We are bombarded daily with marketing hype about toothpaste as manufacturers battle for their share of the 1.8 BILLION dollars that Americans spend on toothpaste each year (Fun Dental Facts @www.dentalgentlecare.com).  That doesn’t include toothbrushes, floss, mouthwash, etc.- just TOOTHPASTE!

We’ve all seen and heard the hype.  This one whitens teeth better, this one strengthens your enamel better, this one removes stains better, and this one will eliminate your bad breath.  So, if all the hype were true, you’d think there would be some agreement among dentists about which toothpaste is the best.  I don’t think that’s the case.

I’ve never seen any research showing one brand or type of toothpaste is better than another.  In fact, when patients ask me what toothpaste they should use, I tell them “whatever one tastes good to you,  as long as it contains fluoride” and has the seal of approval of  The American Dental Society.   (The ADA Seal of Approval means the manufacturer has submitted the product to rigorous testing for safety by the ADA.)

In fact, some research has shown that patients actually do a better job of brushing their teeth if they use a dry brush (JADA129:614,1998).   Perhaps all the foam interferes with our ability to feel the brush actually touching the gumline.  Or, perhaps, having a mouthful of foam drooling out of our mouths makes us stand with our heads over the sink.  That’s messy, boring, and only covers up what we’re trying to see.

Maybe that’s why the average person only brushes 30- 60 seconds when research (J Dent Hyg 83: 11-116, 2009) says that the brush needs to be in our mouths 120-180 seconds per brushing.  In fact, the same study found that “brushing without toothpaste for 60 seconds removed as much plaque as brushing with toothpaste for 60 seconds.  The toothpaste provides no added benefit for plaque removal.”

What about the ability of toothpaste to whiten our teeth and keep them white?  Well, that’s just some more of the marketer’s hype to get a share of that 1.8 billion dollars.  Almost any dentist or dental hygienist will tell you that the chemicals in toothpaste or whitening gels that cause the whitening have to be in contact with your teeth for at least 30 minutes per day to cause any whitening effect.  And, of course, the bleach in toothpaste can’t be very strong or it would make the toothpaste taste like bleach.

Consumer Reports says, “Think they (whitening toothpastes) make your teeth sparkle?  Don’t start smiling yet.  None of the 41 ‘whitening toothpastes’ we tested did any better to actually whiten teeth than any other toothpastes.”  And my own clinical observations would back this statement up.  I’ve never seen evidence of a patient getting whiter teeth from their toothpaste.  (Properly used bleaching gels, yes!  But not from toothpaste.)

In reality then, the brand or type of toothpaste you use isn’t important.  My recommendation is to start brushing your teeth with a dry brush (soft) on the inside surfaces of the teeth.  Spend 60 seconds just on the inside of the teeth.  Most people tend to neglect the insides so it’s best to start there. Then add whatever toothpaste brand tastes good to you, and spend another 60 seconds brushing the outside of the teeth.

Remember, it’s the amount of time spent with the brush in the mouth and not the toothpaste brand that matters.  It’s like exercise equipment.  It doesn’t matter which brand or type you buy if you don’t put your time in using it.

Most patients assume that all dentists are trained in the same way, and, therefore, have the same skills and knowledge. And, in the first four years of our training, this is basically true. We (dentists) all start out with the same basic training. We spend four years in dental school learning anatomy, physiology, pharmacology, and basic dental techniques. I say “basic” because four years is not enough time to teach advanced techniques. It’s also not enough time to give us much experience. We get that when we get out of school. By the way, the training that we get in dental school is so basic that it really doesn’t matter which dental school we go to. Our true skill as a dentist is developed after we get out of dental school.

Once a dentist has graduated from dental school, he/she is free to start practicing by buying a practice from a retiring dentist, or associating with a group practice.  Either way, they are immediately practicing on patients. Some dentists go into the military where they can gain several years of valuable experience treating military personnel before they go into private practice.   Then there are dentists who want to receive extra training and experience by enrolling in a Dental General Practice Residency.  This was my choice after dental school.

A GP Residency is a voluntary 12 month program of intense advanced training and experience. There are a limited number of slots available in GP Residencies, so only a limited number of dental school graduates can get in. There is an application process that involves a review of your dental school grades, recommendations from your dental school instructors, and personal interviews. I did my general practice residency at Denver General Hospital (now called Denver Health) in 1976-1977.  At that time, there were only 6 or 8 slots available for general practice residencies in the whole state of Colorado.  The number of available residency slots has not changed much in the last 30 years, so it is still very competitive.

So, some dentists start treating patients in private practice immediately out of dental school with very little actual experience. They learn on the job. And yes, they learn on you, the patient.  Pretty scary, huh?   The dentists who get their initial experience in the military or in a residency are supervised by other experienced dentists, and where  the patients are receiving free or reduced fee dentistry.

Since I had obtained so much “hands on” experience at Denver General, I felt pretty confident about my skills and knowledge when I started private practice in 1977.   Little did I know how little I knew.   As we all know, we gain skills and knowledge as we gain experience. We all received basic training in driving a car before we were given a license to do so on our own. Yet we all know that the 16 year old driver has a much higher accident rate than the 30 year old driver. Our automobile driving skills improve as we spend more and more time behind the wheel. So it is with a practicing dentist or any other professional. Experience counts!  Just another reason why “Not All Dentists are Created Equal”. Some dentists have more experience than others.

However, experience is not the only factor. There are many 30 year old dentists, that in my humble opinion (IMHO), are better dentists than 50-60 year old dentists I have been acquainted with. This is were the concept of “Life-Long Learning” comes into play.  Once their formal dental education is over, dentists are on their own to learn new skills, keep up with new research findings, and learn the new techniques and technologies.  Some states require a few hours of Continuing Education per year to maintain your license to practice.  But, IMHO, it isn’t enough to even keep you current, let alone become highly skilled. As a matter of fact, the State Dental Board of Colorado has NO continuing education requirements for dentists. In Colorado, a dentist can stop learning right out of dental school and still perform dentistry on his/her patients for the rest of their career.

So, what really separates the “average” dentist from the “master” dentist?  Life-long learning!  And I am proud to say that I am a member a profession that highly encourages dentists to continually upgrade their knowledge and skills on their own, and at their own expense.   And it isn’t cheap. That is another reason why “Not All Dentists are Created Equal”.   Some dentists are passionate about continuing education and some don’t do any.

So, how does a dentist get continuing education?  There are multiple avenues for learning once you are out of dental school.   You can:

• Read journals, listen to instructional CD’s, or watch instructional DVD’s  (there are hundreds published just for dentists), or do on-line learning

• Go to seminars  There are thousands of these available every year and they range from 1 hour to several weeks of 8 hr days in length.

• Take part in group discussions with other dentists on line or in study groups.

Just to give some perspective on the commitment needed to become a master dentist, I’ll tell you about a discussion that I had with a young dentist the other day.   This particular young dentist graduated from a good dental school about a year and a half ago and then did a General Practice Residency in Denver.  He started into dental practice just a few months ago.  He has had a good basic dental education to this point but wants to do what is necessary to become a master dentist.  We were discussing his different options for continuing education to accomplish this goal and he told me that it would cost him about $45,000 over the next few years just to get started.  This will all be out of his own pocket.   Personally, I have spent over 1,000 hours in continuing education classes since I started private practice.  I don’t even want to think about what it has cost me.

There are many other ways for a dentist to obtain continuing education, but I won’t even try to list them all here. IMHO, a passion for continuing education, or lack thereof, is the main reason “Not All Dentists are Created Equal”. Unfortunately, it isn’t common for a dentist to divulge his/her continuing education experience to his patients.  I guess it would be considered bragging by most of us.  But if you do want some idea of how “current” your current dentist is, you might consider asking them about courses they have recently attended, or articles they have read, or on line learning they have done, etc.

In fact, research has shown that many products that we eat and drink are more harmful to our teeth than bleaching gel. A recent study at The Eastman Institute for Oral Health- part of the University of Rochester Medical Center- found that acidic fruit juices are much worse for our teeth than bleaching gel. Orange juice markedly decreased hardness and increased the roughness of tooth enamel. Many other liquids including soda, sports drinks and wine are also erosive to enamel.

This doesn’t mean we should stop enjoying these beverages. It just means we need to follow the “everything in moderation” rule. The people who are most at risk for tooth damage from acidic liquids are those who slowly sip their beverages. Healthy saliva normally buffers the acid and repairs the damage caused by acid. However, slowly sipping a drink over an extended period of time is more likely to cause permanent damage.

So, enjoy your orange juice but don’t over do it. And enjoy the pleasure that a brighter smile can give you without worrying about harming your precious enamel.

As you have no doubt seen in the many articles that are flying around the various media outlets, avoiding preventative dental treatment (cleanings, exams, and x-rays) may save you money now, but will probably cost you more down the road, not just in dental treatment, but in your overall health. Poor oral hygiene is linked to higher risks of hearth disease, stroke, pancreatic cancer, and brain function.

On October 8, 2008, Dr. Stewart of the London Institute of Psychiatry analyzed health records and brain function tests of nearly 7,000 people.  Those with gum disease had poorer mental function than those with healthy gums.  They also found that older people with bad teeth were also more likely to suffer from dementia and cognitive impairment.  Dr. Stewart also noted that gum disease can cause inflammation throughout the body, leading to poor mental function. (To read an abstract of Dr Stewart’s findings, go to http://www.psychosomaticmedicine.org/cgi/content/abstract/70/8/936)

So, I have been wracking my brain to try to figure out ways to help make my dentistry affordable to my patients and families and friends.  I decided the only way to help my patients was to make less profit myself.   Now, for a limited time, I am offering a 20% discount on most treatment to all of my patients and to any new patients you refer to my office.

You can read all about my Stimulus Plan under “Special Offers” on my web site.

My goal is to make my high quality, service oriented dentistry available and affordable in my office – thereby letting you stay with my practice and avoid seeking out lower cost (and, in my opinion, lower quality) dentistry offered by dental clinics and dental franchises.  Please note that I am not saying all clinics and franchises do low quality dentistry, but (again in my opinion) you may only get what you pay for at these facilities.  Guardian Fund instructed employees when selecting a level of a dental insurance to “also be aware of the concern that an HMO may deliver a different level of service than another type of insurance or even restrict necessary care. (”http://dr.hunter.cuny.educommunicationsB.Choice%20Page%202%20and%203%20Back-to-Back1.pdf).

I hope you will take advantage of this offer and get your dentistry taken care of while this offer is still available!  I don’t know how long I can hold fees at this level, since I don’t make much profit.  But I do pledge to you that I will not lower my quality of customer service, materials, and my 30+ years of dental experience .

Christopher Chamberlin

I wanted to write this blog, however, to make a few comments concerning what financial analysts are finally conceding – we are now officially in a recession.  With all of the  financial changes occurring, you may be feeling additional stress in your everyday life. Your body may be sending you a signal that all is not well: you wake up every morning with a throbbing pain in your jaw due to bruxism – grinding your teeth at night.  If left untreated, regular grinding may start to destroy your teeth – flattening your molars and causing cracks in your teeth, aging your teeth by as much as 10 years.

As many as half of the population grind their teeth at some point in time.  But as many as half of the serious grinders don’t seek treatment – either because the don’t see a dentist or because the habit doesn’t cause them pain.  Eventually they’ll wear right through their teeth, and that will be very painful – as well as costly.

If you feel that you might be grinding your teeth at night (or your partner wakes you up because you are making a loud crunching noise), there are various treatments that I can perform to help eliminate your jaw pain and help to save your teeth.

My personal favorite is an NTI-tss – the latest state-of-the-art device used to protect your teeth.  You may read more about this device on my web site.

If you feel you are grinding your teeth and would like some help, please make an appointment at my office and we can at least help you handle your stress by eliminating your pain and saving your teeth.

And, I can commiserate, I have been a life long grinder.  Let me help you save your teeth during this crazy economical time.  Multiple visits to repair your teeth accompanied by a giant dental bill is not what anyone needs at any time!

Sincerely – Chris

Of course, all dentists will recommend brushing and flossing to keep gum disease away, but maybe, if you like yogurt, it certainly sounds like consuming some every day may help keep gum disease away!

Approximately 20 years ago, I started providing professional tooth whitening to my patients when manufacturers perfected a user friendly delivery system and a peroxide formulation that was safe and easy to use. At that time, there was only one kind of whitening system available – dentist supervised tray delivery. After taking a mould of the patient’s teeth, we fabricate a soft plastic, custom fitted tray that adapts intimately to the patient’s teeth and does NOT cover the gums. The patient is then provided with the tray and a 15% – 30% carbamide peroxide gel syringe.

To use this whitening system, the patient places the peroxide gel into the custom tray, inserts the tray into their mouth, and leaves the tray in for 30 minutes. This procedure is used twice a day. The key to getting good results with this method is for the patient to remain motivated. A motivated patient will usually see results in one to two weeks. To get the best results possible, sometimes it may take as long as six weeks.

Since the above method was introduced, slick marketers have tried to introduce techniques that are “faster” or perceived to be less expensive. This includes a one appointment technique where a gel is applied to the teeth (in the dental office), and a specialized light or laser is applied – supposedly enhancing the results and only requiring one to two hours in the dental office. I have used several brands of this technique, and have found the results disappointing compared to tray bleaching. Not only were the results disappointing, the procedure was very expensive due to the amount of time spent in the dental chair. In fact, independent research has shown that the use of special lights or lasers has no effect on the results. The teeth are whitened only because the patient sits still in a chair with a strong bleach on their teeth for 2 hours. Don’t be fooled by slick technology claims for this type of whitening.

Manufacturers have also come out with something that appears similar to the custom tray technique discussed above that can be purchased over the counter. The “custom” trays are made by the patients by heating up the tray, and placing the tray in the patient’s mouth while soft – creating a “mould” of the mouth. The problem with this technique is that the mould allows the bleach to cover the gums – which can create burns and damage to the gums. Since the bleach comes in contact with the gum tissue, the manufacturers can only use very low strength bleach.

Another whitening technique developed is the use of whitening strips that can be purchased over the counter at drug stores. If a patient is highly motivated, these strips can produce decent results. However, they are very awkward to use – they whiten only the front teeth, not the back teeth – and are very slow to produce results. Once again, since these strips must come in contact with the gums tissue, the manufacturers can only use very low strength bleach. Therefore, the patient must use these strips for a long time – continually needing to purchase more strips to get good results. To get results anywhere near the custom tray method provided by a dentist, the cost is almost equal. Plus, remember you are only bleaching the teeth that can be reached by the strips.

Since patients are always looking for inexpensive way to get white teeth, I am constantly being asked about the “whitening” toothpastes that are now on the market. To quote Consumer Reports Magazine, “None of the 41 ‘whitening’ toothpastes we tested did any better to actually whiten teeth than any other toothpaste. We say don’t put the extra money where the mouth is.” And, I concur. I have never seen a patient get any results using a whitening toothpaste.

In summation, after 20 years of trying to improve on the original custom tray technique, I still find this technique to be the most cost effective and predictable way to whiten your teeth. I have had patients use all of the other techniques, and have found that the original dental office fabricated custom tray technique still works the best and is the most cost effective. Anyone can get whiter teeth if they consistently use this technique.