at any given time. These bacteria are constantly forming dental plaque, a sticky, colorless film that can form a difficult-to-remove substance called tartar. Depending on where plaque and tartar form, they may cause:

• Tooth decay (cavities). Almost every time you eat or drink, the crowns of your teeth come under attack. The oral bacteria in plaque feed on the sugars and starches in the foods and drinks you consume, converting them to various forms of acid. When acid-producing plaque clings to your teeth over long periods of time, the acid can progressively dissolve the enamel and dentin. Acid from foods and drinks such as citrus fruits or carbonated beverages – in addition to acid from stomach reflux – can also contribute to tooth demineralization.

• Gingivitis. This mild, early form of gum (periodontal) disease can cause healthy, pink gums to become red, swollen, tender and prone to bleeding. The swelling and tenderness associated with gingivitis is caused by your immune system’s inflammatory response to plaque or tartar buildup along your gumline.

• Chronic periodontal disease. This advanced form of periodontal disease may develop if plaque and tartar spread beneath your gumline. With chronic bacterial irritation, gum tissue may begin to detach from the teeth. As plaque and tartar spread into the pockets and continue to irritate the gum tissue, your gums may further detach from your teeth. Eventually, infections in the dark, airless pockets can destroy the tissue and bone supporting your teeth. Untreated, periodontal disease can progress until your teeth loosen and fall out. Chronic periodontal disease is the leading cause of tooth loss in older adults.

General Risk Factors

No matter what your age, everyone is susceptible to gum disease and tooth decay. But some factors may increase your risk. They include:

• Lack of fluoridated water. Fluoride helps fortify teeth, helping them resist cavities. It’s most effective when the teeth are developing. It’s been added to many public water systems, but not everyone had exposure to fluoridated water, especially those in rural areas.

• Poor diet. The effects of an unbalanced or inadequate diet often may appear in the mouth as tooth decay and gum disease.

• Frequent snacking. The more often you snack on sugary foods or sip sugary beverages, the more often you provide fuel for the cavity-causing bacteria and increase the acidity of saliva in your mouth.

• Genetics. In some people’s gums, an altered immune response may exacerbate periodontal disease.

• Tobacco use. Smokers are seven times more likely to develop gum disease than nonsmokers. That’s because smoking slows your gums’ ability to heal from bacterial damage – or even from a dental procedure. In addition, the practice of chewing tobacco has been linked to gum recession and root cavities.

Oral Hygiene

A professional cleaning by your dentist every 6 to 12 months – or more often if your dentist recommends it – is an important part of dental health. But what you do between visits is extremely important. Here are tips you can use to get the most out of your oral hygiene efforts:

• Use a toothbrush with soft, rounded bristles. Combined with gentle brushing, a soft-bristled brush helps minimize wear and tear on your gums. Replace your toothbrush every three to four months or when the bristles become worn, bent or frayed. Proper brushing can disrupt or remove plaque from your teeth and from the gingival sulcus groove between your gums and teeth.

Hold the brush so the bristles point at a 45-degree angle toward the gumline; that allows the tips of the bristles to slip in slightly under the gums. (If the toothbrush won’t fit horizontally to clean the inside of the front teeth, hold the brush vertically.) Use a gentle circular motion to clean the gingival sulcus groove along your gumline. Use a back-and-forth or up-and-down motion to clean the fronts, backs and chewing surfaces of your teeth. Light brushing on the rough surface of your tongue – especially at the back – and on your gums help remove additional bacteria from your mouth.

Proper brushing takes about three minutes – about the length of a song on the radio. Unfortunately, many people spend less than a minute at the task. If you brush properly, you need to do it only twice a day. Excessive brushing can actually damage the teeth just as inadequate brushing can.

• Floss. Gradually work the floss between the teeth with a sawing motion; then gently move the thread down slightly under the gumline. Curve the floss in a "C" around each tooth and sweep it up and down. Don’t snap the thread down into the gums, or continue sawing it back and forth once it has reached the gums. Thorough flossing takes at least two minutes, but it needs to be done only once a day.

For people with healthy gums, most toothpastes do an adequate job of removing bacterial plaque. Others recommend a fluoride toothpaste for an extra dose of cavity-fighting fluoride while you’re cleaning the plaque from your teeth. People who tend to accumulate tartar may benefit from a tartar-control toothpaste. However, such toothpastes don’t remove tartar; they just help keep it from developing. People with gingivitis may want to try a toothpaste which contains triclosan, an antibacterial agent shown to help fight plaque and gum disease. Mouth rinses can also help fight plaque and gingivitis.

Healthy teeth and gums aren’t a given. Brushing, flossing, adequate fluoride and getting regular dental checkups are all-important components in maintaining oral health, especially as you grow older. That’s because aging often brings changes that may make your teeth more vulnerable to gum disease and tooth decay. With many older adults now keeping their natural teeth, it’s more important than ever to make dental care a priority. With the help of your dentist, you can maintain healthy function of your teeth for a lifetime.