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Oral health fact sheet

woman Celia's Story

I started having pain in my mouth about 10 months ago. At first I just ignored it. I hoped it would go away on its own. But it didn't. I told my daughter about it and she said, "Mom, you need to see a dentist." But I didn't make an appointment. I was afraid. I waited several more months and the pain got worse and worse. Then, my gums started bleeding when I brushed my teeth. Now I was really nervous to see the dentist. I was afraid and thought the treatment would hurt worse than the pain I was already having. Also, I felt embarrassed that I had waited so long to make an appointment. So my daughter made the appointment for me. She even went with me to the dentist. And do you know what? It wasn't bad at all! Dental treatments have gotten so much better! I explained to my dentist that I was very anxious, and she made sure that I was comfortable through my whole visit. Now I plan to schedule regular cleanings to keep myself healthy!

What is oral health?

The word "oral" refers to the mouth, which includes your teeth, gums, jawbone, and supporting tissues. Taking good care of your oral health can prevent disease in your mouth. Oral health can affect the health of your entire body. Good oral health does not just mean you have pretty teeth. Your whole mouth needs care to be in good health.

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What are the most common oral health problems?

The most common oral health problems are cavities and gum disease.

Cavities
We are all at risk of tooth decay, or cavities. (Cavities look like chalky white and/or brown holes on your teeth). Bacteria (germs) that naturally live in our mouths use sugar in food to make acids. Over time, the acids destroy the outside layer of your teeth. Then cavities and other tooth harm occur.

Gum diseases
Gum diseases are infections caused by bacteria, along with mucus and other particles that form a sticky plaque on your teeth. Plaque that is left on teeth hardens and forms tartar. Gingivitis (jin-juh-VEYE-tuhss) is a mild form of gum disease. It causes red, swollen gums. It can also make the gums bleed easily. Gingivitis can be caused by plaque buildup. And the longer plaque and tartar stay on teeth, the more harm they do. Most gingivitis can be treated with daily brushing and flossing and regular cleanings at the dentist's office. This form of gum disease does not lead to loss of bone or tissue around the teeth. But if it is not treated, it can advance to periodontitis (pair-ee-oh-don-TEYE-tuhss). Then the gums pull away from the teeth and form infected "pockets." You may also lose supporting bone. If you have periodontitis, see your dentist for treatment. Otherwise your teeth may loosen over time and need to be removed.

Your risk of gum disease is higher if you:

  • Smoke
  • Have a disease such as diabetes or HIV/AIDS
  • Use methamphetamine
Healthy gums and bone anchor teeth firmly in place.Plaque left on teeth hardens into tartar. As plaque and tartar build up, the gums pull away from the teeth and pockets form between the teeth and gums. Bone supporting the teeth may get infected and start to weaken.The gums recede further, destroying more bone and the ligament around the tooth. Teeth may become loose and need to be removed.

Normal, healthy gums
Healthy gums and bone anchor teeth firmly in place.

Periodontitis
Plaque left on teeth hardens into tartar. As plaque and tartar build up, the gums pull away from the teeth and pockets form between the teeth and gums. Bone supporting the teeth may get infected and start to weaken.

Advanced periodontitis
The gums recede further, destroying more bone and the ligament around the tooth. Teeth may become loose and need to be removed.

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What are some other problems I might have with my mouth?

Bad breath. Bad breath is also called halitosis (hal-lih-TOH-suhss). Bad-smelling breath can be caused by several things, including:

  • Poor oral hygiene
  • Some foods
  • Dentures
  • Gum disease
  • Dry mouth
  • Tobacco use
  • Respiratory, digestive, or other health problems
  • Some medicines

Practicing good oral hygiene and avoiding tobacco and some foods often helps people with bad-smelling breath. You may want to try using a tongue scraper to clean food from your tongue. You could also just brush your tongue with your toothbrush. But if doing so doesn't seem to help or if you always need mouthwash to hide bad breath, talk to your dentist.

Burning mouth. People with this condition describe a burning feeling in the mouth or tongue. It is most common in postmenopausal women. The cause is unknown, but might be linked to:

  • Hormones
  • Dry mouth (which can be caused by many medicines and disorders such as Sjögren's syndrome or diabetes)
  • Taste problems
  • Nutritional deficiencies
  • Use of ACE inhibitors (blood pressure medicines)
  • Anxiety and depression
  • Dentures that do not fit
  • Infections (especially fungal infections)

Talk to your doctor or dentist if you have burning mouth. Treatment depends on the cause — if it can be determined — and might include adjusting your dentures, vitamin supplements, or pain or other medicines.

Canker sores. These sores are small ulcers inside the mouth. They have a white or gray base and a red border. Women are more likely than men to have canker sores that recur. The cause of canker sores is unknown. Risk factors include:

  • Fatigue
  • Stress
  • Having your period
  • A cut on the inside of your cheek or on your tongue
  • Allergies
  • Celiac disease
  • Crohn's disease

Canker sores most often heal on their own in one to three weeks. See your dentist if you get a large sore (larger than a half inch, or about the size of a dime). You may need medicine to treat it.

To help with pain:

  • Avoid hot, spicy foods
  • Use mild mouthwashes or salt water
  • Try over-the-counter pain medicines

No proven way exists to prevent canker sores. If you get them often, talk with your dentist.

Cold sores. These small, painful sores are caused by herpes simplex virus type 1. Once you are exposed to the virus, it can hide in your body for years. Things that trigger the virus and lead to cold sores include:

  • Getting too much sun
  • Having a cold or infection
  • Having your period
  • Feeling stressed

Cold sores can spread from person to person. They most often form on the lips and sometimes under the nose or chin. The sores heal in about 7 to 10 days without scarring. You can buy over-the-counter drugs to put on cold sores to help relieve pain. If you get cold sores a lot, talk with your doctor or dentist about a prescription for an antiviral drug. These drugs can help reduce healing time and the number of new sores.

Dry mouth. Dry mouth is also called xerostomia (ZEER-oh-STOM-mee-uh). This problem happens when you don't have enough saliva, or spit, in your mouth. Some reasons why people get dry mouth include:

  • Side effect of medicines or medical treatment, such as cancer treatments
  • Health problems, such as diabetes, Parkinson's disease, and Sjogren's syndrome
  • A blocked salivary gland

Dry mouth may make it hard to eat, swallow, taste, and speak. If left untreated, it can lead to cavities. This is because saliva helps break down bits of food and helps stop acid from forming plaque on your teeth. Treatment of dry mouth depends on the cause and can range from medicines to diet changes. To lessen the dryness, use artificial saliva, suck on sugarless candy, do not smoke, do not drink alcohol, and use a humidifier. Tell your doctor if you have dry mouth.

Oral cancer. This cancer can affect any part of the mouth and part of the throat. If you smoke or chew tobacco, you are at higher risk. Excessive alcohol use along with smoking raises your risk even more. However, nonsmokers can also develop oral cancer. To help protect yourself from lip cancer, use a lip balm with sunscreen (exposure to the sun can cause lip cancer).

Oral cancer most often occurs after age 40. It isn't always painful, so it may go undetected until the late stages. Ask your doctor to check for signs of oral cancer during your regular checkup. Oral cancer often starts as a tiny white or red spot or sore anywhere in the mouth. Other signs include:

  • A sore that bleeds easily or does not heal
  • A color change in the tissues of the mouth
  • A lump, rough spot, or other change
  • Pain, tenderness, or numbness anywhere in the mouth or on the lips
  • Problems chewing, swallowing, speaking, or moving the jaw or tongue
  • A change in the way the teeth fit together

Thrush. Thrush is also called oral candidiasis (CAN-dih-dye-uh-sis). These fungal infections appear as red, yellow, or white lesions, flat or slightly raised, in the mouth or throat. It can look like cottage cheese. This fungus lives naturally in your mouth. Your risk of getting thrush increases if:

  • You have a weak immune system
  • You don't make enough saliva
  • You take antibiotics

Treatment includes antifungal mouthwash or lozenges. If the infection spreads or your immune system is weak, you may need antifungal medicine.

Thrush is common among:        

  • Denture wearers
  • People who are very young or elderly
  • People with dry mouth
  • People with HIV or other chronic disease (like diabetes)

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How might problems in my mouth be linked to health problems in other parts of my body?

The health of your mouth can be a sign of your body's health. Mouth problems are not just cavities, toothaches, and crooked or stained teeth. Many diseases, such as diabetes, heart disease, HIV, cancer, and some eating disorders are linked with oral health problems. Regular dental exams help you maintain good oral health and avoid related health problems.

Cancer. If you are being treated for cancer, you may develop sores or other problems with your mouth. Pay attention to your mouth each day, and remember to brush and floss gently. Call your doctor or nurse if you notice a mouth problem, or if an old problem gets worse. See also: I'm starting cancer treatment. How can I best take care of my mouth?

Diabetes. People with diabetes are at special risk for gum disease. Gum disease can lead to painful chewing and even tooth loss. Dry mouth, often a symptom of undetected diabetes, can cause soreness, ulcers, infections, and tooth decay. People with diabetes can also get thrush. Smoking makes these problems worse. By controlling your blood glucose, brushing and flossing every day, and visiting a dentist regularly, you can help prevent gum disease. If your diabetes is not under control, you are more likely to develop problems in your mouth.

Heart disease.  Before some dental treatments, patients who have certain heart conditions or joint replacements may take antibiotics. These people may be at risk of getting an infection when bacteria that lives in the mouth goes into the bloodstream during treatment. Antibiotics lower this risk. Talk to your doctor or dentist if you are not sure whether you should take antibiotics before dental treatment.

HIV. Oral problems are common in people with HIV because of a weak immune system. These problems can make it hard to eat. If mouth pain or tenderness makes it hard to chew and swallow, or if you can't taste food like you used to, you may not eat enough. The most common mouth problems linked with HIV can be treated.

Nutrition problems. Sometimes people who are missing teeth have to limit their food choices because of chewing problems. This can lead to a lack of vitamins in the body. If you are missing teeth and have trouble chewing, check with your doctor to make sure you are eating the right foods.

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I'm afraid of the dentist. What can I do to make my visit better?

Many people get nervous at the thought of visiting the dentist. Don'tlet your nerves stop you from having regular appointments, though. Waiting too long to take care of your teeth may make things worse. Here are a few tips to make your visit easier:

  • Tell the dentist and dental staff that you are feeling anxious. Getting your concerns out in the open will let your dentist adapt the treatment to your needs.
  • Try to choose a time for your dental visit when you're less likely to be rushed or under pressure. For some people, that means a Saturday or an early-morning appointment.
  • If the sound of the drill bothers you, bring a portable audio player and headset so you can listen to your favorite music. During the dental visit you might try visualizing yourself someplace relaxing, like on a warm beach.
  • Ask your dentist if there are medications he or she can give you to help you relax (this is sometimes called "sedation dentistry").

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As a woman, why do I have to worry about oral health?

Everyone needs to take care of their oral health. But female hormones can lead to an increase in some problems, such as:

  • Cold sores and canker sores
  • Dry mouth
  • Changes in taste
  • Higher risk of gum disease

Taking good care of your teeth and gums can help you avoid or lessen oral health problems.

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I'm pregnant. Do I need to take special care of my mouth?

Yes! If you are pregnant, you have special oral health needs.

Before you become pregnant, it is best to have regular dental checkups. You want to keep your mouth in good health before your pregnancy.

Also, remember that what you eat affects the development of your unborn child — including teeth. Your baby's teeth begin to grow during the third and sixth months of pregnancy, so it is important that you eat a balanced diet that includes calcium, protein, phosphorous, and vitamins A, C, and D.

If you are pregnant:

  • Have a complete oral exam early in your pregnancy. Because you are pregnant, your dentist might not take routine x-rays. But if you need x-rays, the health risk to your unborn baby is small.
  • Remember dental work during pregnancy is safe. The best time for treatment is between the 14th and 20th weeks. In the last months, you might be uncomfortable sitting in a dental chair.
  • Have all needed dental treatments. If you avoid treatment, you may risk your own and your baby's health.
  • Use good oral hygiene to control your risk of gum diseases. Pregnant women may have changes in taste and develop red, swollen gums that bleed easily. This condition is called pregnancy gingivitis. Both poor oral hygiene and higher hormone levels can cause pregnancy gingivitis. Until now, it was thought that having gum disease could raise your risk of having a low-birth-weight baby. Researchers have not been able to confirm this link, but studies are still under way to learn more.

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I'm a new mother. What can I do for my baby's oral health?

You can do a lot! Below are some things you need to know about your baby's oral health.

  • The same germs that cause tooth decay in your mouth can be passed to your baby. Do not put your baby's items, such as toys, spoons, bottles, or pacifiers in your mouth.
  • Wipe your baby's teeth and gums with a clean gauze pad or baby toothbrush after each nursing and feeding. This can help remove sugars found in milk that can cause tooth decay and also get your baby used to having her teeth cleaned on a regular basis.
  • If you bottle-feed your baby, try to finish bottle weaning by age 1. Avoid giving your baby bottles or pacifiers at naps and bedtime. Sucking on a bottle when lying down can cause cavities and lead to "baby bottle tooth decay."
  • All babies should visit a dentist by age 1. The dentist will screen for problems in your baby's mouth. You will also be shown how to care for your child's teeth and mouth.
  • Talk with your doctor about the best water choices for infants. Fluoride is good for teeth. But too much fluoride can harm development of tooth enamel in infants.

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I'm starting cancer treatment. How can I best take care of my mouth?

Cancer treatment can cause side effects in your mouth. A dental checkup before treatment starts can help prevent painful mouth problems. Serious side effects in the mouth can delay, or even stop, cancer treatment. To fight cancer best, your cancer care team should include a dentist. A dentist will help protect your mouth, teeth, and jaw bones from damage caused by head and neck radiation and chemotherapy.

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I'm confused! What type of toothpaste or mouthwash should I use?

So many different kinds of toothpaste are available today. Some say they're made for whitening, others for reducing gingivitis and plaque, and others for sensitive teeth. Before choosing toothpaste for your family, know the basics.

ADA accepted: American Dental Association
  • As long as toothpaste contains fluoride and its box has the American Dental Association's (ADA) seal of acceptance, it is good for your oral health. Beyond that, choosing toothpastes is a personal choice.
  • Mouthwashes claim to freshen your breath. But they really only mask breath odor for a few hours. If you always need to use a mouthwash to hide bad breath, see your dentist.
  • You can also use a tongue scraper to freshen breath. A tongue scraper removes food particles trapped in the pits along the tongue's surface. Brushing your tongue with your toothbrush can also remove these bits of food.

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I'm not happy with the stains on my teeth. How can I safely whiten them?

There are three ways that you can whiten your teeth:

  • In-office bleaching
  • At-home bleaching
  • Whitening toothpastes

The first thing you should do before whitening your teeth is talk to your dentist. He or she will be able to help you decide the best option for you. Whiteners will not fix all kinds of stains. Also, if you have bonding or tooth-colored fillings, these will not be affected by whiteners and they may stand out if you whiten your teeth. Remember that a using a whitener does not make your mouth healthier.

In-office bleaching.
This kind of whitening, called "chairside bleaching," is done in your dentist's office. It may require more than one office visit. Each visit may take from 30 minutes to one hour. During chairside bleaching, the dentist puts a whitener on the teeth and uses a special light to make the whitener work. Lasers are sometimes used during tooth whitening to make the whitening agent work better.

At-home bleaching.
There are a few different products that can be used to whiten teeth at home. Some come from your dentist, and others can be bought over-the-counter. These contain peroxide(s), which bleach the tooth enamel. Most come in a gel and are placed in a mouth guard or tray that fits inside your mouth. They help many types of staining. Only the dentist-dispensed solutions have the American Dental Association (ADA) seal.

Other over-the-counter whitening products include whitening strips, paint-on products, gels, and trays. They have a low amount of peroxide. For better results, have a cleaning at the dentist before you use these products. These gels and trays do not have the ADA seal.

Whitening toothpastes.
All toothpastes help remove surface stains through mild abrasives. "Whitening" toothpastes that have the ADA seal have special polishing agents or chemicals that remove even more stains. Unlike bleaches, these products do not change the actual color of teeth. They help surface stains only.

Products used to whiten teeth can make teeth more sensitive. They can also bother your gums. These side effects most often go away after you stop using the product.

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What small, easy steps can I take to have a healthy teeth and gums?

1. Brush your teeth at least twice each day with fluoride toothpaste.
Aim for first thing in the morning and before going to bed. Once a day, use floss or an interdental cleaner to remove food your toothbrush missed. Make sure you:

  • Drink water that contains added fluoride if you can. Fluoride protects against dental decay. Most public water systems in the United States have added fluoride. Check with your community's water or health department to find out if there is fluoride in your water. You also may want to use a fluoride mouth rinse, along with brushing and flossing, to help prevent tooth decay.
  • Gently brush all sides of your teeth with a soft-bristled brush. Round and short back-and-forth strokes work best.
  • Take time to brush along the gum line, and lightly brush your tongue to help remove plaque and food.
  • Ask your dentist or dental hygienist to show you the best way to floss your teeth.
  • Change your toothbrush every three months, or earlier if the toothbrush looks worn or the bristles spread out. A new toothbrush removes more plaque.
  • If you wear dentures, be sure to remove them at night and clean them before putting them back in the next morning.

2. Have a healthy lifestyle.

  • Eat healthy meals. Cut down on tooth decay by brushing after meals. Avoid snacking on sugary or starchy foods between meals.
  • Don't smoke. It raises your risk of gum disease, oral and throat cancers, and oral fungal infections. It also affects the color of your teeth and the smell of your breath.
  • Limit alcohol use to one drink per day for women. Heavy alcohol use raises your risk of oral and throat cancers. Using alcohol and tobacco together raises your risk of oral cancers more than using one alone.
  • Limit how much soda you drink. Even diet soda contains acids that can erode tooth enamel.

3. Get regular checkups.

  • Have an oral exam once or twice a year. Your dentist may recommend more or fewer visits depending on your oral health. At most routine visits, the dentist and a dental hygienist will treat you. During regular checkups, dentists look for signs of diseases, infections, problems, injuries, and oral cancer.
  • See your dentist right away if:
    • Your gums bleed often
    • You see any red or white patches on the gums, tongue, or floor of the mouth
    • You have mouth or jaw pain that won't go away
    • You have sores that do not heal within two weeks
    • You have problems swallowing or chewing
  • Besides your dentist, there are other types of dental providers. Your dentist may send you to a specialist if you need extra care. Other providers include:
    • Dental hygienists: Members of the dental staff who clean gums and teeth and teach patients how to maintain good oral health.
    • Periodontists: Dentists who treat gum disease and place dental implants.
    • Oral surgeons: Dentists who operate on your mouth and supporting tissues.
    • Orthodontists: Dentists who straighten teeth and align jaws.
    • Endodontists: Dentists who perform root canals.
    • Prosthodontists: Dentists trained in restoring and replacing teeth.

4. Follow your dentist's advice.
Your dentist may suggest ways to keep your mouth healthy. He or she can teach you how to properly floss or brush. Follow any recommended steps or treatments to keep your mouth healthy.

5. If you have another health problem, think about how it may affect your oral health.
For instance, if you take medicines that give you a dry mouth, ask your doctor or nurse if there are other drugs you can use. Have an oral exam before starting cancer treatment. And if you have diabetes, practice good oral hygiene to prevent gum disease.

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More information on oral health

For more information about oral health, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

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The information on our website is provided by the U.S. federal government and is in the public domain. This public information is not copyrighted and may be reproduced without permission, though citation of each source is appreciated.

Oral health fact sheet was reviewed by:

Marian Mehegan, D.D.S., M.P.H.
CAPT, USPHS
Regional Women's Health Coordinator
USDHHS Office on Women's Health

Content last updated: July 16, 2012.

Resources last updated: November 17, 2010.

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