Prevention

Instructions in oral hygiene involve detailed tips on oral care. After an examination, the doctor chooses an appropriate tooth brushing technique individually for each patient, depending on their needs, the condition of their teeth and periodontium, as well as their dexterity. Taking into account the issue of cleaning smooth tooth surfaces, interdental surfaces and inaccessible areas, the dentist recommends the right type of toothbrush and toothpaste, as well as additional tools. While presenting the oral hygiene products, the dentist often demonstrates their use on models or directly in the patient’s mouth.

The food that we eat – its quality, consistency and frequency of meals, have a great impact on the state of our teeth. Our teeth are protected by dental enamel, which is susceptible to damage caused by low pH in the mouth, which occurs right after consuming carious foods, particularly carbohydrates that remain on the surface of the enamel for a long time. Carbohydrates are the most significant compounds in the development of dental caries. They are the basis of bacterial metabolism. Carbohydrates break down into acids, which demineralize the enamel.

The diet of pregnant women and babies is of no small importance for the correct development and mineralization of teeth.

Mother’s milk, which is the main source of nutrition for the baby, isn’t particularly cariogenic, despite the fact that it contains the disaccharidelactose. It also contains calcium and phosphates, which inhibit demineralization of tooth enamel, as well as casein, which covers the surface of teeth and slows down the carious process.

Also important is vitamin D intake, which promotes the correct development of tooth enamel. Proteins support the development of salivary glands, which are responsible for the release of appropriate amounts of saliva.

Here are a few examples of foods that help prevent dental caries:

• hard cheese (e.g. Camembert) stimulates saliva production, which increases the concentration of calcium in dental plaque and protects tooth enamel due to casein content,
• groats, leguminous plants, vegetables, nuts– they inhibit the development of bacteria that are responsible for caries,
• chewing gum, preferably containing sorbitol, xylitol or fluorides, chewed within 10 minutes after a meal,
• low-calorie sweeteners – they have low cariogenic potential, as they are not converted into acids by oral bacteria.

Some foods are highly sticky and cling to tooth surfaces, which makes them more cariogenic than other foods. They include chewy candies (like toffee) and crisps.

With our patient’s health in mind, and appreciating the role of diet in tooth and periodontium disease prevention, we provide our patients with comprehensive information about both beneficial and harmful nutritional habits.

The aim of professional tooth cleaning is removing dental plaque and other sediments that accumulate on the surface of teeth, which cannot be removed with home-applied hygiene measures. Depending on the type of deposits on the teeth, we use different methods:

• Mechanical tooth cleaning with the use of special brushes and rubbers, as well as professional toothpastes.
• Sandblasting–the procedure of removing sediments and discolorations on tooth crowns, caused by coffee, tea and tobacco. This is achieved through the use of air abrasion devices – known as “sand blasters”–which produce a fine, high-pressure stream of powder and water. It effectively removes sediments and discoloration, which cannot be removed using a toothbrush.
• Scaling is the removal of hard dental deposits (tartar) that accumulate on the surface of the crown of the teeth, with the use of ultrasonic devices called scalers.Scaling is usually a painless procedure. However, pain may occur in case of an inflammation of tissues surrounding the tooth. In such cases, local anaesthetic is applied.Each scaling procedure is completed with the polishing of all tooth surfaces, which prevents further build-up of dental plaque and gives the patient a pleasant sensation of smooth teeth.

Fluorineis a scientifically proven weapon of dentists, widely used in dental disease prevention. The most common form of professional fluoride prevention is the varnishing of clean teeth with a fluoride-based varnish, such as Fluor Protector or Duraphat, which is recommended particularly for children. Varnishing is widely used to prevent disease of both the entire dentition, as well as selected teeth. Owing to the varnishes’ good adhesion to tooth enamel, they stay on the tooth surface for longer and release fluorine slowly, thus providing up to 40% reduction in dental caries.The varnishing procedure should be repeated 2-4 times a year, depending on the patient’s susceptibility to caries. Fluorine applied in the form of such varnish:

• strengthens the enamel in adults and children;
• reduces the build-up of dental plaque;
• prevents the development of secondary caries (adjacent to fillings);
• prevents the development of caries during treatment with permanent braces;
• reduces hypersensitivity of the necks of the teeth.

Pit and fissure sealing consists in filling teeth pits and fissures with a special material called fissure sealant.Pits and fissures are places where food debris accumulates and bacteria grow. Their intricate shapes make it difficult or even impossible to clean them with a toothbrush, thus promoting the development of caries. Therefore, sealing both milk and permanent teeth is done to protect them from the carious process. The sealing procedure should be performed as early as possible after the tooth appears in the mouth; however, the tooth should be erupted enough to be able to separate it from saliva. The procedure involves especially healthy permanent molar and premolar teeth, as well as molar milk teeth. It is also possible to seal pits and fissures in the palatine surfaces of permanent 2nd incisors. It is an excellent method of caries prevention. Simple, painless and efficient, it offers caries reduction of 90%.

At Villa Nova Dental Clinic, our youngest patients are taught about oral hygiene by our certified dental hygienist in a dedicated room, equipped with teaching materials, i.e. real-size tooth models, all kinds of toothbrushes and other oral hygiene accessories, posters, booklets etc.

The visit begins with dental plaque staining performed with the use of a special liquid. It lets our youngest patients see how effective their tooth brushing is.

Education depends primarily on the parents and involves several significant elements:

• appropriate diet,
• selection of an appropriate toothbrush and toothpaste,
• oral hygiene instructions and motivating the young patient

If you teach your child to brush their teeth, it’s like you’ve taught them everything. 
Julia Roberts

1. What is the cause of dental caries and periodontosis?

The main cause for caries is the dental plaque, consisting of residual food and bacteria, which are deposited on teeth after each meal. The bacteria contained in the plaque transform sugars in the food into acids, which wash out minerals (calcium, phosphorus) from dental enamel. This results in weakening and damage to the enamel, allowing the further development of caries. The bacteria in the plaque also attack the gums and deeper periodontal tissues; thus, they are the principal cause of periodontosis; other causes include smoking, systemic diseases (diabetes, osteoporosis, etc.), stress and genetic predisposition.

2. What is dental plaque?

Dental plaque is a strongly adherent, soft, white to yellowish deposit that occurs on the surface of teeth, gums and prosthetic appliances. It comprises various organic material (elements of saliva, food debris, dead cells) and wide range of bacteria. Non-removed plaque is transformed, due to saturation for some time with minerals contained in the saliva, into dental tartar, which cannot be removed by home oral hygiene measures.

3. How can the development of caries and periodontosis be prevented?

To prevent the development of caries efficiently, you should take care to strengthen the hard tooth structures by:

• a well-balanced diet (rich in vitamins and minerals) in pregnant women and children from birth until the end of tooth development;
• fluoride prevention: teeth varnishing, the use of fluoride toothpaste and mouthwash, fluoride drops and tablets (the decision to introduce a fluoride preparation into a child’s diet should be taken only by a dentist);
• tooth sealing – sealing of the tooth’s pits and fissures with special material.

On the other hand, as the main cause for caries and periodontosis is dental plaque, the primary method of prevention against caries is the efficient and systematic removal of the dental plaque.

4. Is it necessary to stop eating sweets to maintain healthy teeth?

Sugar in the food is in fact a prerequisite for dental plaque bacteria on the production of acids, and thus commencement of the carious process. However, it is impossible to eliminate sugar from the diet completely. So you should remember that the frequent eating of sweets (the time they remain in your mouth) and their texture are more important than the overall amount of sweets you eat. The most harmful for your teeth is the frequent eating of sticky products that adhere to teeth, such as toffee, crisps, etc. Thus, you do not have to deprive yourself completely of the pleasure of sweets; it is important to observe regular meal times, limit snacking between meals and to clean your teeth immediately after eating sweets.

5. What are sugar substitutes?

Sugar substitutes (sweeteners) are substances that give a sweet taste to the food, and have no harmful effect on the teeth and gums. There are two types of sugar substitutes:

• nutritional agents that provide the body with energy, such as xylitol and sorbitol;
• artificial sweeteners that have no nutritional properties apart from the sweet taste itself, such as aspartame, cyclamate, acesulfam and dulcin.

All the substances are used to eliminate sucrose (table sugar), the sugar most dangerous to teeth, from the diet.

6. What type of toothbrush should I choose?

The selection of an appropriate toothbrush is of significant importance to oral hygiene. As there is a huge diversity of toothbrushes available, you may have some problem in choosing the most suitable. The most important is that the size and bristle hardness of the toothbrush is matched individually to the patient’s needs. The toothbrush should not be too big and should have a long thin neck, allowing access to molar teeth. Usually medium or medium-hard toothbrushes with multiple bunches, made of synthetic bristle of gently polished and rounded tips, are recommended. In the case of any periodontal disease, a soft toothbrush with a flexible neck that reduces pressure on the gums should be used. There are various versions of bristle pattern. The bristle may be of various lengths or serrated to improve cleansing of dental gaps (longer tips easily penetrate between the teeth) and to massage the gums.

There are also electric toothbrushes available which are very easy to use and reduce the time required for brushing the teeth compared to conventional toothbrushes.

7. How frequently should I replace my toothbrush?

In general your toothbrush should be replaced every two months. After that period the bristles stiffen and irritate gums. Some toothbrushes have a wear indicator in the form of a bristle bunch in a different colour, which discolours as the toothbrush wears.

To function properly, the toothbrush needs to be taken care of. After brushing your teeth, the toothbrush should be thoroughly rinsed and stored in a place where it can dry. You should also pay attention to whether the bristle in your toothbrush is crushed, if it is, this indicates that you press your toothbrush against your teeth too firmly.

8. How should I brush my teeth?

In general, each method of brushing the teeth is good provided that it is efficient and not harmful to teeth and gums. Ideally, the tooth brushing technique should be chosen individually by a dentist or hygienist depending on the patient’s needs, the condition of his or her dentition and gums and dexterity. Regular tooth brushing should last at least three minutes. The minimum frequency of the procedure should be twice a day: in the morning after breakfast and in the evening after the last meal. However, in some circumstances, e.g. in patients wearing permanent braces, teeth should be brushed after each meal.

9. Is a toothbrush alone sufficient?

Efficient tooth care requires that all their surfaces (facial, lingual, masticatory and interproximal ones) be cleaned. However, only the first three of them are accessible to a toothbrush; thus, a toothbrush alone is not sufficient for maintaining appropriate oral hygiene. You should use additional tools:

• Dental floss – a bunch of waxed silk threads formed into a band, used for cleaning interdental spaces where teeth are close together;
• Dental toothpicks made of soft, non-splintering wood and saturated with fluorine compound are designed for people with spaced or missed teeth;
• Interdental toothbrush – a bristle spiral used similarly to a toothpick, and also for maintaining oral hygiene in people with permanent braces;
• Dental irrigator – a device producing a water stream that cleans interdental spaces and gingival pouches, as well as massaging gums;
• A single bunch toothbrush used for cleaning difficult to reach back teeth.

10. What toothpaste should I choose?

The selection of toothpaste is not as important as the selection of the toothbrush; however, the use of an appropriate toothpaste may improve the efficiency of brushing. Most of the toothpastes marketed conform to basic requirements and contain clinically proven substances, such as polishing agents (help in the removal of dental plaque and deposit), foaming agents, fluorine compounds (sodium fluoride, calcium fluoride or amine fluorides). In particular circumstances you may choose a toothpaste containing appropriate additional ingredients:

• protective toothpastes containing fluorine;
• herbal toothpastes containing herbal extracts that relieve the gums;
• whitening toothpastes that remove food-related discolorations (caused by tea, coffee, smoking and red wine);
• multi-action toothpastes, that include the above-mentioned properties.

11. Is sugar-free chewing gum worth using?

Recently sugar-free chewing gum has been considered a hygienic agent. A study conducted among Finnish children has shown that the use of chewing gum containing a sugar substitute (xylitol) between meals may cause up to 80% caries reduction. It has been stated that chewing the gum stimulates saliva production, which has a beneficial effect on the dental enamel, and xylitol contained in the gum inhibits the growth of dental plaque bacteria. Thus, chewing gum containing xylitol or sorbitol should be used after meals in cases where toothbrushing is impossible. However, gum chewing is not able to replace morning and evening toothbrushing. Moreover, the gum should not be chewed for longer than 5-10 minutes to prevent its transformation into a habit harmful to the temporomandibular joints.

12. What are the advantages of the application of fluorine products?

Fluorine is a scientifically proven weapon of dentists, widely used in dental prevention in various formulas (toothpaste, mouthwash, varnish, gel, tablets, drops, and as an additive to tap water, kitchen salt or milk).

The beneficial effect of fluorine consists of:

• strengthening of the developing enamel, before the teeth appear;
• increase in the resistance of the dental enamel to acids produced by dental plaque bacteria;
• inhibition of the build-up of dental plaque;
• remineralisation and reversal of the initial stage of carious process;
• reduction of hypersensitivity in the necks of the teeth.

13. Can fluorine be overdosed?

Yes, fluorine overdose is possible and may occur in chronic form, in the case of long-term use of a dose slightly exceeding the normal (fluorosis), or as acute fluorine poisoning. Fluorosis symptoms include:

• loss of enamel gloss;
• white opaque spots on the enamel surface;
• enamel defects

Acute fluorine poisoning, which luckily is very rare manifest itself by:

• sickness;
• vomiting;
• abdominal pain;
• headache;
• increased saliva, tears and sweat production;
• diarrhoea.

Should the symptoms above occur, with the possibility of significant fluorine intake, call an ambulance immediately, make the patient drink plenty of milk and provoke vomiting.