What are dental diseases?

Causes and Symptoms

Dental diseases fall into four major categories: dental caries, or tooth decay; periodontal disease, including gingivitis and pyorrhea; Vincent’s infection, or trench mouth; and oral cancer. The first of these diseases was the largest contributor to tooth loss among people under thirty-five in the United States before the widespread fluoridation of drinking water was begun; it remains a major cause of tooth loss in much of the world. Periodontal disease in its two stages, gingivitis and pyorrhea, is the most widespread dental problem for people over thirty-five. Most people who suffer the loss of all of their teeth do so because of this condition. Vincent’s infection, which shares many characteristics with gingivitis, is bacterial. The infection flares up, is treated, and disappears, whereas gingivitis is more often a continuing condition that requires both persistent home treatment and specialized treatment. The most serious but least frequently occurring dental disease is oral cancer. It is the only dental disease commonly considered life threatening, and there is a risk that it may spread to other parts of the body.

Dental caries occur because the food that one eats becomes trapped in the irregularities of the teeth, creating lactic acids that penetrate the enamel through holes (often microscopic) in it. Once lodged between the teeth or below the gum line, carbohydrates and starches combine with saliva to form acids that, over time, can penetrate a tooth’s enamel, enter the dentin directly below it, and progressively destroy the dentin while spreading toward the tooth’s center, the pulp.

This process often is not confined to a single tooth. As decay spreads, adjoining teeth may be affected. Some people have much harder tooth enamel than others. Therefore, some individuals may experience little or no decay, whereas others who follow similar diets and practice similar methods of dental hygiene may develop substantial decay.

Toothache occurs when decay eats through the dentin and enters the nerve-filled dental pulp, causing inflammation, infection, and pain. A dull, continuous ache, either mild or severe and often pulsating, may indicate that the infection has entered the jawbone beneath the tooth. An aching or sensitivity in the back teeth during chewing is sometimes a side effect of sinusitis.

One of dentistry’s nagging problems is periodontal disease, which results from a buildup of calculus, or tartar, formed by hardened plaque. Plaque is formed when food, particularly carbohydrates and starches, interacts with the saliva that coats the teeth, creating a yellowish film. If this film is not removed, it inevitably lodges between the gums and the teeth, where, within twenty-four hours, it hardens into calculus. Dental hygienists can remove most of this calculus mechanically. If it is allowed to build up over extended periods, however, the calculus will irritate the gums, causing the soreness, swelling, and bleeding that signal gum infection. Eventually, this infection becomes entrenched and difficult to treat.

Periodontists can control but not cure most periodontal disease. In its early manifestations, periodontal disease results in gingivitis, marked by inflammation and bleeding. Untreated, it progresses to pyorrhea, which is characterized by gums that recede from the teeth and form pockets in which infections flourish. As pyorrhea advances, the bone that underlies the teeth and holds them in place is compromised and ultimately destroyed, causing looseness and eventual tooth loss.

Vincent’s infection (trench mouth) is communicable through kissing or sharing eating utensils. Although it is sometimes mistaken for gingivitis, Vincent’s infection has one distinguishing characteristic that gingivitis does not have: it is accompanied by a fever stemming from sustained bacterial infection, which also causes extremely foul breath. Vincent’s infection is curable through proper treatment. It is unlikely to recur unless one is again exposed to the infection.

Oral cancer is the most serious of oral diseases. It often spreads quickly, destroying the tissues of the mouth during its ravaging advance. It not only threatens its original site but also can spread to other areas of the body and to vital organs. Fortunately, oral cancer is uncommon. Nevertheless, dentists look vigilantly for signs of it when they perform mouth examinations because early detection is vital to successful treatment, containment, and cure. People who have persistent mouth sores that do not heal may be experiencing the early manifestations of oral cancer and should see their dentists or physicians immediately.

Two other dental conditions afflict many people: malocclusion and toothache. Malocclusion occurs when, for a variety of reasons, the teeth are out of alignment. People with malocclusion are prime candidates for dental caries and periodontal disease, largely because their teeth are difficult to reach and hard to clean. Malocclusion may also cause one or more teeth to strike the teeth above or below them, causing injury to teeth and possibly fracturing them.

Treatment and Therapy

Modern dentistry has succeeded in controlling most dental diseases. In the United States, dental caries have been almost eliminated in the young by the addition of fluoride to most water systems. Used over time, fluoride strengthens the teeth by increasing the hardness of the enamel, making it resistant to the acids that form in the mouth and cause decay. Countries such as the United Kingdom, Canada, Singapore, and Israel have likewise implemented fluoridation programs in an attempt to prevent tooth decay. Fluoride has also been added to toothpaste and mouthwash, which offer considerable protection from dental caries.

Researchers discovered in the mid-1960s that a substance found in the mouth’s streptococcal bacteria creates dextran. Dextran enables bacteria to cling to the surface of the teeth and invade them with the lactic acid that they generate. Researchers ultimately discovered dextranase, an enzyme effective in dissolving dextran. Strides are being made to use dextranase in toothpaste or mouthwash to reduce or eliminate the effects of dextran.

Some people’s teeth seem to be impervious to tooth decay. It has been determined that such people have a common substance in their blood that protects their teeth from dental caries. Attempts are being made to identify and isolate this substance and to make it generally available to the public and to dentists in an applicable form. Some dentists coat the teeth with a durable plastic substance to make them resistant to penetration by the acids that cause dental decay, creating a hard protective coating above the enamel and making it difficult for food to lodge between the teeth or in irregularities in the teeth.

Because malocclusion, or poor spacing, can lead to tooth decay, dentists have become increasingly aware of the need to replace lost teeth so that the alignment of the remaining teeth will not be disturbed. Tooth implantation, a process by which a tooth, either artificial or natural, is anchored directly and permanently in the gum, solves many dental problems that in the past were addressed by attaching artificial teeth to existing ones beside them. In situations where malocclusion is caused by malformations, the use of orthodontic braces results in a more regular alignment.

Nutrition has come to the forefront of recent research in dental health. A lack of calciferol, a form of vitamin D2, may result in dental abnormalities, including malocclusion. Among substantial numbers of hospital patients who suffer from nutritional problems, the earliest symptoms occur in the soft tissue of the mouth.

Brushing the teeth after meals and before bed controls plaque, as does regular flossing. Such daily attention must be supplemented by twice-yearly cleaning, performed by a dentist or dental hygienist, and by annual or biennial whole-mouth x-rays to reveal incipient decay. Various mouthwashes also contain substances that control decay.

People who cannot brush after every meal should use a mouthwash or rinse the mouth out with water after eating, then brush as soon as they can. Special attention must be given to the back surfaces of the lower front teeth because the salivary glands are located there. This area is a breeding ground for the bacteria that cause the formation of lactic acid. Routine home care of this kind, particularly daily flossing, will help prevent both tooth decay and periodontal disease and can also reverse some of the inroads that periodontal disease has made. When gingivitis advances to pyorrhea, however, dental surgery may be necessary.

The major villain in both gingivitis and pyorrhea is tartar, or calculus, which is produced when plaque hardens. When tartar accumulates beneath the gums, it causes an irritation that can lead to infection. Sometimes, this infection moves to other parts of the body, causing joint problems and other difficulties.

People can control plaque by practicing daily dental hygiene at home. They must also have accumulated tartar regularly scraped away or removed by ultrasound in the dentist’s office. Malocclusions and defects in the production of saliva can be corrected by dentists and can greatly reduce the progress of periodontal disease.

When gum surgery is advised for the removal of the deep gum pockets that occur with pyorrhea, further surgery can usually be avoided with regular home care. Meanwhile, researchers are trying to develop a vaccine to immunize its recipients against the bacteria that cause tooth decay. Other decay-inhibiting agents are being studied closely with the expectation that they may in time be added to common foods and beverages.

Vincent’s infection is successfully treated with antibiotics, accompanied by a prescribed course of dental hygiene that is begun in the dentist’s office and continues at home on a daily basis. Some patients have found a peroxide mouthwash helpful in treating this disease.

When dentists find evidence of oral cancer, they usually refer patients to their primary physicians, who coordinate referrals to oncologists. An oncologist will determine if the patient has cancer and will determine the best ways to treat it. Laser treatment and radiation are used in controlling oral cancer, as are chemotherapy and surgery. The most important element in cancer treatment is time. It is essential, therefore, that specialized treatment be initiated as soon as oral cancer is discovered or suspected. In cases of oral cancer, a delay of even days can affect outcomes negatively.

The most immediate treatments for
toothache range from the application of cold compresses to the taking of aspirin or another analgesic every few hours. If the decayed part of the tooth is visible and reachable, sometimes applying a mixture of oil of cloves and benzocaine to the decayed area with a small swab soothes the pain. These treatments, however, offer only temporary relief.

Dentists resist treating toothache by removing the tooth, although removal offers an immediate solution to the problem. In some cases, dentists can drill out the decay and fill the tooth with silver amalgam, gold, or plastic. Quite often, by the time a tooth begins to ache, the pulp and dentin have been ravaged by decay. The best solution is endodontistry, or root canal, which will preserve the tooth but may necessitate the attachment of a crown.

Perspective and Prospects

Great strides have been made in preventing and treating dental disease, as researchers have reached deeper understandings of the root causes of such disease. Dentistry has become increasingly less painful through the use of anesthetics and high-speed, water-cooled drills. The public at large has grown aware of the close relationship between dental health and general health. People are unwilling to accept tooth loss as a natural consequence of aging. They have also begun to realize that orthodontistry is more than a cosmetic procedure. Rather, it is a necessary procedure for correcting misalignments of the teeth that can result in difficulty if uncorrected.

Advances in preventing and treating dental disease are constantly being made. Through genetic engineering, it is almost inevitable that substances will soon be available to increase an individual’s resistance to tooth decay. Nevertheless, controlling the buildup of calculus, the major factor in periodontal disease, will probably remain the responsibility of individuals through daily home care and twice-yearly visits to their dentists.

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