The Tribune

By Dr Emmanuel W Francis

Question 1: Do I have to visit the dentist every six months?

Answer: Six months is usually the minimum time it takes for a cavity to develop, and for accumulated dental plaque to harden under the gums. This time frame, however, is consistent with patients who eat a lot of refined carbohydrates (sugars) and exhibit poor oral hygiene practices. Your dentist will tell you how often you should come and this will be directly related to your dietary habits and oral hygiene index.

A six-month recall is indicated for patients at risk for decay and gum disease who need help with plaque control and early detection of decay. Patients with advanced gum disease, reduced resistance to infection due to diabetes, decreased manual dexterity, physical disability and immunodeficiency may require a three months recall for oral prophylaxis (cleaning). Additionally, older patients on medication for systemic diseases, or who have had head and neck radiation therapy for cancer may experience dry mouth due to a side effect of decreased salivary flow which makes the teeth susceptible to decay necessitating a shorter recall period.

Conversely, patients who exhibit very good oral health may only need a dental check up and cleaning every one or two years.

Question 2: Does teeth cleaning hurt?

Answer: Fear of pain is the number one reason why patients refuse to see the dentist for any treatment, and unfortunately, cleaning is undesirable for a significant number of persons. This is because they believe reports or have experienced that cleanings are tortuous and painful. The greatest challenge for any dentist, therefore, is to gain the trust and confidence of a patient who anticipates that this necessary treatment will inevitably involve pain and suffering.

Rest assured that cleanings will not hurt when dental plaque control therapists exercise due diligence and care to avoid unnecessary tearing of the gingival (gum) attachment in the removal of subgingival (under the gum) deposits by sharp hand instruments. Best practices demand that if pain is anticipated due to the need for deep scaling of deposits in periodontal pockets, the dental professional would apply a local anaesthetic to ensure patient comfort at the start of treatment. This anaesthetic convenience does not negate the need for judicious use of cleaning instruments, since post operative pain is directly related to the degree of trauma induced by the procedure.

Question 3: Are milk (baby) teeth important since they will be changed anyway?

Answer 3: Healthy baby teeth are essential for proper growth and development in children. These teeth are best classified as foundation or primary teeth since they pave the way for the permanent or secondary (adult) teeth which replace them. Please remember that all teeth are necessary for proper mastication (chewing) of food and this is especially true in children where the digestive system is more delicate. No child should have to suffer the pain, low self esteem, and poor nutrition caused by tooth decay since this is a one hundred per cent preventable disease predicated on poor lifestyle choices and habits.

Premature loss of baby teeth also causes crowding of permanent teeth due to decreased arch length and could necessitate expensive orthodontic treatment (braces). Furthermore, good oral hygiene habits learned during childhood will carry over into adulthood; conversely, dental neglect of the baby teeth creates a lifestyle of neglect when the child matures.

Lastly, the first permanent molars begin to erupt at age six directly behind the last primary molars creating a mixed dentition of milk and adult teeth. Unfortunately, neglect of the baby teeth usually causes destruction of the first permanent molars long before most of the baby teeth exfoliate (fall out).