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24.3 Bacterial Diseases of the Upper Alimentary System ride before the permanent teeth erupt. Fluoride applied to tooth surfaces in the form of mouthwashes, gels, or toothpaste is generally less effective.

Mechanical removal of plaque by toothbrushing and use of dental floss is another important preventive measure, reducing the incidence of dental caries by about 50%. Toothbrush bristles cannot remove plaque from the pits and fissures normally present in children's teeth, however, because they are too deep and narrow. Caries commonly develops in these pits and fissures and can be prevented by using a sealant, a kind of epoxy glue that seals the fissures, kills the plaque, and prevents bacterial recolonization. Older people have less fissure-related caries; however, receding gums can expose root surfaces that become sites for dental caries. Treatment requires drilling out the cavity, filling the defect with amalgam or other material, and restoring the contour of the tooth.

Periodontal Disease

Periodontal disease is a chronic inflammatory process involving the gums and tissues around the roots of the teeth. It usually develops slowly over many years, and it is an important cause of tooth loss from middle age onward.

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