Gateway of Health

By ANSHUMAN JAMDADE and VAISHALI JAMDADE

Gateway of Health

Today's Medical Science is well equipped with advanced tools and techniques. But unfortunately, it focuses more on detection and treatments rather than on the cause and prevention of diseases. We too often spend time and money on correcting the problem but always ignore the actual cause of the problem. You need to hit the cause before it hit you. Prevention can make you not only healthy but wealthy too. It can save a lot for you. This book is about causes, risk factors, features, prevention, early detection, care to be taken, remedies and treatments of common and important diseases of teeth, gums, jaws, and mouth, and how oral health plays a pivotal role in overall health and in the ultimate outcome of pregnancy, systemic diseases, Covid-19, and in patients undergoing major therapies or surgeries. The information provided will help you in the prevention and early identification of not only oral but important systemic (body) diseases.

 

The mouth is not only the mirror but the gateway of systemic health. Good general health and quality of life cannot be complete without good oral health. Harmful microbes and their toxins from gums and tooth infections not only cause systemic diseases but badly influences the entire course of the disease. Poor oral hygiene during pregnancy can affect the developing baby and can lead to miscarriage, low birth weight, and premature delivery. Good oral hygiene not only prevents spread but complications of Covid-19, including death. So, just by keeping your mouth clean, you can not only save yours but others' lives too. Oral hygiene is the most effective and affordable method of preventing not just oral but systemic diseases and thereby improving overall health.

 

Treatment to correct crooked teeth or even wisdom teeth has become the norm in our society, but we have never taken steps to prevent this. Actually, the foundation of oral health has to be laid during childhood or even before birth. Oral care you need to take in your younger ones to ensure a healthy future. What precautions and care you are required to take during dental emergencies and post-dental treatments to prevent complications, minimize pain, preserve natural tissues, and speed up recovery. Oral cancer is one of the most common cancers and leading causes of death worldwide. It guides you about how to prevent oral cancer and even, how to catch it early before it becomes too late. It explains how to quit tobacco and how kicking smoking can make you a famous millionaire. Clear all your facts and myths about dental X-rays. The information about oral hygiene products will not only help you buy and use these products wisely but can save your money too.

 

This book has been created with the sole purpose of awareness and education about oral health amongst the people. Everything you always wanted to know about oral health and dentistry is answered in this book. However, it's not just about teeth but life having teeth. It also enlightened important information about how to balance healthy and happy life. Layman's language, clinical photographs along pictorial representations will save the reader's time and energy. Please read the whole book for a better understanding.  

 

Special features of the Book:

• Documented all our studies, experience, and research.
• Based on scientific evidence.
• Contain more than 300 pages and 200 images and illustrations for easy understanding.
• It cost less than the cost of your one-time oral hygiene kit.

• Language: English
• Publisher: ANSHUMAN JAMDADE
• Release date: Aug 22, 2021
• ISBN: 9798201722487

Book preview

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Gateway of Health

Anshuman Jamdade

Vaishali Jamdade

Copyright ©2021, Authors

All rights reserved. No part of this book should be reproduced, stored in retrieval system, or transmitted in any form or by any means, electronic, mechanical, including photocopying, recording, or otherwise, without the prior written permission of the authors.

Legal Notice:

You cannot amend, modify, sell, commercial use, quote or paraphrase any part of this book without the consent of the authors and publisher.

Disclaimer Notice:

This book has been published in good faith that the material provided by the authors is original. No warranties of any kind are expressed or implied. Readers acknowledge that the author is not engaging in the rendering of legal, financial, medical or professional advice. Please consult a licensed professional before attempting any techniques outlined in this book. Under no circumstances will any legal responsibility or blame be held against the authors and publishers (or future publisher) for any reparation, damages or monetary loss due to the information herein, either directly or indirectly, including, but not limited to, -errors, omissions, or inaccuracies. Neither the Authors nor the Publisher (or future publisher) assume any liability for any injury and/or damage to persons or property arising from this document. This book cannot be used for any medico-legal purposes.

Acknowledgements

We would like to thank Almighty God and our parents and teachers who have been our constant source of blessing and inspiration during all phases of creation of this book. We will forever remain indebted to our parents and teachers.

We would like to express our sincere thanks to Dr. ML Swarankar [Emeritus Chairperson, Mahatma Gandhi University of Medical Sciences and Technology (MGUMST)], Dr. Vikas Swarankar (Chairperson, MGUMST), Dr. Ram Ratan Soni (Managing Trustee, MGUMST), Dr. Sudhir Sachdev, Vice-Chancellor, MGUMST, Dr. Narendra Padiyar (Principal & Dean, Mahatma Gandhi Dental College & Hospital (MGDCH), Jaipur) and Dr. Deepak Raisingani (Vice-Principal, MGDCH) for providing us a serene environment to compile this e-book. We consider ourselves blessed that we are associated with Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, a great University which has always inspired and encouraged us. In fact, its dream comes true for us. Most of clinical photographs presented in this book are of patients attending OPD of MGDCH and obtained with courtesy from the ever helpful staff and PG students.

Our sincere thanks to our colleagues Dr. Sumant Prasad, Dr. Nikhil Marwah, Dr. Kamal Bajaj, Dr. Vikas Singh, Dr. Ashish Yadav, Dr. Manish Jain, Dr. Ruchika Tiwari, Dr. Satyapal Yadav, Dr. Neeraj Yadav, Dr. Amit Bamboo, Dr. Yogesh Sharma and Dr. Amrita Agarwal for their flawless support. We would also like to thank Dr. B. Srinivasan, Dr. Avinash Kshar, Dr. Aman Kataria, Dr. Sumit Grover and Dr. Sudhanshu Gupta for providing us photographs of their patients.

We immensely thank our daughters Aaradhya and Avani and our family for their support, love and care throughout development of this book. In the end we wish to thank publisher and all those who have helped us in completion of this book.

We will continue to learn and look forward to share our knowledge and experience with you.

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To Our Parents and Teachers

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About the Authors

Anshuman Jamdade, MDS (Oral Medicine and Radiology), is currently Professor and Head, Department of Oral Medicine and Radiology, Mahatma Gandhi Dental College and Hospital (A unit of Mahatma Gandhi University of Medical Sciences and Technology), Jaipur, INDIA. He is a dedicated teacher and has more than 18 years of experience in the subject of Oral Medicine and Radiology.

Vaishali Jamdade, MDS (Oral and Maxillofacial Surgery), is currently Senior Lecturer, Department of Oral and Maxillofacial Surgery, Mahatma Gandhi Dental College and Hospital (A unit of Mahatma Gandhi University of Medical Sciences and Technology), Jaipur, INDIA. She is a dedicated clinician and has more than 3 years of experience in the subject of Oral and Maxillofacial Surgery.

Table of Contents

Introduction

1. Tooth and Mouth Anatomy

2. Tooth Cavity/Decay

3. Gum Diseases

4. Teeth Stains

5. Milk Teeth (Baby Teeth)

6. Wisdom Tooth (Last Molar or Third Molar)

7. Tooth Wear

8. Tooth Injury

9. Misaligned/Crooked Teeth

10. Missing Teeth

11. Bad Breath (Halitosis)

12. Mouth Ulcers

13. Jaw Pain and Dysfunction (TMD)

14. Oral Cancer and Pre-Cancer

15. How to Quit Tobacco?

16. Oral Care in Systemic (Body) Diseases

17. Oral Care in Pregnancy

18. Dental Radiography (Teeth X-ray)

19. Dry Mouth (Xero-stomia)

20. Dental Emergencies

21. Post-Operative Care in Dentistry

22. Oral Health and Pandemic Infections (COVID-19)

23. Dental Sleep Medicine

24. Dentistry and Its Branches

Conclusion

References

Introduction

Today’s Medical Science is well equipped with advanced tools and techniques. But unfortunately it focuses more on detection and treatments rather than on cause and prevention of diseases. We too often spend time and money on correcting the problem but always ignore the actual cause of the problem. We have to be ahead in eliminating the cause rather than running behind throughout the life. Hit it before it hit you.

Tooth decay and gum disease are one of the most common diseases affecting mankind despite of many treatment measures. Mouth is not only the gateway but mirror of systemic (body) health. Many systemic diseases often manifested in the mouth and can be identified early from their oral picture. Oral health affects systemic health and vice-versa. Poor oral health not only linked with systemic diseases but badly influence their entire course. Poor oral hygiene during pregnancy can affect developing baby and can lead to complications such as miscarriage, low birth weight and premature delivery. Bacteria and toxins from gum disease can cause narrowing of important arteries which increases the risk of heart, liver or kidney diseases. Good oral hygiene not only prevents the spread but severity of respiratory pandemics such as Covid-19 infection. So, just by keeping your teeth and mouth clean, you can not only save yours but others lives too. Oral cancer is one of the most common cancers and leading causes of death worldwide. Oral cancer can be preventable as well as treatable. Oral problems such as misaligned or crooked teeth, wisdom tooth related complications or jaw pain and dysfunction are increasing now days. Poor oral care, bad oral habits such as thumb sucking or mouth breathing and refined food during childhood can affect development of their teeth, jaws, face and even body.

This book is about causes, risk factors, features, prevention, early detection, care to be taken and treatments of common and important diseases of teeth, gums, jaws and mouth and how oral health plays a pivotal role in the ultimate outcome of pregnancy, systemic diseases and in patients undergoing major therapies or surgeries. This information will help you in prevention and early identification of not only oral but important systemic diseases. It also explained how to prevent oral cancer or catch it before it becomes too late. What oral cares to be taken in systemic diseases and conditions? What cares required for successful dental treatments. What preventive measures you need to take in younger ones to ensure their healthy future. Book has also provided important information about how to maintain a healthy and happy life. This book has been created with sole purpose of awareness and education about oral health amongst the people. All you always wanted to know about oral health answered in the book. However, it’s not just about teeth but life having teeth. Layman’s language, clinical photographs along with pictorial representations will save reader’s time and energy in understanding oral health and care.

CHAPTER 1

Tooth and Mouth Anatomy

Teeth and mouth are beautiful unequaled creations. A function-less mouth is nothing but a life-less body. It is important to understand what is normal, then only you’ll be able to differentiate abnormal. Anatomically, mouth is a largest entry door of the body. Mouth is a cavity made up of teeth embedded in jaws and covered by a layer of mucosa from inside and a skin outside (Fig. 1.1). Mouth cavity is constantly flooded in saliva.

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Humans have two sets of teeth – 20 baby (milk) teeth and 32 adult (permanent) teeth. All 20 milk teeth erupt by the age of 3 years. The shedding of baby teeth and eruption of permanent teeth occur simultaneously. This process starts from the age of 6 years till 13 years of age (Fig. 1.2). By the age of 13 years, most children have a full set of permanent teeth (28 teeth) except 4 wisdom teeth (last or third molars) (Fig. 1.3). The wisdom teeth erupt between 17 to 21 years of age. In some individuals, either they do not develop or they do not erupt (get partially or completely blocked because of lack of space).

Baby teeth help child to bite and chew food, make the jaw grow to accommodate larger and stronger permanent teeth. Baby jaw isn’t large enough to hold adult teeth. So baby teeth act as space keeper for upcoming adult teeth. Meanwhile, children also learn how to keep their teeth and mouth clean.

Teeth help person to bite, chew, eat, speak, smile and gives shape to their jaws and face. Teeth help make the jaw and face to grow and develop. Teeth and mouth actually gives real pleasure of eating food, it’s not just filling but feeling. Teeth also help make the job of gut easier, which indirectly help to absorb vital nutrients and remove toxins from the body.

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Development of teeth starts inside the jaws even before birth. Baby teeth erupt first followed by permanent teeth (Fig. 1.3 and 1.4). Baby teeth shed (fall out) when their roots are resorbed by the push from growing permanent teeth.

Types of teeth

There are four types of teeth, and each plays an important role in different functions like eating, drinking and speaking. Functions of each type of teeth during eating as follow:

Incisors: Incisors are front teeth with blade edge that helps us to cut the food.

Canine: Canines are at corner of mouth with nail-like pointed part to tear and grasp the food.

Pre-molar: Help to crush and tear the food.

Molar: Molars are the main and large teeth that help us to chew and grind the food.

Structure of a tooth (Inside look of a tooth)

Each tooth consists of a crown and one or more roots. Molars have 2 or 3 roots. The remaining most teeth have single root. The approximate length of the tooth is around 2 cm. Crown is a working part that is visible above the gums. It is the only part of the tooth that you can see in mouth. It is approximately 1/3rd of total length of the tooth. Root is the unseen part that holds the tooth in the jawbones with the help of gums fibers (periodontal ligament). It is same like tree-roots that fasten and support the whole tree. Root is around 2/3rd of total length of the tooth.

Periodontal ligaments (Gums Fibers) attach the tooth to the bone and also work as shock absorber against chewing forces. Gums are a part of oral mucosa that surrounds and covers the neck of all teeth and supporting bone. Mucosa is a pink-colored, hair-less skin that lines the mouth cavity from inside. Gums are circumferentially attached like a collar around the neck of all teeth, and then firmly attached to the jaw-bones on both outer and inner sides. Root of the tooth is inside the bone while crown and neck are outside the bone. Tooth neck is present outside the bone but beneath the gums. Neck of the tooth is the junction between the crown and the root (Fig.1.5 – 1.8).

Tooth is a highly mineralized structure, hardest in the body that envelops the central soft structure (pulp). Each tooth is made up of four different tissues. Three of them - enamel, dentin and cementum are hard tissues. The fourth one is the soft tissue (pulp) that is present in the center of the tooth and contains nerves, blood vessels and connective tissue (glue that holds all tissues). Even though each tooth contains blood vessels inside, but all three of its hard tissues doesn’t have blood supply (Fig. 1.6). Therefore, tooth cannot regenerate or repair once damaged from decay or fracture. Only dentist can restore the damaged structure.

Enamel: Hardest mineralized structure in the body that covers the cover the dentin in the crown portion of the tooth. It provides strength to withstand pressure from chewing. It also protect teeth form bacteria and toxins. It has no living tissue (no nerves or blood vessels), just a mineralized layer, so never pain on damage or decay. Enamel is approximately 1 millimeter (mm) in thickness.

Dentin: 2nd hardest mineralized structure in the body that envelops whole central pulp tissue. It contains nerves but not blood vessels. When dentin loses its protective covering (enamel or cementum), nerve endings get exposed to hot, cold or acidic food or germs results in sensitivity. Dentin is approximately 2 mm in thickness. If dentin is exposed or involved by any means either decay or fracture or wear, your dentist can restore it with a filling or a crown. As long as your pulp is healthy, the tooth can be fixed with a filling or a crown.

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Cementum: 3rd hardest mineralized structure in the body that covers the dentin in the root part of the tooth. It gives attachments to the collar gums and gum fibers (periodontal ligaments). Gum fibers that attach the tooth to the jaw bone. Cementum is a micro-thin layer (200 microns) and gets easily abraded when exposed after gum recession. Therefore, receded gums if not treated in time, rarely come back to original position. Cementum and gums can be regenerated by regenerative gum surgery and preventive measures such as gentle brushing and gum massage.

Pulp: It is present in the center of each tooth. It contains nerves and blood vessels. If the pulp is damaged, treatment becomes more complicated, either root canal treatment (RCT) to save the tooth or extraction (removal) of the tooth followed by replacement with artificial one.

Soft Tissues of Mouth

Mouth mucosa is a pink-colored, hair-less skin that lines (covers) the oral cavity. Mouth mucosa is firmly attached to the underlying jaw-bones in the areas of gums and hard palate, while it is free and mobile in the areas of lips, cheeks, tongue, soft palate and remaining parts of the mouth. Gums are nothing but firm mouth mucosa. Gums are circumferentially attached to and surrounding the necks of all teeth like a collar and adjacent jaw-bone on both outer and inner sides (Fig. 1.9 – 1.12).

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Key-Points

Teeth

Enamel doesn’t contain nerves, so it doesn’t pain on getting damaged. That’s why; we usually miss decay in its early stage. You need to regularly inspect your oral cavity to catch decay early.

Dentin contains nerves. If your dentin gets exposed after loss of overlying enamel or cementum either due to cavity or injury or wear, your tooth can become sensitive to cold or hot beverages. Aggressive or flawed brushing technique causes wear of outer layer (enamel and cementum) and gum recession. Wear of outer layer usually occur at the neck of the tooth because enamel and cementum are very thin at the neck of the tooth that is near gum line.

Three most important disease-prone areas of the teeth are:

Inter-dental (between teeth) areas – very important area to focus – both decay and gum diseases usually occur in this area.

Natural or developmental pits and fissures on the biting surfaces of teeth – second most important area – decay commonly occur in this area.

Area below gum-line on outer and inner surfaces of teeth – third most important area - gum disease can also start in this area.

Food particles and germs get easily trapped in these areas and furthermore, these areas are not easily accessible and cleansable, results in decay or gum disease.

Mucosa

Oral mucosa is nothing but inner skin that covers inside of your mouth except crowns (heads) of teeth. Gums are nothing but oral mucosa, a firm oral mucosa. Oral mucosa has rich blood supply. Oral mucosa daily exposed to variety of germs and environmental factors. That’s why, its cells replicate faster. It is necessary to replenish shed cells. Cells shedding and replenishing is continuously going on. Hence, most systemic diseases are manifested in mouth either in early or late stages. Systemic disease is a disease that affects all parts (systems) of the body i.e. from hair to toe (e.g. Diabetes, Kidney disease, Blood disorders, Cancers, Hormonal or Immunological diseases etc.).Oral features of such diseases are either red or white patches or ulcerations or resorption (loss of minerals) of jaw-bones. These features may be an initial sign of oral cancer or a serious systemic disease. Therefore, regular self as well as professional check-up along with teeth X-rays can catch diseases of teeth as well as body early.

Conclusion

Hard tissues of teeth (enamel, dentin and cementum) doesn’t have blood supply, so once get damaged by cavity or injury cannot be repaired or regenerated by body itself, only dentist has to repair or replace it with an artificial filling or tooth.

Dental diseases (decay and gum disease) most commonly occur in inter-dental areas of back teeth. Inter-dental cleaning is very important especially of back teeth. You have to focus more on this area. We unnecessarily extra clean easily visible and accessible areas and regularly miss important areas. Remember, those extra strokes can wear down your teeth.

Most systemic diseases are manifested in oral mucosa either in early or late stages.

Most oral diseases including tooth decay, gum disease or even oral cancer are usually painless and will not give you any early warning. You need regular self as well as professional inspection of your oral cavity to catch disease early before it becomes too late.

CHAPTER 2

Tooth Cavity/Decay

Mouth is the only natural way of food intake. Mouth contains all types of microbes because of easy availability of food and easy access to body for survival. Primitive people have comparatively lesser cavities or gum problems, despite the fact they never brushed their teeth. Their raw (unprocessed) diet containing a great deal of roughage cleanses teeth during the chewing excursions. The diet itself kept the teeth clean and healthy by flushing away food and microbial deposits (plaque) from the surfaces of teeth and gums. It’s very difficult for microbes to breakdown unprocessed, raw food to satisfy their hunger. It’s like giving them raw seeds to eat. Such food keeps control over microbes, and maintains mouth and gut eco-system.

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But at the same time, excessive roughness in the primitive diet had also caused severe wear of their teeth. Therefore, primitive people had premature wear of their teeth. When humans shifted to farming and started eating more carbs/grains, bacteria in their mouth flourished, pouring out acids that rotted away teeth. The incidence of tooth decay was much more among first farmers than hunter-gatherers. In modern times, we tend to eat more refined (highly processed) sugary food to satisfy our craving for taste. Such food is detrimental not only to teeth but general health. Soft refined food tends to cling tenaciously to the teeth and is not removed easily. This modern refined diet made us weaker and porous. It’s very easy for microbes to breakdown such refined food. We need to balance these factors to maintain healthy mouth as well as body.

Causes (How a tooth gets decay or gum problems?)

Dental Plaque (Bacterial and food deposits) is the main cause of tooth decay and gum diseases. Dental plaque is a sticky invisible bacterial film formed when refined sugar or starches aren’t cleaned off your teeth; bacteria quickly begin feeding on them and form plaque. Plaque is a home for bacteria which provide protection and food for them. Plaque constantly forms in our mouth especially after meal. Acid released from plaque after bacterial breakdown of sugar causes decay and gum diseases. Carbohydrates (sugar and starches) can be easily broken down by bacteria compared to protein, fat and vitamins.

Cavity is formed at a particular point only after repeated fresh plaque formation and acid attack for longer duration. Cavity simply don’t form overnight by just few acid attacks. It takes months to form a cavity. That’s why Dentist always advice for periodic check-up at least every 6 months. Cavity/decay is not found in areas of tarter (hardened/dried plaque) accumulation. Acid is released only from fresh plaque not from dried plaque (tarter). Tarter is usually formed and accumulated in those areas where plaque not get removed and allowed to dry. Therefore, tarter is usually formed below the gum line. Tarter provide perfect hiding place for plaque to build under your gums. Tarter is firmly attached directly on the surfaces of teeth, not allowing cavity to form underneath it. Gum disease is formed in areas with tarter formation and repeated fresh plaque accumulation while cavities are formed in tooth surfaces only with repeated fresh plaque accumulation.

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RISK FACTORS

Food and Drinks

Frequent snacking and sipping of sugary/starchy food or drinks: High and frequent consumption of soft, refined, sticky, sugary or starchy food and beverages. Solid food cleared slowly from mouth than liquid, giving the plaque bacteria more time to produce acid. Solid sticky sugary food is worst as it tend to stay in close contact with teeth much longer. Frequent snacking or sipping between the meals that retain more sugar on the surfaces of the teeth compared to sugar consumed during meal. The clearance time of sugar from mouth and the frequency of intake are very important in tooth decay and gum disease than the total amount of sugar ingested.

Food containing carbohydrates and starches that sticks to your teeth for long time such as sugary foods, chocolate, sweets, cake, biscuits, sugary cereals, cereal bar, candies, pasta, bread, chips, crackers, jams, ice-cream, honey, mints, dried fruits, fruits canned in syrups, sauces, starches made from white flour, sugary drinks (tea, coffee, soda, cola, fruit juice, sport drinks) are more likely to cause decay/cavities than the food rich in protein, fat, leafy greens and fiber.

Carbonated drinks are loaded with sugars and acids that not only erode the enamel but make it vulnerable to decay. Even sugar-free sodas contain acids that can cause tooth erosion. Alcohol has bad effect on teeth and gums because of its sugar content. Alcohol causes dehydration and dry mouth. Saliva is required for cleansing and keeping mouth moist. Saliva also contains antibodies that help fighting out harmful microbes. Dry mouth increases the chances of decay and gum disease. It can also cause difficulty in tasting, chewing, swallowing and speaking.

Most fruits are acidic in nature mainly citric fruits; their acid can erode the enamel (outer layer), making teeth more vulnerable to decay. Citric fruits like lemon, oranges, grapes, blueberries, pineapples and pomegranate have higher amount of acids that can cause enamel erosion over time. Most fruits like mangoes, grapes, cherries, litchis, bananas, apple, papayas, pomegranates, pears and guavas contain natural sugar that can also cause decay. Some dried fruits too have higher sugar content. However, eating fruits is a great idea. Never stop it. Fruits contain important vitamins, minerals and anti-oxidants that help us to prevent and fight most diseases such as infection, cancer and heart diseases. While some firm fruits like apple, green guavas can help cleanse, disrupt the plaque, and fight bad breath. Papaya contains enzyme papain that helps to remove stains. Some fruits have natural antimicrobial properties. Natural sugar is usually a lesser cause of teeth problems than added, refined sugar.

Common Locations

Decay most often occurs in back teeth (Molars and Pre-molars). These teeth have lots of natural grooves and pits, which can collect food particles. Front teeth have smooth surfaces. As areas between front teeth are small and visible, that’s why, they are easy to clean. Even tongue can clean all parts of front teeth very easily. Decay is more common in inaccessible, non-cleansable, and invisible areas with easy food lodgment e.g. inter-dental surfaces (area between teeth), natural grooves and pits on the top (biting) surfaces of back teeth. Decay is also common in crowded areas of teeth.

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Naturally Strong or Weak Tooth

Enamel is a hard outer layer of tooth that serves to protect against decay. It is hardest structure in our body, even much stronger than bone. It is hard yet porous. Plaque produces acid that seep into the pores of the enamel and break down tooth’s internal structure results in Decay/Cavity. Cavity progresses if left untreated. In some people, enamel crystals are harder, thicker and more resistant to acid. Even if they don’t take much care of their teeth, they are having no or minimal cavities. If they take proper care, there will be no cavity. Stronger enamel is either of genetical origin or amalgamation of perfect environmental balance provided during teeth formation. This answers why some people never get cavity? The perfect environmental balance during teeth formation includes balanced diet, fluoride, balanced roughage in food, balanced forces (chewing) and proper care of milk teeth. Softer enamel is weaker and easily get breakdown to decay from acid attack. Weaker enamel is thin and more porous. It is usually associated with deeper grooves and pits that provide more hiding places to plaque. Pits and grooves makes teeth more vulnerable to decay. But if you take thorough care, there will be no cavity; no matter soft or hard enamel. Oral hygiene maintenance is difficult but not impossible.

Age

Tooth decay is more common in children than adults. Enamel layer in children (both in milk and freshly erupted permanent teeth) is thinner and softer (less mineralized) as compared to permanent teeth in adults. Children usually eat sugary food and do not take proper care of their teeth. That’s why children are more susceptible to decay. Balanced roughage in diet and chewing forces make help their teeth stronger. However, with time enamel in permanent teeth become thick as a part of defense reaction. Grooves and pits on teeth become shallower and cleansable. Optimal biting forces not only clean the teeth but limit the wear. The chance of cavity formation reduces with age. This doesn’t mean adults never get cavities. Balanced chewing forces and proper oral hygiene are the main positive factors. Some older adults are at risks of getting cavities. Faulty brushing technique or gum disease recede gums and provide hiding places