Most of the problems that come up in our mouths are not painful until they are fairly serious. Waiting until something hurts is an expensive way to manage a mouth.
Nearly all problems in the mouth start out small and are easily managed when they are small. Later in the disease progression, the treatment options become time consuming and expensive if the problems are left to get larger.
From a very basic point of view, there are two very common problems to be concerned with in a mouth: tooth decay and periodontal disease. Tooth decay is caused by a type of bacteria that is found in nearly everyone’s mouth. This bacteria eats whatever you eat and as a byproduct of life, puts out acid that dissolves away some of the chemicals in the teeth. Once a cavity has established itself, it will progress right into the pulp (nerve) of the tooth if left untreated. There will usually be no pain until the cavity is very close to the nerve of the tooth. Once a cavity enters the nerve of the tooth, the tooth is often still salvageable, but only if the nerve is removed (a root canal), or of course, the tooth can be removed.
Periodontal disease is caused by a different type of bacteria as compared to tooth decay. More is being learned about periodontal disease every year. From a classical point of view, periodontal disease is caused when the soft white stuff on your teeth (dental plaque) is left on the teeth until it begins to harden (calcify). Once the plaque turns hard it is called tarter (or calculus). In this hardened state, plaque cannot be removed with a toothbrush and floss. A toothbrush and floss simply glide over the calculus or get awkwardly caught by it. Calculus must be removed by someone specially trained in the use of miniature knives (scalers) and sometimes a machine that uses ultrasonic energy to shake or even sandblast the calculus off the teeth. If calculus is left on a tooth, its surface is very rough as compared to the surface of the tooth. This roughness makes attachment of new plaque very fast. The plaque turns to calculus in a matter of hours and by this method, the calculus gets thicker. Left in place long enough, the calculus will actually glue the teeth together.
Calculus does not cause cavities, but harbours new soft plaque that puts out acid on the surface of the gums. This acid causes the gums to remain inflamed for prolonged periods. Inflammation is the reaction of the body to irritation. The gums are irritated by the acid plaque is putting out and the body responds by becoming inflamed. The gums get puffy and red next to the calculus. The body sends fancy “killer cells” into the area to get rid of the irritating agent. The immune system could remove the calculus if it was inside the area served by the blood supply, but calculus is not inside the part of the body served by the blood supply. Calculus sits on the outside of the blood supply similar to how a necklace or a ring remains outside the blood supply. Since the irritating agent (the soft plaque) is not removed by the “killer cells” circulating in the blood, the inflammation does not stop. In time, the cells the body sends in to fight the irritating agent that they cannot access begin to attack the bone that holds the teeth in place. Sadly, this process is usually painless. The bone will continue to be whittled away by the “killer cells” the body sends in to get rid of calculus until the calculus is removed or until the tooth or teeth fall out.
So, to make a long story short, you need a cleaning to get rid of calculus. You need to get rid of calculus to stop periodontal disease. How long does it take to form calculus? That depends on the person. Your dentist or dental hygienist can advise you individually on that. To start with, dentists often recommend that a person gets a cleaning, and then another cleaning in about six months. At that time, the dentist and the hygienist evaluate if the time interval was too long (a whole lot of calculus formed in the six months), or the interval was too short (no or very little calculus formed in the six months since the last cleaning). The dentist and or the hygienist will recommend the length of the next cleaning interval based on how much calculus formed since the last cleaning. You can affect the cleaning interval suggested by your dentist or hygienist. It is important to remember that all calculus started out as soft plaque. This means that a person can brush and floss while the plaque is soft, and if the person is doing a thorough job at plaque removal, calculus will not have a chance to form. Most of us miss a spot or two, and this gives the plaque in the small missed area a chance to turn into calculus. As well, there are some mouth rinses that cause calculus to take longer to form, like tarter control Listerine. These products cannot remove calculus, but make it take longer to form. Ask your dentist what cleaning interval is right for you and why.
- This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)