Unlike medical doctors, dentists usually only deal with three diseases: dental decay, gum disease, and occlusal disease.
Dental decay, also known as caries, is a bacterial infection of teeth. This disease is almost always initiated by Streptococcus mutans. This bacteria is usually passed from mother to child when the child is being trained to eat solid food. The condition known as “soft teeth” where someone has large and frequent cavities is actually caused most often by more virulent strains of bacteria. Occasionally, developmental events or genetic factors will influence the number of cavities a person gets, but since the disease starts with bacteria, good oral hygiene will decrease risk of caries.
Caries can be determined through a variety of diagnostic test. As the photos below show, caries can be seen as a hole in a tooth, or discolorations in the enamel. Most caries starts in the pre-existing grooves and pits occurring on the chewing surfaces of back teeth and the inside surfaces of upper front teeth. Failure to floss can lead to caries formation between teeth. These cavities can be best seen in a radiograph (x-ray).
Gum disease, known as gingivitis in its mild form and periodontitis in the more severe forms, is also associated with bacteria. Plaque is the accumulation of bacteria and the sticky substances they excrete. This plaque can irritate and infect the gums. As a result, immune cells leave the blood stream to destroy these bacteria. These same cells cause the bone loss and resulting loss of connection of the tooth to the gum. Loss of bone and gum tissue results in recession. Bone recession with or without gum recession (as seen in the measurement in the illustration) results in tooth loss. This can been seen in x-rays and can be measured using a periodontal probe. The x-ray seen here demonstrates bone loss on the left side of the right tooth. As a result of the bone loss, this tooth has too little support to survive for long.
The photo below shows the effects of bone and gum loss including extrusion of the teeth and recession. The alignment in the upper arch is due more to gum disease that to other causes.
Occlusal disease is the result of mechanical disharmony in the movements of the jaws and teeth, especially during chewing. In addition, oral habits such as grinding, biting on pens, habitual chewing of gum, and eating ice all contribute to excessive stresses on teeth and their supporting structures. The stress produce cracks, broken teeth, pain, sensitive teeth, excessive wear, and pain in the jaws. The stress can also contribute to larger cavities and gum disease by producing easier bacteria attachment in cracks or bruised tissue.
In our office we trace the causes of these diseases when possible. Occlusal analysis, a diagnostic procedure, will often indicate if occlusal disease is a factor in a high rate of decay or is a factor in gum disease. This procedure uses models of your teeth and records of your bite to set up a machine know as an articulator. When properly setup, this allow us to find out where mechanical interferences exist and how much correction is needed.
©2003 Dr. James S. Eaves, DDS
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