ADA Patient Education Library

What is the focus of your child’s beautiful SMILE? Strong, healthy teeth!Baby teeth-also called primary teeth-are important in the growth and development of a child. Baby teeth can help your child chew foods and speak. They also hold space in the jaws for adult teeth that are growing under the gums.

Babies are born without teeth. Usually baby teeth start to appear in the mouth when the child is 6 months old. By the third birthday, most children have a full set of 20 baby teeth including incisors, canines and molars.

The chart below tells the names of baby teeth, when they come in (erupt) and when they fall out (are shed). Baby teeth be will replaced by permanent (adult) teeth. However, not all children get the same teeth at the same times. Your child’s teeth may erupt earlier or later than the times shown here.

Baby (Primary) Teeth

What causes tooth decay?

The bacteria that cause decay are in everyone’s mouths. Babies get these decay-causing bacteria from their caregivers, mom and dad, just as we all are exposed to germs in our families. These bacteria then stick onto the baby teeth. Brushing the teeth to clean off the bacteria is important to keep teeth healthy. Bacteria on the teeth use the sugar in foods and drinks and turn it into acid. Each time your child eats or drinks, this acid can attack the teeth for 20 minutes or longer after eating or drinking. Over time, enamel gets damaged, tooth decay develops and cavities appear.Children are more likely to get decay if their teeth are in contact with sugar often or for long periods of time. Babies should not be put to bed with a bottle. If your baby falls asleep with the bottle in his or her mouth, the liquid in the bottle pools around the teeth. Liquids such as fruit juice, soda and even milk contain sugar. Plain water in a bottle or sippy cup at the end of the day is a better choice.

Decay in baby teeth

Begin Dental Visits Early

Protect your child’s teeth by starting dental checkups early. The American Dental Association and the American Academy of Pediatric Dentistry recommend that the first dental visit should occur when the baby’s first tooth appears, but no later than the child’s first birthday.

Why schedule a visit so early? A dentist can show you how to clean your child’s teeth, talk about feeding, oral habits and recommend dental care products. He or she also can help you make sure your child is getting the right amount of fluoride (FLOOR-ide), a natural mineral that protects teeth. And your dentist can answer questions about your baby’s teeth.

Having a well-baby checkup at this age also connects your child to a dental home. This is a place where you can take your child from year to year. This helps the dentist get to know your child’s and family’s needs, so your child will have the best care.

If your child is a toddler, the dentist will gently examine his or her teeth and gums, looking for decay and other problems. The dentist may also clean the child’s teeth. Your toddler can also be checked for problems related to habits such as thumb or finger sucking.

Fluoride treatments and dental sealants are two important ways your dentist can prevent cavities. Dental sealants are a coating that the dentist puts on the grooves of your child’s back teeth to protect them. Your dentist will let you know if these treatments are right for your child.

Children need strong, healthy teeth to chew their food, speak and smile. Your child’s teeth also help give his or her face its shape and keep space in the jaw for adult teeth.

A baby’s teeth start to come in when the baby is about six months old. Baby teeth will later be lost one by one. This makes space for adult (permanent) teeth. By the time children are teenagers, they usually have all of their adult teeth. The last four teeth that come in are the wisdom teeth.

The charts below tell the names of the baby and adult teeth. The pictures show when each tooth usually comes in and is lost. But not all children get the same teeth at the same times. Your child’s teeth may erupt earlier or later than the ages in these charts.

Healthy baby (primary) teeth

Healthy adult (permanent) teeth

The Transition

Adult teeth start to form under the baby teeth. After the baby teeth are lost, the adult teeth will come in through the gums.

Most children go through a stage when they have a mix of primary and permanent teeth. During this time the smile can look uneven, with some big teeth, some small teeth, some crowded teeth or maybe even some missing teeth. Try not to worry. Smiles often even out once all the permanent teeth are in place.

When your child is about age seven, the dentist will do a “bite check” to make sure your child’s adult teeth are coming in properly and that the back teeth are working together the way they should. You dentist may also take an x-ray of the teeth. If your child’s teeth or bite need treatment, it’s best to get an early start.

A bridge is a replacement tooth or teeth that fill the space where one or more teeth are missing. The bridge restores your bite and helps keep the natural shape of your face.

Before you get a bridge, your dentist wants you to know more about the steps involved. He or she can advise which type of bridge is best for you.

Why Do I Need a Bridge?

A missing tooth is a serious matter. Teeth are made to work together. When you lose a tooth, the nearby teeth may tilt or drift into the empty space. The teeth in the opposite jaw may also shift up or down toward the space. This can affect your bite and place more stress on your teeth and jaw joints, possibly causing pain.

Teeth that have tipped or drifted are also harder to clean. This puts them at a higher risk for tooth decay and gum disease.

When a tooth is missing, the bone may shrink. If that happens, it may change the way the jawbone supports the lips and cheeks. Over time, this can make your face look older.

How Do I Replace a Tooth?

Placing a bridge usually takes more than one dental visit. On the first visit, your dentist prepares the teeth on both sides of the gap. He or she will later attach the bridge to these teeth.

Your dentist then takes an impression or an image of your teeth and the space and sends it to a dental laboratory. Technicians at the lab make the bridge. Your dentist will place a temporary bridge to protect your prepared teeth while you are waiting for the permanent bridge.

When the permanent bridge is ready, the dentist fits, adjusts and cements the bridge to the prepared teeth. This type of bridge is permanent and cannot be taken out of your mouth without a dentist’s help.

Fixed Bridge Placement

Missing tooth

Teeth next to the space are prepared for placement of the bridge.

The custom-made bridge is placed over the prepared teeth.

The bridge is cemented into place.

Do I Need Implants?

Dental implants may be used to support a bridge when several teeth are missing. Implants are posts that are surgically placed into the jaw. Over time, the bone grows around the implants to hold them in place.

• A key benefit of implants is that they don’t need support from the surrounding teeth.
• Candidates for dental implants should be in good general health and have enough bone to support an implant. For some patients, implants help preserve the jawbone where teeth have been lost.
• Implants may be placed in one day or might require multiple visits depending on your dentist’s treatment plan.

Implant-Supported Bridge

Missing teeth

A bridge is placed on implants

After the bridge is placed

What Materials Are Used in a Bridge?

Bridges are made from metal, ceramics (porcelain) or a combination of the two. Ceramics often are bonded to a metal alloy. Your dentist will talk with you about the materials that are best for you and your mouth.

Caring for Your Bridge

A bridge can fail if the support teeth or the jawbone is damaged by dental disease. Follow these tips for good oral health:

• Brush your teeth twice a day and floss or use another between-the-teeth cleaner once a day. Brushing and cleaning between the teeth helps remove plaque, a sticky film of bacteria that is always forming on the teeth.
• See your dentist regularly for exams and professional cleanings.
• Eat a healthy diet.

Your gum disease treatment will depend on several factors, including your personal health history and the stage of your gum disease. This page covers:

• Professional Cleaning
• Deep Cleaning – Scaling and Root Planing
• Periodontal Surgery
• Bone Graft Surgery and Guided Tissue Regeneration
• Keeping your teeth and gums healthy after treatment

Professional Cleaning

In the very early stages – when it is gingivitis – you may just need a professional cleaning from your dental team. They can also give you some great advice and tips on how you can keep your teeth and gums healthy.

Deep Cleaning – Scaling and Root Planing

If your gum disease is beyond gingivitis, the first step in treating gum disease usually involves a special deep cleaning called scaling (SCAY-ling) and root planing (PLAY-ning). This treatment may be done over more than one visit, depending on your personal needs.

Scaling:

Your dentist or hygienist removes plaque and tartar down to the bottom of each periodontal pocket.

Root Planing:

Then, the root surfaces of your teeth are smoothed, or “planed”, to allow the gum tissue to heal and reattach to the teeth.

Your dentist or hygienist may recommend certain medicines to help control infection and discomfort or to aid healing. You may be given pills, a mouthrinse or they may place medication directly into the periodontal pocket after the treatment.

Scaling removes plaque and tartar from below the gumline.

Root planing smoothes the tooth root and helps the gums reattach to the tooth.

Healed pocket after treatment.

Periodontal Surgery

Sometimes, scaling and root planing isn’t enough treatment on its own. If pockets do not heal enough after scaling and root planing, gum surgery may be needed.

Surgery allows your dentist to remove plaque and tartar from hard-to-reach areas. Afterwards, your gums will be stitched into place to tightly hug your teeth.

Surgery can also help to shrink pocket depth and make it easier for you to keep your teeth clean.

Probe shows pockets due to gum disease. Gums are inflamed and bone loss has occured.

The bone is contoured and any remaining tartar is removed.

Healed site after periodontal surgery.

Bone Graft Surgery and Guided Tissue Regeneration

If bone has been damaged or lost by gum disease, then you may need surgery to rebuild or reshape the bone in your mouth. This kind of surgery is called a bone graft.

First, your dentist may use splints, bite guards or other types of tools to hold loose teeth in place and help tissues heal. If too much gum or bone tissue has been lost from your gum disease, he or she may need to also do a bone graft.

Your dentist may place a membrane layer at the surgical area to help your gums stay in place while the tooth root reattaches to the supporting bone tissues. This is called guided tissue regeneration.

To help you heal after surgery, your dentist may put a protective dressing over the area and recommend or prescribe a medicated mouthrinse. You may also be given a prescription to treat infection or for pain relief.

Diseased tissue is removed from the pocket. In some cases, the bone may be reshaped.

Bone has been reshaped.

Grafting material is placed over the bone. A membrane covers the grafting material.

After the healing period

Keep your Gums Healthy After Treatment

Periodic periodontal cleanings help you stay on top of your gum disease

Once your gum disease is under control, it is very important for you to get dental care on a consistent basis. The periodic cleanings recommended after these treatments are called periodontal maintenance care. These cleanings are more extensive than the standard cleaning and will help you keep your gums healthy. Your periodontal maintenance involves cleanings that are deeper than a normal cleaning in the dental office. With periodic maintenance, the amount of plaque bacteria is lowered. Then, the inflammation can get better, pockets can shrink and your gums can become healthier.

Plan for more visits to the dentist

You will need to see your dentist more often than other people. The pockets and other issues from your gum disease will make it harder for you to clean plaque from your teeth.

Your dentist will talk to you about a treatment plan that works best for you, and he or she will recommend a maintenance care schedule that is based on your personal case. Over time, fewer appointments may be necessary. Once your gums are healthy, your dentist will determine a maintenance schedule based on your clinical evaluations.

Once your gums are healthy, your dentist will determine a maintenance schedule based on your clinical evaluations.

Medication

You may also need special medications than can help control the infection and pain or to help your gums heal. The medicine could be a pill, a special mouthrinse, or a medication that your dentist places directly into the pocket right after deep cleaning.

You may have sensitive teeth and gums after your treatment

Your teeth and gums may be sensitive after your treatment. This soreness may make you want to avoid cleaning the treated areas. But it’s important to follow your dentist’s instructions on home care! If plaque is not removed, root decay may form. Talk with your dentist or hygienist if a special toothpaste or other treatments can lower your tooth sensitivity.

Don’t Use Tobacco!

Smoking, chewing, vaping and dipping puts you at a higher risk for cancer and other life-threatening diseases. Tobacco use also can make gum disease worse and make it harder to treat it. If you use tobacco, ask your dentist or physician for information about how to quit.

Tooth Decay in Baby Teeth

Did you know that tooth decay is the most common long-term childhood disease? Children of any age can get tooth decay, even babies and toddlers. And tooth decay is five times more common than asthma. The good news is that tooth decay can be prevented!

How does tooth decay affect baby teeth?

Tooth decay in the primary (baby) teeth of young children is also called early childhood caries. Caries is another word for a cavity. It happens when the child’s teeth come into contact with sugary foods and drinks often and for long periods of time. These drinks include fruit juices, soda and other drinks with sugar.

Parents are often surprised to learn that tooth decay can begin as soon as a baby’s teeth come in, usually by age six months. Decay in baby teeth can cause pain, and the infection can spread. If decay is not treated, it can destroy the baby teeth.

Tooth decay can also have an effect on a child’s general health. If a child has tooth pain, she may have trouble eating. The child may not get enough vitamins and minerals to grow up healthy.

Decay in Baby Teeth

1. Healthy baby teeth

2. Moderate to severe decay

3. Moderate to severe decay

4. Severe decay

Why are baby teeth important?

Baby teeth hold space in the jaw for the adult teeth. If a baby tooth is lost too early, the teeth beside it may drift into the empty space. When it’s time for the adult teeth to come in, there may not be enough room for them. This may cause adult teeth to be crowded and crooked. Crooked teeth may be hard to keep clean.

If a baby tooth is lost too early, the teeth beside it may drift into the empty space.

If a child’s baby teeth are healthy, it is more likely his adult teeth will be healthy too. Children who have decay in their baby teeth are more likely to have decay in their adult teeth.

Decayed and crooked teeth also can affect your child’s self-esteem. Tooth decay is not only unhealthy, it also looks bad. If your child has tooth decay he may feel bad about his smile. On the other hand, a nice-looking smile can give your child confidence at school.

How to keep your child’s teeth healthy

Children learn healthy habits from their parents and caregivers. You can start good habits if you clean your child’s teeth every day, feed your child a healthy diet and take her to the dentist regularly.

Clean your child’s teeth at home

• Wipe the baby’s gums with a clean, wet gauze pad or washcloth after each feeding, before sleep. This removes bits of food that can harm teeth that are starting to come in. It also helps the child get used to having his mouth cleaned.
• As soon as the first tooth appears, start brushing your baby’s teeth twice a day (morning and night). Use a soft-bristled, child-sized toothbrush and a fluoride toothpaste. Until the child is three years old, use no more than a smear or grain-of-rice-sized amount of fluoride toothpaste. For children three to six years old, use no more than a pea-sized amount of fluoride toothpaste.
• The American Dental Association recommends that you brush your child’s teeth until she is at least six years old. When your child is old enough to do the brushing, watch to make sure she is not “rushing the brushing.” Children should be taught to spit out toothpaste, not swallow it.

For children under three years old

For children three to six years old

Bottles, pacifiers and breastfeeding

• Infants should finish their bedtime or naptime bottle before going to bed.
• After your child’s first tooth comes in, he should not be allowed to breastfeed constantly or fall asleep while breastfeeding.
• Infants should not be put to bed or allowed to fall asleep with a bottle that contains milk, formula, fruit juices, or any liquids with sugar. Even watered-down drinks can damage teeth.
• If your child uses a pacifier, don’t dip it in sugar or honey. Also, do not put it in your mouth before giving it to the child. Decay-causing bacteria in your mouth can be passed to your baby.
• A bottle should not be used as a pacifier. Frequent sips of sugary liquids can cause tooth decay.

Training (“sippy”) cups

• To lower the risk of tooth decay, try to get your child to drink from a cup by her first birthday.
• Do not let your baby constantly sip on liquids with sugar (including juice drinks). Offer these liquids only at mealtimes. Keep the cup out of reach while the child is in a car or stroller. If your child is thirsty between snacks or meals, offer water in the cup.
• Training cups should be used for only a short time. Once your child has learned how to sip, the training cup is no longer needed and should be set aside.

A healthy diet builds strong teeth

• Limit between-meal snacks.
• Avoid using sweet foods and drinks to reward your child.
• If your child eats sweets, make sure it is with a meal.
• Infants and young children should have a healthy diet. Information can be found at www.choosemyplate.gov.

First Dental Visit

• Talk to your dentist about planning the child’s first dental visit. It’s helpful to have the first visit after the baby’s first tooth appears but no later than the first birthday. This first visit is a “well-baby checkup” for your child’s teeth.
• At this visit, the dentist can check for decay and other problems. He or she can show you how to properly clean your child’s teeth.
• Also, the dentist may offer advice on your child’s diet, pacifier use, and oral care products for your family. He or she can tell you how to prevent injuries to your child’s teeth and mouth and what to do in case of a dental emergency.
• Children should get the ideal level of fluoride to help prevent tooth decay. Ask your child’s dentist about how your child can get the right amount of fluoride.

Your mouth is a window into the health of your body

Insight about your overall health can sometimes be seen in your mouth. In fact, periodontal (perry-oh-DON-tal) – or gum – disease is common in people with chronic diseases like heart disease or diabetes. This page explains the connection between your oral health and your overall health.

What you should know about gum disease

Gum disease is an infection and inflammation that affects the tissues and bone that support your teeth. The infection is caused by the bacteria in plaque, a sticky film that’s always on your teeth. Your body reacts to the infection and your gums will become inflamed – red, puffy and swollen.

If left unchecked, gum disease affects the tissues and bone that support your teeth. It is the most common reason why adults lose teeth.

Gingivitis

When your body reacts to this infection and your gums are inflamed, this condition is called gingivitis (jin-ja-VY-tis), and it can lead to more serious types of gum disease. The good news about gingivitis is that it can be reversed.

If the gum disease is caught early enough (when it is gingivitis), you may simply need a professional cleaning. Your dental team can also give you advice for improving your daily oral hygiene.

Periodontitis

If gingivitis is not treated, it can turn into periodontitis (perry-o-don-TIE-tis). Periodontitis is usually not painful, but it can lead to bone loss.

Effects of gum disease

Healthy gums and bone hold teeth firmly in place.

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Periodontitis happens over time, as plaque builds up along the gum line.

Your body responds to the toxins that the bacteria produce by breaking down the gum tissues and bone around your teeth.

Warning signs of gum disease:

• gums that bleed when you brush or floss
• gums that are red, swollen, puffy or tender
• gums that no longer tightly hug your teeth
• bad breath that doesn’t go away
• pus between your teeth and gums
• feeling that your teeth are loose
• a change in the way your teeth fit together when you bite
• a change in the way your partial dentures fit

You may notice one or some of these warning signs, or you may not have any signs of gum disease at all. This is why it’s important to see your dentist regularly – treatment of gum disease is most successful when it’s caught early.

Using tobacco raises your risk of gum disease

Keeping your teeth and gums healthy is very important.

Using tobacco products of any kind (cigarettes, dip/chew, e-cigs, hookah, etc.) is a common risk factor for many chronic diseases including gum disease. Tobacco increases the risk of getting gum disease. The disease can also get worse the longer you use tobacco.

Many of the medications used to treat other diseases can affect your mouth by causing dry mouth. These include medications used to treat blood pressure, allergies, and pain. Dry mouth can increase your risk of tooth decay and gum disease.

Did you know that your dentist screens you for cancer at every visit?

Oral cancers can be deadly diseases. Each year in the United States, roughly 45,000 new cases of mouth and throat cancer are diagnosed, and about 13% of people die within the same year they are diagnosed.

Treatment may be more successful with oral cancers that are found early. Your dentist checks for these cancers every time you visit, so this is one more reason to see your dentist regularly.

This brochure will tell you some ways to lower your risk for mouth and throat cancer. And by watching for the signs and symptoms listed here, you are more likely to find the cancer earlier if you do have it.

What Are the Signs and Symptoms?

Below is a list of mouth and throat cancer signs and symptoms. Check your mouth in the mirror each day when you brush and floss. If there are any changes in your mouth or neck, or if you notice any of these signs or symptoms, contact your dentist.

Signs and symptoms of oral (mouth) cancer:

• A sore or irritation that doesn’t go away
• Red or white patches
• Pain, tenderness or numbness in mouth or lips
• A lump, thickening, rough spot, crust or small eroded area
• Difficulty chewing, swallowing, speaking, or moving your jaw or tongue
• A change in the way your teeth fit together when you close your mouth

Cancer on the tongue

Cancer on the lip

Leukoplakia (which can turn into cancer) inside the cheek

Additional signs and symptoms of throat cancer include:

• Lump or growth in the throat or neck area
• Cough or sore throat that doesn’t go away
• Ear ache
• Trouble with swallowing
• Hoarseness or other changes in your voice

Throat cancer affecting the base of the tongue and the tonsils.

Am I at Risk for Oral Cancer?

Anyone can get cancer. There are some factors that you may control – such as smoking cigarettes or chewing tobacco, heavy alcohol consumption, and exposure to the human papillomavirus (HPV) – which increase your risk of developing of developing oral cancer. Below is more information about factors that can affect your chance of developing mouth or throat cancer.

• Infection with HPV is associated with increased risk of developing oral cancers. HPV is very common and many people are not even aware that they have been infected.
• Tobacco associated risk, which includes chewing tobacco or smoking cigarettes, cigars or pipes, is affected by the amount of tobacco you use and the length of time you’ve been doing it. When you quit using tobacco, your risk of developing oral cancer continues to go down. In ten years of being tobacco free, your risk is about the same as someone who never smoked or chewed.
• People who use tobacco products and drink alcohol have a greater chance of developing oral cancer than if they only did one or the other.
• Spending long periods of time in the sun increases your risk of developing higher risk for lip cancer.
• Eating too few fruits and vegetables may increase your risk for developing oral cancer.
• The risk of mouth and throat cancer increases with age. Though not always the case, it can occur more often in people over the age of 40.

How Can I Lower My Risk for Mouth and Throat Cancer?

• As part of your oral hygiene routine, watch for changes in the soft tissues of your mouth.
• Avoid all tobacco products, including cigarettes and chewing tobacco
• Avoid heavy alcohol use.
• If sexually active, practice safe sex to prevent the spread of HPV
• Eat a diet rich in fruits and vegetables
• Visit your dentist for regular oral cancer screenings.

How Can My Dentist Help?

During a dental exam, your dentist will check your face, neck and mouth for lumps, red or white patches, and sore areas that do not heal. Your dentist may check you for oral cancer visually, manually, with special screening tools, or with a combination of these methods.

Be sure to tell your dentist if you notice any changes in your mouth and/or neck. If signs of cancer are found early, treatment may be more successful.

Be aware of any changes in your mouth and throat. If you have any concerns about mouth and throat cancer, talk with your dentist. It may help save your life.

Do you have frequent headaches, earaches, tender jaw muscles or a dull, aching facial pain? Does your jaw lock or stray to one side when you open your mouth? These aches and pains may be related to the jaw joint, called the temporomandibular (tem-PORO-man-DIB-u-lar) joint or “TMJ,” and the muscles that work to move the joint. When the source of these problems is this joint or its muscles, they are often referred to as “TMD” for temporomandibular disorders.

Temporomandibular joint (TMJ)

Signs and symptoms

A temporomandibular disorder is a condition, not a specific disease. TMDs can have many different signs and symptoms, from mild to severe. Some patients may have symptoms but are still able to fully function in their everyday lives. TMDs appear to be more common in women. Specific signs and symptoms include:

• pain in or around the ear
• tender jaw muscles
• clicking or popping noises in the jaw
• difficulty opening or closing the mouth
• pain when yawning or chewing
• jaw joints that feel as if they are “locked,” “stuck” or they “go out”
• headaches

What causes TMD?

Several conditions may be linked with TMD. This often makes it difficult to pinpoint the cause of a particular case of TMD. These conditions include:

• jaw or head injuries
• diseases that affect the muscles or joints, such as arthritis
• tooth grinding
• anxiety and/or stress

To determine how best to treat your TMD, a complete evaluation is recommended. Your dentist may check the joints and muscles for tenderness, clicking, popping or difficulty moving. Your complete medical history may be reviewed, so it is important to keep your dental office record up-to-date about your health even though you may not think it has anything to do with your teeth. Your dentist may take X-rays of your teeth, jaw or TMJ, and may make a model of your teeth to see how your bite fits together.

How the jaw joints and muscles work

The joints and muscles on each side of your jaw work to open and close the mouth. These joints move in many different directions to give you the range of motion needed to chew, talk and swallow.

The two temporomandibular joints are among the most complex joints in the body. They work together in a delicate balance with muscles, ligaments, cartilage and your jaw bones. Pain can result when these parts don’t work together properly.

Treatment Options

For some patients, the disorders may disappear by themselves; for others, they may come and go, or may worsen over time. TMD disorders are often managed, rather than cured. Your general dentist may recommend treatment, or refer you to a physician or dental specialist.

There are a number of ways in which TMD may be managed. Success likely will require you and your dentist working together to find what the approach that relieve your symptoms.

Treatment may involve a series of steps. The step-by-step plan will allow you to try simple treatment before moving on to something that is more involved. Experts generally recommend a “less is often best” approach to treating TMJ disorders. This means that the simplest treatment that provides you with pain relief may be the best for you.

In some cases, your dentist may recommend fixing an uneven bite by adjusting or reshaping some teeth. Orthodontic treatment may also be recommended.

Mouth sores can be painful, annoying and unsightly.

Some appear inside the mouth – on the gums, tongue, lips, cheeks or palate (roof of the mouth). Others, like cold sores, can appear outside the mouth, such as on and around the lips, under the nose and on the chin.

Although there are many types of mouth sores, the most common are canker sores, cold sores, leukoplakia (a thick white or gray patch) and candidiasis or thrush (a fungal infection).

Some people may experience occasional discolored, painless spots in their mouth. Most are harmless and will disappear or remain unchanged. However, some sores or spots can be serious and need the attention of your dentist or physician. For example, oral cancer may not be painful at first, but it can be deadly. That’s why regular dental checkups are important. Have your dentist examine any mouth sore or spot that fails to heal within two weeks.

Canker Sores

Canker sores appear inside the mouth. They usually are small ulcers (minor aphthous ulcers) with a white, yellow or gray center and a flat red border. Rarely, canker sores can be very large (major aphthous ulcers) with a raised border. There may be one or several ulcers and they recur at varying periods of time.A canker sore usually begins as a red spot or bump. It may produce a tingling or burning sensation before other symptoms appear. Canker sores are painful. Fortunately, most canker sores heal spontaneously in 7 to 10 days.

The exact cause of canker sores is not known. Genetics play a role. White cells (lymphocytes) in our immune system may affect the lining of the mouth causing these irritating, but harmless, sores. Fatigue, emotional stress, and certain foods can increase the possibility of a canker sore for some people. Even biting the inside of the cheek or tongue or chewing a sharp piece of food may trigger a canker sore.

Canker sores are not contagious or precancerous. There is no permanent cure for canker sores; therefore, treatment is for discomfort or pain. Over-the-counter topical medications (such as numbing agents or protective ointments) and antimicrobial (germ-fighting) mouth rinses may offer temporary relief. Avoid hot, spicy or acidic foods and beverages that can irritate the sore. Treatment for an attack involves corticosteroids, Prednisone-like medications that control troublesome lymphocytes. The medication may be in a topical form (applied to the skin), or systemic (taken as a tablet or capsule).

Cold Sores

Cold sores are groups of painful, fluid-filled blisters (often called fever blisters). These unsightly sores usually erupt on the lips, and sometimes on skin around the lips. Clusters of small blisters may also occur on the gum tissue near the teeth and/or on the bony roof of the mouth.

Cold sores – caused by herpes virus Type 1 or Type 2 – are contagious. The initial infection (primary herpes), which often occurs before adulthood, may be confused with a cold or the flu. The infection can cause painful lesions to erupt throughout the mouth, and some patients can be quite ill for a week. Most people who get infected with herpes do not get sick, however. Once a person is infected with herpes, the virus stays in the body, where it may remain inactive. Unfortunately, in some people, the virus becomes activated periodically, causing the cold sore to appear on the lips or other sites. A variety of irritants (wind, sun, fever, stress) can cause a flare.

Cold sores usually heal in about a week. Once the blister breaks, an unsightly scab forms. Over-the-counter topical anesthetics and protectants, anti-inflammatory agents or topical antiviral agents may provide temporary relief for the discomfort but do little to speed healing. As with the common cold, there is no cure for these viral infections. Topical or systemic antiviral drugs can be prescribed by your dentist, but they are ineffective after 3 to 4 days of blister formation and usually are not recommended in otherwise healthy patients.

Leukoplakia

Leukoplakia (loo-koh-PLAY-kee-ah) is a white or gray patch that develops anywhere on the inside of the mouth. It is caused by excess cell growth of the lining of the mouth. It is often a response to chronic irritation, such as smoking or smokeless tobacco (snuff, chewing tobacco), certain foods, cheek biting, irregular dental restorations or broken teeth. In some instances, a cause cannot be determined. Leukoplakia patches develop slowly over a period of time. The patch may eventually become rough. It typically is not sensitive or painful.

Leukoplakia generally is harmless, but there is a risk that it can become cancerous. To be certain that a spot or sore is not a threat, your dentist may do a biopsy to determine if any potentially dangerous cells are present. If the leukoplakia is sensitive, cancer must be ruled out by biopsy.

Erythroplakia

Erythroplakia (e-ryth-ro-PLAY-ki-a) is a red patch that may be found in any part of the mouth but is most common in the floor of the mouth or on the gum tissue behind the back teeth. The cause is unknown but is most likely associated with smoking or other tobacco use and alcoholic beverages. Chronic irritation and poor nutrition may also be contributing factors. Although erythroplakia is less common than leukoplakia, most of these lesions are found to be precancerous or cancerous when biopsied. Red lesions that do not heal in a week or two should be evaluated by your dentist. This applies even if you do not smoke or drink alcohol.

Lichen Planus

Lichen planus (li-ken PLAY-nus) is a disorder that involves a chronic, itchy, inflammatory rash or lesion on the skin or in the mouth. The lesions may consist of white spots or “lacelike” white changes. Lesions on the sides of the tongue, insides of the cheek and on the gums, may be tender or painful. Its cause is genetic and related to a chronic immune system reaction.

Lichen planus generally occurs during or after middle age. Lichen planus is not contagious and does not pose a high risk for becoming cancer. There is no cure, so treatment is for discomfort or pain. Rinses, ointments, or pills can be prescribed by your dentist, if needed. The diagnosis can be confirmed by biopsy and clinical characteristics.

Candidiasis

Candidiasis (can-di-DI-a-sis), also known as oral thrush or moniliasis, is a fungal infection. It produces creamy white and red patches that form on surfaces of the mouth. It can be painful and may cause bad breath and difficulty tasting and/or swallowing.

It occurs when the yeast Candida albicans reproduce in abnormally large numbers. For example, Candida may flourish after antibiotic treatment, when normal bacteria in the mouth have decreased, when the immune system is suppressed or when the mouth is dry (xerostomia). Dry mouth is a common side effect of many prescription or over-the-counter medications.

Candidiasis most often occurs in the very young, the elderly, and those debilitated by disease, such as diabetes and AIDS. It also frequently occurs among people who wear dentures.

Treatment consists of controlling conditions that cause the outbreak. Cleaning dentures to remove Candida is important in preventing denture-induced problems.

Saliva substitutes or prescription medications are also available to treat dry mouth. Antifungal medications may be used when the underlying cause cannot be treated or eliminated. Good oral hygiene is essential.

Oral Cancer

Oral or mouth cancer may appear on the lips, tongue, cheek lining, gums, palate (roof of the mouth) or floor of the mouth. Cigarettes and other tobacco products, including smokeless tobacco, are associated with 70 percent of oral cancer cases. Drinking alcoholic beverages can also increase your chances of having oral cancer.

Oral cancer may appear as a white or red lesion, lump or ulcer. It is usually small and painless at first, but can grow and spread quickly. Many oral cancers are discovered during routine dental examinations. Control of leukoplakia and erythroplakia may prevent some oral cancers from developing. Some oral cancers can resemble benign (non-dangerous) changes, so may delay early diagnosis. Early diagnosis and treatment increase the chance of a good quality of life.

When your teeth are healthy, your gum tissue tightly hugs each of your teeth. But, when your gums pull away from your teeth, it is called gum recession (re-SESH-un). Gum recession can happen at any age.

Even if you take good care of your teeth, it is possible that gum recession may still happen.

Gum recession can cause problems for your teeth. Your dentist can help you understand what is causing it to happen and suggest a treatment.

Gum recession can leave the tooth root exposed. The root surface does not have a hard, protective layer covering like the top of the tooth, so it may become sensitive to hot and cold. The exposed tooth root is also more at risk for decay.

What causes gum recession?

• gum disease
• brushing your teeth too hard or using a toothbrush with hard bristles
• trauma to gum tissues, such as a sports injury
• partial dentures that don’t fit right
• genetics–some people are born with gums that are thin or weak
• larger-than-normal tooth roots or attachment muscles that can push gums out of place
• smoking and using any kind of tobacco

Gum recession of a tooth

Treatments

It is important to treat gum recession so that it doesn’t get worse and cause other problems. The type of treatment for gum recession depends on the cause.

If gum recession is caused by brushing too hard, your dentist or hygienist can show you a better way to clean your teeth. This will not repair the existing damage, but it will prevent new damage to your gums.

If gum recession is caused by periodontal (gum) disease, the first step is usually a deep cleaning treatment called scaling (SKAY-ling) and root planing (PLAY-ning). Your dentist removes plaque and tartar from your tooth and root surfaces. This helps gum tissues heal and reattach to the tooth. For many patients, this plus excellent oral care at home and regular dental visits can help control gum disease and recession.

If gum recession is caused by partial dentures that don’t fit right, your dentist can adjust or remake them for you.

If your recession is advanced, a gum graft may be needed. A thin piece of gum tissue is taken from another place in your mouth and attached where the gum tissue has receded. Once the graft heals, it covers the exposed tooth root.

Grafts may be done around one or more teeth. They protect the tooth root from sensitivity and decay. A graft can also be used to make a smile look better.

Before gum graft

After gum graft

Care after your treatment

If you have a gum graft, your dentist will tell you how to care for your gums. This may include using a special mouthrinse and changing what you eat. A bandage or dressing may be placed over the graft to help it heal.

Gum grafts are a kind of surgery and the area may be tender or sore and may swell. Most people are able to go back to their normal routines the next day. However, you may need to avoid chewing for a week or two where the surgery was done. Your dentist will talk with you about your specific healing time.

To help your gums heal after surgery:

• Avoid smoking or using any kind of tobacco.
• Do not drink alcohol.
• Follow all instructions from the dental team.

There are other things that can slow down healing. These include older age, grinding your teeth, not eating a healthy diet, and some medicines or health issues. Be sure to tell your dentist about all medications, drugs, or vitamins you are taking and health issues you may have.

After your gums have healed from surgery, keep your teeth and gums healthy by brushing gently twice a day with a fluoride toothpaste. Also, be sure to clean between your teeth daily with floss or another between-the-teeth cleaner. Look for products with the American Dental Association Seal of Acceptance. These products have been tested and proven to be both safe and effective in keeping your mouth healthy.