Cleaning Your Own Teeth

If you are concerned about keeping your roots and pockets clean while you are healing, get a drug store issue tartar scraper. You can clean your own teeth and keep any irritations removed from under your gums. You should not be too forceful with this tool because even though it is blunt, it can still remove natural material. Your teeth are not made of indestructible stone. You can test how well you have done at your dental checkups.

The tools that the oral practitioners use are sharp. Every time they clean your teeth they strip off some of the bone on your roots and some of the enamel off your teeth. If you are in pain after any cleaning, your body is trying to tell you that something is wrong. If they are using a painkiller while they are doing it, you cannot tell much damage they are doing while it is in progress. If you are in serious pain afterward, that pain is due to tissue damage. See the abstracts section for more information.

You can do a lot of damage to your gums with a toothbrush. You should be gentle around your gum line.

Here is a description of the gross anatomy of the main oral structures. This is not instructions on cleaning, but rather information on the teeth and the supporting tissues. This is provided so that you are aware of the various structures that are involved in your condition and how they are attached to eachother.

Overview of the Anatomy of the Tooth, Dentin, Enamel, Cementum, Pulp, Periodontal Membrane, Gingiva and Alveolar Bone

Tooth

All teeth consist of 2 gross anatomical portions, the crown which projects above your gingiva (gum tissue) and the tapering root. The root fits into a socket called the alveolus, which is in the alveolar bone of your mandible (jaw). The crown and root meet at the neck or cervix of the tooth. There is a cavity inside the tooth whose shape roughly corresponds with the outer form of the tooth. This cavity is called the pulp chamber or the cavity. It continues downward into each root as a narrow canal that communicates with the periodontal membrane through one or more openings, called the apical foramina, at the apex of the root. That means at the very bottom of each root tip, there is a small opening called the apical foramina that puts the pulp chamber in contact with the periodontal membrane for chemical communication with the rest of your system.

The hard portions of your teeth can be one of three different tissues. The three tissue types are the dentin, the enamel and the cementum. The bulk of a tooth is the dentin and the dentin surrounds the pulp chamber. The dentin is thickest in the crown and gradually tapers down in thickness as it reaches the apex of the root. The dentin is covered by enamel in the region of the crown. The enamel is thinnest in the cervical region (the place where your gum line should be). The root part of the tooth is covered with a thin layer of material called cementum. This layer extends from the neck of the tooth to the apical foramina at the apex.

The soft portions of a tooth are the pulp and the periodontal membrane. Pulp is the tissue that fills the pulp chamber. The periodontal membrane connects the cementum covered surface of the root with the alveolar bone and the gingiva. Gingiva is an oral mucous membrane that surrounds your tooth.

Dentin.

Dentin is a lot like bone only it is harder. It is similar to bone in its structure, chemical nature and in its development. Dentin is 80% inorganic minerals. The remaining 20% is organic, or carbon containing. The organic portion of the dentin consists of collagen. The inorganic portion is a lot like the corresponding material in bone, only it is denser and less soluble. Most of the inorganic component of the dentin is in the form of hydroxyapatite crystals. Hydroxyapatite is a specific typeof crystal formation consisting of calcium and phosphate.

The dentin contains innumerable little canals which originate at the pulp cavity and radiate outward toward the periphery. These canals penetrate every part of the dentin and are called dentinal tubules.

Most of these tubules make an ‘S’ shaped curve. There are special cells called ondontoblasts that extend into these tubes. In the center of the dentin these cells are larger and toward the outer portions of the dentin they are narrower. These cells start in the pulp cavity and migrate along the tubule. These cells make a special layer in the dentin around each tubule called the Sheath of Neumann.

Between the dentin tubules there are systems of collagen fibrils that are arranged in bundles. These bundles correspond to collagen fibrils in bone. These collagen fibers are embedded in another substance that contains protein. These collagen fibers run parallel to the long axis of the tooth and perpendicular to the dentin tubules. They also run around tubules. In the crown, the ends of them are at the surface.

The way that the dentin tubules are branched can lead to further distinctions in the dentin. The dentin closest to the pulp is thicker and has thinner and straighter tubules. This layer is called the circumpulpar dentin. The layer outside this layer has dentin tubules that are more branched and comprise a thinner layer. This layer is called the cover or mantle dentin.

When dentin develops it is calcified. Calcium and phosphate are deposited on the organic portion of the dentin. These deposits are not always uniform. Deposits of calcium and phosphorous form little spheres on the organic layer and gain in size until they fuse together. They start off in little rows or chains in or on the collagen fibrils. Sometimes an area does not completely mineralized leaving only the organix matrix of the dentin. This does not disrupt the dentin tubules from forming correctly. In many normal human teeth there are non mineralized places that contain only the organic matrix. These areas are called interglobular spaces and they are generally found in the deeper parts of the enamel covered dentin of the crown of the tooth.

Dentin continues to be formed very slowly throughout life. The pulp cavity is progressively narrowed with advancing age.

The dentin itself is sensitive to touch, hot, cold, acid and other stimuli. There are no nerves in the dentin. The nerve in the pulp chamber penetrates the dentin and extends for short distances. The ondoblastic processes that make up the dentin tubules transmit the environmental change down the dentin tubule to the nerve.

In a tooth without any dental work, there is a constant interchange of calcium and phosphorous going on between the dentin and the enamel and between the dentin and the blood stream. This means that a calcium ion may come off the mineralized crystal in the dentin and goes into the blood stream or can be incorporated into the enamel where one was missing. In a like manner, a calcium ion may come out of the blood stream or off the enamel and be incorporated into the dentin.

In a tooth with dental work, the only difference is that whatever material your dental work is made out of is participating in this exchange. Mercury amalgam fillings are constantly losing molecules by this process and these molecules are being incorporated into the tooth mineral matrix around the filling even though there was never any drilling or dental work done to that part of the tooth. These leaching molecules also enter your blood stream and attach to various tissues in your body. The mercury amalgam that is incorporating into a tooth part that was never worked on is called an amalgam stain.

An ondontoblast is the primary cell type responsible for making dentin. These are long cells that extend into the tubular channels in the mineralized dentin matrix. These cells are always making the precursor molecules of the collagen and the glycosaminoglycans of the organic part of the dentin matrix.

The Enamel

Enamel is bluish white and it is the hardest substance found in the body. When it is fully developed it consists almost entirely of calcium salts in the form of large apatite crystals and only ½ of a percent is organic. The organic portion is not collagen or keratin. The primary amino acid that comprises this protein is proline. Enamel consists of thin rods or prisms that stand up on the surface of the dentin. They tend to be bent a little. In between these prisms is interprismatic substance which is a substance with a sub structure almost identical to the rods but it is oriented in a different direction. Surrounding each rod is a clear area or the organic matrix called the organic sheath or prismatic rod sheath. Every rod runs through the entire thickness of the enamel layer. In the human tooth, the rods have a fluted, semicircular shape with the convex surface pointing toward the dentin.

The free surface of the enamel is covered by two thin layers. The inner layer is called the enamel cuticle. The outer layer is keratinized. This layer of keratin goes all the way down to the cementum covering the root where it is similar in composition. This layer is tenaciously adhered to the tooth and is distinct from the connective tissue of the gingiva. This layer persists for some time after the tooth has erupted.

Cementum

Cementum is coarsely fibrillated bone substance. The periodontal ligament attaches to it and to the alveolar bone. Of all the oral hard tissues, the cementum is the material that is most closely related to the bone in the rest of the body with respect to physical and chemical characteristics. It contains an organic matrix which contains cells called cementocytes that are embedded in this organic matrix. The cervical portion of the cementum does not have these cells. At the apex there is only a thin layer of cementum, without cells, adjacent to the dentin. As one ages this cementum layer gets thicker, especially at the end of the root. It may look a lot more like real bone on a microscopic level with some distinct attributes of bone. Normally these microscopic structures are absent.

Course fibers of collagen from the periodontal membrane penetrate the cementum. They appear as empty canals. Dentin does not die off if the material inside the pulp is removed and replaced. This is not true for cementum. If the periodontal membrane is destroyed the cementum will readily undergo necrosis (cell death) and the material that it is made of might be absorbed by the connective tissue that surrounds it.

New layers of cementum can be deposited on the roots of a tooth. This deposit of new cementum might be irregular forming a bumpy surface on the root. This deposition is called cementum hyperplasia when it becomes excessive and it is a reaction to an irritation.

Given the amount of inflammation that the gums of a person with severe signs of periodontal disease may have due to a severe allergic reaction to a substance, it may not be unusual to see this "bumpy" surface on the root of the tooth.

Before you allow the surface of your roots to be planed or scaled or cleaned, you should verify that there is actually tartar there and the lack of smoothness of the surface is not hypermineralization of the surface due to inflammation of the gum tissue.

Pulp

The pulp occupies the pulp cavity of the tooth. In the adult, it is abundant in a gelatinous, ground substance similar to mucoid connective tissue. There are a multitude of thin collagenous fibrils running in all directions and not aggregated into bundles. Elastic type fibers are only found in the walls of the vasculature. The ondodontoblasts are actually cells of the pulp that are adjacent to the dentin. Beneath these osteoblasts there is an area with no cells. In this area there are bundles of reticular fibers. These fibers pass from the pulp into spaces between the ondontoblasts and are incorporated into the dentin. Capillaries and nerves are plentiful. Adjacent to this cell free zone is a cell rich zone, at the periphery of the pulp. In this cell rich zone are the cells of your body’s defenses. There are also a primitive type of cell around the blood vessels in this area called mesenchymal cells. It has been theorized that under the influence of toxins, they can differentiate into different cell types.

The pulp continues into the narrow canal of the root where it surrounds the blood vessels and nerves. It continues through a small opening at the apex of the tooth and goes into the periodontal membrane. The pulp contains many blood vessels. Lymphatics enter and leave the pulp at the apex also.

The circulatory system inside the pulp consists of small arteries and capillaries close to the bases of the ondontoblasts. These drain into small veins which are more central in the pulp.

Periodontal Membrane

The periodontal membrane serves as a periosteum to the alveolar bone. Periosteum is a special type of connective tissue that can form bone. The periodontal membrane furnishes a firm connection between the root of the tooth and the bone with fibrous networks. It is not an elastic tissue and does not have elastic fibers. It is composed of thick collagenous bundles that run from the alveolar wall into the cementum. The orientation of these fibers varies at different levels of the alveolus.

From the root tip to the neck of the tooth there are fibers called cementoalveolar fibers. These fibers have designations such as apical, oblique, or horizontal. There are also alveolar crest fibers. The names actually describe their orientation and their attachment. These fibers make up the periodontal ligament.

When the tooth is not functioning, these fibers are relaxed and permit the tooth to move slightly when stresses are applied. The ligament attachment to the cementum of the tooth contains cementoblasts and the usual complement of connective tissue cells. On the alveolar bone side of this ligament, there are cells that are responsible for normal skeletal metabolism and turnover called osteoblasts and osteoclasts. The word "osteo" means bone. The word "blasts" is for those cells that form bone and the word "clast" applies to those cells that break down bone.

The periodontal membrane, especially near the cementum contains blood and lymph vessels and nerves as well as small islands of skin like tissue called epithelium. Sometimes these islands of epithelium calcify giving rise to cementicles.

The Gingiva or The Gums.

The gingiva is a mucous membrane that is firmly connected with the periosteum at the crest of the alveolar bone. It is mainly composed of a skin like tissue with keratin in it. It has numerous little projections called papillae that project into its base. It is linked to the surface of the tooth by a special type of skin like cells called the epithelial attachment of Gottlieb. This tissue recedes as you get older.

The gingiva has many papillae but the epithelial attachment is devoid of these papillae except when there is chronic inflammation. Between this epithelium and the enamel there is a small furrow that surrounds the crown called the gingival crevice. This crevice is lined with a skin like tissue that does not have keratin. There is a junction between the attached gingiva and the marginal gingiva or the unattached gingiva. This junction is called the crevicular margin. It surrounds the tooth like a collar and it is about 1 mm wide.

The thinner areas of the gingiva that cover the little papillae allow the papillae to show through and give a sort of granular appearance to what is otherwise a smooth, free, surface. The free gingival margin does not have these irregularities in it and the crevicular tissue is also devoid of these papillae unless it is chronically inflammed. The cells of the body’s defense system are always found at the gingival crevice.

The alveolar bone is between the periodontal ligament and the gingival tissue. Working outward from a tooth, the structures are the tooth outer layer of cementum, which is attached to the periodontal membrane, which attaches to some alveolar bone between your teeth that protrudes like a small triangle and that alveolar bone is covered with your gum tissue or your gingiva which also attaches to your teeth. The periodontal membrane is attached to the tooth lower than the gingival tissue.

Alveolar Bone

This bone is formed while the teeth are formed. The principal fibers of the periodontal ligament attach to this bone. The bone is made like a sandwich. There is cortical bone on the outside of the structure and cancellous bone on the inside. The outer cortical plate is a continuation of the cortical layer of the mandibular bone, the maxilla or the mandible. The inner layer that is attached to the periodontal membrane is called the lamina dura. The lamina dura surrounds the root of each tooth to form a socket.

The vessels and nerves to the teeth course through the alveolar bone to the apex of the root where they enter the pulp chamber.

Alveolar bone is very labile. That means that if your body needs calcium for normal operations, one of the first places it might take it from is this bone. The calcium levels in your blood stream are under strict, tight control. They do not swing up and down over a wide range of values. Calcium is a salt. If your blood calcium was too high, the presence of the salt in your blood stream would start to pull the fluids out of your tissues. The inverse can happen if it is too low. You would be quickly dead if there was a problem with the amount of calcium in your blood stream. Calcium is carried by your blood stream and stored in bones when it is not needed for many cellular functions. When the amount of calcium in your blood stream drops to the bottom edge of a small range, calcium is taken out of your bones and is deposited into the blood stream.

In your bones you have two major cell types that are responsible for normal bone maintenance. These are called osteoclasts and osteoblasts. The osteoclasts have little packets in them that contain HCL or hydrochloric acid. When there is a call for calcium, osteoclasts may release their HCL and cause the hydroxyapatite crystal to dissolve into solution, essentially putting calcium salt into solution and into your liquid blood stream.

If your body does not need calcium when you consume it by ingesting foods or supplements that contain it, it does not absorb it. Instead the extra calcium must be eliminated by your kidneys. Under certain circumstances calcium salts can accumulate in you kidneys and you can develop kidney stones.


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