OPEN WIDE: Preventing tooth decay requires daily attention; annual dental cleans are not enough.

Photo: CPL Bernard Pearson

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

Brush up on tooth cleaning practices
It’s a daily battle against dental plaque – your weapons are a decent toothbrush and dental floss, says dental hygiene instructor SGT Shirley Robinson.

Dental plaque is a tenacious, sticky substance, consisting of highly organised bacterial colonies in gel-like 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 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.

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:

• hold the toothbrush at a 45-degree angle to the gum-line;
• use a gentle, circular brushing motion to remove the plaque;
• brush in this way on every surface of every tooth, the outside, inside and chewing surfaces;
• brush for at least two minutes each time;
• use a fluoride toothpaste for the extra protection of fluoride; and
• remember to change your brush regularly, either when it is worn or at least every three months.

• take a piece of floss about 45cm long and wind the ends around your middle or index fingers;
• grip the floss firmly with your index finger and thumb and gently guide the floss between your teeth using a side-to-side motion. Be careful not to snap the floss into the gums;
• gently scrape the floss up and down on each tooth to remove the plaque;
• move on to a clean piece of floss to clean between the next two teeth and so on; and
• as with tooth brushing, floss in a pattern so that no teeth are missed out.

• Mouthwash will not remove plaque and is not a substitute for brushing.
• Using toothpaste that contains fluoride will help to prevent tooth decay, as the fluoride gets into the enamel and strengthens it, any brand will do.
• Electric toothbrushes do give a better clean and studies show that two minutes brushing with some electric toothbrushes is the equivalent to eight minutes of hand brushing.
• Pregnancy does not leach calcium out of your teeth.
• A soft-bristle toothbrush will give your teeth and gums a better clean than a hard one and reduce the sensitivity of your gums.
• You should have a check-up at the dentist at least once a year to help prevent dental disease and prevent it developing further.
• Professional plaque removal and education measures, performed by a dental hygienist, are also essential in the prevention and early treatment of dental disease.

• For more information, visit the school’s web site at:
  http://intranet.defence.gov.au/NavyWeb/sites/ADF_Dental_School/.

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