Doc of the Bay Family Dentistry
Roger A. Stroud, DMD, FAGD
2693 Bienville Boulevard
Ocean Springs, MS 39564
It's no secret that practicing good oral hygiene daily is important. We've been told since childhood to brush and floss daily. And the words plaque and gingivitis have become commonplace due to their exposure on television, radio, and in magazines.
We are constantly being bombarded by ads from the media that try to sell us new dental products. Models with dazzling smiles insist that you must try this new wonder toothpaste. Every product boasts that it is new and improved, better than the rest. Buying a new toothbrush is enough to make your head spin.
So why is it that three out of four adults will develop some form of periodontal disease (gum disease) in their lifetimes? And why are children still getting cavities at alarming rates?
To keep your teeth healthy, it is important to have a basic working knowledge of gum disease and tooth decay. It is also important that you establish an effective daily oral hygiene routine and have regular visits to your dentist/dental hygienist.
What Causes Periodontal Disease?
Bacterial plaque is the primary cause of gum disease and tooth decay. Plaque is a sticky, colorless film of bacteria that constantly forms on your teeth and gums. Certain types of plaque bacteria create toxins (poisons) that can injure the gums and underlying bone. Over time, these toxins can destroy your gums and the bone underneath them.
Plaque is removed with careful brushing and flossing. Plaque that is not completely removed every 24 to 48 hours can combine with other materials and harden into a rough, porous deposit called calculus (tartar). Calculus above the gum line is primarily a cosmetic problem. However, calculus that extends below the gum line interferes with thorough plaque removal and can, therefore, contribute to the development of periodontal disease. Once calculus has formed, only your dentist or dental hygienist can remove it. Good brushing and flossing helps prevent calculus buildup in your mouth.
Other Contributing Factors
Although bacterial plaque is the main culprit in periodontal disease, there are other contributing factors. Your genetic makeup determines how your body will react to the bacteria, and heredity plays a major role in whether or not you are likely to develop the disease. If your parents lost teeth to gum disease, then you are susceptible.
Other contributing factors include:
- poor diet
- clenching, grinding of teeth
Pregnant women's gums will overreact in the presence of bacterial plaque, due to their increased hormone levels. People who have systemic diseases such as AIDS and diabetes have a lower resistance to infection, making periodontal disease more severe. There are some medications that can affect the gums as well, such as steroids, cancer therapy drugs, some calcium channel blockers, antidepressants and some types of anti-epilepsy drugs. It is important to update your medical history at each dental appointment so that your dentist or hygienist is aware of any factors that may cause increased susceptibility to gum disease.
Common Types of Periodontal Disease
Gingivitis is the earliest and most treatable stage of gum disease. Only the gums are affected, and it is reversible. If you have gingivitis, your gums will be red and swollen, and you are likely to bleed easily. Often, people will tell me, "I don't have gingivitis. My gums have always bled, that's normal for me." Sometimes we become comfortable with what we consider to be "normal." But the fact is that healthy gums don't bleed.
Treatment can be as simple as having your teeth professionally cleaned and following a daily home-care routine. But if not treated early, it can progress to the next stage of gum disease, which is periodontitis.
Periodontitis is a more advanced stage of gum disease and is irreversible. At this stage the gums, bone, and other structures that support the teeth are damaged. Toxins destroy the tissues that anchor the teeth in the bone. Gums pull away from the teeth forming pockets that fill with more plaque. The deeper the pocket, the harder it is to clean, which can lead to further bone loss. Sometimes, the gums drift down the neck of the tooth exposing the root surfaces. Now plaque can adhere to the root surface making it more susceptible to decay and sensitive to cold and touch. Breathing in cold air can be painful.
At this stage your teeth may become loose or fall out. It may become necessary for your dentist to remove teeth. Treatment is more involved and usually requires multiple visits to your dentist/dental hygienist or a referral to a periodontist (dentist specializing in gum disease). Left untreated the disease will progress. The gum and bone that is lost will not grow back. You are never cured at this stage. But with treatment and good home-care, you can stabilize the disease or slow it down.
Diagnosis of Periodontal Disease
The only accurate method of diagnosing periodontal disease is to have a complete examination by your dentist. It should include x-rays of all your teeth (to check the bone) and a full mouth probing (measuring the pocket depths). The earlier you are diagnosed, the easier it will be to treat your periodontal disease.
Warning Signs of Periodontal Disease
Diagnosing periodontal disease early can increase your chances of a successful treatment. It is helpful to be aware of any changes that may occur in your mouth that may signal trouble. Warning signs (from the American Dental Association) include:
- gums that bleed
- red, swollen, or tender gums (healthy gums are pink)
- gums that have pulled away from the teeth
- pus appears between the teeth and gums when the gums are pressed (pus can look white or yellowish in color)
- persistent bad breath or bad taste
- permanent teeth that are loose or separating (gaps between the teeth that weren't there before)
- changes in the way your teeth fit together when you bite (difficulty chewing certain foods, like raw vegetables)
- changes in the fit of partial dentures
What causes tooth decay? You guessed it -- bacterial plaque. It is the primary cause of tooth decay. If you eat sugary foods, and plaque is present in your mouth, a reaction occurs. The sugar and the bacteria in the plaque combine and form acids. Acids can form very quickly, sometimes within minutes after eating. Then these acids are held against the tooth surfaces by the sticky plaque. The acids penetrate and a cavity is formed.
A simple formula to remember is:
SUGAR + BACTERIA (PLAQUE) = ACID ACID + TOOTH = DECAY
How to Prevent Decay
Here are some important factors in preventing tooth decay:
- Plaque removal: Brushing and flossing after meals is important to keep the bacteria under control. There are two types of cavities-brushing cavities on the biting surfaces of teeth and flossing cavities that occur between teeth. So you must use different methods to remove plaque from these two areas.
- Daily diet and general nutrition: Foods containing sugar should be limited and are better eaten with a meal.
- Fluorides: Using fluorides is one of the most effective ways to control decay. Fluorides make tooth enamel more resistant to the decay action of acids, and it benefits both children and adults. For adults, fluoride can strengthen and desensitize the root surfaces with regular application.
- How to Prevent Decay (Sealants): Sealants are protective plastic shields that are placed on the biting surfaces of children's permanent teeth. Eighty-six percent of tooth decay in children occurs on the biting surfaces. Sealants should be applied soon after teeth appear since teeth are most vulnerable in the first two to three years-this includes the primary (baby) teeth as the permanent ones. There are 8 primary (baby) molars that should be sealed and 16 permanent molars and premolars. In some individuals there are developmental pits on the back of the maxillary (front) permanent teeth that should also be sealed.
- Periodic checkups: Regular visits to your dentist or hygienist provide the best opportunity to catch problems while they are small and correct them before they become big.
The following are some details about brushing and flossing that will help you in your fight against plaque.
What's the best toothbrush? The brand is not as important as the size and texture of the brush. You should always choose a soft or ultra soft toothbrush with rounded bristle ends. The brush head shouldn't be too big for your mouth. It is difficult to reach all the places where plaque hides with a large brush. Look for compact sizes, they have smaller brush heads but the handles are for adults.
Replace your toothbrush on a regular basis, every two to three months or when you notice the bristles fraying. Toothbrushes with fraying bristles won't clean as well and they can irritate the gums. Children are likely to wear out toothbrushes more quickly because their brushing strokes are not yet perfected and they have a tendency to chew on the bristles. Parents should keep a close eye on their children's brushes.
Toothbrushes should be allowed to air-dry between uses. If you brush frequently, alternating between toothbrushes is recommend.
How often should you brush?
If you are healthy and free of periodontal disease, two to three times a day should be adequate. In the morning after breakfast and before bed are the most important times to brush. Try to schedule additional brushings around meals.
If you have a form of periodontal disease, increased brushing is necessary. I usually recommend a minimum of three times and up to five times per day. Controlling plaque is a tough business. Many of my patients keep a toothbrush at work to make mid-day brushing convenient. The key is to make your routine as uncomplicated as possible.
The optimum amount of time to brush is two minutes. Two of your daily tooth-brushings should be for two minutes and supplement with shorter brushing times if necessary. If you time yourself the next time you brush, you might be surprised how quickly you go.
What is the best brushing technique?
Since everyone's mouth is different, individual instruction given by your dentist or dental hygienist is essential. Unless you use a proper technique, you can brush five times a day and still not get your teeth clean. There are some basic techniques to follow in proper tooth-brushing:
- Focus your soft bristled toothbrush at the gumline. This is where plaque hides.
- Begin by placing the bristles of your toothbrush at a 45-degree angle on the outside of your teeth (cheek side) where the gums and teeth meet.
- Move the brush in a circular motion brushing two to three teeth at a time.
- Use light pressure so the bristles glide gently between the teeth.
- The same method is used on the inside (tongue side) surfaces of the back teeth.
- To brush the inside of the front teeth, hold the brush vertically using a back-and-forth motion. Then move to the biting surfaces using the same back-and-forth motion.
- Finish by brushing your tongue. Bacteria that forms on your tongue, especially on the base (back), can cause mouth odor. In fact, the tongue harbors the most bacteria in the whole mouth, therefore it is very important to clean it to prevent cavities, periodontal (gum) disease and bad breath.
- The best way to clean your tongue is with a special tongue cleaning device. Start as far back as you can and pull the device forward. Do this 3-4 times until the residue is clear. Do this daily and your mouth will be much cleaner and fresher.
Parents will need to assist their children until they are about five years old. Their small motor skills are still developing and it is impossible for them to be effective alone. I recommend that children be allowed to brush alone first, then parents should brush them again.
Is flossing really necessary? In a word--yes. Periodontal disease in adults starts primarily between the teeth. Plaque forms mainly at the gumline (where the teeth and gums meet) and in between the teeth. Brushing takes care of the gumline and flossing reaches between the teeth.
Think of it this way: There are five sides to each tooth. When you brush, only three are cleaned (top, outside, and inside). That means the surfaces on the sides (between) of the teeth are untouched. The plaque has a protected environment, free to damage the teeth, gums and bone. There is no real substitute for flossing. Floss reaches below the gumline into the pocket area where plaque bacteria multiplies and toxins are produced. Daily flossing is required to hinder calculus formation, which leads to future breakdown. There are other dental tools that can be used to clean between teeth but floss is the only one that can remove plaque below the gumline.
Children can be expected to start flossing for themselves, around age eight. Until then, parents need to floss for them. Guidance from your hygienist on how to floss your child's teeth is advisable. The trick is to start early.
Which floss is the best?
There are dozens of flosses on the market, waxed, unwaxed, flat, round string, ribbon, textured, spongy, flavored, fluoridated, etc. According to a recent study from Ohio State University-Columbus, there aren't significant differences between flosses. The primary issue is comfort and ease of use for the flosser.
In my opinion, a flat, waxed floss is preferred because it is less likely that the gum tissue will be cut. For my patients who have wider spaces between their teeth, I recommend the textured or woven flosses. You can get a floss recommendation from your own hygienist, and once you've tried a few different types, I'm sure you'll find a favorite.
Flossing aids are very popular. They simplify hold the floss. They are especially useful for people who have trouble flossing with their fingers. I prefer the disposable floss holders that have the floss already attached. They are available in bright colors and smaller sizes for children.
What's the best time to floss?
The ideal time to floss is before bed. As stated before, it is imperative that your mouth is clean before sleep because the levels of bacteria in the mouth rise during sleep. I encourage my patients with periodontal disease to floss at night to gain the greatest benefit. But if your teeth are relatively healthy, you can be flexible about when you floss. You don't even have to floss at the same time as you brush. The important thing to remember is that you should floss once within a 24-hour period. Remember, plaque will start to calcify and form calculus within that time frame.
How do you floss?
Proper flossing is a skill that takes time and practice to master. You will need perseverance and patience if you are just beginning, but the end result is worth the effort. If you have never flossed before, it will probably take about two weeks of daily practice to get the hang of it. Make the commitment to yourself to try flossing at least once a day for two weeks. If you are having trouble with a particular area, don't give up on the rest of your teeth. At your next dental appointment, tell your hygienist where you are having trouble. She may have a flossing tool to recommend.
I encourage patients to call me during office hours if they have any questions or concerns regarding their oral hygiene. The dental staff at your office is there to assist you, don't be afraid to ask questions.
While flossing, keep in mind that you are not cleaning the space between the teeth or the gum. You are cleaning the tooth itself. The floss should hug the tooth when being inserted. Use a back and forth motion to guide the floss down the tooth. When you feel a slight resistance, stop, pull both ends of the floss forward to form a "C" around the back of the frontmost tooth and slide the floss in an up-and-down motion to clean the tooth. Then push both ends of the floss back to form a "C" around the front of the backmost tooth and repeat the up-and-down motion. Do this between all of the teeth to clean thoroughly. Notice how the gum tissue fills in the space between the teeth. If you pop the floss straight down, you will hit the gum, causing injury and pain.
Choosing Oral Hygiene Products
We have already discussed how to select a manual toothbrush and dental floss, but there are numerous other products that might be useful. Walking down the dental supply aisle at your favorite store shouldn't leave you feeling overwhelmed. I have listed the products most asked about by my patients. A good starting point is to look for the ADA Seal of Approval. This is not a guarantee that the product will work, but at least you are assured it won't harm you. I have listed the products most asked about by my patients.
Most mouth rinses will change the bacterial level in your mouth. Even rinsing with water will have a benefit to some degree. The majority of rinses contain alcohol to some degree and I do not recommend them for three reasons: 1) alcohol dries the mouth and decreases saliva flow which is a natural cleanser of the mouth; 2) There are studies that show that continued use of alcohol containing mouthrinses can lead to a greater risk of oral cancer; 3) Alcohol breaks down bonded fillings and since that is the only ones that we do, we do not want something that would harm your investment in your mouth.
The best over-all mouthrinses we have found are the ones containing chlorine dioxide that do kill bacteria, and most importantly neutralize the harmful by-products that bacteria produce in our mouths, thus helping prevent cavities, periodontal (gum) disease, and bad breath.
In my opinion, it is better to use rinses after flossing and brushing and not before. This will help remove loose particles removed by the brush and floss.
Your dentist may recommend a prescription mouth rinse in cases of acute or advanced periodontal disease. They are only used as an adjunct to periodontal treatment and good brushing and flossing. Keep in mind, rinsing will not remove bacterial plaque.
Using an automatic toothbrush can give you an advantage in your war on bacterial plaque. They are easy to use and are sold everywhere.
Most of them have a two-minute timer (the optimum amount of time). The handles are easy to hold, especially for those affected by arthritis or diseases that limit motor skills. The cleansing action is greater overall and anyone can benefit, especially the lazy brusher. We have found the rotary toothbrush to be overall the most effective in cleansing the whole mouth for adults and teenagers, and especially good for orthodontic patients. Children can use it or the inexpensive "fun" battery operated toothbrushes made by some of the toothpaste manufacturers. Automatic toothbrushes are more expensive, but the results are worth it.
Take Care With Medications
If you are medicated (taking antibiotics) before dental treatment, then these brushes might not be for you. It is imperative that you check with your physician, cardiologist or orthopedist before using any automatic toothbrush.
For Kids With Braces
Parents, if your children have braces, do them a favor and buy them an automatic toothbrush. You can't imagine how difficult it is to adequately clean teeth with braces using a manual toothbrush.
Water piks have come into favor again after years of sitting under the sink. The new models are compact and easy to use. Some units come with attachments (Pik Pocket) that make flushing the periodontal pockets feasible. You can get rid of food debris in hard-to-reach areas (around and under bridges, orthodontic braces), but water piks will not remove plaque. They should only be used in conjunction with brushing and flossing. A relatively new type of irrigator available is the Hydromagnetic Irrigator. The solution you use to irrigate is run through a magnet and the result is that it puts a negative charge on your teeth and gums which is the same magnetic charge as the bacteria in your mouth This is like holding two magnets together with like poles facing each other and the teeth and gums actually repel the bacteria. Research studies have shown these irrigators to reduce plaque and calculus (tarter) that is there is much easier to remove during your cleaning. I have seen a dramatic decrease in bleeding gums in patients who use these regularly. Again, if you need to be pre medicated before dental visits, consult with your physician before using these products.
There isn't much difference between pastes in their effectiveness. If you find one you like and will use longer in your mouth that is most important. If it burns or is uncomfortable or you don't like the taste you will not brush as long. This is important for adults as well as children. For children especially, make sure the toothpaste contains fluoride.
Tartar-control toothpastes are very popular and are billed as pastes that will reduce calculus (tartar) formation. The fact is, they will reduce calculus, but only above the gumline. Calculus that forms above the gumline is strictly cosmetic. Tartar-control pastes do not affect calculus formation below the gumline where gum disease starts. Therefore, they have not been proven to reduce gingivitis.
Tooth-whitening pastes in general have little lasting effect on the teeth. I have never seen anyone's teeth get whiter using an over-the-counter tooth-whitening product. Stain reduction is possible, but any paste can achieve this with good brushing. Due to the added chemicals in tartar-control and whitening pastes, some of my patients have experienced increased sensitivity in their teeth and/or gums. If any of this occurs discontinue use of these products.
Desensitizing toothpastes can be helpful in decreasing root sensitivity. The active ingredient varies in the different pastes. So if one paste doesn't work, it might be worth trying another brand. It could take up to several weeks before you will know if the paste is working. Read the label and follow the instructions to gain the maximum benefit.
Fluoride toothpastes and mouth rinses, used in conjunction with brushing and flossing, can reduce tooth decay as much as 40 percent. Regular fluoride use can also help desensitize and prevent decay on root surfaces in adults. In cases of excessive decay and extreme sensitivity, your dentist may write a prescription for a toothpaste that contains a higher dosage of fluoride.
Children who receive fluoride from many sources (vitamins, water, foods, rinses, and toothpastes) should be monitored to avoid fluoride overdosing. Only a pea-sized dab of fluoride toothpaste is necessary for any child.
Interproximal toothbrushes are tiny brushes that clean between your teeth. The brushes come in various shapes and sizes that can be attached to a handle. As the brushes wear out they can be replaced.
Some disposable pocket versions come with the brushes attached. These are great tools, and valuable in removing plaque and food from wide spaces between the teeth. Still, they do not replace flossing. These brushes should only be used in areas where they easily fit between the teeth. Applying force could lead to trauma to the gum and tooth.
Toothpicks should be avoided. Since they are made of wood, they can break and become lodged under the gum causing pain and trauma. Sometimes it takes a trip to the dentist to remove them. There are some plastic interdental toothpicks shaped to fit well in between the teeth and if used properly can be helpful in good oral hygiene.
Rubber tips are used to massage and stimulate the gums. They can be useful in decreasing red swollen gums. Rubber tips can sometimes be found on the end of your toothbrush or they are sold separately. Place the tip gently against the gums between the teeth and massage. Only use a light pressure, just enough to see the gum tissue blanch.
See Your Dentist Regularly
Even with good daily brushing and flossing, it is difficult to remove all the bacterial plaque that leads to calculus. Hardened calculus must be removed by your dentist or hygienist on a regular basis to help prevent gum disease. How often you need to have your teeth professionally cleaned depends on how long you can stay healthy between visits. If you have a normal level of health, six months is the suggested length of time between visits. Your dentist/hygienist may vary the interval from time to time to suit your needs. People with periodontal disease will need shorter intervals, three to four months, indefinitely. Others may temporarily need closer visits (like pregnant women, patients with braces, and lazy brushers/flossers).
Controlling periodontal disease is not only important to your teeth, it is important for your overall health. New research indicates there is a link between gum disease and certain heart disease. Additionally, doctors are currently researching a potential link between gum disease in pregnant women and low-birth-weight babies.
It is necessary to take an active role in your dental health, and your dentist/hygienist can assist you in keeping a healthy mouth. Fighting bacterial plaque with good oral hygiene is an integral part in keeping your teeth for a lifetime.
An appealing and healthy smile is a great asset. A smile can communicate ideas and feelings. It can build your confidence in business and social situations. Good digestion depends on strong healthy teeth to chew food effectively.
If you have loose or missing teeth, your health could be compromised by a limited diet and insufficient digestion. A clean mouth will have fewer dental problems, and your dental work will last longer and look better. The need for new treatment and painful emergency situations will decrease. All this will save you time and money at the dentist's office.