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Health Information

Caring for your teeth

Published by Bupa's health information team, June 2009.

This factsheet is for people who would like information about caring for their teeth.

We need teeth to chew food and speak clearly. Teeth also affect the appearance of your face and smile. It's important to look after them. Maintaining good dental hygiene, including brushing your teeth and visiting your dentist regularly, is a crucial part of caring for your teeth. This factsheet describes some of the most common dental problems, and outlines what you can do to keep your teeth healthy.

Tooth decay
Gum disease
Dental erosion
How to look after your teeth
Visiting the dentist and hygienist
Questions and answers
Related topics
Related Bupa products and services
Further information
Sources

Tooth decay

Soon after brushing your teeth, a thin, sticky layer of bacteria forms on the surface of all your teeth. This layer of bacteria is called plaque.

When you eat anything sugary, the bacteria in plaque turn the sugar into the energy they need, producing acid at the same time. The acid softens and dissolves the hard enamel surface of the teeth (demineralisation). Over time, frequent demineralisation causes cavities to form in your teeth. This is called tooth decay, or caries.

Enamel doesn't contain any nerves so you won't feel any pain at first. Eventually a cavity may reach the dentine - the yellowish substance underneath the enamel that forms the bulk of a tooth. Dentine is sensitive to pain so more advanced cavities may be sensitive, especially when eating or drinking anything hot, sugary or acidic.

Saliva helps to wash away and neutralise the acid. It also contains minerals to replace those lost from the enamel during acid attack (remineralisation).

Demineralisation and remineralisation are repeated every time we eat or drink something sugary. It's an ongoing battle between the acid and our saliva. If sugary food or drinks are consumed too often, the saliva doesn't get long enough to fully remineralise the teeth, making tooth decay more likely.

Gum disease

Gum disease is inflammation of the gums (gingivae) and damage to the bone that anchors teeth in the jaws. Gum disease is very common, affecting more than half of adults with natural teeth.

If plaque isn't cleaned off your teeth regularly, your gums will become red, swollen and shiny, and they may bleed. This is the early stage of gum disease, called gingivitis. Gingivitis is completely reversible. If the plaque is removed, the gums will recover.

If gingivitis is not treated, the gums may begin to pull away from your teeth, leaving a little pocket around each tooth. These pockets trap plaque that you can't reach with a toothbrush. Over time, plaque hardens to become tartar (calculus). Plaque and tartar build up, causing further irritation.

The irritation gradually spreads to the bone structures around your teeth. As time goes on, the pockets get deeper and more difficult to clean, and the gum and bone may shrink. This is called periodontitis. The shrinking gums may expose some of the roots of your teeth, making them wobbly and sensitive. If left untreated over a number of years, your teeth may fall out, or need to be taken out by a dentist.

Preventing gum disease involves controlling the amount of plaque and tartar that builds up on your teeth. Regular visits to your dentist or hygienist, brushing and flossing your teeth properly and stopping smoking will help to do this.

Dental erosion

Dental erosion is the loss of enamel and dentine, caused by acid attacking the surface of your teeth. But unlike in tooth decay described above, the acids aren't from bacteria. Instead, they usually come from drinks such as fruit juices, fizzy drinks and squashes - even the 'diet' varieties. These drinks are so popular that over half of all children in the UK have some dental erosion by the age of five.

Drinking acidic drinks less often can prevent erosion. You should try to only give babies and toddlers water or milk to drink, and if you do give other types of drinks, these should be in cups rather than feeding bottles and confined to main meals.

The stomach acid in vomit can also cause dental erosion. So people who are sick often (because of bulimia nervosa, alcohol or stomach problems for example) risk damaging their teeth in this way.

Dental erosion is irreversible and can result in sensitivity if the dentine becomes exposed. This also makes tooth decay more likely, and it can be unsightly as exposed dentine is yellowish in colour.

How to look after your teeth

Maintaining good oral hygiene is critical to prevent tooth decay and gum disease. This means cleaning your teeth at least twice a day with fluoride toothpaste, visiting the dentist and hygienist regularly and limiting the amount of sugar in your diet.

Brush your teeth

Brushing is the most effective way to remove plaque. Here are some tips for getting the most benefit from brushing your teeth.

Brush at least twice a day. Make sure you brush every surface of every tooth. To do this properly can take longer than you think. Most dentists would recommend around two minutes.
Use fluoride toothpaste to protect against decay.
Use a toothbrush with a small head and synthetic bristles.
Start at one side of your mouth and move round to the other side, brushing all the tooth surfaces thoroughly.
Pay particular attention to the gumline, angling the bristles into the crevice where the gums meet the teeth.
Replace your toothbrush every month.

Some people prefer an electric toothbrush. There is some evidence that certain types of electric toothbrush are more efficient at removing plaque than brushing by hand. However, the thoroughness of the cleaning is much more important than what type of brush you use. You must clean every surface of every tooth and a small toothbrush, whether electric or not, will help.

Clean between your teeth

Dental floss or inter-dental brushes remove plaque and particles of food from between the teeth and under the gumline. These are areas that a toothbrush cannot reach. Correct technique is important, so ask for advice from your dentist or hygienist.

Consider mouthwash

Fluoride mouthwashes can help to prevent tooth decay. Some antiseptic mouthwashes reduce the number of plaque bacteria and help prevent gum disease. If you use mouthwash regularly to freshen your breath, talk to your dentist for advice, as bad breath may be a sign of poor oral hygiene. Always read the instructions on the mouthwash box or bottle. Avoid mouthwashes that contain alcohol.

Chew gum

Chewing sugar-free gum after a meal stimulates the production of saliva, which helps to neutralise plaque acid. Some chewing gums contain a sugar-free sweetener called xylitol, which may help to reduce decay, although this is still being investigated.

Control sugar in your diet

Eating sugary food and drink encourages tooth decay. But it's how often these sugars are eaten - rather than the amount - that is important. Avoiding sugars between meals gives your teeth a chance to be remineralised by saliva. Limiting sugar between mealtimes is particularly important for children. It's also good for your general health to reduce your sugar intake.

Don't eat acidic food or drinks such as fizzy drinks or citrus fruit juice, between meals, as these also encourage tooth decay and erosion.

Alcohol and tobacco

Drinking alcohol and smoking or chewing tobacco are associated with an increased risk of developing mouth cancer.

Smoking also stains the teeth and increases the risk of gum disease and tooth loss. Alcoholic drinks, and the mixers used with them, often contain lots of sugar, and so increase the risk of tooth decay.

Visiting the dentist and hygienist

Dentists and hygienists play an important role in preventing problems such as tooth decay, gum disease and erosion. At check-ups, they will be able to detect any problems early, and provide advice and treatment.

Your dentist will give you advice about how often you should have a check-up. For adults, this can vary from six months upwards. For people with very healthy mouths they may be advised to return every two years.

Children, and adults who are at high risk of developing dental disease, need to see a dentist more often. You may be at high risk if you smoke, have a diet high in sugar, or have had lots of dental treatment in the past. Even thorough brushing and flossing can't remove every trace of plaque. Most people have irregularities in their teeth where plaque can build up out of reach and harden into tartar. This can only be removed by a dentist or hygienist using special tools in a process called scaling. Polishing, using a rotating brush and abrasive paste, removes stains from teeth.