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Bacteria and Dental Disease

The two main dental diseases that account for much of the work dentists and hygienists do are

  1. Dental Decay (Dental Caries)
  2. Gum Disease (Periodontitis)

So, what is the common feature of all infections? They are caused my micro-organisms in the mouth and in the case of decay, these micro-organisms are BACTERIA

Bacteria ferment any substrate that comes their way (eg sugar is a substrate, a fermentable carbohydrate) and then excrete acids and other by-products. The acid is not good for the mouth. It increases your chances of decay. Other by-products of the bacteria-carbohydrate reaction can cause reactions in the gum.

Now, we all have bacteria in the mouth and we can never get rid of them totally. In fact we don't want to. We just want to control their numbers.

How can we do this?

  1. By keeping their numbers down by brushing and flossing to loosen them off the teeth and to remove them from the mouth (spitting down the sink) and using mouthwash to inactivate them on the tooth surface (some mouthwashes prevent bacteria from clinging to the tooth).
  2. By not feeding them too often - if you feed bacteria all day, they increase their numbers more quickly, they produce more acids and they create an environment in the mouth where you can get decay.

So, this is why you must not have fermentable carbohydrate in the mouth more often than occasionally in the day - meal times and occasional in-between meal snacks.

Do not

  1. Suck any sugared sweets, mints, throat lozenges for prolonged periods or
  2. chew sugared gum repetitively or
  3. sip sugary drinks all day or
  4. suck a sweet, mint or lozenge immediately before going to bed or

Case Reports from the Seaside Dental Files

CASE ONE

bulletProblem:   Male, middle-aged, smoker, rarely sees the dentist presents with generalised decay, with one tooth causing extreme pain. Apart from relieving the toothache, we investigate the cause of the decay and find that he sucks a packet of throat lozenges a day.
bulletSolution:   Remove this habit immediately or try a sugar free lozenge but try to not suck them at all if possible - work on smoking cessation - instruct on cleaning routines, regularity and technique.

CASE TWO

bulletProblem:  Female, over 65, reasonably regular with visits presents with new decay. After extensive interview we ascertain the problem - the patient suffers from dry mouth at night and does not want to get up or even sit up to to take a drink because she has trouble getting back to sleep. She has a bunch of grapes next to the bed so reaches over to get one when she wakes. This puts sugar all over the teeth for a prolonged period.
bulletSolution:   Remove this habit immediately and use a sports water container which can be squirted into the mouth without sitting up. Just water, no additive.

CASE THREE

bulletProblem:  Male middle-aged, reasonably regular with visits presents every visit for a year or so with a lot of visible plaque. We think he is not brushing much at all but he claims he does. He finally admits that he has mints in the car and is on the road a lot with his job. He sucks them to keep awake and had not realised the effect it was having on the teeth.
bulletSolution:   Remove this habit immediately. The use of sugar to keep awake is common and probably useful, but you don't need to suck sugar to get that effect - have a drink and send it straight down with a straw so it doesn't linger in the mouth. Better still, just use water when driving and snack when stopping for a break.

CASE FOUR

bulletProblem:  Child 2 years of age presents with decay. We suspect that the child is being given a bottle as a pacifier - it has access to a bottle all day. We find out that the bottle is being used both when the child is awake and roaming the house and in the cot when trying to sleep. Furthermore, it contains milk sometimes and dilute juice at other times. The child rejects it if it only contains water.
bulletSolution:   When the bottle is used for feeding, then it can contain whatever is being used to feed, but the child should only have access to it for the period of a normal meal, say 10-15 minutes. After that, the use of the bottle is not for feeding but for pacifying. That's OK, but when pacifying, the bottle should only contain water with no additive. The child may be rejecting water because it is straight from the tap. The taste of the water can be improved by using a simple filter.

 

 

 

 

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