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.
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.
And Lay Off The Soda
Did your last dental checkup find you sinking lower and lower into the dental chair with each cavity your dentist found? If so, one of the first questions you may want to ask yourself is this: are soft drinks a big part of your daily routine? If you answered “yes”, you may want to re-think your dietary habits.
Some of the worst cases of dental decay that I have seen involve sodas, or sweetened (prepared) iced tea. One 12 oz. can of soda averages about 12 teaspoons of sugar. That’s basically liquid sugar. Just cut it out. Read the ingredient list on the bottle or can. Be aware of added concentrates, syrups and juices used to sweeten the drink. If it states high fructose corn syrup (HFCS), read “sugar”.
Imagine sitting next to someone in a restaurant or diner as you watch them put a teaspoon of sugar into a mug of coffee. Then they proceed to put in eleven more! You might just do a double-take.* And yet most people don’t even blink when consuming a can or bottle of soda. Many children (and adults) drink it by the liter.
Aside from the sugar that soft drinks contain, you are essentially giving your teeth an acid bath every time you drink a can or bottle. It’s pretty strong stuff. I understand some cola will loosen rusty nuts on bolts, or even clean battery terminals! Just try to keep it out of your body. If you need help weaning yourself off of the sugar, speak to your doctor about it right away. You will be happy to know there are healthy alternatives. Apart from enamel erosion, drinking soda has been linked to diabetes, formation of kidney stones, osteoporosis and even low potassium levels with associated muscle weakness.
Cutting back on (or preferably eliminating) soda may be one of the most significant things you can do to help your teeth -and the rest of your body.
(*) Some time after I originally wrote this piece for Ezine @rticles I came across the following ad by the New York City Health Department. It makes a very similar point!
There are a number of factors that can contribute to the formation of dental cavities. One fundamental that will apply to most everyone concerns the reduction of dental plaque. If you want fewer cavities, reduce your plaque levels.
Dental plaque can be defined as a complex microbial community, with greater than 10 to the 10th power bacteria per milligram. (That’s really a lot of bacteria.) Just to keep things simple, though, the problem is that these bacteria produce acids on your teeth – and the acids dissolve the enamel, leading to tooth decay.
After only a few years of practice, it became obvious to me that most people have difficulty identifying plaque. Even now, I’ll begin a dental exam or cleaning on a person and start removing large areas of plaque. If I casually ask the patient about their cleaning regimen, often I’m told “I brushed just before I came in here!”
Since that much plaque can’t form in an hour, the obvious conclusion is that the patient missed it or simply doesn’t see it. Just to be clear, plaque is the soft, sticky film that occurs on the surface of teeth – not the hard substance your dentist or hygienist has to pick away, which is tartar. Though it is basically mineralized plaque, virtually no amount of tooth brushing and flossing will remove tartar after the fact (dentists call it ‘calculus’). Once formed, calculus needs to be removed at your office visit.
It is useful to know that if you control your plaque well, calculus won’t be much of a problem. So let’s focus on that for a moment. What do you do if you feel you are brushing, but the dentist tells you he still sees plaque? Stain it!
Lately, I have been seeing more commercials advertising products for children that stain their teeth blue after they have rinsed with it. The child then brushes until all of the blue stain has been removed. What the liquid is staining is plaque. I think this is a great way to simplify the process of identifying the problem. Whether you are six or sixty, the principle is the same.
If you want to be certain you have gotten the plaque off, rinse with the stain after each meal and then brush (and floss) until you have removed the discolored areas. Barring other systemic or external contributory factors (such as medications leading to a dry mouth), you and your dentist should see a big improvement in the cleanliness of your mouth, and fewer cavities over time!
When we are born we come into the world without teeth. Some of us leave the same way, but that really isn’t what nature intended.
When you are on a liquid diet having teeth doesn’t appear to be vital, since there is obviously nothing to chew. Nature pretty much handles a baby’s nutritional needs with mother’s milk. As we grow and begin to eat solid food, however, having and maintaining healthy teeth becomes an entirely different matter.
So when teeth become lost due to cavities, periodontal disease or trauma, the consequences for good health can become significant. Let’s not forget that digestion begins in the mouth. There are actually two forms of digestion – mechanical and chemical.
Mechanical digestion is the grinding and tearing of food, as in chewing, in order to increase its surface area. Creating a greater surface area means that there is a better chance that chemical digestion can do its job. In chemical digestion, enzymes react with the food to help break it down into simpler substances which can either be absorbed in the bloodstream as nutrients or passed out of the body as waste. This process of breakdown and assimilation occurs within the digestive tract – but it starts in the mouth with your teeth, tongue, and saliva.
Because a full set of adult teeth numbers thirty-two, it seems many people feel the occasional loss of a tooth is a relatively insignificant event. And while it is true that a person can still function with thirty-one, the long-term consequence of losing just one tooth can be more significant than most people realize.
While all of our teeth are important, structurally, the loss of certain teeth will bring about more change than the loss of others. Think of this in terms of the walls of your house. If you take down a non-supporting wall, the house will still stand. Take out a supporting wall, however, and you have a much bigger problem. Teeth are constructed much like an arch, though. If you have ever seen a stone arch, you know it has a keystone at the top that keeps the arch together. Remove that one stone, and the whole thing collapses. In your dental arch, you can think of your canines as a keystone. Lose them, and the ensuing change can be rapid. You can lose several teeth – even all – over time. But it’s not just the loss of canines that creates a problem.
Losing a first molar, for example, can create a domino effect of changes in your mouth that can affect your ability to chew easily. It can cause shifting of the teeth in a manner that even affects the appearance of your front teeth. Or, it can lead to periodontal problems and the formation of cavities on portions of the teeth that might not have been otherwise affected before the loss.
The point is that if you lose a tooth, you should consult your dentist about what tooth replacement options are right for you. Today, we have many ways of providing functional replacements that can improve your ability to chew your food, maintain your good appearance, and keep you from losing still more teeth. Depending upon your circumstances and financial considerations, these replacements may include removable dentures, bridges (which are non-removable, cemented tooth replacements), or dental implants (think of them as artificial tooth-roots that have crowns, bridges, or dentures attached to them).
If you are missing a tooth, speak with your dentist about what tooth replacement options are right for your situation. Replacing a lost tooth early is often much less involved (and costly) than when you begin to experience the problems resulting from long-term neglect.
Is it possible to have a cavity and not know it?
Consider this article a public service announcement. I really dislike it when patients lose their teeth unnecessarily. My practice philosophy is that if a person has a dental problem, the goal is to handle that difficulty first, but then empower the patient with the correct knowledge that will keep him out of trouble from there on out. Ideally, my hope is that most future visits to my office will only be for routine maintenance.
Unfortunately, and all too often, I encounter new patients with teeth that are so badly decayed there is little hope of salvage. Possibly just as frequently, I find these patients scheduling a checkup – usually after a long absence from dental care – who are surprised to learn that they have any cavities at all. Sometimes they will think they lost a filling when, in fact, a piece of their enamel has broken away.
Why are they surprised? The common denominator seems to be the idea that cavities are supposed to hurt.
Well, sometimes they do hurt. But most of the time – especially in the early stage – they don’t.
In fact, by the time a tooth does start to hurt you it’s usually pretty bad. More often than not, it is so bad that a dentist is evaluating whether it can be treated with endodontic (root canal) therapy or whether it needs to be extracted. A little understanding of basic dental anatomy is helpful here.
Take a look at the illustration below:
The outer layer of the tooth is comprised of enamel. This is the hardest substance in your body. It breaks up your food and is designed to last you a lifetime.
And now, here is the important part for you to understand: it doesn’t contain any nerves.
It is more than ninety-five percent mineral. Water and organic materials make up the balance. And because it doesn’t have nerves, it doesn’t have feeling. This is actually quite practical since it wouldn’t do to have pain every time you bit into something. On the other hand, it also means that it can be decayed without giving you a warning.
In fact, decay can also travel into the supporting layer – the dentin – and still not cause you pain. It usually has to travel pretty close to the inner layer that contains the blood vessels and nerves – the pulp – before you feel it. Of course, by then, the tooth has generally undergone considerable destruction.
Another factor that makes spotting decay difficult is the way it spreads. I have drawn two black triangles into the enamel above. Notice that the narrow point is on the outside of the enamel. The broader base faces the inside of the tooth. This is how decay usually travels. Sometimes, it will undermine the interior of the tooth while the outer, harder enamel still maintains its form . . . until it eventually crumbles because the underlying supporting dentin has been eaten away by decay.
Many cavities also form at the contact point between two teeth. These are areas that you simply cannot see. Even the dentist needs an x-ray to spot these cavities in most cases.
So what does all this really mean? Spotting decay is not always that easy. As dentists, we use visual examination, but we also rely on probes, x-rays, and even laser detection devices to locate cavities. Even then, it can be difficult to find cavities under existing fillings.
Don’t rely on pain to tell you if you have a cavity in your tooth. If you do, you can be assured that your treatment is likely to be more uncomfortable, expensive, and may even result in the loss of a tooth that could have been treated much more easily earlier in the game.
If you have a loved one, who still has their teeth and hasn’t seen a dentist in a while, have them read this article. You may be saving them from quite a bit of discomfort – not to mention time and money – if they catch potential problems before they are hopeless.
Some of you may be thinking, “No big deal. If it’s that bad, I’ll just pull it.” OK, sometimes that is necessary, but therein lies a lesson for another day.
Many of my patients have seen me use a dental instrument called a Diagnodent in the office. It is one of the latest diagnostic tools in dentistry.
No more poking and prodding. No additional radiation. No waiting until the film develops. A laser now detects cavities. And it may do it more accurately than conventional x-rays in many cases. How does it do it? It measures the amount of enamel and dentin lost and assigns a number using a special scale. The number helps the dentist decide if the tooth needs a filling or should just be checked again in several months. Small amounts of decay can disappear if the tooth hardens the softened enamel, a process called remineralization.
It gives you such accurate readings that if you decide to watch a tooth, six months down the road, you’ll rescan the tooth and check the reading. Sometimes we may find the numbers get smaller.
The device (the Diagnodent) is painless, and very safe. It does not necessarily find more decay. It helps us decide if it’s true decay. If small cavities are detected, patients can take steps that will help to remineralize the tooth and may avoid a filling entirely.
This new laser cavity detection system does not replace all x-ray technology. But it is one more tool we have to help keep your cavities small and your dental bill smaller.