TEETH, GUMS AND BACTERIA — Floss only the ones you want to keep

Most of us are born without any visible teeth and some of us pass on in that same condition. Having said this, I believe that the general consensus is that having both healthy gums and a full complementation of teeth are desirable. But what constitutes healthy gums and teeth and how do we achieve this state?

A brief explanation of oral bacteria and how they affect us will help answer our questions and understand the science behind the old adage “be true to your teeth or they’ll be false to you.” With patients I use a simplified model and explain that we have three major categories of bacteria: cavity forming bacteria, bacteria that promote periodontal (gum) disease and normal flora (good bacteria). As a fetus our oral cavities are sterile without any of the “bad” bacteria that help promote many of the diseases of our gums and teeth. However, upon birth we begin to establish our normal bacterial flora. This flora or community of bacteria may include “bad” bacteria and can change and evolve throughout the different stages of our lives.

We begin to see the first signs of cavity forming bacteria with the eruption of the deciduous (baby) teeth at about seven months of age. These bacteria are introduced to us by our primary caregivers such as our parents and are with us for as long as we have teeth. While most of us have these cavity forming bacteria we do not have to be destined to a future filled with cavities.

Tooth decay is the result of a rather simple process that is reversible if caught in time. Specific bacteria (streptococci and lactobacilli) produce acid waste products that demineralize and breakdown tooth structures such as enamel and dentin when exposed to carbohydrates. On the other hand, our saliva contains water and minerals that buffer these acids and reverse the cavity forming process. In general, our ability to protect and rebuild our teeth diminishes with age, a result primarily due to a decrease in salivary flow.

Bacteria that promote periodontal disease tend to be anaerobic in nature. These bacteria prefer living in the space between our teeth and gums called our pockets where there is less oxygen. They in turn cause an inflammatory response resulting in disease states such as gingivitis and periodontitis. Bleeding gums are a cardinal sign of when our gums, and in more advanced case our bone, suffer from the inflammatory process. When left untreated these anaerobic bacteria and inflammation can lead to the loss of tooth supporting bone. Often, with bone loss comes sensitivity, increased risk of cavities and premature tooth loss.

Many people mistakenly believe that deciduous teeth are not important. Instead, “baby” teeth play several important rolls for developing children. These teeth help children with phonetics, aesthetics and mastication, which directly and in some cases indirectly affect the child’s physical development, educational progress, self-esteem and confidence. For example, children who prematurely lose their front teeth often have difficulty pronouncing words properly and are mislabeled as slow. From a structural standpoint the deciduous teeth help maintain spacing which allows for the proper eruption and alignment of the permanent dentition. For infants and children, in addition to good oral hygiene and maintenance, proper amounts of systemic fluoride can help build teeth that are less susceptible to the caries process for life.

While the next generation is not particularly prone to periodontal disease, teens and young adults in their early 20s should be concerned with the prevention of cavities. Tooth health is achieved when we are unable to observe any signs of demineralization both clinically and radiographically. Good oral hygiene is a critical component of caries prevention and incorporates three important keys. Duration: The individual must “brush” their teeth for the proper amount of time: two minutes. Frequency: The individual should “brush” their teeth at least 2-3 times a day and floss at least once a day. And Technique: Proper massaging motions should be practiced utilizing a soft bristled toothbrush. In addition, once the permanent teeth have formed, in order to aid in remineralization, the need for topical fluoride begins to outweigh systemic forms.

When we begin to age and enter our late 20s and early 30s our dental concerns shift toward periodontal disease and its side effects. Many of us begin to notice that our gums are receding and that our teeth are more sensitive. In fact, research confirms that anaerobic bacteria are able to establish colonies in the gums and bone. This results in inflammation, loss of tooth supporting bone, and even promotes heart disease. Once again, good oral hygiene is critical. However, increases in professional cleaning intervals and potential surgical intervention are not uncommon. Our goal should be to maintain firm gums that do not bleed.

As we continue to age, the habits and practices that we learned as children and young adults continue and the benefits and consequences become more apparent. With our modern diets filled with carbohydrates such as bread, pasta, candy and juices we must compensate by removing gross bacteria and decreasing their populations through diligent brushing and flossing. We must also understand that remineralizing our teeth with fluoride is one of the most effective ways to prevent dental caries.

And while all of this may seem very complex, fortunately the solution is quite simple: keep your amount of dental disease under control through regular professional cleanings and more importantly diligent brushing and flossing. Which teeth? Only the ones you want to keep.

Grant Tsuji, DDS runs a family dentistry practice at 735 Santa Clara Ave. in Alameda, Calif. For more information, call (510) 523-6281.