The mouth is often considered the dirtiest part of the body, harbouring over 700 different species of bacteria. It's exposed to ingress of bacteria with water, food, air, and kissing of any object, pet, or person, and provides a warm, moist, mildly alkaline environment, with residual food that provides an ideal breeding ground for various bacteria.
A recent Japanese study of over 1,500 hospitalised patients found that those who brushed only in the morning had a higher risk of cardiovascular events. Neglect of dental care leads to overgrowth of harmful bacteria, bad breath, social ostracism, tooth decay, oral infections, and spread of infection via the blood throughout the body, including the heart.
Bacteria in the mouth, particularly Streptococcus mutans, feed on food particles, especially those high in sugars and starches, producing acids that erode tooth enamel and can cause cavities and gum and oral infections. Some bacteria in the mouth are beneficial, e.g., Streptococcus salivarius K12 and M18 are known for producing substances that inhibit the growth of harmful bacteria and help to reduce plaque formation; Lactobacillus strains can help to break down sugars and starches, preventing them from feeding harmful bacteria that contribute to tooth decay. Some good bacteria can buffer acids in the mouth, thus protecting tooth enamel. Maintaining good oral hygiene supports the growth and activity of these beneficial bacteria.
CONSEQUENCES OF FOOD STUCK IN MOUTH: Food stuck in your mouth can lead to bad breath, tooth decay, gum disease, and pain. Food stuck between teeth can cause sharp pain, especially when biting down, and cause teeth sensitivity if roots are exposed or the enamel is eroded by acidic food or acid produced by bacterial action on starchy food. This can progress to tooth decay and loss. Food getting stuck on the teeth or at the gum line can make it uncomfortable to chew, especially if it consistently gets lodged in the same area and causes pockets of infection. Any food lodged near or below the gums leads to gum disease.
GUM DISEASE (PERIODONTITIS): Bacteria in the mouth with sugars and starches form a soft, sticky, yellowish film on the teeth called plaque, which can be removed by brushing and flossing. If not removed, it hardens due to mineral deposits from saliva and gingival crevicular fluid into tartar, a hard, yellowish or brownish deposit on the teeth. Tartar is removed by deep cleaning (scaling and root planing or SRP) by a dentist using hand scalers and ultrasonic instruments.
Food debris and plaque can irritate the gums, causing inflammation (gingivitis) that presents as red, swollen, bleeding gums and bad breath. Untreated, plaque hardens into tartar, creating deeper pockets for bacteria, and progresses to periodontitis, affecting the tissues surrounding and supporting the teeth, leading to receding gums, loose teeth, painful chewing, and bone and tooth loss. Smoking, diabetes, and certain medications can increase the risk of gum disease. Chewing betel nut, especially with tobacco, leads to recession of gums and bleeding, oral lesions (ulcers, patches and submucous fibrosis), bone loss around teeth, tooth loss, and cancer.
TOOTH DECAY OR DENTAL CARIES OR CAVITIES: Acids formed by bacterial breakdown of sugars and starches in residual food erode the hard outer layer of a tooth (enamel), causing it to lose minerals (demineralization), forming painful, infected cavities in the dentine and inner pulp of the tooth, requiring root canal treatment to avoid tooth loss. The infection can spread to the gums and jawbone, presenting with swollen or tender gums, a swollen jaw or a boil on your gums or jaw that oozes pus, and a lymph node swelling below your lower jaw.
Fluoride in toothpaste strengthens the tooth enamel, helps it to resist acid attacks from bacteria, combats plaque and aids in the repair of early tooth decay. Fluorosis disease is caused by excessive longterm exposure to fluoridecontaminated groundwater or ingestion of fluoride toothpaste. Dental fluorosis, a cosmetic problem, causes white spots, discolouration, and pitting on developing teeth of children.
Associated skeletal fluorosis is a debilitating bone disease with weakened bones, painful joints, impaired mobility, fractures and spinal problems. Defluoridation removes excess fluoride from drinking water. Calcium, phosphorus, and vitamin D deficiency, or excess parathyroid hormone from a parathyroid tumour or hyperactive parathyroid glands, lead to weak, less-dense bones and teeth, tooth decay and tooth loss.
MOUTH SORES OR ULCERS: These are painful lesions or open sores that can appear on the gums, lips, inner cheeks, or palate. They are a common occurrence and can be caused by injury (by hard, sharp food particles, sharp tooth), vitamin deficiencies, certain medications, infections (bacterial, viral like herpes simplex, fungal like Candida), and some medical conditions (like celiac disease or inflammatory bowel disease). Diabetes and HIV/ AIDS can impair the body's ability to fight oral infections.
Aphthous ulcers or canker sores are recurring ulcers that can be triggered by stress, hormonal changes, or nutritional deficiencies (like iron, folate, or B vitamins). While most mouth sores are harmless and heal by avoiding hot, spicy, or acidic foods and gargling with salt water, persistent or unusual sores may be precancerous or cancerous and should be evaluated by a healthcare professional. Difficulty in eating, or swallowing, or accidental inhalation of food (can lead to aspiration Pneumonia), and choking sensation need medical attention, and should not be ignored.
BAD BREATH: Poor oral hygiene (gum disease, dental cavities, and poorly cleaned dentures) is the commonest cause of bad breath (halitosis). Not gargling or brushing after food intake allows food and bacteria to accumulate in the mouth. Residual food decomposition by bacteria releases volatile sulphur compounds (VSCs), causing bad breath. Sulphur compounds in garlic, onions, and certain chemical compounds in spices absorbed into the bloodstream are expelled through the lungs as bad breath. Coffee and alcohol cause a dry mouth (Xerostomia), allowing bacteria to multiply in the absence of saliva that washes away bacteria and food particles.
Tobacco products cause bad breath, gum disease, and oral health problems, including cancer. Some dairy products contain compounds that break down in the mouth and cause bad breath. Fish containing Trimethylamine (TMA) can cause fishy bad breath and body odour. Any infection in the air passages, like sinusitis, tonsillitis, tonsiliths (calcium, food debris, and bacterial deposits in the crevices of the tonsils), bronchitis, and bronchiectasis, can lead to bad breath due to the production of VSCs and other malodorous substances. The uneven texture of the tongue provides a place for food debris and dead mouth lining (mucosa) cells to collect and bacteria to thrive, leading to the production of odorous VSCs. Reflux of acid into the mouth (Gastroesophageal reflux disease or GERD) results in a sour or unpleasant odour and erosion of teeth. Uncontrolled diabetes (acetone-like odour), kidney (ammonia-like odour) or liver failure (sulphurous odour called "fetor hepaticus"), certain cancers, and some medications cause bad breath.
MAINTAINING GOOD ORAL HYGIENE: Stay hydrated with adequate water intake to avoid a dry mouth. Saliva is alkaline and helps neutralise acids and remineralise teeth. Avoid snacking between meals, especially of sugary, sticky food that encourages bacterial overgrowth and acid formation in the mouth. Beverages like colas are sugary and acidic. Such high-calorie snacks and beverages with synthetic additives will ruin your teeth, gums, and lead to obesity and chronic illnesses mentioned in earlier articles. Hard or sharp foods like popcorn, prone to impaction, can affect oral health.
Clean your mouth regularly by thoroughly, gently brushing of teeth at least twice a day, after breakfast and dinner with a soft-bristled toothbrush and fluoride toothpaste, and gargling with water after any other food intake. Brush gently all surfaces of your teeth, including the back and chewing surfaces. The back of the lower teeth is the common site of plaque and tartar formation. Replace your toothbrush if the bristles are frayed. Regular tongue cleaning with a tongue scraper or the tongue cleaner on a toothbrush can help remove bacteria and debris, and prevent biofilm (a layer of bacteria embedded in a matrix) formation, reducing bad breath. Gargling with a germicidal mouthwash can improve oral hygiene and freshen the breath.
Floss to remove any stuck food particles and plaque from between tightly spaced teeth and under the gum line by gliding the floss gently between your teeth and curving it around each tooth. Interdental brushes can clean wider gaps between teeth, braces or other orthodontic appliances. A Waterpik or irrigating syringe may help flush out food debris from hard-toreach areas.
Regular dental check-ups can help identify and address potential problems like cavities, gum disease, and misaligned teeth that can trap food. If you frequently experience food getting stuck, consult a dentist to check for any underlying issues like misaligned teeth, faulty dental work, or enamel erosion. If bad breath persists despite good oral hygiene, consult with a doctor to rule out any medical conditions. Good oral hygiene is essential for good health and avoiding pain, expenses, bad breath and social ostracism.
Dr. P.S.Venkatesh Rao is a Consultant Endocrine, Breast & Laparoscopic Surgeon, and a polymath, in Bengaluru.
