Frequently Asked Questions
Q) How often should I brush my teeth:
A) Teeth should be brushed twice per day using a fluoridated toothpaste. Toothpastes without fluoride are not recommended as the fluoride is essential in keeping the inorganic, or mineral content high. The mineral content needs to be high because acids elaborated by certain bacteria dissolve tooth structure. The fluoride helps keep teeth strong by shifting the equilibrium between acid penetration and re-mineralization towards re-mineralization. When this equilibrium is disrupted in favor of acid, a cavity or tooth decay is the result over time. The act of brushing removes the bacterial plaque from the teeth, while the fluoride enhances the re-mineralization of the teeth. After brushing, spit, but do not rinse as this can dilute the fluoride exposure. If you don't get enough flouride because you don't brush often enough or if you have a disability that reduces dexterity, then an ADA approved flouride rinse may be a benefical adjunct. Frequently in high decay prone individuals we recommend application of a fluoride varnish at the time of dental cleanings or we prescribe a toothpaste with high fluoride content.
Q) What kind of toothbrush should I use:
A) In the past many dentists recommended a hard bristled brush, but studies have shown that a soft brush is best. Ultrasonic brushes (mechanical) are more effective at removing plaque than manual brushes. Does this mean that everyone should go out and buy one? The short answer is no, but for those individuals that do not effectively remove plaque with a manual brush may remove more plaque with an electric brush. Use a circular motion with gentle pressure. Too much pressure or a back and forth action can cause trauma to the soft tissues and can result in gum recession. Most toothpastes are fine, but baking soda pastes tend to be gritty and lend themselves to tissue trauma and can result in gum recession and notches in the tooth near the gum line.
Q) My teeth are hot or cold sensitive, what should I do:
A) Temperature sensitivity is common, and most often it is brought on by cold fluids (water, ice cream, air). Teeth that are sensitive usually have either exposed roots as a result of gum recession, exposed dentin, hairline fractures or a restoration that is not well sealed. These surfaces are connected by microscopic channels to the pulp/nerve of a tooth. When fluids contact these surfaces, sometimes there is a sensation brought on by such fluids. Specialized toothpastes for sensitive teeth contain ingredients that help occlude these channels and bring you relief. Other ways to treat these problems are with gum grafting, or with a filling. Teeth that have had root canals have no nerve, so exposed roots in these teeth should not pose a problem.
Q) How often should I floss:
A) Flossing should be done at least once daily. Studies show that daily flossing in the majority of people is adequate to remove the bacterial plaque between teeth. Brushing alone is not sufficient at removing the plaque as it does not reach between the teeth. Flossing achieves this. Be sure to bring floss all the way below the gum and curve floss around teeth while moving it up and down. Flossing above the gum removes very little of the plaque that is associated with gum or periodontal disease. Flossing under bridges and around dental implants is essential as well.
Q) What kind of floss is best:
A) The best floss is the floss the one you feel comfortable using. Studies show that it doesn't matter what type of floss is used. Waxed, ribbon type are the same. It is a personal preference.
Q) Do mouthrinses matter:
A) If you brush and floss regulary and get frequent dental checkups, then likely you are doing an adequate job without these rinses. Some patients with gum disease or with a high decay rate may benefit from certain rinses. For decay prone patients we recommend mouthrinse that contains fluoride ( Act, Listerine Total and others). For patients with inflamed gums we recommend Listerine or Chlorhexidine. Chlorhexidine is a prescription only product. In our practice we do not recommend Cepacol, Plax, and Scope because the literature does not support reduction in dental decay or periodontal disease with these products.
Q) Do water irrigation devices work?
A) Yes, but they work by removing food debris because it is loosely adherent. Dental plaque is a sticky, adherent film and usually must be removed with a toothbrush and floss. These devices are an adjunct and are not recommended as a primary means of tooth cleaning.
Q) How often should I get a cleaning?
A) The ADA recommends twice a year for individuals with no gum disease. Those with gum disease should be seen more frequently. Some pregnant women might need additional cleaning appointments during pregnacy in case they experience increased inflammation and bleeding of their gum tissue.
Q) What is peridontal or gum disease:
A) Data from the American Academy of Periodontology report than nearly half of all Americans have some form of gum disease. Gum diease can effect anyone from the very young to the very old. Gum disease or periodontitis is a word for inflammation around the teeth, most notably the bone, ligament and gum tissue. Over time the gum separates from the root, bone loss ensues, and eventually can culminate in tooth loss. Gingivitis, the first stage of periodontal disease is reversible, but all the other stages result in some form of bone loss. Early treatment is recommended. The primary risk factors for gum disease are reduced oral hygiene, smoking, and uncontrolled diabetes. Periodontal disease is often a chronic inflammatory disease and involves a unique interplay between the host response (how well your immune system fights off certain bacteria) and your succeptibility (how your body reacts or tolerates bacteria). Some people never have gum disease even when they have reduced oral hygiene, and some people are meticulous cleaners and still have it. An individual with an exagerrated immune response produces lots of damage to the host (bone loss, tissue inflammation, separation of gum from root) when their immune system interacts with harmful bacteria (think collateral damage). Just because someone has an exagerrated response generally has nothing to do with being immuno-compromised per se; it only means the response is strong against the harmful bacteria. Your dentist may refer you to a periodontist (a dentist that specializes in the management and treatment of gum disease). Generally, improved home care, periodontal treatment, and good compliance with frequent dental visits will help arrest the disease. Current technology allows use of an periodontal endoscope or perioscope (very small camera) to be placed gently under the gum. The endoscope is then viewed under magnification on a monitor. The teeth can be cleaned very effectively with this technology (Perioscopy). The alternative to this treatment sometimes involves surgery, but in most cases non-surgical treatment is sufficient.
Q) What is a crown or cap:
A) A crown is a restoration that is used to cover the cusps of a tooth that has been broken-down so much that a regular filling is not sufficient to maintain its strength. It often overlays the cusps and can prevent a weakend tooth from fracturing, especially in people that clench their teeth. Most teeth that have had root canals commonly have crowns for protection.
Q) What is a dental implant:
A) A dental implant is an artificial root that replaces the root of your missing tooth. Together with the help of an abutment and a crown we can recreate your missing tooth. In our practice we try to preserve your natural teeth, but in certain instances, it is best to sometimes remove a tooth that has cracked, or that has extensive tooth decay or periodontal disease, and replace the missing tooth with a dental implant. Traditionally, replacement of a missing tooth was done with a bridge, but today implants are the standard of care. In certain situations, a fixed bridge is still a viable option, and occassionally may be a better option. Please discuss this with your dentist.
Q) Do I need a gum graft:
A) A gum graft is soft tissue usally taken from the roof of the mouth and transplanted to an area around a tooth for several reasons. Sometimes donor tissue can be used in lieu of your own tissue. The reasons for grafting are numerous, but just having recession is not necessarily a reason to have a graft. Covering an exposed root with a tissue graft can be done for cosmetic purposes. Roots can also be covered if the root is exposed and the individual has thermal sensitivity. Sometimes the tissue around a tooth is very thin and at risk for gum recession. Sometimes an individual may have had recession or the recession is slowly progressing. In these situations monitoring is recommended. Please see your dentist if you have specific questions concerning your gums.
Q) Is smoking harmful to the oral cavity:
A) Yes, in many ways. Smoking is a 3-fold risk factor for periodontal disease, can increase risk for oral cancers, and inhibits normal immune function. Even in the presence of zero plaque, smoking can cause attachment loss of the tissue around the teeth. Smokers have nearly double the failure rate when dental implants are placed. Once a person quits smoking, it takes about 11 years for the body to attain similar periodontal risk as somebody who never smoked.
Q) What should I do if I grind or clench my teeth:
A) Grinding and clenching are two common habits that people have. Grinding is a dynamic movement that grinds away tooth structure at moderate forces while clenching is a static movement that places very high biting forces on teeth and can fracture or crack them. A nightguard/splint is a device that is worn at night to prevent the teeth from wearing. A properly made splint is also designed so the posterior teeth do not touch when wearing the splint during a functional tooth movement (side to side for example). It is important that the posterior teeth don't touch because the jaw is like a nut cracker, and much higher forces are near the hinge. The anterior teeth or area away from the hinge has much smaller forces. Talk to your dentist if you think you might clench or grind your teeth.
Q) What should I do if my mouth is dry:
A) A dry mouth, or xerostomia, is common, especially in older individuals and those that take certain medications, or people that have radiation that has effected salivary gland function. The salivary glands secrete saliva that helps buffer acid in the mouth. A dry mouth from salivary gland dysfunction, or a salivary gland deficit secondary to certain medications such as those involved with depression, can result in increased dental caries/cavities. Anything that stimulates the salivary glands (chewing etc.) or drinking water can help improve a dry mouth. Certain medical conditions also produce a dry mouth such as diabetes. Sometimes we recommend a product line called Biotene that was created for patients with dry mouth.
If you have a specific question please ask your dentist or email us and we will try our best to answer it. This list is incomplete, but we hope it answers many common questions that you may have. This material is © and is for educational purposes only. It is not a substitute for a proper diagnosis by a dentist.