You enter the dental office and it is time for your yearly exam. Have you ever wondered what is going on with the x-rays and what is going on inside your mouth? There is a method to all this madness, just like at your physical you are getting checked for various diseases.
Cavities, or dental caries are caused by acid and bacteria. The bacteria themselves cause acid which dissolves the enamel of the tooth. When the bacteria feed on carbohydrates the produce this acid, which is why sugary snacks are a risk for tooth decay. Other sources of acid can also cause damage. Carbonation from soda, energy drinks, and even acid reflux and vomiting can weaken the enamel. The enamel softens gradually and decays,eventually the softened area becomes large enough that it needs to be filled.
At your dental visit there are a few ways that cavities are detected. One way is x-rays. Your dentist will look for areas on the x-ray that look like shadows, these areas are where the enamel is less dense and cavities have formed. Another method that may be used is a visual exam by the dentist. They may blow air on the teeth to see if the tooth has a chalky color that is common in early cavities or areas where there is obvious visual decay. They may also feel the teeth with an instrument to check for soft areas. Finally there is a method that uses laser fluorescence to detect decay. These instruments give a numerical value that equates to how severe the decay is, from healthy with no decay to severe decay. The DIAGNOdent and the Spectra Caries Detection Aid are the most common ones used. These instruments allow detection of early decay so it can be treated before it becomes more severe and costly.
Periodontal Disease is extremely common. The most obvious result of periodontal disease is loss of bone and eventually teeth. If you have ever looked at someone’s smile and their teeth appear long you have seen someone with periodontal disease. The way level of periodontal disease is assessed at the dentist includes a full periodontal assessment. During this assessment your gums will be measured with an instrument that is like a little ruler. It measures the space between the tooth and the gum called the sulcus or pocket. Additionally any root surface showing above the gum-line will be measured. The teeth will be checked for mobility or looseness, bleeding and the degree of plaque and tartar on the teeth will be assessed. The combination of this data, along with your health history will help determine your treatment.
Your x-rays are another way that your bone level can be evaluated. There are additional screenings that can be done which will tell which particular bacteria are in your mouth but those are not used as frequently in initial screenings.
If there is no bone loss or bleeding your gums are healthy. That is great. If there is bleeding but you have not lost bone you have gingivitis, which is the earliest stage of periodontal disease. Luckily this is reversible with proper treatment. Finally if you have lost bone and there is bleeding you will be diagnosed with active periodontal disease, which will need treatment to avoid losing even more bone and eventually teeth.
The third disease that is screened for at the dental office is cancer. During a manual oral cancer screening you will be asked to stick out your tongue and areas of the mouth will be looked at and touched. Your dentist may pull on your tongue to get a better look. Dental professionals are trained to find suspicious lesions. In addition to this manual oral cancer screening many offices do additional screenings using the aid of special lights. You may go to an office that does Vizilite, Velscope of Identifi screenings. These additional screening methods are used to detect cancer earlier than the manual screening. It is a great addition to your check up because early detection saves lives.
Why is all this necessary?
A thorough assessment should be done at regular intervals to make sure that you are healthy and avoid painful, costly and lengthy procedures. Problems in the mouth don’t tend to get better on their own. Without proper treatment these problems progress. A cavity will get bigger and may eventually need a root canal, or an extraction. Untreated periodontal disease is an infection that can interfere with your health in other parts of your body. Bone loss will not get better, but can progress without treatment. Undiagnosed cancer will not go away and can spread to other areas of the body. Knowledge is power. Understanding what is going on in your own body is important to taking control of your health and you life.
Like doctors and nurses, dentists and dental hygienists care about your health and aim to provide the best care possible. Unfortunately there are many people who don’t constantly get these check ups. Often, patients with dentures think they don’t need to go to the dentist because they don’t have natural teeth to worry about. They may not realize that oral cancer screenings are so important. Another barrier to treatment is lack of insurance. Even patients that do have insurance often turn down recommended treatment due to cost. Unfortunately many patients believe that if they really needed something insurance would cover it. This is unfortunate because it may lead to more serious disease in the long run, when diseases are not diagnosed early.
Next time you go in for your check up at the dentist pay attention to the screenings that you receive. If you feel like you did not get screened for any of these diseases ask for it. It is important that you take control of your own health. If you had a suspicious lump you would fight to get it checked by a physician, but more importantly you would hope that it would be caught before it became something dangerous. Be your own advocate. Ask to be screened for all three, cavities, periodontal disease and cancer.