dental health
I’ve now been involved in Dentistry for over 35 years. For some strange reason, it has taken me that long to realize that 99% of all the patients whom I’ve had contact with over the years have been misguided in their dental decision making process by a belief based on an “old wife’s tale”. Their misguided belief is that CAVITIES CAUSE PAIN and, therefore, they will know when they have a cavity. Due to this belief, patients fail to follow up on preventative care, fail to take the advice of their dentist and treat cavities when they are small, and distrust their dentist when he/she tells them they have a cavity when they have no pain.
Most patients seem to trust their bodies to tell them when they have a cavity. So, many times, new or emergency patients come in to see me because they have a mild sensitivity in a tooth and they think they have a cavity. Most often, this mild pain is not caused by a cavity, but by some other minor problem. However, many times, a thorough exam to determine the cause of the pain reveals small to moderate cavities in other areas of the mouth which are absolutely painless.
For all these years, I really thought that it was obvious to most people that only “really big” cavities caused pain. Recently, I mentioned to my wife of 30 years that patients don’t understand that SMALL TO MODERATE CAVITIES don’t hurt! They don’t even hurt just a little- they don’t hurt AT ALL! Her own shock and amazement at this fact has finally made me aware of how widespread this false belief really is. After all, she is a highly educated woman who has been involved in a dental practice for 34 years. If she doesn’t understand the painless nature of most dental cavities, how can I expect a normal patient to understand this fact. And, after doing a random poll of several other friends and acquaintances, I realized how widespread this false belief is.
Of course, over the years, I have been continually asked by patients why they didn’t feel any pain from the cavities I had just diagnosed in their mouth. I always patiently explained that cavities usually do not cause ANY pain until they get huge! In fact, many patients have told me they thought their previous dentist “ripped them off” because he/she did some filling on teeth that they weren’t feeling any pain in. I only recently realized how common this belief is and how much extra money and time it is costing patients. It costs a lot less to treat dental decay when it is small vs when a cavity gets large enough to hurt!
Even though I was so slow to realize how widespread this false belief really is, I’m pretty sure I understand why it exists. I’ll elaborate on that in my blog tomorrow.
Many recent studies have linked gum disease to other health problems. Pregnant mothers are always very concerned with improving their chances of giving birth to a healthy baby. Here’s a simple way to do so.
A University of Pennsylvania study of 160 pregnant women with gum disease found that successful treatment lowered the rate of premature delivery from 23 percent to just 7 percent. In other words, expectant mothers with gum disease have a much better chance of avoiding premature birth if they keep their gums healthy.
Gum disease releases bacteria that can lead to early labor. Having regular professional cleanings removes these bacteria. It’s really that simple.
A recent article in the June, 2010 edition of The Journal of The American Dental Association, discusses the use of tooth bleaching agents to improve the oral health of patients with special care needs. Basically, we are talking about patients who are unable to brush and floss their teeth properly due to physical or mental issues. These patients may also be highly prone to decay due to low salivary flow (dry mouth) caused by age and/or medication side effects.
Tooth decay occurs when the pH of dental plaque and saliva reach a certain level of acidity. In a healthy patient with good salivary flow and good oral hygiene, decay is not a problem because plaque does not sit on the teeth long enough to cause cavities and the saliva neutralizes the acid and helps to wash it away. Patients with poor oral hygiene or poor salivary flow are very susceptible to tooth decay (cavities).
It now appears that certain tooth bleaching materials may actually reduce cavity rates and improve gum health.
The most commonly used tooth bleaching agent is a chemical called carbamide peroxide. Besides causing the teeth to lighten, one of the side effects of a 10% carbamide peroxide bleaching gel is to decrease the acidity of dental plaque and saliva. Carbamide peroxide breaks down in the mouth into urea and hydrogen peroxide. The release of urea is what changes the pH of saliva and plaque. The hydrogen peroxide which is released delivers the antimicrobial effect.
Some bleaching agents contain only hydrogen peroxide. While they are effective for tooth whitening, they do not have the same decay preventing effect as carbamide peroxide because they do not release urea. Urea is the chemical that reduces the acidity which causes decay..
The safety and effectiveness of tooth bleaching by means of application of 10% carbamide peroxide using a custom tray are thoroughly documented. Long term use has also been shown to be safe and effective. The only known negative side effect is occasional tooth sensitivity. This is usually easy to control and causes no long term problem for the teeth.
While more research is needed, it appears tooth bleaching (using carbamide peroxide) may have a dual beneficial effect for decay prone patients. Of course, for those patients considering tooth whitening for it’s cosmetic effects, it’s nice to know that bleaching has beneficial secondary effects.
That line is actually the title of a small article in a recent Consumer Reports magazine issue. But it brings to mind a question that I have been asked over and over in my 34 years of doing dentistry. One of the most common questions I get from patients is “What is the best toothpaste to use?”
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.
It is so hard to watch the news, read Internet articles, or grab a local newspaper without being overwhelmed with what is happening with the global economy melt-down. Watching the stock market is like watching a bouncing ball – up, down, up, down. Reading about the bank bail-out and the obscene bonuses being paid to CEO just makes my blood boil.
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.
