The baby boomer generation is the first where the majority of people will keep their natural teeth over their entire lifetime. This is largely because of the benefits of water fluoridation and fluoride toothpaste. However, threats to oral health, including tooth loss, continue throughout life.

The major risks for tooth loss are tooth decay and gum disease that may increase with age because of problems with saliva production; receding gums that expose “softer” root surfaces to decay-causing bacteria; or difficulties flossing and brushing because of poor vision, cognitive problems, chronic disease, and physical limitations.

Although more adults are keeping their teeth, many continue to need treatment for dental problems. This need is even greater for members of some racial and ethnic groups—about 3 in 4 Hispanics and non-Hispanic black adults have an unmet need for dental treatment, as do people who are poor. These individuals are also more likely to report having poor oral health.

In addition, some adults may have difficulty accessing dental treatment. For every adult aged 19 years or older without medical insurance, there are three who don’t have dental insurance.

Oral health problems in adults include the following:

• Untreated tooth decay. More than 1 in 4 (26%) adults in the United States have untreated tooth decay.
• Gum disease. Nearly half (46%) of all adults aged 30 years or older show signs of gum disease; severe gum disease affects about 9% of adults.
• Tooth loss. Complete tooth loss among adults aged 65-74 years has steadily declined over time, but disparities exist among some population groups. If left untreated, cavities (tooth decay) and periodontal (gum) disease lead to tooth loss.
• Oral cancer. Oral cancers are most common in older adults, particularly in people older than 55 years who smoke and are heavy drinkers.
  • People treated for cancer who have chemotherapy may suffer from oral problems such as painful mouth ulcers, impaired taste, and dry mouth.
• Chronic diseases. Having a chronic disease, such as arthritis, heart disease or stroke, diabetes, emphysema, hepatitis C, a liver condition, or being obese may increase an individual’s risk of having missing teeth and poor oral health.
  • Patients with weakened immune systems, such as those infected with HIV and other medical conditions (organ transplants) and who use some medications (e.g., steroids) are at higher risk for some oral problems.
  • Chronic disabling diseases such as jaw joint diseases (TMD), autoimmune conditions such as Sjögren’s Syndrome, and osteoporosis affect millions of Americans and compromise oral health and functioning, more often among women.

A healthy mouth is just as important for adults' overall health and well-being as it is for children. When adults have a healthy mouth, they can speak clearly, eat healthy foods, look healthy, and feel good about themselves.

Oral Health and Overall Health and Well-Being

In addition to tooth decay, many adults have gingivitis or periodontal disease. Both are infections that affect the gums and bones that hold the teeth in the jaw. In most cases, these diseases occur when bacteria are not cleaned from the teeth and gums daily. Signs of gingivitis and periodontal disease may or may not be noticed.

Gingivitis is a common and mild form of periodontal disease. Signs of gingivitis can include red, swollen gums that bleed when brushing or flossing. Pregnant women often have gingivitis from hormone changes that make their gums more sensitive to bacteria. Brushing twice a day and flossing once a day usually reverses gingivitis.

Untreated gingivitis can spread into the bone that holds the teeth in the jaw. Bone loss around the teeth can occur in mild to moderate periodontal disease. Possible signs of mild to moderate periodontal disease include sensitive teeth, purple or receding gums, or teeth that look long. It is key to have ongoing care by an oral health professional to prevent more bone loss.

People with severe periodontal disease may notice pus in their gums, bad breath, and loose teeth. It is difficult to treat severe periodontal disease. Often these people lose many or all of their teeth.

In addition to saving a person's teeth, treating periodontal disease is important because the infection can affect a person's overall health by:

• Making it harder for people with diabetes to control their blood sugar. Also, people with diabetes are more likely to develop periodontal disease than those without diabetes
• Increasing risk for developing heart disease and possibly making existing heart disease worse
• Increasing risk for stroke

How to Promote a Healthy Mouth

The steps to keep a healthy mouth are simple. They include:

1. Brush twice a day with fluoride toothpaste. Brushing in the morning and just before bed removes the bacteria that cause oral diseases. Use a soft bristled toothbrush and focus on the gums. Use a small amount of fluoride toothpaste and do not rinse after brushing so the fluoride has time to soak in and strengthen the teeth. For more information on brushing, see the How to Brush handout from the American Dental Association (ADA).
2. Floss once a day. Flossing once a day removes the bacteria that cause periodontal disease from the sides of each tooth where a toothbrush cannot reach. Learning to floss can take time and practice. A dental hygienist or dentist can show you the best method and give feedback on how to improve your flossing. For more information on flossing, see ADA's How to Floss handout.
3. Drink fluoridated water throughout the day. Fluoride in drinking water helps prevent tooth decay. Most bottled water does not contain fluoride.
4. Avoid frequent snacking throughout the day. Snacking frequently during the day increases adults' risk of developing tooth decay. This is especially true if the snacks include foods and drinks with added sugars. For more information, see Brush Up on Oral Health: Understanding How Sugar Contributes to Tooth Decay.
5. Visit the dental office/clinic regularly. Visiting the dental office/clinic on a regular basis allows the dental team to check for tooth decay and periodontal disease and develop a plan to help prevent or treat oral diseases. They also provide preventive care and oral hygiene education.

Pregnancy is an exciting time in a person’s life. It is safe and important to get oral health care during pregnancy. For example, pregnant people can have their teeth cleaned, have X-rays taken, and receive treatment. Preventing oral disease can help keep a person healthy during pregnancy.

Oral Health Concerns During and After Pregnancy

Many pregnant people develop pregnancy gingivitis (gum disease). Signs of gingivitis include red, swollen gums that bleed when brushing or flossing. During pregnancy, hormones change making gums more sensitive to the bacteria that cause gum disease. If pregnancy gingivitis is not treated, the infection can cause a person to lose teeth and can impact their overall health.

After the baby is born, a mother with untreated tooth decay has more bacteria that cause tooth decay than a mother who has a healthy mouth. This bacteria can be passed from the mother to their baby through saliva sharing activities, such as when the mother tests the temperature of a bottle with their mouth and then gives the bottle to their baby, places the baby’s pacifier or bottle nipple in their mouth to clean it, or shares a fork or spoon with the baby. Babies who get the bacteria early in their life are much more likely to develop tooth decay in their primary (baby) teeth and permanent teeth than babies who get the bacteria later.

How to Keep a Healthy Mouth

1. Brush twice a day with fluoride toothpaste. Remind pregnant people that brushing with a soft bristled toothbrush and fluoride toothpaste in the morning and before bed removes bacteria that cause oral disease.
2. Floss once a day. Help pregnant people understand that flossing once a day removes bacteria from the sides of teeth where a toothbrush cannot reach. This is especially important for keeping gums healthy. Invite a dental hygienist or dentist to the program to show pregnant people the best method for flossing and give feedback to improve their flossing technique.
3. Consume healthy foods and beverages. Consuming healthy foods and beverages, especially those low in sugar, helps keep pregnant people healthy. Teach pregnant people how to read nutrition labels to identify foods and beverages high in sugar. Remind them to drink fluoridated water throughout the day.
4. Receive oral health care. Help pregnant people find a dentist if they don’t have one. Ask for a referral to a dentist from the person’s physician, the local or state health department, the local or state dental association, social service professionals, or the state dental hygienist liaison. Healthy Habits for Happy Smiles: Getting Oral Health Care While You Are Pregnant also offers strategies for getting oral health care during pregnancy.
5. Tackle morning sickness. Many people feel sick or vomit during pregnancy, especially during the first three months. Many times, having small snacks throughout the day helps. However, this can increase a pregnant person’s risk of developing tooth decay. Encourage pregnant people to choose healthy foods low in sugar or to brush more than twice a day. Urge those who vomit often to rinse with a teaspoon of baking soda mixed in a cup of warm water to stop stomach acids from attacking their teeth.
6. Role-play a dental visit. Role-playing can help relieve fears that pregnant people may have about dental visits. Prepare a script with the person where they tell the dental team that they are pregnant and when the baby is due. Work with the person to develop questions that cover any concerns or questions they have about getting care while pregnant. Invite a dentist or dental hygienist to participate in the role-playing activity.

A disability can affect a child’s activities and ability to learn. Some children with disabilities need extra health services and support services.

Children with disabilities are at higher risk for tooth decay and other oral health problems than children without disabilities.

Oral Health Challenges for Children with Disabilities

• Children with physical disabilities, such as cerebral palsy, may not have the motor skills they need to use a toothbrush safely or to sit still in a dental chair during dental visits.
• Children with communication disorders, such as delayed speech and language development, may not be able to tell their parents or Head Start staff that they have a toothache.
• Children who get frequent medical care, such as having many medical visits or hospital stays, may be afraid of the dental office and may not cooperate during visits.
• Children who take medicines with added sugars or that cause dry mouth are at high risk for tooth decay. Sugar is added to some medicines to make them taste better. Other medicines used to treat cerebral palsy, seizures, and depression can cause dry mouth by lowering the amount of saliva in the mouth. Saliva plays an important role in preventing tooth decay. Medicines given to children with diseases or disorders, such as asthma or allergies, can also cause dry mouth.
• Children on special diets may be at high risk for tooth decay. Foods that are soft or high in starch (e.g., potatoes, corn) stick to children’s teeth and give bacteria in the mouth more time to cause tooth decay.

Taking care of babies’ oral health is important. Care should start before the baby’s first tooth comes in. Healthy primary (baby) teeth help children chew nutritious foods and speak clearly. Primary teeth also make space for permanent (adult) teeth. A baby’s first tooth usually comes in at around age 6 to 10 months. As soon as the first tooth comes into the mouth, a baby can develop tooth decay.

Care of Babies’ Mouths

In addition to cleaning babies’ mouths after feedings, staff can educate pregnant people and parents on the best ways to care for their baby’s mouth. Here is some key advice staff can share:

• Clean the baby’s gums even before the first tooth appears in the mouth. Use a clean, damp washcloth to wipe any remaining milk off the gums. Doing this at least twice a day, especially after night feeding, will help the baby get used to having his or her mouth cleaned.
• After the baby’s first tooth comes in, use an infant toothbrush with soft bristles and a small head. Put a rice-size amount of fluoride toothpaste on the toothbrush, and brush the fronts and backs of the baby’s teeth. Lift the baby’s lip to brush at the gum line of the front teeth. The best time to brush teeth is in the morning and at bedtime.

Preventing tooth decay and other oral health problems takes more than just brushing a baby’s teeth with fluoride toothpaste every day. Here are other ways to keep a baby’s mouth healthy and to keep babies comfortable:

• Do not put a baby to sleep with a bottle filled with breastmilk, formula, juice, or other drinks with sugar. These practices should be avoided because the sugar in the liquid stays on the baby’s teeth, which can lead to tooth decay.
• Parents should not use their mouths to test the temperature of milk in bottles. Parents and other caregivers can pass the bacteria that cause tooth decay to their babies through saliva.
• Teething can make babies’ gums sore. When babies are teething, they can be cranky, drool more than usual, and chew on their fingers or objects. To help a baby be more comfortable while teething, give him or her a cool teething ring, cool spoon, or a cold, wet washcloth.
• Many babies suck their thumbs, fingers, hands, a pacifier, or another object such as a blanket or toy. Sucking is a normal baby reflex. It helps babies feel secure and happy. Most children stop sucking between ages 2 and 4.
• If parents choose to have their baby suck a pacifier, Head Start staff should make these recommendations:
  • Clean the baby’s pacifier with soap and water.
  • Replace the pacifier when it becomes worn or broken.
  • Do not dip a pacifier in sweetened foods or liquids (for example, sugar, honey, or syrup) because this can cause tooth decay.
  • Never clean a pacifier with saliva before giving it to the baby because the bacteria that can cause tooth decay can be passed to the baby.
  • Never attach a pacifier to a ribbon or string around the baby’s neck because it might strangle the baby.

The First Dental Visit

Babies should have their first dental visit by age 1. The dentist will check to make sure everything is normal. The dentist will also look for signs of tooth decay or other problems that may affect the baby’s oral health. In addition, the dentist will answer parents’ questions about their baby’s oral health. Going to the dentist at a young age helps children become accustomed to visiting the dental office and receiving care.

Oral health is an important part of your overall health. Maintaining good oral health affects your well-being and quality of life in many ways.

• A healthy mouth helps you enjoy your food, chew better, eat healthy foods, maintain fresh breath, and avoid pain and tooth loss.
• It can affect your physical and mental health and your financial and social life.
• Oral conditions can be painful and annoying, and can lead to other problems.
• Most oral health problems are preventable and easily treated if they are found early. If not found early, oral health problems can be expensive to treat, and treatments can be more complicated and invasive.
• Many studies have found a link between poor oral health and health conditions in other parts of the body.
  • These conditions include diabetes, heart disease, pulmonary (lung) issues, certain cancers, pre-term birth, and even Alzheimer’s disease.
  • Many studies have also found that gum disease (also known as periodontal disease) is associated with conditions such as diabetes, heart disease, pregnancy-related problems, and dementia. The exact connection between these conditions and gum disease isn’t understood yet.

Nearly 18% of working-age adults report that the appearance of their mouth and teeth has affected their ability to interview for a job.

How can I maintain good oral health?

• Brush and floss your teeth every day.
• Visit a dentist for regular check-ups.

Health and well-being include all aspects and parts of the body, including the mouth. Good oral health supports life-long health and achievements in education, employment, and social relationships. Unfortunately, tooth decay or dental caries (cavities) and periodontal disease are bacterially mediated processes that infect many children, most adults, and the elderly. These two common diseases are preventable, but they remain highly prevalent. The best protection from dental caries is good oral hygiene, regular access to professional care, a healthy diet of low sugar food and beverages, the mineral fluoride, and dental sealants.

Your teeth are meant to last a lifetime. The main diseases in the mouth are tooth decay, gingivitis (gum disease), and periodontal disease. These can be almost completely avoided by the daily removal of bacteria. A toothbrush with worn-out bristles cannot clean your teeth properly. Try to replace your toothbrush at least every three to four months.

What is plaque?

Plaque is made up of millions of germs or bacteria that combine into a sticky film that builds up on teeth. It is important to remove this plaque daily to prevent these germs from releasing acid and other products that can cause cavities and harm your gums and the bone that supports your teeth. Spend at least two minutes brushing all sides of your teeth. Use floss to remove the germs in hard-to-reach places, such as between teeth and under gums.

A dental home care plan should include:

• Twice daily toothbrushing with a soft toothbrush that is not worn out or frayed.
• Using dental floss daily to clean areas that are hard for your toothbrush to reach between your teeth and under the gumline.
• Using a toothpaste with fluoride
• Eating balanced meals and limiting foods/drinks that are high in sugar or carbohydrates.
• Limiting how often you eat/drink.
• Mouthwash is optional, but it may be a helpful addition to a daily hygiene routine.

To properly remove the plaque on your teeth, follow these steps:

1. Clean in between your teeth with dental floss before toothbrushing. Wrap the floss around your fingers and make a "C" shape around your tooth. Move up and down several times. Do this on both sides of each tooth.
2. With brushing, start by brushing the sides of your teeth that touch your cheek. Angle your toothbrush so it is up against your teeth and gums and in a circular motion jiggle the toothbrush back and forth in small strokes. Do only a few teeth at a time and do it several times in each spot.
3. When you have completed the cheek side of your top and bottom teeth, brush the side that faces your tongue on the top and bottom teeth in the same way.
4. Brush the chewing surfaces of your top and bottom teeth. These surfaces have many deep grooves where germs can “hide out.” Brush or use a tongue cleaner when you finish brushing your teeth to help your mouth feel fresher.

Brushing removes dental plaque: a sticky, colorless film of bacteria on the surface of your teeth. If plaque remains, it can harden below the gumline and irritate your gums.

What can happen if I don't brush my teeth regularly?

Gum Disease

Irritated gums can become red and swollen and may bleed easily. These are signs of gingivitis. Gingivitis is a mild form of gum disease; you can usually reverse it with daily brushing and flossing.

Serious or untreated gum disease can cause you to lose teeth. If there are areas where your gums have pulled away from your teeth (called gum recession), then the exposed roots of the tooth can decay, too.

The root is the part of the tooth that extends into the bone and holds the tooth in place.

Tooth Decay (Cavities)

Tooth decay is damage to a tooth that can happen when decay-causing bacteria in your mouth make acids that attack the tooth’s surface, or enamel. This can lead to a small hole in a tooth, called a cavity. If tooth decay is not treated, it can cause pain, infection, and even tooth loss.

Even a tooth with a filling is at risk for tooth decay if it isn’t brushed and flossed daily or if you don’t have regular check-ups with your dentist. Bacteria in plaque can get under a chipped or broken filling and cause new decay.

What type of toothbrush do I need?

Use a soft bristle brush that is small enough to reach all areas of your mouth.

What is the best way to brush my teeth?

• Brush two times every day, morning and night.
• Use toothpaste with fluoride.
  • Fluoride is a naturally occurring mineral that protects teeth from cavities.
  • It works by strengthening the tooth’s hard outer surface, called enamel, to resist cavities.
• Angle the bristles toward your gumline, so that they clean between your gums and teeth.
• Brush gently. Use small, circular motions. Do not scrub hard back and forth.
• Brush all sides of each tooth.
• Brush your tongue to remove bacteria and help maintain fresh breath.
• Do not eat or drink sugary foods after you brush your teeth at bedtime.

How should I take care of dentures?

• Keep your dentures clean and free from food and drinks that can cause stains or bad breath.
• Brush dentures every day with a denture-care product, and soak them in water or a denture-cleansing liquid at night.
• Leave them out of your mouth while you sleep to prevent sore gums.

Flossing removes dental plaque between teeth where a toothbrush cannot reach. If dental plaque remains, it can build up and cause tooth decay and gum disease.

What if it’s hard to floss?

You can use several other flossing tools if you need to:

Floss holder

A small, plastic tool with a handle that holds a piece of floss. When you use this tool, you do not need to wrap the floss around your fingers.

Floss threader

A plastic loop that helps pass floss through hard-to-reach or tight spaces, such as between crowded teeth, between dental crowns and caps, or under dental bridges.

Water flosser

A device that sprays pulsing water between your teeth.

Interdental brush (also called a proxy brush)

A very small brush with a handle that is shaped like a cylinder, tube, or pine tree. It rotates 360 degrees and can clean between your teeth.

What is the best way to floss?

1. Use a string of floss about one foot long. Wrap that piece around the middle finger of each hand.

2. Grip the floss between your thumb and index finger on each hand.

3. Ease the floss gently between your teeth until it reaches your gumline. Don’t “snap” or force the floss into place—that could harm your gums.

4. Curve the floss like the letter “C” around each tooth, keeping it in contact with the side of the tooth. Slide the floss up and down under your gum.

5. Do this for both sides of every tooth, one side at a time. Adjust the floss as you move from tooth to tooth so that the floss is clean for each one.

6. Floss all your teeth, including the backs of the last teeth on each side.

Be sure to floss regularly!

What type of floss do I need?

Waxed, unwaxed, flavored, or plain floss all do the same thing. Use the type of floss that works best for you.

Do toothbrushes spread germs?

The Centers for Disease Control and Prevention is unaware of any adverse health effects directly related to toothbrush use, although people with bleeding disorders or who are severely immunosuppressed may suffer trauma from tooth brushing and may need to seek alternate means of oral hygiene.

How should toothbrushes be cared for?

The mouth is home to millions of germs. In removing plaque and other soft debris from the teeth, toothbrushes become contaminated with bacteria, blood, saliva, oral debris, and toothpaste. Because of this contamination, a common recommendation is to rinse one's toothbrush thoroughly with tap water following brushing. Limited research has suggested that even after being rinsed visibly clean, toothbrushes can remain contaminated with potentially pathogenic organisms. Various means of cleaning, disinfecting, or sterilizing toothbrushes between uses have been developed, but no published research documents that brushing with a contaminated toothbrush has led to recontamination of a user's mouth, oral infections, or other adverse health effects.

Recommended toothbrush care:

• Do not share toothbrushes. Toothbrushes can have germs on them even after rinsing that could raise the risk of infection, especially for people with immune suppression.
• After brushing, rinse your toothbrush with tap water until it is completely clean, let it air-dry, and store it in an upright position. If more than one brush is stored in the same holder, do not let them touch each other.
• You do not need to soak toothbrushes in disinfecting solutions or mouthwash, which may actually spread germs under the right conditions.
• You do not need to use dishwashers, microwaves, or ultraviolet devices to disinfect toothbrushes. These methods may damage the toothbrush.
• Avoid covering toothbrushes or storing them in closed containers, which can cause the growth of bacteria.
• Replace your toothbrush every 3 to 4 months, or sooner if the bristles look worn out. This is because a worn-out toothbrush may not work as well, not because it might carry more germs.

How should toothbrushes be handled in group settings such as in schools?

Tooth brushing in group settings should always be supervised to ensure that toothbrushes are not shared and that they are handled properly. The likelihood of toothbrush cross-contamination in these environments is very high, either through children playing with them or toothbrushes being stored improperly. In addition, a small chance exists that toothbrushes could become contaminated with blood during brushing. Although the risk for disease transmission through toothbrushes is minimal in group settings, it is a potential cause for concern. Therefore, officials in charge of tooth brushing programs in these settings should evaluate their programs carefully.

Recommended measures for hygienic tooth brushing in schools:

• Ensure that each child has his or her own toothbrush, clearly labeled. Do not allow children to share or borrow toothbrushes.
• To prevent cross-contamination of the toothpaste tube, ensure that a pea-sized amount of toothpaste is dispensed onto a piece of wax paper before dispensing any onto the toothbrush.
• After the children finish brushing, ensure that they rinse their toothbrushes thoroughly with tap water, allow them to air-dry, and store them in an upright position so they cannot contact those of other children.
• Provide children with paper cups to use for rinsing after they finish brushing. Do not allow them to share cups, and ensure that they dispose of the cups properly after a single use.

In the United States, water fluoridation is not the only form of fluoride delivery that is effective in preventing tooth decay in people of all ages. Use the information listed below to compare the other fluoride products that may lower the risk for tooth decay, especially for people who are at higher risk for decay.

Although all of these products reduce tooth decay, combined use with fluoridated water offers protection greater than any of these products used alone.

Fluoride Toothpaste

Form
Concentrations of fluoride in toothpaste sold in the United States range from 1,000–1,500 ppm.

Use
Most people report brushing their teeth at least once per day, but more frequent use can offer additional protection. Fluoride in toothpaste is taken up directly by the dental plaque and demineralized enamel and also increases the concentration of fluoride in saliva.

Availability
Fluoride toothpaste is available over-the-counter and makes up more than 95% of toothpaste sales in the United States.

Recommendations
For most people (children, adolescents, and adults) brushing at least twice a day with a fluoride toothpaste—when you get up in the morning and before going to bed—is recommended.

Advice for Parents
For children aged 6 years and younger, some simple recommendations are advised to reduce the risk of dental fluorosis.

• Supervise brushing to discourage swallowing toothpaste.
• Place only a small pea-size amount of fluoride toothpaste on your child’s toothbrush.
• For children younger than 2, consult first with your doctor or dentist regarding the use of fluoride toothpaste.

Fluoride Mouth Rinse

Form
Fluoride mouth rinse is a concentrated solution intended for daily or weekly use. The most common fluoride compound used in mouth rinse is sodium fluoride. Over-the-counter solutions of 0.05% sodium fluoride (230 ppm fluoride) for daily rinsing are available for use by persons older than 6 years of age. Solutions of 0.20% sodium fluoride (920 ppm fluoride) are used in supervised, school-based weekly rinsing programs. Other concentrations also are available.

Use
Rinses are used daily or weekly for a prescribed amount of time. The fluoride from mouth rinse is retained in dental plaque and saliva to help prevent tooth decay.

Availability
Mouth rinses intended for home use can be purchased over-the-counter. Higher strength mouth rinses for those at high risk of tooth decay must be prescribed by a dentist or physician.

Recommendations
Children younger than 6 years of age should not use fluoride mouth rinse without consultation with a dentist or other health care provider because dental fluorosis could occur if such mouth rinses are repeatedly swallowed. Because fluoride mouth rinse has resulted in only limited reductions in tooth decay among schoolchildren, especially as their exposure to other sources of fluoride has increased, its use should be targeted to individuals or groups at high risk for decay.

Fluoride Supplements

Form
Tablets, lozenges, or liquids (including fluoride-vitamin preparations) are available. Most supplements contain sodium fluoride as the active ingredient. Tablets and lozenges are manufactured with 1.0, 0.5, or 0.25 mg fluoride.

Use
Fluoride supplements can be prescribed for children at high risk for tooth decay and whose primary drinking water has a low fluoride concentration. To maximize the topical effect of fluoride, tablets and lozenges are intended to be chewed or sucked for 1–2 minutes before being swallowed.

Availability
All fluoride supplements must be prescribed by a dentist or physician.

Recommendations
For children aged less than 6 years, the dentist, physician, or other health care provider should weigh the risk for tooth decay without fluoride supplements, the decay prevention offered by supplements, and the potential for dental fluorosis. Consideration of the child’s other sources of fluoride, especially drinking water, is essential in determining this balance. Parents and caregivers should be informed of both the benefit of protection against tooth decay and the possibility of dental fluorosis.

Fluoride Gel and Foam

Form
Fluoride gel is often formulated to be highly acidic (pH of approximately 3.0). Products available in the United States include gel of acidulated phosphate fluoride (1.23% [12,300 ppm] fluoride), gel or foam of sodium fluoride (0.9% [9,040 ppm] fluoride), and self-applied (i.e., home use) gel of sodium fluoride (0.5% [5,000 ppm] fluoride) or stannous fluoride (0.15% [1,000 ppm] fluoride).

Use
In a dental office, fluoride gel is applied for 1–4 minutes. Home use follows instructions provided on the prescription.

Availability
Most fluoride gel and foam applications are delivered in a dental office by a dental professional. These higher strength products, if used in the home, must be prescribed by a dentist or physician.

Recommendations
Because these applications are relatively infrequent, generally at 3 to 12–month intervals, fluoride gel poses little risk for dental fluorosis, even among patients younger than 6 years of age. Routine use of professionally applied fluoride gel or foam likely provides little benefit to persons not at high risk for tooth decay, especially those who drink fluoridated water and brush daily with fluoride toothpaste.

Fluoride Varnish

Form
Varnishes are available as sodium fluoride (2.26% [22,600 ppm] fluoride) or difluorsilane (0.1% [1,000 ppm] fluoride) preparations.

Use
High-concentration fluoride varnish is painted by dental or other health care professionals directly onto the teeth. Fluoride varnish is not intended to adhere permanently; this method holds a high concentration of fluoride in a small amount of material in close contact with the teeth for many hours. Varnishes must be reapplied at regular intervals with at least 2 applications per year required for effectiveness.

Availability
All fluoride varnish must be applied by a dentist or other health care provider.

Recommendations
No published evidence indicates that professionally applied fluoride varnish is a risk factor for dental fluorosis, even among children younger than 6 years of age. Proper application technique reduces the possibility that a patient will swallow varnish during its application and limits the total amount of fluoride swallowed as the varnish wears off the teeth over several hours.

Although it is not currently cleared for marketing by the Food and Drug Administration (FDA) as an anti-caries agent, fluoride varnish has been widely used for this purpose in Canada and Europe since the 1970s. Studies conducted in Canada and Europe have reported that fluoride varnish is as effective in preventing tooth decay as professionally applied fluoride gel.

Stress is a reaction to a physical, psychological, or emotional demand. Everyone has felt stress at one time or another. Some stress is good because it pushes us to do things that are challenging and meet the demands of daily life. However, too much stress is not good and can have negative short- and long-term effects on our health, including our oral health.

Stress Affects Oral Health Too!

Long-term stress can cause problems with your mouth, teeth, and gums. These problems can include:

• Sores in or around the mouth. Canker sores are small spots with white or grayish centers surrounded by red borders inside the mouth that can cause pain when chewing or talking. Canker sores are not contagious. Cold sores (also called fever blisters) are painful, filled with fluid, and most often appear outside the mouth, on or near the lips. Cold sores can be spread easily to others. Care should be taken to not share utensils or drinks and to not put your hand to your mouth and then touch other things.
• Teeth clenching and grinding. Stress may make you clench and grind your teeth. Clenching or biting the top and bottom teeth together tightly happens mostly during waking hours. Grinding is more common during sleep and occurs when the top and bottom teeth rub together. Clenching and grinding can wear down or chip teeth, cause jaw pain, and strain muscles in the face.
• Tooth decay and gum disease. In some cases, people under stress adopt unhealthy behaviors, such as snacking on foods or drinks that are high in sugar throughout the day or skipping brushing and flossing, that can increase their risk for oral diseases. To combat stress, some people use alcohol, tobacco, or drugs, which also increases their risk for oral diseases.

Tips to Help Manage Stress

• Eat healthy foods. Eating healthy foods – such as vegetables, fruits, whole grains, and lean protein – helps you feel good and may help control your moods, too. Skipping meals is not good and can put you in a bad mood, which can increase your stress.
• Take care of your mouth. If you grind or clench your teeth, talking to your dentist about getting a bite guard to prevent tooth damage, an aching jaw, and sore facial muscles can help. Your dentist can also recommend over-the-counter medicines or prescribe medicines to treat mouth sores and reduce the pain they cause.
• Seek treatment for unhealthy habits. Behavioral health experts and other health professionals can help you change unhealthy habits and find better ways to cope with stress. If you are practicing unhealthy behaviors to reduce stress, ask your physician, dentist, or another health professional or a trusted friend for a referral.
• Practice relaxation techniques. To combat stress, it’s important to activate the body’s natural relaxation response. You can do this by practicing mindfulness, breathing deeply, meditating, and exercising. These activities can help boost your energy and mood and improve your mental and physical health, including your oral health.
• Talk to friends, family, and coworkers. Talking about things that bother you with friends, family, and coworkers is one of the best ways to handle stress. Face-to-face or telephone conversations are better than texting or using social media to communicate. Have a conversation about what’s going on and listen to other people’s viewpoints, which may give you ideas on how to manage stress.

Not smoking or quitting smoking is important for overall health, including oral health. When a smoker quits, it improves their health and quality of life and the health and quality of life of those around them, especially young children.

Oral Health Problems Related to Smoking

Long-term use of products containing tobacco and/or nicotine can result in serious health problems, including cancer and heart and lung diseases. Smoking traditional cigarettes, e-cigarettes, cigars, pipes, and water pipes – and using smokeless tobacco – can cause these diseases. Using tobacco products also affects oral health.

• Tooth decay. Smokers can have more tooth decay than non-smokers. The nicotine in tobacco slows down the mouth’s ability to make saliva and creates dry mouth. Saliva helps prevent tooth decay by washing food and bacteria from the teeth. It also helps repair very early stages of tooth decay. Also, young children who are regularly exposed to secondhand smoke have higher rates of tooth decay in their primary teeth, compared with those who are not exposed.
• Gum disease. Gum disease is an infection of the gums that can affect the bone structure that holds teeth in the jaw. In severe cases, gum disease can make teeth fall out. Smoking causes gum disease because it weakens the body’s ability to fight infection, making it hard for gums to heal. Smokers are twice as likely to develop gum disease as non-smokers, and treatment may not work as well as for non-smokers.
• Oral cancer. Tobacco use increases the risk of oral cancer in the lips, tongue, cheeks, floor of the mouth, hard and soft palate, sinuses, saliva glands, and throat.
• Poor birth outcomes. Pregnant people who smoke are more likely to have miscarriages, babies born too early, or babies with low birthweight. They also are at higher risk for sudden infant death syndrome. Smoking during pregnancy also increases a person’s risk of delivering a baby with cleft lip and/or cleft palate (when a baby’s upper lip or roof of the mouth does not join completely during pregnancy).
• Stained teeth, bad breath, and loss of taste and smell. Nicotine and tar in tobacco stain teeth and can turn them yellow. Smoking is also a common cause of bad breath, and it affects ability to taste and smell.

Strategies to Help Parents and Pregnant People Quit Smoking

• Help families understand the impact of smoking on health, including oral health. Ask the family if anyone smokes. Getting this information and discussing the hazards of smoking with pregnant people, parents, and other family members who smoke can be a first step in helping the family establish a tobacco-free environment and in creating a quit-smoking action plan.
• Share methods to quit smoking. Use motivational interviewing to share information about the dangers of smoking and to assess pregnant people’s and parents’ willingness to quit smoking. The Motivational Interviewing Suite provides information about the approach and how to use it. On Smokefree.gov, Explore Quit Methods describes different methods to quit smoking. It explains which methods are most effective, which are most affordable, and which may have side effects. Smokefree.gov also offers quit-smoking tools and tips specific to veterans, women, teens, and adults ages 60 and over.
• Develop and enforce tobacco-free policies. Tobacco-free environment policies are designed to protect non-smokers from secondhand and thirdhand smoke. The Oregon Head Start Association and the American Lung Association of Oregon developed a model policy for early childhood education and care programs seeking to promote a tobacco-free facility. The American Academy of Pediatrics provides resources that Head Start programs can use to inform pregnant people and parents about the dangers of tobacco and how to establish policies and practices that promote a tobacco-free environment.

Halitosis, or bad breath, is a common problem that affects almost everyone from time to time. There are a few causes, including certain foods, mouth cleaning habits, some medications, or an infection in the mouth. These all can contribute to bad breath. Gums, mints, mouthwashes, and other products designed to fight bad breath are temporary solutions that only cover up the odor.

Mouth/Body Conditions

The most common cause of bad breath is mouth-related. Poor toothbrushing and flossing mouth care (or hygiene) leave food particles that increase the numbers of bacteria and cause bad breath. Home care that does not properly clean the teeth, the tongue of plaque, and food debris will result in bad breath.

Periodontal disease is severe swelling of gum tissues with bacteria and calculus (tartar) build-up. A foul-smelling breath is often associated with periodontal disease. An abscessed tooth or deep cavities may also cause a bad taste in your mouth and add to the possibility of an odor.

Bacteria associated with bad breath may accumulate in the nose, sinuses, or tonsils. Once the infection has healed, the halitosis should be gone. Other medical conditions such as gastric reflux, diabetes, and liver or kidney disease may bring about breath odor.

Other Causes

Certain foods and drinks can cause temporary halitosis. Common causes are garlic, onions, spices, and specific nutrition plans like the ketogenic diet. Pay attention to what you eat and drink.

Medications (prescription or over-the-counter), alcoholic beverages, and coffee can dry out your mouth and attribute to an odor. Saliva helps to cleanse the mouth after eating and drinking. Low amounts of saliva will have a definite effect on bad breath. All forms of tobacco use: cigarettes, pipe, cigar, and e-cigarettes will also contribute to halitosis.

Controlling Bad Breath

The most logical place to start with controlling the bad breath is proper care of the mouth. Proper and consistent home care with thorough brushing, cleaning the tongue, and flossing are the first steps to treating halitosis. It is important to add cleaning of the tongue to your oral hygiene routine. This can be done by using a tongue scraper to remove the trapped food and bacteria on the surface of the tongue.

Regular preventative dental appointments are also crucial. A dental hygienist will keep teeth and gums clean and work with you to make your home care effective. If you have gum disease or periodontal disease, more frequent dental appointments may be needed.

Consult your primary care physician if you suspect something other than your mouth is causing the halitosis

Exercise has so many documented benefits, including its ability to lower the risk of heart disease, obesity, Type 2 diabetes and some types of cancer but research indicates it can also boost oral health. One study published in the Journal of Dentistry showed that regular physical activity can boost periodontal health.

To be more precise, people who exercised regularly had a 54% lower likelihood of developing periodontitis compared to those who led sedentary lives. The National Health and Nutrition Examination Survey additionally revealed that people who exercised three times a week or less could also reap benefits, which means they have a 33% lower likelihood of developing periodontitis.

There is a vital link between people’s Body Mass Index (BMI) and their dental health. One study published in the Journal of Periodontology found that people who maintain a normal weight and get the recommended amount of exercise had a 40% lower likelihood of having periodontitis. Other health-enhancing behaviors include:

• Consuming a healthy Mediterranean-style diet;
• Eating fruits, vegetables; and
• Healthy fats.

We know that exercise can benefit oral health but it works the other way around too. That is, taking care of your teeth can help protect your heart and therefore, your ability to stay fit and active. A recent study by the European Society of Cardiology found that brushing teeth frequently is linked to a lower risk of atrial fibrillation and heart failure.

Exercise as a whole is conducive to better oral health, particularly gum health. Remember, the recommended amount of exercise to boost oral health varies according to age. For most healthy adults, the Department of Health and Human Services recommends around 150 minutes of moderate cardiovascular exercise or 75 minutes of vigorous cardiovascular exercise. Strength training is also key at least twice a week for major muscle groups.

Oral health refers to the health of the teeth, gums, and the entire oral-facial system that allows us to smile, speak, and chew. Some of the most common diseases that impact our oral health include cavities (tooth decay), gum (periodontal) disease, and oral cancer.

More than 40% of adults report having felt pain in their mouth within the last year, and more than 80% of people will have had at least one cavity by age 34. The nation spends more than $124 billion on costs related to dental care each year.  On average, over 34 million school hours and more than $45 billion in productivity are lost each year as a result of dental emergencies requiring unplanned care.

Oral conditions are frequently considered separate from other chronic conditions, but these are actually inter-related. Poor oral health is associated with other chronic diseases such as diabetes and heart disease. Oral disease also is associated with risk behaviors such as using tobacco and consuming sugary foods and beverages.

Public health strategies such as community water fluoridation and school sealant programs are safe and effective interventions proven to prevent cavities and save money.

Cavities (Tooth Decay)

Cavities are caused by a breakdown of the tooth enamel by acids produced by bacteria located in plaque that collects on teeth, especially along the gumline and in the crevices on the chewing surfaces of the teeth. Eating and drinking foods high in carbohydrates cause this bacteria to produce the acids that can cause the outer coating of the tooth (enamel) or root surface to break down (demineralize).

Although cavities are largely preventable, they are one of the most common chronic diseases throughout the lifespan. About one-fourth of young children, half of adolescents and more than 90% of adults experienced tooth decay. Untreated tooth decay affected 10% of young children to 26% of adults aged 20–64. Untreated tooth decay can lead to abscess (a severe infection) under the gums which can spread to other parts of the body and have serious, and in rare cases fatal, results.

Community water fluoridation and school-based dental sealants programs are both cost-saving, proven strategies to prevent tooth decay.

Gum (Periodontal) Disease

About 4 in 10 adults aged 30 years or older had gum (periodontal) diseases in 2009–2014. Gum disease is mainly the result of infections and inflammation of the gums and bone that surround and support the teeth. Certain chronic conditions increase one’s risk for periodontal disease including diabetes, a weakened immune system, poor oral hygiene, and heredity. Tobacco use is also an important risk factor for gum disease. If early forms of periodontal diseases are not treated, the bone that supports the teeth can be lost, and the gums can become infected. Teeth with little bone support can become loose and may eventually have to be extracted.

Oral Cancer

In 2016, there were nearly 45,000 new cases of cancer of the oral cavity and pharynx diagnosed in the United States and more than 10,000 deaths. The 5-year survival rate for these cancers is about 61 percent. The mortality rate from oral cancer is nearly three times as high in males as it is in females (4 vs 1.4 for every 100,000 people) and nearly twice as high in white and black populations as it is in Hispanic population (2.6 vs. 1.5 for every 100,000 people). Preventing high risk behaviors, that include cigarette, cigar or pipe smoking, use of smokeless tobacco, and excessive use of alcohol are critical in preventing oral cancers. Early detection is key to increasing the survival rate for these cancers. Oral Human Papilloma Virus (HPV), the most common sexually transmitted disease, can cause cancers in the back of the throat, called “oropharyngeal cancers.” More research is needed to determine whether HPV itself causes oropharyngeal cancers, or if other factors (such as smoking or chewing tobacco) interact with HPV to cause these cancers.

• Periodontal disease, also known as gum disease, is an infection that attacks the bone and gums that support your teeth. It is the most common cause of tooth loss in adults.
• Bacteria in your mouth, called plaque, are the major cause of periodontal disease. Other things — such as the general condition of your teeth, your nutrition and general health, habits and emotional stress — can contribute to periodontal disease.
• If bacteria are not removed regularly by brushing and flossing, plaque can harden into tartar (also called calculus). The rough surface of this tartar will help more bacteria to stay close to your teeth and under the gumline.
• This bacteria make products that can harm your gums and the bone around your teeth.
• Periodontal disease is painless and, in the early stages, it is difficult to detect. Common early warning signs may include bad breath and tender or swollen gums that bleed when you brush and floss your teeth.
• Periodontal disease can be prevented with proper dental care, started at an early age, that includes brushing, flossing and regular dental visits. Caught in the early stages, periodontal disease is easy to treat.

You can keep your teeth and mouth healthy for a lifetime! Ask your dental hygienist and dentist to evaluate the health of your gums.

What is oral cancer?

• Oral cancer includes cancers of the mouth and pharynx (the back of the throat). Oral cancer accounts for about 3% of all new cancers diagnosed every year in the United States.
• Doctors/dentists diagnose approximately 54,000 people with oral cancer each year, and about 11,230 people die from the disease.
• It’s important to identify oral cancer as early as possible. Then doctors can treat it more successfully.

What puts a person at risk for oral cancer?

Men are twice as likely as women to get oral cancer. The following also increase the risk:

• Tobacco and alcohol use. Using tobacco in any way, including smoking cigarettes, puts you at risk. So does heavy alcohol use. And using tobacco plus alcohol poses a much greater risk than using either one alone.
• Human papillomavirus (HPV). In the past 20 years, oral cancer related to HPV has doubled; in fact, oral cancer is now the most common HPV-related cancer in the United States.
• Age. Risk for oral cancer increases with age. It occurs most often in people ages 55 to 64.
• Ultraviolet (UV) light exposure. Exposure to UV light from the sun or tanning beds can cause cancer of the lip.

What are possible signs and symptoms of oral cancer?

See a dentist or physician if you have any of the following symptoms for more than two weeks.

• A sore, irritation, lump, or thick patch in your mouth, lip, or throat (these are not always painful)
• A white or red patch in your mouth
• A sore throat or a feeling that something is caught in your throat
• Hoarseness
• Difficulty chewing, swallowing, or speaking
• Difficulty moving your jaw or tongue
• Numbness in your tongue or other areas of your mouth
• Swelling of the jaw; if you wear dentures, this could feel like your dentures have become uncomfortable or no longer fit right
• Ear pain

How can I detect oral cancer early?

• See your dentist regularly, even if you have no natural teeth anymore or you have dentures.
• Your routine dental check-up is an excellent opportunity to have an oral cancer examination, which can detect early signs of cancer. A screening for oral cancer—part of a full dental check-up—is painless and takes less than a minute.
• During the exam, ask your dentist or dental hygienist to check your face, neck, lips, and entire mouth for possible signs of cancer.
• Some parts of the pharynx aren’t visible during an oral cancer exam. Talk to your dentist about whether a specialist should check your pharynx.

You should have regular dental appointments and check-ups.

Professional cleanings:

• Are as important as brushing and flossing at home.
• Can help you avoid treatment that costs more.

A dentist or dental hygienist can:

• Identify any problems early, when needed, before they cause unnecessary pain or infection.
• Review your medical history and suggest an oral-care routine that may make it easier for you.
• Recommend a special toothpaste or mouthwash to help prevent tooth decay and to fight germs that cause gum disease. Follow the dentist’s instructions on how to use these items.

What should I bring to my dental appointment?

• A list of medicines you’re taking
• A list of any allergies you have
• Any insurance or billing information

You can keep your teeth for your lifetime. Here are some things you can do to maintain a healthy mouth and strong teeth.

• Drink fluoridated water and brush with fluoride toothpaste.
• Practice good oral hygiene. Brush teeth thoroughly twice a day and floss daily between the teeth to remove dental plaque.
• Visit your dentist at least once a year, even if you have no natural teeth or have dentures.
• Do not use any tobacco products. If you smoke, quit.
• Limit alcoholic drinks.
• If you have diabetes, work to maintain control of the disease. This will decrease risk for other complications, including gum disease. Treating gum disease may help lower your blood sugar level.
• If your medication causes dry mouth, ask your doctor for a different medication that may not cause this condition. If dry mouth cannot be avoided, drink plenty of water, chew sugarless gum, and avoid tobacco products and alcohol.
• See your doctor or a dentist if you have sudden changes in taste and smell.
• When acting as a caregiver, help older individuals brush and floss their teeth if they are not able to perform these activities independently.