Dental Care

Overview of dental care

Oral health forms the basis of a healthy life. Proper hygiene conditions and healthy dietary habits are essential for maintaining the quality of oral health. The most essential aspect of oral health is “dental care”. It involves not only the health and hygiene of teeth but also the gums and the tissues of the mouth. Dental disorders are the leading causes of deteriorating oral health in the low and middle-income countries. In the long term, it might even lead to loss of teeth and gum bleeding. Recent reports by the World Health Organization suggest that 60-90% of school children and nearly 100% of adults suffer from dental cavities. This suggests that more stress on dental care techniques are necessary at the moment.

What is a dental disorder?

Dental disorders refer to decay of the teeth, gums, and tissues inside the buccal cavity caused by bacterial infections or anatomical defects.

It is a collective term for defects of enamel, dental abrasion and diseases of the gums. The most severe form of the dental disorder is dental caries which causes localized or major decay of the teeth enamel and calcified tissues.

There are no specific vulnerable groups for dental disorders. Children and adults can be affected equally due to dental problems. At present, dental disorders have become a major factor behind the loss of productivity and performance in different countries, especially the ones where awareness related to dental health is less.

What are the causes of dental disorder?

Dental health and care depend mainly on the lifestyle trends and dietary patterns in a particular geographical region or age group. The major contributing factors for dental disorders can be grouped into (1) Direct Causes and (2) Indirect Causes.

Direct causes: The direct etiological factors behind dental decay are discussed below-

• Teeth: Any deficiency (iron, zinc, fluorine, lead) in the composition of enamel can lead to reduced immunity against bacterial infections and cause decay. Anatomical defects of the teeth like fissures, occlusions (blockages), pits (buccal or lingual) can trap food particles and cause dental caries. These are more prominent in misaligned or crowded teeth.
• Saliva: Under normal conditions, saliva performs a “cleansing” function and protects the teeth from bacterial decay (due to the presence of enzymes like lysozyme and lactoferrin). But certain clinical conditions such as Xerostomia (oral dryness), Aplasia of salivary glands or lowered pH can cause an abnormal reduction in the secretion of saliva and trigger dental decay.
• Plaque: Formation of a thin membrane (plaque) on the tooth occurs due to microbial infection. It causes decomposition of the various organic and inorganic components of the teeth and impedes the “cleansing” of teeth due to lack of contact with saliva. This causes dental decay.
• Substrate: Consumption of refined carbohydrates (Eg: disaccharide glucose) adversely affects the dental health of an individual.

Indirect causes: There are numerous factors that indirectly precipitate dental decay. These are as follows-

• Loss of existing teeth and shifting of the adjacent teeth into the emptied space (edentulous space) which captures food particles within the gaps.
• Improper cleaning of teeth due to misalignment or crowding
• Recession or erosion of gums (due to gingivitis)
• Selenium present in the soil
• Cold climatic conditions
• Dietary habits (non-vegetarians are more prone to dental disorders than vegetarians)
• Excessive smoking and alcohol consumption

Symptoms of dental disorders

Dental disorder symptoms are very prominent in the early stages. Hence easy identification and early diagnosis is possible. The commonly observed symptoms are –

• Formation of cavities within the teeth
• Gradual deformation of teeth
• Yellowish discoloration of teeth
• Swollen and bleeding gums
• Loosening of teeth
• Dried up mouth
• Difficulty in chewing and swallowing
• Bad breath (due to teeth and gum infection)
• Tenderness of gums and teeth
• Receding and eroding gums
• Loss of teeth (in advanced stages)
• Swollen and painful parotid glands (salivary glands)
• Secretion of sticky saliva
• Mouth ulcers (in advanced stages)

Types of dental disorders

Depending on the region of occurrence and degree of infection, dental disorders may be classified into three main types- (1) Dental caries (2) Periodontal Disease (3) Malocclusion

• Dental caries: It is defined as the localized degeneration of the tooth surface which slowly penetrates the enamel and attacks the inner layers of the tooth. At the onset of enamel decay, lesions appear that cause a considerable loss of enamel opacity. The mineral content of the enamel slowly degrades (by about 30-50%). In the next stage, the layer behind the enamel, that is the dentin, is attacked, leading to occlusal dentin caries.

• Periodontal disease: Periodontal disease is the collective term for all diseases related to tissues supporting the teeth and gums. Two most common diseases of this category are- Gingivitis and Periodontitis. Gingivitis is a disease of the gum in which acute inflammation of the gum occurs along with discharge of pus at an advanced stage. Periodontitis refers to the inflammation of the gum and other adjoining structures of the teeth like teeth roots, external bone of tooth socket and supporting tissues. One particular form of Periodontitis that mainly affects children is “Localized Juvenile Periodontitis”. In this condition, bone loss (alveolar bone decay) occurs due to excessive erosion of supporting tissues.

• Malocclusion: Malocclusion is the dental disorder in which misalignment of the teeth present in the upper jaw bone (maxillary teeth) and lower jaw bone (mandibular teeth) occurs. This condition is usually triggered by genetic factors.

Diagnosis

For dental caries and cavities, dentists usually perform a dental probe to determine the cause and nature of caries. A dental radiograph is recommended in most cases.

Treatment & Prevention

• Dental Caries: Early detection of dental caries can help prevent tooth decay. The treatment usually involves the use of fluorides and following a list of preventive measures for tooth decay. In case the tooth decay has reached an advanced stage, the dentist will have to break in the enamel to repair the damaged tooth. This requires drilling (numbing agent applied to dull the pain) and filling the cavity created due to the decayed tooth. The most widely used filling materials are dental amalgam or composite resin.
• Periodontal Diseases: These can be treated by cleaning the pockets in the gums that surround the teeth thoroughly so that there is a negligible risk of infection. The most common techniques used to treat gum diseases and infections are scaling, root planing, and administering the required antibiotics. These techniques aim at removing plaque and tartar from teeth and keeping the oral cavity bacteria-free.
• Malocclusion: Cases of malocclusion are treated by an orthodontist. The error is corrected by wearing braces. In case there is overcrowding of teeth, it might require removal of one or more tooth. Once the teeth realign correctly after wearing braces, the braces are taken off and the patient has to wear a retainer till the teeth positions stabilize.

Prevention of tooth decay and gum infections can be done by following these important measures:

• Brush your teeth twice daily, especially before going to bed.
• Flossing and using a mouthwash regularly is equally important.
• Refrain from eating sugary and acidic foods. This includes candies, pretzels, aerated beverages, soda drinks, high-carb junk foods etc.
• Visit your dentist regularly. Don’t just wait for any dental issue to come up for making a visit to your dentist.

References