Why is it happening?

Nothing in a mouth goes wrong for no reason.

A tooth does not simply decide to hurt. Something caused it — and it is almost never the thing people blame themselves for. This is the list we work from: 201 causes behind dental problems, from the bacteria on a tooth surface to the medicine in your cabinet, written so you can find yourself in it.

201Causes listed

11Groups

0You are to blame for

How to read this page

Most people arrive here after step 3, having found the symptom that matches what they are feeling. This is the layer underneath: the thing that produced the symptom.

Two honest warnings before you scroll. First, a cause is not a diagnosis — several of these produce almost identical symptoms, and separating them needs a look, a radiograph and sometimes a test. Second, you will very likely find more than one that fits. That is normal. Dental problems are rarely caused by a single thing.

We have included our own profession's mistakes. One of the eleven groups below is treatment-related — decay left under a filling, a root canal never crowned, a gap never replaced. Those cause as much trouble as anything a patient does, and a list that left them out would not be honest.

Jump to a group

Biofilm & Bacteria

The organisms themselves. Almost every dental problem starts here.

Dental Plaque Accumulation

A soft, sticky film of bacteria that forms on teeth within hours of brushing.

High concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Tooth decay, gum inflammation and bad breath if not removed daily.
What helps: Brush twice daily and clean between teeth once a day.

Hardened Calculus (Tartar)

Plaque that has mineralised into a hard deposit which brushing cannot remove.

High concern Usually treated by Scaling Grade II - Ultrasonic Teeth Cleaning

What it leads to: Gum recession, bone loss and persistent bleeding.
What helps: Professional scaling every six months.

Subgingival Calculus

Hard deposits forming below the gum line, out of sight and out of reach of a brush.

High concern Usually treated by Scaling Grade III - Ultrasonic Teeth Cleaning

What it leads to: Deep periodontal pockets and loosening teeth.
What helps: Deep cleaning and regular periodontal review.

Streptococcus mutans Colonisation

The main decay-causing bacterium, which turns sugar into acid on the tooth surface.

High concern Usually treated by Composite Class I Tooth Restoration

What it leads to: Cavities, especially in pits and fissures.
What helps: Reduce sugar frequency, use fluoride toothpaste.

Lactobacillus Overgrowth

Bacteria that thrive in existing cavities and drive decay deeper.

High concern Usually treated by RCT - Root canal therapy

What it leads to: Rapid progression of a small cavity into the nerve.
What helps: Treat early cavities before they deepen.

Porphyromonas gingivalis Infection

A key bacterium in advanced gum disease that destroys the attachment around teeth.

High concern Usually treated by Flap Surgery

What it leads to: Periodontitis, bone loss and eventual tooth loss.
What helps: Deep cleaning, good home care, stop smoking.

Candida (Fungal) Overgrowth

A yeast infection of the mouth, common under dentures or after antibiotics.

Moderate concern Usually treated by Consultation

What it leads to: White patches, soreness and denture stomatitis.
What helps: Clean dentures nightly, remove them while sleeping.

Actinomyces Colonisation

Bacteria that colonise exposed root surfaces in older adults.

Moderate concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Root surface decay, which spreads quickly.
What helps: Fluoride varnish and cleaning around exposed roots.

Biofilm on Rough Restorations

Old or poorly finished fillings give bacteria a surface to grip.

Moderate concern Usually treated by Composite Class II Tooth Restoration

What it leads to: Decay restarting at the edge of an existing filling.
What helps: Replace worn fillings and polish margins.

Bacterial Invasion of Dentinal Tubules

Once decay reaches dentine, bacteria travel down microscopic tubes toward the nerve.

High concern Usually treated by RCT - Root canal therapy

What it leads to: Pulpitis and severe lingering pain.
What helps: Treat decay while it is still in enamel.

Pericoronal Bacterial Trap

A flap of gum over a partly erupted wisdom tooth traps food and bacteria beneath it.

High concern Usually treated by Scaling - Pericoronitis

What it leads to: Pericoronitis, swelling and difficulty opening the mouth.
What helps: Clean the area carefully; remove the tooth if it recurs.

Peri-implant Biofilm

Bacteria colonising the neck of a dental implant.

High concern Usually treated by Flap Surgery

What it leads to: Peri-implantitis and implant failure.
What helps: Implant-specific hygiene and regular maintenance visits.

Root Canal Reinfection

Bacteria re-entering a previously treated root canal through a leaking crown or filling.

High concern Usually treated by Re-RCT - Root canal therapy

What it leads to: Periapical abscess and the need for retreatment.
What helps: Seal the tooth promptly with a well-fitting crown.

Tongue Coating Bacteria

A bacterial layer on the back of the tongue producing sulphur compounds.

Low concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Persistent bad breath even after brushing.
What helps: Gentle tongue cleaning daily.

Mother-to-Child Bacterial Transfer

Decay bacteria passed to an infant by sharing spoons or cleaning a dummy in the mouth.

Moderate concern Usually treated by Consultation

What it leads to: Early childhood caries before the age of three.
What helps: Avoid sharing utensils; treat the parent's own decay.

Overhanging Restoration Margins

A filling edge that sits proud of the tooth, sheltering bacteria.

Moderate concern Usually treated by Composite Class II Tooth Restoration

What it leads to: Recurrent decay and localised gum inflammation.
What helps: Replace or reshape the restoration.

Plaque Around Orthodontic Brackets

Braces create dozens of new places for plaque to sit undisturbed.

High concern Usually treated by Scaling Grade II - Ultrasonic Teeth Cleaning

What it leads to: White spot lesions and permanent marks after braces come off.
What helps: Interdental brushes, fluoride rinse, hygienist visits during treatment.

Denture Biofilm

A bacterial and fungal layer on the fitting surface of a denture.

Moderate concern Usually treated by Complete Denture

What it leads to: Sore, red palate and angular cheilitis at the corners of the mouth.
What helps: Soak and brush dentures daily; leave them out overnight.

Fusobacterium in Deep Pockets

A bacterium that bridges early and late colonisers in gum disease.

High concern Usually treated by Flap Surgery

What it leads to: Rapid destruction of the tissue holding teeth in place.
What helps: Deep cleaning and periodontal maintenance.

Abscess Tracking Through Bone

Infection from a dead nerve finding a path out through the jaw bone.

High concern Usually treated by RCT - Root canal therapy

What it leads to: A pimple-like sinus on the gum that discharges pus.
What helps: Root canal treatment or extraction of the source tooth.

Diet & Nutrition

What goes in the mouth, and — more importantly — how often.

Frequent Sugar Snacking

It is how often sugar is eaten, not how much, that drives decay.

High concern Usually treated by Composite Class I Tooth Restoration

What it leads to: Repeated acid attacks and rapid cavity formation.
What helps: Keep sugar to mealtimes; avoid grazing.

Sugary Drinks and Sodas

Sweet drinks bathe every tooth surface in sugar and acid at once.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Widespread decay, especially on front teeth.
What helps: Water between meals; use a straw for occasional drinks.

Sipping Drinks Slowly

A drink sipped over an hour keeps the mouth acidic the whole time.

Moderate concern Usually treated by Composite Class I Tooth Restoration

What it leads to: Continuous demineralisation with no recovery period.
What helps: Finish drinks within a short window, then rinse with water.

Citrus and Acidic Fruits

Lemon, lime and other acids dissolve enamel directly, without bacteria.

Moderate concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Erosion, thinning enamel and sensitivity.
What helps: Rinse with water afterwards; do not brush for 30 minutes.

Carbonated Water and Sparkling Drinks

Carbonation makes even unsweetened water mildly acidic.

Low concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Gradual enamel erosion over years.
What helps: Drink with meals rather than throughout the day.

Sticky and Retentive Foods

Toffee, dried fruit and biscuits cling to grooves long after eating.

Moderate concern Usually treated by Composite Class I Tooth Restoration

What it leads to: Decay in the biting surfaces of back teeth.
What helps: Rinse or brush after sticky foods.

Bedtime Bottle or Night Feeding

Milk or juice pooling around an infant's teeth overnight.

High concern Usually treated by Consultation

What it leads to: Severe early childhood caries on upper front teeth.
What helps: Water only in the bottle after teeth appear.

Refined Carbohydrate Diet

Bread, crisps and biscuits break down into sugars in the mouth.

Moderate concern Usually treated by Composite Class I Tooth Restoration

What it leads to: Decay even without obvious sweets in the diet.
What helps: Balance meals with protein and fibre.

Vitamin D Deficiency

Low vitamin D impairs calcium use and the immune response in gums.

Moderate concern Usually treated by Consultation

What it leads to: Weaker enamel, higher decay risk and worse gum disease.
What helps: Sunlight, diet and supplementation where advised.

Vitamin C Deficiency

Severe lack of vitamin C weakens the collagen that holds gums together.

Moderate concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Swollen, spongy, bleeding gums and loose teeth.
What helps: A diet with fresh fruit and vegetables.

Calcium and Phosphate Deficiency

The minerals enamel needs to repair itself daily are missing.

Moderate concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Enamel that cannot remineralise after acid attacks.
What helps: Dairy or fortified alternatives; fluoride toothpaste.

Iron Deficiency Anaemia

Low iron affects the lining of the mouth and tongue.

Moderate concern Usually treated by Consultation

What it leads to: Sore tongue, cracks at the mouth corners and delayed healing.
What helps: Investigate and correct the anaemia medically.

Vitamin B12 and Folate Deficiency

Deficiency affects rapidly renewing tissues, including the mouth lining.

Moderate concern Usually treated by Consultation

What it leads to: Recurrent mouth ulcers and a burning tongue.
What helps: Medical assessment and supplementation.

Chronic Dehydration

Too little water reduces saliva, the mouth's natural defence.

Moderate concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Dry mouth, higher decay rate and bad breath.
What helps: Drink water regularly through the day.

Excess Alcohol Intake

Alcohol dries the mouth and irritates the soft tissues.

High concern Usually treated by Consultation

What it leads to: Dry mouth, gum disease and raised oral cancer risk.
What helps: Reduce intake; keep hydrated.

Energy and Sports Drinks

Highly acidic and sugary, often consumed during exercise when saliva is low.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Rapid erosion plus decay on the same surfaces.
What helps: Water for hydration; keep sports drinks occasional.

Vegetarian and Vegan Diets Without Planning

Poorly planned plant-based diets can lack B12, iron and calcium.

Low concern Usually treated by Consultation

What it leads to: Ulcers, sore tongue and weaker enamel.
What helps: Plan for B12, iron and calcium; supplement if needed.

Chewing Ice

Ice is harder than enamel and applies force in a single point.

Moderate concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Cracked cusps and micro-fractures in teeth.
What helps: Break the habit; treat any underlying anaemia.

Frequent Herbal or Sweetened Tea

Sweetened hot drinks sipped through the day.

Low concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Staining plus continuous sugar exposure.
What helps: Unsweetened between meals.

Eating Disorders

Repeated vomiting exposes teeth to stomach acid.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Severe erosion of the inner surfaces of upper front teeth.
What helps: Medical and psychological support; protective measures for teeth.

Acid Reflux from Diet

Spicy, fatty or late-night meals triggering reflux into the mouth.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Erosion on the inner and back tooth surfaces.
What helps: Dietary changes and medical treatment of reflux.

Betel Nut and Areca Chewing

A very common habit in India with strong local effects on the mouth.

High concern Usually treated by Consultation

What it leads to: Staining, worn teeth, and oral submucous fibrosis.
What helps: Stop the habit; screen the mouth regularly.

Oral Hygiene

Not whether you clean, but whether the cleaning reaches.

Infrequent Brushing

Brushing less than twice a day lets plaque mature undisturbed.

High concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Decay, gum inflammation and calculus build-up.
What helps: Brush morning and night, every day.

Brushing Too Hard

Heavy pressure wears the tooth and pushes the gum back.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Gum recession and notched, sensitive necks of teeth.
What helps: Light pressure, soft bristles, small circles.

Hard-Bristled Toothbrush

Stiff bristles abrade enamel and traumatise the gum margin.

Moderate concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Recession and root sensitivity.
What helps: Use a soft or medium brush.

Worn-Out Toothbrush

Splayed bristles no longer reach into grooves or below the gum edge.

Low concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Plaque left behind despite brushing daily.
What helps: Replace the brush every three months.

Never Cleaning Between Teeth

A brush cannot reach the surfaces where teeth touch.

High concern Usually treated by Composite Class II Tooth Restoration

What it leads to: Decay between teeth and gum disease starting there.
What helps: Floss or interdental brushes once daily.

Incorrect Brushing Technique

Scrubbing sideways rather than angling into the gum line.

Moderate concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Plaque left at the gum margin and abrasion elsewhere.
What helps: Angle bristles 45 degrees to the gum; short strokes.

Skipping the Back Teeth

The last molars are hardest to reach and most often missed.

Moderate concern Usually treated by Composite Class I Tooth Restoration

What it leads to: Decay and gum problems concentrated at the back.
What helps: Deliberately start brushing at the back each time.

Not Cleaning Dentures Daily

Dentures gather plaque exactly as natural teeth do.

Moderate concern Usually treated by Complete Denture

What it leads to: Sore gums, fungal infection and bad odour.
What helps: Brush and soak dentures daily; leave out at night.

Not Cleaning Around Bridges and Implants

These need threading floss or special brushes to clean underneath.

High concern Usually treated by Flap Surgery

What it leads to: Gum inflammation and failure of expensive work.
What helps: Superfloss, interdental brushes or a water flosser.

Rinsing Immediately After Brushing

Washing the mouth out removes the fluoride before it can act.

Moderate concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Reduced protection despite brushing correctly.
What helps: Spit, do not rinse.

Not Using Fluoride Toothpaste

Fluoride-free pastes clean but do not help enamel repair itself.

High concern Usually treated by Composite Class I Tooth Restoration

What it leads to: Higher decay rate, particularly in children.
What helps: Use a fluoride toothpaste appropriate to age.

Ignoring Bleeding Gums

Bleeding is the earliest warning of gum inflammation, and it is reversible.

High concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Progression from gingivitis to irreversible bone loss.
What helps: Do not stop cleaning the area; see a dentist.

Skipping Regular Check-ups

Most decay and gum disease is painless until it is advanced.

High concern Usually treated by Consultation

What it leads to: Small problems found only once they need major treatment.
What helps: Six-monthly examination, or as advised.

Delaying Professional Cleaning

Once hardened, deposits can only be removed with instruments.

High concern Usually treated by Scaling Grade II - Ultrasonic Teeth Cleaning

What it leads to: Progressive gum detachment and bone loss.
What helps: Scaling at the interval your dentist advises.

Mouthwash Instead of Brushing

Rinsing freshens breath but does not remove the plaque film.

Moderate concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: A false sense of cleanliness while decay progresses.
What helps: Mouthwash as an addition, never a replacement.

Overuse of Chlorhexidine Mouthwash

Long-term use of strong antiseptic rinses beyond the prescribed period.

Low concern Usually treated by Scaling Grade II - Ultrasonic Teeth Cleaning

What it leads to: Brown staining, altered taste and calculus build-up.
What helps: Use only for the period prescribed.

Not Cleaning the Tongue

The tongue holds a large share of the mouth's bacteria.

Low concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Bad breath and reinfection of cleaned teeth.
What helps: Gentle tongue cleaning as part of the routine.

Poor Hygiene During Illness

Routines lapse during long illness, hospitalisation or depression.

Moderate concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Rapid decline in gum health within weeks.
What helps: Simplify the routine rather than abandoning it.

Habits & Parafunction

Things the mouth does that it was never designed to do.

Night-Time Teeth Grinding (Bruxism)

Clenching and grinding during sleep, often without the person knowing.

High concern Usually treated by Consultation

What it leads to: Worn, flattened teeth, cracks, jaw pain and headaches.
What helps: A night guard and stress management.

Daytime Clenching

Holding the teeth together while concentrating or under stress.

High concern Usually treated by Consultation

What it leads to: Aching jaw muscles, tooth sensitivity and headaches.
What helps: Awareness training; keep teeth apart at rest.

Nail Biting

Repeated small forces on the front teeth edges.

Moderate concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Chipped incisal edges and front tooth movement.
What helps: Habit interruption; keep nails short.

Pen and Pencil Chewing

Concentrated biting force on a hard object.

Low concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Chipped enamel and localised wear.
What helps: Substitute the habit.

Thumb Sucking Beyond Age Four

Persistent sucking applies constant outward force to developing teeth.

High concern Usually treated by Traditional Braces

What it leads to: Protruding upper front teeth and an open bite.
What helps: Positive habit-breaking; orthodontic appliance if needed.

Prolonged Dummy or Pacifier Use

Similar forces to thumb sucking, applied for years.

Moderate concern Usually treated by Traditional Braces

What it leads to: Open bite and narrow upper arch.
What helps: Wean off by age two to three.

Tongue Thrusting

The tongue pushes forward against the front teeth when swallowing.

Moderate concern Usually treated by Traditional Braces

What it leads to: Open bite and relapse after orthodontic treatment.
What helps: Myofunctional therapy alongside orthodontics.

Mouth Breathing

Breathing through the mouth dries the gums and alters facial growth.

High concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Gum inflammation, dry mouth and a long facial pattern.
What helps: Treat the nasal obstruction; ENT referral.

Lip Biting and Sucking

Repeated trauma to the lip and pressure on the front teeth.

Low concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Lip lesions and tooth movement.
What helps: Habit awareness.

Opening Packets with Teeth

Using teeth as tools for bottles, packets and thread.

Moderate concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Fractured cusps and chipped edges.
What helps: Use scissors, not teeth.

Holding Objects Between Teeth

Pins, nails or thread held habitually in the same spot.

Low concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: A characteristic notch worn into the biting edge.
What helps: Change the working habit.

Cheek Biting (Morsicatio)

Chronic chewing of the inside of the cheek.

Moderate concern Usually treated by Consultation

What it leads to: A rough, white, ragged line along the bite level.
What helps: Address stress; smooth any sharp tooth edges.

Bruxism from Sleep Apnoea

Grinding as part of the arousal response in obstructive sleep apnoea.

High concern Usually treated by Consultation

What it leads to: Severe wear plus daytime tiredness and headaches.
What helps: Sleep study; treat the apnoea, not just the teeth.

Chewing on One Side Only

Avoiding a painful side loads the other side twice as hard.

Moderate concern Usually treated by Consultation

What it leads to: Uneven wear, TMJ strain and calculus on the unused side.
What helps: Treat the painful tooth so chewing balances again.

Smoking

Tobacco reduces blood flow to the gums and masks bleeding.

High concern Usually treated by Flap Surgery

What it leads to: Severe gum disease that progresses silently, plus cancer risk.
What helps: Stop smoking; every reduction helps.

Smokeless Tobacco and Gutkha

Tobacco held against the cheek or gum for long periods.

High concern Usually treated by Consultation

What it leads to: White patches, gum recession and a high oral cancer risk.
What helps: Stop the habit; regular oral cancer screening.

Vaping and E-Cigarettes

Aerosols dry the mouth and alter the bacterial balance.

High concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Dry mouth, gum inflammation and increased decay.
What helps: Reduce or stop; keep hydrated.

Chewing Tobacco with Lime

Lime raises the pH and increases the mucosal effect of tobacco.

High concern Usually treated by Consultation

What it leads to: Submucous fibrosis and restricted mouth opening.
What helps: Stop the habit; early screening for fibrosis.

Toothpick Overuse

Forcing wooden picks between teeth repeatedly.

Low concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Gum trauma, recession and widened gaps.
What helps: Interdental brushes sized correctly instead.

Aggressive Flossing

Snapping floss down onto the gum instead of guiding it.

Low concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Cuts in the gum and localised recession.
What helps: Curve the floss around each tooth; ease it in.

Habitual Jaw Posture

Resting the chin on the hand or sleeping on one side of the face.

Low concern Usually treated by Consultation

What it leads to: Asymmetric jaw pressure and TMJ discomfort.
What helps: Posture awareness.

Chewing Gum Excessively

Hours of chewing overloads the jaw muscles and joints.

Low concern Usually treated by Consultation

What it leads to: Jaw muscle fatigue and TMJ clicking.
What helps: Limit chewing; use sugar-free gum briefly after meals.

Mechanical & Trauma

Force, in one moment or repeated for years.

Sports Injury to Front Teeth

A direct blow during contact or ball sports.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Chipped, loosened or knocked-out teeth.
What helps: A properly fitted mouthguard for sport.

Falls in Children

Toddlers and young children commonly land face-first.

High concern Usually treated by Consultation

What it leads to: Displaced or intruded baby teeth, affecting the adult tooth beneath.
What helps: Supervision; prompt dental assessment after any fall.

Road Traffic Accidents

High-energy facial trauma.

High concern Usually treated by Minor Surgery

What it leads to: Fractured teeth and jaw, requiring surgical care.
What helps: Seat belts, helmets; immediate assessment.

Biting on a Hard Object Unexpectedly

A stone in rice or a bone in food, hit at full force.

High concern Usually treated by Zirconia Crown

What it leads to: A split cusp or a vertical crack through the tooth.
What helps: Care with unfamiliar foods; treat cracks early.

Cracked Tooth Syndrome

A hairline crack that opens under biting pressure.

High concern Usually treated by Zirconia Crown

What it leads to: Sharp pain on release of biting, progressing to nerve damage.
What helps: Crown the tooth before the crack propagates.

Traumatic Occlusion

One tooth taking more force than it can handle when biting.

High concern Usually treated by Consultation

What it leads to: Loosening, sensitivity and bone loss around that tooth.
What helps: Adjust the bite; investigate why it is high.

Overloaded Dental Implant

Excessive force on an implant, often from grinding.

High concern Usually treated by Dental Implant

What it leads to: Bone loss around the implant and eventual failure.
What helps: Night guard; balance the bite.

Abfraction Lesions

Flexing of the tooth under bite stress chips enamel at the neck.

Moderate concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: V-shaped notches at the gum line and sensitivity.
What helps: Address the bite; restore the notch.

Denture Clasp Trauma

A metal clasp resting on a tooth and moving with every chew.

Moderate concern Usually treated by Valplast Removable Partial Denture

What it leads to: Wear, decay and loosening of the supporting tooth.
What helps: Reline or redesign the denture.

Orthodontic Force Applied Too Fast

Moving teeth faster than the bone can remodel.

High concern Usually treated by Traditional Braces

What it leads to: Root shortening and loosening of teeth.
What helps: Controlled forces; regular radiographic review.

Ill-Fitting Crown or Bridge

A restoration that does not seat correctly on the tooth.

High concern Usually treated by Crown Removal Procedure

What it leads to: Decay beneath it and chronic gum inflammation.
What helps: Remake the restoration.

Fractured Restoration

A large old filling breaking under normal function.

Moderate concern Usually treated by Onlay

What it leads to: Sharp edges, food packing and decay underneath.
What helps: Replace with a cusp-covering restoration.

Tooth Wear from Opposing Ceramic

Hard ceramic grinding against natural enamel over years.

Moderate concern Usually treated by Zirconia Crown

What it leads to: Rapid wear of the natural tooth facing the crown.
What helps: Polish the ceramic; monitor the opposing tooth.

Vertical Root Fracture

A split running down the root, often in root-treated teeth.

High concern Usually treated by Extraction of tooth - Basic

What it leads to: Deep isolated pocket, swelling and loss of the tooth.
What helps: Careful restoration of root-treated teeth with cuspal coverage.

Food Impaction Between Teeth

Food repeatedly wedged into the same gap by the bite.

Moderate concern Usually treated by Composite Class II Tooth Restoration

What it leads to: Gum inflammation, pain and decay at that contact.
What helps: Restore the contact point properly.

Jaw Fracture

A break in the mandible or maxilla from impact.

High concern Usually treated by Minor Surgery

What it leads to: Malocclusion, pain and inability to bite together.
What helps: Immediate surgical assessment.

Avulsed (Knocked-Out) Tooth

A tooth completely out of its socket.

High concern Usually treated by Dental Implant

What it leads to: Permanent loss unless replanted within the first hour.
What helps: Keep the tooth in milk; go straight to a dentist.

Intrusion of a Tooth

A tooth driven up into the bone by a blow.

High concern Usually treated by RCT - Root canal therapy

What it leads to: Nerve death and damage to the developing tooth beneath.
What helps: Urgent assessment and monitoring.

Chemical Burn from Aspirin

Placing a tablet against the gum to relieve toothache.

Low concern Usually treated by Consultation

What it leads to: A painful white chemical burn on the gum.
What helps: Take painkillers by mouth, never held against the tooth.

Systemic & Medical

The mouth is part of the body. Conditions elsewhere show up here first.

Type 2 Diabetes

Raised blood sugar impairs healing and the response to infection.

High concern Usually treated by Flap Surgery

What it leads to: Faster gum disease, abscesses and delayed healing.
What helps: Good glycaemic control; more frequent dental review.

Uncontrolled Blood Sugar

Poor glycaemic control has a direct two-way link with gum disease.

High concern Usually treated by Flap Surgery

What it leads to: Gum disease worsens control, which worsens gum disease.
What helps: Treat both together with your doctor and dentist.

Pregnancy Hormonal Changes

Raised hormones exaggerate the gum response to plaque.

High concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Pregnancy gingivitis and occasionally a pregnancy epulis.
What helps: Meticulous cleaning; safe dental care during pregnancy.

Menopause

Falling oestrogen affects bone density and the oral lining.

Moderate concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Dry mouth, burning sensation and bone loss around teeth.
What helps: Discuss with your doctor; saliva substitutes.

Osteoporosis

Reduced bone density throughout the body, including the jaws.

High concern Usually treated by Flap Surgery

What it leads to: Faster bone loss around teeth and denture fit problems.
What helps: Bone health management; careful periodontal care.

Rheumatoid Arthritis

Shares inflammatory pathways with gum disease and limits hand function.

Moderate concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Worse gum disease, and difficulty holding a toothbrush.
What helps: Adapted brush handles; treat inflammation in both.

Cardiovascular Disease

Chronic gum inflammation is linked to vascular inflammation.

High concern Usually treated by Flap Surgery

What it leads to: A recognised association between gum health and heart health.
What helps: Treat gum disease as part of overall health care.

Chronic Kidney Disease

Altered calcium and phosphate handling plus a dry mouth.

Moderate concern Usually treated by Scaling Grade II - Ultrasonic Teeth Cleaning

What it leads to: Enamel defects, calculus build-up and a metallic taste.
What helps: Coordinate care with the renal team.

HIV and Immunosuppression

A weakened immune response to normal oral bacteria and fungi.

High concern Usually treated by Consultation

What it leads to: Fungal infection, rapid gum disease and unusual ulcers.
What helps: Medical management plus frequent dental review.

Leukaemia

Abnormal white cells infiltrate the gums and impair clotting.

High concern Usually treated by Consultation

What it leads to: Swollen, spontaneously bleeding gums, sometimes the first sign.
What helps: Urgent medical investigation.

Thyroid Disorders

Altered metabolism affects saliva, healing and tooth eruption.

Moderate concern Usually treated by Consultation

What it leads to: Dry mouth, delayed eruption in children and gum problems.
What helps: Treat the thyroid condition medically.

Sjogren's Syndrome

An autoimmune condition that destroys the salivary glands.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Severe dry mouth and rampant decay at the gum line.
What helps: Saliva substitutes, high-fluoride paste, frequent review.

Gastro-Oesophageal Reflux (GERD)

Stomach acid reaching the mouth, often silently at night.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Erosion of the inner surfaces of the upper back teeth.
What helps: Medical treatment of reflux; protect the teeth.

Coeliac Disease

An immune reaction to gluten affecting enamel formation and the mouth.

Moderate concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Enamel defects on adult teeth and recurrent ulcers.
What helps: Gluten-free diet; restore affected teeth.

Crohn's Disease

Inflammatory bowel disease with oral manifestations.

Moderate concern Usually treated by Consultation

What it leads to: Mouth ulcers, swollen lips and a cobblestone cheek lining.
What helps: Manage the bowel disease; symptomatic oral care.

Epilepsy

Seizures risk dental trauma; some medications enlarge the gums.

High concern Usually treated by Flap Surgery

What it leads to: Broken teeth from falls and overgrown gum tissue.
What helps: Mouthguard where advised; meticulous plaque control.

Stroke and Reduced Dexterity

Weakness on one side makes brushing that side almost impossible.

High concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Rapid decay and gum disease on the affected side.
What helps: Powered brush, carer assistance, frequent hygiene visits.

Dementia

Loss of routine and the ability to report pain.

High concern Usually treated by Consultation

What it leads to: Undetected decay and infection until it becomes severe.
What helps: Carer-supported hygiene and regular screening visits.

Down Syndrome

Altered immune response, tooth shape and eruption pattern.

High concern Usually treated by Flap Surgery

What it leads to: Early and aggressive gum disease, missing teeth.
What helps: Early preventive programme; frequent maintenance.

Cerebral Palsy

Muscle control difficulties affecting cleaning and swallowing.

Moderate concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Plaque accumulation, trauma and severe wear.
What helps: Adapted aids; carer support; general anaesthetic care where needed.

Anaemia

Reduced oxygen delivery to the oral tissues.

Moderate concern Usually treated by Consultation

What it leads to: Pale gums, sore tongue and slow healing.
What helps: Investigate and correct the cause medically.

Bleeding Disorders

Haemophilia and similar conditions affecting clot formation.

High concern Usually treated by Consultation

What it leads to: Prolonged bleeding after cleaning or extraction.
What helps: Haematology liaison before any dental procedure.

Obesity and Metabolic Syndrome

Chronic low-grade inflammation throughout the body.

Moderate concern Usually treated by Flap Surgery

What it leads to: Higher risk and faster progression of gum disease.
What helps: Weight management as part of gum treatment.

Chronic Stress

Raised cortisol suppresses immunity and drives clenching.

High concern Usually treated by Consultation

What it leads to: Gum disease, grinding, ulcers and delayed healing.
What helps: Stress management; night guard if grinding.

Medication Effects

Medicines you should not stop — but whose oral effects can be managed.

Antihypertensive Drugs (Dry Mouth)

Many blood pressure medicines reduce saliva flow.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Dry mouth and a sharp rise in decay at the gum line.
What helps: Saliva substitutes, high-fluoride paste, sip water.

Antidepressants

A very common cause of long-term dry mouth.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Root decay, sore mouth and difficulty wearing dentures.
What helps: Do not stop medication; manage the dryness.

Antihistamines

Drying effects extend to the salivary glands.

Low concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Temporary but repeated dry mouth episodes.
What helps: Water, sugar-free gum, fluoride.

Diuretics

Increased fluid loss reduces saliva volume.

Moderate concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Dry mouth and altered taste.
What helps: Hydration and fluoride protection.

Phenytoin (Epilepsy)

Causes overgrowth of gum tissue in a proportion of users.

High concern Usually treated by Flap Surgery

What it leads to: Gums growing over the teeth, trapping plaque.
What helps: Excellent plaque control; surgical reshaping if needed.

Calcium Channel Blockers

Amlodipine and nifedipine can enlarge the gums.

High concern Usually treated by Flap Surgery

What it leads to: Swollen gums that bleed and hide the teeth.
What helps: Discuss alternatives with the physician; gum surgery.

Ciclosporin (Transplant Patients)

Immunosuppression plus gum overgrowth together.

High concern Usually treated by Flap Surgery

What it leads to: Severe gum enlargement with a high infection risk.
What helps: Intensive hygiene; coordinated medical care.

Bisphosphonates

Bone-strengthening drugs that alter jaw bone healing.

High concern Usually treated by Consultation

What it leads to: Risk of exposed dead bone after extraction.
What helps: Complete dental treatment before starting; tell every dentist.

Denosumab and Anti-Resorptive Agents

Similar jaw healing risk to bisphosphonates.

High concern Usually treated by Consultation

What it leads to: Osteonecrosis of the jaw following surgery.
What helps: Dental clearance before treatment starts.

Chemotherapy

Damages rapidly dividing cells, including the mouth lining.

High concern Usually treated by Consultation

What it leads to: Severe mucositis, ulceration and infection.
What helps: Pre-treatment dental assessment; supportive oral care.

Head and Neck Radiotherapy

Permanently damages salivary glands in the treatment field.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Lifelong dry mouth and rampant radiation caries.
What helps: Pre-radiotherapy dental clearance; lifelong fluoride.

Long-Term Steroid Use

Suppresses immunity and thins the oral lining.

High concern Usually treated by Consultation

What it leads to: Fungal infection and delayed healing.
What helps: Rinse after inhalers; monitor for thrush.

Inhaled Asthma Medication

Inhalers are acidic and encourage fungal growth.

Moderate concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Erosion and oral thrush at the back of the mouth.
What helps: Rinse with water after every dose; use a spacer.

Blood Thinners

Warfarin and newer anticoagulants prolong bleeding.

High concern Usually treated by Consultation

What it leads to: Extended bleeding after extraction or deep cleaning.
What helps: Never stop without advice; inform the dentist beforehand.

Iron Supplements (Liquid)

Liquid iron stains the teeth on contact.

Low concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Black extrinsic staining, usually removable.
What helps: Take through a straw; rinse afterwards.

Tetracycline in Childhood

Taken while teeth are forming, it binds into the enamel.

High concern Usually treated by Zirconia Plus Advanced Esthetic Crown

What it leads to: Permanent grey or banded discolouration of adult teeth.
What helps: Avoid in children and pregnancy; veneers or crowns later.

Developmental & Genetic

Present before the first tooth appeared.

Amelogenesis Imperfecta

An inherited condition where enamel forms abnormally.

High concern Usually treated by Zirconia Crown

What it leads to: Weak, discoloured, easily worn teeth from eruption.
What helps: Early protective restorations; full coverage crowns.

Dentinogenesis Imperfecta

Inherited abnormal dentine formation beneath the enamel.

High concern Usually treated by Zirconia Crown

What it leads to: Teeth that chip and wear rapidly despite normal enamel.
What helps: Protective crowns from an early age.

Enamel Hypoplasia

Enamel that formed too thinly due to illness or fever in childhood.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Pits, grooves and a high decay risk in those areas.
What helps: Seal and restore affected surfaces early.

Molar Incisor Hypomineralisation (MIH)

Soft, chalky first molars and incisors of uncertain cause.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Rapid breakdown and severe sensitivity in children.
What helps: Early diagnosis, fluoride, protective restorations.

Dental Fluorosis

Too much fluoride while teeth were forming.

Moderate concern Usually treated by Zirconia Plus Advanced Esthetic Crown

What it leads to: White flecks to brown mottling of the enamel.
What helps: Age-appropriate toothpaste amounts; cosmetic treatment later.

Congenitally Missing Teeth

One or more adult teeth never formed.

High concern Usually treated by Dental Implant

What it leads to: Gaps, drifting of neighbours and bite collapse.
What helps: Space management; implant or bridge when grown.

Supernumerary Teeth

An extra tooth blocking or displacing the normal ones.

High concern Usually treated by Extraction of tooth - Sugical

What it leads to: Failure of a front tooth to erupt; crowding.
What helps: Radiographic diagnosis; surgical removal.

Impacted Canines

The canine fails to find its path and lodges in the bone.

High concern Usually treated by Traditional Braces

What it leads to: Damage to the roots of neighbouring teeth; a gap in the smile.
What helps: Early radiographs; surgical exposure and orthodontics.

Impacted Wisdom Teeth

No room for the third molars to erupt straight.

High concern Usually treated by Wisdom tooth extraction - Surgical

What it leads to: Pericoronitis, decay in the tooth in front, cysts.
What helps: Assessment and removal when indicated.

Skeletal Class II Jaw Relation

The lower jaw sits behind the upper by skeletal proportion.

Moderate concern Usually treated by Traditional Braces

What it leads to: Protruding front teeth, deep bite and trauma risk.
What helps: Growth modification in children; orthodontics or surgery later.

Skeletal Class III Jaw Relation

The lower jaw sits ahead of the upper.

Moderate concern Usually treated by Traditional Braces

What it leads to: Underbite, chewing difficulty and speech effects.
What helps: Early interception; orthognathic surgery if severe.

Narrow Upper Arch

A constricted upper jaw, often with mouth breathing.

Moderate concern Usually treated by Traditional Braces

What it leads to: Crossbite, crowding and a narrow smile.
What helps: Expansion in growing patients.

Crowding from Tooth-Jaw Discrepancy

Teeth larger than the space available in the jaw.

Moderate concern Usually treated by Traditional Braces

What it leads to: Overlapping teeth that trap plaque and decay between.
What helps: Orthodontic alignment, with extractions if needed.

Peg-Shaped Lateral Incisors

A small, conical upper lateral incisor.

Low concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: An uneven smile and spacing.
What helps: Composite build-up or veneers.

Fused or Geminated Teeth

Two teeth joined, or one splitting during formation.

Moderate concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: A deep groove that traps plaque and decays.
What helps: Seal the groove; restore or separate.

Dens Invaginatus

A developmental infolding creating a channel into the tooth.

High concern Usually treated by RCT - Root canal therapy

What it leads to: Early nerve infection in an apparently sound tooth.
What helps: Prophylactic sealing; root treatment if infected.

Taurodontism

An enlarged pulp chamber and shortened roots.

Low concern Usually treated by RCT - Root canal therapy

What it leads to: Complicates root canal treatment and reduces support.
What helps: Recognise before treatment planning.

Cleft Lip and Palate

A developmental gap in the lip or roof of the mouth.

High concern Usually treated by Traditional Braces

What it leads to: Missing and malformed teeth, speech and feeding effects.
What helps: Coordinated team care from infancy.

Age & Wear

Decades of ordinary use, accumulating.

Physiological Attrition

Normal tooth-against-tooth wear accumulated over decades.

Moderate concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Flattened biting surfaces and gradual loss of tooth height.
What helps: Monitor; restore when function or aesthetics suffer.

Gum Recession with Age

Gums gradually recede, exposing softer root surface.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Sensitivity and root decay.
What helps: Gentle brushing, fluoride, monitor.

Secondary Dentine Formation

The tooth lays down dentine inwardly through life.

Low concern Usually treated by RCT - Root canal therapy

What it leads to: Narrower canals, making root treatment harder later.
What helps: Nothing preventive; plan treatment accordingly.

Reduced Saliva with Age

Salivary flow declines, compounded by medications.

High concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Dry mouth and a sharp rise in root decay.
What helps: Hydration, saliva substitutes, high-fluoride paste.

Enamel Thinning

Decades of acid and abrasion thin the outer layer.

Moderate concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Yellower appearance and increasing sensitivity.
What helps: Protect from acids; consider bonding.

Old Restorations Reaching End of Life

Fillings and crowns do not last forever.

High concern Usually treated by Composite Class II Tooth Restoration

What it leads to: Leaking margins and decay beneath long-standing work.
What helps: Regular radiographic review and planned replacement.

Loss of Vertical Dimension

Cumulative wear shortens the face height.

High concern Usually treated by Zirconia Crown

What it leads to: Collapsed bite, jaw discomfort and an aged appearance.
What helps: Full mouth rehabilitation where indicated.

Over-Eruption of Unopposed Teeth

A tooth with nothing to bite against keeps erupting.

High concern Usually treated by Dental Implant

What it leads to: Interference with the bite and difficulty restoring the gap.
What helps: Replace missing teeth before this happens.

Tooth Discolouration with Age

Dentine darkens and enamel thins together.

Low concern Usually treated by Zirconia Plus Advanced Esthetic Crown

What it leads to: A naturally yellower smile over decades.
What helps: Whitening or veneers if desired.

Reduced Dexterity in Older Adults

Arthritis and weakness make thorough brushing difficult.

High concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Plaque accumulation despite good intentions.
What helps: Powered brush, adapted handles, hygienist support.

Lifestyle & Environment

Work, water, routine and access.

Irregular Sleep and Shift Work

Disrupted routine means missed brushing and more snacking.

Moderate concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Higher decay rate and worse gum health.
What helps: Anchor brushing to fixed points in the day.

High Stress Occupation

Sustained stress drives clenching and suppresses immunity.

High concern Usually treated by Consultation

What it leads to: Grinding wear, gum disease and mouth ulcers.
What helps: Stress management; a night guard.

Swimming in Chlorinated Pools

Frequent training in poorly balanced pool water.

Low concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Enamel erosion in competitive swimmers.
What helps: Check pool pH; protective measures for athletes.

Occupational Acid Exposure

Industrial acid vapour in battery or plating work.

Moderate concern Usually treated by Composite Anterior Tooth Restoration

What it leads to: Erosion of the front teeth over years.
What helps: Respiratory protection; regular dental screening.

Flour and Sugar Dust Exposure

Bakery and confectionery workers inhale and swallow sugar dust.

Moderate concern Usually treated by Composite Class I Tooth Restoration

What it leads to: Widespread decay despite normal home care.
What helps: Rinse during shifts; extra fluoride.

Wind Instrument Playing

Sustained lip and tooth pressure from a mouthpiece.

Low concern Usually treated by Traditional Braces

What it leads to: Tooth movement and jaw muscle fatigue.
What helps: Custom mouthpiece cushions; monitor alignment.

Poor Access to Dental Care

Distance, cost or fear preventing routine visits.

High concern Usually treated by Consultation

What it leads to: Problems presenting only as emergencies.
What helps: Preventive plans; phased affordable treatment.

Dental Anxiety and Avoidance

Fear leading to years of avoided appointments.

High concern Usually treated by Consultation

What it leads to: Extensive decay and gum disease found late.
What helps: Gradual desensitisation; sedation where appropriate.

Low Health Literacy

Not knowing that bleeding gums or a black spot matter.

Moderate concern Usually treated by Consultation

What it leads to: Late presentation with avoidable damage.
What helps: Clear education at every visit.

Non-Fluoridated Water Supply

Water with very little natural fluoride.

Moderate concern Usually treated by Composite Class I Tooth Restoration

What it leads to: A measurably higher decay rate across a population.
What helps: Fluoride toothpaste; varnish for high-risk patients.

Very High Fluoride Groundwater

Some regions of India have naturally excessive fluoride.

High concern Usually treated by Zirconia Plus Advanced Esthetic Crown

What it leads to: Dental and skeletal fluorosis.
What helps: Alternative water source; defluoridation.

Air Pollution and Particulates

Chronic irritation of the airway leading to mouth breathing.

Low concern Usually treated by Scaling Grade I - Ultrasonic Teeth Cleaning

What it leads to: Dry gums and increased inflammation.
What helps: Air quality measures; treat nasal obstruction.

Migration and Interrupted Care

Treatment started in one place and never completed elsewhere.

Moderate concern Usually treated by Temporary Crown

What it leads to: Temporary restorations left in place for years.
What helps: Complete records; finish outstanding treatment.

Cost-Driven Treatment Delay

Choosing the cheapest option repeatedly rather than the right one.

High concern Usually treated by Consultation

What it leads to: Repeated failures costing more than one correct treatment.
What helps: Phased planning with clear priorities.

You have a likely reason. Now what?

Knowing the cause is step four. Step five is what to do about it — and step six is what it actually takes to fix. Both are written, both are on the journey.

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Step 4 of 20 · The AR 32 patient journey

What happens next

This is step 4 of 20. Nothing here is a diagnosis — it is the ground you cover before one.

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Biofilm & Bacteria

Dental Plaque Accumulation

Hardened Calculus (Tartar)

Subgingival Calculus

Streptococcus mutans Colonisation

Lactobacillus Overgrowth

Porphyromonas gingivalis Infection

Candida (Fungal) Overgrowth

Actinomyces Colonisation

Biofilm on Rough Restorations

Bacterial Invasion of Dentinal Tubules

Pericoronal Bacterial Trap

Peri-implant Biofilm

Root Canal Reinfection

Tongue Coating Bacteria

Mother-to-Child Bacterial Transfer

Overhanging Restoration Margins

Plaque Around Orthodontic Brackets

Denture Biofilm

Fusobacterium in Deep Pockets

Abscess Tracking Through Bone

Diet & Nutrition

Frequent Sugar Snacking

Sugary Drinks and Sodas

Sipping Drinks Slowly

Citrus and Acidic Fruits

Carbonated Water and Sparkling Drinks

Sticky and Retentive Foods

Bedtime Bottle or Night Feeding

Refined Carbohydrate Diet

Vitamin D Deficiency

Vitamin C Deficiency

Calcium and Phosphate Deficiency

Iron Deficiency Anaemia

Vitamin B12 and Folate Deficiency

Chronic Dehydration

Excess Alcohol Intake

Energy and Sports Drinks

Vegetarian and Vegan Diets Without Planning

Chewing Ice

Frequent Herbal or Sweetened Tea

Eating Disorders

Acid Reflux from Diet

Betel Nut and Areca Chewing

Oral Hygiene

Infrequent Brushing

Brushing Too Hard

Hard-Bristled Toothbrush

Worn-Out Toothbrush

Never Cleaning Between Teeth

Incorrect Brushing Technique

Skipping the Back Teeth

Not Cleaning Dentures Daily

Not Cleaning Around Bridges and Implants

Rinsing Immediately After Brushing

Not Using Fluoride Toothpaste

Ignoring Bleeding Gums

Skipping Regular Check-ups

Delaying Professional Cleaning

Mouthwash Instead of Brushing

Overuse of Chlorhexidine Mouthwash

Sharing Toothbrushes

Not Cleaning the Tongue

Poor Hygiene During Illness

Habits & Parafunction

Night-Time Teeth Grinding (Bruxism)

Daytime Clenching

Nail Biting

Pen and Pencil Chewing