Brushing Up on Oral Health
Look at the latest stats and talk to dentists, and this much becomes clear: The pandemic has been murder on our mouths. A 2021 survey commissioned by the American Association of Endodontists reveals more than half of Americans say it’s led them to blow off checkups.
What’s more, those working from home seem to have slacked off when it comes to their daily dental hygiene routine: 31 percent report snacking more on sweets, 21 percent confess they don’t brush in the morning, and 24 percent say they're flossing less frequently. Additional data, compiled by the American Dental Association's Health Policy Institute, illustrates the consequences of our less-than-stellar habits. As more people return for their checkups, about 30 percent of dentists interviewed said they noticed an increase in cavities and periodontal disease (aka gum disease), while a whopping 69 percent and 76 percent saw an uptick in cracked teeth and sore jaws, respectively.
“The longer you wait to take care of an oral problem, the more extensive — and expensive — it gets,” says Leonardo Marchini, associate professor in the Department of Preventive and Community Dentistry at the University of Iowa College of Dentistry.
This is something Stefanie Russell, a New York City-based periodontist and associate professor at the New York University College of Dentistry, has seen firsthand. “I’ve had patients who kind of disappeared for a while and have deteriorated,” she says. “Disease that had been controlled is now back, and they need to go through the periodontal treatment again.”
Broken and fractured teeth are another consequence of the pandemic, according to Clark Stanford, dean of the University of Illinois at Chicago College of Dentistry. “There’s also a feeling of isolation that’s only increased stress and tension, and some people take it out on their teeth,” he notes, resulting in things like clenched jaws and bruxism, or teeth grinding.
Teeth change as we age
With age, oral hygiene becomes even more crucial because older adults are vulnerable to a slew of dental issues. Adults over 65, for instance, have a higher rate of tooth decay than candy-chomping schoolkids. One reason is related to the greater occurrence of dry mouth in older adults. Less saliva production means teeth are left more vulnerable to the decay-causing acids in our mouths. Daily chomping and grinding over a period of decades also wears away the outer layer of enamel. What's more, nerves inside the tooth lose sensitivity, which means you may have problems and not know it.
You may also not realize you have gum disease, the most common culprit for adult tooth loss. The condition tends not to be very painful and very gradually worsens, meaning it can go undetected for years if you aren't visiting the dentist. That’s part of the reason that 70 percent of adults over 65 have some form of gum disease, as a study by the Centers for Disease Control and Prevention (CDC) found.
Finally, fillings collected over the years also create risk. “The more dentistry you accumulate in your lifetime, the more potential problems you’ll have later on,” says Allen Samuelson, associate professor at the Adams School of Dentistry at the University of North Carolina at Chapel Hill, who explains that fillings can weaken and fracture along the edges, allowing bacteria to seep into the tiny crevices, also leading to decay. “There’s an expression: There’s no dentistry like no dentistry. It’s particularly important to take care of your mouth after 50 if you’ve had tons of work done before 50. The more restoration you’ve had, in a way, the more of a predictor it is for future problems.”
Tooth decay can be stopped in its tracks — or even reversed — if detected early enough. If not, a cavity will eventually work its way through the dentin layer of your tooth, just below the enamel. Left untreated, such decay may reach the nerve, and a cavity that could have been treated with a filling will require a more involved (and painful) procedure, such as a root canal and crown — or possibly an extraction and dental implant.
The American Dental Association (ADA) recommends regular professional cleanings to do away with cavity-causing plaque and tartar buildup that brushing alone cannot eliminate. Once-a-year dental cleanings may be enough for patients with no risk factors (such as smoking or diabetes), according to a study in the Journal of Dental Research. “Proper oral health should be individualized,” says Alice Boghosian, DDS, a spokesperson for the ADA.
“Some patients build up tartar faster than others and need to come more often. A patient without a single filling in their mouth does not need X-rays as often as somebody who has had several crowns in their mouth, because that person is more prone to decay and needs more dental treatment,” she says.
What to know as you schedule your appointment
While understandable fears of COVID-19 transmission kept many from the dentist’s chair, a recent study led by the Massachusetts Institute of Technology (MIT), published in the journal Proceedings of the National Academy of Sciences, found that dental offices (along with banks and colleges) have one of the best risk-benefit profiles of businesses providing everyday services during the pandemic.
“Basic infection control we were already doing was good, but we’ve upgraded beyond that,” says Stephen Shuman, professor and director of the Oral Health Services for Older Adults Program at the University of Minnesota School of Dentistry. To address the fact that research shows the virus causing COVID-19 can be spread through aerosols in the air (creating concern about airborne saliva during dental procedures), many dentists have adopted extra safety precautions such as the use of face shields and impenetrable masks, as well as the installation of air purifiers and upgraded suction systems to whisk away such aerosols from procedures. Some hygienists have set aside aerosol-spewing power equipment and are relying on traditional hand tools to remove built-up plaque.
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A 2021 study, published in the Journal of Dental Research, offers some reassurance. Researchers collected samples from personnel, equipment and other surfaces reached by aerosols during procedures, such as implants and restorations. What they found: Water from the irrigation tools contributed to about 78 percent of the organisms in aerosols distributed around the room — whereas saliva from patients accounted for a mere 0.1 to 1.2 percent.
Beyond your dental checkup
The most thorough cleaning by a dental hygienist won’t make much difference if you don’t practice good oral hygiene at home. That means brushing for a minimum of two minutes, at least twice daily. The longer you brush, the more plaque you’ll remove. A study published in the Journal of Dental Hygiene found that patients who brushed for 45 seconds removed 26 percent less plaque than those who brushed for two minutes. And don’t forget to floss, once a day. Gums recede with age, leaving more room for food to get trapped between teeth, creating a breeding ground for bacteria.
And watch what you’re eating. “Tooth decay is a dietary illness,” Samuelson says. “Getting your teeth cleaned every six months is wonderful, but it’s like going to the doctor, then only exercising once every six months and expecting to be healthy.” The bacteria from refined carbs is bad news, and sticky snacks such as raisins and caramels, which glom onto teeth and stay there, are particularly damaging.
Barbara Stepko is a longtime health and lifestyle writer, and former editor at Women’s Health and InStyle. Her work has appeared in The Wall Street Journal, Parade and other national magazines.