Does my dentist only look at my teeth – what’s in a comprehensive exam?
A healthy mouth is influenced by our diet, beverage consumption, medications that we may be on, oral habits and how we care for it.
Dental examinations/check ups is not just about teeth. Your dentist looks at
your whole mouth and jaw.
A healthy mouth covers:
- the soft tissues – your tongue, cheeks, gums; the hard tissues – your teeth, alveolar bone
- good quality salivary flow,
- the bite/occlusion and how it relates to your TMJ.(temporomandibular joint)
- growth pattern of the jaw (especially with children).
The soft tissue examination is really about abnormal tissue screening. An early pre-cancerous tissue change is what your dentist is checking for. This is normally associated with smokers, tobacco chewers, areas of constant trauma and in the elderly. The first signs of general health problems can also be reflected in the oral tissues.
When is the best time to bring my baby to the dentist?
It is never too early to bring your child in for a dental visit. Give your child a head start for a healthy mouth. Your child’s first tooth appears as early as 3-4 months and the full set erupts pretty much by 2-3 years of age. It is about familiriasation with the dental sights and sound.
Early childhood assessment is essential in identifying abnormal growth patterns. Diagnosing the need for early orthodontic intervention early is important so your child’s growth spurt can be taken advantage of. In particular with functional appliances that can assist in directing jaw development. Growth can also be monitored until the need for braces is indicated later.
In this way children can develop into dentally healthy adults with good set of dentition to serve them for life.
Pregnancy is an exciting time for expectant mothers. It is also a time of hormonal changes that affect oral health. The old wives tale ‘a tooth is lost for every pregnancy’ can be prevented with proper oral health care.
Some aspects to manage are:
- Food cravings – with more frequent snacks and possible high carbohydrate food there is a higher chance of dental decay. Maintaining oral hygiene is an important issue.
- Bleeding and swollen gums – hormonal levels changes the way the gums react to plaque and bacteria. (Pregnancy gingivitis). If severe it may need to be managed by your dentist. Scientific studies have also shown gum disease is linked to premature low-weight babies.
- Morning sickness – acid reflux from your stomach can cause erosion which dissolves the tooth enamel. Try rinsing out thoroughly with water instead of brushing straight away which may contact the remaining acid on your teeth.
- Your baby’s developing teeth– just as babies derive nutrition from their mothers’ diet so does your baby’s teeth. The primary baby teeth start calcifying in the 3rd to 4th month of pregnancy in the mother’s womb. You have to ensure your calcium intake from dairy produce or calcium supplementary is adequate according to the RDI recommendations.
Visit your dentist regularly. Elective treatment can be postponed but planning ahead is essential to manage any dental problems. A healthy mother is essential to your baby’s growth.
Newborns do not have tooth decay causing bacteria in their mouths. The bacteria can however be transferred to the baby by oral saliva contact. This is commonly passed from eating utensils or the dummy during food tasting, from the parents and carers. If you ensure the providers are decay free and healthy dentally it would make a difference to your baby.
What is bottle caries?
Infants and toddlers that are allowed to suckle frequently or for prolonged sessions are at risk of getting decay on their primary ‘milk’ teeth. This is especially worse while they sleep as there is less saliva flow to protect the teeth. Dummy dipped in sweeteners or fruit juice in a bottle has the same effect.
Bad Breath (Halitosis)
What causes bad breath?
Bad breadth is a common embarrassing social problem as well as a personal health issue. There are many different causes. Unpleasant smell is a result breakdown product of bacteria in the presence of saliva or body fluids. These produce smelly gases.
Some common sites of bacteria collection in the mouth are from the gum pockets surrounding the teeth, faulty filling margins, sites of food impaction between the teeth or under the gum flap of wisdom teeth and also under poorly maintained dentures that are worn overnight.
90% of bad breath originates from the mouth and 10% have other medical conditions such as stomach problems. Gum disease is the most frequent dental cause of bad breath.
The type of food you eat can contribute to mouth odor typically garlic, onion, spicy food, aromatic cheese, tuna and beef.
A dry mouth also contributes to bad breath. Smoking, alcohol and caffeine are the strongest drying agents in our lifestyle habits. Morning breath results from dehydration and lack of saliva during sleep.
What can I do to prevent bad breath?
- Regular checkups with your dentist can help prevent bad breath and allows your dentist to treat the bacterial sites
- Practice good oral hygiene with proper tooth brushing technique and flossing especially before sleep and waking up in the morning
- Don’t forget to brush the top surface of your tongue as well
- Chew sugar free gum for short periods to stimulate salivary flow
- Maintain good fluid balance e.g. rinsing after eating , drink plain water
- Avoid smoking, drinking coffee and alcohol
A mouth rinse can help but cannot substitute good oral hygiene.
Why is brushing important?
Daily tooth brushing and flossing easily removes plaque. Plaque is bacteria and food debris on the teeth and gums which irritates the gums causing gingivitis. After eating food that contains sugar and simple starch, the bacteria in plaque produces acid. This acid then attacks your teeth and causes cavities (decay).
What is the correct way to brush my teeth?
Proper tooth brushing is all about technique and being thorough. There are different ways but this is our favored technique.
- Always use a soft bristled toothbrush with a small head to reach your back teeth
- Angle the toothbrush bristles toward the gum line/the neck of the teeth
- Use a round circular motion and apply gentle firm press at a 45 degree angle towards the gums
- A back and forth motion should only be used on the biting surfaces of the teeth
- Be systematic and work your way around your mouth. It does not matter where you start but make sure you cover all surfaces
- Floss your teeth as the toothbrush cannot reach between your teeth effectively
- Spend at least 2-3 minutes to clean your teeth.
Why do I keep getting cavities even though I brush my teeth often?
After each meal or snack there will be food debris left behind. The more often you eat or drink beverages the more often you need to brush. It is not just sweet food but also healthy snacks can leave debris behind. This will allow bacteria to release acid which causes decay. It takes time for your saliva to buffer and dilute the acid levels in your mouth. Check your toothbrush, flossing technique and your time spent brushing.
- Cut down on frequent snacks, stick to your main meals
- Avoid grazing and prolonged sipping of beverages
- Drink milk or fluoridated tap water instead
- Brush your teeth after your meals/snacks if this is not possible then rinse out with plain water
- Chew sugar free gum. It stimulates saliva flow which is protective
- Visit your dentist to have a caries risk assessment and preventive program
Remember it is not how much you eat, or what you eat; it is how often you eat.
Why are my teeth sensitive to cold?
Often gum recession is the most common cause exposing the roots/neck of the teeth. This region does not have as thick a protective layer as the crown of the tooth hence irritates the nerve.
- Check proper toothbrush technique
- Use sensitive toothpaste (long term use)
- Use of recalcifying tooth cream (ask your dentist)
- Consult your dentist to rule out gum disease or broken/ leaky fillings, chipped tooth or decay
Why are my gums receding?
There is some correlation in the saying ‘getting long in the tooth’ with the associated wear and tear of age. However premature gum loss is normally caused by using a hard bristled toothbrush in combination with an improper ‘scrubbing’ toothbrush technique. Gum disease can also accelerate gum loss. Other times it is a result of passive eruption/growth of your teeth. What is the correct way to brush my teeth?
Why do my gums bleed?
In its mild form gum disease presents as gingivitis where the gums are swollen, puffy and occasionally bleeds and sometimes tender. Most of us have some level of gingivitis if we are a bit slack with our tooth brushing and flossing.
Plaque when left behind develops into ‘tartar’ (calculus) - a calcified deposit which causes further gum irritation. Calculus cannot be removed with tooth brushing unlike plaque. Your dentist will be able to remove it by scaling during your regular checkups. Once tartar deposits develop and mature, the gums begin to push away from the tooth and root. This causes gum pockets which are dark, moist spaces harboring bacteria. It left untreated develops into periodontal disease.
Periodontal disease is the progression to the more severe form of gum disease. It is the major cause of adult tooth loss. Deeper gum pockets develop as there is destruction of the bony socket that holds your tooth in place. The deeper the pocket the harder it is to maintain. This becomes self sustaining resulting in loosening and eventual loss of the tooth. In uncontrolled periodontal disease, your body’s immune system reacts aggressively to the bacteria and tartar irritation and adds to the bone destruction.
How can my dentist help me?
Prevention of gum disease is first and foremost about proper supervised oral hygiene care. The first step is to have your teeth professionally cleaned by your dentist on a regular basis. This has to be followed by proper home self care.
Gingivitis is a reversible form of gum disease if treated early. However bone loss that occurs in periodontal disease is irreversible. The key to successful management and treatment of periodontal disease is early diagnosis and treatment. Treatment involves removal of the deep seated tartar and bacteria harboring in the gum pockets. Periodontal disease can be stabilized if managed correctly in timely fashion.
General Health Conditions related to gum disease
Undiagnosed diabetes is a common concurrent health condition associated with severe uncontrolled periodontal disease. You should have this checked by your family doctor if in doubt.
Heart conditions like rheumatic fever require antibiotic cover prior to gum treatment. The species of bacteria found in the mouth is linked to heart valve involvement. Maintaining healthy gums with your dentist lessens the likelihood of infection spreading and worsening the condition.
Older adults face a different set of dental problems, sometimes a result of also having a different set of teeth.(i.e. dentures) A lot of these can be managed by proper professional dental care.
What can I do about my dry mouth?
As you get older, you might be on more prescribed medications for your health. The cocktail of medications may reduce your quality and quantity of salivary, frequently altering your taste sensation as well.
Dry mouth can increase decay incidence as well as cause gum problems. Saliva is important for protecting both teeth and gums. Lack of saliva can also affect the retention of your dentures.
Try drinking more fluoridated tap water, taking more frequent sips. It is important to avoid excessive beverage intake which may be conducive to decay. Artificial saliva replacements are also available at your chemist.
My teeth are wearing down, is this normal?
You can expect more wear and tear both on your gums and teeth. “Getting long in the tooth” occurs due to gum recession which could a combination of aging as well as toothbrush abrasion. What is the correct way to brush my teeth?
Gum recession exposes the root surface of your teeth which leads to higher susceptibility for root decay.
Use of fluoridated toothpaste will minimize this. Special interproximal toothbrushes – miniature ‘bottle brushes’ are available for you to slide between the teeth around the gum line. Food impaction is more common due to the recession.
Your dentist can also help cover the exposed root surface of teeth with preventive bonded fillings as well chemically treat it with recalcifying gel and fluoride.
Can wearing partial plates cause cavities?
It is not uncommon for partial denture wearers to have a higher decay rate. There is a need for removing the plates more often to clean your teeth as well as the denture. Food remnants can collect under the denture and the clips around the teeth which causes decay. Thrush (fungal infection) can also develop if dentures are kept too long in the mouth and not cleansed properly.
What should I do if my front tooth is knocked out? (Avulsed tooth)
The following procedure applies only to adult (second) teeth.
Speed is of the essence in replacing the tooth back into its socket in the correct orientation. (Preferably within ½ hour to an hour) If replacement is not possible, storing the tooth in a moist environment is crucial before trying to get to a dentist. Cold milk is the best, followed by saliva. Never scrub the root surface; it only needs a light rinse if it is dirty. Try to avoid tap water, milk is advisable. A tetanus shot would be indicated as well if there is soil contamination of any wounds. Seek professional dental help early.
With baby teeth it is probably better to leave it out as replacing it in the socket has a chance of injuring the adult tooth within. Adult teeth normally start eruption around 5-6yrs of age onwards.