A dental examination, or check-up for most people should be conducted every six months. Dental check-ups form part of what is known as preventative dentistry .
The aim of preventive dentistry is to retain healthy teeth and gums throughout your life. Those who suffer from a dental phobia tend to not want to come in for a routine check-up as they are fearful of what treament they may need.
The truth is that during a dental examination your dentist can detect any issues before they become big problems.
The aim of this article to explain what Preventative Dentistry iis made up of.
A Dental Examination
At your dental check-up we like to update your medical histry.
This allows us to assess any possible interaction with any medication you are taking if any, and your dental treatment and your dental status. Some medications can cause an abnormal growth of the gum tissue, while others can cause a dry mouth.
The mouth is part of the body and often reflects the first signs, and symptoms of many systemic diseases, for example, vitamin B deficiency.
The check-up starts on the outside of your head, noting symmetry, jaw opening ,and lateral movements. Finally, the lymph glands under the jaw are checked.
Next, we inspect all the soft tissues inside the mouth as far back as the tonsillar area. We then examin the teeth in detail. Looking for discolouration, cracks, stain, wear facets, toothbrush abrasion, abnormal tooth movement and of course decay.
Also noted is the amount of plaque and calculus present as well as toothbrush abrasion and gingival recession. We also check the gingivae for inflammation.
Periodontal charting is where we measure the crevice depths around each tooth at six defined points. It is the only quantitative gauge we have to indicate periodontal health.
Healthy crevicular depths range from 1 to 3 mm. Any more than this indicates the possible presence of periodontal disease.
Ideally, we carry out Periodontal charting every two years. This builds up a history over time that monitors periodontal health. It allows us to assess to see if our efforts together with your efforts at home, are maintaining, and improving periodontal health, or if the situation is deteriorating.
Periodontal disease occurs when calculus (tartar) forms around the necks of the teeth. This build-up of calculus is full of bacteria that excrete toxins that directly cause bone loss leading to loss of tooth support.
Calculus is rough and ulcerates the gingivae causing gums to bleed particularly when brushing. This is the first sign of periodontal disease.
Periodontal disease is painless in its early stages and often the first thing the patient knows is that the teeth are becoming loose. At this point, it is often too late as we cannot grow new bone to support the teeth.
Calculus is formed from plaque that builds up on the teeth and starts as a mixture of: saliva, mucins, bacteria, and food debris.
Depending on the pH of the plaque and the type of bacteria in the plaque, determines whether it will lead to tooth decay or periodontal disease. If the plaque hardens becoming calculus, it continues to build up creeping down the tooth root, destroying the periodontal ligament and bone as it goes.
Generally, it is a slow disease that takes many years to get to an advanced stage. Again the best defence is thorough brushing and flossing twice a day.
Importantly preventive dentistry requires you to use a good fluoride toothpaste with a small soft toothbrush twice a day. Together with a meticulous brushing technique as well as thorough flossing to ensure a healthy dentition for life.
We cannot be 100% efficient in our cleaning efforts, and once the plaque hardens to form calculus, we need professional help.
The reason we ask patients to have six-monthly check-ups is to monitor their efforts at home, advise new techniques as indicated and remove calculus if need be. Once plaque becomes calculus, only a dentist or hygienist can remove it.
Simply put, there is a triangle of decay. The three sides of the triangle are teeth, bacteria, and sugar (simple carbohydrates). Remove any one of these and you will have no decay.
Obviously, if you have no teeth you have no decay, but that defeats the purpose. If we remove the bacteria by brushing and flossing thoroughly we will stop decay.
If we remove all sugar and simple carbohydrates from the diet we will have no decay. Clearly, it is impossible to clean out teeth 100% efficiently.
However, it is achievable by cleaning and flossing thoroughly twice a day, and reducing the number of simple carbohydrates that we eat. At your check-up a dentist will assess whether you are cleaning your teeth thoroughly and will point out any areas that you are missing, or need extra attention.
We recommend Bite-wing x-rays every two years. They allow us: to check the level of the bone that supports the teeth, find decay between teeth, and to check the margins of existing restorations as well as monitor for early decay.
Over time, a history is built up that can be sequentially reviewed. For example, early decay can be detected and the tooth re-mineralised avoiding the need for a filling. This can be monitored over time.
We refer you for an OPG x-ray every five years. An OPG gives us a good overview from the floor of the nose to below the chin and often includes the temporomandibular joints. These x-rays are particularly useful for assessing wisdom teeth, periapical tissues and bone lesions.
X-rays and Radiation
We can compare successive x-rays over time. Occasionally people worry about the amount of radiation in taking x-rays.
We are constantly subjected to many types of radiation from the sun, ultraviolet being the one everyone is aware of, but also we are constantly being bombarded with cosmic, gamma and x-radiation. The atmosphere of our planet reduces the impact this radiation has on us.
Whenever we fly we are exposed to more radiation than we are on the ground. To put it in perspective the radiation from two bite-wing x-rays is about the same as the extra radiation taking a flight from Melbourne to Sydney.
At Dentist On Collins we use digital x-rays which produce a much lower level of radiation than traditional x-rays. Digital x-rays do not only produce a sharper image than the traditional ones, they are better for the environment as we do not have to deal with toxic chemicals to develop them.
When the back teeth develop, they have particular shapes according to which tooth they are. When you look at your teeth in a mirror, you will see hills and valleys. We call them cusps and fissures.
The fissures can be particularly deep and in some cases be an actual defect in the tooth. Fissures are very hard to clean, but an ideal place for bacteria and food to remain.
This is the number one area for tooth decay. Sealing the fissures with a resin that locks into the enamel, makes it easier to clean the teeth and eliminates the potential for decay.
The benefit of fluoride has long been known, but only recently understood.
When the teeth first erupted into the mouth, the enamel is immature, and through repeated dissolving and re-mineralisation, becomes mature enamel.
Acidic foods dissolve the calcium out of the surface layer of teeth, and when the pH returns to normal about half an hour to an hour later the surface of the tooth can be re-mineralised under favourable conditions.
In the 1950s it was noted that in two similar towns in New Zealand, Napier and Hastings, the children had different rates of dental decay. Naturally occurring fluoride reduced the amount of decay in children living in one of the towns. This has led to the fluoridation of water supplies around the world.
Fluoride treatments do not form part of your dental check-up and hygiene visit. Melboure’s water is flurodated and toothpaste contains fluoride also.
The Controversy Surrounding Fluoride
There has been much controversy surrounding fluoridation and its role in Preventative Dentistry. But like many elements, it is essential for good health.
It is amazing that there is no controversy about the addition of iodine to salt to prevent thyroid problems, which was endemic in Australia and New Zealand due to the lack of iodine occurring naturally in the diet.
The main brands of toothpaste contain fluoride, as it continues to have a beneficial effect on the surface of mature adult teeth.
Colgate has included Arginine in their pro-relief toothpaste to reduce decay by neutralising sugar acids.
Sugar has been legally defined as sucrose. Sucrose is only one of many sugars that is properly regarded as a fermentable carbohydrate, the simplest of which is glucose. Two glucose molecules form sucrose and so the sugars build in complexity to include fructose, lactose and others.
In simplified terms, fermentable carbohydrates are metabolised by bacteria into acid which leads to tooth decay.
Today many foods are highly refined and contain high amounts of hidden sugar. The effect is that these foods tend to clag on our teeth to the bug’s delight.
Highly refined and high sugar foods and drinks are causing obesity and tooth decay in developed nations.
During the two world wars, sugar was rationed and tooth decay dropped dramatically. Once rationing ceased, decay rates returned to pre-war levels.
Keeping an Eye on Sugar Consumption
There is a direct link between sugar consumption and tooth decay not to mention obesity and diabetes, both of which are increasing at an alarming rate.
Being aware of the sugar content of foods, and limiting the total amount of sugar that you eat, will have beneficial effects for your dental health, and your health generally.
Read labels when buying savoury as well as sweet products. Bread, and tomato sauce for example can have high amounts of added sugar.
Obviously brushing and flossing away the food debris is important too.
So your best approach to Preventative Dentistry is to avoid excessive sugar consumption, clean your teeth thoroughly twice a day by brushing and flossing and have a professional dental check-up twice a year, or as recommended by your dentist.
Copyright Dr Richard Skinner 2023