Oral Care is as important as other areas of health care. More than 95% of the population is suffering from diseases related to tooth. Preventive actions can reduce the risk level to a great extant. Let us look at the different aspect of tooth care.
Human Dentition and its Environment
Teeth & associated oral structure
During childhood, human have complement of 20 teeth, which erupt from 6 month of age to 20-24 months. Adult normally have 32 teeth erupting from 6-7 years to 17-21 years(in some cases even after 30). Tooth is a multi-layer structure(fortunately) having layers like Crown, Enamel, Pulp Chamber, Dentin, Root firmly placed on spongy and Cortical bone.
Saliva
Saliva perform two functions:
a. involve in protection of oral cavity through several factors related to the bacterial population of the oral cavity.
b. the initial process of food digestion
Saliva could be anti-cariogenic by
a. reducing acid production by fermentation
b. buffering the drop in pH caused due to acid production in plaque
Calcium ions in salvia play double role in microbiological process involved in both protection and destruction of tooth by bacteria
Oral Accretion and condition
Dental Pellicle
Dental pellicle is a film that covers the tooth within minutes to hours after thorough cleaning of tooth. Bacterial mass, known as dental plaque, sticks on this film and stains when exposed to chromogenic materials.
Dental plaque can be removed without removing pellicle. Tooth brushing is not enough to remove pellicle. Chemical removal is possible but underlying enamel is at risk. Some may suggest using hydrogen peroxide but you must be very careful. Never do it without consulting a dentist.
Dental Plaque
Dental plaque is primarily accumulation of bacterial mass. It occurs above and below the gum line.
Plaque above the gum line may be removed by self administrated oral care practices like tooth brushing. For plaque below the gum level we have to take help of a dentist.
Insufficient care for plaque leads to Dental Caries and Periodontal disease. Several weeks of refraining from tooth brushing and substantial deposition of plaque result in gingivitis. Gingivitis does not develop without plaque but there may be some area with plaque but no gingivitis.
There is close relationship between plaque and dental caries. Generation of acid from carbohydrate due to plaque attacks enamel of tooth leading to dental caries.
Dental Calculus or Tartar
There are two type of dental calculus
Supragingival(above the gum level) – is hard mineralized dental plaque with crystals of various calcium phosphates.
Subgingival(below the gum level) – is organic structure of microorganism and intermicrobial matrix containing crystalline calcium phosphate.
Formation of calculus is pretty fast and due its direct contact with gum tissues leads to irritation and periodontal diseases.
^ Gingivitis may develop without Supragingival calculus causing gingival inflammation.
^ Calculus is porous and capable to retain bacterial antigens and toxic stimulators of bone resorption. This together with plaque can produce destructive effects.
^ Subgingival calculus may contribute to chronic character and progression of periodontal disease.
Periodontal disease
Bacterial plaque develops at the gum level and spreads if not removed in time. Bacteria generate toxin, which inflame the soft gum resulting soft, puffy and red gum that bleeds easily. In first stage a periodontal pocket is formed. In second stage, the inflammatory process is aggravated due to continuous deposition of plaque. Due to this progression pocket continues to deepens and tooth start to loosen. Ultimately due to destruction of bone tissues the tooth fall out or extracted by dentist.
Relation between periodontal disease and dental plaque is well established. Some findings are: -
^ Removal of Supragingival plaque once in 24 hours is adequate to preserve gingival health. Regular removal of plaque prevents infection.
^ Self administered oral hygiene procedure reduces progression of periodontal disease
^ Affect of Subgingival infection may vary from man to man, tooth to tooth. Pathological process should be followed for such infection. Pathological route will also help to overcome Supragingival plaque.
Dental Stain – Stains are mainly due to
production of colored substances in plaque
retention of colored substances from diet like tea, coffee, wine(cold drinks?) and even smoking
formations of colored substances due to chemical transformation of pellicle component
Dental Hypersensitivity – Is mainly due to gingival recession(gum). This may also be due to any surgery or periodontal treatment. Some of our habits like drinking very chilled water may be one of the causes. People use Clove Oil to get temporary relief. Some even go for tobacco leaves.
Oral Care Products
There are two types of products -: -
Mechanical device – Toothbrush, irrigation system(rarely used in our country), picks of various designs.
Chemical formulation – Tooth Paste, Tooth Powder, Oral rinse,
Toothbrush – This is the single most important oral care device. Toothbrushing even without toothpaste is good enough to take care of more than 50% of preventive care. It’s the real workhorse. The major contribution is by removal dental plaque and along with toothpaste it removes strains.
Toothpaste – It enhance the effect of toothbrush. Primarily it removes strains and freshening of breath and mouth. There are various types of OTC products. One has to choose the right one. There are some special formulations normally prescribed by Dentist. One may consult dentist to choose the right one. It is important to use the right quantity. Too less may not be too good.
Toothpowder – There are various types and brands. I have never used it. Worldwide its demand is going down because of poor application system.
Oral rinse – No away it can supplement Toothbrushing. Mostly it is used as mouth / breath freshener. There are some formulations to take care of infections but toothbrushing has to continue at least twice a day.
Toothpicks – Made of plastic or wood. Do not use metallic one.
FYI –
Many housewives use hydrogen peroxide as a bleaching agent. Hydrogen Peroxide, looks like water but is a very dangerous chemical and it can create havoc and many of you cannot handle such situation. It reacts with acid. Most of you must be storing Citric Acid in your kitchen cabinet and some may be keeping it by the side of a bottle of peroxide. Friends, be careful. A drop of very diluted peroxide in your eye is capable to make you blind in seconds and there is no treatment.
Reference book - “ Chemistry and Technology of the Cosmetic and Toiletries Industry” edited by DF Williams and WH Schmitt(second edition).
It is better to consult a dentist at least once in a year.
