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Gum disease or periodontal disease, a chronic inflammation and infection of the gums and surrounding tissue, is the major cause of about 70 percent of adult tooth loss, affecting three out of four persons at some point in their life.

Bacterial plaque – a sticky, colorless film that constantly forms on the teeth – is recognized as the primary cause of gum disease. Specific periodontal diseases may be associated with specific bacterial types. If plaque isn’t removed each day by brushing and flossing, it hardens into a rough, porous substance called calculus (also known as tartar). Toxins (poisons) produced and released by bacteria in plaque irritate the gums.

These toxins cause the breakdown of the fibers that hold the gums tightly to the teeth, creating periodontal pockets which fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper and the bacteria moves down until the bone that holds the tooth in place is destroyed. The tooth eventually will fall out or require extraction.

Signs include red, swollen or tender gums, bleeding while brushing or flossing, gums that pull away from teeth, loose or separating teeth, puss between the gum and tooth, persistent bad breath, change in the way teeth fit together when the patient bites, and a change in the fit of partial dentures. While patients are advised to check for the warning signs, there might not be any discomfort until the disease has spread to a point where the tooth is unsalvageable. That’s why patients are advised to get frequent dental exams.

In the early stages, most treatment involves scaling and root planing-removing plaque and calculus around the tooth and smoothing the root surfaces. Antibiotics or antimicrobial drugs may be used to supplement the effects of scaling and root planing. In most cases of early gum disease, called gingivitis, scaling and root planing and proper daily cleaning achieve a satisfactory result.

More advanced cases may require surgical treatment, which involves cutting the gums, and removing the hardened plaque build-up and re-contouring the damaged bone. The procedure is also designed to smooth root surfaces and reposition the gum tissue so it will be easier to keep clean.

Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk. Your dentist can design a personalized program of home oral care to meet your needs. If a dentist doesn’t do a periodontal exam during a regular visit, the patient should request it. Children also should be examined.

Tooth decay is the disease known as caries or cavities. Unlike other diseases, however, caries is not life threatening and is highly preventable, though it affects most people to some degree during their lifetime. Tooth decay occurs when your teeth are frequently exposed to foods containing carbohydrates (starches and sugars) like soda pop, candy, ice cream, milk, cakes, and even fruits, vegetables and juices. Natural bacteria live in your mouth and form plaque.

The plaque interacts with deposits left on your teeth from sugary and starchy foods to produce acids. These acids damage tooth enamel over time by dissolving, or demineralizing, the mineral structure of teeth, producing tooth decay and weakening the teeth .

The acids formed by plaque can be counteracted by simple saliva in your mouth, which acts as a buffer and remineralizing agent. Dentists often recommend chewing sugarless gum to stimulate your flow of saliva. However, though it is the body’s natural defense against cavities, saliva alone is not sufficient to combat tooth decay. The best way to prevent caries is to brush and floss regularly.

To rebuild the early damage caused by plaque bacteria, we use fluoride, a natural substance which helps to remineralize the tooth structure. Fluoride is added to toothpaste to fight cavities and clean teeth. The most common source of fluoride is in the water we drink. Fluoride is added to most community water supplies and to many bottled and canned beverages.

If you are at medium to high risk for cavities, your dentist may recommend special high concentration fluoride gels, mouth rinses, or dietary fluoride supplements. Your dentist may also use professional strength anti-cavity varnish, or sealants-thin, plastic coatings that provide an extra barrier against food and debris.

Because we all carry bacteria in our mouths, everyone is at risk for cavities. Those with a diet high in carbohydrates and sugary foods and those who live in communities without fluoridated water are likely candidates for cavities. And because the area around a restored portion of a tooth is a good breeding ground for bacteria, those with a lot of fillings have a higher chance of developing tooth decay. Children and senior citizens are the two groups at highest risk for cavities.

The best way to combat cavities is to follow three simple steps:

1. Cut down on sweets and between-meal snacks. Remember, it’s these sugary and starchy treats that put your teeth at extra risk.

2. Brush after every meal and floss daily. Cavities most often begin in hard-to-clean areas between teeth and in the fissures and pits, the edges in the tooth crown and gaps between teeth. Hold the toothbrush at a 45-degree angle and brush inside, outside and between your teeth and on the top of your tongue.

Be sure the bristles are firm, not bent, and replace the toothbrush after a few weeks to safeguard against reinfecting your mouth with old bacteria than can collect on the brush. Only buy toothpastes and rinses that contain fluoride (antiseptic rinses also help remove plaque) and that bear the American Dental Association seal of acceptance logo on the package. Children under six should only use a small pea-sized dab of toothpaste on the brush and should spit out as much as possible because a child’s developing teeth are sensitive to higher fluoride levels. Finally, because caries is a transmittable disease, toothbrushes should never be shared, especially with your children.

3. See your dentist at least every six months for checkups and professional cleanings. Because cavities can be difficult to detect a thorough dental examination is very important. If you get a painful toothache, if your teeth are very sensitive to hot or cold foods, or if you notice signs of decay like white spots, tooth discolorations or cavities, make an appointment right away.

The longer you wait to treat infected teeth the more intensive and lengthy the treatment will be. Left neglected, cavities can lead to root canal infection, permanent deterioration of decayed tooth substance and even loss of the tooth itself.