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Oral Health

Medically Reviewed by Michael D. Turner, DDS, MD

Department of Oral and Maxillofacial Surgery
New York University
New York, New York

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Overview

What Is It?
The mouth (including the gums, teeth and jawbone) is a "mirror for general health and well-being." Major oral health issues of concern to women include gum disease, dry mouth, canker sores, tooth loss and tooth decay.

Oral health goes far beyond having sound white teeth and no cavities. According to the U.S. Surgeon General's Report on Oral Health, the mouth (including the gums, teeth and jawbone) is a "mirror for general health and well-being."

Major oral health issues of concern to women include gum disease, dry mouth, canker sores, tooth loss and tooth decay. Researchers also have found that people with periodontal disease (gum disease) have an increased risk of stroke, diabetes and respiratory problems. A significant association between obesity and prevalence of periodontal disease, especially among individuals aged 18 to 34 years, has also been established. Low dietary intake of calcium and vitamin C are cited as probable causes.

In recent years, there has been an increase in female smokers. A significant association exists between smoking and periodontal disease and oral infections. Smoking decreases the blood supply to the oral tissues, making the teeth more susceptible to gum disease, and more importantly, oral cancer.

Women's oral health care needs change at specific times during the lifespan. Nearly one out of four women between the ages of 30 and 54 has periodontitis (an advanced state of gum disease in which the bone and gum tissue that support the teeth are breaking down). In addition, nearly half of women ages 55 to 90, who still have their teeth, have periodontitis. And a recent study published in the Journal of Dental Research from the Centers for Disease Control and Prevention and the American Academy of Periodontology (AAP) found that the prevalence of periodontal disease in the United States may have been underestimated by up to 50 percent. The study suggests that more adults may suffer from moderate to severe gum disease than thought previously.

Because gum disease is usually painless, many women may not realize they have it until it reaches an advanced state (one of the warning signs is persistent bad breath or a bad taste in the mouth). At that time, teeth may become loose and need to be extracted.

The basic principles of good oral health are quite simple and take just a few minutes each day. Brush twice a day and floss or use an interdental cleaner also known as a proxy brush, daily; see your dentist and dental hygienist regularly; and limit snacks between meals. When your mouth and teeth are disease-free, your risks for developing other diseases throughout your life may be reduced. Don't make caring for your teeth and gums the last thing on your health to-do list.

The main cause of gum disease is bacteria, which is found in plaque. Plaque is a sticky colorless film that constantly forms on your teeth and tongue. Daily brushing, flossing, tongue scraping and other forms of interdental cleaning remove plaque.

The bacteria in plaque produce toxins, which trigger an immune response, and the body releases chemicals to wall off and kill the bacteria. The chemicals produced by the body (inflammatory cytokines) cause the symptoms of gum disease. In the earliest stage of gum disease, the bacterial toxins and inflammatory cytokines cause gingivitis—a condition in which gums swell, turn red and bleed easily. Left untreated, periodontitis can develop. Periodontitis is advanced gum disease. As plaque and calculus (tartar) continue to build up, pockets form between the teeth and gums. The gums may begin to recede (pull down on lower jaw or up on the upper jaw) on the teeth. With advanced periodontitis, the periodontal pockets get deeper and the gums may recede farther. The disease destroys more gum tissue and progresses to the bone. At this late stage of gum disease, teeth (even healthy teeth) can become loose, fall out or have to be extracted by a dentist.

Recent research shows a direct link between periodontal infections and cardiovascular disease, particularly elevated blood pressure and hypertension, which can contribute to strokes. More study is needed to determine whether there is a connection between periodontal infections and heart disease, but so far there is little evidence linking dental health and lipid metabolism and cholesterol levels, both of which are tied to heart attacks.

In addition to heart disease, women have special oral health needs during certain phases of their lives, such as puberty, menstruation, pregnancy and menopause. At these times, women need to be proactive with their dentist and dental hygienist and bring up general health issues for discussion. For example, if you are pregnant or are contemplating pregnancy, it's important to treat any areas of oral infection so they won't interfere with your baby's fetal development.

Some studies had suggested a link between periodontal disease in pregnant women and an increased risk of preterm birth or low birth-weight babies, but a recent analysis of research showed that routine periodontal treatment of pregnant women did not reduce their risk of preterm or low birth-weight babies. The American Academy of Periodontology says there is still a need for research to clarify the potential impact that periodontal disease has on the risk of preterm births and to determine what periodontal treatments are most appropriate for pregnant women.

The fluctuations of female sex hormones at various stages in a woman's life cause an exaggerated response by the gums to plaque. Bacteria in plaque are the cause of gum disease. During these times, women need to be extra vigilant about brushing and flossing every day to prevent gum disease. Below is some specific information on what happens at each stage:

  • Menstruation: Just prior to or during menstruation, some women find their gums swell and bleed. Others develop cold sores and canker sores. In addition, some women find it takes longer to stop bleeding after oral surgery. The symptoms usually go away once your period starts.
  • Pregnancy: Up to 75 percent of all pregnant women have gingivitis. During pregnancy, hormonal changes make your mouth more susceptible to gingivitis. Pregnancy-related gingivitis usually increases in the second trimester. During this time, some women may notice swelling, bleeding, redness or tenderness in the gum tissue. They may also have halitosis (bad breath) from the increase in hormones from the pregnancy.
  • Oral contraceptives: One of the most common problems in women who take oral contraceptives is hormonal gingivitis. The inflamed gums become swollen, red and bleed easily. The hormone progesterone in oral contraceptives can make your gum tissue more sensitive to irritants in the mouth, such as food or plaque. Tell your dentist if you take the pill and are having symptoms of gingivitis. The pill may be causing your gum inflammation, and, if your dentist prescribes an antibiotic, it may interfere with the effectiveness of the contraceptive, although this is theoretical and no case reports have been found. Other methods of birth control are advised while taking the antibiotic.
  • Menopause: This normal transition, usually around the age of 50, marks the time in a woman's life when she stops menstruating. It can also signal the beginning of changes in her mouth, such as oral pain or discomfort, red or inflamed gums, burning sensations, altered taste sensations (salty, metallic, peppery, sour), dry mouth (xerostomia) and oral bone loss. The changes associated with menopause may be due to hormonal changes, calcium and vitamin deficiencies, various medical conditions and medications.
  • Osteoporosis: This condition is characterized by decreasing bone mass and density. Osteoporosis causes about 1.5 million bone fractures each year, with most of those affected being women. A number of studies have suggested a link between osteoporosis and bone loss in the jaw. Researchers suspect it may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation. Osteoporosis, when combined with the bacterial infection of gum disease, speeds the process of bone loss around the tooth, which increases your risk of tooth loss. There have been concerns about the increase of dead bone forming in the mouth in people taking bisphosphonate medications (Fosamax, Actonel, Boniva) to treat osteoporosis or as part of cancer treatment. If you take a bisphosphonate medication to treat osteoporosis or as part of a chemotherapy regimen, be sure to tell your dentist.

Diagnosis

There are a few ways a dentist or dental hygienist can tell if you have gum disease:

  • By looking at the gums to see if they are red, swollen and inflamed and by checking for tartar or calculus (hardened plaque) beneath the gum line. The dentist or dental hygienist will also check for gum recession.

  • By using an instrument called a periodontal probe to see if the gums bleed when they are probed and by checking for and measuring the periodontal pockets. Deeper pockets usually signal advanced disease.

  • By checking for loose teeth.

  • By taking dental X-rays to check for any loss of the bone that helps anchor teeth.

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Treatment

The primary goal of periodontal therapy is to remove the bacteria in the periodontal pocket that cause the disease. Controlling the infection treats gum diseases. A dentist, dental hygienist or periodontist begins treatment by first giving thorough instructions on at-home oral hygiene. He or she will then remove the plaque and tartar on the teeth above and below the gum, by a procedure called scaling and root planing. These procedures are performed with ultrasonic instruments, and/or with sharp hand instruments to scrape the surfaces of the teeth clean. The purpose of removing the plaque, tartar and bacteria is to allow the gums to heal rapidly. These procedures may require local anesthesia. Some dentists and periodontists also use lasers to disinfect the periodontal pockets.

Your dentist may prescribe a special anti-germ mouth rinse containing a chemical called chlorhexidine to treat gingivitis. In cases of chronic periodontitis, a local antibiotic/antimicrobial may be placed directly into the periodontal pocket in the form of fibers, chips, gels or microspheres containing powder encapsulated in a polymer. This kills the bacteria directly at the site of infection. This avoids the majority of problems associated with systemic antibiotic use, such as bacterial resistance or allergic reaction. For other forms of periodontitis, a systemic (taken by mouth) antibiotic may be necessary to treat that particular form of gum disease.

After scaling and root planing, you must brush twice a day and floss your teeth daily to keep plaque from accumulating again. If scaling and root planing do not bring the infection under control, periodontal surgery might be necessary. Flap surgery (also called pocket depth reduction) involves lifting back the gums, removing the bacteria, tartar and other disease-causing substances, and then sewing the gums back in place. Regenerative periodontal surgery aims to decrease pocket depth by adding bone to the pocket and increasing the attachment level of the periodontal ligament (the ligament that holds the teeth into the jaw bone); grafting procedures are used for recession.

In addition to controlling infection, women need to be aware of their special needs during the various phases of life and under certain conditions. Here are some specific guidelines:

  • Menstruation: Just prior to or during menstruation, some women may experience the following symptoms: swollen and bleeding gums; cold sores and canker sores; or longer time needed to stop bleeding after oral surgery. If you notice these symptoms around the time of your period, ask your dentist or dental hygienist about more frequent cleanings, gum treatment, antimicrobial rinses and topical or local anesthesia to ease discomfort.

  • Eating disorders: Eating disorders are more prevalent in women, often occurring before the age of 20. These are serious medical conditions so psychiatric or medical care should be obtained. In addition, discuss this with your oral health care provider. Oral complications can be minimized or controlled with appropriate care.

  • Oral piercing: Some women have oral piercings and use various types of jewelry in their mouths or on their lips or faces. If you choose to get an oral piercing, take care to minimize potential life-threatening complications. Infection, hemorrhage, broken teeth and other problems can result if those performing the procedures are not knowledgeable about oral anatomy and infection-control procedures.

    If a woman is going to have her tongue pierced, she must understand that the metal of the tongue bolt is harder than the enamel of the teeth, and repeated contact between the metal and the enamel can result in fractures of the teeth. This damage can be reduced by:

    • Using a shorter bolt, which mean less contact between the bolt and teeth, reducing the chance of tooth fracture.
    • Have the spheres on either end of the bolt made of plastic, which will reduce the amount of damage to the adjacent teeth.
  • Pregnancy: If you are pregnant or considering pregnancy, follow these tips:

    • Contact your dentist and dental hygienist and make him or her a part of your prenatal health care team.

    • You may need more frequent dental checkups.

    • Keep brushing. During pregnancy, the gums may become sensitive and uncomfortable, especially during brushing or flossing, prompting some women to avoid good daily oral hygiene. This avoidance sets up a vicious circle. As oral hygiene becomes even more uncomfortable, the cycle continues. During your pregnancy, it's important to brush at least twice a day with a fluoride toothpaste and floss every day.

    • Take the prenatal vitamins prescribed by your health care professional every day. If you take chewable vitamins, do not use those containing sugar. Your baby's developing teeth depend on your proper intake of vitamins and minerals.

    • Eat a balanced diet.

    • Sip water. When some women become pregnant, they find they prefer to eat smaller meals more frequently throughout the day. Following this dietary pattern increases your risk for gum disease and tooth decay because you're constantly exposing your teeth to food, especially the sugars and starches that set the stage for bacterial infection. After each small meal, drink or rinse with water. Drinking water throughout the day keeps up the saliva level in your mouth, which can help prevent tooth decay. Rinsing and spitting removes food particles from teeth.

    • If you suffer from morning sickness and vomiting is part of your pregnancy, immediately rinse your mouth before you brush your teeth. Rinse with plain water or with a neutralizing solution of water mixed with baking soda (1 quart water mixed with 1/4 teaspoon baking soda and 1/4 teaspoon salt - optional); do not swallow. Then clean your teeth with fluoride toothpaste. Bringing stomach acids into your mouth can dissolve tooth enamel.

    • Ask about fluoride treatments or rinses. If you have tooth decay or are prone to it or are vomiting a great deal, talk to your dentist and dental hygienist about in-office or at at-home fluoride treatments. A simple fluoride rinse once a day is very effective in controlling tooth decay. Your dentist or oral health care professional can also custom-make trays for you to use at home for fluoride gels.

    • Plan for the future. It's important for parents to get information on their child's oral health when their children are very young. If they don't, their children may suffer unnecessary dental problems. Generally speaking, when a child has all of his or her primary teeth in place is a good time for a first oral exam. The American Academy of Pediatric Dentistry and the American Academy of Pediatrics recommend that a child have his or her first oral health care appointment by age 1.

    • Ask about early childhood caries (ECC), formally called baby bottle tooth decay. Dental caries (cavities) occur when sweetened liquids are left clinging to an infant’s teeth for long periods. Milk, fruit juice and formula can all cause this problem. Bacteria in the mouth eat away at these sugars and then produce acids that attack the teeth. Each time your child drinks these liquids, the resulting acids attack the teeth for at least 20 minutes. Over time, the teeth may decay.

    • It is important to know that it is safe for pregnant women to have dental care, including extractions. The safest period is during the second trimester, although most dental surgeries are safe and the medications that are used are not harmful to the fetus. The main concern in the third trimester is induction of labor, although this is very rare and generally occurs during late stages of pregnancy.

  • Contraception: If you take oral contraceptives, they may make your gums swell and bleed. The hormone progesterone in oral contraceptives can make your gum tissue more sensitive to irritants in the mouth, such as food or plaque.

  • Menopause: This normal transition can trigger a variety of oral health problems. Here's what you can do to keep your mouth healthy:

    • Call your dentist or oral health care professional. Talk to your dentist and dental hygienist if you experience any oral problems related to menopause. Saliva substitutes may be prescribed to reduce dry mouth.

    • Inquire about substitutes. In some cases, medications cause dry mouth or other oral health problems. Ask your health care professional if there are substitutes for the medications you are taking. Perhaps another brand name or a different dosage can help.

    • Some middle-aged women may begin to experience a burning sensation in the lips, palate and tongue––a poorly understood (and difficult to diagnose) condition known as burning mouth syndrome. This condition is sometimes accompanied by dry mouth, thirst, altered taste perception, changes in eating habits, irritability, depression and reduced desire to socialize and interact with others.

      If you experience any of these symptoms, your oral or general health care professional will first seek to rule out other conditions, such as anemia, leukemia, severe vitamin deficiency, undiagnosed diabetes or a yeast or candida infection of the mouth.

      Medications used to treat the disorder include: oral thrush medications, special oral rinses or mouthwashes, saliva replacement products, vitamin and mineral replacements, capsaicin (a natural chemical found in cayenne pepper), alpha-lipoic acid (a strong antioxidant produced naturally by the body) and certain antidepressants.

  • Ask about Sjögren's syndrome. This condition is 90 times more frequent in women than men and is most common in postmenopausal women. It is an autoimmune condition in which immune cells mistakenly attack and destroy tissue of the salivary glands (located in the mouth) and lacrimal glands (located in the eyes).

    Symptoms of Sjögren's include dry mouth, dry eyes and stiff, painful joints. If you experience these symptoms, ask your oral or general health care professional to examine you for Sjögren's syndrome.

  • Look out for osteoporosis. Because research has revealed a possible link between osteoporosis and bone loss in the jaw, you should:

    • Determine your risk. Health experts recommend that women over 65 should be screened for osteoporosis with a bone density test. Postmenopausal women under age 65 who have suffered bone fractures or who are at high risk for osteoporosis should also be screened. If you are a premenopausal woman with any risk factors for osteoporosis, talk to your health care provider about getting a bone density test. This quick test measures bone strength, predicts if your bones are at risk for fracture, may be helpful in monitoring the effects of treatment if the test is conducted at intervals of a year or more and can help predict your risk for osteoporosis.

    • Talk to your dentist and dental hygienist about your concerns associated with osteoporosis. Ask them what you can do to slow oral bone loss. You will be taking steps to lower your risk of tooth loss.

  • According to national surveys, many women consume less than half of the daily recommended amount of calcium. The National Osteoporosis Foundation (NOF) recommends between 1,000 mg daily (for women 19 to 49 years old) and 1,200 mg daily (for women 50 years old and older). Good calcium sources include low-fat dairy products, soy milk and other soy products, dark green leafy vegetables, such as spinach and collard greens, and calcium-fortified juices, breakfast cereals, cereal bars and waffles.

  • Don't forget vitamin D. Vitamin D plays a major role in calcium absorption and bone health. The NOF recommends a daily intake of between 400 and 800 IU for adults under age 50, and a daily intake of between 800 and 1000 IU for adults age 50 and over. Besides taking a nice walk in the sun, good food sources of vitamin D include fortified dairy products, egg yolks, saltwater fish and liver. As we age, our skin is less effective in converting sunlight into Vitamin D, and many women and men use sunscreen to prevent them from skin cancers. Older individuals should rely on supplements and foods to get their daily recommend allowance of Vitamin D.

  • Reach for soy. Soy products, including soy milk, are good sources of calcium, which is an important mineral in building bones and teeth and in maintaining bone strength.

  • Watch that sugar. Some women chew antacid tablets as a source of supplemental calcium. The problem is, in women with dry mouth or who are prone to oral problems, the sugar content of the tablets can cause tooth decay. If you chew antacid supplements, be sure to brush and floss afterward. Don't stop taking them until you talk to your health care practitioner about alternative calcium sources.


Prevention

There's plenty you can do to prevent gum disease. At the heart of the matter is removing the plaque from your teeth, tongue and the area around the gums every day with proper brushing, flossing, tongue scraping and interdental cleaning. Follow these tips to prevent gum disease, and keep your teeth for life:

  • Brush twice a day and floss or use an interdental cleaner every day. Plaque is the major cause of periodontal (gum) disease. You can remove plaque by brushing your teeth thoroughly and cleaning the spaces between your teeth. Be sure to use a toothbrush that has soft bristles to effectively clean below the gum line without harming gum tissue. Your toothbrush should be in good condition. Dentists and dental hygienists recommend changing it at least every three to four months, as a measure against worn bristles and bacteria accumulation. Bacteria can adhere to the tongue, which has many small papillae (projections) and must be cleaned daily. Powered toothbrushes charged by a unit that is plugged into an electrical outlet are excellent alternatives or adjuncts to hand toothbrushes. There are also many low-cost battery operated toothbrushes and powered toothbrushes for children. Powered toothbrushes are recommended because they often remove more plaque than hand toothbrushes.

  • Cleaning between your teeth with floss or interdental cleaners (small brushes, picks or sticks that remove plaque between teeth) removes bacteria and food particles from between the teeth, where a toothbrush can't reach. Daily brushing and flossing can often reverse early gum disease (gingivitis). Later stages of gum disease (periodontitis) can be treated, but not reversed. If you use interdental cleaners, ask your dentist and dental hygienist how to use them properly, to avoid injuring your gums.

  • Choose oral care products that have been proven safe and effective. Some products carry the American Dental Association (ADA) Seal of Acceptance. This symbol signifies the product is safe and effective. The ADA reviews all advertising claims for any product bearing the seal. However, if a product does not carry the seal, it does not necessarily mean that it is NOT safe and effective. The manufacturer may not have applied for the ADA Seal.

  • Practice healthy eating. Follow a balanced diet for good general health and limit snacks. Choose a variety of foods from the basic food groups, which are outlined in the U.S. Department of Agriculture (USDA) Food Guide Pyramid. The recommended number of servings of each food group varies based on age and gender. To view your specific recommendations, go to the USDA Web site: https://www.choosemyplate.gov. Also make sure you get enough calcium in your diet. Low calcium intake has been associated with an increased risk of gum disease. The NOF recommends between 1,000 mg daily (for women 19 to 49 years old) and 1,200 mg daily (for women 50 years old and older). One eight-ounce glass of milk contains about 300 mg of calcium.

  • Limit sweet snacks. The average American eats about 150 pounds of sugar a year. Eating sugary snacks, such as candies, cakes and cookies, between meals can cause tooth decay. When you put sugar in your mouth, the bacteria in the plaque converts the sugar into acids, which can dissolve the tooth structure. Starchy snacks can also break down into sugars once they're in your mouth. Each time you eat food that contains sugar or starches, acids attack the teeth for 20 minutes or more.

  • Switch to healthy snacks. If you do snack, choose nutritious foods, such as cheese, raw vegetables, plain yogurt or a piece of fruit.

  • Reach for water. The less sugar you consume, the better. Try to drink less soda and more water. In addition, water dilutes and flushes the sugar, acid and toxins from the mouth.

  • Time it right. It's not only what you eat but also when you eat it that makes a big difference in your dental health. Foods that are eaten as part of a meal cause less harm to your teeth. More saliva is released during a meal, which helps wash foods from the mouth and helps lessen the effect of acids.

  • Chew gum. Chewing sugarless gum can help eliminate food particles caught between teeth after a meal and helps prevent plaque build-up by stimulating saliva production. Xylitol, a natural sweetener found in plants and fruits, is used in sugar-free gum, mints and toothpaste. Approved by the U.S. Food and Drug Administration (FDA) as a food additive, research has shown that Xylitol helps reduce and prevent cavities, possibly by inhibiting the growth of streptococcus mutans, the oral bacteria that cause cavities.

  • See your dentist and dental hygienist regularly. Regular dental visits and professional preventive cleanings are essential to good oral health. Plaque that is not removed can cause problems, and a rough, porous deposit called calculus, or tartar, may form. Tartar can only be removed when your teeth are cleaned in the dental office. A professional cleaning at least twice a year is necessary to remove tartar from places your toothbrush and floss may have missed. Be sure a licensed dental hygienist or dentist cleans your teeth. Ask questions if you aren't sure of their qualifications, and ask to see a copy of the license. A dental assistant, while a very valuable part of an office staff, is not qualified or licensed to perform dental cleanings.

  • How often you see the dentist and dental hygienist depends on how prone you are to dental problems. For example, an average woman with healthy gums may only need to see the oral health care professional every six months for preventive maintenance. But women with gum disease may need treatment more often, such as every three or four months. Talk to your dentist and dental hygienist about how often he or she thinks you need to schedule an office visit based on your individual needs.

  • Here's yet another reason to quit smoking: Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. Smokers are much more likely than non-smokers to have bacterial plaque and tartar form on their teeth, have deeper pockets between the teeth and gums and lose more of the bone and tissue that support the teeth. Spit (smokeless) tobacco, bidis (flavored or unflavored tobacco rolled in tendu or temburni leaves) and kreteks (clove cigarettes) can also cause oral problems. Bidis and kreteks contain higher concentrations of tar, nicotine and carbon monoxide than conventional cigarettes. Smokeless tobacco contains 28 cancer-causing agents and increases the risk of developing cancer of the oral cavity. And recent research shows that people with periodontal disease who are exposed to secondhand smoke are more likely to develop bone loss, the number one cause of tooth loss. According to the American Heart Association, since 1965, nearly half of all adults who have ever smoked have quit. Ask your dentist, dental hygienist or health care professional to recommend a tobacco-cessation program for you, or contact the American Lung Association.

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Facts to Know

  1. The main cause of gum disease is bacteria, which is found in plaque.

  2. Nearly one out of four women ages 30 to 54 has periodontitis, an advanced state of gum disease in which the bone and gum tissue that support the teeth break down.

  3. Nearly half of women ages 55 to 90 who still have their teeth have periodontitis.

  4. You can help prevent gum disease by brushing twice a day and flossing every day, limiting between-meal snacks and seeing your dentist and dental hygienist regularly.

  5. A significant association between obesity and prevalence of periodontal disease, especially among individuals aged 18 to 34 years, has recently been established. Low dietary intake of calcium and vitamin D are cited as probable causes.

  6. Osteoporosis is a condition characterized by decreasing bone mass and density. A number of studies suggest a link between osteoporosis and bone loss in the jaw.

  7. Low calcium intake in the diet has been shown to increase the risk for periodontal disease. According to national surveys, many women consume less than half of the daily recommended amount of calcium.

  8. Most dental professionals recommend that toothbrushes be replaced every three to four months or more frequently if you are an extremely vigorous brusher. Brushing carefully and gently is better and less harmful than brushing too hard. Toothbrushes should also be replaced after you or family members have had a cold, flu or other upper respiratory infection.


Questions to Ask

Review the following Questions to Ask about oral health so you're prepared to discuss this important health issue with your health care professional.

  1. What kind of toothpaste and mouth rinse should I use?

  2. What kind of toothbrush should I use?

  3. How often should I change my toothbrush?

  4. What characteristics should I look for in a toothbrush?

  5. What is the proper way to brush and floss my teeth?

  6. How can I slow oral bone loss?

  7. How often should I schedule a dental office visit?

  8. At what age should my child first visit the dentist?

  9. If I have periodontitis, will I lose my teeth?

  10. Did you perform an oral cancer examination?

  11. Am I a candidate for the genetic test for periodontal disease?

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Key Q&A

  1. How can I prevent gum disease?

    Preventing gum disease is really quite simple and takes only minutes each day. Follow this easy seven-step plan to prevent gum disease:

    • Brush at least twice a day and floss or use an interdental cleaner at least once a day.

    • Purchase oral care products that are safe and effective (and may carry the ADA Seal of Acceptance).

    • Choose a variety of foods from the basic food groups, and make sure you get enough calcium in your diet.

    • Limit sweet snacks. If you do snack, choose nutritious foods, such as cheese, raw vegetables, plain yogurt or a piece of fruit.

    • Drink water instead of soda.

    • See your dentist and dental hygienist regularly. Ask how often you should schedule an office visit.

    • Stop smoking and other forms of tobacco use.

  2. How is gum disease diagnosed?

    First, your dentist and dental hygienist will look at your gums to see if they are red, swollen and inflamed and will check for tartar (hardened plaque) beneath the gum line. The dentist and dental hygienist will also check for gum recession. Second, he or she will use an instrument called a probe to see if the gums bleed when they are probed and will check and measure the periodontal pockets. Deeper pockets may signal advanced disease. Third, the dentist and dental hygienist will check for loose teeth. Finally, if he or she feels it's necessary, mouth X-rays will be taken to check for any loss of the bone that helps anchor teeth.

  3. How is gum disease treated?

    Controlling the infection treats gum diseases. The dentist, dental hygienist or periodontist removes the plaque and tartar with scaling and root planing, which are nonsurgical, deep-cleaning procedures. During scaling, the dentist or dental hygienist removes the bacteria and tartar from above and beneath the gum line. The dentist or dental hygienist also eliminates any rough spots where bacteria gather (such as rough filling margins), allowing the gums to become healthy. Your dentist might prescribe a special anti-germ mouth rinse containing a chemical called chlorhexidine. In cases of chronic periodontitis, a local antibiotic/antimicrobial may be placed directly into the periodontal pocket in the form of fibers, chips, gels or microspheres containing powder encapsulated in a polymer. This kills the bacteria directly at the site of infection. This avoids the majority of problems associated with systemic antibiotic use, such as bacterial resistance or allergic reaction. For other forms of periodontitis, the dentist may prescribe a systemic (taken by mouth) antibiotic to treat that particular form of periodontal (gum) disease. After periodontal therapy scaling and planing, the patient must brush and floss her teeth at home to keep plaque from accumulating again. If scaling and planing nonsurgical therapy does not bring the infection under control, surgery might be necessary. Flap surgery (also called pocket depth reduction) involves lifting back the gums, removing the tartar and then sewing the gums back in place.

  4. Do I really need to floss my teeth?

    Yes! Flossing removes food particles between teeth that your toothbrush can't reach. Brushing alone reaches only three out of five tooth surfaces. Also, the surfaces tooth brushing can't reach are areas where gum disease can most easily get started in your mouth. For healthy teeth and gums, floss every day. If you have large spaces between your teeth, an interdental brush may also be helpful.

  5. How often should I change my toothbrush?

    Most dental professionals recommend that toothbrushes be replaced every three to four months or more frequently if you are an extremely vigorous brusher. Ideally, you should brush gently (so you do not injure the gum tissue) and carefully, not vigorously. Toothbrushes should also be replaced after you or family members have had a cold, flu or other upper respiratory infection. Do not share toothbrushes with other family members.

  6. At what age should my child first visit the dentist?

    Generally speaking, when a child has all of his or her primary teeth in place, it is a good time to have his or her first oral exam. The first cleaning and checkup appointment can follow a few months later, depending on the child's maturity and readiness to accept the treatment. The goal is to have your child's first dental experience be a positive one. The American Academy of Pediatric Dentistry and the American Academy of Pediatrics recommend that a child have his or her first oral health care appointment by age 1.

  7. Are fluoride treatments effective for adults?

    Yes. Topical application of fluoride increases the level of fluoride on the outermost surface of the tooth, regardless of the age of the tooth. While most people tend to think of children as being more prone to cavities, adults still get decay. Women are keeping their own natural teeth longer, and root decay is a condition that is more likely to occur as we age. The key is multiple applications of fluoride with fluoridated toothpaste, possibly a home fluoride rinse or gel and in-office treatments. Your dentist or dental hygienist can prescribe the best home care and in-office treatment options based on your individual oral health care needs.

  8. How often should I get my teeth cleaned by a dental health professional?

    All women have individual, varied needs. The interval of six months for "cleaning and checkup" is a commonly recommended time frame, which may or may not be appropriate for you. For example, during pregnancy, hormonal changes may make your mouth more susceptible to gingivitis. Women who are pregnant may need to see their dentist and dental hygienist more often than every six months. If you have concerns about the frequency of your maintenance appointments, you should discuss them with your dentist and dental hygienist. Together you can reach a maintenance schedule that is appropriate for your oral condition and that fits your busy schedule.

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Lifestyle Tips

  1. Wondering what kind of toothbrush to use?

    Whether you achieve better dental hygiene with a powered toothbrush compared to a manual one depends on how well you brush in the first place. However, many studies show that powered toothbrushes are more effective than manual toothbrushes at removing plaque and achieving gingival (gum) health. The newer powered toothbrushes have bristles that move in ways that would be difficult, if not impossible, to duplicate manually. If you are not sure how good a job you are doing keeping your teeth clean, ask your dentist or dental hygienist.

  2. Proper nutrition good for gum health

    Most periodontists—dental professionals specializing in gum disease—recommend calcium supplements and multivitamins for patients who are not getting adequate amounts from their diet. Research shows that people who consume inadequate amounts of calcium and vitamin D have higher rates of periodontal disease. Many other nutrients likely play a role in maintaining good periodontal health. Conversely, some foods are best avoided to maintain healthy gums. A leading culprit is popcorn because husks can get caught between the teeth and gums and cause abscesses.

  3. Lower your risk for oral cancer

    According to the Oral Cancer Foundation, approximately 36,000 Americans will learn they have mouth and throat cancers in 2010.. Smoking and the use of smokeless and spit tobacco and alcohol are the most important risk factors in cancer of the oral cavity and oropharynx (the part of the throat just behind the mouth). Quitting tobacco and alcohol significantly lowers your risk of developing these cancers, even after many years of abuse. Oral irritation (such as dentures that do not fit properly) may also increase your risk for oral cancer, but this has not been proven. If you have a lesion or mouth sore that does not go away within two weeks, ask your dentist to perform a biopsy to check the lesion.

  4. Dental sealants not just for kids

    The potential for tooth decay begins early in life, so children and teenagers are obvious candidates for dental sealant—a plastic, professionally applied material that is put on the chewing surfaces of back teeth to prevent cavities. But certain adults at high risk for tooth decay can benefit from sealants, as well. Sealants provide a physical barrier so that cavity-causing bacteria cannot invade the pits and fissures on the chewing surfaces of teeth.

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Organizations and Support

For information and support on Oral Health, please see the recommended organizations, books and Spanish-language resources listed below.

Academy of General Dentistry
Website: http://www.ada.org
Address: 211 E. Chicago Avenue, Suite 900
Chicago, IL 60611
Hotline: 1-888-AGD-DENT (1-888-243-3368)

American Academy of Pediatric Dentistry
Website: http://www.aapd.org
Address: 211 East Chicago Avenue, Suite #700
Chicago, IL 60611
Phone: 312-337-2169

American Academy of Periodontology
Website: http://www.perio.org
Address: 737 N. Michigan Avenue, Suite 800
Chicago, IL 60611
Phone: 312-787-5518

American Association of Public Health Dentistry
Website: http://www.aaphd.org
Address: 3085 Stevenson Dr., Suite 200
Springfield, IL 62703
Phone: 217-529-6941
Email: [email protected]

American Dental Assocation (ADA)
Website: http://www.ada.org
Address: 211 East Chicago Ave.
Chicago, IL 60611
Phone: 312-440-2500

American Dental Hygienists Association (ADHA)
Website: http://www.adha.org
Address: 444 North Michigan Ave., Suite 3400
Chicago, IL 60611
Phone: 312-440-8900
Email: [email protected]

American Equilibration Society
Website: http://www.aes-tmj.org
Address: 207 E. Ohio Street, Suite 399
Chicago, IL 60611
Phone: 847-965-2888
Email: [email protected]

American Orthodontic Society
Website: http://www.orthodontics.com
Address: 11884 Greenville Ave, Suite 112
Dallas, TX 75243
Phone: 1-800-448-1601

Dental Resource Library
Website: http://dentalassistantedu.org/dental-resource-library/

Hispanic Dental Association (HDA)
Website: http://www.hdassoc.org
Address: 3085 Stevenson Drive, Suite 200
Springfield, IL 62703
Hotline: 1-800-852-7921
Phone: 217-529-6517
Email: [email protected]

National Dental Association
Website: http://www.ndaonline.org
Address: 3517 16th Street, NW
Washington, DC 20010
Phone: 202-588-1697
Email: [email protected]

National Institute of Dental and Craniofacial Research
Website: http://www.nidcr.nih.gov
Address: National Institutes of Health
Bethesda, MD 20892
Phone: 301-402-7364
Email: [email protected]

National Maternal and Child Oral Health Resource Center
Website: http://www.mchoralhealth.org
Address: 2115 Wisconsin Avenue, N.W., Suite 601
Washington, DC 20007
Phone: 202-784-9771
Email: [email protected]

Oral Health America
Website: http://www.oralhealthamerica.org
Address: 410 North Michigan Avenue, Suite 352
Chicago, IL 60611
Phone: 312-836-9900
Email: [email protected]

Support for People with Oral and Head and Neck Cancer
Website: http://www.spohnc.org
Address: P.O. Box 53
Locust Valley, NY 11560
Hotline: 1-800-377-0928
Email: [email protected]

Trigeminal Neuralgia Association
Website: http://www.fpa-support.org
Address: 925 Northwest 56th Terrace, Suite C
Gainesville, FL 32605
Hotline: 1-800-923-3608
Phone: 352-331-7009
Email: [email protected]

Healthy Teeth: A User's Manual: Everything You Need to Know in Order to Find a Good Dentist and Take Proper Care of Your Teeth
by Marvin J. Schissel, DDS

Take This Book to the Dentist With You
by Charles B. Inlander, J. Lynne Dodson, and Karla Morales

Taking Control of TMJ: Your Total Wellness Program for Recovering from Tempromandibular Joint Pain, Whiplash, Fibromyalgia, and Related Disorders
by Robert O. Uppgaard

Understanding Dental Health
by Francis G. Serio

Understanding Herpes
by Lawrence R. Stanberry