Dental care

Dentists take the time to show patients exactly how to break up and clean away plaque with toothbrushing methods not the same as those most of us use; and they demonstrate the use of dental floss, not as most of us use it to merely dislodge food particles from between the teeth, but also to get plaque off the sides of the teeth. 

They send patients home with a supply of wafers and a little dental mirror to be used for self-checking on home cleaning. They take the time to recheck with wafers in the office on subsequent visits to make certain home care is effective. Ideally, the mouth should be cleansed immediately after a meal or snack. Practically, that is a difficult goal for many people. But these dentists emphasize that, because it takes 24 hours or more for plaque to reform, even a single thorough cleansing of the mouth at night before retiring can go a long way to minimize decay and gum disease.

And these dentists can point to patients, children andadults, with long histories of severe decay brought under control by educated home care. Among these dentists are periodontitis, specialists in gum diseases, who get only the worst cases referred to them-so far advanced that surgery to eliminate the deep gum pockets is necessary. But, typically, they will not operate until the patient is shown how to care for his mouth at home and goes on a prevention program for several weeks or even months. In virtually every case, these periodontitis report, they are able to demonstrate that the patient himself, with proper home care, can bring even the most advanced periodontal disease under control so that, once surgical repairs are made, there will be no recurrence.

 Under way today is a vast amount of research seeking additional preventive measures. Before long, anti-decay agents may be going into foods. Recent studies with children suggest that a chemical, sodium dihydrogen phosphate, added to breakfast cereals, can help reduce decay. Other work indicates that adding phosphate to chewing gum can be similarly helpful. In a dozen laboratories, scientists are busy trying to develop a vaccine that may immunize against decay-causing bacteria. Much other research is going on. But the preventive measures available right now can drastically reduce dental disease. 

Gum disease progresses in stages-pyorrhea-Plaque

Gum disease progresses in stages

 It starts with gingivitis, in which the gums become inflamed, swollen, and tender. Left uncontrolled, the inflammation advances and the gums begin to stand away from the teeth so that pockets are formed which harbor bacteria and pus. 

This ispyorrhea. As pyorrhea progresses, fibers holding the teeth in their sockets weaken and gradually the bone supporting the teeth is destroyed, and the teeth become loose and are lost. What starts the process?.There is now evidence-thanks to the brilliant work of many investigators, notably Dr. Sumter Arnim of the University of Texas, Houston- that, just as in tooth decay, bacteria are involved.

Clinging to the teeth and working on food particles to produce acid, bacteria also produce a material-a film called plaque-that covers them over, allowing them to work undisturbed. Plaque not only furthers decay; it triggers the formation of tartar, or calculus. 

And it is calculus that, spreading down below the gum line, irritates the gums, starts up inflammation and gingivitis, and opens the way for pyorrhea and gum disease progression. "Calculus cannot form unless plaque is present," says Dr. Irving Glick- man, Chairman of the Department of Periodontology at Tufts University School of Dental Medicine. "It's important for a dentist to remove calculus once formed; but it's also vital for the individual to minimize formation. In no other field of medicine can the patient so effectively assist in preventing and reducing the severity of disease.

Other factors may enter into decay and gum disease. In some caries- rampant individuals-those with far more even than the bad-enough average of decay-poor nutrition or faulty saliva flow may play a role; dentists can correct both. Faulty bite may help foster gum trouble; this can be corrected. But it is now clear that against both decay and periodontal disease, effective home care to prevent plaque formation is a prime weapon of prevention.

And more and more dentists are taking time to educate patients in proper home care methods. Recently, one of us spent two and a half months visiting such men in and around more than a dozen cities and in small communities. It was gratifying to see them lift bits of plaque from patients' teeth and place them under special microscopes so the patients could see for themselves the teeming colonies of bacteria in the plaque. 

Plaque on the teeth is invisible, but these dentists reveal it to patients graphically with a simple tool, a disclosing wafer. It's a small tablet containing a harmless vegetable dye. Chewed up, it stains the teeth temporarily, but only where the plaque is.