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Cause

Plaque is a yellow sticky biofilm consisting of large quantities of various bacteria that form on teeth and gums. It can be seen at gum margins of teeth with a food dye. The bacteria in plaque change carbohydrates such as sugar to acid that demineralises teeth eventually causing cavities after repeated attacks over a number of years where demineralisation exceeds saliva, calcium and fluoride remineralisation. If not removed regularly, plaque buildup can lead to dental cavities (caries) or periodontal problems such as gingivitis. Given time, plaque can mineralize along the gingiva, forming tartar. The microorganisms that form the biofilm are almost entirely bacteria (mainly streptococcus and anaerobes), with the composition varying by location in the mouth. Streptococcus mutans is the most important bacterium associated with dental caries. Certain bacteria in the mouth live off the remains of foods, especially sugars and starches. In the absence of oxygen they produce lactic acid, which dissolves the calcium and phosphorus in the enamel. This process, known as demineralisation, leads to tooth destruction.

Plaque can also cause irritation to the gums, making them red, tender, or bleeding easily. In some cases, the gums pull away from the teeth, leaving cavities inhabited by bacteria and pus. If this is not treated, bones around the teeth can be destroyed. Teeth may become loose or have to be removed as with periodontal (gum) disease in mostly adults.

Treatment

To reduce the amount of plaque avoid sugar, and don't smoke. Brush your teeth, floss, use a mouthwash, eat beneficial foods, and chew xylitol gum.

Avoid Sugar

Since the plaque bacteria feed off sugar, avoiding sugar, especially refined sugar, will reduce the amount of plaque. The best substitute sweetener for teeth is xylitol, because it inhibits some bacteria which lead to tooth decay, it raises the pH of saliva, and it may aid in the remineralization of tooth enamel.

Avoid soft drinks, both because of the sugar in the drinks, and the acid in the drinks. Because soft drinks are acidic, even diet drinks with sugar substitues are bad for teeth because of the acid, although they are not as bad as the original drinks with acid and sugar. The acid in soft drinks comes from a variety of sources including the carbonic acid from the dissolved carbon dioxide, the phosphoric acid contained in some drinks, and the citric acid in orange flavored drinks and many other fruit floavored drinks.

Avoid alcoholic mixed drinks because the drink the alcohol is mixed with almost always has sugar and/or acid.

Avoid cakes, biscuits, and dried fruits.

Don’t give sugary drinks and milk in bottles to children too often, never during sleep. You should never let a child sleep while sucking a liquid, because when the child is sleeping sucking and saliva flow decreases, so the sugars in the liquid pool around the teeth.

Although fresh fruits and vegetables contain carbohydrates that can be fermented by bacteria, the fiber content cleans the teeth, therefore counteracting the effect and protecting against dental caries and plaque. However, fruit juice usually has less fiber, and will therefore lead to dental problems. So if you want a sweet food, eat fresh fruit, but avoid fruit juice.

Don't Smoke

Smoking weakens the immune system, therefore leading to a higher level of bacteria, including the bacteria causing tooth decay. It also discolors teeth directly.

Brush Teeth

Health care professionals recommend regular brushing at least twice a day (in the morning and in the evening, or after meals) in order to prevent formation of plaque and tartar.

The toothpaste should also have calcium and xylitol. Amorphous calcium phosphate will help restore the necessary mineral balance in the mouth. Calcium in other forms like calcium carbonate, and calcium peroxide may also help restore necessary calcium in the mouth. Commercial toothpastes with calcium and xylitol include Tom's of Main Antiplaque and Whitening (Fluoride Free), Tom's of Main Maximum Strength Sensitive, (with Fluoride), Natural Day Natural Toothpaste, and Starbrite Whitening Toothpaste.

Baking soda raises the pH level and neutralizes acids in the mouth, some from bacteria in the mouth and some from food. As the pH of the tooth surface rises above the critical pH, remineralisation begins, the return of the dissolved minerals to the enamel. However, baking soda is very abrasive and can irritate sensitive gum tissue when brushing. So baking soda is best used in mouthwash only, rather than toothpaste.

You can make a baking soda, calcium and xylitol toothpaste yourself with the excellent Homemade Remineralizing Toothpaste Recipe. To make a toothpaste without baking soda, simply omit the baking soda from the recipe.

Fluoride in toothpaste makes the surface of teeth more resistant to acids during the process of remineralisation. Since fluoride is toxic, it is important to never swallow fluoridated toothpaste. In practice, because some toothpaste will generally be swallowed, in the case of a small child 25% to 33%, fluoridated toothpaste will cause some side effects, which may be greater than the benefit to the teeth. So a good toothpaste should have calcium and xylitol, but it need not have fluoride.

Fluoride in drinking water has many harmful side effects, including substantial evidence of developmental neurotoxicity, reduction of thyroid function, increased chance of skeletal fluorosis, increased uptake of lead, and many others. It is medical malpractice on a massive scale to put fluoride in drinking water, because by forcing people to drink fluoride, people get the full range of fluoride risks, while getting no more benefit than if it was only in toothpaste.

To summarize the toothpaste choice, in general use a toothpaste with only calcium and xylitol, like Tom's of Main Antiplaque and Whitening (Fluoride Free), Tom's of Main Maximum Strength Sensitive, (with Fluoride), Natural Day Natural Toothpaste, and Starbrite Whitening Toothpaste. If you do not have gum problems, you're careful not brush the gums, your gums are not sensitive or receding and you're willing to take a risk to your gums to get a bit of extra tooth protection, you can try a toothpaste which contains baking soda like Tom's of Main Antiplaque and Whitening (Fluoride Free), or Tom's of Main Whole Care, (with Fluoride). If you are making your own toothpaste use the excellent Homemade Remineralizing Toothpaste Recipe, and don't add the baking soda if you have any concern about gum abrasion. Whatever you use for toothpaste, use baking soda in your mouthwash, this way you get the dental health benefit of baking soda without the gum abrasion risk from brushing with baking soda.

Floss

A toothbrush is able to remove most plaque, except in areas between teeth. As a result, is recommended at least once per day, preferably before brushing so toothpaste has better access between teeth to help remineralise teeth, remove plaque from between teeth and at the gum line, prevent gum disease, and prevent cavities between the teeth.

It is recommended to use enough floss to enable easy use, usually ten or more inches with three to four inches of taut floss to put between teeth. Floss is then wrapped around the middle finger and/or index finger, and supported with the thumb on each hand. It is then held tightly to make taut, and then gently moved up and down between each tooth. It is important to floss under visible areas by curving the floss around each tooth instead of moving up and down on gums, which are much more sensitive than teeth. However, bleeding gums are normal upon first usage of floss, and will harden with use. One should use an unused section of the floss when moving around different teeth. Removing floss from between teeth requires using the same back-and-forth motion as flossing, but gently bringing the floss up and out of gaps between teeth.

Or you can use soft plastic picks to clean between teeth.

Mouthwash

An excellent mouthwash that you can make at home is one quarter of a teaspoon of baking soda with warm water (50 ml or 2 oz). Baking soda raises the pH level and neutralizes acids in the mouth, and kills some bacteria, also as the pH of the tooth surface rises above the critical pH, remineralisation begins. Unfortunately baking soda may lose some of its potency after a day or two mixed with water so it is better to make the baking soda solution on the spot, which takes a bit more time, about ten seconds to scoop the quarter teaspoon of baking soda into a cup of warm water and mix it. If you want extra power and are willing to take the extra time, add a quarter teaspoon of salt and up to a quarter teaspoon of xylitol. A convenient way to gargle for several minutes without wasting time is to gargle while you're in the shower.

Hydrogen peroxide is also used to treat bad breath, however the oxidative effect of hydrogen peroxide may harm some tissues so baking soda should be used first. Only try hydrogen peroxide if for some reason baking soda does not work. Mix about a half teaspoon of hydrogen peroxide with (50 ml or 2 oz) of water. Rinse your mouth with the solution and let it stand for a minute. If you look into your mouth you will be able to see the peroxide solution working in between your teeth and under your gum line. If you're sure you won't accidentally drink it, you can try gargling with it to get more cleaning action.

Commercial mouthwashes often use alcohol to kill bacteria, however the alcohol dries the mouth, which several hours later will cause bad breath and other problems. Also alcohol mouthwashes may increase the risk of oral cancer.

Some commercial mouthwashes include chlorhexidine, however long term use of chlorhexidine can cause stains on teeth, especially on silicate and resin, and alter taste sensation. Also while chlorhexidine has immediate bactericidal action when it is activated, it is deactivated by anionic compounds commonly used in toothpastes, therefore in practice its bactericidal action may be small. If a chlorhexidine mouthwash is used, it is probably advisable to use mouthwash at least an hour after brushing with toothpaste. Zinc and chlorhexidine provide a strong synergistic effect, so if a mouthwash has chlorhexidine, it should also have zinc. Zinc and cetylpyridinium chloride have a smaller synergistic effect, and cetylpyridinium chloride can cause brown stains between the teeth and on the surface of teeth similar to a chlorhexidine rinse.

Some commercial mouthwashes include sodium chlorite, or as it sometimes misnamed, “Stabilized chlorine dioxide”; sodium chlorite is an oxidizer so it may harm sensitive tissues. Other mouthwashes include other oxidizers. A two phase solution of essential oil and water is safe and reasonably effective. The ”Efficacy of Oil..” study showed that oil pulling with sesame oil (Idhayam oil) is a bit less effective than using chlorhexidine. Sunflower oil is also recommended for oil pulling. Xylitol is in some mouthwashes, as a sweetener and bacteria inhibitor.

According to the ”Impact of Mouthrinses..” study, sulphur compound formation was inhibited in descending order, by positive control (0.2% chlorhexidine), 0.12% chlorhexidine, triclosan and essential oils and cetylpyridinium chloride. Plaque formation was inhibited by chlorhexidine mouthrinses and essential oils.

Overall, the most powerful mouthwash is a combination of zinc and chlorhexidine, however chlorhexidine has adverse effects. Cetylpyridinium chloride is less effective, and has adverse effects similar to chlorhexidine. Oxidizers may harm sensitive tissues. The safe and effective mouthwash components are baking soda, essential oil and water mixtures, xylitol and salt water.

Because many of the ingredients in commercial mouthwashes have adverse effects or have little effect, the best way to get a mouthwash which is safe and effective is to make your own baking soda mouthwash. Add xylitol and salt if you want extra power, and if you want to freshen your mouth chew a few leaves of fresh parsley, or basil.

Beneficial Foods

Some foods may protect against cavities. Milk and cheese are rich in calcium and phosphate, and may also encourage remineralisation. All foods increase saliva production, and since saliva contains buffer chemicals this helps to stabilize the pH to near 7 (neutral) in the mouth. Foods high in fiber may also help to increase the flow of saliva and a bolus of fibre like celery string can force saliva into trapped food inside pits and fissures on chewing surfaces where over 80% of cavities occur, to dilute carbohydrate like sugar, neutralize acid and remineralise teeth. Sugar-free xylitol chewing gum stimulates saliva production, and helps to clean the surface of the teeth.

There are many lists of foods for healthy teeth, including the World Dental 10 Most Healthy Foods for Teeth, and the Huffington Post Foods For Healthier Teeth. From those lists, the top top ten foods ranked in order of dental health minus dental side effects follow below.

  1. Celery protects teeth by producing saliva which neutralizes acid that causes demineralisation and cavities. It also massages the teeth and gums.
  2. Sesame seeds reduce plaque and help build tooth enamel. They are also very high in calcium.
  3. Vegetables such as pumpkins, carrots, sweet potatoes and broccoli contain Vitamin A which is necessary for the formation of tooth enamel. Crunchy vegetables may also help clean gums.
  4. Water cleans the mouth and produces saliva that deposits essential minerals into the teeth. It keeps gums hydrated and washes away particles from the teeth.
  5. Cheese contains calcium and phosphate, which helps balance pH in the mouth, preserves (and rebuilds) tooth enamel, produces saliva, and kills bacteria that cause cavities and disease.
  6. Milk and yogurt are good for teeth because they contain are not very acidic, which means that tooth wear is reduced. They are also low in decay-inducing sugar. Milk is a good source of calcium, the main component of teeth and bones.
  7. Fruits such as apples, strawberries and kiwis contain Vitamin C, which holds cells together. If this vitamin is neglected, gum cells can break down, making gums tender and susceptible to disease.
  8. Onions contain antibacterial sulfur compounds. Tests show that onions kill various types of bacteria, especially when eaten raw.
  9. Animal foods such as beef, chicken, turkey, and eggs contain phosphorus which, with calcium, is one of the two most vital minerals of teeth and bone.
  10. Green tea contains polyphenol antioxidant plant compounds that reduce plaque and help reduce cavities and gum disease. Tea may help reduce bad breath. Tooth enamel is strengthened because green tea contains fluoride which promotes healthy teeth.

Chew Xylitol Gum

Chewing gum after a meal stimulates the production of saliva, which helps to neutralize plaque acid. Xylitol in the gum inhibits some bacteria which lead to tooth decay, raises the pH of saliva, and may aid in the remineralization of tooth enamel. To reduce dental paque, only chew gums which have xylitol in them and no other type of sugar.

Disclaimer

The information presented is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional. You should consult with a health care professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem.


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