Are there ways to avoid dental problems?

Yes — the majority of dental disease is avoidable. Prevention is better than cure holds unusually well in dentistry, because the two most common diseases, decay and gum disease, are both driven by factors within your control and both progress slowly enough to be caught.

The pattern is predictable: people who leave long gaps between examinations, pay little attention to daily hygiene, and eat a diet high in sugar and acid have more dental problems as a result. The corollary is the useful part — changing those three things changes the outcome. Top tips on how to avoid dental problems is the companion to this article and goes through each of the three in turn.

What the common problems are

The Australian Dental Association has reported that tooth decay is Australia's most prevalent health problem, and one of its most costly diet-related diseases.

After decay, according to the Australian Institute of Health and Welfare, the next most common dental problems are:

Those three are related in sequence. Untreated decay and untreated gum disease are what produce tooth loss. How does tooth decay develop? and the stages of dental decay cover the first; bridges, implants, or dentures for replacing missing teeth? covers the last.

Decay and erosion — two different things

The source of this article treats these together, and it is worth separating them, because the fix differs.

Decay is destruction of tooth enamel caused by a combination of plaque and diet. Bacteria in plaque metabolise sugar and produce acid, which dissolves mineral out of the tooth. How does sugar affect your dental health? and sugar: what does it do to your teeth? go further into that half.

Erosion is direct chemical wear from acidic food and drink — no bacteria involved. Regular, heavy consumption of acidic items erodes the protective enamel, eventually exposing the less mineralised, more vulnerable root surface underneath. What is dental erosion and how is it addressed?, I've heard a lot about acid wear — what is this and how can I avoid it? and how does acidic food affect your teeth? are the reading on that half.

So reducing sugar addresses decay, and reducing acid addresses erosion. A diet lower in both avoids more than a diet lower in one. That is also why are sugar free soft drinks better for my teeth than regular soft drinks? and is soda water bad for your teeth? do not have the reassuring answers people expect.

The refinement worth knowing: frequency matters more than quantity. Each exposure begins an acid attack lasting roughly 20 to 40 minutes. The same amount of sugar spread across a day does far more damage than the same amount eaten at once. How does your diet affect your teeth? and six foods to avoid for healthy teeth apply that to a shopping list.

Why examinations matter even when nothing hurts

This is the most important point on the page: it is entirely possible to have disease, injury or malformation of the teeth, jaw and mouth without any pain or discomfort.

Decay between the teeth is invisible to the eye. Gum disease is usually painless until it is advanced. Oral cancer is often painless. Cracks develop before they hurt. By the time a dental problem produces symptoms, the cheap and simple treatment window has usually closed. How often should I go to the dentist?, start the New Year with a dentist check up and is it important to have a family dentist? cover attendance; why does a cracked tooth hurt so much? covers the one that eventually announces itself.

There are also documented links between oral and general health. Conditions with recognised oral associations include HPV, HIV, osteoporosis, obesity, coronary heart disease, cardiovascular disease, diabetes, stroke, and autoimmune conditions such as rheumatoid arthritis. The strength of the evidence varies considerably between these — the relationship with diabetes is the best established and runs in both directions — but the practical conclusion is the same either way. Health problems linked to poor oral hygiene, the importance of dental hygiene — a window onto your overall health, dental health and general wellbeing and diabetes and dental health: the two-way street go through the evidence.

What the appointment actually involves

The dentist will visually examine the hard and soft tissues of the mouth, take a medical history, and take radiographs where indicated to identify and diagnose problems that are not visible. How safe are dental x-rays answers the usual question about that.

The dental hygienist will examine the soft tissues for indications of gum disease, provide treatment to restore the mouth to a healthy state, and advise on the hygiene practices that reduce the risk of chronic gum disease. What does a dental hygienist do?, dental hygienist vs dentist — what's the difference? and your Smile Solutions dental hygienist visit: what to expect explain who does what; dental cleans and hygienists is the service page.

The soft-tissue examination deserves particular note. For most adults it is the only routine screening for oral cancer they receive. Oral cancer: how your dentist can help with early detection and oral cancer: signs, risk factors and how your dentist can help describe what is being looked for.

Complacency

Research suggests Australians have become somewhat complacent about oral care, despite the World Health Organization describing oral hygiene as an essential component of overall health and important to wellbeing.

The basis of good oral hygiene is straightforward: effectively removing plaque — the sticky, colourless bacterial film that adheres to the hard and soft tissues of the mouth and drives both decay and gum disease.

Because plaque is a biofilm, it has to be physically disrupted. No rinse dissolves it. A brush, floss or an interdental brush is what removes it. That is the point missed in should I be using mouthwash as well as brushing and flossing my teeth? and the truth and myths about mouthwashes — and the same reasoning applies to oil pulling.

A tailored approach

Oral hygiene requirements vary between individuals, based on risk and need. What suits a low-risk adult with excellent home care is not what suits someone with orthodontic appliances, dry mouth from medication, or a history of gum disease. See what are the hygiene benefits of Invisalign?, my mouth is always dry and when do you need deeper cleaning?

Our dentists and hygienists work together to advise on the most effective products for an individual — toothbrushes, toothpastes, mouthwash and speciality products — as part of a tailored preventive approach. Which toothbrushes do dentists recommend? and with so many toothpastes on the market, how can I make a wise choice? are the starting points.

A simple regimen

When prevention is not enough

Sometimes preventive measures alone are insufficient — genetics, medical conditions, medications that dry the mouth, and enamel defects all raise risk independently of behaviour. That is not a failure on anyone's part; it is a reason to work with your dentist and hygienist to establish your actual risk and build a programme around it, rather than assuming the standard advice is enough. Everything you need to know about chalky teeth and are women especially prone to oral health problems? are two examples of risk that is not behavioural.

Common questions

That list of general-health conditions is long. How strong are those links, really?

They are not all the same strength, and a page that presents them as though they were is overselling. The honest position is that diabetes is the well-established one, and most of the rest are associations rather than demonstrated cause and effect.

On diabetes, Diabetes Australia states that "there is increasing evidence of a two-way relationship between periodontitis and diabetes" — gum disease is more likely when blood glucose is outside the recommended range, and, running the other way, "people with periodontitis exhibit a higher chance of developing prediabetes and diabetes" and have "poorer glycaemic status (higher level of HbA1C), compared to people without periodontitis."

Even there, the same source is careful about how much treating the gums achieves: professional periodontal treatment "has been shown to create a mild improvement in blood glucose levels. However, these results lasted for only a short three-month period of time (longer term studies are ongoing)." That is a real effect, honestly sized. It is not a claim that treating gum disease manages diabetes.

For the other conditions on the list, treat the association as a reason for the examination rather than as a promise about what the examination will prevent. Nobody should be having their gums treated in order to prevent a stroke.

Can gum disease be reversed, or only stopped?

This depends entirely on which stage you are at, and the distinction is the single most useful thing to understand about gum disease.

Gingivitis — inflamed, bleeding gums with no bone loss — is reversible. Remove the plaque consistently and the gums usually settle within one to two weeks. That is why bleeding when you start flossing is a reason to keep going rather than to stop.

Periodontitis is not. Diabetes Australia describes it as "a chronic disease that requires life-long care and professional treatment" which "causes recession of the gum and/or bone surrounding affected teeth," and then states the key fact in four words: "These changes are irreversible." Treatment arrests the disease and keeps the remaining bone; it does not grow back what has gone. Left untreated, "severe untreated disease can result in teeth becoming loose, painful and eventually being lost."

What that means practically is that the goal changes at the boundary between the two. Before it, the goal is cure. After it, the goal is control — ongoing maintenance at an interval set by your clinician, indefinitely. See Bleeding Gums, when do you need deeper cleaning? and Periodontists.

I have diabetes. What should I actually do differently?

Three things, and the first is the most encouraging fact in this whole area.

Blood glucose control is the lever. Diabetes Australia's position is that the risk of periodontitis is greater in people with diabetes "particularly when blood glucose levels are not within the recommended range of 4-7 mmol/L" — but that "with optimum blood glucose management the risk of developing periodontitis is the same as for a person without diabetes." The elevated risk is not a fixed feature of having diabetes.

Know the specific problems to watch for. Diabetes Victoria lists higher risk of periodontal disease, of "dry mouth, which can lead to ulcers and infections", of "delayed healing after dental procedures", and of "oral thrush and other fungal infections." The healing point matters before any surgical treatment, and is a reason your dentist will ask about your recent results.

Raise it with your GP as well, because the system will not raise it for you. Diabetes Victoria notes that "dental visits are not formally included in the Annual Cycle of Care for diabetes in Australia" — that cycle covers blood pressure, HbA1c, cholesterol, kidney function, podiatry and eye examinations, and "oral health is missing from the checklist." If nobody in your care team asks about your teeth, that is why. Ask them to note it anyway, and tell your dentist your most recent HbA1c. See diabetes and oral health and diabetes and dental health: the two-way street

I am in my forties and have never had a filling. Do I really need check-ups?

Yes, and the reason is that a clean decay record protects you from exactly one of the things an examination is looking for.

The risks that do not care about your filling history: gum disease, which is painless until it is advanced and which causes irreversible bone loss before it announces itself; erosion from acid, which needs no bacteria and shows up on people with immaculate hygiene; cracks, which develop silently in heavily loaded back teeth and in teeth worn by grinding; and the soft-tissue examination, which for most adults is the only routine screening for oral cancer they will ever have.

There is also a shift with age that catches low-decay adults out. As gums recede, root surface becomes exposed — and root surface is dentine, not enamel, so it is softer and decays faster. People who went forty years without a cavity sometimes acquire several in a decade, and the usual cause is a combination of recession and a newly dry mouth from medication.

The interval is the thing to discuss rather than the attendance. A genuinely low-risk adult may not need six-monthly visits — but that is a conclusion your clinician should reach with you after looking, not an assumption to make from the absence of symptoms. See how often should I go to the dentist?

Related reading

Practical details

This article references public statements by the Australian Dental Association, the Australian Institute of Health and Welfare and the World Health Organization; those organisations' own publications remain the primary sources.

Specialist registration can be verified on the AHPRA register, or by calling 1300 419 495. The clinical team is listed by name, and dentists and registered specialists explains the difference between the two.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Published 21 September 2015. General information only; it does not replace advice from your treating practitioner.

Smile Solutions trades under ABN 28 193 514 103.

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