Our mouths are full of bacteria. Hundreds of different types live on our teeth, gums, tongue, and other places in our mouths. Some bacteria are helpful. But some can be harmful, such as those that play a role in tooth decay and gum disease. And just for the record, because you may hear us use these words on occasion, the official term for tooth decay is “dental caries.” This decay, or caries, is what causes cavities. The official term for gum disease is “periodontal disease” or “perio” for short. Perio disease begins as gingivitis, and if it is not treated properly, it progresses to the more serious condition called periodontitis, which produces periodontal pockets that can be measured by the use of a periodontal probe. These conditions will be discussed in greater detail in upcoming sections.
What Causes Dental Diseases?
There are many dental diseases, but the most common ones are tooth decay and gum disease. They are both caused by certain bacteria in the mouth that have been allowed to overgrow and accumulate to the point where they can cause damage to the teeth and gums. This damage occurs as a result of acids produced by the bacterial overgrowth. Over time, these acids can make a cavity in the tooth or cause periodontal pockets.
The name given to that overgrowth is bacterial plaque or “plaque” for short. Plaque starts as an invisible, sticky film that comes from saliva and coats the teeth. Bacteria that normally live in the mouth get stuck in this film and the longer this film is allowed to remain undisturbed on the teeth, the harder it is to remove and the more damage it can do. Therefore, removing this film or plaque from every surface of every tooth every day prevents the dental disease process from getting started. In addition to dental disease, recent studies have shown that the accumulation of dental plaque has a connection to cardiovascular diseases, including heart attack and stroke, as well as premature births and diabetes. Just more reasons why cleaning your teeth on a daily basis is so important.
Scientific research has shown that a few bacteria cannot produce enough of the acid that causes dental diseases to do any damage. However, when these bacteria remain undisturbed on the teeth and gums, they multiply rather rapidly. Over several days and weeks the bacteria gather in the hard to reach places, like between the teeth and below the gumline. The bacteria are living things which require food just like all living things. The source of the food for these oral bacteria is the food that we put in our mouths. Like all living things, the bacteria take the food in and break it down into smaller parts that can be used to keep them healthy and strong and allow them to reproduce. This process is called metabolism. At the end of the bacterial metabolic process, the unwanted remains are expelled out of their tiny bodies into the surrounding environment, which, in this case, is on our teeth and gums. The end product of this bacterial metabolism is, as mentioned above, acid.
Clean Teeth Before Eating
The bacterial metabolic process takes about 20 minutes from ingestion of the food to acid release. That is why I recommend to anyone who will listen that the teeth should be cleaned before eating. Tooth decay requires 3 things: the first thing is a tooth; the second thing is bacterial plaque on the tooth; and the third thing is a food source for the bacteria. If you eliminate any one of those things, tooth decay cannot occur. Well, you don’t want to eliminate the tooth. You have to eat to stay healthy, so you can’t eliminate the food source. The only remaining thing is the bacterial plaque.
The message in the past was always “brush your teeth after every meal.” I suspect it was intended to encourage people to remove the food particles from their teeth. And that is not a bad thing. But the facts do not support that message. Eliminate acid production is what we want as the message. I have never met anyone who has routinely begun brushing their teeth within 20 minutes of taking the first bite of a meal. And I suspect I never will. You can take the following statement to the bank. Plaque free teeth cannot decay, even if they are covered by food particles. So logically it makes sense to remove the plaque before you start eating. Unfortunately, I seem to be the only one delivering this message.
Your Ideal Checkup Schedule
Another piece of the science puzzle is that if you remove all of the plaque when you or the dental professional cleans your teeth, saliva continues to flow and plaque begins to form again in about two hours. It takes about 24 hours to develop to the point that it can do theoretical damage. And it takes about 90 days, or 3 months, to grow to the point that the damage can become noticeable and possibly detected by the dentist. Heredity and diet each play their part in this puzzle. No two people are the same, not even identical twins. So the safest thing to do is to keep the teeth clean and get regular dental checkups and cleanings, preferably every three months based on the science.
I have always said to my patients, “I don’t care if you use a pick and shovel as long as you get the teeth clean.” Of course, a pick and shovel do not work well for this particular job. And a toothbrush and floss are not much better if you don’t know how to use them properly. So in future installments I am going to make an effort to explain how to properly use toothbrushes, floss, and other things that will help to get the teeth clean.
Posted July 12, 2017, by Dr. Kevin Kelaher