A couple of years ago, during one of my regular visits to my dentist, I told him that my goal is to live to 120 and wanted to make sure that my teeth will last and stay healthy until then.

He immediately turned to me hygienist and said, “Dr. Thareja here has just given us permission to challenge him to do everything he needs to do for optimal dental health.”

Now I was 35 years old when I visited a dentist for the first time. You see, I grew up in India. My parents taught me that all I needed to do was brush my teeth every day and my teeth will be just fine. But something bothered me all the time.  Both my parents had lost most of their teeth when they were in their forties. They had gotten the last few pulled out so that they could get fitted with dentures.

Turning 35, even though nothing was hurting, I realized that I did not cherish the thought of having dentures in my forties.  Hence the first visit to the dentist.

The dentist was surprised to learn that I had never seen a dentist until that day.  He did a thorough cleaning. Although there was bleeding and pain during the cleaning, there were really no issues – no cavities, no gum disease etc. He told me to regularly brush and floss.

I bought floss and tried it for a few times. I did not really know how to do the flossing or what good it was doing. I did a little bit of reading, but gingivitis, tartar, gum disease, plaque these words did not seem to make any sense to me. So, I stopped flossing and went back to just brushing my teeth. And, continued with my once a year visit with the dentist.

Few years later, a dentist moved into our office building it. I decided to try him out.  My very first visit with Dr. Doug Drewyer’s office was quite different. He asked me that they would like to measure my gum separation before doing the cleaning. After the hygienist had done the measurements, Dr. Doug explained the significance of the measurements. He showed me that for certain teeth gums had separated much more. And, that was not good.

My next question was obvious: What could I do to prevent this gums separating from the teeth?  He told me the key was flossing. Since with flossing, you scrape off any plaque that might cause gums to inflame, lose vitality in the tissue and start separating from the teeth and eventually result in teeth falling out – even when the teeth themselves are healthy.

So then it finally made sense to me: So that’s how my parents lost their healthy teeth even when they were brushing every day!! 

Initially, Dr. Doug told me to floss just twice a week and then three times a week and then every day.  I later learned that he was taking this incremental approach to not overwhelm me.  His experience is that if he tells patients to floss every day on the first visit, very few are able to do that.

You may have heard the dentist joke.  Someone asks his dentist, “Which teeth should I floss?”  Dentist’s snap answer, “Only the ones you want to keep!”

Researching for this blog, I found a website called Mouth Healthy, sponsored by American Dental Association. It has a lot of very user-friendly information that explains all those things that I was trying to learn 15 to 20 years ago. And, if you are not familiar with these basis terms, here is a quick overview:

Your teeth are covered with a sticky film called plaque that can contribute to tooth decay and gum disease. Plaque contains bacteria, which following a meal or snack containing sugar can release acids that attack tooth enamel. Repeated attacks can cause the enamel to break down, eventually resulting in cavities. Check out these fascinating (or disgusting?) pictures of plaque attack close up.

Cavities, or tooth decay, is the destruction of your tooth enamel, the hard, outer layer of your teeth. It can be a problem for children, teens and adults. Plaque, a sticky film of bacteria, constantly forms on your teeth. When you eat or drink foods containing sugars, the bacteria in plaque produce acids that attack tooth enamel. The stickiness of the plaque keeps these acids in contact with your teeth and over time the enamel can break down. This is when cavities can form. A cavity is a little hole in your tooth.

Cavities are more common among children, but changes that occur with aging make cavities an adult problem, too. Recession of the gums away from the teeth, combined with an increased incidence of gum disease, can expose tooth roots to plaque. Tooth roots are covered with cementum, a softer tissue than enamel. They are susceptible to decay and are more sensitive to touch and to hot and cold. It’s common for people over age 50 to have tooth-root decay.

Decay around the edges, or a margin, of fillings is also common for older adults. Because many older adults lacked benefits of fluoride and modern preventive dental care when they were growing up, they often have a number of dental fillings. Over the years, these fillings may weaken and tend to fracture and leak around the edges. Bacteria accumulate in these tiny crevices causing acid to build up which leads to decay.

Decay can also be the result of dry mouth, which can be caused by certain medication or other health issues.

Plaque that is not removed with thorough daily brushing and cleaning between teeth can eventually harden into calculus or tartar. This makes it more difficult to keep your teeth clean. When tartar collects above the gum line, the gum tissue can become swollen and may bleed easily. This is called gingivitis.

Gingivitis is the early stage of gum disease. Gum disease, also known as periodontal disease, is an infection of the tissues that surround your teeth, and is caused by a buildup of plaque. In its early stages, symptoms may include:

• gums that bleed easily
• red, swollen, tender gums
• bad breath

Some factors that can put you at higher risk of developing gingivitis include:

• poor dental care
• smoking or chewing tobacco
• genetics
• crooked teeth that are hard to keep clean
• pregnancy
• diabetes
• medications, including steroids, certain types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers and oral contraceptives

Take care of your gums…help your heart?

The American Heart Association published a Statement in April 2012 supporting an association between gum disease and heart disease. The article noted that current scientific data do not indicate if regular brushing and flossing or treatment of gum disease will decrease the incidence, rate or severity of the narrowing of the arteries (called atherosclerosis) that can lead to heart attacks and strokes. However, many studies show an as-yet-unexplained association between gum disease and several serious health conditions, including heart disease, even after adjusting for common risk factors.

You may have seen health and lifestyle surveys used for estimating life-expectancy that want to know if you floss daily. If you do the models give you credit for an extra 2 to 4 years of life.

You may have seen commercial or ads for chewing gum claiming better dental health from chewing gum.  What is that about? Saliva, or spit, plays a significant role in maintaining oral health. It is derived from blood and acts as the bloodstream of the mouth. What this means is, like blood, saliva helps build and maintain the health of soft and hard tissues. When saliva flow is reduced oral health problems such as tooth decay and other oral infections can occur. Chewing is the most efficient way to stimulate salivary flow. It causes muscles to compress the salivary glands and release saliva. Saliva

• Washes away food and debris from teeth and gums
• Helps moisten and break down food to ease swallowing and enhances ability to taste
• Provides disease-fighting substances throughout your mouth to help prevent cavities and other infections
• Helps keep the surface of your teeth strong by providing high levels of calcium, fluoride and phosphate ions at the tooth surface.

Bottom Line

So, when I asked Dr. Doug to tell me everything I need to do to have my teeth until 120, he incrementally added a suggestion of using tiny gum brush to catch plaque that floss might not catch. But other than that he reinforced the same things that he has told me before – which is very consistent with everything I have learned through my research.

You can help prevent tooth decay, cavities, gum disease etc. and keep healthy teeth for life by following these tips:

1. Brush twice a day with fluoride toothpaste.
2. Clean between your teeth daily with floss or interdental cleaner.
3. Eat nutritious and balanced meals and limit snacking.
4. Check with your dentist about the use of supplemental fluoride, which strengthens your teeth, and about use of dental sealants (a plastic protective coating) applied to the chewing surfaces of the back teeth (where decay often starts) to protect them from decay.
5. Visit your dentist regularly for professional cleanings and oral examination.

And, if you are not sure how exactly to floss, here are instructions from National Institute of Dental and Craniofacial Research: PLAQUE: What it is and how to get rid of it.  You will notice that NIH also recommends brushing (or scraping) tongue in addition to the teeth.

I can tell you from my experience that the above list of five steps works. These days my twice annual dentist cleaning visits are basically cleaning stains and some scarping and very little, if any, pain, bleeding or discomfort. And, it has been getting better over time.

What are your thoughts and experience on maintaining optimal dental health?

I would love to learn from you.