Left alone, the surfaces of all your teeth naturally become covered with a thin layer of bacteria, food and other substances. This layer is called plaque.
When you eat anything containing carbohydrates, the bacteria on your teeth digest these carbohydrates for their own nutrition. As a waste product of this, they also produce acids. These acids soften and dissolve the hard enamel surface of your teeth. This is called demineralisation. Over time, demineralisation can cause small holes (cavities) to form in your teeth. This is known as tooth decay or dental caries.
The enamel surface of your teeth doesn't contain any nerves, so you won't feel any pain when you first start to get a cavity. Eventually, however, a cavity may reach the dentine. This is the substance underneath the enamel that makes up most of your tooth and covers the blood vessels and nerves. Exposed dentine can be sensitive to pain, so more advanced cavities may cause pain, especially when you eat or drink anything hot, cold, sugary or acidic. The decay will also spread more quickly once it has reached the dentine.
If tooth decay keeps progressing, it can cause severe pain. You probably won’t be able to bite with the affected tooth. You may have to have a filling, or in serious cases the dentist may need to remove your tooth.
Saliva helps to neutralise the acid on your teeth, allowing the enamel to recover and harden again. This replacement process is called remineralisation.
Demineralisation occurs every time you eat or drink something sugary and the saliva needs time to remineralise after each ‘acid attack’. If you consume sugary food or drinks at regular intervals throughout the day, the saliva doesn't get long enough to fully remineralise your teeth. This will increase your risk of tooth decay spreading more quickly.
Gum disease is the inflammation of your gums. It may also involve damage to the bone that anchors your teeth into your jaw. Gum disease is very common; it affects more than half of adults worldwide.
The early stage of gum disease is called gingivitis, and it is most commonly associated with plaque on your teeth. If you don't clean plaque off your teeth regularly, the bacteria in the plaque infect the gums and cause inflammation. Gingivitis may not cause pain, but your gums will become red and swollen and they may bleed easily, especially when you brush your teeth. You can treat gingivitis by having a thorough teeth-cleaning routine. This means brushing your teeth and flossing regularly to remove plaque.
It’s important to treat gingivitis, otherwise the inflammation may spread to the structures that support your teeth. Your gums may begin to pull away from your teeth, leaving small pockets between the teeth and the gum. This stage of gum disease is known as periodontitis. If you have this, plaque can become trapped in the pockets around your teeth, meaning it’s harder to reach with a toothbrush. Over time the plaque will harden to become calculus (also known as tartar) – a hardened deposit that you can’t remove by brushing your teeth. This in turn can cause more plaque to build up, leading to further irritation.
If periodontitis isn’t treated, the plaque will eventually attack your gums and the bone that holds your teeth in place, making them wobbly and sensitive. If periodontitis remains untreated over a number of years, your teeth may become very loose and need to be taken out by a dentist.
A professional clean called a scale and polish may help treat gum disease. A dentist or hygienist will perform your scale and polish. Scaling removes calculus that has formed on your teeth, as well as trapped food and plaque. Polishing removes stains from teeth and leaves a smooth surface that slows down the build-up of plaque.
Dental erosion is a common condition where acid attacks the surface of your teeth, leading to the loss of enamel and dentine. However, unlike tooth decay, the acids don’t come from plaque bacteria. They usually come from acidic drinks such as fruit juices, fizzy drinks and squashes – this includes the 'diet' varieties. Certain foods, for example pickled foods, crisps or ketchup, can also cause dental erosion.
Stomach acid in vomit can also cause dental erosion. If you have a health condition that causes you to be sick frequently (for example, bulimia or a digestive problem), you may be at risk of dental erosion.
You can’t reverse the damage done by dental erosion. It can cause your teeth to become sensitive if the dentine becomes exposed.
Good dental care and oral hygiene are very important to help prevent tooth decay and gum disease. This involves cleaning your teeth at least twice a day with fluoride toothpaste, visiting the dentist and hygienist regularly, and limiting the amount of sugar and acid in your diet.
Brush your teeth
Brushing your teeth regularly is very important for removing plaque. To get the most benefit from brushing your teeth:
- use a toothbrush with a small head and synthetic bristles
- use fluoride toothpaste to protect against decay
- brush all the tooth surfaces thoroughly, including the top of your lower teeth, the bottom of your upper teeth, and the back (tongue side) of all your teeth
- develop your own routine or order of brushing, to help ensure you brush each surface every time
- pay particular attention to your gumline, angling the bristles into the area where your gums meet your teeth
- spit out the toothpaste when you’re finished, but don’t rinse your mouth out; this stops the chemicals in the toothpaste continuing to clean your teeth
- brush at least twice a day for about two to three minutes
- replace your toothbrush at least every three months, or sooner if the bristles are worn down
A good electric toothbrush will reduce the effort involved in ensuring that you clean your teeth effectively. Overall, they’re better at ensuring good oral hygiene.
Clean between your teeth
Dental floss or interdental brushes can help to remove plaque and small bits of food from between your teeth and under your gumline. These are areas that a toothbrush can't reach. It's important to use the correct technique, so ask for advice from your dentist or hygienist.
Brushing and flossing can’t remove all calculus, especially that between the gums and the teeth. This can only be removed with special tools during a scale and polish by your dentist or hygienist.
Mouthwashes containing fluoride are available, which can help to prevent tooth decay. Some antiseptic mouthwashes reduce plaque bacteria on your teeth and help to prevent gum disease.
If you use mouthwash to freshen your breath, talk to your dentist for advice. Bad breath may be a sign of poor oral hygiene. It’s a good idea to let your dentist recommend a mouthwash for you. Always read the information on the box or bottle.
Chewing sugar-free gum can benefit dental health. Chewing after a meal stimulates the production of saliva, which can remove food debris and may help to neutralise acid in your mouth. However, more research is needed to understand how this might work. It’s important to remember that chewing gum isn’t a substitute for brushing your teeth and flossing.
Control sugar in your diet
Eating sugary foods and drinks encourages tooth decay. However, it's how often you eat these sugars, rather than the amount, that is important. Try not to eat or drink them between meals to give your teeth a chance to be remineralised by saliva. It's also good for your general health to reduce your sugar intake.
Control acid in your diet
To prevent dental erosion, it’s important not to have too many acidic foods and drinks. These include fruit juices, fizzy drinks and squashes (including 'diet' varieties), flavoured waters, vinegar, pickled foods, crisps and ketchup. If you enjoy these foods and drinks, try and hold them back for mealtimes only.
Quit smoking and cut back on alcohol
Smoking can stain your teeth and increase your risk of gum disease and tooth loss. Certain alcoholic drinks contain lots of sugar and increase the risk of tooth decay, so cutting back on these will protect you as well.
Dentists and hygienists can help you to keep your teeth healthy and give you advice about dental care, teeth cleaning and removing stains from teeth.
At check-ups your dentist will try to find any problems early and give you advice and treatment. They will also advise you on how often you should come back for a check-up. For adults, this can vary from every three months to every two years if you have very good dental health and hygiene, but it’s important to follow your dentist’s advice on how often to visit.
If you’re at high risk of developing dental problems, you may need to see a dentist more often. You may be at high risk if you smoke, have a diet that’s high in sugar or have had lots of dental treatment in the past.
A range of things can cause bad breath. It's important to go to your dentist, who will be able to find out what’s causing it. Bad breath may be caused by a build-up of bacteria and food around your teeth and gums because of poor dental hygiene. It can also arise from gum disease, smoking and eating strong-smelling foods. Certain medicines and medical problems such as dry mouth, diabetes and infections can also cause bad breath.
Things that you can do that may help include:
- thorough teeth cleaning, as outlined above
- using dental floss or interdental brushes to remove plaque and food from between your teeth
- stopping smoking
- not eating strong-smelling foods (such as onions, coffee and garlic)
If your bad breath doesn’t improve, see your dentist. They may recommend treatment for any decayed teeth or gum disease.
If your dentist can't find out what’s causing your bad breath, or suspects that your bad breath is caused by a medical condition, they may advise you to see your GP.
No. Wait at least 20 minutes after eating before you brush your teeth.
When you eat and drink, the enamel on your teeth becomes softer because of the acids being released. If you brush straight after eating, over many years it can cause the enamel to wear away and expose the dentine underneath. This can cause pain and sensitivity and may lead to tooth decay or erosion.
Wait between 20 minutes and an hour after eating before you brush your teeth. This will give your saliva enough time to neutralise the acid caused by eating and drinking.
The best times to brush your teeth are before breakfast and last thing in the evening before you go to sleep.
FAQ: Discoloured teeth after treatment Why have my teeth and tongue suddenly turned brown after treatment for a gum infection?
If you have a gum infection, you may be prescribed a mouthwash or spray containing chlorhexidine. This is a very commonly used and effective antiseptic treatment, but it can cause brown or even black staining of your teeth and tongue.
Make an appointment with your dentist if you notice staining on your teeth after using chlorhexidine mouthwash. They’ll be able to confirm whether the staining is caused by your mouthwash or something else. If it's chlorhexidine staining, your dentist or hygienist can remove stains from your teeth. Your tongue should go back to its usual colour once you stop using the mouthwash.
To prevent further staining, follow the instructions on the bottle carefully.
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- Some Dental and Periodontal Diseases. PatientPlus. patient.info/patientplus, last checked July 2014
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- Gingivitis. Medscape. emedicine.medscape.com, updated December 2014
- Gingivitis and periodontitis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, revised August 2012
- Gingivitis. BMJ Best Practice. bestpractice.bmj.com, updated November 2015
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- Halitosis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, revised November 2014
- Halitosis. PatientPlus. patient.info/patientplus, reviewed May 2014
- Nutrition and dental health: Guidelines for professionals. Health Promotion Agency for Northern Ireland. Revised 2008
- The prevention of oral disease (4th ed). Oxford: OUP, 2003
- Preventing excess weight gain. National Institute for Health and Care Excellence (NICE), March 2015
- Type 2 diabetes prevention: population and community-level interventions. National Institute for Health and Care Excellence (NICE), May 2011
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- Chlorhexidine gluconate – Side-effects. British National Formulary. www.evidence.nhs.uk, accessed June 2016
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Reviewed by Nick Ridgman, Lead Health Editor, Bupa Health Content Team, July 2016.
Peer reviewed by Dr Steven Preddy, Dental Clinical Director, Bupa UK.
Next review due July 2019.
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