Last partial update: July 2016 - Please read disclaimer before proceeding
Dental caries (Tooth decay)
Dental caries is the most common disease known to man. It is due to acid, produced by bacteria in the mouth, that slowly destroys the hard tissues of the tooth and can occur as soon as teeth are present in the mouth (i.e. in young children). Over the past few decades its incidence has decreased dramatically in communities where artificial fluoridation of the water supply is practiced. In most cases dental caries can be avoided by good health prevention that includes the following.
- Regular visits (at least yearly) to the dentist from the age of three. (Unfortunately, a recent (July 2016) survey found that only about 25% of Australian children had seen a dentist by the age of four years.) A dentist can help with preventative advice, applying fluoride, removing solids that accumulate on teeth, and arresting the progression of existing disease.
- Regular brushing of the teeth at least twice a day. In the morning after breakfast and before going to bed are the best times. Adequate tooth brushing takes about two minutes. Good technique is essential and can be learned from a dentist. The use of dental floss to remove food from between teeth aids greatly in this cleaning process and should be done after each brushing. Tooth-picks and the like are not useful and can harm gums.
- If your water supply is not fluoridated, then you should purchase supplements to add to your water. This principally applies to people who use tank water or bottled water for drinking. Fluoride used in recommended quantities causes no health problems.
- Eat wisely. Try to eat regular, larger meals and avoid snacks. Continually grazing on food, especially sweet foods, provides ideal growing conditions for the bacteria that cause dental caries. This is a particular problem for teenagers and young adults who often tend to disregard both their teeth and their general diet.
- Restrict intake of carbonated soft drinks, cordial and new ‘energy drinks’, including the ‘diet’ varieties. They are a significant cause of tooth decay as most are slightly acidic and this extra acid makes decay occur more quickly. Limiting these drinks is especially important in children. Fruit juices are also generally acidic and excessive amounts, especially if they have added sugar (avoid these altogether), can accelerate tooth decay.
- Baby-bottle caries: Letting an infant suck on a bottle filled with sweetened fluids for a prolonged period is a particular problem. These fluids can be fruit juice, cordial or milk. This problem is worse if the bottle is given at night as saliva flow is low at this time and this increases acid production by bacteria.
- Try to avoid children taking syrupy medications, as many of these medications contain sucrose (sugar) which can increase the likelihood of caries developing. Often there is a sugar-free alternative available. If there is not, then avoid taking the medication immediately before going to bed as it is a greater problem if left in the mouth overnight. Also, ensure the child’s teeth are brushed after the medication is taken. This issue is mainly a problem when such syrupy medication needs to be taken for prolonged periods e.g. antibiotics for otitis media or antihistamines / cough syrups.
- Wine is also acidic and can increase dental caries. However, it is generally only consumed occasionally and usually with food. It can be a problem for wine tasters.
Teeth and fluoride
Fluoride is a very important in reducing the incidence of dental caries in our community.
Most water supplies have fluoride added to them and this provides adequate fluoride. However, it will only do so if the person drinks tap water. Bottled water and other bottled drinks generally do not contain fluoride.
People who do not get fluoride via their water supply and wish to take advantage of this very important tooth protective measure will need to take fluoride tablets.
Fluoride is most important when teeth are forming as it is its incorporation into the developing tissues of the teeth that provide most benefit regarding resistance to tooth decay. This occurs from birth until about the age of six or seven. The use of fluoridated water from birth decreases tooth decay by up to 65 per cent.
Fluoride applications:
In older children and adults, fluoride can be applied to the outside of teeth to help reduce the amount of tooth demineralisation that acids cause in the mouth. This can be applied through the use of fluoride tooth pastes, gels, mouth rinses or foams. These products should be spat out and not swallowed as they are meant for topical use only. They are also not suitable for children under the age of six as they may cause fluorosis. (See below.) Dentists usually apply products with higher fluoride concentrations to teeth at check-ups.
Fluoride supplements:
Some water supplies in Australia are not fluoridated and these people will not benefit from this important preventative health measure. In the past fluoride tablets have been recommended as an alternative. However, there have been issues with ensuring people get the right dosage, with some children not taking enough to gain benefit and others taking excess and getting fluorosis. (See below.) The fact that most water supplies that are not fluoridated have a natural fluoride content means that people using this water will get some degree of protection and fluoride supplements should probably only be considered where the fluoride level in the water supply is particularly low; below 0.3mg/L. (It may also be considered in children at higher risk of developing dental caries.) The best option is to try to get a fluoridated water supply.
Fluorosis:
Ingesting excessive amounts of fluoride when the teeth are forming may lead to too much fluoride being incorporated into the teeth and this can cause yellowy flecking marks in the teeth. If intake is very excessive, it can also cause pitting and chipping of the teeth. This process is termed fluorosis. It usually only occurs when children under the age of six use high-fluoride content tooth paste and swallow the paste rather than spitting it out, thus ingesting far more than they would normally get from the water supply. The risk can be minimised by ensuring that children under the age of six use reduced fluoride tooth pastes specifically designed for young children and avoid swallowing tooth paste. To ensure that this occurs, children under the age of six should be supervised when brushing their teeth.
A whole permantent tooth that is traumatically dislodged from its socket can usually be saved. The most important thing is to get it back into its socket as soon as possible. (Within a minute / minutes is best; half an hour at a maximum.) The following guidelines should be followed.
- The tooth should be picked up by the crown (shiny white part) only. Do not hold the root.
- Be gentle.
- The tooth may be washed with some normal saline to remove debris (i.e. dirt etc). If normal saline is not available, the person can clean the tooth by just licking / sucking it, being careful to hold it securely so that it is not inhaled / swallowed. (This should be done by the person who has lost the tooth.)
- The socket where it came from can be rinsed gently with normal saline to remove any blood clot that has formed in it.
- The tooth should then be reinserted gently, paying attention to its placement so that it looks like it is in its normal position (i.e. not rotated). Comparing it with an adjacent tooth is helpful.
- The tooth should then be held in position as best as possible with something such as ‘Blu-Tac’ or aluminium foil.
- The person should then be taken to a dentist as soon as possible to have the tooth examined and have it held in position more securely.
- If there is any delay in the insertion process, the tooth should be stored in milk or normal saline. This often happens when there are other, more serious injuries that need more immediate attention. While the tooth can be stored in such mediums for long periods, the sooner it is re-inserted the better the chance of keeping the tooth.