X-Rays

What Are X-Rays?

X-rays are a form of energy that travels in waves. X-rays can enter solid objects, where they either are absorbed or continue to pass through. X-rays tend to be absorbed by denser objects. They pass easily through less dense objects.

Teeth and bone are very dense, so they absorb X-rays. X-rays pass more easily through gums and cheeks. That's why cheeks and gums appear dark and without detail on a dental X-ray, but teeth show up much lighter. Restorations such as crowns and fillings are even denser than bone. They show up as solid, bright white areas on X-rays. Dental decay and caries (cavities) appear as darker patches.

What You See on an X-Ray

How Often Should You Go to the Dentist?

More than 50 years ago, examinations of people entering the military showed that Americans' teeth were in pretty bad shape. Few people took good care of their teeth. There were no guidelines for how often you should see a dentist. Many dentists focused on fixing problems rather than preventing them.

Dental and health organizations decided there was a need to set standards for preventive dentistry. They didn't have much evidence, so they made a "best guess" recommendation. They said people should go to the dentist twice a year for checkups and cleaning.

This proved to be a useful rule of thumb and has remained common. Even if you take excellent care of your teeth and gums at home, you still need to see your dentist regularly. Your dentist can check for problems that you may not see or feel. Many dental problems don't become visible or cause pain until they are in more advanced stages. Examples include cavities, gum disease and oral cancer.

Regular visits allow your dentist to find early signs of disease. Problems can be treated at a manageable stage.

On average, seeing a dentist twice a year works well for most people. A few people can get away with fewer visits. Others may need more frequent visits. People with very little risk of cavities or gum disease can do fine seeing their dentist just once a year. People with a high risk of dental disease might need to visit every three or four months, or more. This high-risk group includes:

* Smokers
* Diabetics
* People with current gum disease
* People with a weak immune response to bacterial infection
* People who tend to get cavities or build up plaque

The schedule for any person may change during a lifetime. In times of stress or illness, you may need to see the dentist more often than usual. The dentist may help you to fight off a temporary infection or treat changes in your mouth.

If you take good care of your teeth and gums at home and your dentist doesn't find any cavities or gum disease for a few years, he or she may choose to lengthen the time between visits. Ask your dentist the best schedule for your routine dental visits.

Your Dental Visit: What To Expect

Types of Dental Visits

Most people are familiar with the typical dental checkup visit. If the office has a dental hygienist, he or she will clean your teeth, do an examination and sometimes take X-rays. Then the dentist will check the X-rays and your teeth for signs of decay, check your gums for changes, and check for signs of oral cancer or other diseases.

From time to time, however, your dentist should do a more thorough exam. This is called a comprehensive examination. It includes a thorough examination of your entire mouth, head and neck area. The dentist also will ask about your medical history, and you will get X-rays if indicated.

A comprehensive examination likely will be done the first time you visit a dental office. Even if you have had regular care under another dentist, your new dentist will want to become familiar with your health. This will allow him or her to notice changes or problems more easily during future visits.

Some activities are standard for a checkup or comprehensive exam, but dentists and hygienists have their own style and skills. If your dentist doesn't do everything listed here, that doesn't necessarily mean he or she isn't doing a good job. If you are concerned, ask why certain things are left out or why others are included.

The order in which things are done may vary as well. And it doesn't all have to be done at every visit.

An important part of every visit is updating your medical history. Your dentist will want to know if you've had any changes in your health or your medicines since your last visit.

Mention everything about your health, even if you don't think it relates to your mouth. Many diseases can have significant effects on your mouth and teeth. Researchers continue to discover ways in which oral health is related to overall health. For example, people with diabetes are at a higher risk of developing periodontal disease. Research also suggests that periodontal infection can affect your blood sugar levels and make your diabetes harder to control. Other health conditions may require your dentist to change the type of anesthesia given.

Bring a list of all medicines you take, with dosages. Some medicines cause dry mouth, which can increase the risk of cavities. Your dentist also will want to check that any drug he or she prescribes doesn't interact with drugs you are already taking.

What To Tell Your Dentist

Your dentist needs to know everything that may help him or her diagnose problems or treat you appropriately. Tell your dentist:

* Your fears — Many people have fears of the dentist that go back to childhood. Pain control and treatment techniques change constantly. The things you fear most may not exist any longer, or there may be new and improved ways of dealing with them. If you fear you have a particular disease or condition, let your dentist know. He or she can look for signs and either diagnose the problem or set your mind at ease. Often, just talking about your fears will take some of the edge off.


* Your overall health — Tell your dentist if you've been diagnosed with any diseases or are taking any new medicines. It is important to tell your dentist about all medicines you take. This includes those that have been prescribed by your physician and over-the-counter medicines. Even diseases that seem to be unrelated to the mouth may require a different approach to dental treatments or prevention.


* Your dental health — If you think you have a new cavity, if your teeth have become sensitive or if you feel lumps inside your mouth, tell your dentist before the examination starts. Don't wait to see if the dentist catches it or silently hope the dentist misses it. By telling your dentist your symptoms, you may help him or her make an early diagnosis.

Oral Cancer

Tobacco's greatest threat to your health may be its link to oral cancer. The American Cancer Society reports that:

* About 90% of people with mouth cancer and some types of throat cancer have used tobacco. The risk of developing these cancers increases as people smoke or chew more or for a longer time.

* Smokers are six times more likely than nonsmokers to develop these cancers.

* About 37% of patients who continue to smoke after cancer treatment will develop second cancers of the mouth, throat or larynx. This compares with only 6% of those who stop smoking.

* Tobacco smoke from cigarettes, cigars or pipes can cause cancers anywhere in the mouth or the part of the throat just behind the mouth. It also can cause cancers of the larynx, lungs, esophagus, kidneys, bladder and several other organs. Pipe smoking also can cause cancer in the area of the lips that contacts the pipe stem.

* Smokeless tobacco has been linked to cancers of the cheek, gums and inner surface of the lips. Smokeless tobacco increases the risk of these cancers by nearly 50 times.

Implant Failure

Implants can replace lost teeth in people who smoke. However, smokers should know they have an increased risk that the procedure will fail.

"Studies have consistently found that patients who smoke have more implant failures," Dr. Albert says. Smokers who are considering getting a dental implant need to realize this risk, he says.

"Before getting implants, consider seeking counseling and support to help you quit smoking," he says.

Smoking: A Danger to Healthy Gums

You've probably seen the warning on cigarette packages: "Quitting smoking now greatly reduces serious risks to your health." What smoking-related diseases come to mind? Lung cancer, probably. Emphysema, maybe.

But did you know that half of periodontal (gum) disease in smokers is caused by smoking? Chronic (long-term) gum disease can lead to the loss of your teeth.

"Studies have found that tobacco use may be one of the biggest risk factors in the development of periodontal disease," says David A. Albert, D.D.S., M.P.H. Dr. Albert is an associate professor at the Columbia University College of Dental Medicine.

Periodontal (gum) disease is a bacterial infection. It destroys soft tissue and bone that anchor your teeth to your jawbones. Bacteria grow in the dental plaque that forms in the pockets around your teeth. Your body's reaction to the plaque leads to the breakdown of soft tissue and bone.

In early stages of the disease, you may notice that your gums bleed when you brush or floss. As the infection worsens, your gums begin to break down. They pull away from your teeth, forming pockets. Later, the pockets between your teeth and gums deepen as more of the supporting structures are destroyed. Ultimately, your teeth may become loose and painful. They may even fall out.

Studies have shown that smokers have more calculus (tartar) than nonsmokers. This may be the result of a decreased flow of saliva. Calculus is the hardened form of plaque.

Smoking tobacco products can make gum disease get worse more quickly. Smokers have more severe bone loss and more deep pockets between their teeth and gums than nonsmokers. In studies, smokers were three to six times more likely to have gum destruction than nonsmokers. Severe bone loss was five times greater among current or former heavy smokers than among people who never smoked.

"Smokers have much less gum bleeding and redness than other people even though their mouths are not healthy," Dr. Albert says. "This can lead to the false impression that the gums are healthy. It is therefore very important that tobacco smokers have regular dental exams to evaluate their gum health."

Not only does smoking increase the chance that you will develop gum disease, it makes treatment much more difficult. And the treatment is less likely to succeed. That's because smoking hinders healing in your mouth.

One study found that smokers were twice as likely as nonsmokers to lose teeth in the five years after completing periodontal treatment. In most studies of nonsurgical gum treatment (deep scaling), smokers improved less than nonsmokers. Smokers also didn't respond as well to surgery. Implants are much more likely to fail in people who smoke, because of poor bone healing.

Crowns and bridges look great when first placed in the mouth. In smokers they often lose this beautiful appearance, especially as the gums recede and bone is lost. Popular cosmetic procedures, such as porcelain laminates, will not look good for a long time in a person who smokes.

Researchers still are studying just what smoke does to mouth tissue. It appears to interfere with basic functions that fight disease and promote healing. Researchers have found that smoking affects the way gum tissue responds to all types of treatment.

"It is believed that the chemicals contained in tobacco interfere with the flow of blood to the gums," Dr. Albert says. "This leads to a slowdown in the healing process. It makes the treatment results less predictable and often unfavorable."

It is not just cigarette smoke that contributes to periodontal disease, Dr. Albert says. All tobacco products can affect gum health. This includes pipe tobacco, smokeless tobacco and cigars.

A study conducted at Temple University showed this risk. Researchers reported that 18% of former cigar or pipe smokers had moderate to severe gum disease. "This is three times the amount found in non-smokers," Dr. Albert says. The study was published in the Journal of Periodontology in 2000.

Experts say pipe smokers have rates of tooth loss similar to those of cigarette smokers. Smokeless tobacco can cause the gums to recede. This increases the chance of losing the bone and fibers that hold teeth in place.

The only good news about smoking and oral health is that the Surgeon General's warning holds true. Quitting now does greatly reduce serious risks to your health. A recent study reported that people who had quit smoking 11 years before had about the same rate of periodontal disease as people who never smoked.

Even reducing the amount you smoke seems to help. One study found that people who smoked more than a pack and a half per day were six times more likely to have periodontal disease than nonsmokers. Those who smoked less than a half pack per day had only three times the risk.

"The dental office is a good place to visit for help with quitting," Dr. Albert says. "Your dentist can show you the effect of smoking on your mouth and teeth. She or he can help you set a quit date and provide you with advice on which medicines can help you quit, such as nicotine patches or gum."

Dental Sealants

What Is It?

A sealant is a clear or tinted plastic protective coating for teeth. It is painted onto the chewing surfaces of the back teeth (molars and premolars). These are the areas where most cavities form.

Molars and premolars have grooves and crevices. Dentists call these pits and fissures. Food can get stuck in these crevices. Some are so deep that the bristles of a toothbrush can't reach into them.

Grooves and crevices provide the perfect environment for bacteria to grow and cause cavities. Sealants help to prevent this from happening. They cover the grooves and crevices so that food cannot get into them.

What It's Used For

Sealants are applied to teeth to help prevent cavities. In the past, they usually were used only in children. But adults also can get sealants. Click here to see illustrations showing how sealants are applied.

Not only are sealants very effective, they cost a lot less than filling cavities.

In children, sealants can be applied to baby molars to protect them from cavities. Eventually, these molars fall out and the new, permanent molars come in. These molars can be sealed, too. Most dentists recommend that sealants be applied to each permanent molar as soon as possible. This can be when the tooth is only partially erupted into the mouth. However, it can be done only if the tooth can be kept dry and free of saliva while the sealant is applied.

If your child has a high risk of cavities, your dentist may decide to seal the premolars, or bicuspids, as well. The premolars are the teeth directly in front of the molars.

Sealants can be used in adults who have an increased risk of developing cavities. Your dentist can suggest whether sealants are appropriate for you.

Sealants can be put on teeth that show early signs of decay. But once the decay has broken through the enamel, the tooth will need a filling.

Preparation

Applying sealants is quick and painless. It can be done during a routine dental visit. No injections are needed. However, it is very important to sit still so the tooth or teeth being worked on will stay dry. This allows the sealant material to stick properly to the tooth.

How It's Done

The dentist cleans the area to remove any food or debris in and around the teeth. Then he or she makes sure the teeth are dry so that the sealant can stick. The sealant is applied in liquid form. It flows over and into the grooves and crevices. The sealant usually hardens (sets) within 20 to 60 seconds. Sometimes it is set with a special light.

Follow-Up

Studies show that sealants can last a long time, sometimes as long as 15 years. But they don't last forever.

The dentist will check the sealants during routine visits. If necessary, the sealants can be replaced.

Remember, sealants work well, but they can't keep teeth cavity-free without some help. Keep brushing twice a day, flossing at least once a day, and visiting a dentist regularly.

Children with sealants still should:

* Brush twice a day with a pea-size amount of fluoride toothpaste.
* Floss between any teeth that touch each other.
* Get the right amount of fluoride, either by drinking fluoridated water or taking fluoride liquid or pills.
* See a dentist regularly

Risks

Although it is rare, sealants can cause problems in people who are allergic to plastics or components of plastics. In addition there has been some concern about the possible harmful effects of bisphenol A (BPA). This chemical is found in some sealants. However, studies show that any release of BPA from sealants is very small and limited to the time right after they are applied. The American Dental Association and the U.S. Food and Drug Administration have found that sealants are safe.

When To Call a Professional

Ask your dentist to talk with you about the benefits of sealants. Most pediatric dentists (dentists who specifically treat children) use sealants routinely. However, not all dentists do so. Therefore, your dentist may not think to talk with you about them.

Mouth-Healthy Eating

If you want to prevent cavities, how often you eat can be just as important as what you eat. That's because food affects your teeth and mouth long after you swallow. Eating cookies with dinner will do less harm to your teeth than eating them as a separate snack. Of course, overall poor nutrition can contribute to periodontal (gum) disease. It also can have other long-term effects on your mouth. Learning how food affects your oral health is the first step toward mouth-healthy eating.

Immediate Effects of Food

Changes begin in your mouth the minute you start to eat certain foods. Bacteria in your mouth make acids. The acids start the process that can lead to cavities.

How does this happen?

All carbohydrate foods eventually break down into simple sugars: glucose, fructose, maltose and lactose. Fermentable carbohydrates break down in the mouth. Other foods don't break down until they move further down the digestive tract.

It's the fermentable carbohydrates that work with bacteria to form acids that begin the decay process and eventually destroy teeth. They include the obvious sugary foods, such as cookies, cakes, soft drinks and candy. But they also include less obvious foods, such as bread, crackers, bananas and breakfast cereals.

Certain bacteria on your teeth use the sugars from these foods and produce acids. The acids dissolve minerals inside the tooth enamel. The process is called demineralization. Teeth also can regain minerals. This natural process is called remineralization. Saliva helps minerals to build back up in teeth. So do fluoride and some foods.

Dental decay begins inside the tooth enamel when minerals are being lost faster than they are being regained.

The longer food stays near the bacteria on the tooth, the more acids will be produced. So sticky carbohydrates, such as raisins, can do more acid damage. But other foods that pack into crevices in the tooth also can cause decay. Potato chips are a terrific example. Eat a handful of chips and see how long you have to work to get all the stuck bits out from between your teeth. Teeth with a lot of nooks and crannies, such as molars, are more likely to trap food. That's why they tend to have more decay.

To make matters worse, many of the foods that are unhealthy for teeth don't just create acids while they are being eaten. The acids stick around for the next half-hour.

Depending on your eating and drinking patterns, it's possible for the bacteria to produce acid almost constantly. This can happen if you sip soft drinks or sweetened coffee throughout the day. Eating many small sweet or starchy snacks can produce the same effect. The resulting acid damage adds up, so decay is more likely. Studies have shown that people who eat sweets as snacks between meals have higher rates of decay than people who eat the same amount of sweets with their meals.

On the brighter side, some foods actually help to protect teeth from decay. That's because they increase saliva flow and neutralize the acids produced by bacteria. This makes it less likely that the enamel will lose minerals. For example, aged cheese eaten immediately after other food helps to buffer the acid.

Chewing sugarless gums also can help protect your teeth against cavities. Xylitol is an ingredient in some sugarless gums. This sweetener has been shown to reduce the amount of bacteria in the mouth. It also helps to buffer the teeth against the effect of acid. Most sugarless gums and sugarless candies increase the flow of saliva, which helps to protect your teeth against bacteria.
Long-Term Effects

Like the rest of your body, your mouth depends on overall good nutrition to stay healthy. In fact, your mouth is highly sensitive to poor nutrition. It can lead to tooth loss, serious periodontal (gum) disease and bad breath.

What To Eat

The current and best advice for overall good nutrition is found in the Dietary Guidelines for Americans. This document was developed by the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services.

The guidelines are simple in concept:

* Eat whole grains daily instead of refined grains. Whole grains include brown rice, oatmeal and whole wheat bread. Refined grains include white bread and white rice.
* Eat healthier vegetables, including dark green and orange vegetables.
* Eat a variety of fruits.
* Choose a diet with plenty of grain products, fruits and vegetables.
* Choose fish, beans, nuts and seeds for some of your protein needs.
* Choose beverages and foods to moderate your intake of sugars.
* Choose and prepare foods with less salt.
* If you drink alcoholic beverages, do so in moderation.
* Aim for a healthy weight and be physically active each day.

To help people understand these guidelines, the USDA has replaced the old Food Guide Pyramid. The new guide is an interactive tool called MyPyramid. It is actually many different pyramids, depending on a person's age, gender and physical activity. The tool can be found at www.mypyramid.gov.

Your diet, like the pyramid, should have:

* A strong base of grains
* At least 2½ cups of vegetables a day
* At least 2 cups of fruits a day
* At least 3 cups of calcium-containing milk, yogurt and cheese
* Proteins such as meats, beans, eggs and nuts

Eat fats and sweets sparingly.

To prevent tooth decay, you should follow a few additional guidelines. This can help to keep the amount of acid created by the bacteria on your teeth to a minimum. Here are some tips:

1. Limit between-meal snacking. Fewer snacks mean less acid exposure for your teeth. If you snack, choose foods that are not fermentable carbohydrates.
* Best choices — Cheese, chicken or other meats, or nuts. These foods actually may help protect tooth enamel. They do this by neutralizing acids or by providing the calcium and phosphorus needed to put minerals back in the teeth.

* Moderate choices — Firm fruits such as apples and pears and vegetables. Firm fruits contain natural sugars. However, their high water content dilutes the effects of the sugars. These fruits also stimulate the flow of saliva, which fights bacteria and helps protect against decay. Vegetables do not contain enough carbohydrates to be dangerous.

* Worst choices — Candy, cookies, cakes, crackers, breads, muffins, potato chips, french fries, pretzels, bananas, raisins and other dried fruits. These foods provide a source of sugar that certain bacteria can use to produce acid. The problem can be worse if the foods stick to teeth or get caught between them.

2. Limit the amount of soft drinks or any other drinks that contain sugar. These include coffee or tea with added sugar, cocoa and lemonade. Fruit juices contain natural sugars that also can cause decay. Limit the amount of time you take to drink any of these drinks. Avoid sipping them throughout the day. A can of soda that you finish with a meal exposes your teeth to acids for a shorter time than a soda that takes you two hours to drink.

* Better choices — Unsweetened tea and water, especially fluoridated water. Tea also has fluoride, which can strengthen tooth enamel. Water helps flush away bits of food. It also can dilute the sugar acids.

3. Avoid sucking on hard candies or mints, even the tiny ones. They have enough sugar to increase the acid produced by bacteria to decay levels. If you need a mint, use the sugarless varieties.

4. Very acidic foods (such as citrus fruits) can make the mouth more acidic. This may contribute to a loss of minerals in the teeth. The effects of acid exposure add up over time. Every little bit counts.

5. Brush your teeth after eating and after drinking sugary drinks, to remove the plaque bacteria that create the destructive acids. If you cannot brush after every meal, brush at least twice a day.

6. Chew sugarless gum that contains xylitol. This can help reduce the risk of cavities. The gum helps dislodge some of the food stuck to your teeth. It also increases saliva flow to help neutralize the acids.

Fluorosis

What Is It?

Your permanent teeth form under your gums in the jawbone during early childhood. They appear in your mouth after the primary or "baby" teeth are lost. The crowns of nearly all of the permanent teeth are fully formed by the time you are about 8 years old. The exception is the wisdom teeth, which form in young adulthood. The crown is the part of a tooth you can see in your mouth.

Consuming too much fluoride while the teeth are being formed can lead to fluorosis. This condition causes white or brown discoloration or spots on the enamel, or tooth surface. The effects can range from minor color changes to surface irregularities of the teeth. Fluorosis does not develop after teeth have erupted into the mouth.

Fluorosis is a cosmetic condition, not a disease. Often, it is so mild that only a dental professional can detect it. Most cases of fluorosis result from young children taking fluoride supplements or swallowing fluoride toothpaste when the water they drink is already fluoridated.

Symptoms

Teeth affected by mild fluorosis may show no changes or changes visible only to a dental professional. Mild to moderate fluorosis produces white lines, streaks or spots. In more severe fluorosis, the teeth can become pitted and have brown, gray or black spots. The enamel also may have an unusual shape.

Diagnosis

Your dentist and dental hygienist will ask about your child's fluoride intake. This will help to determine if the discoloration seen is a result of fluorosis. They also will ask about past and present medical conditions or disabilities that may affect your child's teeth. Your dentist will examine your child's teeth and gums and take X-rays to make sure the teeth have no other defects or cavities.

Other conditions may look like fluorosis. Developmental defects and problems with the skull or bones of the face can disrupt the enamel or dentin of the teeth. In addition, high fevers or trauma (such as a fall that injures a tooth) in infants or young children may discolor teeth. Young children can get cavities in their primary teeth, so any tooth discoloration should be checked at the dental office.

Expected Duration

The spots and stains left by fluorosis are permanent. They may darken over time.

Prevention

If you have a child under 6, put only a small pea-sized amount of toothpaste on his or her toothbrush. Encourage your child to spit rather than swallow after brushing. Avoid toothpastes with flavors that may encourage swallowing. Keep all fluoride-containing products out of the reach of young children. These include toothpastes and mouthwashes.

Adding fluoride to drinking water is one of the great preventive disease programs of the 20th century. Children should take fluoride supplements only if the water they drink does not contain enough fluoride. If your child is taking fluoride supplements now, check the amount of fluoride in your water. If you are on a public water supply, call your supplier to ask about the fluoride level. You can also have your dentist check a sample of your water. Then discuss with your dentist or pediatrician whether your child needs fluoride supplements.

Some foods and drinks contain fluoride. For example, many fruit juices and soft drinks contain fluoride at levels similar to fluoridated water. Some bottled waters now have added fluoride. All of this can add up. It is important to know how much fluoride your child consumes.

Treatment

Remember that fluorosis affects only the appearance of teeth. It does not result in cavities. As a result, most of the treatment for fluorosis consists of masking the stain.

Many cases of fluorosis are minor enough not to need treatment. Sometimes fluorosis occurs only on the back teeth, where it can't be seen. More serious cases and cases involving the front teeth can be treated by removing the surface-stained areas through tooth whitening or other procedures. Severe cases of fluorosis can be covered with bonding, crowns or veneers.

When To Call a Professional

If you notice white streaks or spots on your child's teeth or notice that one or more teeth are discolored, contact your dental office.

Prognosis

Teeth affected by fluorosis are not diseased. Fluorosis will not result in cavities or other dental problems. Concerns about appearance can be addressed with whitening to remove surface stains and veneers or other procedures to cover the discoloration.

Does Your Child Need Fluoride Supplements?

Talk with your pediatrician about whether your child should receive fluoride supplements. Supplements often are recommended if your drinking water does not provide enough fluoride to strengthen teeth as they develop.

How much fluoride is enough? The American Dental Association, American Academy of Pediatrics and American Academy of Pediatric Dentistry have developed this table as a guide for when children should be given fluoride supplements.

Fluoride Ion Level in Drinking Water in parts per million (ppm)

Age of Child Less than 0.3 ppm 0.3 to 0.6 ppm More than 0.6 ppm

Less than 6 months No supplementation No supplementation No supplementation

6 months to 3 years 0.25 mg/day No supplementation No supplementation

3 years to 6 years 0.5 mg/day 0.25 mg/day No supplementation

6 years to 16 years 1.0 mg/day 0.5 mg/day No supplementation

For reference:
1 ppm = 1 milligram per liter of water
1 ppm = 0.5 milligram per pint (16 ounces) of water
1 ppm = 0.25 milligram per cup (8 ounces) of water
1 gram of fluoridated toothpaste contains about 1 milligram of fluoride

Can Fluoride Help Adults?

Fluoride isn't just for children.

"The use of fluoride can prove beneficial for both children and adults," says Sandra Burkett, D.D.S. Dr. Burkett is an instructor of clinical dentistry at the Columbia University College of Dental Medicine.

Young children were the main focus of early efforts to add fluoride to water. Now, research has shown that fluoride applied directly to teeth is just as important for fighting decay.

"The regular use of fluoride helps to protect the permanent teeth from decay and sensitivity," Dr. Burkett says. "This allows patients to keep their permanent teeth much longer."

Everyone should use fluoride every day. But some adults are at higher risk of decay than others. They might need more intensive use of supplements. To find out if you might be one of them, consider these questions:

1. Are you taking any medicines that cause your mouth to become dry? Do you have a disease that causes dry mouth?

Many adults take medicines that can cause dry mouth, which is also called xerostomia. Many common drugs have this side effect. They include antihistamines and medicines for allergies, anxiety and high blood pressure.

Some diseases also can cause dry mouth. The most notable are Sjögren's syndrome and diabetes.

"Decreased saliva flow can increase your risk for dental decay," Dr. Burkett says.

That's because saliva washes away bits of food that are fuel for decay-causing bacteria. These bacteria produce acids that decay teeth. Saliva helps to neutralize the acids. It also contains many minerals, including fluoride, that help keep your teeth decay-free.

If you are having dry mouth, try using a fluoride mouthwash. It can help to moisten your mouth and protect your teeth. Saliva substitutes are also available at the pharmacy. Many people use them to replace the saliva they have lost.

Dr. Burkett also recommends sucking on sugar-free hard candy or chewing sugar-free gum to increase the flow of saliva. In particular, she recommends products that contain xylitol. This natural sugar helps to protect teeth from decay.

2. Have your gums receded so more of your teeth show, or has your dentist told you that you have periodontal (gum) disease?

By the time you're an adult, you may already have some form of periodontal disease. This condition can cause your gums to recede and expose more of your teeth. Receding gums give bacteria more room to roam and put you at risk of getting cavities in the roots of your teeth. For example, more than half of adults over age 75 have had root decay. If your dentist has treated you for periodontal disease, your gums may have been reshaped. This process exposes tooth roots, which also can lead to decay.

To protect your teeth's roots, your dentist can paint a fluoride varnish or gel on them. You can use a fluoride mouthwash or a prescription fluoride gel to get more fluoride.

3. Have you needed a filling in the last year?

If you have had recent tooth decay, you're at risk for more. You still have the bacteria and other conditions in your mouth that can lead to cavities. "The use of fluoride should be an important part of your daily oral health care regimen if you have prior cavities," Dr. Burkett says.

4. Do you have crowned teeth and/or bridges?

Crowned teeth are not safe from cavities. As long as some natural tooth remains, these teeth are at risk. "The edges of fillings or crowns can provide a hiding place for decay-causing bacteria," Dr. Burkett says. "Fluoride can protect the tooth from decay. In certain cases, it can stop the decay process and allow the tooth to get stronger."

5. Are you wearing dental braces?

"Braces make it difficult for you to reach all areas of the teeth. They provide niches where food can become lodged. The plaque that forms as a result can lead to cavities," Dr. Burkett says. "Your dentist can recommend a fluoride rinse or gel. Applying this daily protects the teeth against cavities."

6. Are you receiving, or have you received, radiation therapy to the head and neck?

Adults who get this type of therapy are at very high risk of tooth decay. That's because the radiation damages their salivary glands, causing dry mouth. Saliva fights tooth decay, so people with dry mouth are at higher risk for decay.

"If dry mouth results from radiation therapy, then it is important that you use generous amounts of fluoride to prevent decay," Dr. Burkett says. "You also should visit your dentist every two to three months, or as recommended."
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Water Fluoridation: When, Where and Why

Fluoride's benefits to teeth were discovered in the 1930s. Dentists started to notice that people who drank water that naturally contained fluoride had less tooth decay.

Communities have added fluoride to water supplies since 1945. Fluoridation involves adjusting the natural level of fluoride in the water. The goal is a level of 0.7 to 1.2 parts per million (ppm). This is one part of fluoride in one million parts of water. It's roughly comparable to one minute in two years, or one cent in $10,000.

In 1945, Grand Rapids, Mich., became the first city in the world to have its water fluoridated. A 15-year study there showed that water fluoridation reduced tooth decay in children by more than 60%. Around the country, adding fluoride to water has led to reduction in decay rates of:

* 30% to 60% in children younger than 8
* 20% to 40% in children ages 8 to 12
* 15% to 35% in older children and adults

With less tooth decay, fewer teeth have to be filled or extracted. Dental treatment costs go down.

Today, about 62% of people served by public water supplies have adequate levels of fluoride in their water. Of the 50 largest U.S. cities, 43 have water fluoridation systems. In the United States, water fluoridation costs an average of 50 cents per person per year. About 60 other countries also practice water fluoridation.

A 1998 survey found that 70% of Americans support community water fluoridation. However, some people oppose the practice. Some say it limits their freedom of choice. Others misinterpret scientific information on the safety of fluoride.

To date, more than 70 studies have shown that fluoride helps to reduce tooth decay. The most recent studies have shown less of a benefit to water fluoridation than older studies did. That's because more people are now getting fluoride from sources besides water. Other common sources include toothpaste and mouth rinses. Also, more foods and beverages — for example, soft drinks and spaghetti sauce — now contain fluoride because they are made with fluoridated water.

Is My Water Fluoridated?

he easiest way to find out if your water is fluoridated is to contact your local water district or water company. They also can tell you the concentration of fluoride in your water. Information on how to contact your water supplier should be on your water bill. You also could look in the "Local Government" section of your phone book.

Some types of home water filters can remove significant amounts of fluoride from water. Reverse-osmosis systems and distillation units have been shown to remove fluoride. Research on other systems has not shown conclusive results. Pitcher filters and filters that attach to your water faucet generally do not remove fluoride. To be certain, check with the manufacturer or read the information that came with the filter.

If you use a home water-treatment system, have the fluoride level of your water tested at least once a year. You may be able to get tests through your local or state health department. A private laboratory is another option.

Fluoride Treatments and Supplements

What Is It?

Fluoride is a naturally occurring element that strengthens teeth. In doing this, it can help to prevent tooth decay. Experts say the best way to prevent tooth decay is to use several sources of fluoride.

Fluoride is found naturally in water sources in small amounts. Some foods, such as meat, fish, eggs and tea, contain fluoride. It also is added to water in some areas. Many toothpastes, rinses and professional treatments contain fluoride. Prescription fluoride tablets are available for children who do not get fluoride in their water.

What It's Used For

Enamel is the outer layer of the crown of a tooth (the visible part). It is made of closely packed mineral crystals. Every day, the enamel loses and gains minerals. The loss of minerals is called demineralization. Gaining new minerals is called remineralization. These two processes balance each other.

Demineralization begins with the type of bacteria that cause plaque on your teeth. These bacteria feed on sugar in your mouth and produce acids. The acids dissolve the crystals in your teeth. Remineralization builds the enamel back up. In this process, minerals such as fluoride, calcium and phosphate are deposited inside the enamel. Too much loss of minerals without enough repair of the enamel leads to tooth decay.

Fluoride strengthens teeth by helping to speed remineralization. It also helps to stop bacteria from making acids. Teeth can absorb fluoride in two ways. One way is through the small doses that children swallow in food, supplements and fluoridated water. This fluoride enters the bloodstream and becomes part of the permanent teeth as they develop. The teeth become stronger, so it is harder for acids to destroy the enamel.

Fluoride also can enter teeth directly in the mouth. This occurs in several ways:

* When you get a fluoride treatment at the dental office
* When you brush with fluoride toothpaste or use a fluoride rinse
* When fluoridated water washes over your teeth as you drink

Fluoride treatments commonly are given to children as their teeth are developing. If your child has a history of cavities or is at high risk of decay, he or she should use additional fluoride. This promotes remineralization of the teeth. Many children get fluoride treatments every six months. The treatments provide extra protection against cavities, even if children already drink fluoridated water.

Fluoride mouth rinses also can help children with a history of cavities or a high risk of decay. These rinses are recommended for children over age 6. You can find them in the mouthwash section of most stores. Prescription fluoride rinses and gels that provide a higher level of fluoride also are available.

Fluoride supplements generally are reserved for children between the ages of 6 months and 16 years who don't drink fluoridated water. These are available as liquids for younger children and tablets for older children. Either your pediatrician or your dentist can prescribe them.

Fluoride treatments help all teeth. They help to prevent decay in both children and adults. Anyone who is at risk of dental decay is a good candidate for fluoride treatments.

Factors that increase the risk of tooth decay include:

* A history of cavities
* Infrequent dental visits
* Poor brushing habits
* Poor diet habits, especially frequent snacking

Many common medicines can cause the mouth to be dry. Examples include antihistamines and medicines for high blood pressure, anxiety and depression. Without enough saliva, tooth decay gets worse quickly.

Preparation

Before you have an in-office fluoride treatment, your teeth should be clean. Your dentist may need to polish away stains. If you use fluoride rinses or gels at home, first brush your teeth thoroughly and floss them. It's a good idea to use fluoride products at night before bedtime. When you are sleeping, they are less likely to be washed or rinsed away.

Risks

As with other compounds, fluoride is safe and effective when used properly. However, it can be hazardous at high doses. All water-fluoridation systems are checked daily to maintain safe fluoride levels. Parents should supervise the use of all fluoride products, including toothpaste, in the home. Keep fluoride tablets stored safely away from young children.

Toxic fluoride doses are based on weight. For instance, a toxic dose of fluoride for an 8-year-old child weighing 45 pounds is 655 milligrams. In comparison, an 8-ounce glass of water with 1 part per million of fluoride contains 0.25 milligrams of fluoride. A small dab of toothpaste contains 0.24 milligrams of fluoride. Since these fluoride products are used in such small amounts, it is very difficult to receive toxic doses in a home setting.

When used properly, fluoride is safe and effective. Young children, in particular, should be supervised during in-office treatments and when using fluoride products at home. If they swallow too much fluoride, young children may become nauseous. Also, too much fluoride can cause spots to form on the enamel of any developing teeth. The spots will be visible when these teeth come into the mouth. Discuss these concerns with your dental professional. He or she can recommend which fluoride products are appropriate for you.

Can Fluoride Cause Harm?

As with other compounds, fluoride is safe and effective when used properly. It can be hazardous at high doses, however. All water-fluoridation systems are checked daily to maintain safe fluoride levels. Parents should supervise the use of all fluoride products in the home.

Fluoride-supplement tablets should be stored safely away from young children. These supplements are taken each day in small quantities. The dose can range from 0.25 to 1 milligram per day based on the child's age and the amount of fluoride in the water.

Dentists limit the amount of tablets they prescribe at one time to reduce the risk of overdose. To avoid any chance of overdose, do not stock up on fluoride tablets. If you have any questions regarding fluoride risks, talk to your dentist or physician.

Toxic fluoride doses are based on weight. For example, the toxic dose of fluoride for a 2-year-old child weighing 22 pounds is 320 milligrams. For an 8-year-old child weighing 45 pounds, the toxic dose is 655 milligrams.

In comparison, an 8-ounce glass of water fluoridated to 1 part per million contains 0.25 milligrams of fluoride. Since these fluoride products are used in such small amounts, it is very difficult to receive toxic doses when using fluoride products at home.

Fluoride Supplements: Who Needs Them?

Children between 6 months and 16 years old who do not drink fluoridated water should take fluoride supplements . They are available as liquids for younger children and tablets for older children. Either your pediatrician or your dentist can prescribe them.

All children should use fluoridated toothpaste. If your children are younger than 6, be cautious about how they use it, however. Young children are more likely to swallow toothpaste after brushing instead of spitting it out. Use only a pea-sized amount of toothpaste when they brush. Encourage them to spit out as much as possible. Avoid flavored toothpastes that might encourage swallowing.

If your child has a history of cavities or is at high risk of decay, he or she should use additional fluoride. This will promote remineralization. Fluoride mouth rinses are recommended for children over the age of 6. They are found in the mouthwash section of most stores.

Your dentist can prescribe fluoride rinses and gels if your child needs a higher level of fluoride. Carefully supervise your children when they use any fluoride product. Keep fluoride out of reach of young children.

Fluoride Treatments

Fluoride in foods, supplements and water enter the bloodstream through the stomach. From there, it is absorbed into the body. In children, the fluoride then becomes available to the teeth that are developing in the jaw.

Topical fluoride products are applied directly to the teeth. They include toothpaste, mouth rinses and professionally applied fluoride treatments. Topical fluoride treatments are in the mouth for only a short time. However, fluoride levels in the mouth remain higher for several hours afterward. Fluoride found in the water and in food products also works this way because the water washes over the teeth and some fluoride remains in the saliva.

Fluoride treatments are given in a dental office. They are applied as a gel, foam or varnish. The fluoride used for these treatments is at much higher strength than mouthwashes or toothpastes.

Fluoride supplements also are available by prescription. They usually are reserved for children who live in areas where the water supply does not contain enough fluoride. Children who need supplements receive them from ages 6 months to 16 years.

Fluoride's Importance to the Teeth

Enamel, the outer layer of the crown of a tooth, is made of closely packed mineral crystals. Every day, minerals are lost and gained from inside the enamel crystals. These processes are called demineralization and remineralization.

Demineralization is when acids in the mouth dissolve the enamel crystals that make up the outer layer of the tooth. These acids are formed by the combination of plaque bacteria and sugar in your mouth. The loss of enamel is balanced by remineralization. In this process, minerals such as fluoride, calcium and phosphate are deposited inside the enamel. Too much loss of minerals without enough replacement leads to tooth decay.

Fluoride helps teeth in two ways. When children eat or drink fluoride in small doses, it enters the bloodstream and becomes part of their developing permanent teeth. This also makes it harder for acids to cause demineralization. In addition, fluoride works directly on teeth in the mouths of children and adults. It helps to speed remineralization and disrupt the production of acids by bacteria.

All About Cavities 4

Preventing Cavities

Do you or your family members get cavities often? Dental research has found out that certain factors can affect your risk of tooth decay. These factors include:

* The current number of decayed or filled teeth
* Your fluoride exposure
* Family history of decay
* How well you take care of your teeth
* The amount of saliva and the balance of minerals, enzymes and buffering agents it contains
* How often and what types of foods you eat (especially carbohydrates)

Ask your dentist about the best ways to reduce your risks and limit dental decay.

To prevent your teeth from decaying, you can do two things:

* Strengthen your teeth's defenses with fluoride, sealants and agents that contain calcium and phosphate ions.
* Reduce the number of bacteria in your mouth.

Fluoride penetrates into teeth. It strengthens them by replacing minerals that acid has destroyed. The benefits of fluoride to teeth were first discovered in the 1930s. Dentists started to notice that people who drank water that naturally contained fluoride had less tooth decay. In 1945, communities started to add fluoride to water supplies. Adding fluoride to water systems has been the most successful cavity prevention method to date.

In the early 1960s, fluoride also began to be added to toothpaste. This also had a major impact on cavity prevention. Now almost all toothpastes contain fluoride. Everyone should brush with a fluoride toothpaste every day. Dental offices sometimes recommend higher levels of fluoride in toothpastes, gels and mouth rinses for both children and adults.

More recently, agents containing calcium and phosphate have been developed. MI Paste and MI Paste Plus both contain Recaldent (the calcium-phosphate ingredient). Your dentist can apply them to your teeth. Recaldent also also can be found in chewing gum (some Trident products) and toothpaste. These agents help prevent and reverse early decay that has not yet led to a cavity.

Sealants are protective coatings placed over the tops of the back teeth — molars and premolars. They block bacteria and acids from sticking in the tiny grooves on the chewing surfaces of these teeth. Sealants can be placed in adults and children. Children can have sealants on their baby molars, and also on the permanent molars once they come in. Dentists can put sealants on molars with signs of early decay, as long as the decay hasn't broken through the enamel.

You can never get rid of all the bacteria in your mouth. But you can take steps to control bacteria:

* Brush twice a day.
* Floss daily.
* Reduce the number of times each day that you consume fermentable carbohydrates.

Some prescription mouthwashes (those that contain chlorhexidine) reduce bacteria in your mouth. This can help prevent decay. Chewing sugarless gums, especially those with xylitol, can help reduce bacteria levels and increase the flow of saliva.

Most importantly, visit your dentist regularly. Then the dentist can find any decay early, when it can be treated and reversed.

All About Cavities 3

Types of Decay

Young children can get a type of decay called baby bottle tooth decay or early childhood caries. It destroys enamel quickly. This type of decay is common in children who are put to sleep with a bottle of milk or juice. The bottle exposes the teeth constantly to carbohydrates through the night. Bacteria can grow rapidly and produce acid that decays teeth.

Decay can become worse if the parent does not clean the child's teeth. It can eat through enamel and leave a large cavity in a matter of months.

In older adults, the exposed roots of teeth can develop cavities. This is called root caries. Older adults are more likely to have receding gums caused by years of hard brushing or periodontal disease. They also are more likely to have dry mouth (xerostomia). The decrease in saliva results in less protection of the teeth. This increases the risk of decay. Many common medicines can cause dry mouth. Be sure to ask the doctor or pharmacist if any of your medicines cause dry mouth.

Decay can form beneath fillings or other tooth repairs, such as crowns. Sometimes bacteria and bits of food can slip between the tooth and a poorly placed filling or crown. This also can happen if the filling cracks or pulls away from the tooth, leaving a gap

All About Cavities 2

How Your Teeth Decay
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The bacteria in your mouth need food to live and multiply. When you eat sugary foods and other carbohydrates, the bacteria use them as food, too. The bacteria then produce acids that can dissolve tooth enamel (outer layer of the tooth).

It's not just candy and ice cream we're talking about. All carbohydrate foods eventually break down into simple sugars. These include glucose and fructose. Some of this process begins in the mouth.

Foods that break down into simple sugars in the mouth are called fermentable carbohydrates. These include the obvious sugary foods, such as cookies, cakes, soft drinks and candy. But they also include pretzels, crackers, bananas, potato chips and breakfast cereals.

Bacteria in your mouth turn the sugars in these foods into acids. These acids begin to dissolve the mineral crystals in teeth. The more times you eat each day, the more times your teeth are exposed to an acid attack.

This attack can lead to tooth decay, also known as dental caries. First, the acid begins to dissolve calcium and phosphate crystals inside a tooth. A white spot may appear on the enamel in this weakened area. But the loss of minerals develops beneath the surface of the enamel. The surface may still be smooth.

At this stage, the tooth can be repaired with the help of fluoride, proteins and minerals (calcium and phosphate) in the saliva. The saliva also helps reduce the acid levels from bacteria that attack the tooth.

Once the decay breaks through the enamel to cause a cavity, the damage is permanent. A dentist must clean out the decay and fill the cavity. Left untreated, the decay will get worse. It can destroy a tooth all the way through the enamel, through the inside dentin layer and down to the pulp or nerve of the tooth. That's why it is important to treat caries at a very early stage, when the process can be reversed.

All About Cavities 1

What's in Your Mouth?

To understand what happens when your teeth decay, it's helpful to know what's in your mouth naturally. Here are a few of the elements:

* Saliva — Your mouth and teeth are constantly bathed in saliva. We never give much thought to our spit, but this fluid is remarkable for what it does to help protect our oral health. Saliva keeps teeth and other parts of your mouth moist and washes away bits of food. Saliva contains minerals that strengthen teeth. It includes buffering agents. They reduce the levels of acid that can decay teeth. Saliva also protects against some viruses and bacteria.


* Plaque — Plaque is a soft, gooey substance that sticks to the teeth a bit like jam sticks to a spoon. It contains colonies of bacteria and other organisms, clumping together with bits of food. Also in the mix are bacteria byproducts, white blood cells and body tissue. Plaque grows when bacteria attach to the tooth and begin to multiply. Plaque starts forming right after a tooth is cleaned. It builds up to measurable levels in about an hour. As time goes on, the plaque thickens. Within two to six hours, the plaque teems with bacteria that can cause cavities.


* Calculus — If left alone long enough, plaque absorbs minerals from saliva. These minerals form crystals and harden the plaque into calculus. Then new plaque forms on top of existing calculus. This new layer can also become hard.


* Bacteria — We have many types of bacteria in our mouths. Some bacteria are good; they help control destructive bacteria. When it comes to decay, Streptococcus mutans and Lactobacilli are the bacteria that cause the most damage to teeth.

Other Cleaning Tools

Other Ways To Clean Between the Teeth

To supplement your at-home brushing and flossing, your dentist or hygienist may suggest one or more of the following:

* Interdental cleaners — These cleaners work better than floss for people who have large spaces between their teeth. Some look like tiny brushes. Others look like three-sided, wide toothpicks. These cleaners also work well in people who have braces or missing teeth, and in people who have had gum surgery. You can find them at most grocery stores and drugstores.

* Oral irrigators — These are electrical devices. They pump water in a steady or pulsating stream. They do not seem to remove plaque that is attached to the tooth. But they are great for flushing out food and debris in pockets between teeth, or in braces. They also are used to deliver medicine to hard-to-reach areas. For example, prescription rinses can be sprayed into gum pockets with an oral irrigator.

* Interdental tip — These flexible rubber nibs are used to clean between the teeth and just below the gum line. Plaque and bits of food can be removed by gently running the tip along the gum line.

* Mouthwashes and rinses — As with toothpaste, your choice of mouthwash or rinse will be guided by your mouth care needs. Over-the-counter rinses can freshen the breath, add fluoride or kill the bacteria that cause gingivitis. Some mouthwashes are designed to help loosen plaque before you brush. Ask your dentist or hygienist to recommend the rinse that would be best for you. If you need to avoid alcohol, read ingredient labels carefully. Many over-the-counter mouthwashes contain high amounts of alcohol. In some cases, your dentist might prescribe a stronger fluoride or antibacterial rinse for you.

Toothpaste

Toothpastes don't just clean teeth anymore. They have special ingredients for preventing decay, plaque control, tartar control, whitening, gum care or helping sensitive teeth.

Most toothpastes contain fluoride, which has been proven to prevent cavities. Fluoride also can stop small cavities from getting worse. It can even reverse early tooth decay.

Tartar-control toothpastes are useful for people who tend to build up tartar quickly. Someone who gets tooth stains may want a whitening toothpaste. Whitening toothpastes will remove only surface stains, such as those caused by smoking, tea or coffee. To whiten teeth that are stained at a deeper level, talk with your dentist.

Your needs will likely change as you age, so don't be surprised if your hygienist recommends a type of toothpaste you haven't used before. Look for the ADA seal of approval on any toothpaste. The seal assures that the toothpaste has met the standards set by the American Dental Association. Then, choose the toothpaste that tastes and feels best. Gel or paste, wintergreen or spearmint: These work the same way, so pick the one you like.

Some people find that some toothpaste ingredients irritate their teeth, cheeks or lips. If your teeth have become more sensitive or your mouth is irritated after brushing, try changing toothpastes. If the problem continues, see your dentist.

Brushing Technique

Modified Bass Brushing Technique

• Hold the toothbrush sideways against your teeth with some of the bristles touching your gums.



• Tilt the brush so the bristles are pointing at your gum line.



• Move the brush back and forth, using short strokes. The tips of the bristles should stay in one place, but the head of the brush should wiggle back and forth. You also can make tiny circles with the brush. This allows the bristles to slide gently under the gum. Do this for about 20 strokes or 20 circles. In healthy gums, this type of brushing should cause no pain. If it hurts, brush more gently.



• Roll or flick the brush so that the bristles move out from under the gum toward the biting edge of the tooth. This helps move the plaque out from under the gum line.



• Repeat for every tooth, on the insides and outsides.



• On the insides of your front teeth, it can be hard to hold the brush sideways. So hold it vertically instead. Use the same gentle back-and-forth or circular brushing action. Finish with a roll or flick of the brush toward the biting edge.



• To clean the biting or chewing surfaces of the teeth, hold the brush so the bristles are straight down on those surfaces.



• Gently move the brush back and forth or in tiny circles to clean the entire surface. Move to a new tooth or area until all teeth are cleaned.



• Rinse with water.



• You can clear even more bacteria out of your mouth by brushing your tongue. Brush firmly but gently from back to front. Do not go so far back in your mouth that you gag. Rinse again.

Brushing Your Teeth

Information on how to brush your teeth and choose a toothbrush and toothpaste.

Brushing Tips

Most of us learned to brush our teeth when we were children. We have stuck with the same brushing technique into adulthood. Unfortunately, many of us learned how to brush the wrong way. And even if we learned the right way, we might not always stick to it. Brushing correctly is tricky. You want to remove plaque without brushing too hard and damaging your gums.

There are different ways to brush correctly. See our animated instructions for some ideas. Your dentist or dental hygienist can show you the method that might be best for you.

The modified Bass technique (below) is among the most popular for adults. Parents should supervise their children's brushing until age 9 or 10. Here are a few general pointers about brushing.

• Brush at least twice a day — One of those times should be just before you go to bed. When you sleep, your mouth gets drier. This makes it easier for acids from bacteria to attack your teeth. Also try to brush in the morning, either before or after breakfast. After breakfast is better. That way, bits of food are removed. But if you eat in your car or at work, or skip breakfast, brush first thing in the morning. This will get rid of the plaque that built up overnight.



• Brush no more than three times a day — Brushing after lunch will give you a good midday cleaning. But brushing too often can damage your gums.



• Brush lightly — Brushing too hard can damage your gums. It can cause them to recede (move away from the teeth). Plaque attaches to teeth like jam sticks to a spoon. It can't be totally removed by rinsing, but a light brushing will do the trick. Once plaque has hardened into calculus (tartar), brushing can't remove it. If you think you might brush too hard, hold your toothbrush the same way you hold a pen. This encourages a lighter stroke.



• Brush for at least two minutes — Set a timer if you have to, but don't skimp on brushing time. Two minutes is the minimum time you need to clean all of your teeth. Many people brush for the length of a song on the radio. That acts as a good reminder to brush each tooth thoroughly.



• Have a standard routine for brushing — Try to brush your teeth in the same order every day. This can help you cover every area of your mouth. If you do this routinely, it will become second nature. For example, you can brush the outer sides of your teeth from left to right across the top, then move to the inside and brush right to left. Repeat the pattern for your lower teeth.



• Always use a toothbrush with soft or extra-soft bristles — The harder the brush, the greater the risk of harming your gums.



• Change your toothbrush regularly — Throw away your old toothbrush after three months or when the bristles start to flare, whichever comes first. If your bristles flare much sooner than every three months, you may be brushing too hard. Try easing up.



• Choose a brush that has a seal of approval by the American Dental Association — The type of brush you use isn't nearly as important as brushing the right way and doing it twice a day. Any approved brush will be a good tool, but you have to know how to use it.



• Electric is fine, but not always necessary — Electric or power-assisted toothbrushes are a fine alternative to manual brushes. They are especially useful for people who don't always use proper brushing techniques. They also are a good choice for people with physical limitations that make brushing difficult. Use a powered toothbrush for at least two minutes, and don't press too hard.
  

Information on how to floss your teeth, and how to choose the right floss

Flossing Your Teeth

Many people never learned to floss as children. But flossing is critical to healthy gums and it's never too late to start. A common rule of thumb says that any new habit becomes second nature after only three weeks. See our animated demo for tips. If you have questions, ask your dentist or dental hygienist to give you a lesson.

Here are a few general pointers about flossing:

• Floss once a day — Most dentists recommend flossing at least once a day. If you tend to get food trapped between teeth, you can floss more often.



• Take your time — Don't rush.



• Choose your own time — Most people find that just before bed is an ideal time to floss. But it's best to find the time that's most convenient for you. That way, you are more likely to floss regularly.



• Don't skimp on the floss — Use as much floss as you need to clean both sides of every tooth with a fresh section. In fact, you may need to floss one tooth several times (using fresh sections of floss) to remove all the food. Some professionals think that reusing sections of floss may move bacteria from one tooth to another.



• Choose the type that works best for you — There are many types of floss: waxed and unwaxed, flavored and unflavored, ribbon and thread. Try a few before you settle on one to use every day. Waxed floss works better in people with very closely spaced teeth. Tougher, shred-resistant varieties of floss work well for people with rough tooth edges.

How To Floss

Hold the floss in whatever way you prefer. The most common method is to wind the floss around your middle fingers. Then pull it tight and guide it with your index fingers. You also can wind it around your index fingers and guide it with your thumb and middle fingers. Some people just hold the ends of the floss, or use a floss-guiding tool. (If you have a fixed bridge, a bridge threader can help guide floss under the bridge for better cleaning.)

How you hold the floss is not as important as what you do with it. If you can't settle on a good method, ask your dentist or hygienist for suggestions.

• Hold the floss so that a short segment is ready to work with.



• Guide the floss gently between two teeth. If the fit is tight, use a back-and-forth motion to work the floss through the narrow spot. Do not snap the floss; you could cut your gums.



• Hold the floss around the front and back of one tooth, making it into a "C" shape. This will wrap the floss around the side edge of that tooth.



• Gently move the floss toward the base of the tooth and into the space between the tooth and gum.



• Move the floss up and down with light to firm pressure to skim off plaque from the tooth. Do not press so hard that you injure the gum.



• Repeat for all sides of the tooth, including the outermost side of the last tooth. Advance the floss to a clean segment for each tooth edge.

Simple Steps To Better Dental Health

Taking Care of Your Teeth

Thanks to better at-home care and in-office dental treatments, more people are keeping their teeth throughout their lives. Some diseases and conditions can make dental disease and tooth loss more likely. But most of us have a good deal of control over whether we keep our teeth into old age.

The most important thing you can do is to brush and floss your teeth each day.

Most mouth woes are caused by plaque. Plaque is a sticky layer of bacteria, bits of food and other organic matter that forms on your teeth. The bacteria in plaque make acids that cause cavities. Plaque also leads to periodontal (gum) disease. This can become a serious infection. It can damage bone and destroy the tissues around your teeth.

The best defense is to remove plaque before it has a chance to build up and cause problems. Brushing removes plaque from the large surfaces of the teeth and from just under the gums. Flossing removes plaque from between your teeth. You also can use other tools to keep your mouth and teeth clean.