Preventistry

Did you know that dentistry is preventable? (Hopefully you do, if you've been reading my other posts!)  Tooth decay, gum disease and even halitosis, as well as many other dental issues are not inevitable.   And, as much as I know you love coming to the dentist and spending your money there, I'd rather you were healthy!   Today's post will discuss preventive dentistry ("preventistry" is my new favorite word) and risk assessment.

Healthy deciduous teeth

Most of us are born with a great set of deciduous (or baby) teeth, as well as fabulous permanent teeth.  Then, we start eating, kissing, mouth breathing, and ugh...swapping saliva- first with mom and dad, and then other people as they enter our lives.  We trade bacteria and disease-causing pathogens with these folks.  Then uh oh!  Problems start occurring in our mouths.  Tooth decay begins and we blame it on "weak" or "soft" teeth, and then gums start bleeding, and we consider that part of childhood.  Sorry to burst this bubble but, no, tooth decay is not inevitable, and neither are bleeding gums.  Soft teeth are a myth.  Let's instead prevent these two nasty infections!  But how, you ask?

Prevention-- before we can prevent disease, we need to assess your risk for this disease so we know where your weak links are- so to speak.  Just like your physician looks at your risk of getting heart disease, diabetes, or other illnesses, your dental office needs to look at your lifestyle, as well as your habits, medical history, and dental history to see how likely you are to have cavities or gum disease in your future.  Each person is unique and should be treated that way- one size does not fit all in this area.  Then your dental professionals will  know exactly what to recommend to help you prevent dental diseases from happening, thus PREVENTISTRY is born!  We talked a little bit about risk assessment in my post: Do You Know Your Numbers?,  here's more information. 

Tooth decay along the gumline 

Cavity caused by soda pop

Tooth Decay 

CAMBRA:

 Dr. John Featherstone is the father of CAMBRA (Caries Management By Risk Assessment) and one of the leading researchers on tooth decay and tooth decay prevention.  In my blog post on CAMBRA, I reviewed the risk factors in more detail so you can understand why we look at each item so closely.  Tooth decay does not "just happen," it needs the right environment.  Just as with any disease, if you don't have the bacteria/pathogens that cause it to begin with, you won't get the disease.  Decay needs Streptococcus mutans, Streptococcus sobrinus, Bifidobacteriaceae, Veillonella, Scardovia wiggsiae, as well as any other bacteria that produce acid as their byproduct.  There are about 40 total bacteria that contribute to tooth decay  Then they need food (I.E.your carbohydrates), and an acidic environment.  They sound scary, and they are!  They are really the bad guys of the mouth, at least as far as tooth decay is concerned.  Learn more about tooth decay  so you can stop its development in your own mouth as well as help your children live decay free!.  

Never had any tooth decay risk assessment done? You can do this yourself-
Check out for ages  6 to adult: http://ncpaahec.org/CAMBRA_Forms_Over_6.pdf
Check out for ages 0 to 6: http://ncpaahec.org/CAMBRA_under_6.pdf

So, now that you have your risk level, what does this mean and what the heck should you do at home?  Our office uses the Carifree System and their products.  You can purchase these online. Carifree was developed according to Dr. Featherstone's protocols and system so I have faith in these products.
Low risk- you still have a 23.6% risk of developing a new cavity in the next 12 months.  Know your weak links, be aware of your homecare routines, maintain your current level of brushing and cleaning in between your teeth.  If any changes occur, (new medications, medical changes, you broke your hand etc...) let your dental professional know. They can modify your recommendations to help reduce your risk factors.
Moderate risk- you have 38.6% chance of a new cavity in the next 12 months.  The least expensive  option is to modify existing risk factors.  Look at what acidic drinks, or foods you ingest, what carbohydrates you eat, any medications that may dry out your mouth.  I'd suggest looking at increasing the good sugar- xylitol to five servings a day.  Read my Mouth Magic blog post to learn more about xylitol.  It really is magical!
High risk-  Time to re-assess your homecare routines and start looking at changing some habits.  Your chances of getting a new cavity in the next six months range from 38.6% to 69.3%- depending on the bacterial challenges you have.  Acidic mouth, high carbohydrate levels, dry mouth, new medications, poor oral hygiene habits?  How about those daily soda or energy drinks?  That will all add up to new tooth decay.  Up your fluoride intake, as well as other remineralizing products, and then time to really kill the decay bacteria.  Do you have an electric toothbrush?  The cost of business just went up, up, up.

The dark spots between the teeth are cavities

Extreme high risk- Rate of new decay puts you at an 88% chance of a new cavity within the year. Yikes!  Do you take two or more prescription medications?  The side effect of many medications is dry mouth.  Low or no saliva means no or low remineralization of your teeth.  Chemotherapy or radiation therapy also reduces saliva flow and causes this extreme high risk level.  More frequent care in your dental office, more fluoride, and other remineralization treatments at home, as well as dry mouth therapy are called for with this extreme condition.  Carifree treatment rinses are a must until the bacterial load is at a safe level.
All of the Decay Prevention Programs in my dental office consist of five aspects- pH neutralization, bacterial load reduction, remineralization with fluoride, five servings of  xylitol intake daily to reduce bacterial growth and acid production, and then more remineralization with calcium and phosphate in the toothpaste.  Re-moisturization products can also be vital.  Depending on your risk levels, you may need some or all of these protocols.  It depends on your risk level.   Prevention is so much better that drill, fill and bill.

Gum Disease 

Current Risk Assessment Tools

Gum disease or as we call it, Periodontal disease, is a little more complicated to assess risk.  Here are some (but not all) things we look at: 

     Patient Level Risk Assessment looks at bruxism, medical history, smoking, and hygiene motivation levels

     Mouth Level Risk Assessment  covers the pocket depths around each tooth, gum recession levels, occlusion (the way your teeth come together), and plaque retention

     Tooth Level Risk Assessment- loose teeth, tartar build up,  bone support, and tooth anatomy

     Site Level Risk Assessment- pus, bleeding,  and pathogens,  

   There's a lot of information here to put together.  All this is then entered into a computer program and out pops your risk assessment level.  

Red, swollen inflamed gums = INFECTION

  It is not quite as simple as the tooth decay assessment but just as important.  Forty seven percent of people aged 30 and older have mild,  moderate or severe gum disease, and then after age sixty  90% have moderate to severe levels of this infection!  With the connection between gum infections and heart disease, diabetes, dementia, erectile dysfunction, stillbirth and so very many other health ailments, it's vital to prevent this disease from even starting.  Ever.

All that said, here's the short version to give you a quick assessment tool to see what your risk is for gum disease: 

Check out the Previser website and see  where you stand:   http://service.previser.com/aap/default.aspx

Genetic Risk Assessment for Gum Disease- the Future is Here!

There are genes that make you more susceptible to the gum disease bacteria.  Our office tests for these genes.  If you have these certain genetic markers, you may be at increased risk for not only gum infection but also cardiovascular disease as well.   The Interleukin -1 gene tells us you are more sensitive to any type of inflammation.  Finding out if you carry this gene, especially when young, can put you on alert and help you to take charge before damage shows up.   There are other genes as well and thankfully, new research that should be available soon  can identify possibly aggressive gum disease conditions years before significant damage occurs.  Early genetic testing is where periodontal disease risk assessment needs to head.   Why wait for damage to occur?

What to do if you are anything other than low risk for gum infection?  Gum therapy and improve your homecare .  Be aggressive at killing those perio pathogens, increase your homecare routines, get yourself to a point where there is NO bleeding, no bad bacteria or other bad pathogens, and then see your dental hygienist every three months to maintain this state.  (Yes, it's possible. I promise!) Click on all the highlighted words to other posts for more information.

Before there is disease, there is risk for disease.

 The very best dentistry is NO DENTISTRY!

Comments or questions?  Contact me at Topgums4u@msn.com
Keep Smiling,
Barbara