Very often patients ask me about what toothpaste they should use. Seldom, however, am I asked about the best technique for cleaning teeth, when brushing should be done, how often they should brush, or for how long.
The subject of tooth cleansers can be confusing. There are pastes, powders, cavity-fighting and gum-protecting formulas, as well as whitening varieties. Most toothpastes use some form of mild abrasive to clean teeth, while others rely on enzymes to lift the stains out of your teeth. Some are foaming and some are not. Most contain fluoride, while others don’t.
While I do have a personal favorite toothpaste, I honestly believe that an effective job of cleaning can be accomplished with the vast majority of toothpastes available on the market. Why are there so many out there? In a word: marketing. I’m pretty sure toothpaste companies have discovered that if a toothpaste has the word “whitening” on it, they are likely to sell more than if it is omitted — even if the whitening benefit is small.
Some people have even taken to the idea that almost anything will work to clean your teeth. Even soap. Here is a short video I ran across recently that discusses this, and also why you may not want to wash your mouth out with soap. I tend to agree that you should use the right product for the correct purpose.
Click on the toothbrushes below to view the VIDEO:
For the curious, here is an earlier posting that answers some of the other questions discussed above, including how often you should brush.
Just last week I encountered another case of a cracked tooth needing to be extracted. I can’t say this is uncommon. Yet something about this one stuck with me . . . probably because I felt it was avoidable.
Cracked teeth as a result of the grinding and clenching of teeth — also known as bruxism — appears to be reaching epidemic levels. Frankly, that wasn’t the only case of of problems I saw as a result of tooth clenching that day.
The patient I treated right after him had a series of problems connected to clenching as well: among them, bone loss — (with at least one tooth that will have to be removed as a result), front teeth that were chipped, and another that that developed an abscess. Yes, all of these problems had direct connections to the patient’s habit of clenching his teeth.
But let’s return to original patient for a moment. When he first came in and saw me for his initial consultation six months earlier, I pointed out that there was evidence of bruxism. I recommended doing something about it at that time.
The patient looked at me funny — it was clear that he didn’t think he had that problem. I explained why I thought he clenched his teeth and pointed to several things that indicated that condition. He handled a few other problems, but decided to let this one go (“for now”). I’m not going to put a gun to anyone’s head when it comes to my recommendations, but inwardly I wished him good luck.
While conducting my follow-up exam I observed a crack running through his root. Given it’s size and location, his only option is removal. It didn’t hurt him as much as it could have because the nerve had already been removed, but I couldn’t help thinking this was a shame. Had we followed the recommendations I made six months ago, we probably wouldn’t be dealing with this now.
It’s too late for that patient, but the underlying message here is simply this: if a dentist tells you there is a body of evidence suggesting you grind your teeth — don’t ignore it. Most people simply don’t know if they grind because they often do it while they are sleeping. What is more, they don’t do it consistently. Remember, damage can occur in many different ways. It can be slow and steady, like wind erosion wearing down mountains or very quick and short-term, like a bullet to the head. Either way, there is visible change in the end.
Here is a link to an earlier article I wrote about grinding. If a dentist has ever told you that you might grind or clench your teeth, take it to heart. You may be saving yourself a few dollars . . . as well as a few teeth.
As readers of my blog may know, I have long been an advocate of dietary supplements. While the ideal form of nutrition is always a healthy diet, today’s food is simply not the nutrient-rich, non-chemically altered, or non-genetically engineered food our grandparents ate.
While that might just be a topic for another discussion, I want to point out that whereas supplements have their place, it is always prudent to understand what you are consuming and what potential effects it may produce. This advice holds equally true for vitamins and herbs as it does for medications.
While the side-effects of supplements are typically far less dire than those encountered with many common medications, there can be side-effects nonetheless — especially when used in combination with medications.
As dentists, we are particularly interested in knowing what herbal medications a patient takes that may cause drowsiness, excessive bleeding, cardiovascular problems or that interfere with other drugs.
Here are a few examples:
St. John’s Wort, used as a mood enhancer, can interfere with the effectiveness of many heart and blood pressure medications, as well as blood thinners. On the other hand, garlic, ginseng, ginger, chamomile and gingko, to name a few, can cause bleeding after surgery.
A patient given sedatives by a dentist or oral surgeon before surgery who is also taking Valerian root and kava may experience an interaction that causes excessive drowsiness.
Ginseng has been associated with an increased chance of arrhythmias (irregular heart beats. Patients who take ginseng and also get a local anesthetic with epinephrine (commonly used for fillings and many other dental procedures) may be putting themselves at risk for cardiovascular complications.
Echinacea, while it is widely considered to be an immune system enhancer, may inhibit wound healing and increase the risk of post-surgical infection.
This list is by no means exhaustive, and the simple message here is just because an herbal remedy is considered “natural” doesn’t mean you should neglect to inform your dentist that you are taking them. Neither he nor you want to risk negative effects or complications that can come about as a result of interactions.
More likely than not, your doctor will simply ask you to stop taking a particular supplement before surgery or modify the anesthesia accordingly.
Good communication is the key.
Here is another example of this point. Not uncommonly, patients take “baby aspirin” as a blood thinner. Of course, this is not an herb, but many people feel it is not worth mentioning because it is just a “baby” aspirin. That is, until they fail to stop bleeding after an extraction.
You should always be sure to tell your doctor about ALL of the substances you are taking, including prescriptions and over-the-counter drugs. Even doctors aren’t always fully aware of every potential interaction between herbs and drugs, as new drugs are constantly being developed and introduced into the market. It is in your best interest to let your doctor “know before you go.”
No matter how you slice it, tooth problems can be a pain. Among these, cracked teeth stand out for their confusing and erratic nature. A cracked tooth can be painful, annoying, and an exercise in frustration for patients and dentists alike. While there can be many factors that contribute to cracked teeth, the bottom line is that if your tooth is cracked the solution is often involved, potentially expensive — and, despite best efforts, tooth loss is still a very real possibility. Clicking on the picture below will take you to a compilation of questions and answers about cracked teeth. It covers a lot of ground, but if you think you may have a cracked tooth, it is worth reading so that you can know what to expect.
Did you know that there are way more bacteria in your mouth than there are people on the planet? By some estimates: 120 BILLION bacteria can grow in 24 hours!
That’s really a lot of bugs!
Germophobes might get a little skittish reading this, so it may make you feel better to know that most of them are harmless.
Typically, the body’s natural defenses and good oral health care — such as daily brushing and flossing — can keep these bacteria in check. However, without proper oral hygiene, bacteria can reach levels that might lead to oral infections, such as tooth decay and gum disease. After more than twenty years of practice I have also observed that oral health can act as a window to your overall health.
For example, your oral health might be affected by, may itself affect, or may contribute to, various diseases and conditions — including:
Cardiovascular disease. Some research suggests that heart disease, clogged arteries and stroke might be linked to the inflammation and infections that oral bacteria can cause.
Endocarditis. Endocarditis is an infection of the inner lining of your heart (endocardium). Endocarditis typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart.
Pregnancy and birth. Periodontitis has been linked to premature birth and low birth weight.
Diabetes. Diabetes reduces the body’s resistance to infection — putting the gums at risk. Gum disease appears to be more frequent and severe among people who have diabetes. Research shows that people who have gum disease have a harder time controlling their blood sugar levels.
Osteoporosis. Osteoporosis — which causes bones to become weak and brittle — might be linked with periodontal bone loss and tooth loss.
HIV/AIDS. Oral problems, such as painful mucosal lesions, are common in people who have HIV/AIDS.
Alzheimer’s disease. Tooth loss before age 35 might be a risk factor for Alzheimer’s disease.
Other conditions. Other conditions that might be linked to oral health include Sjogren’s syndrome — an immune system disorder that causes dry mouth — and eating disorders.
Because bacteria can proliferate as quickly as they do, we now provide our patients with a way to minimize bacterial risks during their cleaning appointments. We have the ability to use a laser decontamination process that dramatically reduces bacterial levels in your gum pockets painlessly, without the need for anesthesia, and in as little time as 5 to 10 minutes. Better still, the lowered bacterial levels are expected to continue for six to eight weeks.
Unfortunately, dental insurance still tends to be a little behind the times in terms of their coverage for the procedure. We have kept the cost low, however, in order that most patients can benefit from this exciting new technology. You can read more about it by clicking HERE.
Very often the ideas that I have for articles in this blog come from real-life experiences in my dental practice. One of the things that caught my attention most recently was the prevalence of patients who come in for emergency treatment of broken dentures (typically rather old dentures) and who only have the single set to work with.
Now this creates a real problem for them because it is difficult to go out in public without teeth. People at work who may not know they wear dentures will suddenly become acutely aware of the fact. This can create considerable embarrassment and, even for a retiree, is often enough to prevent attendance at important milestone events such as a graduations, weddings, or anniversaries.
Some repairs can be handled quickly and relatively easily in the office, whereas others have to be sent to a dental laboratory. Depending upon the severity of the problem, that can take time: days, or even up to a week with certain types of dentures.
If you don’t wear dentures, this post may not appear to have anything to do with you. That is, until your mother, father, or grandparent call you in a panic, reporting they just dropped and broke their denture. (Or lost it.) You may find yourself pressed to leave work to bring them to the dentist’s office.
While it may be easy to say that every denture wearer should have a spare set, I understand the economics of the situation. Since I started practice some 20+ years ago, I have seen the cost of producing dentures nearly triple. Nevertheless, there are still many good reasons to think about having a spare set made.
Very often, when making a new denture, your doctor can manufacture a spare set at a reduced cost because he does not have to do the work twice. Similarly, an “economy” version can sometimes be produced by the laboratory which can make a duplicate of your existing denture. It may not be as cosmetic or “perfect” as the original, but it sure is nice to have something to go out and eat with while your main set is being repaired.
And sure, a denture costs more than your average article of clothing — but can you imagine having only one set of pants?! How do you even go out to buy another if you lose it? I suspect that even people who wear hair-pieces have back-ups. They may not want to go out in public without hair, but at least they can still eat.
If you or a loved one only have one denture, seriously consider a spare. And if the denture is older than seven years, it is a good idea to think about a new one. (For more information about why this is recommended check out another one of our blog posts on the subject.) No one needs the stress or embarrassment caused by having to be without teeth.
What?! Is the sky falling? What dentist would dare utter such blasphemy!
Stick with me for a moment. You may learn something about flossing.
Here are the facts as I see them after more than twenty years in dental practice:
Most patients don’t floss. Most patients don’t like to floss. Most patients won’t floss even if you explain the benefits of flossing at every checkup visit for ten years. Most patients are convinced flossing makes their gums bleed and is uncomfortable to do. Most patients will tell you they floss, but “probably not as much as I should.” So really, why bother?
Another observation I have made about flossing regards what people think flossing is. I will sometimes hand a patient a piece of floss and ask them to show me how they floss. Without exception, I have seen patients pass the floss between their teeth and then pop it back out.
That sounds right, doesn’t it? Special effects department please sound the buzzer. That’s not flossing.
Add to this the fact that most patients will only perform this routine once in a while. If you call that “flossing” I say don’t lose sleep over the fact that you are not flossing regularly. That can be effective at pulling food out from in between your teeth, though, so feel free to do so. But if that’s not flossing, just what is it, really?
Flossing is the action of taking a length of floss – either the conventional “string” kind or pre-threaded on a fork-like device – and then passing it between your teeth while holding it in a “C-shape” against the side of the tooth. You then take the floss and rub the edge of the tooth, sliding it all the way under the gum-line in an up and down motion. How often can one do this? After every meal would not be too much. But if people did this at least once a day, the average case would see dramatic results after an average of two weeks of daily flossing.
If you haven’t been flossing regularly here is what you can expect: your gums will bleed when you start to floss. It is also likely to be a little uncomfortable at first. But over time, the bleeding should stop. If you haven’t had a dental checkup and cleaning for a while, it is a good idea to do so this first. Flossing against existing tartar will be an unending battle. Once the teeth are clean, however, daily flossing will usually result in pink, firm and healthy gums that don’t bleed. Other benefits? Fresher breath and reduced inflammation – which also means a lowered chance of heart attack and stroke.
If you only floss once in a while, though, inflamed gums will likely never get up to a point where the occasional activity makes any difference. So, if you don’t make it a discipline, why bother? But if you would like healthy teeth and gums for a lifetime, start flossing today!
Dr. Richard Walicki is a dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.
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