Take Care of Your Teeth While Wearing Braces

So, you just got your braces on, and you're wondering why you should continue visiting your general dentist since you’re seeing your orthodontist every other month. Patients always ask us if they should continue to see their dentist while in orthodontic treatment. In short, the answer is yes. While you are wearing braces, it is essential that you take care of your teeth and gums so it is crucial to keep up with your regular visits with your dentist in addition to going in for your regular orthodontic adjustments . 

One of the best reasons to visit your dentist while you undergo orthodontic treatment is to remove plaque and tartar. Having braces provides additional nooks and crannies in which food particles and bacteria can hide. Eventually, plaque and tartar can form around your brackets, bands or other appliances which can lead to cavities. Having your teeth professionally cleaned can help ensure most, if not all, plaque and tartar is removed. Even if you are undergoing clear aligner treatment, dental checkups and cleanings are equally as important.

The next reason to visit a dentist is to help protect your teeth from decalcification, or the loss of calcium in your teeth. A potentially serious condition in which white spots on your tooth surfaces, decalcification is irreversible and if left untreated, can lead to cavities. Decalcification is preventable; patients who cut down on sugary sweets and acidic foods, practice good oral hygiene, and visit their dentist regularly can help prevent decalcification.

The final reason we recommend visiting your dentist while you have braces is this: cavities can prolong your treatment. If you are interested in completing your orthodontic treatment on time and without any delays, visiting your dentist every six months or as recommended can go a long way toward making that a realistic goal. Your dentist can provide fluoride treatments or other treatments that strengthen your teeth and protect them from cavities. Making sure to visit your dentist will help ensure your teeth look their best once your braces come off.

DON'T BE CONFUSED ABOUT DENTAL CLEANINGS!

 

The different types of dental cleanings that we perform can be confusing and we are asked often about the differences in treatment and cost for getting teeth cleaned. Since it has become such a common question, I thought I would try to explain the differences here in not so abstract terms!

DENTAL CLEANINGS: According to the American Dental Association, this is the definition of an adult dental cleaning (technically a prophylaxis): "A dental prophylaxis performed on transitional or permanent dentition, which includes scaling and polishing procedures to remove coronal plaque, calculus, and stains. Some patients may require more than one appointment or one extended appointment to complete a prophylaxis.
MY Explanation: A lot of scary words in there, so let me break it down. A dental cleaning is done for people with healthy gums. It removes plaque and calculus (also known as tartar) from above the gum line. This is typically completed by a hygienist in one visit. The hygienist may use a scaler/curette (patients refer to them as metal picks) or an ultrasonic scaler (commonly referred to as the tool that "vibrates, buzzes and shoots water"). Lastly, the hygienist will polish your teeth with an air-driven slow-speed prophy cup filled with flavored pumice. The key: the patient has healthy gums (meaning no bone loss, no periodontal disease) and the teeth are simply cleaned in one visit.

ROOT PLANING: According to the American Dental Association, root planing (deep cleaning) is defined as follows: "This procedure involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces. It is indicated for patients with periodontal disease and is therapeutic, not prophylactic, in nature. Root planing is the definitive procedure designed for the removal of cementum and dentin that is rough and/or permeated by calculus or contaminated with toxins or microorganisms. Some soft tissue removal occurs. This procedure may be used as a definitive treatment in some stages of periodontal disease and/or as a part of pre-surgical procedures in others."
MY  Explanation: This is not a cleaning. The patient getting root planing does not have healthy gums. It is therapy or treatment for diseased gums. Your teeth are probed/measured for the purpose of diagnosis. Patients with good oral hygiene can manage pocket depths at 3-4mm. Probing depths 5mm and above with evidence of plaque, calculus, inflammation or infection require treatment of the tooth and root surfaces. This is done typically one corner of the mouth at a time with dental anesthetic. It is always followed up with a reevaluation, to make sure the treatment was successful. The key: the patient has been diagnosed with periodontal disease (bone loss has occured and acute or chronic gingival inflammation is present). This treatment is completed 1/4 of the mouth at a time with dental anesthetic. The patient may leave with an antibiotic or an antimicrobial rinse.  

PERIDONTAL MAINTENANCE: This is the most confusing part of periodontal therapy. Periodontal Maintenance is defined by the ADA as follows: "This procedure is for patients who have previously been treated for periodontal disease. Typically, maintenance starts after completion of active (surgical or nonsurgical) periodontal therapy and continues at varying intervals, determined by the clinical diagnosis of the dentist, for the life of the dentition. It includes removal of supra and subgingival microbial flora and calculus, site specific scaling and root planing where indicated, and/or polishing teeth. When new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered."
MY Explanation: This seems like a cleaning, except it's for patients who have previously had gum surgery or root planing...aka they do not have a healthy mouth. The hygienist will go after troubled spots, numb if necessary, and constantly evaluate the "state of disease." The name explains a lot: Periodontal Maintenance, in other words the dentist/staff are maintaining the current conditions and trying to prevent them from getting worse. They may be more frequent than dental cleanings too. The key: Not a cleaning, but it sure feels like one, because the whole mouth is treated in one visit. It is more active, more thorough and more involved.

Want Healthy Knees? Focus On Your Gums

Want healthy knees? Then you better floss your teeth. Yes, you read that right. Scientists have found traces of gum bacteria in the knees of people with rheumatoid arthritis and osteoarthritis. The study, published in the Journal of Clinical Rheumatology, adds more evidence of the link between poor oral health and poor health in general.

Researchers from Case Western Reserve University in Cleveland essentially traced the passage of bacteria in the mouth to the fluid surrounded the kneecap, called synovial fluid. By analyzing the DNA of the bacteria, the researchers could determine that gum bacteria entered into the bloodstream and settled in the synovial fluid, which was in a weakened state because of arthritis.  In healthy people, the synovial fluid is essentially sterile. Bacteria can make the diseased area much, much worse.

Although it is not conclusive that the gum bacteria caused or worsened the arthritis in the patients it studied, the finding provides a new wrinkle in the still controversial theory of gum disease's role in a host of ailments.

 

Knee and mouth disease?

Advanced gum disease, or periodontitis, has long been associated with heart disease. One example of this link is the accumulation of plaque in the arteries, called atherosclerosis, which may be exacerbated by the same bacteria causing plaque on the teeth. Another example is an inflamed heart valve, irritated by gum bacteria. That's the theory, anyway.

  

People with periodontitis are twice as likely to have cardiovascular disease. Researchers in this study have also said his group has unpublished data showing how periodontitis is more of a risk factor for heart attacks than LDL "bad" cholesterol levels or C-reactive protein levels, a measure of inflammation.

And now his group has data tying gum disease to arthritis. The bacteria found in the mouth and in the synovial fluid were genetically nearly identical, providing smoking-gun evidence of bacteria relocating. It is well known that advanced periodontitis can lead to harmful bacteria entering the bloodstream. Once it gets in, it can go anywhere.  The target is often a site of existing inflammation, such as the arteries or, in this case, the knee.

It wouldn't be such a bad idea to start brushing and flossing!

 

 

Pregnancy Gingivitis

Pregnancy can bring many wonderful new joys to an expectant mothers’ life. Pregnancy gingivitis is not one of them.

The shocking truth is that pregnancy gingivitis affects anywhere from 50 to 70 percent of pregnant women, and those with the disease are 7 times more likely to go into preterm labor, preclampsia and have low-birth weight babies! Premature infants are at greater risk for short and long term complications, including disabilities and impediments in growth and mental development. Additionally, if an expectant mom had untreated tooth decay and/or consumed a lot of sugar, their children have 4 times the risk of developing tooth decay.

Pregnancy gingivitis is characterized by swelling/inflammation of the gums, and is caused by a bacterial film that grows on the teeth, resulting in plaque buildup. This plaque irritates the gum tissue, making them tender, bright red, swollen, sensitive, and easy to make bleed. These infected and swollen gums harbor disease causing bacteria, which release toxins that can attack ligaments, gums, and bones surrounding your teeth to create infected pockets similar to large infected wounds in the oral cavity. These pockets provide access to your bloodstream and allow bacteria to travel throughout your body. Since the bacteria that cause gingivitis can enter the bloodstream, they are able to travel down to the uterus. This triggers the body to produce prostaglandins, which is a natural fatty acid that normally controls inflammation and smooth muscle contraction. When a woman is pregnant, her level of prostaglandins increases, and peaks when she goes into labor. It is possible that if extra prostaglandins are produced when the body is reacting to infected gums, a pregnant woman’s body may think it is a signal to go into labor sooner than expected, thus causing a baby to be born too early.

Ultimately then, hormonal changes during pregnancy affect the body’s natural response to dental plaque, which affect how gum tissues react to the bacteria in plaque; thus resulting in a higher chance of pregnant women getting gingivitis.  If you already have gingivitis going in to a pregnancy, it will likely get worse during pregnancy if you do not seek treatment. Although the gingivitis generally subsides shortly after birth, it should nonetheless be periodically monitored by your dentist (during and after pregnancy), in order to prevent the gingivitis from turning into the more serious (and irreversible) form known as periodontitis.

The following are guidelines suggested by the American Academy of Pediatrics (AAP), in response to the increased concern about oral health during pregnancy:

1) Oral Health Education – DO have consultations with your dentist before, during and after your pregnancy. Early intervention is key, but ongoing care is just as important!
2) Oral Hygiene – DO brush and floss regularly – and properly. It is especially important to try and always brush after meals and snacks, especially sugary ones. Also, have more frequent dental cleanings than you normally would (2-3 during your pregnancy is about right). This will greatly increase the amount of plaque that is removed from the teeth and gums, thereby lowering your risk.

3) Nutrition – DON’T eat junk. This is good advice in general during your pregnancy, but just know that proper diet and nutrition during pregnancy will limit sugar intake which, in turn, will minimize plaque build up.

4) Treat Tooth Decay – DO try and have all urgent dental work completed prior to becoming pregnant. Although, it is safe to perform certain emergency dental procedures during your pregnancy, it is best to have it done prior to becoming pregnant, and especially prior to it becoming an emergency dental treatment!

5) Transmission of Bacteria – DON’T share food and utensils, so as not to potentially transmit bacteria known to cause tooth decay.

6) Use of Xylitol Gum – DO chew gum. Expectant mothers, and everyone, are encouraged to chew xylitol gum (around 4x/day), since research suggests that it may decrease the rate of tooth decay. Chewing sugarless gum increases saliva and thus increases the production of salivary enzymes that help equalize the Ph in the mouth and thus reduce cavity growth.

To sum up, pregnancy gingivitis is a real and prevalent threat but, so long as you take the appropriate steps, it can be managed with relative ease. 

Eating Disorders Affect Oral Health

The National Eating Disorders Association (NEDA) estimates that in the United States, nearly 10 million women and 1 million men are affected by anorexia or bulimia. Millions more suffer from binge-eating disorders. With so many men and women suffering from eating disorders, more dentists are becoming the first line of defense when it comes to recognizing these problems in patients. Although parents may not know that their children have an eating disorder, they often ensure that their children have regular dental appointments. In such cases, a dentist may spot the warning signs of an eating disorder and be able to point parents in the right direction to get help.

Anorexia and bulimia nervosa have a profound effect on the teeth. Well known dental consequences of these disorders are:

• Eventual tooth loss.
• Erosion of the enamel on the "tongue side" of the teeth as a result of teeth being bathed in stomach acid.
• Worn-away enamel, which make dental fillings appear to be raised and teeth appear dark.
• Possible bone loss from osteoporosis.
• Jagged edges on the biting surfaces of the top teeth.
• Altered bite such that lower teeth hit the roof of the mouth.
• Bleeding gums and burning tongue.
• Decreased salivary flow (dry mouth) and swollen glands.
• Sensitivity and soreness in the teeth, mouth, throat, tongue and gums.

Because teeth and gum tissue reflect a person's health, the dentist may be the first to detect an eating disorder. Too often, neither the medical community nor the patients realize the serious impact that eating disorders have on teeth. Irreversible damage -- even total loss of all teeth -- is possible if left untreated. Some dental offices work with health professionals in their area that treat patients' eating disorders, specifically anorexia and bulimia nervosa, because dental care is part of the recovery program.

A key element in this treatment program is education. For patients with eating disorders, we do not recommend the standard dental hygiene guidelines. For example, since many bulimic patients follow a pattern of binge eating then purging, often regurgitating food and stomach acid, it is important that they do not brush their teeth afterwards. Doing so would only encourage even more erosion of the dental enamel because the patient would actually be scrubbing his or her teeth with acidic solution. In such cases, we suggest that our patients simply rinse their mouth with water or with a solution of sodium bicarbonate (baking soda and water). The baking soda rinse neutralizes the acid by raising the pH level in the mouth. Brushing the tongue with baking soda may also be recommended.
Dental treatments can and should begin during recovery in order to protect the teeth. If diagnosed and treated at an early stage, enamel loss may be replaced with tooth-colored materials known as composite resins. These resins are sculpted into place -- duplicating or improving the appearance of the missing enamel.

In some cases more extensive dental treatment may be required, depending upon the extent of the damage to the teeth. There may be the need for dental restorations, such as overlays, tooth crowns or veneers, especially if a proper bite needs to be achieved.

Sometimes, eating disorders are not discovered until it is too late and irreversible damage has been done to the body as well as the teeth. According to NEDA, early detection of the disease may ensure a successful recovery period for the body and teeth.

Gingivitis vs. Peridontitis...Yes There is a Difference

Gingivitis is a formal term for "bleeding" of the gums, which is reversible by proper flossing and brushing. Periodontitis means there is some degree of irreversible breakdown of the bone under the gum. Dentist have a tool , a perio probe,  which is basically a dip stick we use to measure the depth of the collar of gum around each tooth. A good measurement is "3" and NO bleeding. If we get bleeding with a value of 3, then that is gingivitis and we "slap" your hand and lecture you about flossing these areas more. Usually the bleeding is between the teeth and you can access these areas only by flossing. Brushing, alone, does not do the trick.

Now if we measure a "4" or "5" or higher, and we have bleeding, then we are having some degree of bone loss. This is not good and not reversible. The dentist has to "clean"or scale and root plane under the gums. The patient really cannot access these areas. However, once we are able to clean these areas, chances are good, healing occurs and the patient can access these areas. So, my point is, not all cleanings are the same. It is vital and so important, time is taken each year or as needed to measure these areas and explain these readings to you.

Finally, if a patient has dental insurance and the contract says "100% payment for a cleaning," please note that means your gums are healthy with NO bleeding. The definition of "prophylaxis" in the context of dentistry, means to clean above the gums. Moderate to severe Gingivitis and Periodontitis places the patient under another category with your insurance. Instead of 100% payment for preventive work, this changes to the basic category which could mean paying a deductible and a percentage (usual 20%) for the treatment. So don't think the dentist is pulling a fast one on you. Invest a little now to clean them properly and get into the habit of proper home oral hygiene.

The Importance of Flossing

Flossing is relatively easy, right? So why are there so many people who don’t do it? Here at my practice, me and my team want to be sure you understand how important it is.

Flossing removes bacteria between your teeth that...if left alone...turns into plaque, and then tartar. Tartar buildup can be hard on your teeth and gums and can only be removed through professional cleanings. If tartar is not removed it can cause gum swelling or bleeding, commonly called gingivitis, which is the first stage of gum disease. The American Dental Association recommends flossing at least once each day as part of your oral care routine.

Is There A “Rule of Thumb” For Flossing Frequency?

I've come to the conclusion that I should tell all my patients to floss seven times a day....that way perhaps they will do it once a day.  A little overkill?..Maybe...but at least they know that my goal is to get them to floss. There are lots of ways to properly floss. One good idea is to first use your toothbrush to spread your toothpaste around in your mouth. Then, without rinsing, floss before you brush because the floss can carry the fluoride in your toothpaste to places in your mouth where your toothbrush can’t reach. It is best to floss at night, before you go to bed. That way you don’t have to worry about the bacteria from your day’s meals sitting in between your teeth for 8 hours.

Why Are There So Many Floss Choices And Techniques?

For something as simple as a piece of string rolled up inside a plastic container, how is it that there so many varieties? Waxed or unwaxed?…Mint or cinnamon?…Flat or rounded…? Regular floss or a floss wand? We understand that this myriad of choices might make it seem impossible to choose. Luckily, there really isn’t a wrong choice! The only reason there are so many choices is because there are so many different types of mouths and teeth. All you have to do is find the thickness, flavor and type that you like the best and you’re good to go! Our team reminds you that the type you use isn’t nearly as important as your regularity in using it. So, pick a flavor, set your routine, and get flossing! Keep your teeth healthy and clean!

Want Healthy Gums? Hit the Dairy Aisle.

Consumers have long known that including dairy in their diets can help maintain healthy bones and even help promote weight loss. However, a study published in the Journal of Periodontology, the official publication of the American Academy of Periodontology (AAP), demonstrated that routine intake of dairy products may also help promote periodontal health. The study analyzed the periodontal health of 942 subjects and determined that those who regularly consumed dairy products such as milk, cheese and yogurt had a lower instance of gum disease. This study reinforces what much of the public already knows – the importance of dairy in helping achieve a healthy lifestyle, including a healthy mouth.


Periodontal, or gum, disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. Periodontal disease is a major cause of tooth loss in adults and has been connected to the development of heart disease and increased risk of stroke, and can contribute to complications from diabetes, respiratory disease or osteoporosis.

Millions of adults already suffer from periodontal disease and by regularly consuming dairy products such as cheese and milk, something many people do each day, the risk of developing gum disease may decrease. These findings are important since maintaining healthy gums is a critical component to maintaining a healthy body.