Preventing Tooth Decay
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Manual vs. Powered
Good news — you don’t have to buy an electric toothbrush
to get clean teeth. As more power toothbrushes hit the store shelves,
you may feel pressure to buy one. More expensive is better, right? Not
necessarily. According to the American Dental Association (ADA), a manual
toothbrush can clean teeth just as well as a power toothbrush. The secret
lies in how the toothbrush is used.
By following the tips below you can ensure a good brushing:
- Brush the inner, outer, and chewing surfaces of the teeth with
short (teeth-wide), back and forth strokes.
- Place the brush at a 45-degree angle against your gums when brushing
along the gum line.
- To clean the inside surfaces of the front teeth, use gentle up and
down strokes with the tip of the toothbrush.
- Use a soft touch. Vigorous brushing won’t get more plaque off
and can irritate your gums.
- A set time is not necessary; just make sure you are cleaning all
the surfaces of your teeth thoroughly.
- Be sure to replace your toothbrush once the bristles have become
frayed or every three to four months.
An electric toothbrush may be the right choice for you, however. People
with arthritis or other conditions that impair motor skills may need
the relative ease of a powered toothbrush to do an adequate job of brushing
their teeth. You should talk with your dentist or hygienist to determine
which type of toothbrush is best for you.
When purchasing a toothbrush, look for the ADA Seal of Acceptance. To
take part in this voluntary program, dental product manufacturers must
prove their product meets ADA criteria for effectiveness and safety.
Also, scientific studies must support the claims of any packaging or
advertising of products bearing the ADA Seal.
December 2002 Update
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Periodontitis and Heart Disease
The question of whether gum disease is associated with heart disease
is controversial. The first research to suggest a connection, published
in 1989, found that even after controlling for such cardiovascular disease
risk factors as smoking and diabetes, heart-attack patients had significantly
worse dental health than control subjects. Since then, several studies
have also suggested a link, but the nature of the relationship
is it causative or coincidental? remains in question.
In 2001, researchers sought an answer to this question, examining data
from 4,027 people who participated in the First National Health and Nutrition
Examination Survey Epidemiologic Follow-up Study. During 17 years of
follow-up, there were 1,238 cases of heart disease, 538 of which proved
fatal. The rate of heart disease was three times higher in those with
periodontitis than in those with healthy gums.
However, the connection became less prominent once investigators adjusted
the numbers to account for other risk factors for cardiovascular disease
smoking, cholesterol levels, high blood pressure, and diabetes.
After this adjustment, the heart disease risk among people with and without
chronic dental infections was similar.
In fact, even those people who had eliminated any potential of dental
infection through extraction of all teeth didn't have a lower heart disease
risk when compared to those diagnosed with periodontitis (inflammation
of the gums). The risk of developing CHD didn't decrease over time among
those with no dental infections or increase over time among people with
A higher rate of other heart-disease risk factors among people with periodontitis
might explain this relationship between gum disease and heart disease.
For example, those with periodontitis were more likely to have high blood
pressure and diabetes, and to smoke cigarettes.
These findings support the theory that the presence of periodontitis
may occur coincidentally with increased cardiovascular risk but it is
not its cause.
March 2002 Update
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Sugar and Tooth Decay
"If you eat too much candy your teeth will rot!" We've known
about the link between sugar consumption and tooth decay for centuries.
The bacteria in dental plaque feeds on sugar, and the acid produced by
the bacteria attacks the protective enamel surface of the teeth, allowing
for tooth decay to proceed. But since the advent of fluoride in water,
toothpaste, dental treatments, and even processed foods, do we still
need to restrict how much sugar we eat?
A recent review answers this question. Researchers examined the results
of 36 studies conducted in countries where fluoride exposure is widespread.
Only two of the studies showed people who consumed high amounts of sugar
had a high risk of tooth decay. The remaining studies showed only a moderate
to weak association. Does this mean we can eat all the candy we want
and not have to worry about tooth decay? Not quite. Moderation is still
key, because while the risk is much less than it was during the pre-fluoride
era, consuming sugar was still found to be a moderate to mild risk factor
for tooth decay.
If sugar has a role in tooth decay, can sugar substitutes have a role
in the prevention of tooth decay? A review of fourteen studies showed
a 30 to 60 percent decrease in the rate of tooth decay among study participants
who used sugar substitutes compared to participants using sugar. In the
studies, participants chewed gum or used toothpaste containing either
sugar or the sugar substitutes xylitol or sorbitol. Xylitol gave the
largest decrease in tooth decay. Sugar-free gums, particularly those
containing xylitol, may help prevent tooth decay by decreasing acid production
and promoting the flow of saliva to clear sugars from the mouth.
January 2002 Update
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