General and Preventive Dentistry
The domain of general dentistry is dominated by prevention and education, as well as simple restorations.
Dental decay, the major source of oral disease has only really been well understood since the early 1960’s – and therefore – its prevention has only relatively recently been quantified.
Advanced restorative techniques and modern dental materials, in combination with effective home care in first world nations, have largely controlled dental decay. However, there are a number of factors that are hindering the elimination of dental disease which we will discuss below.
Fissure sealants are not recommended enough
Fissure sealing is the treatment of the grooves in the biting surfaces of teeth with restorative resin materials. These resin materials have the ability to seal the grooves on the teeth, preventing the entry of bacteria and subsequent prevention of decay. It is the opinion of Dr Alex Huszti that the use of fissure sealing is not carried out often enough, or that this preventive treatment is carried out too late after eruption of the tooth, or that the fissure sealing is not being comprehensively completed. At Belle Dental, we recommend the placement of fissure sealants early in the tooth’s life – for molars this would be at the age of 6 or 7. We also recommend that the fissures/grooves on the teeth are opened up somewhat to inspect for existing decay which can form very early after the eruption of these teeth.
Our modern diet is destroying our teeth
The drift away from whole foods (i.e. natural, unprocessed foods) has resulted in foods that have a higher acid content (in order to increase shelf life), higher sugar content (to both improve taste for consumer as well as extend shelf life) and reduced fibre content (due to processing). These changes to the foods that we eat result in a number of undesirable effects, which can be summarised in the following table:
|Type of food processing||Reason for food processing||Effect of food processing on teeth|
|Increased acid content||Improved shelf life and taste||The buffered acids that act as the preservative in the food are also responsible for dissolving tooth structure. On top of this, they are also responsible for making the consumer MORE acidic as a person. Because the person’s metabolism becomes more acidic, their metabolism doesn’t function as well as it should – also, the saliva of these people is not as alkaline as it should be – which means their saliva has a reduced buffering capacity against the acids i.e. reduced ability to prevent decay|
|Higher sugar content||Improved shelf life and taste – ‘low fat’ health claim||The higher sugar content can be responsible for increased decay (by providing the carbohydrates required by the bacteria in your mouth – the bacteria process these carbohydrates to make their own energy with the byproduct being acids that can dissolve teeth. In addition, there may be acid preservatives included in the food in addition to the high sugar content – further compounding the problem|
|Lowered fibre content||Improved taste, easier to package / handle||The reduced fibre content usually appears in combination with both increased acidity and higher sugar content. These alterations to the food increase the food’s capacity to cause decay AS WELL AS makes the food MORE retentive. More retentive foods stick into the grooves on teeth as well as pack around teeth – creating a ready source of carbohydrate for bacteria and greatly increased capacity for causing decay|
The recommendation of Belle Dental is to consume a diet as close as possible to whole foods – the less processing the better. If processed foods are to be consumed, consume the processed foods as part of a main meal. In-between meal snacks should be restricted to water, tea/coffee (preferably unsweetened), fruit and vegetables – these foods have the lowest cariogenic (decay causing) potential.
It should be noted that comprehensive home care – including the careful use of floss in combination with regular effective tooth brushing – WILL NOT overcome poor dietary choices (in the same way that NO amount of exercise will overcome the weight gain associated with a poor diet).
Home care is not up to scratch
The effectiveness of your home care/personal care obviously plays a significant role in the development of dental disease – but as you have already read…it’s not the total picture. Dental plaque – a bacterial film that develops on all of your teeth surfaces – is the responsible agent for both dental decay and gum disease. However, research is indicating that this bacterial film (also called a biofilm) will vary depending on genetics and diet. Daily removal of this biofilm is recommended using tooth brushing (with a toothpaste containing fluoride) as well as some form of cleaning between the teeth (using floss, interproximal brushes, waterpick, toothpicks or some combination of these appliances). It would appear that there are also foods such as the artificial sweetener (xylitol) – which can have the effect of reducing the ability of bacteria in the biofilm to produce acids. There are sugar-free chewing gums that contain xylitol. Chewing these gums not only promotes saliva (which has a buffering effect against the acids) but also releases xylitol from the gum, which permeates the biofilm and reduces the bacteria’s ability to produce acids.
Individuals may have predispositions to dental issues
In the same way that you have a predisposition to be tall or short; your family may have a history of diabetes or short sightedness. It is these genetic traits that also carry your predisposition to dental disease. This predisposition may manifest in a number of ways. You may have a predisposition to gum disease (but experience very limited dental decay). You may experience dental decay (but experience very little gum disease) or you may have the misfortune of being susceptible to both. Following the above suggestions regarding diet, home care and preventive treatments will help – but just like someone who suffers from any kind of genetic predisposition, you may need to be extra careful and have more frequent visits with your dentist. It is normal as part of Belle Dental’s examination and patient management process to identify patients who have these predispositions (based on response to treatments). We will then provide more intensive education and preventive therapies so they may avoid debilitation with dental disease.
Our teeth need to be even more durable to cope with our extended lifespan
The human body was not designed to live to 100 years of age – yet it is estimated that 2/3 of all generation Y (born after 1975) will live to 100 years of age. This may very well be facilitated by advanced medications. Many of these medications will have side effects, including reduced or altered saliva quality. Reduced and altered saliva quality is already a problem in many patients today and it results in increased dental disease. This extension of the human lifespan is my argument around the promotion of Low Biological Cost Dentistry. In order to function well into old age, we need to become more aware of our diet, personal care and the decisions we make regarding health care treatment choices. This is the only way we may enjoy the marvels of the human body well into old age!
To find out more about our approach to dentistry, please click here.