Why oral healthcare should be taken more seriously.
JUST mentioning the word toothache is usually enough to make people wince. Understandably, many avoid seeing a dentist until the pain becomes unbearable. Such delays can lead to complications, and potentially compromise the ability to swallow or speak.
Although statistics from the National Oral Health Survey of Adults (NOHSA 2010) showed that an alarming 88.9% of adults had dental caries, the public’s cognizance on the importance of oral healthcare still remains at low levels.
In addition, we still see reports from studies showing that more than 70% of 12-year-old children suffer from dental decay. Worse still, surveys have shown that eight to 10 milk teeth of Malaysian pre-school children are affected by caries even before they turn five.
The good news is, despite the high prevalence of caries, there is mounting evidence that tooth decay and cavities can be most effectively deterred by understanding what causes caries and following a few simple rules.
A combination of an effective daily oral care routine and an annual consultation with a dentist can be a good start.
Oral care is important for everyone’s health and well-being for a variety of reasons. Considering the impact of dental disorders, it is astonishing to see how often it is ignored. Evidence shows more than 3.6 billion people are suffering from caries globally, which today is categorised as an infectious disease.
It’s more unfortunate if children are the sufferers – the pain combined with swelling can hinder the ability to eat and speak, stunting a child’s growth. They end up missing hours of school, affecting their quality of life.
The pain increases when the tooth has to be extracted, leaving a wound that is just as painful, if not more painful, than before the extraction, and which takes time to heal.
A child under five with 50% of the 20 baby teeth affected by caries is at a higher risk of having other health problems when he/she becomes an adult. Unfortunately, the impact of caries is not limited to oral health, but to general health and overall quality of life.
Why do cavities develop?
Dental decay is caused by three major factors: bacteria, food and bad oral health. Except for bacteria, the other two – the food we eat and the oral condition of teeth and saliva – are within our control.
Make sure to have a balanced diet with fibrous foods, and limit the amount of daily sugar consumption.
Eat at the right time, with few snacks in between. Avoid foods that are sticky and starchy, as they retain the plaque mass for a longer duration on the tooth surface.
Plaque sticks on both hard and soft surfaces, and nurtures bacteria. It takes less than five minutes for your sugared food to be sought after by some two million resident bacteria in your mouth, particularly Streptococcus mutans and its relatives (Strep salivarius, Strep viridians, etc).
The end result is a lowering of the acid level in the mouth to below pH 5.5. At this level, good chemical ions that make up the outer enamel matrix (the pearly white outer layer) will be demineralised or dissolved, leaving openings that can pick up poor chemical ions from your saliva in the mouth to be attached to the holes.
Therefore, to make sure you have a good pool of positive chemical ions like fluoride, you must drink fluoridated water instead of sweetened beverages. A regular size café latte contains up to nine teaspoons of sugar.
Those who like to drink distilled water or use filtered water should note that evidence has shown fluorides are often lost during the distillation or filtration process.
Also, do not forget to brush your teeth with fluoridated toothpastes.
As soon as it becomes foamy, the fluoride ions in the toothpaste will fill up the microscopic holes in your enamel to make your teeth stronger.
At the minimum, stronger teeth delay the formation of big cavities. We should aim to acquire the Japanese 80/20 concept. It means Japanese seniors in their 80s still retain 20 occluding permanent teeth out of 32, enabling them to eat, smile and enjoy a healthy life.
More importantly, remember that it takes at least half an hour for the post-eating acidic environment to return to a neutral pH of six or more.
More often than not, we don’t have a chance to reach that level as we Malaysians love to snack in between meals. Leaving an acidic ecosystem in the mouth is certainly dangerous as other harmful bacteria, such as Lactobacillus acidophilus and its relatives, thrive in acidic pH.
Snacking maintains the acidic environment for a longer period, allowing more time for teeth dissolution.
This is a dynamic ongoing process that lasts a lifetime.
Yes, you will have some caries that may or may not be visible to the naked eye during your lifetime, but if you take good care of your teeth and visit your dentist for early painless intervention, chances are, you will not have a cavity or collapsed gums early or late in your life.
How to care for your mouth
Although our mouths are exposed to tooth decay, we can decrease the chances of getting cavities by caring for our general and oral health, and making small lifestyle changes.
·If you are pregnant, start loving your unborn baby by providing a balanced diet with lots of vitamins from vegetables and fruits, and avoid or limit sugary foods and drinks.
At the minimum, drink lots of fluoridated water.
Make sure you always clean your teeth at least twice a day with fluoridated toothpaste; especially before going to bed. Cut down on snacking habits in order to reduce mouth acidity.
Do not forget to see your dentist regularly to make sure all is well.
> Protect your baby’s health by starting the oral hygiene habit early. With a wet and clean small towel, wipe baby’s mouth after milk feeding.
> Keep your baby smiley and healthy. Start brushing baby’s teeth without toothpaste first when the baby teeth are out at five to six months.
When you start using toothpaste on baby around two years of age or so, make sure you supervise the brushing so that baby will not swallow excessive toothpaste, particularly if it has fluoride.
Rinse baby’s mouth well. Like you, your baby will feel fresh and nap well.
> When you start feeding solid food, keep the sugar level threshold low. Do NOT add any flavours (sugars or salt) to your baby’s food. Their taste buds should not be stimulated to these tastes early.
Start with a few spoons of non-sweetened cereal or rice porridge with some vegetable gravy. Subsequently, include tasteless meat soup and fruits. You are well on the way to helping your baby adopt a healthy lifestyle.
> If you are wearing dentures, make sure you take them out at night and brush well to keep them clean.
Put them in water overnight. The soft tissue in your mouth needs to breathe, so clean your mouth well.
Make sure you brush your tongue (which usually traps dead cells, food debris etc), and rinse with a fluoridated mouth rinse. You will feel good and fresh when you go to bed.
> If you have chronic diseases like diabetes or heart problems, it is even more important that you have good oral health, with no open cavities.
As the mouth is the first port of entry for everything and contains billions of bacteria, we don’t want these to travel down into your inner organs and wreak havoc.
Poor oral health has the potential to exacerbate chronic ailments.
It may help to add mouth rinse to your shopping list. But mouth-rinsing is to be done only after toothbrushing.
Four basic steps
In general, there are four essential steps that you can take to achieve good oral health:
> Maintain good oral hygiene – brush your teeth thoroughly at least twice a day to make sure you remove dirt and bacteria that sticks to your tooth surface and collects in the loopholes of your tongue papilla.
Use other oral hygiene devices like floss or interdental brushes to help you get rid of food debris stuck in hidden places between your teeth.
This is especially important if you are wearing braces for orthodontic treatments or other forms of expensive restorations like bridges and even implants!
Ask your dentist what is best for you.
> Use fluoridated toothpaste to strengthen your teeth against dental decay.
> Avoid frequent consumption of sugary foods and drinks, and cut down on snacks to reduce the chances of dental decay.
> Visit your dentist at least once a year so that any decay problems can be detected early and interventions can be carried out. It will cut your dental budget down as you will need less complicated or expensive procedures.
At the turn of the 19th century, caries was termed as a disease of affluence in the developed West. We hope that as we achieve developed status as a nation, caries will be a story of the past.
Prof Dr Rahimah Abdul Kadir is dean of the Faculty of Dentistry, Lincoln University College, elected member of the Malaysian Dental Council, assessor for the Malaysian Qualification Agency, and chairman of the Alliance for a Cavity-Free Future (ACFF).