Did you know that your mouth is home to many species of living organisms, including germs like fungus and bacteria? Not all of them are bad –the composition of the bacterial flora in a healthy mouth differs considerably from that of a mouth with oral disease.
Some of these microbes are helpful and others may cause damage such as tooth decay and gum disease. Streptococcus mutans, or “S. mutans,” is the bacteria most responsible for tooth decay, and it is present in all the areas of the mouth. For dental cavities to form, the normal presence of “S. mutans” in the mouth has to make contact with sucrose or sugar-containing products. This causes “S. mutans” to increase in numbers and to secrete acids that attack your teeth’s enamel. Decay starts when microbes start to form a sticky, colourless film called plaque on your teeth.
Flossing and brushing regularly will help to keep your mouth clean and will discourage the growth of microbes and accumulation of plaque, but germs will start to grow again almost immediately after you have brushed and/or flossed.
Different microbes will grow in different places – some grow on your teeth, others prefer your tongue. Some prefer the tiny spaces between the teeth and the gums. Once they find a suitable space, they start to multiply and form diverse colonies in combination with other microbes.
Mouth microbes protect themselves and their colony with a sticky substance called a matrix. The matrix in plaque is what makes it so difficult to remove.
The colonies within the matrix include both beneficial and harmful microbes. The good ones help to keep the bad ones in check and may help you digest food, but the nett result depends on which colony is prevalent.
You can teach yourself some habits to help the good microbes such as avoiding food and drinks that contain a lot of sugar and starch. Sugar feeds the microbes and stimulates their growth and spread in the oral cavity.
Some sugar-loving microbes can metabolise sugar into matrix and acid which can destroy the surface (enamel) of the teeth. Copious amounts of sugar in food and drinks provides fuel for the harmful microbes to create plaque that will eventually cause tooth decay.
Limiting the amount of sugar in your diet and a good cleaning routine can stop the bad microbes from multiplying out of control.
It is not a single microbe that is responsible for tooth decay – microbes multiply in communities and need help from the rest of the community to survive and grow.
Studies have shown that microbes produce certain substances that promote the growth of other microbes. Scientists are trying to identify what these substances are in order to find better ways to prevent and treat dental decay.
Early childhood tooth decay is caused by mouth microbes in children between the ages of 1 and 5. Tooth decay can progress very fast if left untreated and can be traumatic for children in this age group. The microbe matrix and acid produced by bacteria are estimated to be the main cause of tooth decay. Children often take antibiotics or use corticosteroid sprays that can alter the flora in the mouth adversely. Probiotic supplements can be valuable in these situations.
Researchers also found a fungus that lives in the plaque of children with uncontrolled tooth disease. The fungus aggravates the tooth decay as it collaborates with the matrix and the acid-producing bacteria to create a decaying environment.
Some research has shown that the fungi can utilise the sugar that bacteria release when making acid for their own energy requirements. In turn, the fungus produces substances to aid the growth of the bacteria. The result is an even more resilient matrix that produces more acid, creating a vicious circle of decay. Sugar is bad news for your teeth!
What can you do to keep the mouth microbes under control?
- Stick to a rigorous routine of brushing twice a day and flossing daily.
- Use a toothpaste or mouthwash that contains fluoride.
- Regularly remove the plaque between your teeth with floss.
- Remember to brush your tongue.
- Be aware of the sugar content in food and drinks and limit your intake.
- Go for regular dental examinations and professional cleaning every 6 months.
Brushing and flossing regularly can get rid of most of the plaque, but if any plaque remains on your teeth for an extended period, it can harden and form tartar, a hard, yellowish deposit consisting of a precipitation of minerals from saliva and oral fluids. The precipitation kills the bacteria in the dental plaque but the rough surface forms an ideal base for more plaque deposits.
Plaque and the build-up of tartar can lead to gum disease—also known as periodontal disease. Gingivitis is the most common and mildest type of gum disease. The gums turn red and are swollen, bleeding easily. Gingivitis can usually be treated at home with a rigid routine of brushing and flossing. Rinsing with a saltwater solution can help to reduce the swelling of the gums.
If gingivitis is left untreated, it can progress to a more severe type of gum disease called periodontitis. Symptoms of periodontitis include bad breath that persists no matter how often you brush your teeth, red, swollen and tender or bleeding gums, pain whilst eating and loose or sensitive teeth.
As periodontitis progresses, the gums start receding, exposing the roots of the teeth, creating an opportunity for infection underneath the gums. The resulting infection and bacterial toxins start to break down the bone and soft tissue that hold the teeth in place. If left untethered, the teeth may eventually become loose and will have to be removed or they can just fall out. Loss of bone in the jaw can further complicate the treatment as implants may not be possible. A dentist may recommend a deep-cleaning method called scaling and root planing to treat periodontitis. Gum tissue graft surgery may be required to treat severe cases. All of the treatment options can cause severe discomfort and may be very traumatic.
Most people do not show signs of gum disease until they are older. Smoking and alcohol use increase the risk for periodontitis. Other risk factors include hormonal changes in women, certain medications and diseases like diabetes, cancer and AIDS.
Although gum disease is more common amongst the elderly, cavities can still occur at any time while you still have your natural teeth. Sometimes older people experience physical challenges to brush and floss regularly and effectively. Encourage them to use an electric brush or help them to brush their teeth. A fluoride mouthwash can also contribute towards keeping teeth healthy.
Older adults commonly complain about a dry mouth. Dry mouth is a common problem that occurs when you do not have enough saliva to keep your mouth wet. Dry mouth can make it difficult to eat, swallow, taste or even speak. Saliva has protective factors that reduce the incidence of dental cavities, gum disease and fungal infections. Dry mouth can be caused by certain medication, poorly controlled diabetes and excessive alcohol or tobacco use. Fortunately, dry mouth is a treatable condition and your dentist or doctor should be able to assist. Try to keep your mouth comfortable by sipping water or any other sugarless drink. Sugarless gum may also provide relief.
No bacteria is beyond the control of proper tooth brushing and flossing. Using a variety of products that are gentle yet abrasive enough will allow you to access the “bad” bacteria’s natural habitats as well as remove any traces of remaining sugar residue.
If you help the good bacteria in your mouth to banish the bad by consistently practising good oral hygiene, you can be sure of a healthy mouth, no matter what type of bacteria lives there.