Oral Hygiene and The Fight Against Tooth Plaque

The War on Plaque: What is a Cavity?

Living on the surface of your teeth are tiny villages of plaque, mostly made up of bacteria. These villages of plaque, if not removed often through teeth brushing, will become permanent cities, called tarter. The resulting habitation of theses villages and cities results in tooth decay. A hole of tooth decay will grow bigger and deeper over time into something no one wants to hear they have: a cavity.

The Cavity

A cavity, or a hole in the tooth, is a direct result of tooth decay. Simple enough, right? When that sticky, pesky plaque decides that it is going to begin calling your teeth home, it is time to brush your teeth. Some toothpaste and a little bit of elbow grease can easily remove temporary plaque villages. However, as humans are very busy creatures, tooth brushing is sometimes missed. Plaque takes this opportunity to lay down semi-permanent foundations of a city, called tarter. Tarter is just like plaque but very hard, and can only be removed by a dentist or dental hygienist. Both plaque and its relatively harder tarter are mostly made up of bacteria (Inga, 2011).

While plaque and tarter are what we physically observe as the source of cavities, it is the bacteria making up plaque, which actually causes cavities. This bacterium begins producing acids, which eats away at the tooth enamel, or the tooth’s outer layer. Quick action through the physical removal of the bacteria through proper oral care can prevent further decay. If removed early enough, the enamel will be able to strengthen its weak spots. There are even fortified mouthwashes that claim to regenerate enamel. This is only partially true, for enamel can only be restored in the early stages of decay. Enamel is very strong and its power of tooth defense should not be underestimated. It acts as a one million-man army does defending the inner parts of the country under attack. Like a large army, is the forefront of protection for the inner tooth and is very strong. It can also able to regenerate in early stages of defense, like a field hospital is able to restore the wounds of infantrymen. After much of the enamel is eroded through, like when an army suffers mass casualties, enamel is unable to regenerate and protect the inner tooth. A breach in the enamel and the resulting hole in the tooth is a cavity and must be repaired by a dentist to avoid further infection, recognized by many people as a persistent pain (Inga, 2011).

So why do people need to get a cavity filled? Patients often wonder why they need a filling if their tooth does not hurt in the first place. Redbud dental explains, “maintaining teeth is similar to maintaining a car engine”. In other words, by waiting to change your oil until the engine begins to have problems, the repair is going to be more complicated. Becoming more complicated is not just the mechanics problem; it is the consumer’s problem as well. These larger issues will be more expensive and time consuming to fix. Teeth are the same way (Redbud Dental, 2012). If there is a small hole, or cavity, in a tooth, the filling is generally small resulting in quick and relatively cheap fix. A small cavity can be easily fixed in less than 30 minutes at a general dentist as costs around $150- $300 (Legacy Dental). On the other hand once the hole is allowed “into the middle of the tooth which contains a soft tissue,” or pulp, where the nerves live, the tooth is going to begin to hurt. A large hole, or cavity, often infects the pulp, which is the soft center of the tooth containing the nerves. The fix to this problem often requires more time and will cost more in the form of a root canal, where the pulp is cleaned out, and a crown, where the entire top of the tooth is replaced by a lab made, artificial cap (Redbud Dental, 2012). A large cavity requiring this much work can require multiple office visits, a referral to a specialist, and a financial burden upwards of $2000 (Legacy Dental). Unfortunately, because the infection of the pulp is the beginning stages of tooth death, if a person younger than middle age were to get a root canal, it is still “unlikely to last the rest of the person’s life” (Redbud Dental, 2012).

While up to this point, fixing a cavity often means being able to keep a tooth, the longer decay is kept in place, the more the tooth will hurt and the more likely the tooth will not be saved. When bacteria enter the soft tissue or pulp, as stated before, sensitivity begins. It worsens as the soft tissue swells from infection, like a swollen thumb will swell from slamming it in the door. The swelling of a tooth, conversely, is held captive in the dentin, or hard bone like material of the tooth, and exerts pressure of the walls of the tooth. This swelling and increasing pressure results in the cutting off of the blood supply to the tooth. This is when the tooth is dead beyond repair (Redbud Dental, 2012).

External Factors

Although regular maintenance of one’s mouth through regular tooth brushing, flossing, and a visit to the dentist can help avoid cavities, diet also plays a huge role. From the beginning of dentistry, there has been a recognized correlation between nutrition and good oral health. The healthier a diet one chooses to follow, the healthier the gums and teeth of the person will be. Since dentistry is a clinical science, much of the research it uses is in the form of case studies. Let us look at a hypothetical case study of Jane Doe to examine the correlation between diet and oral health (ADA, 2002).

Jane is a sixteen-year-old female living in Chicago. As with all humans, Jane’s body is a “complex machine” that relies on a balanced diet and exercise to stay healthy and perform effectively. Jane runs cross country at her high school to stay active. While she gets enough exercise and tries to eat healthy on weekends, she sees nothing wrong with consuming large quantities of Gatorade to stay hydrated and having a quick fast food run after practice. With practice being four times a week and her drink of choice during her fast food run being regular coke, she does her part to contributing to the average “53 gallons of soft drinks-per person,” per year. With each soft drink Jane consumes, she is introducing up to 12 teaspoons of sugar to her mouth. Also, remember Jane drinks Gatorade during practice resulting in another 9 teaspoons per 20 oz. bottle (ADA, 2002)

At her dental appointment, Jane is in for a big surprise. While she brushes her teeth early in the morning before going to school and late at night before going to bed, her dentist tells her that she has a cavity in her back left molar. This is likely due to her poor diet. Jane’s large intake of sugars has an important affect on how quickly she is able to develop tooth decay. Every time she consumes sugar she is feeding the bacteria to produce acid. Every time she takes a drink of soda or Gatorade or every time she decides to snack on a snickers bar for quick energy, she comes in contact with sugar. Acid is produced at every occurrence where a bacterium is fed with sugar or starch, allowing an attack on the teeth for twenty minutes or more (ADA, 2002)

Dentistry- A History and Future

Back in 5000 BC, it is difficult to imagine how the Sumerians blamed tooth decay on the invasion of teeth by tooth worms. The little worms are thought to bore tittle holes in your teeth and hide inside. Some ancient doctors, in an attempt to remove these, “mistook nerves as tooth worms and tried to yank them out” While this is a primitive idea to most people, the ‘tooth worm’ theory lasted into the 1700’s, when it was proven false (Davis, 2012).

In Greece, Hippocrates and Aristotle are the dentists writing about tooth extractions as a way to “keep mouth pain away.” This method of ridding the mouth of decay continued into the Middle Ages where not dentists, but barbers, would extract teeth from their patient’s mouths. The barbers begin using a specialized type of pliers call a “Dental Pelican” and later a “Dental Key” to remove teeth. These tools are the ancestors of modern day forceps, again just a specialized plier, used in modern extractions (Davis, 2012).

“Modern” dentistry really begins between 1650 and 1800 with French physician Pierre Fauchard who is considered to be the “Father of Modern Dentistry.” Fauchard is the mastermind behind many modern procedures such as the dental filling. He also explains how acids from sugars are the source for tooth decay, not tiny worms. Modern density continues into the 1800’s with the founding of Baltimore College of Dental Surgery, now University of Maryland School of Dentistry, in 1840. It is also in the 1800’s that government regulation boomed, the American Dental Associate was formed for oversight, and Colgate mass-produced the first toothpaste in a jar. Visiting the dentist became a bit more bearable in 1905 when Novocain was invented as a local anesthetic (Davis, 2012).

As far as the future goes, there seem to be no limits when it comes to dentistry. Dr. Timothy Rose, a past president of the American Dental Association, emphasizes the path towards tissue regeneration and implant dentistry. Soft gum tissue regeneration is beginning its move toward the future through the use of tissue grafts. The grafting procedure is similar to repairing a rip in a hole-punched piece of paper through the use of a reinforcement label. When the gum recedes, or moves away from the tooth, a piece of gum tissue from another area is moved to protect the exposed part of the tooth. Additionally, hard tissue regeneration is limited but possible through the use of calcium phosphate in toothpaste to rebuild enamel. This is like introducing a chemical to promote a cracked sidewalk from filling its own cracks, increasing strength. In the same way, the calcium phosphate will induce re-mineralization of the enamel, which is very important to the integrity of a tooth (Rose, 2006).

While tissue regeneration is an important future of dentistry, the impact of implant dentistry is just as promising. Implants are already being made as porcelain teeth on a stainless steel rood screwed into the jawbone. While this advancement is huge given that implants can be used for a life time and look much like natural teeth, they are often expensive. The cost of a new implant can range anywhere from $1600 up to and over $2000 depending on the individual case. Implant dentistry and the replacement of lost teeth will be the treatment of choice in the future according to Rose. “Dentures hopefully won’t be the treatment” that dentist and patients agree on in the future. Drawing to a close a world of dentures and increasing the use of implants will be possible once new technology is formed to drive down current prices. Implants create a lifetime solution and are already slightly more cost effective over a long period of time as they require less follow up work and cause fewer problems. A fixed, in mouth appliance, is more stable and does not cause the bone recession and gum problems associated with dentures (Rose, 2006)

Dentistry has come a long way from its primitive tooth worm days. From pulling out nerves, thought to be tooth-decaying worms, to the use of implants and regeneration of diseased tissues, dentistry has undoubtedly come a long way in repairing cavities caused by tooth decay. Eliminating the sticky pesky bacteria in plaque may be near impossible but keeping it under control is the key to good oral health. Tooth brushing is paramount and should be the forefront in protecting ones teeth from invasion of acid boring bacteria. A toothbrush and toothpaste can be amplified through the use of floss and a mouthwash. Adults only have one set of teeth to use. Abuse them are they will be lost forever.