Tooth decay occurs when your teeth are frequently exposed to food containing carbohydrates (starches and sugars) like soda pop, candy, ice cream, milk, cakes, and even fruits, vegetables and juices. Natural bacteria live in your mouth and form plaque. The plaque interacts with deposits left on your teeth from sugary and starchy foods to produce acids. These acids damage tooth enamel over time by dissolving, or demineralizing, the mineral structure of teeth, producing tooth decay and weakening the teeth.

How is caries prevented?
The acids formed by plaque can be counteracted by simple saliva in your mouth, which acts as a buffer and a remineralizing agent. Dentists often recommend chewing sugarless gum to stimulate the flow of saliva. However, though it is the body's natural defense against caries, saliva alone is not sufficient to combat tooth decay.

The best way to prevent caries is to brush and floss regularly. To rebuild the early damage cause by plaque bacteria, we use fluoride, a natural substance that helps to remineralize the tooth structure. Fluoride is added to toothpaste to fight cavities and clean teeth. The most common source of fluoride is in the water we drink. Fluoride is added to most community water supplies and to many bottles and canned beverages.

If you are at medium to high risk for caries, your dentist may recommend special high concentration fluoride gels, mouth rinses, or dietary fluoride supplements. Your dentist may also use professional strength anti-cavity varnish, or sealants - thin, plastic coatings that provide an extra barrier against food and debris.

Who is at risk for caries?
Because we call carry bacteria in our mouths, everyone is a risk for caries. Those with a diet high in carbohydrates and sugary foods and those who live in communities without fluoridated water are likely candidates for caries. And because the area around a restored portion of a tooth is a good breeding ground for bacteria, those with a lot of fillings have a higher chance of developing tooth decay. Children and senior citizens are the two groups at highest risk for caries.

What can I do to help protect my teeth?
The best way to combat caries and cavities is to follow three simple steps:

1. Cut down on sweets and between-meal snacks. Remember, it's these sugary and starchy treats that put your teeth at extra risk.

2. Brush after every meal and floss daily. Cavities most often begin in hard-to-clean areas between teeth and in the fissures and pits - the edges in the tooth crown and gaps between teeth. Hold the toothbrush at a 45-degree angle and brush inside, outside and between your teeth and on the top of your tongue. Be sure the bristles are firm, not bent, and replace the toothbrush after a few weeks to safeguard against reinfecting your mouth with old bacteria that can collect on the brush. Only buy toothpastes and rinses that contain fluoride (antiseptic rinses also help remove plaque) and that bear the American Dental Association seal of acceptance logo on the package. Children under six should only use a small pea-sized dab of toothpaste on the brush and should spit out as much as possible because a child's developing teeth are sensitive to higher fluoride levels. Finally, because caries is a transmittable disease, toothbrushes should never be shared, especially with your children.

3. See your dentist at least every six months for checkups and professional cleanings. Because caries can be difficult to detect, a thorough dental examination is very important. If you get a painful toothache, if your teeth are very sensitive to hot or cold foods, or it you notice signs of decay like white spots, tooth discolorations or cavities, make an appointment right away. The longer you wait to treat infected teeth the more intensive and lengthy the treatment will be. Left neglected, caries can lead to root canal infection, permanent deterioration of decayed tooth substance and even loss of the tooth itself.

What is the process for sealants?
The dentist cleans and rinses the tooth surface to make sure that it is free of any decay. Then a special cleansing liquid is rubbed on the tooth and washed away. Finally, a seal is applied, usually on the chewing surface of the back teeth until it hardens. The procedure is pain-free and takes about five minutes per tooth.

Who is a good candidate for sealants?
Anyone who is at a high risk for dental caries should consider sealants. In general, children are good candidates for sealants as long as they are applied before their teeth have a chance to decay.

It may be beneficial to apply sealants to newly erupted molars (six and twelve year). You should talk with your general dentist about sealants if you have a disability or do not use fluoridated water. Adults also can benefit from this procedure because they have the same grooves and pits. Ask your dentist if you are a good candidate for sealants.

Why should I ask about sealants?
The chewing surfaces of children's teeth are susceptible to decay because children have a harder time cleaning the tiny grooves and pits on certain teeth, and fluoride is not necessarily as effective on the teeth in this area. So although you child may brush and floss carefully, food and bacteria still can build up in the depressions, leaving a higher risk for decay.

Other patients also can benefit from sealant placement, such as those who have existing grooves and pits that are susceptible to decay.

Are sealants better than "filling a cavity"?
Yes, approximately three-quarters of sealed teeth remain cavity free, compared to less than one-third of teeth without sealants. Plus research has shown that almost everyone has a 95 percent chance of eventually experiencing cavities in the grooves and pits of the teeth. Sealants can save time, money and discomfort from more invasive procedures and help maintain intact teeth by preventing decay, which destroys tooth structure.

Some research has shown that sealants may stop cavities when placed on top of a slightly decayed tooth by sealing off the supply of nutrients to the bacteria, which is the cause of caries.

How long do dental sealants last?
Dental sealants have a very high success rate and can last up to 10 years. To receive the maximum benefits from sealants, children should continue practicing good oral hygiene, which includes brushing and flossing daily. Diet also can be a factor in the effectiveness of sealants. Avoid biting hard objects such as hard candies.

Sealants are just one part of a child's preventive dentistry program, which should include fluoride, plaque removal and regular dental care. Loose or defective sealants can be replaced at follow-up appointments. Your general practitioner will check to make sure that the sealants are in place during your checkups.

Soft or hard bristles?
In general, a toothbrush head should be small (1" by ½") for easy access. It should have soft, nylon bristles with round ends. Some brushes are too abrasive and can wear down teeth. A soft, rounded, multi-tufted brush can clean teeth effectively. Press just firmly enough to reach the spaces between the teeth as well as the surface. Medium and hard bristles are not recommended.

How long should I brush?
It might be a good idea to brush with the radio on, since dentists generally recommend brushing 3-4 minutes - the length of an average song. Using an egg timer is another way to measure your brushing time. Patients generally think they're brushing longer, but most spend less than a minute brushing. To make sure you're doing a thorough job and not missing any spots, patients are advised to brush the full 3-4 minutes twice a day instead of brushing quickly five or more times through the day.

Should I brush at work?
Definitely, but mot Americans don't brush during the workday. Dentists say it's a good idea to keep a toothbrush in your desk, which increases the chances that you'll brush during the day by 65 percent, according to a survey released by Oral-B Laboratories and the Academy of General Dentistry. Getting the debris off teeth right away stops sugary snacks from turning to damaging acids, and catches starchy food like potato chips before they turn to cavity-causing sugar. If you brush with fluoride toothpaste in the morning and before going to bed, you don't even need to use toothpaste at work. You can just brush and rinse before heading back to the desk. If you don't have a toothbrush, rinsing your mouth with water for 30 seconds after lunch also helps.

The following tips may improve you work-time brushing habits:

Post a sticky note on your desk or computer at work as a reminder to brush your teeth after lunch

Brush teeth right after lunch, before you become absorbed in work

Store your toothbrush and toothpaste at work in a convenient and handy place.

Make brushing your teeth part of your freshening up routine at work.

Clean your infant's gums with a clean, damp cloth. Ask your dentist if you may rub a tiny dab of toothpaste on the gums.

As soon as the first teeth come in, begin brushing them with a small, soft-bristled toothbrush and a pea-sized dab of fluoride toothpaste. Remember, most children are also getting fluoride from the community water supply.

To avoid baby bottle tooth decay and teeth misalignment due to sucking, try to wean your child off of the breast and bottle by one year of age, and monitor excessive sucking of pacifiers, fingers and thumbs. Never give you child a bottle of milk, juice or sweetened liquid as a pacifier at naptime or bedtime.

Help a young child brush at night-the most important time to brush, due to lower salivary flow and higher susceptibility to cavities and plaque. Perhaps let the child brush their teeth first to build self-confidence, then the parent can follow up to ensure that all plaque is removed. Usually by age five or so, the child can learn to brush his or her own teeth with proper parental instruction.

The best way to teach a child how to brush is to lead by good example. Allowing your child to watch you brush your teeth teaches the importance of good oral hygiene.

New studies suggest that people who have gum disease seem to be at a higher risk for heart attacks, although no one is certain how this relationship works. Your oral health affects your overall health, but the studies that will find exactly why these problems are linked are still underway.

How can gum disease affect my overall health?
The current theory is that bacteria present in infected gums can come loose and move throughout the body. The same bacteria that cause gum disease and irritate your gums might travel to your arteries. Researchers are unsure what causes the bacteria to become mobile, but it has been suggested that bacteria can be dislodged and enter the bloodstream during tasks as simple as brushing, flossing and even chewing.

Research shows that risk varies according to the level of gum infection. The worse the infection, the more likely the bacteria are to become blood-borne. Infected gums bleed, making it easier for bacteria to enter your bloodstream. If bacteria become dislodged, the bacteria enter through cuts or sores in your mouth and travel to other parts of the body through your bloodstream.

Once bacteria reach the arteries they can irritate them in the same way that they irritate gum tissue. This could cause arterial plaque to accumulate in the arteries, which can cause hardening and block blood-flow. Compromised blood-flow to your heart can cause a heart attack. Also, arterial plaque can come loose and travel to other parts of the body. If blockage occurs in the brain, it can cause a stroke.

Your dentist may use a special rinse immediately after dental procedures to neutralize these bacteria, but your best protection is to maintain a healthy mouth.

What should I do?
Keep your mouth healthy! See your dentist at least twice a year for periodic maintenance. Gum disease is a serious gum infection that should always be taken seriously. Although gum disease can often show few or no symptoms at all, watch for gums that are red and irritated, or gums that bleed easily. There are many new treatments available to control and help reverse gum disease.

Always remember that gum disease is caused by plaque buildup. Brush and floss regularly to remove plaque that you can't see below the gum line and remember to schedule regular check-ups. If you remove the plaque, you minimize the change for getting gum disease.

How does a build-up of plaque affect me?
If the plaque isn't removed, it can cause gingivitis - red, swollen, tender gums that are more likely to bleed. So-called "pregnancy gingivitis" affects most pregnant women to some degree, and generally begins to surface in the second trimester. If you already have gingivitis, the condition is likely to worsen during pregnancy. If untreated, gingivitis can lead to periodontal disease, a more serious form of gum disease.

Pregnant women are also at risk for developing pregnancy tumors, inflammatory, benign growths that develop when swollen gums become irritated. Normally, the tumors are left alone and will usually shrink on their own. But if a tumor is very uncomfortable and interferes with chewing, brushing or other oral hygiene procedures, the dentist may decide to remove it.

How can I prevent these problems?
You can prevent gingivitis by keeping your teeth clean, especially near the gumline. You should brush with fluoride toothpaste at least twice a day and after each meal when possible. You should also floss thoroughly each day. If toothbrushing causes morning sickness, rinse your mouth with water or with anti-plaque and fluoride mouthwashes. Good nutrition - particularly plenty of vitamin C and B12 - help keep the oral cavity healthy and strong. More frequent cleanings from the dentist will help control plaque and prevent gingivitis. Controlling plaque also will reduce gum irritation and decrease the likelihood of pregnancy tumors.

When should I see my dentist?
If you're planning to become pregnant or suspect you're pregnant, you should see a dentist right away. Otherwise, you should schedule a check-up in your first trimester for a cleaning. Your dentist will assess your oral condition and map out a dental plan for the rest of your pregnancy. A visit to the dentist also is recommended in the second trimester for a cleaning, to monitor changes and to gauge the effectiveness of your oral hygiene. Depending on the patient, another appointment may be scheduled early in the third trimester, but these appointments should be kept as brief as possible.

Are there any procedures I should avoid?
Nonemergency procedures generally can be performed throughout pregnancy, but the best time for any dental treatment is the fourth through six month. Women with dental emergencies that create severe pain can be treated during any trimester, but your obstetrician should be consulted during emergencies that require anesthesia or when medication is being prescribed. Only X-rays that are needed for emergencies should be taken during pregnancy. Lastly, elective procedures that can be postponed should be delayed until after the baby's birth.

Reprinted from AGD.