Brush up on tooth cleaning
In the daily battle against dental plaque your weapons are a decent toothbrush and dental floss, says dental hygiene instructor Sgt Shirley Robinson.

Open wide: Preventing tooth decay requires daily attention; annual dental cleans are not enough. Photo by Cpl Bernard Pearson

Dental plaque is a tenacious, sticky substance, consisting of highly organised bacterial colonies in a gellike mass. In the mouth, plaque appears as a transparent film of bacteria that accumulates on the tooth surface every 12-24 hours. It initially forms as a thin, sticky film within minutes of brushing and flossing, and builds up as layers of bacterial colonies. Plaque cannot be washed away, so rinsing with either water or mouthwash will not remove it. Basically, plaque is germs. It has been shown to be the common risk factor in all types of dental disease.

Dental diseases

Dental caries is a disease of the hard structures of the tooth, beginning in the enamel, which is the super hard outer coating of the teeth. It is characterised by the destruction (demineralisation) of the mineral component of the tooth and begins at a microscopic level. This means there can be destruction of the tooth taking place long before you or the dentist can detect a lesion.

When there is an environment of bacterial plaque and a cariogenic diet (that is, a sugary diet, which includes soft drinks and sports drinks, which are sugary and acidic), acid forms in the mouth, which can result in demineralisation of the tooth surface and if left untreated, a carious lesion is initiated.

Acid formation occurs immediately when a cariogenic substance is taken into the plaque. This means, if you have plaque present in your mouth and you eat something containing sugar, acid will form immediately and the teeth are at risk of demineralisation.

The carious process is dynamic and occurs constantly in the mouth, this means there is a continuous process of demineralisation and remineralisation occurring at any time. When plaque is removed regularly and thoroughly, the carious process can be interrupted, but when plaque is not removed regularly and thoroughly for any period of time, the balance tips in favour of the acids and the carious process can develop at a rapid pace. The only solution to carious lesions is to see the dentist for restorative procedures, usually fillings.

Gingivitis is also caused by bacterial plaque. Gingivitis can be seen as red, swollen gums that bleed easily when you brush your teeth. It can occur when plaque is left undisturbed within three or four days. The degree of swelling and bleeding (inflammation) will increase gradually and after one or two weeks, gingivitis can be seen easily.

If left untreated, continuous build up of plaque bacteria in the mouth can spread to the tissues surrounding the teeth and the resultant damage can develop into periodontal disease. It is important to note that gingivitis in itself is completely reversible. When the bacterial plaque is removed and controlled with regular, thorough cleaning, the inflammation will disappear and the gums will become healthy again.

Periodontal disease (periodontitis) is a destructive condition that affects the supporting structures of the teeth (the ligaments and bone) and can develop if gingivitis is left untreated, particularly in susceptible individuals. Periodontitis can run in families and if your parents or grandparents have experienced the loss of teeth through this condition, then you may be in a high-risk category.

Periodontitis usually presents as a slow destructive process, attacking the periodontal ligament and surrounding bone, but in some cases it can be a rapid process resulting in tooth loss in some individuals as early as 25-30 years old. Periodontitis is not reversible, but with treatment, education and regular maintenance, the process of destruction can be slowed down and teeth can be retained.

Dental caries destroy the mineral component of teeth, causing decay.

What can you do?

The common factor in all of these dental disease processes is bacterial plaque. Daily removal of plaque is your best defence. Toothbrushing needs to be a daily activity, preferably twice a day, once in the morning and last thing at night. A soft, small-head toothbrush and a strand of dental floss are the tools required for effective and thorough plaque removal. The brush may be electric, battery operated or manual.

Brushing needs to be carried out in a pattern to ensure all surfaces of all teeth are cleaned. A suggested technique is: