Dental health is one of the most important, yet the most neglected practices. From toothaches to bleeding gums, poor oral hygiene manifests in a number of different forms. In this article, Dr. YK Amdekar discusses the different outcomes of poor dental health and practice points for managing these issues in children and adults.

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Introduction

In general, teeth are the most neglected part of the body in the Indian population barring a few exceptions. Parents of infants are concerned about the timely eruption of teeth and thereafter attribute every disease either to erupting teeth or the pre-erupting stage. The younger generation is concerned with cosmetic aspects of teeth with emphasis on well-aligned sparkling white teeth. But, almost no one is concerned about dental health.

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Basic information

The first tooth may appear anytime from 6 months to as late as 18 months of age. Rarely, is a neonate born with a tooth that may have to be extracted because of fear of slipping into the throat and downwards. There is no human without teeth (though such a condition has been reported).

Primary teeth have shorter and thinner roots and thin enamel that looks white. They are 20 in number. They primarily act as “space-makers” for permanent teeth to be placed. Around 6 years of age, deciduous teeth start falling to create a space for permanent teeth and this process continues till all 20 teeth are replaced by 32 teeth. Wisdom teeth may appear as late as 18 to 25 years and often at least one of them is impacted in many individuals.

Though the appearance of primary as well as permanent teeth may vary a great deal in normal individuals, the number remains universally the same. Though extra teeth or the appearance of permanent teeth before falling of primary teeth are also known, they are rare.

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Dental care in early childhood

Care in early childhood

It should start right from the time, the first primary tooth erupts. It is ideal to use a finger or finger-brush with a rice-grain size smear of fluorinated toothpaste and by the time all primary teeth erupt, one may need to use a pea-size dollop of toothpaste. In place of toothpaste, tooth powders of various types can be used as per the prevalent cultural practices. Bottle feeding, prolonged breastfeeding, or night feeding should be avoided to prevent tooth decay.

Care in other age groups

A soft-bristled brush is ideal and must be used with gentle pressure. Vigorous pressure damages the enamel. One must follow the correct technique of brushing. The brush must be held at a 45-degree angle to the gum line and rotational movement should be used.

Molars, the teeth at the back must be properly brushed as most food particles are stuck there. Foods and drinks with acidic pH tend to damage the enamel if one brushes immediately after consumption of such items, so brushing must be delayed by 30-60 minutes.

Brushing should be only two times a day and not after each meal. Cleaning gums with finger and mouthwash are important to maintain hygiene. It is important to clean the teeth, gums, and mouth with water each time immediately after eating anything.

drinks should not be consumed in a lingering way. Eating raw fibrous fruits such as apple, pear, carrot, and cucumber help to keep teeth white. They help to remove plaque over the teeth that are responsible for yellow staining of teeth. Such fibrous foods also need extra chewing, so the generated saliva neutralises acid that may erode teeth.

Water fluoridation helps to prevent tooth decay by 20-40%. It is ideal to use fluorinated toothpaste. Permanent teeth start getting yellowish over time and one may use a whitening toothpaste that has an abrasive ingredient such as silica that scrubs the surface of the teeth and make it white.

Periodic flossing or interdental cleaning helps maintain oral hygiene.

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Dental diseases

Ninety per cent of adults in India have some tooth decay after the age of 20 years. It is seen also in younger children with temporary teeth but usually starts during adolescence due to lack of proper maintenance.

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1. Tooth pain: It is a common problem that may result from an infection of a tooth or its structures but also may indicate other conditions such as cracked tooth (fractured tooth), chipped tooth, impacted tooth and exposure of nerve endings in a cavity.
2. Dental caries or cavities: Commonly known as tooth decay, it is caused by the breakdown of the tooth enamel as a result of bacteria on teeth that acts on foods and produce acid that destroys enamel and results in tooth decay. With worsening destruction, nerve endings are exposed resulting in sensitivity to cold items that leads to sudden and severe pain. A cracked tooth is a fracture that may cause pain on biting or on the release of biting pressure and at times may result in cold sensitivity with inflammation of the pulp. Pain may also be due to infection in a decaying tooth.
3. Gingivitis: It is the infection of gums that is caused by a plaque formed of sticky bacteria. It may localise to form an abscess. Such infections may spread to nearby areas and may even be the cause of brain abscess in a child with a congenital cyanotic heart defect. They also may cause halitosis – bad breath. If left untreated, it causes bone loss, and the tooth may become loose and shift.
4. Impacted wisdom tooth: Fifty per cent of adults may have at least one impacted wisdom tooth. It may damage the adjacent tooth, may result in gum disease, a cavity, or misalignment.
5. Stained teeth: Teeth are often stained due to pigments in food or drugs. With iron deficiency anaemia being so common in India, oral iron is also the cause of staining of teeth. Tobacco chewing is also common in India and is a cause of staining.
6. Crooked teeth: Teeth may be crooked and poorly aligned or there may be a gap between teeth that may come in the way of good hygiene.
7. Bruxism: It refers to the grinding of teeth. It may occur during sleep or even in the daytime. It may result from stress, sleep problems, misaligned teeth or respiratory allergy and may result in headache, cracked tooth and jaw pain.

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Monitoring dental health

Periodic dental check is ideal right from the time the first tooth erupts. Infants and toddlers commonly visit paediatricians or health facilities for immunisation and hence there are opportunities to not only monitor growth but also dental health. Subsequently, parents need to be sensitised to continue maintaining good oral hygiene. A visit to the dentist happens only when routine measures fail. Early detection of dental problems is the only way to preserve good teeth. Unfortunately, this aspect is universally ignored in India.

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Management of dental problems

Dental care has advanced a great deal, applicable even for young children and it is out of the scope of this article. The aim is to prevent dental diseases and correct naturally present defects at the right time. Treatment of neglected diseases would always leave behind permanent damage though at least prevent further worsening.

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Summary

Dental health is a neglected area and the community, including doctors, need to be sensitised to attend to it. Prevention of dental diseases is easy and cost-effective. Early detection is ideal but needs a periodic visit to a dentist even in the absence of any symptoms.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.