Problems with your teeth can disrupt your daily life more than you might think. Your teeth and mouth are necessary for good nutrition-they start the digestive process when you eat food. Your mouth also enables you to communicate with speech or with expressions, such as a smile or frown, that show your emotions. You can keep your teeth healthy for life by brushing and flossing them every day; eating a nutritious, balanced diet; and having regular checkups and cleanings by your dentist. For more about keeping your teeth and gums healthy.

Gum disease occurs when plaque, a sticky substance that contains bacteria, builds up in and around the gums and teeth, often causing swollen or bleeding gums. Gum disease is usually painless, un- less it forms an abscess (a pus-filled pocket). For this reason, many people may not be aware that they have a problem until the disease reaches an advanced stage and threatens loss of teeth. Gum disease is the leading cause of tooth loss after age 35.

Gum disease is common in all adults, but it occurs more frequently in women than men because of fluctuating hormone levels during puberty, pregnancy, breast-feeding, and menopause. Gum disease can take the form of gingivitis, which, if left untreated, can lead to the most serious form called periodontitis.

GINGIVITIS
Gingivitis is inflammation and bleeding of the gums, usually resulting from an infection. Most people experience gingivitis at some time in their life. The most common cause of gingivitis is a buildup of plaque and a hard, crustlike deposit called tartar, or calculus. Plaque is a soft, sticky deposit of bacteria (which is naturally present in your mouth) mixed with proteins from your saliva. Plaque can build up above or below the gums. Brushing and flossing your teeth can remove the plaque, but it rapidly re-forms within 24 hours. The buildup of plaque and tartar results from failure to brush your teeth and floss regularly.

In many cases, the symptoms of gingivitis are temporary and clear up with careful brushing and flossing. Using an over-the-counter antibacterial mouth- wash after you brush your teeth can also help reduce the buildup of plaque and prevent gingivitis. If you have inflammation or bleeding of your gums that does not clear up with brushing and flossing, see your dentist.

Medications that thin the blood, including aspirin, can contribute to bleeding gums. Diseases that reduce the blood's ability to clot, including liver diseases such as hepatitis, can also cause gingivitis. Some medications that are used to treat epilepsy, depression, or heart disease may cause swollen gums. Tell your dentist about any medications you are taking and see him or her if your gums are bleeding.

Symptoms See your dentist if you notice any of the following signs of gingivitis:
. Your gums bleed easily.
. Your gums bleed when you eat.
. Your toothbrush or dental floss turns pink or red when you use it.
. You have bad breath.

Diagnosis To diagnose gingivitis, a dentist places an instrument called a periodontal probe between the gums and teeth to measure the space between them and to check for bleeding or swelling.
Treatment An early case of gingivitis can be cured by brushing yeur teeth at least twice daily with a soft bristle tooth- brush and flossing every day to remove food debris and soft plaque deposits from between your teeth. Devices called oral irrigators-which use a thin, forceful


PERIODONTITIS
When gingivitis is not treated, it can advance to a more serious stage of gum disease called periodontitis, in which the tissue surrounding the tooth becomes infected. Plaque-filled pockets form between the tooth and gum and the gums become inflamed; this inflammation causes the pockets to gradually enlarge further and collect even more plaque, which can gradually detach the gums from the teeth. Bacteria can invade the bacteria and pus may ooze from the bony sockets that hold the teeth in place can erode and cause the teeth to loosen and fall out.

Symptoms See your dentist immediately if you notice any of the following symptoms of periodontitis:
. Swollen or recessed gums
. Pain in a tooth when you eat hot, cold, or sweet foods
. A loose tooth or change in your bite
. Bad breath or unpleasant taste in your mouth

Diagnosis A dentist diagnoses periodontitis by placing an instrument called a periodontal probe between the gums and teeth and checking for bleeding, swelling, or pus. The probe can measure the space between the teeth and gums and help the dentist evaluate the extent of disease. Periodontitis can also be diagnosed from an X-ray that shows deterioration of the bone that surrounds and supports the tooth.

Treatment The first step in treating periodontitis is a thorough cleaning of your teeth by a dental hygienist. Your dentist will instruct you in a strict daily program of dental hygiene to improve your condition. Your gums may bleed when you brush and floss, but this usually stops within 2 weeks if the disease was diagnosed at an early stage. If your gums become less red and swollen and more firm after several weeks of diligent daily care, you may be able to avoid having surgery to treat the disease.

In more advanced cases, surgery is usually necessary. In one surgical treatment for periodontitis, the dentist opens a flap of gum to remove deposits from around your teeth below the gum line or to re- move infected tissue. The flap of tissue is then stitched in place. In another procedure, called a gingivectomy or gingivoplasty, your dentist trims away part of your gum to decrease the size of the pocket in which tartar and bacteria are collecting. After the procedure, the surface of the gum is coated with a protective putty to allow it to heal. This coating should not interfere with your ability to eat or drink; if it causes any problems, call your dentist. After about a week, your dentist will remove the putty and examine your gums to evaluate how well they are healing.

In addition to either of these surgical procedures, and depending on the site of your periodontal disease, your dentist may place a thin fiber that is coated with an antibiotic medication into the affect- ed gum pocket to eliminate the bacteria. The antibiotic fiber is removed after 10 days and your gums are allowed to heal normally.

If gum disease has caused the loss of gum tissue and supporting jawbone, transplants of gum and bone taken from a healthy part of your mouth may be necessary to replace the damaged tissue.

TEMPOROMANDIBULAR DISORDER
Temporomandibular disorder (TMD) is a disorder of the temporomandibular joint, which is located between the temporal bone (part of the skull above the ear) and the mandible (lower jawbone).
TMD causes pain or clicking sounds when you open and close your jaw. Although the condition is not dangerous to your health, it can be uncomfortable. For unknown reasons, women are much more likely than men to have TMD. The cause of TMD is unclear. Many people who clench or grind their teeth (usually at night while sleeping and often in response to emotional stress) have TMD. Teeth that do not fit together properly can cause the jaw to become misaligned, which in turn can cause TMD. TMD can also result from injury to the jaw, osteoarthritis, poor posture (particularly thrusting the head and jaw forward), chewing gum, or eating too many chewy foods.

Symptoms TMD causes pain or clicking or grating sounds when you open and close your jaw. The disorder can also cause headaches, toothaches, earaches, or neck pain. You may have difficulty opening and closing your mouth or your jaws may lock in an open or closed position. Other symptoms of TMD can include dizziness or ringing in your ears.

Diagnosis TMD can be difficult to diagnose. Diagnosis is usually based on your symptoms. Your dentist will ask if you have any habits, such as grinding your teeth or chewing gum, that can cause TMD. Although some dentists may take X-rays or do a magnetic resonance imaging (MRI) scan these tests

Treatment If you are diagnosed with TMD, your dentist will recommend eating soft foods for a specified period of time. Avoid hard, crunchy, or chewy foods, gum, or foods (such as corn on the cob or a large sandwich) that require opening your mouth wide. To relieve pain and muscle spasms, take an over- the-counter pain reliever, such as aspirin, ibuprofen, or acetaminophen. If these over-the-counter medications are not effective in relieving your discomfort, your dentist may prescribe muscle relaxants. Placing cold or hot compresses on your jaw may also help; experiment to see which works best for you. Rest your jaw as much as you can by avoiding excessive chewing and maintaining your jaw in the teeth-apart, lips-closed position. This position is the jaw's physiological rest position. Try to reduce neck strain by maintaining good posture (s; do not carry heavy shoulder bags or use the side of your head to hold a telephone on your shoulder. Your dentist may prescribe gentle exercises to relax your jaw and neck muscles, or he or she may refer you to a physical therapist. To prevent you from grinding your teeth at night, your dentist may recommend a device, such as a bite guard or splint, that fits over the biting surfaces of your teeth and stabilizes your bite (the way in which your upper and lower teeth fit together). It is sometimes necessary to adjust or stabilize your bite with braces, porcelain or gold crowns, or by grinding down parts of any teeth that may be interfering with the normal closing of your jaw.

ORAL CANCER
Cancer may develop in any part of the mouth, but is most common on the lips, the lining of the cheeks, the gums, and the floor of the mouth. Oral cancer usually occurs after age 4S and is most common in people who use tobacco (including chewing tobacco) or who drink excessive amounts of alcohol. If you smoke cigarettes and drink alcohol, you are at even greater risk of oral cancer. Long- term, persistent irritation of tissues in- side the mouth from jagged teeth or dentures may also cause oral cancer.

Like most cancers, oral cancer is treat- ed most successfully when it is detected at an early stage. But more than half of all oral cancers are at an advanced stage when they are detected and many have spread to the nearby lymph nodes in the neck, making treatment more difficult and less likely to succeed. One of the most important benefits of regular visits to your dentist is an examination of the inside of your mouth for signs of oral cancer.

You should also do a regular self-examination of your mouth every month. This monthly examination is extremely important if you smoke or use other forms of tobacco, or if you drink alcohol. Examine the tissues that line your mouth, particularly along the sides or the bottom of your tongue and on the floor of your mouth underneath your tongue, where most oral cancers occur. Look for any changes, lumps, or patches of red or white tissue and report any- thing unusual to your dentist or doctor immediately. He or she will do a more thorough examination.

Symptoms The symptoms of oral cancer can include a number of changes in the tissues that line your mouth, especially on the sides or bottom of your tongue and on the floor of your mouth, under your tongue. See your doctor immediately if you notice any of the following symptoms of oral cancer:
. A small, pale lump or thickening of tissue inside your mouth, particularly along the sides or bottom of your tongue or on the floor of your mouth
. Bleeding from a sore, small lump, or patch in your mouth
. Unusual growth or change in the color of the tissue anywhere in your mouth
. Any sore in or around your mouth that does not heal within 2 weeks
. A lump or thickening in your cheek that you can feel with your tongue
. Soreness or a feeling that something is caught in your throat
. Difficulty chewing or swallowing
. Difficulty moving your jaw or tongue
. Numbness of your tongue or other areas of your mouth

Diagnosis If your dentist suspects that you have oral cancer, he or she will per- form a biopsy to confirm the diagnosis. For a biopsy, a small amount of tissue is removed from the suspicious area of your mouth and sent to a laboratory for examination under a microscope to look for cancer cells.

Treatment Treatment for oral cancer is usually done by an oral surgeon (who is a dentist) or by an oncologist (a doctor who specializes in cancer). If your cancer is diagnosed at an early stage and has not spread to surrounding tissues or the lymph nodes in your neck, surgery can usually remove all the cancerous tissue. The type of surgery you have will depend on the location and size of the tumor and may involve removing parts of your tongue, gums, jaw, or teeth. After the surgery, you may need to have therapy to help restore your ability to speak and chew normally.

When a tumor is too large to remove surgically, radiation therapy is often used to shrink the tumor. If the cancer has spread to the lymph nodes in your neck or to other parts of your body, your dentist or doctor will recommend chemotherapy-treatment with powerful drugs that kill cancer cells throughout your body.

Cosmetic Dentistry
Crooked, cracked, or discolored teeth can affect the way you feel about yourself. Cosmetic dental procedures are not medically necessary but are done to make teeth look better. Most people who have cosmetic dentistry are happy with the results and find it boosts their self-confidence. However, many of these procedures can be expensive and are often not covered by dental insurance. Like any medical procedure, cosmetic dental procedures have risks. If you are considering having a cosmetic dental procedure, such as the following, make sure you ask your dentist to explain the risks and potential benefits:

Bleaching: Bleaching is a cosmetic dental procedure that is done to lighten the color of teeth that are severely stained from decay or damage. The most common bleaching method involves using a custom-fitted mouth guard that you fill with a bleaching gel and wear in your mouth overnight, usually for about 2 weeks. While you are undergoing this process, your dentist will monitor your mouth regularly for any changes in the health of your teeth and gums. He or she will evaluate the degree of whitening by comparing the shades of your teeth be- fore and after the bleaching procedure. Another bleaching procedure, which provides results more rapidly, is done in one visit to your dentist's office. In this procedure, the dentist applies a bleaching solution to your teeth after placing a covering over your gums to protect them. The solution remains on your teeth for about 30 minutes to an hour. The results are noticeable immediately. Bleaching can cause irritation to your gums or other tissues that line your mouth, including your cheeks, tongue, or throat, but the irritation usually goes away in a short time.

Composite bonding: Composite bonding is used to cover stains or to build up a chipped tooth using the same tooth-colored material that is used to fill a cavity in a highly visible tooth. Before applying the composite, the dentist roughens the tooth surface and applies adhesive to it. The composite, which the dentist matches as closely as possible to the natural color of your teeth, is then applied in layers to the tooth and sculpted to create the correct shape. Composite bonding can last 3 to 5 years before it needs to be touched up to correct any discoloration or damage from excessive wear.

Veneers: Teeth that are severely damaged or discolored can be restored by covering the entire visible surface of the tooth with a thin layer of composite material or porcelain. Porcelain veneers resist abrasion and discoloration and are more durable and long-lasting than veneers made of composite material.

Aesthetic contouring: Teeth that are too large, misaligned, or overlapping can sometimes be made smaller and shaped to look more even and matched. The enamel of healthy teeth is usually thick enough to be reshaped to make the teeth look more attractive. Reshaping is also used for other purposes, such as improving your bite so your teeth mesh properly.

Corrective Dentistry
Teeth that are decayed (have cavities) can cause infections, pain, and tooth loss. Tooth decay can also make it difficult, or even impossible, to eat or speak or embarrassing to smile. Corrective, or restorative, dental procedures can repair the areas of decay and restore the teeth to complete functioning. Following are some corrective dental procedures that your dentist may perform:

Fillings: Fillings are usually used to repair small to moderate-sized cavities. The dentist drills away the area of decay and fills it with a strong material such as sil- ver, gold, or tooth-colored materials called composites.

Crowns: Crowns, also called caps, are used to replace the natural enamel of teeth that are damaged too extensively to be restored with fillings. Crowns are stronger and last longer than bonding or veneers and can also improve the appearance of teeth. Porcelain crowns are used for the more visible front teeth; for back teeth, many people choose gold crowns, which last longer than porcelain crowns but look less natural.

Replacing missing teeth: Replacement of missing teeth, in front or back, is important for maintaining the health of your mouth. When teeth are missing, the adjacent remaining teeth can shift and crowd together, which increases the risk of tooth decay and gum disease and interferes with normal chewing. In addition, if back teeth are missing, your cheeks can sink in, altering your appearance. Tooth loss is a common cause of wrinkles in the lower part of the face.

Two or more crowns can be fitted together to replace missing teeth. This structure is called a bridge. Implants are permanent artificial tooth supports that are surgically positioned in the jaw to anchor single-tooth crowns, multiple-tooth bridges, or dentures (artificial teeth). Dentures that are anchored with implants are significantly more stable and secure than traditional dentures, which are held in place by suction that forms between them and the upper or lower gums. Dentures that are held in place with implants also make chewing, eating, talking, and smiling much easier.

<< previous page