(4. It is also encouraged by acid - from foods, stomach, drinks, etc.)

We can control 1, 2, and 4, and to some degree, #3. This is where we place most of our "Preventive" efforts, and this is much of what is traditionally viewed as "preventive" dentistry.

1. BACTERIA (plaque) grows on the teeth every day and must therefore be removed. It converts sugar to acid, and the acid eats holes (cavities) in the teeth. If decay-causing bacteria are completely removed from the teeth every single day, there can be no decay.

Daily brushing and flossing, along with various other plaque-removing devices made for specific situations, if used faithfully and effectively will remove all of the decay-causing bacteria (plaque), and there will be no cavities.

2. SUGAR. Sugar is the substance that the bacterial plaque converts to acid to cause cavities. This conversion takes only 20 minutes from the time that sugar is consumed. It is therefore important that sugar be avoided, or if eaten, that it be removed from the teeth as quickly as possible.

The worst type of sugar is sugar that stays in contact with teeth for prolonged periods of time. This leads to a continuous, and non-ending acid attack.

Such sugars would include sticky foods (jelly beans, licorice), long-lasting candies that dissolve slowly (suckers, mints, cough drops, lozenges), natural dried fruits (raisins, dates, apricots, fruit leathers), repetitively-chewed sweets (non-sugarless gum), and often-used liquid sweets such as pop or several cups of coffee a day with sugar added.

Pop in particular is a double-edged sword. Besides the long-lasting sugar attack, mostly on the front teeth, it is extremely acidic. Acid is added to pop to give it that tart/sour refreshing "zing", and the acidic environment that results is ideal for the enamel-destroying efforts of the acid-causing bacteria. As a matter of fact, pop is so acidic (including diet pops) that it can and does destroy dental enamel by direct acidic destruction quite apart from the decay process. This is called acid-erosion, (hot link down) and can be quite dramatic and devastating.

A special mention is also in order for mints. They cause a particularly destructive type of decay typically found along and around the necks, and on the roots of teeth, where the slowly-dissolving sugar sits in the saliva.

They are commonly found in people who have recently quit smoking, and who are trying a different habit to help them break the evil weed. Unfortunately, it destroys their teeth in a very short time (several months of mints can be devastating).

The second instance is the patient who continually uses "breath mints". Ironically, the sugar in the mints very nicely feeds the bacteria that can cause bad breath, and the decay that results from continual use is a prime cause of really bad breath. All breath mints do is mask the underlying bad odours for a very short period of time, and they should be avoided. Far better to address the underlying bacteria than simply trying to mask the odours.

The third, and perhaps saddest instance where we see them commonly is in people with dry mouths. These are commonly elderly patients who are often on medications for high blood pressure or for heart problems. These often also cause a dry mouth. Many patients so affected try to combat the dry mouth by sucking on sour candies to stimulate the flow of saliva. Unfortunately, they also often have receded gums exposing the roots of the teeth.

The combination of exposed roots (no hard enamel to protect them), lack of saliva (no buffering capacity of offset the acid, and no liquid to carry away the sugar), and constant flow of sugar from the candies and mints to create a constant bath of acid is often devastating. Many seniors end up losing some or all of their teeth due to the very rapid and extensive root decay caused by dry mouth and mints.

Dry mouth, for whatever reason, should be combated by carrying bottled water to sip on. There are also artificial saliva solutions that can be purchased. Occasionally drugs can be prescribed to stimulate the flow of saliva.

Under no circumstances should mints be used for this purpose, and our advice would be to avoid using mints for any reason unless you know for certain that they are sugarless!

3. SUSCEPTIBLE TEETH

Some people's teeth are more susceptible to decay due to several factors. These include such things as the anatomy of their teeth (deep pits and grooves vs. relatively flat teeth), or receded gums exposing the roots where there is no hard enamel to protect them. They include crooked teeth which allow food to collect and make them hard to clean. They can also occur with old fillings with deteriorated margins or with previously decalcified teeth. This occurs due to such factors as braces that weren't kept clean, previously poor oral hygiene, or systemic conditions which affected the development of good enamel during the formation of the teeth in the bone.

They can also be more susceptible due to conditions such as radiation therapy for cancer, poorly buffered saliva, or diseases which decrease the flow of saliva. Properly buffered saliva in sufficient quantities to offset the acid attack of decay is an important factor in whether you get decay or not.

We try to offset the negatives of susceptible teeth several ways.

Deep pits and grooves can be sealed with plastic pit and fissure sealants to keep the sugar and bacteria out. They are also sometimes filled with very small bonded fillings if the pits are too deep for sealants.

Crooked teeth can be straightened and old rough fillings can be replaced or refinished. Your diet can be analyzed to see if you are putting your teeth at risk with the food and drink that you put in your mouth each day.

Finally previously decalcified teeth are treated by trying to cut off the acid attack of bacteria and sugar, getting rid of acidic foods and drinks in the diet, and attempting to remineralize the enamel where the acid attack is occuring. This is usually done with fluoride.

Fluoride is placed in our water supplies. It is in much of our toothpaste. It is applied professionally by your dentist if you are at risk for decay. Fluoride helps to catalyze the remineralization of tooth enamel, and may also have some direct effect against the bacteria that cause decay. If you are at risk for decay, all of this can be analyzed and recommendations made on an appropriate course of action to try to maximize the amount of remineralization and minimize the ongoing amount of demineralization.

Periodontal Disease Prevention

Periodontal disease is disease of the supporting tissues of teeth, the gums and bone. In its simplest form, gingivitis, it is simply swollen gums that bleed when you brush or floss. In its worst form, periodontitis, the supporting bone is destroyed and teeth are lost.

Periodontal disease is caused by plaque, the bacteria that accumulate around the teeth, and which also can cause decay and bad breath. Periodontal disease usually smells very bad, another good reason why you want to prevent it from occurring.

It is made worse by several factors.

1. Genetics. A certain proportion of the population carries a gene which makes them much more susceptible to periodontitis, the most serious form of periodontal disease. This doesn't mean they are doomed to losing their teeth, but it does mean that they must keep their teeth extraordinarily clean to avoid this fate.
2. Smoking. A smoker is at the same risk of losing their teeth from periodontal disease as a person with the susceptible gene. If a person smokes and they have the gene, their risk is much greater than the simple sum of the two factors.
3. Several specific very bad bacteria or parasites can attack the periodontal structures and do a great deal of damage in a short period of time.
4. Systemic conditions such as diabetes, or other diseases or medications that affect the immune system.

As dentists, our main preventive measures are aimed at keeping the teeth and gums spotlessly clean. If there is no plaque, it is extremely unlikely that a person will develop periodontitis severe enough to lose their teeth.

Calculus (tartar) accumulates on the teeth when bacterial plaque is left in place long enough to pick up calcium from the saliva and harden in place. It is bad because it is rough, and thus forms an ideal place for more bacteria to collect. As these bacteria are left in place for longer periods of time, the types of bacteria in the place change, and these are much more likely to cause serious damage.

Thus it is important to remove the plaque at home on a daily basis so that the calculus (tartar) doesn't form, and it is just as important to have your teeth cleaned regularly so that any calculus that has built up can be removed. It does not come off with home cleaning, and must be professionally removed by a dentist or a hygienist.

How often you have your teeth cleaned depends on how much calculus you build up in a given amount of time, and whether or not you are at risk for periodontitis. If you have active periodontitis and build up calculus quickly, you may need to have them cleaned 3 - 4 times a year. If you have very clean teeth and have no risk factors at all, they may only need to be cleaned once a year. Everyone is different. Your dentist will be able to make a recommendation for your individual circumstances.

While we cannot yet control the genetics of periodontal disease, we can certainly control smoking. If you smoke, you should quit! There is nothing good about smoking. It is bad for your overall health, it is expensive, it is more and more viewed as socially unacceptable, and it is very, very bad for your teeth.

Once more … if you are a smoker, start today on a plan to quit!

Finally, the bottom line in all prevention for periodontal disease is clean teeth. We can only do so much. To be truly effective at preventing periodontal disease, you need to do your part to thoroughly remove all plaque on a daily basis. This means brushing and flossing effectively. We will instruct you on the tools and methods. But unless you take the time to actually keep them clean as directed, there is only so much that we can do as dentists.

Bad Breath Prevention

Most bad breath comes from your mouth. It can also come from your throat, your lungs and your sinus cavities. As dentists we can help you prevent the bad breath from your mouth.

Like decay and periodontal disease, the enemy in bad breath is bacteria. Once again, the goal is to prevent the accumulation of bacteria which cause bad breath. Clean healthy teeth and gums do not usually smell bad. Diseased gums and decayed teeth can smell horrible.

Prevention of bad breath of a dental origin involves brushing and flossing to remove food particles which will smell bad if left to spoil, and also to remove bacteria which also give off odours. Bacteria collecting on the rough surface of the tongue can also cause bad breath, and for this reason you should brush your tongue thoroughly once a day.

Foods such as coffee, garlic, spices, etc. have their own distinctive smell, and thoroughly brushing following these foods will help to minimize their effects. Again smoking is a prime cause of really bad breath, both from the odours of the chemicals in the smoke itself as well as the odours form the diseased tissues in the mouth, throat and lungs that can result from prolonged smoking.

If your oral hygiene is truly excellent and you are still experiencing bad breath, then it is important to see your doctor to rule out causes elsewhere in your body.

Cancer Prevention

Every time you come to our office for an examination or for your regular "check up", one of the things we are looking for is the presence of any lumps, bumps or ulcers that might be cancerous. Most are not … but some are. Oral cancer is quite curable if it is caught early. If it is advanced, the outlook is often not very good.

The big risk factors for oral cancer are tobacco and alcohol. The two together, especially when used to excess, are a bad combination.

Tobacco poses a risk not only from smoking, but also from smokeless tobacco (chewing tobacco). Once again, there is nothing good about tobacco. If you use it in any way shape or form, quit now!

The recent popularity of cigars is not good news for the future of oral cancer. We will strongly discourage the use of tobacco in all of its forms.

You can check your own mouth for changes that might be early warnings of oral cancer. If you develop white patches that don't heal in a few weeks, have them checked. Red patches that don't heal in a couple of weeks should also be checked. And finally, any ulcers or sores that do not heal in the expected amount of time need to be checked out.

While most such lesions are non-cancerous, and we will reassure you when they are, some others are not so clear and will require further investigation. We will refer you to a specialist for further examination and testing if we feel that the symptoms warrant it.

It is always better to be safe than sorry if you are not certain.

Tooth Wear Prevention

We seem to be seeing a lot of heavily and prematurely worn teeth. These occur due to a number of causes.

This is a concern because it affects appearance and can also make teeth quite sensitive. Shorter teeth in the front often look prematurely "old" while longer teeth are associated with youth. Excessive wear can also lead to loss of fillings as well as to failure of other dental work.

Habits such as gum chewing or nail biting can account for much of the excessive wear and chipping that we see. In general, teeth should not be used as tools to cut thread, open bottles, or cut fingernails.

Diet can also play a big part as acidic foods will seriously destroy tooth structure very quickly. Foods that are sour are acidic. This includes fruit, juices, vinegars, citrus fruits and drinks, and especially pop. In moderation they are fine, but in excess, they can be deadly to teeth.

The other place where we often see excessive wear is along the necks of the teeth where little grooves form which can become very sensitive, and in extreme circumstances, can lead to the tooth breaking off completely. These are often caused by excessive scrubbing with a stiff toothbrush, or can also be caused by excessive grinding of teeth. This grinding causes the teeth to flex, and researchers tell us that the result is loss of tooth crystals and the little grooves at the necks.

Finally, "parafunctional" habits cause much of the damage that we see. These are non-functional movements that occur between teeth, usually at night when sleeping, and totally unaware that it is happening at all. Sometimes the sleep partner will hear the grinding, or you may be aware that you awake with very tense jaws and even headaches. Your teeth may also hurt and be very sensitive as a result.

It is well-known that a certain percentage of night grinders (bruxers) are genetic grinders. It can be seen through several generations of the same family. Some are also affected by stress. Increased stress leads to increased grinding. Still others do it during the day as a habit, albeit subconsciously.

Our goal is to try to determine the cause, and if possible, stop it from occurring. If we are not able to stop it, then we try to control the effects, often with something called a "bite splint" or a "night guard". This is a little dental apparatus made from a mold of the mouth that fits over the teeth in hard acrylic which allows you to grind without damaging your teeth. They are simple and often effective.

Orthodontic Prevention

Orthodontics refers to the position of teeth and correcting the alignment of poorly-positioned teeth. Patients require orthodontic treatment when their teeth are crooked or are becoming crooked. Crooked teeth, besides being unsightly, can lead to decay, periodontal disease, excessive tooth wear and sensitivity, and occasionally worsen pre-existing sore jaws and muscles. Obviously it is desirable to prevent crooked teeth wherever possible.

In young children we often see habits such as thumb sucking or tongue thrusting that force teeth to grow into a crooked position. When caught early enough, corrective measures can often be taken to stop the habit and allow the teeth to align themselves properly.

In other cases, crooked teeth are inevitable and will require correction with braces, orthodontic appliances or both. But even then it is advantageous to catch the problem early, to take certain corrective measures at the right time, and to help guide the teeth and jaws into the best position possible in preparation for the braces. In many cases such intervention prevents the later need for surgery.

Finally, when teeth are post prematurely (due to accident or decay), leaving the space open can often lead to other teeth tipping or migrating into the open space. This often leads to increased decay, insufficient space for other teeth to erupt, or to teeth shifting off-centre. Anticipating these effects and planning treatment to prevent them is a large part of what we do.

Sports Prevention

When teeth become damaged, they are damaged for life. Although dentistry has come a long way in repairing damaged teeth and replacing missing teeth, there is still no substitute for your own teeth. We only make reasonable facsimiles of teeth.

If you play sports where there is a possibility of an unexpected (or expected) blow to the teeth, you need to wear a mouth guard to prevent injury to your teeth. Preventing the injury is far superior to trying to repair the damage after it has occurred.

Sports such as hockey, boxing, karate or lacrosse need no explanation. These are heavy contact sports where hitting is a part of the game and dental injury can be easily anticipated. But other sports such as baseball, racket ball and street hockey are not seen as "dangerous", and dental protection is often not on everyone's mind.

It should be.

Accidents happen fast, in friendly games between good friends.

If a tooth is literally knocked out and it is found, it should be brought along to the dentist. Replanting a tooth that has been knocked out can sometimes work quite well. In other circumstances it does not. Timing is important as is how you treat the tooth.

If a tooth is knocked out, if possible, transport it in milk. Water is not a good idea and success following transport in water will not likely be good. The sooner the tooth is replanted the better.

If a tooth is knocked loose (not out) the sooner you see the dentist the better. The tooth may need to be splinted back in position for a few days if it has been badly displaced.

Cosmetic Prevention

Everyone wants to have nice looking teeth. They are an essential part of an attractive smile.

What makes teeth attractive is colour, brightness, shape, position and proportion.

In general, "white" teeth are more attractive than dark teeth. Straight teeth are more attractive than crooked teeth. Nicely shaped and proportioned teeth are more attractive than misshapened and badly proportioned teeth.
To help you attain all of the desirable traits of nice looking teeth, we try to anticipate what will destroy that appearance, and help you to avoid it. If teeth have some undesirable appearance traits, we can help to overcome or mask them.

This is what cosmetic dentistry is all about.

Poorly coloured teeth can be dark due to external stains (smoking, coffee, etc.), or due to internal discolouration due to medications, heredity, certain filling materials, decay and excessive wear. External discolouration is removed by cleaning your teeth. Internal discolouration can be overcome by bleaching, changing old fillings, or masking the shade with porcelain veneers or crowns.

Crooked teeth can be straightened. Poorly shaped or proportioned teeth can be bonded, reshaped, or veneers or crowns can also be placed. Sometimes some "plastic surgery" of the gums is required to get the proportion you need for a nice smile.

If you are unhappy about the appearance of your teeth, be sure to mention it. There is often something we can do to help give you the smile you really want.

General Health Prevention

Many people are unaware of how closely linked their dental health is with their overall health. Many systemic diseases show up in the mouth, or affect the health of the mouth.

But there is growing evidence that the reverse may also be true.

There appears to be some connection between poor dental health and low birthweight babies in young mothers. There also appears to be a connection between poor periodontal health and certain forms of heart disease. Suggestions have even been made that there may be a link between poor oral hygiene and higher rates of pneumonia in seniors in nursing homes.

Dentists also have to be aware of all of your medical conditions and any medications that you are taking. Many affect how we will treat you, and many can affect the outcome of any treatment.

Be sure to let your dentist know about any and all medical conditions as well as any medications that you are taking. What may not seem to be important to you may indeed affect the success or failure of your treatment as well as help you avoid any unsafe situations caused by your medical condition mixed with dental treatment or drugs prescribed.