The five most common dental problems, and what actually prevents them
Decay, gum disease, sensitivity, erosion and bad breath account for most of what walks through the door. Four of the five are largely preventable, and they share most of the same prevention.
Five problems account for most of what we see. Four of them are largely preventable, and the useful thing is that they share nearly all of the same prevention.
Here they are, with what each one actually is and what stops it.
1. Tooth decay
What it is. Bacteria feed on sugar and starch and produce acid. The acid pulls minerals out of enamel. Saliva puts them back between meals. A cavity is what happens when the losing side wins for long enough.
The important distinction: before there is a hole, the softened enamel can still be re-hardened. Once the surface breaks, it cannot heal, because enamel has no blood supply and no way to rebuild itself.
Where it starts. The deep grooves on back teeth, and between teeth at the contact points where no brush can reach. In adults, increasingly on exposed root surfaces after gums recede.
Why it gets missed. Enamel has no nerves in it. Decay travels a surprising distance before it hurts, and by the time it does, the conversation has often moved from a filling to a root canal.
What prevents it. Fluoride toothpaste, spitting rather than rinsing, cleaning between the teeth daily, and reducing how often you eat sugar rather than how much.
2. Gum disease
What it is. Plaque along and under the gum line irritates the gum, which becomes inflamed and bleeds. That is gingivitis and it is fully reversible.
Left alone, the gum detaches from the tooth, forming a pocket that no brush can reach, and the process begins working on the bone that holds your tooth in. That is periodontitis, and lost bone does not come back.
Why it matters. It is the leading cause of tooth loss in adults, ahead of decay.
Why it gets missed. It is painless until teeth start feeling loose, which is very late. The only reliable early sign is bleeding when you brush or floss, and almost everybody dismisses that as brushing too hard.
What prevents it. Cleaning between the teeth every day, brushing at the gum line rather than across the middle of the teeth, not smoking, and having tartar removed before it entrenches.
Read more: Four steps to healthier gums in 30 days
3. Sensitivity
What it is. Not a diagnosis. A symptom, and worth chasing to its cause.
Usually it means the protective layer has been lost somewhere. Receding gums expose root surface, which has no enamel on it at all and is far more sensitive. Erosion thins the enamel itself. Occasionally it is a crack, or decay, or a filling that needs attention.
Why it matters. Sensitive toothpaste manages the symptom well and does nothing about the cause, and both of the main causes are progressive. Managing it indefinitely with toothpaste means the underlying problem carries on quietly.
What prevents it. A soft brush and a gentle hand, which addresses the recession side. Controlling acid, which addresses the erosion side. And having new sensitivity looked at rather than assumed.
4. Enamel erosion
What it is. Acid from food and drink dissolving enamel directly. No bacteria involved, no sugar required.
This is a separate process from decay, and people with excellent brushing and no cavities in their life get it.
Where it comes from. Lemon water, citrus, juice, soft drink including sugar-free, sports drinks, wine, sparkling water and vinegar dressings. Also reflux, which brings up stomach acid, often overnight without waking you.
The signs. Teeth looking more yellow as the darker layer shows through thinning enamel, front teeth going see-through at the edges, cupped hollows in the back teeth, and fillings that appear to stand proud because the tooth around them has worn down.
What prevents it. Drinking acidic things with meals rather than sipping them for an hour, a straw for cold ones, plain water afterwards, and not brushing for about an hour afterwards, since softened enamel brushes away.
Read more: What causes dental erosion
5. Bad breath
What it is. Most commonly bacteria on the back of the tongue. After that, gum disease. Dry mouth makes both worse, and dry mouth is very often a medication side effect.
Less often it is an untreated tooth or infection, a sinus problem, or something further down the system.
Why it matters. Persistent bad breath is usually a signal rather than a hygiene failure, and mouthwash covers it rather than fixing it. If mouthwash is the only thing keeping it away, something underneath is still going on.
What prevents it. Brushing the tongue gently, cleaning between the teeth daily, staying hydrated, and treating gum disease if it is there. If two weeks of all that does not shift it, come and let us look. See bad breath.
The overlap is the point
Look at what prevents all five and it is largely one short list.
- Brush twice a day for two minutes, soft brush, at the gum line, gently
- Spit rather than rinse
- Clean between the teeth once a day
- Reduce how often, not how much
- Do not sip acidic drinks, and do not brush straight after them
- Do not smoke
- Have the hardened tartar removed and the hidden surfaces x-rayed twice a year
That last one is the only item you cannot do yourself, and it is the only reason a check-up exists. Tartar below the gum line needs an instrument, and decay between teeth is invisible until it is large.
A full check-up and clean is a fixed $249, covering the exam, the scale and clean, fluoride and any bitewing x-rays you need, with your health fund claimed on the spot.
Preventive care FAQ
What is the most common dental problem?
Tooth decay is the most common overall, and gum disease is the leading cause of tooth loss in adults. Both begin in the same places, along the gum line and between the teeth, which is why the prevention for them overlaps almost entirely.
How can I tell if I have early gum disease?
The main sign is bleeding when you brush or floss. Healthy gums do not bleed when touched. Puffy or shiny gums, gums that have gone darker at the edge, persistent bad breath and teeth that look longer than they used to are the others. There is usually no pain at all, which is why it gets missed.
Why are my teeth suddenly sensitive to cold?
Usually because the protective layer has been lost somewhere. Receding gums expose root surface, which has no enamel and is much more sensitive. Erosion thins the enamel itself. Occasionally it is a crack or decay. It is worth finding out which, because sensitive toothpaste treats the symptom and not the cause.
Can tooth decay be reversed at home?
Only at the earliest stage, before a hole has formed. When enamel has begun to soften, fluoride and better habits can harden it back up. Once the surface has broken, it cannot heal, because enamel has no blood supply and cannot rebuild itself.
What causes persistent bad breath?
Most commonly bacteria on the back of the tongue, and after that gum disease. Dry mouth makes both worse. Less often it is an untreated tooth, a sinus problem or something further down. If brushing, tongue cleaning and daily flossing do not fix it within a couple of weeks, it is worth having looked at.
