• P R E V E N T I V E

Your Smile An Owner’s Manual

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DIAGRAM OF A HEALTHY TOOTH

Enamel

Gingiva (gums)

Pulp chamber

Dentin

Alveolar bone (jawbone)

Root canal

Root

Periodontal ligament

Crown

Nerves and blood vessels

What teeth are made ofYour tooth looks solid, but it is a living thing with many layers. The hard enamel outside protects a softer inner tissue, the dentin. In the center of the tooth is a space which holds nerves and blood vessels, called the pulp. The tooth is held in the jawbone with the help of a ligament and other tissues. When your teeth and gums are healthy, teeth are firmly connected to the jaw. This helps you eat and speak normally.

The mouth-body connectionTaking good care of your teeth and gums isn’t just about preventing cavities or bad breath. The mouth is a window into the health of the body. It can show if you are not eating foods that are best for you or signal that you may be at risk for a disease. Diseases that affect the entire body (such as leukemia or diabetes) may first be noticed because of gum disease or other oral problems.

The mouth is filled with many bacteria, some linked to tooth decay and gum disease, also known as periodontal (perry-o-DON-tal) disease. Periodontal disease may be connected with diabetes and cardiovascular disease (heart disease and stroke). However, a link between these conditions and periodontal disease does not mean that one condition causes the other.

Your mouth is part of your body. If your mouth isn’t healthy, your body isn’t totally healthy either. To have a healthy mouth and body, take charge of your dental health! As the owner of your mouth, there is a lot you can do to keep it healthy.

This owner’s manual will show you how to have a healthy and good-looking smile. It will also tell you about the options for treating your teeth and gums in the case of decay or disease. Always keep in mind that your dentist is your partner in the goal of excellent oral health. He or she can help you decide which dental options are right for you.

Take charge!

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Steps to a healthy mouthSince gum disease and other health problems may be linked, you have another important reason to keep your teeth and gums healthy. The first part of this booklet will explain these steps to a healthy mouth:

• Keep your mouth clean by brushing your teeth well twice a day and flossing once a day.

• Visit your dentist regularly for an exam and professional cleaning.

• Avoid tobacco.

• Make healthy food choices.

Keeping your mouth cleanDaily cleanings are important to prevent tooth decay and gum disease. This is because your teeth are covered with a sticky film of bacteria called plaque. Plaque that is not removed can irritate the gum tissue, making the gums swollen or causing them to bleed. This is called gingivitis, the early stage of periodontal (gum) disease (we’ll talk more about this later in the booklet).

Brushing and cleaning between the teeth daily helps remove food particles and plaque from the mouth. Here are some tips on making good oral care part of your daily routine.

Brushing- Brush your teeth well twice a day with fluoride toothpaste. Unless your dentist recommends otherwise, select a soft-bristled toothbrush in a size and shape that will fit your mouth comfortably. Get a new toothbrush when the bristles show signs of wear, usually after about three months.

1. Place your toothbrush against your gums at a 45-degree angle. Move the brush back and forth gently in short (tooth-wide) strokes. Your dentist or hygienist can show you how.

3. Brush the inner tooth surfaces.

5. Use the top part of the brush to clean the inside surface of the top and bottom front teeth. Use a gentle up-and-down motion.

2. Brush the outer tooth surfaces.

4. Brush the chewing surfaces.

6. Brush your tongue to remove bacteria and freshen your breath.

HOW TO BRUSHThere are several effective ways to clean your teeth. Here is one of them:

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HOW TO FLOSSHere are tips for flossing. It may feel clumsy at first, but don’t give up. It takes a little time to get the hang of it.

Flossing- Use floss or another between-the-teeth cleaner every day to remove bits of food and plaque from under the gumline and between the teeth—places your toothbrush can’t reach. If you have trouble handling floss, you may find it helpful to use a floss holder or other between-the-teeth cleaners, which include special picks or narrow brushes that reach between teeth. If you need help, ask your dentist or dental hygienist.

Mouthrinses- Different types of mouthrinses can be used to freshen breath, to help prevent or control tooth decay, to reduce plaque and tartar, or to prevent or reduce gingivitis. Rinse before or after brushing, but don’t skip brushing or flossing. Your dentist can advise you whether you need to use a mouthrinse and which type is best for you.

Look for the ADA SealWhen shopping for toothbrushes, floss or mouthrinses, look for products with the ADA Seal on the package. The seal tells you that the product has met the ADA’s standards for safety and effectiveness—that it does what it the package says it does.

Anti-gingivitis mouthrinseInterdental cleaners

1. Break off about 18 inches of floss and wind most of it around one of your middle fingers. Wind the remaining floss around a finger of the opposite hand. This finger will take up the used floss.

3. When the floss reaches the gum line, curve it into a C shape against one tooth. Gently slide it into the space between the gum and the tooth.

2. Hold the floss tightly between your thumbs and forefingers. Guide the floss between your teeth, using a gentle rubbing motion. To avoid injuring your gums, never snap the floss into gum tissue.

4. Hold the floss tightly against the tooth. Gently rub the side of the tooth, moving the floss away from the gum with up and down motions.

5. Repeat this method on the rest of your teeth. As you move from tooth to tooth, unwind the clean floss with one finger and take up the used floss with the finger on the opposite hand. Do not forget the back side of the last tooth. SAMPLE

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Regular dental visits are importantAlthough you may carefully brush and clean between your teeth each day, your smile needs and deserves a regular professional cleaning at the dental office. There are lots of good reasons to visit your dentist:

• to prevent gum disease

• to check for cavities and other oral diseases or conditions

• to check for signs of oral cancer, which your dentist is trained to detect

• to remove tartar, a hard material that makes cleaning your teeth difficult

• to get rid of food, beverage or tobacco stains on the surface of your teeth that cannot be removed with regular brushing and flossing

• to learn about the best way to keep your teeth clean on a daily basis

• to keep your teeth healthy, which will help to keep your body healthy overall

PROFESSIONAL CLEANING

Each time you visit the dentist, tell him or her about changes in your overall health, especially any recent illnesses or ongoing conditions. Also tell your dentist about any prescription and non-prescription medicines you are taking.

Tobacco means trouble If you smoke or chew tobacco, you are setting yourself up for trouble. Consider these tobacco-related threats to your oral health:

• oral cancer • gum (periodontal) disease—a leading cause of tooth loss

and of sensitivity to hot and cold• bad breath• stained teeth and tongue• reduced sense of taste • slow healing after having a tooth pulled or other oral surgery• build-up of tartar on the teeth

Why take chances? Millions of Americans have quit smoking or chewing tobacco. It is not easy, but it is important. You can quit, too. Ask your dentist to help motivate you to quit. Tips to help you kick the habit are also online at www.smokefree.gov, or by calling 1-800-QUITNOW.

Before a professional dental cleaning After cleaningSAMPLE

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Make healthy food choicesA healthy diet includes a variety of foods from each of the 5 food groups—grains, vegetables, fruits, dairy and protein. Different foods have different benefits for your body. Eating a mix of healthy foods ensures that your body gets all the nutrients it needs.

Why is a healthy diet important? A healthy diet:

• provides nutrients needed for your body to work well

• helps prevent diseases linked with being overweight, like diabetes and heart disease

• helps you keep your teeth and gums healthy

You can have a healthy diet by following these simple steps:

• Choose your foods wisely from each of the food groups.

• Eat foods that are low in saturated fats, trans fats, cholesterol, and salt (sodium).

• Avoid foods and drinks high in added sugar, which increases the risk for tooth decay. These include beverages such as soda, sports drinks or flavored waters.

• Limit snacking throughout the day. If you do snack, make healthy choices like fruit, nuts or cheese. Eat sweets with meals instead of as snacks.

• Drink water between meals, which helps your overall health. Also drink water after eating to help wash away food particles.

Gum diseaseGum disease, also called periodontal disease, is very common. It affects people of all ages, and many do not even know they have it. Finding the disease is the first step in preventing tooth loss.

What is periodontal disease?Periodontal disease is an infection and inflammation that affects the tissues and bone that support teeth.

Healthy gum tissue fits like a cuff around each tooth. When someone has periodontal disease, the gum tissue pulls away from the tooth. As the disease gets worse, the tissue and bone that support the tooth are destroyed. Over time, teeth may fall out or need to be removed. Treating gum disease in the early stages can help prevent tooth loss.

How do I know if I have gum disease?It can be hard to know. You can have periodontal disease without clear symptoms. That’s why regular dental exams are so important.

If you notice any of these signs, see your dentist:• gums that bleed during brushing and flossing• red, swollen or tender gums• gums that have pulled away from your teeth• bad breath that doesn’t go away• pus between your teeth and gums• loose or separating teeth• a change in the way your teeth fit together when you bite• a change in the fit of partial dentures

Common dental problems

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What causes periodontal disease? Periodontal disease is caused by plaque (rhymes with “back”), a sticky film that is always forming on your teeth. Plaque contains bacteria that produce harmful toxins. If teeth are not cleaned well, the toxins can irritate and inflame the gums.

Inflamed gums can pull away from the teeth and form spaces called pockets. The pockets provide a space for more bacteria. If the infected pockets are not treated, the disease can get worse. The bone and other tissues that support teeth are damaged.

PERIODONTAL DISEASE

Healthy gums and bone anchor teeth firmly in place.

As the disease progresses, plaque by-products can harm the tissues that anchor teeth in the bone.

Periodontal treatmentPatients with periodontal, or gum, disease usually need more frequent dental visits than the average patient. Your dental team can treat the disease with special deep cleanings, sometimes combined with medication to treat the infection. Advanced gum disease may require additional treatment.

You can fight periodontal disease with good oral care, regular dental visits, a healthy diet, and by avoiding tobacco.

Tooth decayWhat is tooth decay, and why is it a problem?Tooth decay is a disease that damages and breaks down teeth. A tooth has an outer layer (enamel), a middle layer (dentin), and a center (pulp). The more layers affected by decay, the worse the damage.

Tooth decay is a serious public health problem. It is four times more common than asthma among teens aged 14 to 17 years. Untreated tooth decay can lead to pain, loss of teeth, and even loss of confidence. People with tooth pain often cannot get through their daily routines. They cannot eat or sleep properly, and may miss days of work or school.

An abscess (pus-filled sac) from a cavity can cause serious or even life-threatening infections when not properly treated. It is much simpler and more affordable to prevent tooth decay than to repair a decayed tooth.

Other factors that may contribute to gum diseases include:• smoking or chewing tobacco• diseases like diabetes, blood cell disorders, HIV infections and AIDS

that lower the body’s resistance to infection, making periodontal diseases more severe

• crooked teeth or worn, loose or cracked fillings that may trap plaque• pregnancy, use of birth control pills, or changes in female hormone

levels• certain medicines, such as steroids, some anti-epilepsy drugs,

cancer therapy drugs, and some calcium channel blockers• stress• genetics SAMPLE

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What causes tooth decay?Bacteria in the mouth feed on the sugars found in foods and drinks. The bacteria produce acids that attack the teeth. Mouth bacteria thrive on sugar found in many foods and drinks, not just candy—soda pop, sports drinks, fruit juice, and even milk contain sugar that can lead to tooth decay. Each time these foods and drinks are consumed, acids attack the teeth for 20 minutes or longer.

When you have sugary foods or drinks many times a day, or sip on the same sugary drink for long periods of time, the acid attacks your tooth enamel again and again. The acid eats away at the tooth, and can cause decay. A hole called a cavity can form.

If not treated, tooth decay can cause an abscess and can lead to serious infections.

Abscess

Decay in tooth grooves

Decay under fillingDecay between teeth

Who gets tooth decay?People of all ages can get tooth decay. Risk may increase among those who:

• often sip and snack on foods and drinks high in sugars• drink bottled water or other water without fluoride,

which helps protect teeth • have dry mouths due to medications or other reasons• have weak enamel due to genetics or a childhood illness • don’t brush twice daily and floss once • don’t visit their dentist regularly

Can tooth decay be passed from person to person?Not exactly, but the bacteria that cause decay can be shared. Parents may pass along harmful bacteria to infants and children, for example. Bacteria can be passed by kissing, sharing a cup or spoon, or anything else that carries a drop of saliva from one mouth to the other.

Common places where decay formsTooth decay can damage any tooth. It often occurs between the teeth and in the grooves of the back teeth, where bits of food collect. Back teeth are harder to keep clean because they are not as easy to reach. Decay also can form at the tooth root and go below the gum line.

Do you have tooth decay?Tooth decay can get worse quickly, but it often takes months or years for a cavity to develop. Symptoms of tooth decay can include spots on the teeth, bad breath, and loose fillings. Tell your dentist if your teeth are sensitive to heat or cold or if you have any tooth pain. Your dentist will examine your teeth and take X-rays if necessary.

Tooth decay treatmentTreatment depends on how early the decay is caught. Before cavities form, fluoride treatments may solve the problem. If you have a cavity, you’ll need a filling. A large cavity may need a crown to replace the decayed part of the tooth. If the center (pulp) of your tooth is involved, root canal treatment may be your last chance to save the tooth. Finally, a badly damaged tooth might have to be pulled and replaced. Your dentist will discuss options and plan the best way to get your mouth healthy again.

By following a healthy oral care routine, making smart food choices, and visiting your dentist regularly, you can lower your risk for tooth decay. Chewing sugarless gum with the ADA Seal of Acceptance after eating can also help to increase saliva flow and rinse away sugars.SAMPLE

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Replacing missing teethAll your teeth work together to help you chew, speak, and smile. When teeth are missing, it is difficult to do these things. Also, the loss of a back tooth may cause your mouth to sink and your face to look older. If one or more teeth are missing, your dentist can replace them with a crown, a fixed bridge or a removable denture. Discuss replacement options with your dentist to find one that meets your needs. (Also see “Spotlight on Implants” on the next page.)

Improving the look of your smileYour dentist has many different techniques to shape, sculpt, and make your smile more beautiful. With a few simple steps, you can have a smile you feel great about. And treatment may be more affordable than you think. What are you waiting for? Make your smile the best it can be!

Here are some issues that can be corrected by dentists:

• Discolored or darkened teeth can be lightened with whitening treatments or veneers, thin ceramic shells that fit over the teeth.

• Broken or chipped teeth can be corrected with bonding, in which an enamel-like resin is added to a tooth, sculpted into shape and polished.

• Gaps between teeth can be filled in with veneers or with a bonding material that matches your tooth color.

• Poorly shaped teeth can be reshaped by contouring tooth enamel, the outer layer of the tooth structure.

• Gummy smiles can be corrected by contouring the gum tissues.

• Crooked teeth can be straightened with braces or other methods.

Other treatments your dentist can provide

Before veneers After veneers

If you are having one of these dental problems, such as gum disease or tooth decay, your dentist can recommend a treatment that is right for you. If there is something missing from your smile, your dentist can also talk with you about your options for replacing teeth, or for otherwise improving your smile.

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Top Tips for a Healthy Smile• Brush your teeth well twice a day.

• Clean your teeth with floss or another between-the-teeth cleaner every day.

• Visit your dentist regularly for an exam and cleaning.

• Tell your dentist about changes in your medicines or overall health.

• Make healthy food choices and limit snacks.

• Avoid tobacco.

• Choose dental products with the American Dental Association’s Seal of Acceptance.

• If you see changes in your mouth, make an appointment with your dentist.

Teeth can last a lifetime if you take good care of them!

Spotlight on ImplantsMany patients choose implants to replace a single tooth, several teeth, or to support a full set of dentures. Implants are posts that are surgically placed in the upper or lower jaw, where they fuse with the jawbone and act as a sturdy anchor for replacement teeth.

Dentures, bridges or single teeth mounted to the implants won’t slip or shift in your mouth—a very important benefit when eating and speaking. Implants are also a good value, because they can last a lifetime with good care.

If you are in good general health, with a jawbone that can support an implant, this treatment may be an option for you. However, implants are not an option for everyone. Because implants require surgery, patients should be in good health. Also, patients either must have enough bone to support the implant, or be able to grow enough bone. Patients who smoke or have chronic illnesses, such as diabetes or leukemia, may not be good candidates for implants.

Your dentist can help you decide whether implant treatment is right for you. There are many different kinds of implants. Treatment can take only one day, or it can take several months, or somewhere in between. Your dentist can outline a treatment plan that is most likely to be successful for you.

DENTAL IMPLANT AND CROWN

Crown

Abutment (post)

Bone

Gum tissue

Implant

NATURAL TOOTH AND ROOT

Crown

Gum tissue

Tooth root

Bone SAMPLE

© 2011 American Dental Association. All rights reserved.

W302 To order additional copies, call 1-800-947-4746 or visit www.adacatalog.org

Tartar photos courtesy of Dr. Daniel M. Schweitzer.

Before-and-after veneer photos courtesy of Dr. John R. Nosti, www.cosmeticdentistryofsj.com. Reprinted with permission from Dentaltown Magazine.

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