From early infancy, the first examination will be the first in a life-long series of regular dental visits. Over the life of an individual, the areas of focus will change to reflect his or her changing needs, but the underlying purpose remains constant: to preserve healthy teeth and gums for life.

 Dental experts recommend that the first oral examination should occur at the time the first tooth.  The baby teeth need proper care because they will set the stage for the permanent ones that follow.  Of particular note is the importance of informing the parents of the dangers of "baby bottle caries" (tooth decay). This condition usually occurs when the child is put to sleep with a bottle containing sugary liquid.

 During the toddler and pre-school years exams should focus on the preservation of the baby teeth. The teeth will be examined for early signs of decay and treated as necessary.  Unfortunately, a recent report from the Centers for Disease Control and Prevention (CDC) indicates that decay is on the rise in children aged 2 to 5.

 The elementary school years coincide with the development of the "mixed dentition,” a time when baby teeth and permanent teeth coexist. The first permanent molars come in at about the age of six. Examination may disclose the need for sealants to prevent decay on the biting surfaces of the molars and the other back teeth which will appear between ages 6 and 12. When the pits and fissures on the teeth are deep, tooth decay may occur soon after eruption even with appropriate diet and hygiene. Therefore, regular exams are exceedingly important for the prevention of decay during this age period. It is also important to monitor the timing and sequence of the loss of the baby teeth and appearance of the permanent teeth. Interventions may be required to prevent crowding and facilitate the development of proper alignment and "bite.”

 During the middle school years cavities can become a greater problem as children have more control over their diet. They may make poor choices, substituting sugary snacks for healthy foods. The dental team should continue to provide reinforcement of proper hygiene and diet and provide treatment for cavities as necessary. At this stage some children will require orthodontic treatment (braces) to straighten their teeth. This period is also a good time for a frank discussion between dentist, patient, and parents about the negative effects of tobacco and oral jewelry. Also during this period gum disease begins to occur with increasing frequency. Some youngsters will get gingivitis (inflammation of the gums) during puberty due to the interaction of fluctuating hormone levels and dental plaque.

 In the high school years and into early adulthood concerns continue to include tooth decay and gum (periodontal) disease. The regular reinforcement of a message of prevention including candid discussions about risky habits continues to be extremely important. At about the age of 18 the third molars (wisdom teeth) come in. Occasionally the area around these teeth can become infected or they may only come in part way or not at all. This may mean removing them to prevent further infection or other serious problems.

 If regular preventive and treatment services have been a part of the individual's childhood, the adult years will be reached with few problems, healthy teeth, and a winning smile. However, many adults will face an increasing risk of gum disease. Dental examination will thus include screening for gum disease and treatment if necessary, but prevention through good home care remains the best strategy.

As one reaches the mature adult years systemic medical conditions may compromise health. Every oral examination should include a review of the health history and medications taken, even non- prescription items. The mouth is the mirror of the body and the dentist may detect systemic disease or note changes in the progress of disease. Additionally, medications can result in oral complications or affect the body's response to oral disease. A classic example is dry mouth (xerostomia), seen in several disease states and with several medications.

Here are a few of the many health problems that can be aggravated by poor oral hygiene:  Stroke › Those with adult periodontitis may have increased risk of stroke.  Respiratory Infections › Inhaling bacteria from the mouth and throat can lead to pneumonia.  Heart Disease › Those with adult periodontitis may have increased risk of fatal heart attack. › And are more likely to be diagnosed with cardiovascular disease.  Severe Osteopenia › Reduction in bone mass (osteopenia) is associated with gum disease and related tooth loss. › Severity has been connected to tooth loss in postmenopausal women.  Uncontrolled Diabetes › Diabetes can contribute to bacterial overgrowth in the mouth. › Smokers with diabetes increase their risk of tooth loss by twenty times. › People with type II diabetes are three times as likely to develop periodontal disease than are nondiabetics.

 Periodontal Disease (gum disease) is caused by plaque, a sticky film of bacteria that constantly forms on the teeth. If this plaque is not removed on a daily basis, it will get mineralized to form a stony crust called calculus or tartar.

 It is not possible for you to remove this tartar (calculus) - your dentist will use a special instrument called a scaler to remove it. This bacteria creates toxins that can damage the gums and bone.

 Tobacco smoking or chewing  Systemic diseases such as diabetes  Some types of medication such as steroids, some types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers and oral contraceptives  Bridges that no longer fit properly  Crooked teeth  Fillings that have become defective

 Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless "plaque" on teeth. Brushing and flossing help get rid of plaque.  Plaque that is not removed can harden and form bacteria-harboring "tartar" that brushing doesn't clean.  Only a professional cleaning by a dentist or dental hygienist can remove tartar.

 Periodontal (gum) disease is the most common cause of tooth loss. Gums gradually shrink as people age. After age 35, about three out of four adults are affected by some form of gum disease.  It is a slowly progressing infection and is mostly painless in the early stages, and hence most people do not pay any attention to it till it is too late.  However, it is a totally preventable disease, and can be treated if caught early.

 Gingivitis is one of the first signs of Periodontal Disease.

Some or all of the following signs may be present:  Visible plaque/tartar build-up at the gum line  Gums are red and puffy (swollen)  Gums may bleed when you brush or floss  Bad breath odor that doesn't go away Bone and fibers holding your teeth in place have not yet been affected.  With treatment, gingivitis can be reversed.

 Plaque spreads to the roots of your teeth  Infection continues to worsen  This infection has damaged the supporting bone and fibers that hold your teeth in place  Gums may have begun to pull away from your teeth forming a "pocket" below the gum line, which traps food, bacteria, plaque  Immediate treatment can stop further damage and tooth loss.

 Gingivitis may lead to more serious, destructive forms of periodontal disease called periodontitis which can damage gums and supporting tissue.

Periodontitis is an infection of the underlying bone. Periodontal disease is primarily caused by a "silent" and "painless" bacterial infection of the bone and ligaments which hold the teeth in place. Symptoms often do not appear until later stages. Some of the signs may be :  Spacing between teeth  Mobility of teeth  Receding gums  Pain or other discomfort  When enough bone has been lost, the tooth will become loose. The progress of the disease depends on individual health and resistance to disease.

Normal, healthy gums Healthy gums and bone anchor teeth firmly in place. Normal gums are pink in color and have a sharp outline. Gingivitis Gums red and swollen. Slight separation of gum from teeth but attachment to teeth still intact. Periodontitis Unremoved, plaque hardens into calculus (tartar). As plaque and calculus continue to build up, the gums begin to recede (pull away) from the teeth, and pockets form between the teeth and gums.

 Gums may have begun to pull away from your teeth forming a "pocket" below the gum line, which traps food, bacteria, plaque.

Normal, Healthy Gums and Teeth Start of Gingivitis Progression into Periodonitis Advanced Periodonitis (large pockets)

At this stage, gums recede further and separate from the tooth.

 With advanced disease the gums recede farther, destroying more bone and the periodontal ligament. Teeth — even healthy teeth — may become loose and need to be extracted.  If periodontitis is left untreated, then it can lead to Acute Necrotizing Ulcerative Gingivitis.

 The dentist will look around in your mouth.  Notice any plaque or tartar build up on the bottom or your teeth.  Take x-rays to look at the teeth and bones for any hidden damage.

 The removal of the plaque from the tender gums may be uncomfortable. The gums soreness and bleeding should lessen within a few weeks.  Medications can be given to reduce the swelling of the gums.  Warm salt water can reduce puffiness.  It’s good to have strict oral hygiene.

To prevent gingivitis you need to do is keep the bacterial populations in balance by flossing, brushing, and rinsing daily with an anti- microbial rinse which removes excess bacteria. Professional cleanings during routine dental visits remove excess tartar which harbors and nurtures the proliferation of the undesirable bacteria. If left unchecked, however, gingivitis may progress to periodontal disease

 gums bleed when you brush your teeth  red, swollen or tender gums  gums have pulled away from the teeth  bad breath that doesn't go away  pus between your teeth and gums  loose teeth  a change in the way your teeth fit together when you bite

Take another look at the Progression of Gum Disease.

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