Tooth decay and gum disease are largely caused by plaque, a sticky combination of bacteria and food. Plaque begins to accumulate on teeth within 20 minutes after eating. If this plaque is not removed thoroughly each day, tooth decay will flourish. Over time, plaque will harden into tartar.

Plaque and tartar lead to a number of problems:

• Cavities -- holes that damage the structure of teeth
• Gingivitis -- swollen, inflamed, bleeding gums
• Periodontitis -- destruction of the ligaments and bone that support the teeth, often leading to tooth loss
• Bad breath (halitosis)
• Abscesses, pain, inability to use teeth
• A variety of health problems outside the mouth, from preterm labor to heart disease

Healthy teeth are clean and have no cavities. Healthy gums are pink and firm. To maintain healthy teeth and gums, follow these steps:

• Brush your teeth at least twice daily, preferably after every meal and at bedtime.
• Floss at least once per day.
• Schedule an appointment with a dentist for a routine cleaning and examination. Many dentists recommend having the teeth professionally cleaned every 6 months.
• Keep dentures, retainers, and other appliances clean. This includes regular brushing and may include soaking them in a cleansing solution.

Ask your dentist:

• What toothbrush you should use, and where your problem areas are located.
• How to properly floss your teeth. Overly vigorous or improper flossing may injure the gums.
• Whether you should use any special appliances or tools, such as water irrigation or electric toothbrushes. These may sometimes help supplement (but not replace) brushing and flossing.
• Whether you could benefit from particular toothpastes or mouth rinses. In some cases, over-the-counter pastes and rinses may be doing you more harm than good, depending on your condition.

Regular teeth cleaning by a dentist removes plaque that may develop even with careful brushing and flossing, especially in areas that are difficult for you to reach on your own. Professional cleaning includes scaling and polishing. This uses various instruments or devices to loosen and remove deposits from the teeth. Routine examination may include dental x-rays.

See also plaque identification at home.

Messadi DV, Younai FS. Halitosis. Dermatol Clin. 2003;21(1):147-155.