Oral Health FAQs

Today, Americans are not only living longer — we're also retaining our natural teeth longer than ever before. But this rosy picture isn't free of thorns: Older adults tend to require increasingly complex dental treatments; are often more prone to contracting certain diseases; and sometimes find it challenging to keep up with daily oral health practices.

Yet maintaining good oral hygiene is critically important as we age. When problems occur in the mouth, they can cause difficulty chewing, swallowing, speaking and smiling — basic functions which can affect both physical and social well-being. It's possible that medications prescribed for other diseases can adversely affect a person's oral health; it's also possible that a decline in oral health can worsen existing maladies (such as diabetes), or even cause systemic (whole body) inflammation. What other special dental issues do older people face — and what can be done about them?

Dental Concerns for Older Adults

If you think cavities are just for kids — think again! A recent study found that nearly one-third of people over 65 had untreated dental caries (cavities). In older people, these are found not only in the crown (chewing surface) of the tooth, but also in the root, which may become exposed due to gum recession. Regular dental checkups are the best way to find and treat dental caries; left untreated, they can cause pain, require more complex procedures, and eventually lead to lost teeth.

Blythe Danner Oral Cancer Video.

Gum disease is another major oral health issue faced by older people — and it's presently the leading cause of tooth loss in adults. The disease is caused by plaque bacteria, which thrive on the sticky biofilm that clings to the surface of teeth when they aren't properly cleaned. Poor-fitting dentures can make the problem worse, as can the presence of certain diseases (such as diabetes or cancer).

Sometimes, decreased mobility (due to arthritis or similar conditions) makes routine brushing and flossing more difficult. Special brushes with larger grips and floss holders can help make daily cleaning easier; additionally, therapeutic mouthrinses may be prescribed. In-office treatments can also be effective in bringing gum disease under control.

Oral cancer is a concern at any age, but it's 7 times more likely to show up in a person over 65 — and it causes more deaths in older Americans than skin cancer does. Early detection offers the best chance at controlling the disease and improves survival rates significantly. A thorough screening for oral cancer should be a part of every older person's routine dental checkup.

Dry mouth (xerostomia) isn't just an annoyance — it can be harmful to your oral health. Aside from its lubricating qualities, saliva contains beneficial digestive enzymes, acid neutralizers, and bacteria-fighting agents. A number of factors may cause the body to produce less saliva than normal — but in older adults, this problem is often due to side effects from prescription or over-the-counter medications. If you're experiencing chronic dryness of the mouth, it's sometimes possible to change your medication, and/or use products designed to relieve these symptoms.

Oral Hygiene For Life

It was once commonly believed that dental problems and the loss of teeth were an inevitable consequence of aging. But here's the fact: Age itself isn't a risk factor for tooth loss; properly cared for, your teeth can last a lifetime. However, it's true that the mouth does change as you age. How can you give yourself the best chance of keeping your natural teeth? You guessed it: Maintain a regular practice of good oral hygiene!

Brush twice a day with a soft-bristled toothbrush — use one with a special grip, or an electric brush, if it helps. Clean in between your teeth with floss, or another type of interdental cleaner, at least once a day. If you wear dentures, regularly clean and care for them as instructed. Eat healthy foods and drink plenty of water. And don't forget to have regular dental exams so that little problems don't turn into major headaches!

Antibiotic premedication for dental treatments.Antibiotics are widely prescribed to control bacterial infections. Sometimes they are given before a medical or dental procedure, to prevent a possible infection from occurring; this practice is called "antibiotic prophylaxis." In the recent past, physicians and dentists advised that people with certain medical conditions - including a number of heart problems and several types of bone or joint replacements - should always take antibiotics before many routine dental procedures. Today, their advice may be different.

A growing body of evidence now indicates that far fewer patients need to take this preventive step than was previously thought. As a result, the guidelines for prescribing antibiotic prophylaxis have recently changed - and they may do so again in the future. Why are the recommendations changing - and what do you need to know about taking antibiotics before coming to the dental office?

The Risk of Infection

We all know that bacteria - both helpful and harmful types - thrive in many parts of the body, including the mouth. Whenever circumstances make it possible for these microorganisms to enter the bloodstream, there's a slight risk that a bacterial infection may develop. This could occur in many dental procedures - and it could also occur during routine activities like chewing, brushing and flossing. In most cases, the risk is so small that the chance of a having bad reaction to antibiotics (while rare) is far greater than the chance of developing an infection; therefore, antibiotics aren't routinely used.

Some people, however, need to take extra precautions before having dental procedures. If you have been treated for some types of heart disease, or have had certain orthopedic procedures (including total joint replacement), we may advise taking antibiotics to protect against even a remote chance of infection. Recommendations are made on an individual basis, taking into account your medical history and a clinician's healthcare experience.

Guidelines for Antibiotic Premedication

Prophylactic antibiotics might be recommended before dental procedures if you have one or more of the following heart conditions:

  • A heart transplant
  • Artificial heart valves
  • A history of infective endocarditis
  • Some types of congenital heart problems - particularly if they haven't been completely repaired, or if their treatment involves prosthetic material

If you have undergone a joint replacement procedure, prophylactic antibiotics might be recommended if you also have one or more of the following risk factors:

  • A systemic inflammatory disease such as rheumatoid arthritis or lupus erythematosis
  • A weakened immune system resulting from HIV, cancer, radiation or chemotherapy, or another cause
  • Insulin-dependent (type I) diabetes or hemophilia
  • A history of previous infection in a prosthetic joint
  • Undernourishment or malnourishment

There are other circumstances where taking prophylactic antibiotics would be a prudent step; there are also a number of situations where these medications might have been recommended in the past, but aren't currently required in all cases. For example, the presence of a benign heart murmur, a pacemaker or defibrillator, and certain heart diseases or congenital defects don't automatically mean that antibiotic prophylaxis will be needed.

In recent years, reports of drug-resistant bacteria and harmful side effects from some medications have increased public awareness of the consequences of overusing antibiotics. Fortunately, new scientific research is helping healthcare professionals make better, evidence-based treatment decisions on antibiotic use. If you have questions about whether you should take antibiotics before dental procedure, don't hesitate to ask.

Before prescribing any medications — even life-saving ones, such as those used to reduce blood pressure or prevent epileptic seizures — your health care professionals carefully weigh the benefits a drug offers against the possible risks of taking it, including its potential side effects. In most cases, the side effects are relatively slight: for example, drowsiness, an upset stomach, or minor aches. But in some individuals, particular drugs may produce side effects that are more troublesome.

This is sometimes the case with a class of drugs called calcium channel blockers (CCBs), which are commonly used to treat high blood pressure (hypertension) and certain other heart conditions. Some people who take these medications experience a condition called gingival hyperplasia, or an overgrowth of gum tissue. This effect has also been seen in some epileptics who take an anti-seizure medication called phenytoin.

Possible Side Effects

CCBs work by dilating (widening) the blood vessels, which makes it easier for the heart to pump blood. But in a small percentage of people, they also cause changes in the gums. Gum tissue may become thick and lumpy, and it may sometimes extend abnormally and start to cover the teeth. This change in appearance can cause social embarrassment, as well as discomfort and difficulty in chewing.

The overgrowth of gum tissue also makes it difficult or impossible to clean the spaces between teeth. This can cause a rapid deterioration in oral hygiene that may lead to full-blown gum disease if not treated promptly. And since poor oral hygiene is itself a contributing factor in gum overgrowth, the condition can easily spiral out of control.

In addition, some CCBs also reduce saliva flow. This may not only cause the mouth to feel dry, but may also severely reduce saliva's protective effects on the teeth and gums.

What To Do About Gum Overgrowth

It's always a good idea to tell your health care providers about any side effects you may be experiencing as soon as you notice them. However, even though gum tissue overgrowth may be a worrisome issue, it doesn't mean you should stop taking your blood pressure medication! There are several options for controlling this condition, which should be discussed with all members of your medical team.

With your doctor's consent, it may be possible for you to change your dosage or switch to a different blood pressure medication that produces fewer side effects. It can take a few months for your gums to return to normal after the change, while you are maintaining good oral hygiene at home. But even if it's not possible for you to change your medication, there are a number of in-office treatments that can be used to help alleviate the problem.

Non-surgical treatments like scaling and root planing (a type of deep cleaning) are sometimes the first step to controlling gum overgrowth. These relatively minor procedures can dramatically improve your overall oral hygiene. If necessary, they may be followed by surgical treatments to remove overgrown tissue and eliminate periodontitis — a serious condition which, if left untreated, could result in tooth loss.

In addition to regular dental cleanings, you will need to be extra vigilant at home: proper brushing technique and the use of interdental cleaners (such as floss) are needed to clean the spaces between teeth is a must. Your progress will be monitored at follow-up dental visits as needed.

While gum tissue overgrowth may seem a daunting problem, experience has shown that it can be successfully controlled by initial periodontal therapy, good at-home care, and frequent follow-up visits. Meanwhile, you should continue to follow all of your doctors' recommendations for maintaining a healthy blood pressure.

Millions of people regularly take anticoagulant or antiplatelet medications (sometimes called “blood thinners”) to help prevent heart attack and stroke, and to manage a variety of medical conditions including cardiac arrhythmia and stent placement. While these drugs have proven, life-saving benefits, they can also cause side effects such as increased bleeding. So it may be a cause for concern if you're taking one of them and you need to have a dental procedure.

Anticoagulants are among the more widely used pharmaceuticals today, particularly for heart patients. Some common prescription anticoagulants include heparin, warfarin (Coumadin and generics), clopidogrel (Plavix) and dabigatran etexilate (Pradaxa). Regular aspirin and NSAIDS (like Advil) also have anticoagulant properties. The purpose of anticoagulant medications is to keep the blood from clotting (clumping together) as readily as it normally does; this reduces the chance of a clot forming inside a blood vessel, which could lead to a stroke or heart attack.

If you are taking one or more of these medications, it will take longer for any type of bleeding to stop. For some dental or surgical procedures, that's a factor that must be considered. The most important thing you should do is inform your dentist right away if you are taking any kind of anticoagulant or antiplatelet medication — especially if you have just started taking it. The name and dosage of your medication will be noted in your records, and your cardiologist (or other specialist) will be consulted if necessary, to determine what's best for you.

Having Dental Work with Blood Thinners

While each patient is different, there are some generally accepted guidelines for having dental work while taking anticoagulant medications. If the drug is being taken on a temporary basis (after knee replacement, for example) then the safest choice might be to put off non-essential dental procedures. However, in many cases it's entirely possible to have needed work done while taking anticoagulants. In each situation, the risk of increased bleeding must be balanced against the chance that going off the medication could cause more serious problems.

A number of studies have shown that for many common dental procedures — cleanings, fillings and restorations, for example — it's safer to continue taking anticoagulant medications than to stop, even temporarily. That's because it is generally possible to control bleeding with local measures (such as biting down on gauze), using hemostatic devices and minimally invasive surgical techniques. Scheduling dental work for early in the day and allowing plenty of time for rest afterwards also provides an opportunity to control any bleeding that does occur.

More Complex Procedures

In some cases, more extensive dental procedures such as tooth extraction or implant placement may be recommended for people taking anticoagulants. As always, the potential risks and benefits of stopping the anticoagulant medication must be carefully weighed. To help in the decision-making process, one or more diagnostic blood tests, such as prothrombin time (PT) or International Normalized Ratio (INR), may be ordered. Then a judgment can be made, based on the test results anon clinical experience.

While it's extremely rare for common dental procedures to cause potentially life-threatening complications, it makes sense to take as few chances as possible. That's why you should tell us about any medications you may be taking, including herbs and vitamins. While taking anticoagulants doesn't prevent you from having dental work, it's important to share information about your medications so you can get the best results from your treatment.

Diabetes is a group of chronic inflammatory diseases that affect the body's ability to process sugar. If you have diabetes, it is particularly important to maintain excellent oral health. That's because diabetics are more prone to oral infections such as periodontal (gum) disease, which can result in tooth loss if left untreated. Conversely, the presence of gum disease can make it harder for people with diabetes to control their blood sugar levels.

Periodontal disease is a chronic ailment that is also associated with an elevated level of systemic (whole-body) inflammation. Like diabetes, it may have wide-ranging consequences outside the mouth — possibly increasing a person's chance of experiencing major cardiovascular events (such as heart attack or stroke) or adverse pregnancy outcomes (low birth weight and pre-term delivery). So perhaps it's not surprising that a growing body of evidence suggests the two diseases are related.

Two Diseases With A Lot In Common

It has long been recognized that having diabetes is a risk factor likely to increase the severity of periodontal disease. That's because diabetes reduces the body's resistance to infection, making diabetics more susceptible to both bacterial and fungal infections. Likewise, evidence shows that having serious gum disease (periodontitis) is likely to result in worsening blood glucose control in diabetics; it can also increase the risk of diabetic complications. So, what's the connection?

While no one is sure at present, the two diseases seem to share some common pathways and disease-causing mechanisms. Both are associated with the process of inflammation and the immune response. Inflammation itself — often signaled by pain, heat and redness — is evidence of the body's immune system at work, attempting to fight disease, repair its effects, and prevent it from spreading. Chronic or prolonged inflammation, however, can lead to serious problems in a different part of the body and a decline in overall health.

What does this mean to you? According to one large study, if you're diabetic, your risk of dying from heart attack is over twice as great if you also have severe periodontitis — and for kidney disease, your risk is 8.5 times higher! Plus, uncontrolled periodontal disease makes it six times more likely that your ability to control blood sugar levels will get worse over time. So not only can having one condition put you at risk of worsening the other — having both can cause significant deterioration in your overall health.

A Two-Way Street

While diabetes can't be cured, it's possible to manage the disease on a long-term basis. And here's some good news: Clinical studies show that diabetics who get effective treatment for their periodontal disease also receive some significant benefits in their general health. Many exhibit better blood glucose control and improved metabolic functioning after periodontal treatment.

What kinds of treatments might be needed? While much depends on the individual situation, some typical procedures might include: scaling and root planing (a deep cleaning that removes plaque bacteria from teeth, both above and below the gum line); antibiotic therapy; and oral hygiene self-care instruction.

Likewise, if you're at risk of diabetes but haven't yet developed the disease, there are some things you can do to forestall it. While there is a significant genetic component, a major risk factor for diabetes is being overweight — so keeping your weight under control will better your chances of avoiding it. High levels of triglycerides or low levels of HDL (good) cholesterol are also risk factors. These may respond to changes in your diet — like cutting out sugary drinks and eating healthier foods. Also, high blood pressure coupled with an inactive lifestyle puts you at greater risk. Here, moderate exercise can help.

When you come to our office, be sure to let us know if you're being treated for, or are at risk of developing diabetes. And if you are managing the disease, remember that it's more important than ever to maintain good oral health.

Everybody gets a dry mouth from time to time. Temporary mouth dryness can be brought on by dehydration, stress, or simply the normal reduction in saliva flow at night. But persistent mouth dryness, a condition known as xerostomia, is cause for concern.

Xerostomia occurs when your salivary glands, which normally keep your mouth moist by secreting saliva, are not working properly. A chronic lack of saliva has significant health implications. For one thing, it can be difficult to eat with a dry mouth; tasting, chewing and swallowing may also be affected. This could compromise your nutrition. Also, a dry mouth creates ideal conditions for tooth decay. That's because saliva plays a very important role in keeping decay-causing oral bacteria in check and neutralizing the acids these bacteria produce; it is the acid in your mouth that erodes tooth enamel and starts the decay process. A dry mouth can also cause bad breath.

Possible Causes

There are several possible causes for xerostomia, including:

  • Medications.
    For most people suffering from dry mouth, medications are to blame. According to the U.S. Surgeon General, there are more than 500 medications (both prescription and over-the-counter) that have this side effect. Antihistamines (for allergies), diuretics (which drain excess fluid), and antidepressants, are high on the list of medications that cause xerostomia. Chemotherapy drugs can also have this effect.
  • Radiation Therapy.
    Radiation of the head and neck can damage salivary glands—sometimes permanently. Radiation to treat cancer in other parts of the body will not cause xerostomia.
  • Disease.
    Some systemic (general body) diseases can cause dry mouth. Sjögren's syndrome, for example, is an autoimmune disease that causes the body to attack its own moisture-producing glands in the eyes and mouth. Other diseases known to cause dry mouth include diabetes, Parkinson's disease, cystic fibrosis and AIDS.
  • Nerve Damage.
    Trauma to the head or neck can damage the nerves involved in the production of saliva.

Getting Relief

If you are taking any medication regularly, it's possible that your physician can either suggest a substitute or adjust the dosage to relieve your symptoms of dry mouth. If this is not possible or has already been tried, here are some other things you can do:

  • Sip fluids frequently.
    This is particularly helpful during meals. Make sure what you drink does not contain sugar and isn't acidic, as these will both increase your risk of tooth decay. All sodas, including diet varieties, should be avoided, as they are acidic and attack the tooth surface.
  • Chew sugarless gum.
    This will help stimulate saliva flow if your salivary glands are not damaged. Choose a variety that contains xylitol, a natural sugar substitute that can be protective against tooth decay.
  • Avoid drying/irritating foods and beverages.
    These include toast and crackers, salty and spicy foods, alcohol and caffeinated drinks.
  • Don't smoke.
    This can dry out the mouth and also increase your risk of gum disease.
  • Use a humidifier.
    Running a cool-mist humidifier at night can be soothing.
  • Use saliva stimulants/substitutes.
    There are prescription and over-the-counter products that can either stimulate saliva or act as a substitute oral fluid. We can give you some recommendations.
  • Practice good oral hygiene.
    Brush at least twice a day with a fluoride toothpaste; this will remove bacterial plaque and add minerals to strengthen your teeth. Don't forget to floss.
  • Have an exam/cleaning.
    If you have dry mouth, it's more important than ever to maintain your regular schedule of visits to the dental office. Please be sure to let us know what medications you are taking, particularly if there have been any changes recently. We will do our best to help relieve any dry-mouth symptoms you are experiencing.

Millions of people in the United States, particularly teenage girls and young women, suffer from health-threatening eating disorders, and dentists are often the first to spot the signs. Why? The repeated, self-induced vomiting that characterizes bulimia nervosa has a pronounced effect on teeth. Anorexia nervosa (self-starvation) can also have some noticeable effects on oral health.

More than 90% of those with bulimia experience tooth erosion. This is caused by acid from the stomach, which can dissolve the enamel when it comes in contact with teeth during vomiting. Teeth that have lost enamel can appear worn, chip easily, and become sensitive to hot and/or cold. Of course, acid erosion can also affect people who drink a lot of soda, sports drinks and energy drinks — even the diet varieties. But acid erosion in bulimics has a particular pattern: It is evident on the upper front teeth, particularly on the tongue side and biting edges. The bottom teeth, on the other hand, tend to be protected by the tongue when a person throws up.

Once enamel is lost, it can't grow back. But the damage can be repaired with various restorative techniques including veneers and/or crowns. The best treatment will be determined by how extensive the damage is, which in turn depends on how frequently the person has engaged in binge-purge behavior.

To protect teeth in the short term, it is important not to brush them immediately after vomiting as this can scrape off more of the softened enamel. It is better to rinse with water to which a little baking soda has been added, which neutralizes the acid. Even a plain water rinse is helpful. Sometimes a sodium fluoride mouthrinse is recommended to strengthen the enamel and reduce its loss.

Erosion is not the only sign of an eating disorder that a dentist or hygienist may notice. In severe cases, the salivary glands can become enlarged, causing the sides of the face under the ears to look puffy. Also, the throat, back of the tongue and roof of the mouth can appear reddened or otherwise traumatized from the use of fingers or other objects to induce gagging. Soft tissues of the mouth can also be damaged by acid.

Only about 20% of anorexics experience tooth erosion, but there are other signs that may become apparent in the dental office. Nutrition and hygiene suffer in general, which in turn can mean more tooth decay and gum disease. There is also considerable overlap between anorexia and bulimia.

If you are struggling with an eating disorder or believe that a loved one is, please let your healthcare professionals know. We will make sure you get the help you need for healthy teeth and a healthy life. You can also visit the National Eating Disorders Association for some helpful information.

Fluoride is a mineral that is naturally present to some degree in both fresh and salt water sources. Its major dental benefit is that it is readily incorporated into the teeth's mineral structure, thereby making them stronger and more decay-resistant. Fluoride can even reverse tiny cavities that are starting to form. Less tooth decay means you have a better chance of avoiding significant dental treatments — and keeping your natural teeth for life.

The great majority of toothpastes sold today contain fluoride, because it's an effective, easy and inexpensive way to prevent tooth decay and promote oral health. Because of its proven health benefits, fluoride is often added to municipal water supplies to bring them to the current recommended level of 0.70 parts per million. In fact, the federal Centers for Disease Control and Prevention recently named community water fluoridation as one of the most significant public health achievements of the 20th century.

Making Fluoride Available to the Teeth

Fluoride can be delivered to teeth in two ways: topically (on the surface) and systemically (through the body). The first method helps people of all ages; the latter is only beneficial in childhood while the permanent teeth are forming beneath the gum line — up to about age 9.

Fluoride ingested in drinking water can reach teeth both ways. When swallowed, it travels through the body and becomes incorporated into developing teeth; it also stays in the mouth throughout the day in a very low concentration. Toothpaste and mouthwashes provide higher concentrations over shorter periods of time. Fluoride can also be applied directly to the teeth at the dental office; children who get their water from unfluoridated sources may be prescribed a fluoride supplement in the form of pills or drops.

How Much Do You Need?

The amount of fluoride you need varies according to your particular risk of decay, which is determined by many factors: your body's own biochemistry, your diet, the amount of fluoride you come into contact with daily, and the effort you put into your own oral hygiene. If you maintain an effective daily routine of brushing and flossing, and avoid sugary and/or acidic foods and beverages, your decay risk will likely be low. If you are lax about oral hygiene, drink soda and snack throughout the day, your risk will be much higher.

Poor oral hygiene and constant intake of sweets make an ideal environment for decay-causing bacteria, which need sugar to thrive. In the process of digesting that sugar, they create tooth-eroding acids as a byproduct. And if you drink beverages that are already acidic — soda, sports drinks, energy drinks, even some fruit juices — you are applying those tooth-destroying acids directly to your teeth without using bacteria as a middleman. In that case, you might benefit from fluoride treatments at the dental office and/or regular use of a fluoride mouthrinse.

However, there is such a thing as too much fluoride — particularly when it comes to children. If developing teeth absorb too much fluoride, they can become permanently stained or even pitted — a condition referred to as enamel fluorosis. It is not dangerous, but may require cosmetic dental work. That's why young children should not be allowed to swallow fluoride toothpaste. Adults who take in excessive fluoride throughout their lifetimes may become more prone to bone fractures or tenderness, a condition known as skeletal fluorosis. Severe forms of enamel or skeletal fluorosis are not common in the United States. Still, given that excessive doses of fluoride could cause problems, it's best to consult a dental professional on the most appropriate products for you and your child to use.

Geographic tongue is characterized by harmless lesions, or patches, that can suddenly materialize on the tongue's top surface. The condition gets its name from the physical appearance of the lesions, which resemble smooth, red islands, possibly rimmed with white. Their smoothness comes from the absence of the tiny bumps or “papillae” that normally cover the entire surface of the tongue. These variations in color and texture give the whole tongue a map-like appearance.

The pattern on the tongue can change daily as the lesions appear to move or migrate, healing in one spot only to reappear in another. That's why the medical term for this condition is benign migratory glossitis. It's scary looking, but does not compromise a person's health.

Geographic Tongue Image

Discomfort from the condition can sometimes be relieved with over-the-counter pain relievers; mouthrinses containing anesthetics, antihistamines, or steroids; and by avoiding certain irritants such as tobacco, alcohol, and foods that are spicy, salty or acidic.

No one knows exactly what causes geographic tongue. Some factors that may play a role include vitamin B deficiency, irritation from alcohol or spicy foods, and genetics.

This condition can be diagnosed simply by examining your tongue; laboratory tests are usually not necessary. Geographic tongue normally resolves on its own, but a dental professional should be consulted if you notice any changes in your tongue's appearance.

If you're like most people, you probably learned how to brush as a child… and chances are, you haven't thought about it much since then. That's understandable — but there may come a point when we find our oral hygiene techniques could use improvement. Here are a few tips on the proper way to brush your teeth… plus, a reminder of why we do it.

First, the reasons why: Brushing is an effective way to remove plaque — a sticky, bacteria-laden biofilm that clings stubbornly to your teeth. The bacteria in plaque produce acids, which erode the tooth's enamel and may lead to tooth decay. Plaque can also cause gum disease and bad breath. In fact, it's believed that over 90% of dental disease is caused by plaque accumulation alone.

Besides removing plaque, the fluoride in toothpaste strengthens tooth enamel and makes teeth more decay-resistant. Plus, brushing makes your mouth feel cleaner and your breath smell fresher. While there is no single “right” way to brush your teeth, there are a number of techniques that can help you get them squeaky-clean. So why wait — let's take a refresher course in brushing right now!

Proper Brushing Technique

  • To begin, select a small-headed, soft-bristled toothbrush, grasp it gently with your fingers (not your fist), and squeeze on a pea-sized dab of fluoride toothpaste.
  • Hold the bristles gently against the outside of your top teeth, near the gum line, at about a 45-degree angle upward.
  • Sweep the brush gently back and forth over teeth and gums in soft strokes — or, if you prefer, use an elliptical (circular) motion to clean the teeth.
  • Be sure to clean the spaces between teeth: You can use a sweeping motion to brush food particles away from the gums.
  • When you have done one brush-width, move to the adjacent area of your teeth and repeat. Keep going until you have finished cleaning the outside of the whole top row of teeth.
  • Move to the bottom teeth. Repeat the procedure, tilting the brush down toward the gum line at about 45 degrees. Finish cleaning the outside of the bottom teeth.
  • Go on to the inside of the top teeth. Tilting the bristles up toward the gums, clean the inside of the top teeth with gentle but thorough strokes.
  • Move to the inside of the bottom teeth. Tilt the brush down and repeat the procedure.
  • Now it's time for the chewing surfaces: Holding the bristles flat against the molars, clean the ridges and valleys of the back teeth. Do this for all the top and bottom teeth.
  • Finally, brush your tongue gently to remove bacteria and freshen breath.
Geographic Tongue Image

Check Your Work

How good a brushing job did you do? One way to get an idea is by simply running your tongue over your teeth: If they feel slick and smooth, then chances are they're clean. If not, you should try again. To know for sure whether you're brushing effectively, you can use a “disclosing solution” — a special dye that highlights plaque and debris your brushing missed.

How to Brush Image

One common error is not brushing for long enough: two minutes is about the minimum time you need to do a thorough job. If you have music in the bathroom, you could try brushing along with a pop song; when the song's over, you're done! But no matter your musical taste, good brushing technique can go a long way toward maintaining tip-top oral hygiene.

Variations for Comfort

If you're having trouble with the two-finger method, here's another way to try flossing: Just tie the same amount of floss into a big loop, place all your fingers (but not thumbs) inside the loop, and work it around your teeth with index fingers and thumbs. All the other steps remain the same.

Once you've got the basics down, there are a few different types of flosses you can try, including flavored, waxed, and wider width. Some people find waxed floss slides more easily into tighter gaps between teeth or restorations — but it may not make that satisfying “squeak” as it's cleaning. Others prefer wide floss for cleaning around bridgework. But whichever way works best for you, the important thing is to keep it up!

You always brush twice a day, avoid sugary snacks between meals, and go to the dentist regularly. Do you still have to floss your teeth?

Proper Flossing Technique

The short answer: Yes, at least once a day. Flossing is probably your single most important weapon against plaque, the clingy bacterial biofilm that sticks to the surfaces of your teeth. Plaque is the principal cause of tooth decay; but it is also the cause of periodontitis (gum disease), bad breath, and other maladies. Brushing is a good start — but flossing removes plaque in places a brush can't reach, like the small gaps between teeth and under the gums. It also polishes tooth surfaces and decreases the risk of gum disease.

Some people may think they don't have time to floss, but once you get the hang of it, flossing only takes a few minutes. If you are going to floss only once a day, it's best to do it at night just before going to sleep. That's because there is less saliva present in your mouth when you are sleeping, so plaque is more concentrated and potentially more harmful. Just in case you never really learned proper flossing techniques, here's a step by step approach including some easy tips for doing a great job.

How to Floss Image
  • Cut off a piece of floss about 18 inches long. Wind it around the middle finger of both hands, leaving a gap of around three or four inches. You will now be able to use different combinations of your thumbs and index fingers to correctly position the floss between your teeth for all areas of your mouth.
    TIP: The most common mistake people make while flossing is that they tighten their lips and cheeks, making it impossible to get their fingers into the mouth. Relax your lips and cheeks.
  • Now, guide the floss gently into the space between your teeth.
    TIP: Even if the gap is tight, try not to snap the floss into your gums as you're inserting it. A side-to-side sawing motion is good to use here, but only when slipping the floss gently between the teeth.
  • There are two sides to each space between your teeth and you must floss each side separately so as not to injure the triangle of gum tissue between your teeth. Run the floss up and down the surface of the tooth, making sure you are going down to the gum line and then up to the highest contact point between the teeth. Apply pressure with your fingers away from the gum triangle, letting it curve around the side of the tooth forming the letter “C” with the floss.
    TIP: You want your fingers as close to the front and back of the tooth as possible so both fingers move in harmony up and down until you hear a squeaky clean sound. This is easier with unwaxed floss. The smaller the amount of floss between your fingers, the more control you have flossing.
  • Next, move your fingers to the top contact area between the teeth and slide across to the other side of the space. Apply pressure with your fingers in the opposite direction and repeat.
  • Slide the floss out from between the teeth. If it's frayed or brownish, that's good: you're removing plaque! Unwind a little new floss from the “dispenser” finger, and take up the used floss on the other finger.
  • Repeat the process on the next space between teeth. Work all around the mouth — and don't forget back sides of the last molars.

Variations for Comfort

If you're having trouble with the two-finger method, here's another way to try flossing: Just tie the same amount of floss into a big loop, place all your fingers (but not thumbs) inside the loop, and work it around your teeth with index fingers and thumbs. All the other steps remain the same.

Once you've got the basics down, there are a few different types of flosses you can try, including flavored, waxed, and wider width. Some people find waxed floss slides more easily into tighter gaps between teeth or restorations — but it may not make that satisfying “squeak” as it's cleaning. Others prefer wide floss for cleaning around bridgework. But whichever way works best for you, the important thing is to keep it up!

Almost everyone understands the importance of regular brushing and flossing to their oral health. You've heard it many times before, at office visits and checkups: Proper oral hygiene is your first line of defense against tooth decay and gum disease. Yet, while most of us brush regularly, many people don't floss as often as they should… or at all!

Why not? Sometimes, it's because we don't have the manual dexterity to handle the floss, or because braces or partial dentures get in the way; or, perhaps, we just never got in the habit. Yet proper cleaning of the interdental areas (the small spaces between teeth) is crucial — and here's why:

Consistent brushing with fluoride toothpaste has been proven effective at removing dental plaque from the tooth's surfaces and making them more resistant to decay. But regular toothbrushes simply can't get into the small gaps between teeth, or the tiny crevices where teeth meet gums. Unfortunately for our oral health, that's exactly where tooth decay and gum disease starts — and that's where the tools called “interdental cleaners” can help.

There are several different types of interdental cleaners available, including special brushes and irrigation devices (commonly called “water picks”). None of them, by themselves, are a substitute for brushing and flossing. However, as part of a regular program of oral hygiene, they can be effective at fighting plaque and reducing the incidence of tooth decay and gum disease.

The Interdental Brush

This specially designed toothbrush (sometimes called an interproximal brush or proxabrush) can be successfully utilized to clean the small gaps between teeth, as well as the gums and the areas around braces, wires, or other dental appliances. Because it has a handle, not unlike a standard toothbrush, many people with limited dexterity find it easy to use. Plus, numerous clinical studies have demonstrated its effectiveness at reducing plaque and controlling gingivitis (gum inflammation).

The cleaning surface of an interdental brush is similar in shape to a small, conical pipe cleaner. Its short bristles radiate from a thin central wire, which is small enough to pass through a very tight space. The brushes are available with both coated and uncoated wire, and come in different widths to accommodate an individual's particular dental anatomy. When needed, they can also be used to apply antibacterial or desensitizing agents to certain areas of the teeth or gums.p>

Oral Irrigation Devices

Available to consumers for over 50 years, these devices (sometimes known as water jets or water picks) can also play a role in interdental hygiene. While their popularity has gone up and down over the decades, many studies have shown that they provide a safe and effective method of diluting the acids produced by plaque. Irrigation devices typically use pulsed or steady jets of pressurized water to remove food particles from the hard-to-clean interdental spaces, as well as some subgingival (below the gum line) pockets.

Proper brushing and flossing is still generally considered the gold standard of at-home oral hygiene. But if you have trouble flossing regularly — or if you're at increased risk of developing dental or periodontal disease — then using these interdental cleaners might be right for you.

If you are missing one or more of your adult teeth, you're not alone — an estimated 178 million Americans have the same condition. Many try to get along without all of their teeth, and suffer from some of the familiar problems that go with the territory: smiles that don't look as appealing as they once did, problems eating certain foods, and awkwardness or embarrassment in social situations.

Yet there are other problems associated with tooth loss that are less obvious, but could have more of an impact on your health. These include nutritional difficulties, oral health issues, and bone loss.

Nutritional Difficulties

It is well established that eating plenty of fruits and vegetables and avoiding highly processed foods are essential parts of good nutrition. But many foods become difficult to chew if you have missing teeth — and those “challenging” foods are often the same ones that offer the greatest nutritional value. Softer foods are easier to eat, but they are often highly processed, and offer little nutritional value. Along with the possibility of malnourishment, a poor diet can lead to a compromised immune system and a decline in overall health.

Oral Health Issues

If you have only one or two missing teeth, you may not feel an urgent need to replace them now. Yet the problems that stem from missing teeth don't get better — and in time, they can get much worse. Teeth aren't fixed solidly in the jaw; instead, when even one tooth is missing, the remaining teeth tend to “drift” into new positions. This can cause a cascade of oral health problems, including unstable tooth positions, excessive tooth wear, bite problems, a greater chance of developing tooth decay and periodontal disease — and the loss of even more teeth.

Bone Loss

You can't see the bone inside your jaw — but the consequences of bone loss are very real. Bone tissue needs stimulation to maintain its volume and density. When teeth are lost, the jaw bone that once supported them loses stimulation and begins to deteriorate. It can lose one-quarter of its width in just one year, and even more as time passes. As the jaw becomes smaller, facial height (the distance from nose to chin) decreases, and facial features lose support. The chin rotates forward, the corners of the mouth turn downward (as if frowning), and the cheeks can appear hollow. Loss of bone in the jaw can give you the appearance of being many years older than you actually are.

The consequences of tooth loss are very real, even if they are less visible than a gap in your smile. That's why it is so important not to put off the replacement of missing teeth.

Bone Loss Image

Numerous studies have shown that using an appropriate mouthrinse, in conjunction with regular brushing and flossing, is an easy and effective way for you to improve your overall oral health. As part of a regular program of oral hygiene, mouthrinses (which are sometimes called mouthwashes) can be effective at reducing plaque, controlling bad breath, and helping to prevent tooth decay and gum disease. There are a myriad of mouthrinses lining the drugstore shelves, and they are available in both prescription and over-the-counter (OTC) formulations. Which one is best for you? That depends on what benefit you expect to get from using it.

It's important to keep in mind that many off-the-shelf mouthrinses are primarily cosmetic: That means, they may (temporarily) make your mouth taste or smell good, but they don't offer any lasting benefit to your oral health. There's nothing wrong with that — as long as you weren't expecting anything more. But if you've been told that you are at risk of tooth decay or gum disease, you'll want to use a mouthrinse that has proven clinical benefits.

Therapeutic Mouthrinses

Mouthrinses that offer oral-health benefits are considered therapeutic. These fall into two general categories: anti-cariogenic rinses, which are designed to prevent tooth decay (and thus dental caries, or “cavities”); and anti-bacterial rinses, which help control the buildup of plaque bacteria in your mouth. Some products may even offer both types of protection.

To help prevent tooth decay, anti-cariogenic mouthrinses use an ingredient you're probably already familiar with: fluoride. This is often in the form of a .05% sodium fluoride solution. Because it's a liquid, the rinse can get all around your teeth — even into spaces the smallest brush can't reach.

Fluoride has been consistently proven to strengthen tooth enamel, which protects against decay; it can even reduce tiny lesions on teeth where a cavity may form. There's hardly anyone who couldn't use some extra help in the fight against cavities — but if you've been told you may be at a higher risk of tooth decay, or if you have difficulty brushing and flossing, then an anti-cariogenic rinse is a good choice for you.

Anti-bacterial mouthrinses generally contain ingredients (like triclosan, essential oils, or the prescription medication chlorhexidine) that help to control the microorganisms found in plaque. Plaque, a sticky, bacteria-laden biofilm, occurs not only on the surfaces of the teeth, but also in other parts of the mouth. Rinsing with an anti-bacterial solution has been shown to provide a greater reduction in plaque than brushing and flossing alone. As tools in the fight against gum disease (gingivitis) and tooth decay, anti-bacterial mouthrinses may be a good step toward improving your oral hygiene.

Choosing A Mouthrinse

If you're shopping for an over-the-counter therapeutic mouthrinse, look for the ADA (American Dental Association) seal on the label; it means that the product has been evaluated and proven effective by an independent panel of dental experts. If a mouthrinse has been prescribed for you, you should carefully follow the usage instructions. (Note, however, that due to labeling rules, prescription mouthrinses may not be eligible for the ADA seal.) Mouthrinses can benefit most people, but they generally aren't recommended for children under the age of six, who may swallow them.

You probably already realize that maintaining a balanced diet offers a host of benefits to your overall health. But did you know diet also directly affects the health of your teeth and gums? It all starts before birth, as a baby's teeth begin forming in the sixth week of pregnancy and mineralizing in the third or fourth month. During this time, an expectant mother needs to take in lots of calcium (the major component of teeth) along with vitamin D, phosphorous and protein dairy products including milk, cheese, and yogurt have all of these. Broccoli and kale also have calcium, while meats are good sources of protein and phosphorous. These foods are also important for children, whose teeth continue to develop and mineralize through the teen years.

Throughout life, oral tissues are constantly recycling; they need a variety of nutrients to support this process. It's equally important to recognize that nutritional deficiencies — a particular concern among older adults who have lost teeth — can reduce resistance to disease and hinder your ability to fight infection. Studies have consistently found that a high intake of fruits and vegetables reduces the risk of oral cancer — as well as other types of cancer. That's why eating a nutritious diet is important for oral health — as well as general health — at any age.

Eating Healthy

What's the best diet for you? That depends mainly on your age, gender, height, weight and level of physical activity. But in general, a health-promoting diet is based on the concepts of:

  • Variety. No single food can meet all of the daily nutrient requirements. Eating lots of different foods also makes meals more interesting.
  • Balance. We need to eat the recommended amounts of foods from specific categories on a daily basis. Find out what your specific needs are at www.choosemyplate.gov
  • Moderation. Don't supersize it. Foods and beverages should be consumed in serving sizes that are appropriate to meet energy needs while controlling calories, fat, cholesterol, sodium, and — particularly important in the dental arena — sugar.

Protecting Your Teeth

Your diet (which includes what you drink) plays a major role in tooth decay and enamel erosion. Your mouth is naturally hospitable to all kinds of bacteria. Some of these microorganisms are helpful and some are harmful, and many of the harmful ones thrive on a steady supply of sugar. As they process sugar from your diet, these bacteria produce acids that can eat into the enamel of your teeth, forming small holes called cavities. If left untreated, tooth decay can worsen and become quite painful, and threaten the survival of teeth.

That's why it is important to avoid food and drinks with added sugar. If you have a sugar craving (and we all do from time to time), choose fresh fruit or yogurt instead of a donut or candy bar. Fortunately, there is no evidence that sugars in whole grain foods, whole fruits and vegetables, and in starch-rich staple foods like bread, rice and potatoes are harmful to teeth.

Soft drinks, however, are a double whammy for teeth; many not only contain lots of sugar — up to 10 teaspoons per 12-ounce can — but they are also highly acidic. This means they erode teeth on contact, even before the bacteria in your mouth have processed the sugar these drinks contain. But even if they are sugar-free, the acid can still harm your teeth. So it might be best to avoid soda, sports drinks, energy drinks and canned iced tea. If you do occasionally have a soda, swish some water in your mouth afterward — but don't brush your teeth for at least an hour! Doing so could make it easy for tooth enamel, already softened up by acid, to be eroded away by brushing.

Drinking lots of water can help you maintain a healthy supply of saliva, which protects teeth by neutralizing acid. You can also neutralize the acid in your mouth after a sugary snack by following it up with a piece of cheese.

Finally, remember that it's not just what you eat that affects the level of acidity in your mouth — it's also when. Snacking throughout the day, especially on chips, crackers, cookies or candy, means that your saliva never gets the chance to neutralize the harmful acids being produced. So if you eat sweets, do it only at mealtimes. As an added incentive, you may find this helps you maintain a healthy weight, too!

Teeth can last a lifetime if you take care of them right — and the best time to start is just as soon as they begin appearing. By establishing good oral hygiene routines for your children right from the start, you'll give them the best chance of keeping their teeth healthy — forever.

Tooth decay, the major cause of dental trouble that can eventually lead to tooth loss, is actually an infectious disease caused by bacteria. If it takes hold, it can form a cavity in the enamel and then progress deeper into the tooth — causing discomfort, difficulty eating and speaking, and a need for fillings or root canal treatment. The good news is that tooth decay (also called caries) is completely preventable.

The primary route to good dental health is plaque removal. Plaque is the sticky, whitish film that builds up on teeth in the absence of effective oral hygiene. Decay-causing bacteria thrive in plaque, where they break down any sugar that lingers in the mouth. In the process, they produce acid byproducts that erode teeth. This is how a cavity begins. What are the most effective techniques for plaque removal and decay prevention? That depends on the age of your child.

Babies

Babies can develop a form of tooth decay known as early childhood caries. This occurs when they are allowed to go to sleep with a bottle that's filled with anything but water. The sugars in formula, milk (even breast milk) and juice can pool around the teeth and feed decay-causing bacteria. When it comes to bedtime soothing, a pacifier or bottle filled with water is safer for developing teeth — that is, until about age 3. At that point, sucking habits should be gently discouraged to prevent orthodontic problems from developing later on.

Brush your baby's first teeth gently with a small, soft-bristled toothbrush, using just a thin smear of fluoride toothpaste, at least once a day at bedtime. Before a tooth is fully erupted, you can use a water-soaked gauze pad to clean around the tooth and gums.

Blythe Danner Oral Cancer Video.

Make sure your child has his or her first dental visit by age 1. There, you can learn proper hygiene techniques; have your youngster examined for signs of early decay; and get a recommendation for fluoride supplements if needed.

Children

Starting at age 3, you can begin teaching your child to brush with a children's toothbrush and no more than a pea-sized amount of fluoride toothpaste. But remember, children will need help with this important task until about age six when they have the fine motor skills to do an effective job themselves.

It's also extremely important to start encouraging healthy dietary habits at this time. Your child will have less plaque buildup and decay if you place limits on soda and sugary snack consumption. As a parent, you can model this behavior to instill it in your child. After all, monkey see, monkey do! Any sugary treats that are allowed should come at mealtimes, not in between. This will ensure your child is not creating favorable conditions for oral bacteria to grow around the clock.

Blythe Danner Oral Cancer Video.

At your child's regular, twice-yearly dental checkups and cleanings, topical fluoride can be applied to strengthen tooth enamel and make it more resistant to erosion and decay. If necessary, dental sealants can be applied to the back teeth (molars) to prevent food particles and bacteria from building up in the tiny grooves where a toothbrush can't reach (View Dental Sealant Video).

Teens

At this point, your children have the primary responsibility for maintaining their day-to-day dental health — but you can continue to help them make good dietary and behavioral choices. These include drinking plenty of water and avoiding soda, sports drinks and energy drinks, all of which are highly acidic; avoiding tobacco and alcohol; and continuing to visit the dental office regularly for cleanings and exams. This is particularly important if your teen wears braces, which can make it more difficult to keep teeth clean.

Remember, it's never too soon to help your child develop good oral hygiene habits that will last a lifetime.

At the present time, oral piercings such as tongue bolts, cheek studs, and lip rings seem to be in vogue among a certain number of young people. Whether you find these bodily adornments appealing or repulsive is a matter of personal taste — but whichever side of the fashion divide you're on, there are a few things you should know about the impact they can have on your oral health.

According to the Journal of the American Dental Association, the tongue and lips are the most common sites for intraoral piercings. In either location, the ornament is likely to come into contact with teeth, gum tissue, and other anatomical structures in the mouth. And that's where the trouble may start.

The Anatomy of a Problem

The tongue, composed primarily of muscle tissue, is rich in blood supply and nerve endings; that's why a cut on the tongue is often painful and bloody. In a tongue piercing, a metal stud is inserted through a hole made in the tongue. The possibility of infection or the transmission of a blood-borne disease like hepatitis B exists in this situation. Rarely, the piercing may also cause immediate and severe facial pain. It's the long-term effects of an oral piercing, however, which give the most reason for concern.

As teeth regularly come into contact with the metal parts of the ornament, increased tooth sensitivity and pain may become a problem. Chipping or fracture of the teeth can also occur, which may require tooth restoration. Teeth that have already been restored (with crowns, for example) may be even more prone to damage. Plus, wherever it's located, jewelry in the mouth can trigger excessive saliva flow, impede speech, and cause problems with chewing and swallowing.

Periodontal (gum) disease can also result from wearing an oral piercing. This may first show up as injury to the soft gum tissue, and later as gum recession. It's important to understand that before the gums can recede, some of the underlying bone in the jaw must be lost. Following bone loss, inflammation and infection of the gums may occur.

When gums recede, tooth roots become exposed; this makes tooth decay more likely, since roots lack the protective enamel covering of the tooth's crown. Some studies have even shown that, over time, this condition makes gum disease more likely — primarily because it's more difficult to practice good oral hygiene with an irregular gum line. Besides causing problems in the mouth, advanced gum disease can have a potentially negative effect on your general (systemic) health.

It's Your Health — and Your Choice

If you're old enough to get an oral piercing, you're old enough to take an active part in maintaining your own oral health. If you are thinking about having a tongue bolt, lip ring, cheek stud, or other ornament placed in your mouth, talk to a dental professional about it first. Due to the increased potential for dental or periodontal problems, you will likely need to have more frequent checkups, and pay special attention to your oral hygiene.

And if the time comes when you decide that the piercing you got on an impulse isn't what you want any more, take heart: Removing it will immediately reduce your disease risk, and thus instantly improve your oral health!

Maintaining good oral health has many rewards: A sparkling smile, fresh breath, and healthy gums. But recent scientific evidence suggests that it may have an even greater benefit to your overall health: Specifically, it could potentially reduce your risk of a number of systemic (whole-body) diseases, including cardiovascular disease (CVD), diabetes, and rheumatoid arthritis — even premature birth.

Periodontal (gum) disease is estimated to affect nearly half of all Americans, and is the major cause of adult tooth loss. Numerous studies have shown that patients with severe periodontal disease are at increased risk of developing cardiovascular disease. Periodontitis may also increase the chance that diabetes will develop or progress, and research suggests an association between gum disease and adverse pregnancy outcomes as well.

Oral Systemic Connection Image

Inflammation: Friend and Foe

What's the link between diseases of the mouth — like gum disease — and those of the body? They are connected by the body's natural reaction to harmful stimuli, which we call the inflammatory response. Often characterized by pain, redness and swelling, inflammation is a process by which your immune system responds to damage or disease in your tissues. Inflammation can help the body heal — or, if it becomes chronic, it can lead to more serious problems.

Gum disease (periodontitis), CVD, diabetes and rheumatoid arthritis are all associated with the same type of inflammatory response. Studies have found that moderate to severe periodontitis tends to increase the level of systemic inflammation — a condition that may smolder in the background, awaiting the right conditions to flare into a more serious disease. It has also been shown that the same strains of bacteria that are found in inflamed gum tissue may also appear in tharterial plaques of individuals suffering from CVD.

How Does It Work?

While there is intriguing evidence of a link between gum disease and other systemic diseases, further studies will be needed to prove whether one causes the other. At present, however, several mechanisms have been proposed to explain how the connection works. One suggestion is that oral bacteria themselves may enter the bloodstream, form into clumps, and trigger systemic inflammation. The inflammatory response can cause swelling of cells and tissues, which narrow the arteries and increase the risk of blood clots.

Another possibility is that byproducts of oral bacteria released into the bloodstream could trigger the production of substances called CRPs (C-reactive proteins) in the liver. These proteins tend to inflame blood vessels and promote the formation of clots, possibly leading to clogged arteries, heart disease and stroke. Elevated CRP levels, according to some studies, are a stronger predictor of heart attack than cholesterol levels.

What You Can Do

Since chronic inflammation is a systemic problem, the best way to begin controlling it is via a whole-body approach. Maintaining a healthy weight, getting moderate exercise (and, if you use tobacco, quitting the habit) will help with this. So will bringing untreated inflammatory diseases, such as periodontitis, under control.

There are a number of effective treatments for periodontal disease, including nonsurgical procedures such as root cleaning and the local application of antimicrobials. For more serious conditions, conventional or laser gum surgery is an option. Finally, to keep your gums healthy between office visits, you need to develop an effective oral hygiene routine you can practice at home.

Although it's too early to say that periodontal disease causes heart disease or other systemic conditions, they seem to have a connection. And while medicine and dentistry can't change genetics, together we can control external factors like excess weight, tobacco use… and gum disease. Maintaining good oral hygiene is the best way to avoid periodontal problems. But if problems occur, don't wait: The sooner you have treatment, the better your chances for controlling gum disease — and perhaps, systemic diseases too.

Osteoporosis is a condition that weakens bones and makes them more prone to fracture. Estimated to affect about 10 million Americans at present, it causes some 2 million fractures each year — and as our population ages, these numbers are expected to increase. Osteoporosis can affect any part of the body — including the jawbone that supports the teeth.

This may be of particular concern if you are considering certain dental procedures — for example, getting dental implants to replace missing teeth. Implants are today's gold standard for tooth replacement, because they look and function so much like real teeth. But their success depends on a process known as osseointegration, by which they fuse to living bone in the jaw. For this to occur, that bone must be relatively healthy; yet osteoporosis — and certain medications used to treat it — may affect your oral health.

Bone: An Ever-Changing Tissue

The living bone tissue in the body isn't like the dry, white skeleton you may have seen in a doctor's office or on TV. It is constantly being remodeled by two natural processes: resorption, in which the body removes and breaks down old, damaged bone; and bone formation, where the removed material is replaced by new, healthy bone. In an ideal situation, both processes happen at an equal rate; osteoporosis, however, tips the balance toward resorption, weakening the bone structure.

A class of drugs called bisphosphonates (whose brand names include Fosamax, Boniva, Reclast and Prolia) can inhibit resorption and help bring the two processes back into balance. But for reasons that aren't fully understood, these medications sometimes have a different effect on the bones of the jaw. In rare cases, long-term bisphosphonate users experience osteonecrosis of the jaw (ONJ), a condition in which isolated areas of jawbone lose their vitality and die. If you are a candidate for oral surgery, tooth extraction or implant placement, it's important to consider the possible effect of bisphosphonate use before you have this type of procedure.

Taking Medication

Over 90 percent of the people who suffer from bisphosphonate-associated ONJ received high doses of the medication intravenously — often for cancer treatment. Only a small percentage of those who take the drug orally are likely to develop this condition. So generally speaking, if you have osteoporosis or are at high risk of bone fractures, the benefit of taking these medications far outweighs the risk.

But if you are about to begin therapy with high doses of bisphosphonates, it's ideal to have a dental exam and resolve any oral disease before beginning the medication. Likewise, while you're receiving the medication, it's best to avoid invasive dental treatments if possible. However, since untreated oral disease may cause serious health problems, be sure to discuss the situation with all members of your medical team before making treatment decisions.

Most people who take oral bisphosphonates for osteoporosis won't have to postpone or avoid dental procedures, because they have little risk of developing ONJ. In the case of dental implant placement, the decision to proceed is made on an individual basis, after a thorough examination of the quality and quantity of tooth-supporting bone in the jaw. The presence of osteoporosis may influence the type of implants used, and the amount of healing time needed to complete the osseointegration process.

No matter what dental procedures you are considering, it is vital to keep us informed about any medical conditions you have, and any drugs you may be taking — both prescription and non-prescription.

Preventing Osteoporosis

There are several ways you can help prevent osteoporosis. For a start, make sure you're getting enough calcium and vitamin D. It also helps to decrease your caffeine and alcohol intake, and quit smoking. Weight-bearing exercise — physical activities that force you to work against gravity, like walking, jogging or weight training — can bring a host of benefits. And don't forget your regular visits to the dental office. Your dental professionals don't just help you to maintain good oral health — we encourage you to keep up your overall health as well.

Your baby's teeth will not be visible at birth. But believe it or not, they already exist beneath the gums. Children's primary teeth begin forming at about the sixth week of pregnancy, and start mineralizing — building the bonelike inner tooth layer (called dentin) and the super-hard enamel layer that covers it — around the third or fourth month of pregnancy. So if you're pregnant, it's not too early to start thinking about how to make sure your child's teeth are as healthy as possible!

Like everything else having to do with your baby's physical development before birth, much depends on how well you take care of yourself. Developing teeth need certain nutrients to grow properly; if you don't get them through your diet, your baby won't receive them either. Likewise, you'll have to watch your intake of substances that could harm your teeth in utero, such as certain antibiotics. Here's a brief summary of what to seek and what to avoid.

Eat Right

Certain nutrients are particularly important for prenatal tooth development:

  • Calcium, a mineral, is the main component of teeth. If there is not enough calcium coming from your diet to support fetal development, your body will actually take this mineral from your bones (but not your teeth) and use it to meet your developing baby's needs. Good for your baby, not so good for you. The best sources of dietary calcium are dairy foods such as milk, cheese and yogurt. It can also be found in broccoli and kale.
  • Phosphorous, another mineral, also accounts for the hardness of teeth. It is found in every one of the body's cells, and also in many foods — especially high protein sources such as meat and milk, but also cereals. Of all the nutrients your baby's teeth need, this is the easiest to get.
  • Vitamin D helps the body absorb and retain calcium and phosphorous. Very few foods contain it naturally — oily fish like salmon and tuna are exceptions; that's why it is added to milk and some other beverages and foods (check labels to find out which ones). It is also produced in the body naturally when skin is directly exposed to sunlight. Concerns about the negative effects of sun exposure may prevent you from getting all the vitamin D your body requires this way, so you may be advised to take a supplement.
  • Protein is the most plentiful substance in your body after water. It is responsible for building, maintaining and replacing the body's tissues. Interestingly, it is the action of a single protein that causes calcium-phosphate crystals to form tooth enamel rather than bone. All proteins are made of amino acids, but some amino acids cannot be manufactured by the body and must come from foods. Meats and dairy products are the most protein-rich. It is possible to get all the different proteins your body requires with a vegetarian diet, but you will need to pay closer attention to what combinations of foods will provide all the essential amino acids.

Seek Guidance on Dietary Supplementation & Medications

If you feel your diet is inadequate in some nutrients during your pregnancy, it's best to seek professional medical advice on what supplements you may need. While it's unlikely you will ever receive too much of any given nutrient from your diet, you can overdo certain vitamins and minerals in pill form (vitamin D and calcium, for example).

When you know you're pregnant (or if you may be pregnant), please share the news with all of your healthcare professionals who see you. That way, medications that should not be prescribed will be avoided at this time. For example, if you need antibiotics to combat an infection, some are much safer for developing babies than others. Tetracycline, for example, can permanently stain teeth in utero. Fluoride supplementation at this time is not recommended either, as there are too many unanswered questions about its use during pregnancy.

You probably know that many physical and emotional changes you will experience during pregnancy result from an increase in the levels of certain hormones — the chemicals that regulate many important processes in the body. But what you may not realize is that these hormonal variations can affect your oral health — and usually not for the better. In fact, surges in the female hormones estrogen and progesterone can dilate (expand) the tiny blood vessels in your gums, increasing blood flow. This makes gums more sensitive to the bacteria (and associated toxins) found in the sticky dental plaque that accumulates on teeth every day.

Pregnant women commonly notice that their gums may become red and swollen, and even bleed when they floss or brush their teeth, a condition known as “pregnancy gingivitis.” Similar gum inflammation can result from taking birth control pills that contain a type of synthetic progesterone, or even from the normal hormonal fluctuations of the menstrual cycle.

Another, less common effect of pregnancy hormones on the gums is an overgrowth of gum tissue or small, berry-colored lumps at the gum line or between teeth. These growths are called “pregnancy tumors,” though they are completely benign.

All of the above conditions usually clear up within a few months after giving birth. Still, if you experience gum inflammation, it's a sign that you need to take extra conscientious care of your teeth and gums during pregnancy.

Why It Matters

Pregnancy hormones don't cause gingivitis by themselves — the irritants in plaque need to be present first. So if you experience the signs and symptoms mentioned above, you'll want to redouble your oral hygiene efforts, both for your sake and your baby's. Untreated gingivitis can progress to a more serious form of gum disease called periodontitis — a bacterial infection that attacks not just the gums but also the tooth-supporting bone beneath. It can eventually cause bone loss, loose teeth and even tooth loss. Some research has even indicated a link between periodontal (gum) diseases and other serious health conditions, such as cardiovascular disease and diabetes.

Pregnant women should also be aware that studies have suggested a link between periodontal (gum) disease and preterm delivery. Although the exact mechanism by which this happens is unclear, evidence suggests that the bacteria in dental plaque can reach the placenta and trigger inflammatory responses. This causes substances to be released into the bloodstream that may, in turn, start labor prematurely. Preeclampsia, a form of high blood pressure specific to pregnancy, may also be associated with periodontal disease.

What You Can Do

  • Eat right. Even if pregnancy cravings are driving you to seek out sugar, try to go easy on the sweets. While they offer you and your developing baby virtually nothing in the way of nutrients, they're the favorite food of disease-causing oral bacteria. If you find you can't resist sweets, try to eat them only at mealtimes and make sure to brush your teeth afterward.
  • Stick to a good oral hygiene routine. Make sure to floss every day and to brush your teeth at least twice per day. If morning (or afternoon or evening) sickness is a problem, don't brush immediately after throwing up. That's because the enamel on your teeth, which has been temporarily softened by the acid coming up from your stomach, can now be easily removed. Instead, rinse with a teaspoon of baking soda dissolved in a cup of water (or even plain water) to neutralize the acid. Wait a full hour before brushing your teeth.
  • Have a dental cleaning and exam. Not only are professional cleanings safe during pregnancy, they're highly recommended. So if you haven't been to the dentist in a while, now is a great time to make an appointment. And don't forget to share the happy news! Your teeth can certainly be cleaned and examined — but for other non-emergency dental procedures, it's probably best to wait.

Teeth grinding and clenching are common habits, but that doesn't mean they are harmless. Stresses from the powerful forces generated by grinding and clenching (also known as “bruxing”) can wear down teeth or even loosen them. Teeth that have enamel worn away or scraped off from this repeated rubbing action may become sensitive to hot or cold. And dental work such as crowns and fillings may get damaged. Bruxism can also lead to jaw pain and/or headaches.

Even if you have experienced some of these signs and symptoms, you may not realize you are a bruxer — particularly if your habit is nocturnal, as is often the case. Yet the evidence of tooth damage may become obvious during your regular checkup and cleaning. Dentists can also help you break the habit, relieve any pain you are experiencing, and repair any damage to your teeth or dental work.

Why do we grind or clench our teeth?

The most common reason for grinding/clenching habits is stress, which can affect our health in various ways. Some people experience stomach pain or skin breakouts; bruxing is yet another manifestation. Sometimes people grind their teeth because of misaligned teeth or other bite problems. Using stimulating substances such as caffeine, alcohol, tobacco and illegal drugs can also put you at risk. Additionally, teeth grinding is believed to be an uncommon side effect of certain medications.

What can be done?

Sometimes simply becoming aware of the habit can help you to get it under control. If stress is the issue, try to find healthy ways of managing it: exercise, meditation, listening to relaxing music, or a warm bath may help. Your teeth will be monitored over time at the dental office to make sure the problem is not worsening.

If damage to your teeth or existing dental work is evident, we may recommend a custom-made nightguard, also known as an “occlusal guard,” may be recommended. It resembles an athletic mouthguard. Made of comfortable plastic, the guard is worn at night to keep your teeth from actually contacting each other. It also helps protect your jaw joints from excessive force.

If a bite problem exists where some teeth are hitting before the others (all of your teeth should hit at the same time), it can sometimes be treated by removing a tiny bit of enamel from an individual tooth that is sticking up a bit (and therefore receiving too much force) to bring it in line with the others. This is known as a bite adjustment. If your malocclusion (bad bite) is more serious, orthodontics might be recommended. Replacing any teeth that are missing can also help stabilize your bite by inhibiting the shifting of teeth that occurs when extra space is left open by missing teeth.

A word about kids: Teeth grinding is very common in children, especially when they are shedding their baby teeth. Since they often outgrow it, treatment is not usually recommended.

Cavities are little holes in teeth that can eventually cause big problems. They form when tooth-eroding acid attacks a tooth's protective outer covering (enamel). This acid mainly comes from two sources: your diet, and certain oral bacteria that thrive in the absence of effective oral hygiene. If cavities are not treated promptly, decay-causing bacteria can get further into the tooth, leading eventually to root-canal problems and even tooth loss. The good news is that cavities are completely preventable — meaning it is truly possible to keep all of your natural teeth for life! Here are our top three tips to keep decay away:

Brush & Floss Every Day

Cavity prevention starts with a good oral hygiene routine. This will remove dental plaque — a sticky film that harbors food particles and harmful bacteria. Flossing is particularly important because a toothbrush can't reach in between the teeth the way floss can. Make sure to floss both sides of every tooth, including the back molars, at least once each day. Brush your teeth at least twice each day, using a toothpaste that contains fluoride — a mineral that can become part of your tooth enamel and actually repair tiny cavities that are starting to form.

Pay Attention to Your Diet

Certain foods and beverages are no friends to your teeth, and soda tops the list. Soda, sports drinks, and so-called “energy drinks” are all acidic — even the sugar-free varieties. The acids they contain attack tooth enamel and make your teeth more prone to decay. Fruit juices can also be very acidic. Drinking water is much better for your dental health, not only because it has a completely neutral pH (is non-acidic), but also because it helps replenish your saliva — which has natural cavity-fighting properties. Sugary and starchy foods (cookies, candy, donuts, and chips) are also a problem — especially when they are not promptly cleaned from your mouth. They nourish the oral bacteria that cause cavities and raise the acidity level in your mouth.

See Your Dentist Regularly

Routine professional cleanings and exams are a great way to maintain excellent oral health. Your dental hygienist can clean areas of your mouth that you can't reach with your toothbrush or even with floss. We can check for early signs of tooth decay and take prompt action. What's more, we can recommend specific preventive treatments if you are particularly prone to cavities. These include in-office fluoride treatments and dental sealants, both of which are quick, easy and effective procedures. Special mouthrinses might also be recommended. Working together, we can make sure your oral hygiene routine is all it should be and that decay is kept at bay.

Toothpaste: It's something most people use every day, but rarely give much thought to — except, perhaps, when choosing from among the dozens of brands that line the drugstore shelf. Is there any difference between them? What's toothpaste made of… and does it really do what it promises on the box? To answer those questions, let's take a closer look inside the tube.

The soft, slightly grainy paste that you squeeze on your brush is the latest in a long line of tooth-cleaning substances whose first recorded use was around the time of the ancient Egyptians. Those early mixtures had ingredients like crushed bones, pumice and ashes — but you won't find that any more. Modern toothpastes have evolved into an effective means of cleaning teeth and preventing decay. Today, most have a similar set of active ingredients, including:

  • Abrasives, which help remove surface deposits and stains from teeth, and make the mechanical action of brushing more effective. They typically include gentle cleaning and polishing agents like hydrated silica or alumina, calcium carbonate or dicalcium phosphate.
  • Detergents, such as sodium lauryl sulfate, which produce the bubbly foam you may notice when brushing vigorously. They help to break up and dissolve substances that would normally be hard to wash away, just like they do in the laundry — but with far milder ingredients.
  • Fluoride, the vital tooth-protective ingredient in toothpaste. Whether it shows up as sodium fluoride, stannous fluoride or sodium monofluorophosphate (MFP), fluoride has been conclusively proven to help strengthen tooth enamel and prevent decay.

Besides their active ingredients, most toothpastes also contain preservatives, binders, and flavorings — without which they would tend to dry out, separate… or taste awful. In addition, some specialty toothpastes have additional ingredients for therapeutic purposes.

  • Whitening toothpastes generally contain special abrasives or enzymes designed to help remove stains on the tooth's surfaces. Whether or not they will work for you depends on why your teeth aren't white in the first place: If it's an extrinsic (surface) stain, they can be effective; however, they probably won't help with intrinsic (internal) discoloration, which may require a professional whitening treatment.
  • Toothpastes for sensitive teeth often include ingredients like potassium nitrate or strontium chloride, which can block sensations of pain. Teeth may become sensitive when dentin (the material within the tooth, which is normally covered by enamel, or by the gums) becomes exposed in the mouth. These ingredients can make brushing less painful, but it may take a few weeks until you really notice their effects.

What's the best way to choose a toothpaste? The main thing you should look for is the American Dental Association (ADA) Seal of Acceptance on the label. It means that the toothpaste contains fluoride — and that the manufacturer's other claims have been independently tested and verified.

But once you've chosen your favorite, keep this bit of dental wisdom in mind: It's not the brush (or the paste) that keeps your mouth healthy — it's the hand that holds it. Don't forget that regular brushing is one of the best ways to prevent tooth decay and maintain good oral hygiene.

The dental implant is today's state-of-the-art tooth-replacement method. It consists of a very small titanium post (the actual implant), which is attached to a lifelike dental crown. The crown is the only part of this tooth-replacement system that is visible in your mouth. The implant itself rests beneath your gum line in the bony socket that used to hold your missing tooth. Two, four or more implants can be used to support multiple crowns, or even an entire arch of upper or lower replacement teeth. Whether you are missing one tooth, several teeth or all your teeth, dental implants are preferred by doctors and patients alike. That's because dental implants are:

1. Most like natural teeth

Your natural teeth have roots that keep them securely anchored to your jawbone. In a similar way, implant teeth form a solid attachment with the bone in your jaw. This is possible because dental implants are made of titanium, a metal that has a unique ability to fuse to living bone. After an implant is inserted during a minor procedure done in the dental office, it will become solidly fused to your bone over a period of several months. Once that happens, your implant-supported replacement tooth (or teeth) will feel completely natural. It will also be visually indistinguishable from your natural teeth. Implant teeth allow you to eat, speak and smile with complete confidence because they will never slip or shift like removable dentures often do.

2. The longest-lasting tooth replacements

Because dental implants actually become part of your jawbone, they provide a permanent solution to tooth loss. Whereas other methods of tooth replacement, including removable dentures and bridgework, may need to be replaced or remade over time, properly cared-for dental implants should last a lifetime. That's what makes this choice of tooth replacement the best long-term value.

3. Able to prevent bone loss

You may not know it, but bone loss inevitably follows tooth loss. Bone is a living tissue that needs constant stimulation to rebuild itself and stay healthy. In the case of your jawbone, that stimulation comes from the teeth. When even one tooth is lost, the bone beneath it begins to resorb, or melt away. This can give your face a prematurely aged appearance and even leave your jaw more vulnerable to fractures if left untreated long enough (View Example). Dental implants halt this process by fusing to the jawbone and stabilizing it. No other tooth replacement method can offer this advantage.

4. Safe for adjacent natural teeth

Dental implants have no effect on the health of adjacent natural teeth; other tooth-replacement systems, however, can weaken adjacent teeth. With bridgework, for example, the natural teeth on either side of a gap left by a missing tooth must provide support for the dental bridge. This can stress those adjacent teeth and leave them more susceptible to decay. Likewise, a partial denture relies on adjacent natural teeth for support and may cause those teeth to loosen over time. Dental implants are stand-alone tooth replacements that don't rely on support from adjacent natural teeth.

5. Easy to care for

Caring for implant teeth is no different than caring for your natural teeth. You must brush them and floss them daily. But you'll never have to apply special creams and adhesives, or soak them in a glass overnight, as you would with dentures. They'll also never need a filling or a root canal, as the natural teeth supporting bridgework might. While implants can never decay, they can be compromised by gum disease. Good oral hygiene and regular visits to the dental office for professional cleanings and exams is the best way to prevent gum disease, and to ensure your dental implants last a lifetime, as they're designed to do.

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