ORAL HEALTH

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What is oral health?
How are problems with the tissues in your mouth linked to health problems in other places in your body?
What are the most common oral health problems?
What are some other problems I might have with my mouth?
As a woman, why do I have to worry about oral health?
I’m pregnant. Do I need to take special care of my mouth?
I’m a new mother. What can I do for my baby’s oral health?
I’m confused! What type of toothpaste or mouthwash should I use?
I’m not happy with the stains on my teeth. How can I safely whiten them?
What small, easy steps can I take to have a healthy smile?

Sherri’s Story When I was pregnant, I began to have some bleeding around my gums when I brushed my teeth. My gums also looked swollen, and I started to get worried. I knew many pregnant women have some gum bleeding when brushing their teeth, but I decided to have my dentist check them out anyway. I am glad I did! She said that my problem was worse than what usually happens during pregnancy -- I was starting to get gum disease. I didn’t even know that having serious gum disease while pregnant could lead to an infection that could harm my baby! What did the dentist do? She said having my teeth and gums cleaned, and brushing and flossing regularly can help me prevent gum disease in the future. With her help, we’re all smiling now!

What is oral health?

Oral refers to the mouth, which includes the teeth, gums, and supporting tissues. It is easy to take your oral health for granted, but it is key to living each day comfortably. These tissues allow you to speak, smile, sigh, kiss, smell, taste, chew, swallow, and cry. They also let you show a world of feelings through expressions. Taking good care of these tissues can prevent disease in them and throughout your body.

How are problems with the tissues in your mouth linked to health problems in other places in your body?

The health of your mouth can be a sign of your overall health. Many serious diseases, such as diabetes, HIV, and some eating disorders, show their first signs as symptoms in the mouth. This is why it is important to have complete, regular oral exams.

Most of us think of problems with the mouth in terms of cavities, toothaches, and crooked or stained teeth. Lacking healthy teeth and gums has an effect on how we look, but it also affects the health of our bodies. For example:

• If you have gum disease, you may be more likely to get heart disease.
• Having missing teeth can affect your mental health since it can lead to feeling badly about yourself.
• If you have diabetes, you may be more likely to get gum disease.
• If you have both diabetes and gum disease, you can have more problems controlling your blood sugar levels.

What are the most common oral health problems?

The most common oral health problems are cavities and gum disease.

Dental cavities
Everyone is at risk for getting cavities throughout life. By the time most people are adults, 85% of people will have had a cavity!

Here’s how it happens:
You naturally have bacteria (germs) in your mouth. The bacteria mix with your saliva and bits of food in your mouth to form a coating (dental plaque) that sticks to your teeth. There are acids in the plaque that wear away the teeth. These acids can get inside the teeth and create holes in the teeth, or cavities.

Gum diseases
Gum disease is caused by infection or plaque around your teeth and is a common cause of tooth loss after age 35. The first stage and most common type of gum disease is gingivitis (jin-ji-vie-tus). Gingivitis irritates the gums and causes them to bleed and swell. Gum diseases are more often seen as people age, with most people showing signs of them by their mid-30s.

Periodontitis (pear-ee-o-don-tie-tus) is a more serious type of gum disease that, if left untreated, gets worse as pockets of infection form between the teeth and gums. This causes your gums to grow away from teeth and lose supporting bone. If the teeth can’t be supported, they could fall out. This disease results from bacteria in your mouth. You may be more likely to be infected with these bacteria if:

• someone else in your family has periodontitis
• you are a smoker
• you have a disease like diabetes or HIV

Normal, healthy gums Healthy gums and bone anchor teeth firmly in place.	Peridontitis Unremoved, plaque hardens into calculus (tartar). As plaque and calculus continue to build up, the gums begin to recede (pull away) from the teeth, and pockets form between the teeth and gums.	Advanced peridontitis The gums recede farther, destroying more bone and the periodontal ligament. Teeth―even healthy teeth―may become loose and need to be extracted.

What are some other problems I might have with my mouth?

Cold sores (herpes simplex virus type 1 (HSV-1) infections). If you’ve ever had a cold sore, you’re not alone. A half million people get one every year. Once exposed to this virus, it can hide in the body for years. Getting too much sun, having mild fevers that occur with a cold, or stress can trigger the virus and cause tiredness, muscle aches, sore throat, enlarged and tender lymph nodes, and cold sores. These sores are very contagious and usually form on the lips, and sometimes under the nose or under the chin. The sores heal in about seven to 10 days without scarring. You can buy medicines at the drug store or grocery store to put on the cold sore to numb or relieve the pain. If cold sores are a problem for you, talk with your doctor or dentist about a prescription for an antiviral drug to help lower your chances of getting these kinds of viral infections.

Canker sores. These common, but mostly harmless, sores appear as ulcers with a white or gray base and a red border inside the mouth. They occur in women more often than men, often during their periods. The reason why they appear is unknown but some experts believe that problems with the immune system, the system in our bodies that fights disease, bacteria or viruses may be involved. Fatigue, stress, or allergies can increase your chances of getting a canker sore. You also might get one if you have a cut inside your cheek or on your tongue. Canker sores tend to be tiny and heal by themselves in one to three weeks. If you get a large sore (larger than 1 centimeter) though, it may need to be treated with medicine. Staying away from hot and spicy foods can help the pain. Using mild mouthwashes or salt water, or swabbing the sore with milk of magnesia or with a mixture of hydrogen peroxide and water might also help. There is no proven way to prevent canker sores, but if you get them often, take note of anything that might be irritating your mouth, and talk to your dentist or dental hygienist.

Oral fungal or yeast infections (candidiasis [can-di-die-uh-sis]). These infections appear as red or white lesions, flat or slightly raised, in the mouth. They are common among denture wearers and occur most often in people who are very young, elderly, or who have a problem with their immune system. People who have dry mouth syndrome are also very likely to get oral yeast infections. These can be prevented with good oral hygiene. If you wear dentures, clean and remove them at bedtime. Talk with your dentist or dental hygienist about medicines that may be helpful if you have a problem with these infections.

Dry mouth syndrome. This is common in many adults, especially as they age. It may make it hard to eat, swallow, taste, and speak. It happens when salivary glands fail to work right, often as a side effect from medicines or from other health problems. If left untreated, it can lead to cavities because saliva helps rid your mouth of bits of food and helps stop acid from forming plaque on your teeth.

Oral cancer. This cancer most often occurs in people over the age of 40. It is often found at late stages when it is harder to treat. This is because oral cancer is not usually painful―so you may not know you have it. And many people do not visit their dentists often enough to find the cancer early. The most common sites of oral cancer are on the tongue, lips, and floor of the mouth. Use of tobacco, especially with alcohol, is the main cause for these cancers. Oral cancer often starts as a tiny, unnoticed white or red spot or sore anywhere in the mouth. Other signs include:

• a sore that bleeds easily or does not heal
• a color change of the oral tissues
• a lump, thickening, rough spot, crust or small eroded area
• pain, tenderness, or numbness anywhere in the mouth or on the lips
• problems chewing, swallowing, speaking, or moving the jaw or tongue
• a change in the way the teeth fit together

Oral problems from cancer therapies. Treatments like chemotherapy or radiation to the head and neck can cause dry mouth, tooth decay, painful mouth sores, and cracked, peeling lips.

As a woman, why do I have to worry about oral health?

You need to have good oral hygiene at all stages of your life. As a woman, your changing hormone levels during puberty, your monthly period, and menopause cause changes in your mouth. These hormone changes can cause:

• frequent cold sores and canker sores
• gingivitis during puberty
• dry mouth (often also linked to using certain medicines)
• changes in taste
• increased risk of gum disease
• bone weakness around menopause

I’m pregnant. Do I need to take special care of my mouth?

If you are pregnant, you have special oral health needs:

• Try to have a complete oral exam prior to or very early in your pregnancy. All needed dental work should be done before the pregnancy or between the 4^th and 6^th month of pregnancy, if treatment is needed. It is possible to have urgent treatment for a problem during pregnancy, but it can present risks to your baby. Treatments are most dangerous during the first three months. If you are in the last three months of pregnancy you may have treatment, but you may find the dental chair uncomfortable.
• If you haven’t already, start practicing good oral hygiene and eating a healthy diet. Be complete in brushing and flossing your teeth daily. By doing this, you can control your risk for gum inflammation and disease.

• Some pregnant women get gum disease -- a problem called pregnancy gingivitis -- which raises their chances for getting more serious gum disease. This condition can be caused both by poor oral hygiene and increased hormone levels during pregnancy. Having this problem can cause discomfort when you brush or floss, but it’s important not stop brushing and flossing regularly.
• Pregnant women with gum diseases are much more likely to have premature babies of low birth weight.

I’m a new mother. What can I do for my baby’s oral health?

Here’s what you should know:

• The same germs that cause tooth decay in your mouth can be passed to your baby if you put your baby’s items, such as toys, spoons, or pacifiers in your mouth.
• Wiping your baby’s teeth and gums with a soft cloth or a baby’s toothbrush after each nursing and feeding can help remove sugars found in milk that can cause tooth decay.
• If you bottle-feed your baby, it should end by age one. Never put your baby to bed with a bottle of milk or juice. Never place a pacifier covered with honey or sugar in your baby’s mouth when he or she sleeps. Sucking on a bottle when lying down can destroy the baby’s teeth causing years of tooth pain and problems eating.
• Pediatricians and pediatric dentists suggest that all babies have an oral exam between one and two years old. This is to screen for problems in your child’s mouth. You also can learn how to properly care for your child’s teeth and mouth.

I’m confused! What type of toothpaste or mouthwash should I use?

There are so many types of toothpastes to choose from! Some say they’re made for whitening, others for reducing gingivitis and plaque, and others for sensitive teeth. You should feel good choosing whatever brand and flavor you like if you know these basics:

• As long as the toothpaste contains fluoride and its box has the American Dental Association’s (ADA) seal of acceptance, it is good for your oral health. Beyond that, choosing toothpastes based on what they claim to do is a personal choice.
  
• Mouthwashes claim to freshen your breath, but they really only mask breath odor for a few hours. If you must constantly use a breath freshener to hide bad mouth odor, see your dentist.
• If you need extra help controlling plaque, your dentist might suggest using an antiseptic mouth rinse. Many of these products are accepted by the ADA because they reduce plaque and gum disease, and help kill the germs that cause bad breath.
• You also may want to use a fluoride mouth rinse, along with brushing and flossing, to help prevent tooth decay.
  

I’m not happy with the stains on my teeth. How can I safely whiten them?

You might want to whiten teeth more than is possible through regular brushing, flossing, and check ups. There are several options that vary in price and in how well they work:

• Chairside bleaching or “power bleaching.” In your dentist’s office, he or she applies a gel or rubber shield to protect your gums and oral tissues, and then puts a bleach on your teeth. Ask if the bleaching agents have the ADA Seal. A special light or a laser may be used to help the bleach work better, but no products that use lasers are accepted right now by the ADA. With this method you may have to go for more than one visit. You will see results right away (about 5 shades brighter). It works well on a range of stains.
• Professional dispensed bleaching solutions. These products are for use at home, and you get them from your dentist. They contain peroxide(s), which actually bleach the tooth enamel. Most come in a gel and are placed in a mouth guard or tray that fits inside your mouth around your teeth. How long you use them depends on what results you’re looking for and if you are sensitive to the bleach. Some products are used for about twice a day for two weeks, and others are used overnight for one to two weeks. They help many types of staining. Your teeth turn about six shades brighter with long-lasting results.
• Over-the-counter, TV, and Internet products. These products are for use at home and include whitening strips, paint-on products, and gels and trays. They have a low amount of peroxide. You wear some during the day and apply some at night before bedtime. They have limited results without first having professional removal of the stains. But they can help prolong the results you get from professional removal. They can help staining due to age and certain foods. Your teeth turn about two shades brighter for up to six months. None of these gels and trays are accepted by the ADA.
• Whitening toothpastes. All toothpastes help remove surface stain through the action of mild abrasives. "Whitening" toothpastes that have the ADA seal have special polishing agents that remove even more stains. Unlike bleaches, these products do not change the actual color of teeth. They help slight surface stains only. You might see temporary results with claims of one to two shades brighter.

Before you use any whitening products, talk with your dentist first. He or she can help you decide which method is best for the type of stains that are on your teeth. Not all products will work on all people. Options offered by your dentist can be expensive, so be certain to ask your dentist to fully explain what results you can really expect. Keep in mind that whitening your teeth alone does not make your mouth any healthier.

What small, easy steps can I take to have a healthy smile?

1. Brush your teeth at least twice each day. Aim for first thing in the morning and before going to bed. Once a day, use floss or an interdental cleaner to clean between teeth to remove food that your toothbrush missed.

Make sure you:

• Drink fluoridated water if you can. Fluoride’s protection against dental decay works at all ages. Most communities in the United States are served with public water systems that have added fluoride. But not everyone lives in a community with a centralized, public or private water source that can be fluoridated. Check with your community’s water department or health department to find out if there is fluoride in your water. You also may want to use a fluoride mouth rinse, along with brushing and flossing, to help prevent tooth decay.
• Gently brush all sides of your teeth with a soft bristled brush and a fluoride toothpaste. Circular and short back-and-forth strokes work best.
• Take time to brush along the gum line, and lightly brush your tongue to help remove plaque and food debris.
• Ask your dentist or dental hygienist to show you the best way to floss your teeth.
• Change your toothbrush at least every three months or earlier if the toothbrush looks worn. A new toothbrush can remove more plaque than one that's more than three months old.
• If you wear dentures, be sure to remove them at night and clean them before putting them back in the next morning.

2. Have a healthy lifestyle.

• Eat healthy meals. Cut down on tooth decay by brushing after meals and not snacking on sugary or starchy foods between meals.
• Don’t smoke. Smoking raises your risk for getting gum disease, oral and throat cancers, and oral fungal infections.
• If you drink alcohol, only drink it in moderation―no more than one drink per day for women or two drinks per day for men. Heavy alcohol use raises your risk for oral and throat cancers. When alcohol and tobacco are used together, your risk for oral cancers is even greater than using one of these alone.

3. Get regular check ups.

• Having an oral exam twice each year will help find signs of problems early. During regular check ups, dentists and other types of dental providers can find signs of nutritional deficiencies, diseases, infections, immune disorders, injuries, and some cancers.
• Make an appointment right away if your gums bleed often, if you see any red or white patches on the gums or tongue, have pain mouth/jaw pain that won’t go away, have sores that do not heal within two weeks, or if you have problems swallowing or chewing.
• Besides your dentist, here are some other types of dental providers:

• Dental hygienists―work as part of your dentist’s staff. They clean gums and teeth, and instruct patients on ways to prevent oral disease and to maintain oral health.
• Periodontists―dentists who treat gum disease and place dental implants, or artificial teeth, to replace lost teeth.
• Oral surgeons―dentists who can perform biopsies (taking a sample of tissue in your mouth to look at under a microscope) or surgery on your mouth and supporting tissues if you have a serious problem.

4. Follow your dentist’s advice.
Your dentist may suggest that you do different things to keep your mouth healthy. He or she can teach you how to properly floss or brush, and how often. He or she might suggest preventive steps or treatments to keep your mouth healthy.

5. If you have another health problem, think how it may affect your oral health.
For instance, if you take medicines that give you a dry mouth, ask your doctor or nurse if there’s another drug you can use instead. Have an oral exam before beginning cancer treatment. And know that if you have diabetes, good oral hygiene to prevent gum disease is very important.

For More Information...

For more information on oral health, contact the National Women’s Health Information Center (NWHIC) at 1-800-994-9662 or the following organizations:

Division of Oral Health, NCCDPHP, CDC, OPHS, HHS
Phone: (888) 232-3228
Internet Address: http://www.cdc.gov/OralHealth/index.htm

National Institute of Dental and Craniofacial Research (NIDR), NIH, HHS
Phone: (301) 496-4261
Internet Address: http://www.nidr.nih.gov

National Oral Health Information Clearinghouse (NOHIC), NIDR, NIH, HHS
Phone: (301) 402-7364
Internet Address: http://www.nohic.nidcr.nih.gov

American Academy of Pediatric Dentistry (AAPD)
Phone: (312) 337-2169
Internet Address: http://www.aapd.org

American Association of Women Dentists (AAWD)
Phone: (800) 920-2293
Internet Address: http://www.womendentists.org

American Dental Association (ADA)
Phone: (800) 621-8099
Internet Address: http://www.ada.org

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Publication date: August, 2004