When we are young our teeth make their way into our mouths through a process known as tooth eruption. How do they know when to stop erupting? Basically, they keep going until they find the opposing tooth. But what if we lose a tooth? Much like a computer program, the tooth opposite the missing one starts looking for the tooth that it is supposed to chew against. If it can’t find i
t, it may erupt all the way to the opposing gum. It’s not that the tooth is growing. The bone below (or above it) moves it into position. Of course, at this point, it’s in the wrong position, and entirely new problems often start to appear.
If this were all that happened, we would have enough to worry about in terms of our ability to chew our food well. This is important for good digestion and nutrition. Unfortunately, when teeth border an empty space they also have a tendency to try to drift into it. This means that teeth may drift forward or backward toward the spaces. Perhaps this is nature’s way of distributing the load now that one of the soldiers has fallen. It is an engineering marvel, but it can become a chewing nightmare.
While all of our teeth are important, structurally, the loss of certain teeth will bring about more change than the loss of others. Think of this in terms of the walls of your house. If you take down a non-supporting wall, the house will still stand. Take out a supporting wall, however, and you have a bigger problem. Teeth are constructed much like an arch, though. If you have ever seen a stone arch, you know it has a keystone at the top that keeps the arch together. Remove that one stone, and the whole thing collapses. In your dental arch, you can think of your canines as a keystone. Lose them, and the ensuing change is rapid. If your teeth were straight, they often won’t be for too much longer.
So, why then, do people lose teeth? The most common reasons that I see are:
Periodontal disease – this is sometimes also referred to as “gum disease” but is really a condition more directly affecting the bone. This is the result of a bacterial infection leading to the permanent breakdown of the bone surrounding the teeth. It is actually the most common form of tooth loss world-wide. Because it is generally not painful, often people have no idea that they have periodontal disease until their teeth start to get loose and fall out.
Tooth decay – this is what many people think is the main cause of tooth loss. And while it is true that tooth decay often does lead to tooth loss, it follows periodontal disease in terms of frequency.
Habits – this is the type of tooth loss that results from such things as tooth grinding or clenching. This area is one in which we often see a “domino-effect” of problems. Sometimes clenching or grinding starts with the loss of a single tooth or an accident resulting in a spinal misalignment. At other times, it may be due to stress, a deficiency, or genetic structural anomaly. In any of these cases, if the grinding or clenching results in the wear of your canines (those “key-stones” again), you may find yourself wearing down ALL of your teeth more rapidly. They are pointy for a reason. When you slide your teeth to the side, they are supposed to keep the back teeth from touching. If they wear down to the point where all of your teeth touch in all directions it is possible to wear them all down. Over the years I have had cases where what brought the patient in to see me in the first place was that they wore down their teeth to the point where they exposed their nerves. (Ouch!)
Accidents – this speaks for itself. And it happens. It may be a sports injury, car accident, a fight, or biting into something hard – but if it breaks off enough of the tooth, it can need to be extracted.
Whatever the cause, if you lose a tooth, you should speak with your dentist about replacement options. Together you can discuss the choices that are best for your circumstance. Where possible, try not to delay correcting your bite for too long. The additional changes that may occur with your bite over time can limit your choices or cost you more to correct. While a nice, straight smile may be desirable cosmetically, a good bite is also important for health and function.
Dry mouth, also called xerostomia, is a common oral health problem. Unfortunately, for some patients it becomes a “silent” condition that often goes undiagnosed and untreated. While there are many potential reasons for this condition, one of the most frequent contributing factors is the use of medications. Over four hundred commonly prescribed drugs list dry mouth as a potential side effect.
While this condition is fairly common in the general population, the prevalence increases with age. This is likely because many older adults take medications for one or a number of co-existing medical conditions.
Though some people may consider dry mouth an inconsequential medical or dental concern, it can be a troublesome symptom also associated with systemic diseases and health conditions. Things that most people take for granted, such as being able to chew their food – or even to taste it – result in a reduced quality of life for the patient with xerostomia.
Negative effects of dry mouth can include:
• Increased dental decay
• Oral infections
• Cracks and fissures in the tissues of the mouth
• Denture sores and ulcerations
• A decreased willingness or ability to speak easily
Keep in mind that almost everyone has experienced dry mouth at some time in their lives. Dehydration following excessive perspiration, diarrhea, or alcohol consumption are experiences many people have experienced at one time or another. These situations are generally transient and easily identified. It should be noted here that not only alcohol consumption, but simply rinsing with alcohol-containing mouthwashes can result in a dry mouth. Many patients hold these rinses in their mouths for much longer than the recommended 30 second period. This can produce a type of tissue burn called sloughing; however, even regular use can cause a drying effect for many individuals.
If, however, you find any of the following problems to be daily events, you should raise the issue with your dentist or physician:
• Do you consistently need to sip liquids to help you to swallow your food?
• Does your mouth feel dry whenever you eat?
• Do you have any difficulty swallowing?
• Does the amount of saliva in your mouth seem to be much less than you remember, or do you not notice the difference?
There are several simple things your health practitioner can do to evaluate your condition. A medical history will also provide clues. For example, certain conditions such as diabetes, cancer treatments, and Sjögren’s syndrome have also been connected with dry mouth. (Sjögren’s syndrome is a chronic autoimmune disease in which a person’s white blood cells attack their moisture-producing glands.)
Keep in mind that dry mouth symptoms may not appear until saliva production has been reduced to approximately half the normal flow.
While it is always best to identify the source of the problem to seek a long-term resolution, sometimes it is necessary to provide symptomatic relief. A number of products have been developed that can help the dry-mouth patient who so often has extra sensitive mouth tissues. These include stimulation products such as chewing gums, specially formulated toothpastes and mouthwashes that are free of irritating ingredients, and moisturizing gels or sprays.
The important thing is that you do not ignore dry mouth symptoms if they exist. Talk to your dentist or doctor. Day-to-day symptoms and their complications can be managed. If you and your doctor correctly identify the source, perhaps those problems can even be eliminated over time. The simple pleasures of life – eating comfortably, tasting an enjoyable meal, laughing freely – shouldn’t be just a memory.
Sounds like a pretty basic question for a dentist, doesn’t it? In fact, I’m not really asked that question often because “everybody knows” you should brush your teeth twice a day. But should you really?
After all, you can pick up almost any tube of toothpaste and it says right there” brush twice daily, or as directed by your dentist”.
Some time ago, I started asking patients how often they brushed their teeth when they came in for their periodic cleanings. The most common answer – by far – is “twice a day.” My next question is usually, “Yes, but when during the day do you brush?” As you read this, many of you who do brush twice daily are thinking “when I get up and again before I go to bed.”
If you have experienced dental cavities, that could be part of the problem.
When I mention this to patients I usually get this sort of silent stare. It’s kind of a cross between, “well that makes no sense at all” or, “then I might as well just give up.”
Let me explain.
It starts with an understanding of what causes dental cavities. There are a few basic elements. The most obvious is that you need to have a tooth. Additionally, you need cavity-causing bacteria. Then you also need a fermentable carbohydrate. This is an important point. Carbohydrates include sugars and starches, but the process of fermentation creates acids. Once the acids form, there is another element that comes into play: time.
If we break these factors down further, it is useful to look at what we can control in the cavity-causing process. For the sake of argument, let’s assume we are starting out with a full set of teeth, so that’s not entirely in our control. Next, there is the factor of cavity-causing bacteria. We all have both good and bad bacteria in our mouths. While I could get into a discussion of promoting the good and suppressing the bad, this is also not always easily controlled.
The next two factors, however, we have a great deal of control over.
We can control what we eat. Recognition of which foods are acid forming is also useful. But I’m a realist and understand that sometimes we are just going to eat (or drink) those things anyway.
And this is where the time factor comes in.
A little analogy may be helpful here. What would you do if you spilled a strong acid on your bare skin? Chances are you would run right over to the nearest sink and try to wash it off. But what if you had a leather jacket on and didn’t notice right away? First of all, you would end up with a hole in your jacket, but eventually – with time – it would reach your skin and start to hurt.
It’s much the same with teeth. Your enamel is a protective layer that doesn’t have any feeling because it is mostly mineral and doesn’t contain any nerves. But given enough time, the acid – even a weak one – breaks through and gets to the underlying softer and more sensitive areas. So, don’t give it time.
Change your brushing habits and do so after every meal. About a half hour after eating is ideal. If you absolutely can’t brush on occasion, chewing a sugarless gum (preferably containing xylitol) can help.
What most people do, though, is wake up and brush. Then they have breakfast and don’t brush. The acids that are formed following the meal slowly dissolve our tooth enamel. Roughly when the acids wear off, they have another meal or a snack and freshen up the acid. Few people brush after lunch, so it’s a few more hours of wearing the enamel away. Just when that acid wears off people freshen it up again with dinner. They don’t always brush after dinner either, so the acid now has even more time to work. Finally, they brush before going to bed. This cycle can, and typically does, go on for days, weeks, months and years. Given enough time, the cavity becomes large enough to require a filling.
So, if you only eat two meals a day, brushing twice a day is probably fine. But if you eat three times a day, how often should you brush? You get the idea.
The really odd thing is that I can go over this with someone thinking they get it. A couple of years later, I’ll ask: “How often do you brush your teeth?” Believe it or not, the answer is often the same as when I asked the first time. Hopefully, however, you will get it. Remember also that you can’t ignore flossing and expect to escape cavities, even if you do brush after every meal. The area between your teeth can’t be reached by the toothbrush bristles. About a third of all cavities filled by dentists occur in this location.
Nevertheless, if you follow the advice above I think you will find yourself encountering far less tooth decay over the years. Hoping it works for you as well as it has for me.
Welcome!
Dr. Richard Walicki is a dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.
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