Dental Disease Primer
Caries or tooth decay can start at any age.
The required elements for decay are susceptible teeth, bacteria in the mouth, and certain foods which contain sugar. The tooth decay process begins with a soft, sticky layer of bacteria called plaque. Within the plaque matrix are particular bacteria that metabolize the sugar and starches in the foods we eat to produce acids. The plaque holds this acid against the teeth. Each time this acid is produced it attacks the tooth enamel for about 20-30 minutes. These chronic repeated attacks begin to break down the enamel to create a cavity. Once this occurs, the cavity spreads inward to the center of the tooth called the pulp. At this point an abscess can form at the end of the root that causes severe pain. Treatment is needed to prevent further decay or this destructive process will result in tooth loss. Warning signs of tooth decay are:
• A tooth sensitive to heat, cold or sweets
• Pain during chewing
• Swelling or drainage at or below the gum line
• A white spot on a tooth
• A dark spot on a tooth
• Persistent discomfort in the mouth or sinus
Early Childhood Caries (ECC)
• A severe rapidly developing form of tooth decay in infants and young children
• Can effect all teeth however classically found in the front incisors which erupt first, at about 6 months, and are least protected by saliva
• Baby bottle tooth decay
• Nursing caries
Severe ECC may lead to...
• Extreme pain
• Spread of infection
• Difficulty chewing, poor nutrition, below average weight
• Extensive and costly dental treatment
• High risk of dental decay and crooked bite in adult teeth
• Poor self-esteem, behavioral and social interaction problems
• Speech development problems
• Lost school days and difficulty learning
How teeth develop decay
• Dental decay is the most common chronic disease of childhood:
6% of 1 year old
22% of 2 year old
35% of 3 year old
48% of 4 year old
Periodontal disease or gum disease is the leading cause of tooth loss in the adult population.
Although most tooth loss from periodontal disease occurs in adulthood, early signs of the disease may be witnessed in adolescents. Periodontal disease attacks the gums, bone, and other structures that hold the teeth in the jaws. The toxins produced by bacteria in plaque inflame the gums, making them swollen and tender. Prone to bleeding, the tissues worsen as the accumulating plaque colonizes on the teeth and hardens into calculus (tartar) that collects under the gum line. Calculus cannot be removed by brushing and flossing. Only scaling by the hygienist or dentist can remove calculus. As plaque and calculus continue to form, the gums become red, swollen, tender, and prone to bleeding. This condition known as gingivitis can be reversed by thorough plaque removal and regular periodontal maintenance by the hygienist.
In many cases untreated gingivitis can lead to a more severe condition called periodontitis. Although gingivitis may progress to periodontitis it is not clearly proven that periodontitis is always preceded by gingivitis. In the most common form of destructive periodontal disease the gums pull away from the teeth, forming pockets between the teeth and gums. These crevices fill with bacteria, and become deeper. The gums, bone, and other structures supporting the teeth are seriously compromised and the teeth may pathologically drift and loosen. Surgery may be needed to save the teeth or they may have to be extracted.
Current research demonstrates that periodontal disease is a widespread disease that may not necessarily progress slowly and can eventually result in tooth loss.
Dental researchers now believe the content rather than the amount of plaque may play a more important role in the development of the disease process. It has only been in the past few years that researchers have been able to identify the specific microorganisms in plaque associated with various forms of periodontal disease. Other changes in thinking are that the disease is not generalized or slowly progressive. A patient may have one or more active sites, with the rest of the mouth showing no signs of periodontal disease. The disease may also move in bursts of activity rather than progress at a continuous pace. These new findings are challenging the profession to find new ways to diagnose and treat periodontal disease.
Other factors that may contribute to the progression of periodontal disease include smoking or chewing tobacco, metabolic diseases like diabetes, hormonal changes ranging from puberty to pregnancy, harmful habits presenting as clenching, mouth breathing and grinding, and finally growth and development processes such as misaligned teeth and a bad bite.
Warning signs of gum disease include:
• Gums that bleed on brushing and flossing
• Red, swollen or tender gums
• Gums that have receded from the tooth structure
• Suppurative exudate (pus) discharging from the gums
• Teeth that are loose or drifting
• Changes in the fit of the bite
• Persistent bad breath or a sour taste
Juvenile Periodontitis is a rare form of periodontal disease that affects adolescents and young adults.
Here the mouth appears healthy with little inflammation or discomfort. Loose teeth are the first sign of trouble. X-rays will reveal that the vital bone around molar teeth and upper incisors has been destroyed. Treatment may include surgery and antibiotic therapy by the Periodontist team member at Kids Dental.
Malocclusion refers to the irregular way teeth or jaws fit together. The causes of malocclusion can be inherited or acquired. Tooth size, jaw size, cleft palate, congenitally missing teeth, and other abnormalities are examples of inherited causes. Acquired causes include premature loss of teeth, mouth breathing and other harmful habits such as tongue thrusting and thumb sucking. If left untreated, malocclusion may cause abnormal pressure on the teeth, resulting in uneven wear and/or periodontal disease. Effective plaque removal is difficult to practice when the teeth are not in proper alignment. Malocclusion can also lead to digestive disorders caused by improper chewing. Speech, social and emotional problems may result if the malocclusion is not corrected. The treatment of malocclusion is provided by the Orthodontist team member at Kids Dental, a dentist who has additional training in this area of dentistry.
The most common sites of oral cancer are the tongue, floor of the mouth, lips, soft palate and tonsillar area. Since oral cancers vary widely in appearance, they are often difficult to recognize. This is why it is important to have regular check-ups and perform monthly self exams. The warning signs of oral cancerous lesions are:
• Any swelling, lump or growth located in the head or neck area.
• A sore that does not heal after two weeks
• White or red patches in the mouth or on the lips
• Repeated bleeding from the mouth or throat
• Difficulty in swallowing or persistent hoarseness
• In leukemia the symptoms are red swollen gums that are prone to bleeding
Early detection of oral cancer is critical. Regular screenings are performed at every
check-up appointment by the Children’s General Dentist or Pediatric Dental Specialist.