Oral Health 293

Oral Health

Oral refers to the mouth, which includes the teeth, gums, and 

supporting tissues. And having a healthy mouth means more 

than just having nice-looking teeth—your whole mouth needs 

care. It is also important to be aware that many serious diseases, 

such as diabetes, HIV, and some eating disorders, can cause 

oral health problems. Regular oral exams will help manage any 

problems and maintain good oral health. There is also a lot you 

can do on your own to protect and preserve your oral health.

Steps to a healthy mouth

Use good oral hygiene

l	 Drink fluoridated water. 

l	 Brush your teeth at 

least twice each day 

with fluoride toothpaste. Look for the 

American Dental Association’s (ADA) Seal of Acceptance.

l	 Floss daily. 

l	 Gently brush all sides of your teeth 

with a soft bristled brush and toothpaste. Circular and short back-andforth strokes work best. 

l	 Take time to brush along the gum line. 

Brush your tongue lightly.

l	 Change your toothbrush when the 

bristles spread out, or at least every 3 

months. 

l	 If you wear dentures, remove them at 

night and clean them before putting 

them back in. 

Choose a healthy lifestyle

l	 Don’t use tobacco. It raises your 

risk of getting gum disease, oral 

and throat cancers, and oral fungal 

infections.

l	 Limit alcohol use. Heavy alcohol use 

raises your risk of oral and throat 

cancers.
294 The Healthy Woman: A Complete Guide for All Ages

l	 Using alcohol and tobacco together 

raise your risk of oral cancer even more 

than using one alone.

l	 Eat a well-balanced diet and healthy 

snacks.

l	 Limit soft drinks. Even diet sodas 

contain acid that can erode tooth 

enamel.

Have 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, you will be 

treated by the dentist and a dental hygienist. A thorough checkup includes:

l	 A health history and oral exam of your 

teeth and gums. You will be examined 

for changes, problems, signs of oral 

cancer or other diseases, and overall 

oral health.

l	 Teeth cleaning and polishing to remove hardened plaque and stains.

l	 X-rays of the teeth and mouth to look 

for cavities, injury, and problems below the gumline. How often you need 

x-rays depends on your health, age, 

disease risk, and symptoms. Radiation 

risk is very low. 

See your dentist right away if:

l	 Your gums bleed often.

l	 You see red or white patches on the 

gums, tongue, or floor of the mouth 

that last more than 1 to 2 weeks.

l	 You have mouth or jaw pain that does 

not go away.

l	 You have mouth sores that do not heal 

within 2 weeks.

l	 You have problems swallowing or 

chewing.

Types of Oral Health Care 

Providers

Dentists: Specialists in the care of 

the teeth, gums, and mouth. Dentists 

who specialize in children are pediatric 

dentists.

Dental hygienists: Members of the 

dental staff who clean gums and teeth 

and teach patients how to maintain 

good oral health. 

Dental specialists: Many dentists 

have advanced training in certain 

areas. Your general dentist may refer 

you to one of these specialists for 

more advanced treatments:

• Periodontists: Dentists who treat 

gum disease and place dental 

implants. 

• Oral surgeons: Dentists who operate on the 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.
Oral Health 295

Your teeth, decay, and cavities

Teeth vary in size, shape, and location 

in the jaws. Teeth start to form under 

the gums well before you are born. Most 

people are born with 20 primary (baby) 

teeth. These teeth start to push through 

the gums at around 5 to 6 months of age. 

All 20 baby teeth usually erupt by about 

age 2. Baby teeth are then lost as early as 

age 6 and are usually all gone by age 13. 

Permanent teeth then fill in. By age 21 

most people have 32 permanent teeth—

28 if wisdom teeth are removed.

Everyone is at risk of tooth decay, or 

cavities (CAV-ih-teez). Tooth decay is 

one of the most common oral health 

problems.

Bacteria that naturally live in your 

mouth use sugar in food to make acids. 

Over time, these acids destroy the outside layer of your teeth, causing holes 

Anatomy of a Tooth

Crown

Neck

Roots

Jawbone

Enamel

Pulp

Dentin

Cementum

Periodontal 

Ligaments

Gums

and other tooth damage. There are ways 

to help prevent tooth decay. Your dentist 

may use:

l	 Fluoride (FLOR-eyed) – A mineral 

that helps prevent tooth decay. Studies show fluoride to be safe, and only 

small amounts are needed for good 

oral health. The level of fluoride in 

drinking water varies, so use fluoride 

toothpaste. Many mouth rinses, gels, 

and supplements also contain fluoride.

 Depending on your risk of tooth decay, 

dentists will sometimes put fluoride on 

your teeth during dental visits.

l	 Sealants (SEE-luhnts) – Clear, plastic 

coatings put mainly on the chewing 

surfaces of the back teeth to prevent 

tooth decay.

Dentists can also treat cavities by “filling” 

them. Some materials used to fill cavities 

include, but are not limited to:

l	 dental amalgam (uh-MAL-guhm) 

(silver), made of liquid mercury and a 

powder made of metals and tooth-col-
296 The Healthy Woman: A Complete Guide for All Ages

ored plastic composite materials. Studies have shown amalgams to be safe.

l	 composite (white)

l	 gold

l	 ceramics

l	 porcelain

Gum diseases

Gum diseases are infections caused by 

bacteria in the mouth, along with mucus 

and other particles that form a sticky 

plaque on the teeth. 

Gingivitis (jin-juh-VEYE-tuhss) is a 

mild form of gum disease that causes 

gums to become red and swollen and to 

bleed easily. It can be caused by plaque 

buildup. Plaque that is not removed hardens and forms “tartar.” The longer plaque 

and tartar are on teeth, the more harm 

they do. Gingivitis can most often be 

reversed with daily brushing and flossing 

and with regular cleanings at the dentist’s 

office. Gingivitis does not cause loss of 

bone or tissue surrounding the teeth.

When gingivitis is not treated, it may 

advance to periodontitis (pair-ee-ohdon-TEYE-tuhss). Then the gums pull 

away from the teeth and form infected 

“pockets.” You also may lose supporting 

bone. Left untreated, teeth loosen over 

time and must be removed.

You are at higher risk of gum disease if 

you smoke or have diabetes or HIV.

Normal, healthy gums 

Healthy gums and bone 

anchor teeth firmly in place.

Periodontitis 

Unremoved plaque hardens 

into calculus (tartar). As plaque 

and tartar continue to build, the 

gums pull away from the teeth 

and pockets form between the 

teeth and gums. Bone supporting the teeth may become 

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.
Oral Health 297

Oral Cancer

Oral cancer can affect any part of the mouth. People who smoke or chew tobacco are 

at higher risk. Alcohol use along with smoking greatly raises risk. Yet more than 25 

percent of oral cancers affect nonsmokers.

Warning signs include:

• A sore that bleeds easily or does not heal.

• A color change in the mouth.

• A lump, rough spot, or other change.

• Pain, tenderness, or numbness anywhere in the mouth or on the lips.

• Trouble chewing, swallowing, speaking, or moving the jaw or tongue.

• A change in the way your teeth fit together. Your dentist should check for signs of 

oral cancer at each dental exam.

Early detection is important for the prevention and treatment of oral cancer.

Other Common Oral Health Problems 

Burning mouth

What it is A burning feeling in the mouth or tongue.

Causes The cause is unknown. Most common in postmenopausal women, the condition may be 

linked to:

• Hormones • Dry mouth

• Taste problems • Nutritional deficiencies

• Use of ACE inhibitors (blood pressure medicines)

Treatment Treatment depends on the cause—if it can be determined—and may include:

• Menopausal hormone therapy

• Vitamin supplements

• Pain medicines or other medicines

Canker sores (aphthous ulcers)

What it is Small, open ulcers in the mouth. They are white with a red border.

Causes The cause is unknown, but immune system problems may be one cause. A cut inside your 

mouth can also cause a canker sore to develop. 

Fatigue, stress, trauma, or allergies can trigger canker sores. Some women get canker sores 

during menstruation. And women are more likely than men to have canker sores that recur. 

People with celiac disease or Crohn’s disease also are more likely to develop canker sores.

Treatment Sores heal by themselves in 1 to 3 weeks. See your dentist if you get a large sore (larger than a 

half inch) because you may need medicine. Also see your dentist if you get canker sores often.

To ease pain:

• Avoid hot, spicy foods

• Use mild mouthwashes or salt water

• Try over-the-counter coatings or pain medicines
298 The Healthy Woman: A Complete Guide for All Ages

Other Common Oral Health Problems 

Cold sores—herpes simplex virus type 1 (HSV-1)

What it is Small, painful blisters caused by herpes simplex virus type 1 (HSV-1).

Causes A contagious viral infection. Changes in hormone levels during menstruation may trigger cold 

sores.

Treatment Over-the-counter medicines to relieve pain while sores heal, which takes about 7 to 10 days. 

If you get frequent cold sores, talk with your doctor or dentist about antiviral drugs to reduce 

healing time and the number of new sores.

Halitosis (hal-lih-TOH-suhss)

What it is Bad-smelling breath

Causes • Poor oral hygiene 

• Some foods

• Dentures

• Gum disease

• Dry mouth

• Tobacco use

• Respiratory, digestive, or other health problems

• Some medicines

Treatment • Brush and floss at least twice a day

• Brush your tongue or use a tongue scraper

• Eat more fruits and vegetables 

• Treat gum disease 

• Avoid tobacco

• See your dentist for help

Mouthwashes only mask breath odor for a few hours. If you always need mouthwash to hide 

bad breath, see your dentist.

Osteonecrosis (OSS-tee-oh-nuh-croh-suhss)

What it is When bone becomes infected and dies. It can happen around the teeth or in the jaws.

Causes Cancer and cancer treatments, infection, some medicines.

Treatment Treatment may include surgery to remove bone.

Taste disorders

What it is • Loss of some or all of your sense of taste

• A change in what tastes good and bad

Causes The many causes include:

• Colds • Sinus problems

• Head or nerve injury • Some medicines

• Lack of proper nutrition • Oral cancer

• Tobacco use • Radiation treatment

• Aging

Treatment If you notice a lasting change (more than 2 weeks, or after you stop using tobacco) in how 

you taste food and drink, see your health provider.
Oral Health 299

Other Common Oral Health Problems 

Thrush, or oral candidiasis (kan-dih-DEYE-uh-suhss)

What it is A fungal infection in the mouth or throat. It can cause white patches in the mouth with red 

tissue underneath that may bleed when the white patches are wiped off.

Causes Often caused by overgrowth of the fungus Candida, which lives in your mouth naturally. You 

are at greater risk if your resistance to infection is low, you make very little saliva, or you take 

antibiotics.

Treatment Antifungal mouthwash or lozenges. 

You may need stronger medicine if the infection spreads or your immune system is weak.

If your infection is from having a weak immune system, your doctor or dentist may have you 

take antifungal medicine on a regular basis.

Xerostomia (ZEER-oh-STOH-mee-uh) (dry mouth)

What it is Not having enough saliva in your mouth.

Causes Salivary glands do not make enough saliva. Dry mouth is more common in women than men 

and may be a:

• Side effect of medicines or medical treatment 

• Health problem such as saliva and salivary gland disorders, Sjögren’s (SHO-grins) syndrome, or rheumatoid arthritis (ROO-muh-toid ar-THREYE-tuhss) (For more information, see 

the Autoimmune Diseases chapter on page 83.)

• Blockage of a salivary gland 

Treatment • Medicines that stimulate the salivary glands

• Artificial saliva

• Changes in medicines or health treatments 

• Tobacco and alcohol avoidance

• Dietary changes, such as avoiding spicy and salty foods, sipping water often, and using 

sugarless candy or gum

• Nighttime humidifier 

See your oral health provider if the above treatments do not lessen your symptoms.

Other problems

What is it Oral health problems from other health conditions or treatments

Causes Many health issues can lead to oral heal problems. Three common causes are:

Chemotherapy for any cancer treatment can cause temporary dry mouth, painful mouth 

sores, and cracked, peeling lips.

Radiation treatment to the head and neck can cause permanent dry mouth, tooth decay, 

painful mouth sores, and cracked peeling lips.

HIV/AIDS can lead to many oral health problems, such as fungal and viral infections, lesions 

on the lips and tongue, warts, and white patches on the tongue.

Treatment To maintain oral health, have regular dental and medical visits, use all prescribed medicines, 

and use good oral hygiene. See an oral health provider before you start cancer treatment.

Joint or muscle problems such as temporomandibular joint dysfunction (TMJ) can 

also cause oral or facial pain. For more information on TMJ, see page 358 of the 

Pain chapter.
300 The Healthy Woman: A Complete Guide for All Ages

Tooth arrangement and tooth loss

There are a variety of treatments for tooth 

arrangement problems and tooth loss:

l	 Orthodontics: Braces can fix crooked 

teeth, overbites, underbites, jaw-joint 

problems, and jaw position.

l	 Dental bridges: A dental bridge is a 

way to replace missing teeth. Healthy 

teeth are capped to hold the bridge in 

the mouth.

l	 Dental implants: If you lose a permanent tooth, it can also be replaced with 

an implant. Implants are small posts 

put into your upper or lower jaw bone 

to hold a replacement tooth or set of 

teeth.

l	 Dentures: If you lose all your teeth, 

dentures will be made to replace them. 

They are removable and can look quite 

natural. If you lose some of your teeth, 

a partial denture can made to replace 

them.

Pregnancy and oral health l	

Before you become pregnant, it is best to 

have dental checkups every 6 months to 

keep your mouth in the best health possible before your pregnancy.

If you are pregnant and have not had 

regular checkups, consider the following:

l	 Have a complete oral exam early in 

your pregnancy. Because you are pregnant, you might not receive routine 

x-rays. But if you must have x-rays for 

a dental problem requiring treatment, 

the health risk to your unborn baby is 

small.

l	 Dental treatment during pregnancy 

is safe. The best time for treatment 

is between the 14th and 20th weeks. 

During the last months of pregnancy, 

you might be uncomfortable sitting in 

a dental chair. 

l	 Do not avoid necessary dental 

treatments––you may risk your 

and your baby’s health.

l	 Your dentist may need to avoid giving 

you certain medicines that could affect 

your baby, such as the antibiotic tetracycline. 

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. It can be caused by both poor 

oral hygiene and higher hormone levels during pregnancy. Until recently, it 

was thought that having gum disease 

could raise your risk of having a lowbirth-weight baby. Researchers have 

not been able to confirm this link, but 

some research is still under way to 

learn more.

After you give birth, maintain good 

oral hygiene to protect your baby’s oral 

health. Bacteria that cause cavities can 
Oral Health 301

transfer from you to your child by a kiss 

on the mouth, letting your baby put her 

fingers in your mouth, tasting food on 

your baby’s spoon, or testing the temperature of a baby bottle with your mouth.

Common cosmetic issues

l	 Teeth whitening: Options vary in 

price and effectiveness. Talk with 

your dentist before using them to figure out what is best for you. Whitening your teeth does not make them 

healthier.

l	 Tongue studs: Jewelry worn in your 

tongue after it is pierced. Tongue studs 

put you at risk of chipped teeth, nerve 

and gum damage, and infections. If 

you decide to get a tongue stud, talk 

with your dentist and have the piercing done by a medical professional.

Dental Work: Antibiotics and 

Your Heart

According to the American Heart Association, most people with heart problems do not need short-term antibiotics before dental treatments. Antibiotics may be used before certain dental 

treatments to help prevent infective 

endocarditis—infection of the heart’s 

inner lining or valves—if you have:

• artificial heart valves

• a history of infective endocarditis

• certain serious congenital heart 

conditions 

• a cardiac transplant that develops a 

problem in a heart valve

If you have questions, discuss them 

with your oral health provider.

Low-Cost Dental Services

Clinical trials Oral health clinical trials (research studies) may provide limited free or lowcost dental treatment. To see if you qualify for any current studies, contact 

the National Institute of Dental and Craniofacial Research. Contacts are listed 

in the resource section on page 303.

Dental schools Most schools let dental students treat patients at reduced costs. For a full list 

of dental schools, see the American Dental Association listed in the resource 

section on page 303.

Community health To find community health centers that provide free or low-cost dental care, 

centers call (888) ASK-HRSA (888-275-4772) or visit the HRSA Information Center at 

www.hrsa.gov/pc.

State and local resources Call your local or state health department to find out about financial assistance programs.

Centers for Medicare and For information about low-cost health insurance, call (877) 267-2323.

Medicaid Services

Good oral hygiene and regular dental 

checkups are vital to a healthy mouth. 

If you have problems or questions about 

oral health, see your dentist. For information about oral health issues, see the 

resources at the end of this chapter. A 

healthy mouth can keep you smiling for 

a lifetime. n
302 The Healthy Woman: A Complete Guide for All Ages

One Woman’s Story

Almost everyone has heard of “early detection.” But what do you think of when you hear these 

words? Do you picture a woman having a mammogram or remind yourself to schedule your next Pap Oral cancer is 

test? We may be familiar with screening for breast 

and cervical cancers, but this is not yet the case for 

oral cancer. We need to become more aware of oral 

as common as 

cancer so that we can prevent this deadly disease 

before it begins. leukemia...

Oral cancer often follows changes in your mouth 

that look like white or red patches or spots. Your 

dentist should identify such changes, test them, and 

remove those that have the potential to become cancerous or are early cancer growths. 

Early detection is critical to improving survival rates. Right now, fewer than half the people 

diagnosed with oral cancer are able to survive more than 5 years after the disease is first 

found. Oral cancer is as common as leukemia and claims more lives than either melanoma or cervical cancer. Risk factors include the use of tobacco or alcohol or both, but 

up to 25 percent of oral cancer patients have no known risk factors. For women, the incidence of oral cancer has increased, mainly due to smoking. 

Regular dental exams are important and should also involve an examination of the head 

and neck to check for oral cancer. This involves looking at the hard and soft tissues of the 

mouth to detect abnormal color change or growths and feeling lymph nodes of the head 

and neck to detect abnormal swelling. Dentists and dental hygienists are taught to carry 

out this full exam for all their patients as part of the routine 6-month dental checkup. 

I’m a dentist, and I make sure to get a complete dental exam and cleaning every 6 

months. It’s become so routine for me that I don’t pay attention once I’ve hopped into the 

dental chair. I assume the dental team will ensure that my mouth is healthy. 

But sure enough, one appointment I had with a very popular dentist in a well-established 

practice came and went without any effort by the dentist or hygienist to check for oral 

cancer. I was surprised and disappointed. How many of his patients were leaving their 

appointment without realizing an important part of their dental exam was missing? How 

many oral cancers were being missed?

I realize that dental exams aren’t routine for everyone, but everyone should know what 

they are entitled to expect during one. Oral cancer can happen to anyone, so make sure 

you know your risk and get checked—early detection saves lives!

Mary, Dentist and Patient

Boston, Massachusetts
Oral Health 303

For More Information...

Office on Women’s Health, HHS

200 Independence Ave SW, Room 712E

Washington, DC 20201

Web site: www.womenshealth.gov/faq/

oral_health.htm

Phone number: (800) 994-9662, 

(888) 220-5446 TDD

Division of Oral Health, CDC

4770 Buford Highway NE, MS F-10

Atlanta, GA 30341

Web site: www.cdc.gov/oralhealth

Phone number: (800) 232-4636, 

(888) 232-6348 TTY

National Oral Health Information 

Clearinghouse, NIH

1 NOHIC Way

Bethesda, MD 20892-3500

Web site: www.nidcr.nih.gov

Phone number: (301) 402-7364

Academy of General Dentistry

211 E Chicago Ave, Ste 900 

Chicago, IL 60611-1999

Web site: www.agd.org/public

American Academy of Periodontology

737 N Michigan Ave, Suite 800

Chicago, IL 60611-6660

Web site: www.perio.org

American Association of Orthodontists

401 N Lindbergh Blvd

St Louis, MO 63141-7816

Web site: www.braces.org

American Dental Association

211 East Chicago Ave

Chicago, IL 60611-2678

Web site: www.ada.org