Below are some of the most frequently asked questions patients have about dentistry and oral health issues.  If you have any other questions, or would like to schedule an appointment, we would love to hear from you.

Click on a question below to see the answer.

You should have your teeth checked and cleaned at least twice a year, though your dentist or dental hygienist may recommend more frequent visits.

Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your teeth and gums.  At these visits, your teeth are cleaned and checked for cavities.  Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health.  These include:

  • Medical history review: Knowing the status of any current medical conditions, new medications, and illnesses, gives us insight to your overall health and also your dental health.
  • Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.  X-rays also help determine tooth and root positions.
  • Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
  • Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.
  • Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
  • Examination of existing restorations: Check current fillings, crowns, etc.
  • Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for sometime and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line, and can only be removed with special dental instruments.
  • Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (poisons) that inflame the gums.  This inflammation is the start of periodontal disease!
  • Teeth polishing: Removes stain and plaque that is not otherwise removed during toothbrushing and scaling.
  • Oral hygiene recommendations: Review and recommend oral hygiene aids as needed (electric dental toothbrushes, special cleaning aids, fluorides, rinses, etc.).
  • Review dietary habits: Your eating habits play a very important role in your dental health.

As you can see, a good dental exam and cleaning involves quite a lot more than just checking for cavities and polishing your teeth.  We are committed to providing you with the best possible care, and to do so will require regular check-ups and cleanings.

What Is The Best Technique For Brushing?

There are a number of effective brushing techniques. Patients are advised to check with their dentist or hygienist to determine which technique is best for them, since, tooth position and gum condition vary.  One effective, easy-to-remember technique involves using a circular or elliptical motion to brush a couple of teeth at a time, gradually covering the entire mouth.

Place a toothbrush beside your teeth at a 45-degree angle and gently brush teeth in an elliptical motion. Brush the outside of the teeth, inside the teeth, your tongue and the chewing surfaces and in between teeth. Using a back and forth motion causes the gum surface to recede, or can expose the root surface or make the root surface tender. You also risk wearing down the gum line.

Soft or hard bristles?
In general, a toothbrush head should be small (1" by 1/2") for easy access. It should have a long, wide handle for a firm grasp. It should have soft, nylon bristles with round ends. Some brushes are too abrasive and can wear down teeth. A soft, rounded, multi-tufted brush can clean teeth effectively. Press just firmly enough to reach the spaces between the teeth as well as the surface. Medium and hard bristles are not recommended.

How long should I brush?
It might be a good idea to brush with the radio on, since dentists generally recommend brushing 3-4 minutes, the length of an average song. Using an egg timer is another way to measure your brushing time. Patients generally think they're brushing longer, but most spend less than a minute brushing. 
To make sure you're doing a thorough job and not missing any spots, patients are advised to brush the full 3-4 minutes twice a day, instead of brushing quickly five or more times through the day.

Should I brush at work?
Definitely, but most Americans don't brush during the workday. Yet a recent survey by Oral-B Laboratories and the Academy of General Dentistry shows if you keep a toothbrush at work, the chances you will brush during the day increase by 65 percent. Dentists recommend keeping a toothbrush at work. 

Getting the debris off teeth right away stops sugary snacks from turning to damaging acids, and catches starchy foods like potato chips before they turn to cavity-causing sugar. If you brush with fluoride toothpaste in the morning and before going to bed, you don't even need to use toothpaste at work. You can just brush and rinse before heading back to the desk. If you don't have a toothbrush, rinsing your mouth with water for 30 seconds after lunch also helps.

The following tips may improve your work-time brushing habits: 
  • Post a sticky note on your desk or computer at work as a reminder to brush teeth after lunch. 
  • Brush teeth right after lunch, before you become absorbed in work. 
  • Store your toothbrush and toothpaste at work in a convenient and handy place. 
  • Make brushing your teeth part of your freshening up routine at work. 

Brushing Up at the Office Oral Care Tips
Brushing at work may reduce plaque build-up and keep your smile healthy for years. Following are a few tips to help make brushing at the office a lifetime habit:
  • Leaving an extra toothbrush at the office, rather than carrying one with you, may increase your likelihood of brushing at work by 65 percent. 
  • Post a sticky note on your desk or computer at work as a reminder to brush your teeth after lunch. 
  • Brush your teeth right after lunch, before you become absorbed in work or meetings for the remainder of the afternoon. 
  • Store your toothbrush and toothpaste at work in a convenient and handy place. 
  • Make brushing your teeth part of your routine of freshening up at work. 

When brushing at the office or away from home, it's important to make an extra effort to keep your toothbrush germ-free. Here are a few tips on how to properly store and care for your toothbrush:
  • Always store your toothbrush in some type of travel container. 
  • Dry your toothbrush after use and before returning to its travel container. 
  • Change the toothbrush you take to work more often than your toothbrush at home to avoid bacteria build-up. 

The Academy of General Dentistry is a non-profit organization of more than 37,000 general dentists dedicated to staying up-to-date in the profession through continuing education. A general dentist is the primary care provider for patients of all ages and is responsible for the diagnosis, treatment, management and overall coordination of services related to patient's oral health needs. Learn more about AGD member dentists or find more information on dental health topics at www.agd.org/consumer.  NOTE: Information that appears in General Dentistry, the AGD's peer-reviewed journal, AGD Impact, the AGD's newsmagazine and related press releases do not necessarily reflect the endorsement of the AGD.

Brushing and flossing help control the plaque and bacteria that cause dental disease.

Plaque is a film of food debris, bacteria, and saliva that sticks to the teeth and gums.  The bacteria in plaque convert certain food particles into acids that cause tooth decay.  Also, if plaque is not removed, it turns into calculus (tartar).  If plaque and calculus are not removed, they begin to destroy the gums and bone, causing periodontal (gum) disease.

Plaque formation and growth is continuous and can only be controlled by regular brushing, flossing, and the use of other dental aids.

Toothbrushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

  • Brush at a 45 degree angle to the gums, gently using a small, circular motion, ensuring that you always feel the bristles on the gums.
  • Brush the outer, inner, and biting surfaces of each tooth.
  • Use the tip of the brush head to clean the inside front teeth.
  • Brush your tongue to remove bacteria and freshen your breath.

Electric toothbrushes are also recommended.  They are easy to use and can remove plaque efficiently.  Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.

FlossingDaily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

  • Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
  • Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
  • Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush.  If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.

Brushing our teeth removes food particles, plaque, and bacteria from all tooth surfaces, except in between the teeth.  Unfortunately, our toothbrush can’t reach these areas that are highly susceptible to decay and periodontal (gum) disease.

Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (acids) that cause cavities and irritate and inflame the gums.  Also, when plaque is not removed above and below the gumline, it hardens and turns into calculus (tartar).  This will further irritate and inflame the gums and also slowly destroy the bone.  This is the beginning of periodontal disease.

How to floss properly:

  • Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
  • Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
  • Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Daily flossing will help you keep a healthy, beautiful smile for life!

Bad breath (halitosis) can be an unpleasant and embarrassing condition.  Many of us may not realize that we have bad breath, but everyone has it from time to time, especially in the morning.

There are various reasons one may have bad breath, but in healthy people, the major reason is due to microbial deposits on the tongue, especially the back of the tongue.  Some studies have shown that simply brushing the tongue reduced bad breath by as much as 70 percent.

What may cause bad breath?

  • Morning time – Saliva flow almost stops during sleep and its reduced cleansing action allows bacteria to grow, causing bad breath.
  • Certain foods – Garlic, onions, etc.  Foods containing odor-causing compounds enter the blood stream; they are transferred to the lungs, where they are exhaled.
  • Poor oral hygiene habits – Food particles remaining in the mouth promote bacterial growth.
  • Periodontal (gum) disease – Colonies of bacteria and food debris residing under inflamed gums.
  • Dental cavities and improperly fitted dental appliances – May also contribute to bad breath.
  • Dry mouth (Xerostomia) – May be caused by certain medications, salivary gland problems, or continuous mouth breathing.
  • Tobacco products – Dry the mouth, causing bad breath.
  • Dieting – Certain chemicals called ketones are released in the breath as the body burns fat.
  • Dehydration, hunger, and missed meals – Drinking water and chewing food increases saliva flow and washes bacteria away.
  • Certain medical conditions and illnesses – Diabetes, liver and kidney problems, chronic sinus infections, bronchitis, and pneumonia are several conditions that may contribute to bad breath.

Keeping a record of what you eat may help identify the cause of bad breath.  Also, review your current medications, recent surgeries, or illnesses with you dentist.

What can I do to prevent bad breath?

  • Practice good oral hygiene – Brush at least twice a day with an ADA approved fluoride toothpaste and toothbrush.  Floss daily to remove food debris and plaque from in between the teeth and under the gumline.  Brush or use a tongue scraper to clean the tongue and reach the back areas.  Replace your toothbrush every 2 to 3 months.  If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth in the morning.
  • See your dentist regularly – Get a check-up and cleaning at least twice a year.  If you have or have had periodontal disease, your dentist will recommend more frequent visits.
  • Stop smoking/chewing tobacco – Ask your dentist what they recommend to help break the habit.
  • Drink water frequently – Water will help keep your mouth moist and wash away bacteria.
  • Use mouthwash/rinses – Some over-the-counter products only provide a temporary solution to mask unpleasant mouth odor.  Ask your dentist about antiseptic rinses that not only alleviate bad breath, but also kill the germs that cause the problem.

In most cases, your dentist can treat the cause of bad breath.  If it is determined that your mouth is healthy, but bad breath is persistent, your dentist may refer you to your physician to determine the cause of the odor and an appropriate treatment plan.

Four out of five people have periodontal disease and don’t know it! Most people are not aware of it because the disease is usually painless in the early stages. Unlike tooth decay, which often causes discomfort, it is possible to have periodontal disease without noticeable symptoms. Having regular dental check-ups and periodontal examinations are very important and will help detect if periodontal problems exist.

Periodontal disease begins when plaque, a sticky, colorless, film of bacteria, food debris, and saliva, is left on the teeth and gums. The bacteria produce toxins (acids) that inflame the gums and slowly destroy the bone. Brushing and flossing regularly and properly will ensure that plaque is not left behind to do its damage.

Other than poor oral hygiene, there are several other factors that may increase the risk of developing periodontal disease:

  • Smoking or chewing tobacco – Tobacco users are more likely than nonusers to form plaque and tartar on their teeth.
  • Certain tooth or appliance conditions – Bridges that no longer fit properly, crowded teeth, or defective fillings that may trap plaque and bacteria.
  • Many medications – Steroids, cancer therapy drugs, blood pressure meds, oral contraceptives. Some medications have side affects that reduce saliva, making the mouth dry and plaque easier to adhere to the teeth and gums.
  • Pregnancy, oral contraceptives, and puberty – Can cause changes in hormone levels, causing gum tissue to become more sensitive to bacteria toxins.
  • Systemic diseases – Diabetes, blood cell disorders, HIV / AIDS, etc.
  • Genetics may play role – Some patients may be predisposed to a more aggressive type of periodontitis. Patients with a family history of tooth loss should pay particular attention to their gums.

Signs and Symptoms of Periodontal Disease

  • Red and puffy gums – Gums should never be red or swollen.
  • Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.
  • Persistent bad breath – Caused by bacteria in the mouth.
  • New spacing between teeth – Caused by bone loss.
  • Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).
  • Pus around the teeth and gums – Sign that there is an infection present.
  • Receding gums – Loss of gum around a tooth.
  • Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.

Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

If you’re feeling somewhat self-conscious about your teeth, or just want to improve your smile, cosmetic dental treatments may be the answer to a more beautiful, confident smile.

Cosmetic dentistry has become very popular in the last several years, not only due to the many advances in cosmetic dental procedures and materials available today, but also because patients are becoming more and more focused on improving their overall health.  This includes dental prevention and having a healthier, whiter, more radiant smile.

There are many cosmetic dental procedures available to improve your teeth and enhance your smile.  Depending on your particular needs, cosmetic dental treatments can change your smile dramatically, from restoring a single tooth to having a full mouth make-over.  Ask your dentist how you can improve the health and beauty of your smile with cosmetic dentistry.

Cosmetic Procedures:

Teeth Whitening: Bleaching lightens teeth that have been stained or discolored by age, food, drink, and smoking.  Teeth darkened as a result of injury or taking certain medications can also be bleached, but the effectiveness depends on the degree of staining present.

Composite (tooth-colored) Fillings: Also known as “bonding”, composite fillings are now widely used instead of amalgam (silver) fillings to repair teeth with cavities, and also to replace old defective fillings.  Tooth-colored fillings are also used to repair chipped, broken, or discolored teeth.  This type of filling is also very useful to fill in gaps and to protect sensitive, exposed root surfaces caused by gum recession.

Porcelain Veneers: Veneers are thin custom-made, tooth-colored shells that are bonded onto the fronts of teeth to create a beautiful individual smile.  They can help restore or camouflage damaged, discolored, poorly shaped, or misaligned teeth.  Unlike crowns, veneers require minimal tooth structure to be removed from the surface of the tooth.

Porcelain Crowns (caps): A crown is a tooth-colored, custom-made covering that encases the entire tooth surface restoring it to its original shape and size.  Crowns protect and strengthen teeth that cannot be restored with fillings or other types of restorations.  They are ideal for teeth that have large, fractured or broken fillings and also for those that are badly decayed.

Dental Implants: Dental implants are artificial roots that are surgically placed into the jaw to replace one or more missing teeth.  Porcelain crowns, bridges, and dentures can be made specifically to fit and attach to implants, giving a patient a strong, stable, and durable solution to removable dental appliances.

Orthodontics: Less visible and more effective brackets and wires are making straightening teeth with orthodontics much more appealing to adult patients.  Also, in some cases, teeth may be straightened with custom-made, clear, removable aligners that require no braces.

Thanks to the advances in modern dentistry, cosmetic treatments can make a difference in making your smile shine!

Porcelain veneers are very thin shells of tooth-shaped porcelain that are individually crafted to cover the fronts of teeth.  They are very durable and will not stain, making them a very popular solution for those seeking to restore or enhance the beauty of their smile.

Veneers may be used to restore or correct the following dental conditions:

  • Severely discolored or stained teeth
  • Unwanted or uneven spaces
  • Worn or chipped teeth
  • Slight tooth crowding
  • Misshapen teeth
  • Teeth that are too small or large

Getting veneers usually requires two visits.  Veneers are created from an impression (mold) of your teeth that is then sent to a professional dental laboratory where each veneer is custom-made (for shape and color) for your individual smile.

With little or no anesthesia, teeth are prepared by lightly buffing and shaping the front surface of the teeth to allow for the small thickness of veneers.  The veneers are carefully fitted and bonded onto the tooth surface with special bonding cements and occasionally a specialized light may be used to harden and set the bond.

Veneers are an excellent dental treatment that can dramatically improve your teeth and give you a natural, beautiful smile.

Since teeth whitening has now become the number one aesthetic concern of many patients, there are many products and methods available to achieve a brighter smile.

Professional teeth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel, and is an ideal way to enhance the beauty of your smile.  Over-the-counter products are also available, but they are much less effective than professional treatments and may not be approved by the American Dental Association (ADA).

As we age, the outer layer of tooth enamel wears away, eventually revealing a darker or yellow shade.  The color of our teeth also comes from the inside of the tooth, which may become darker over time.  Smoking, drinking coffee, tea, and wine may also contribute to tooth discoloration, making our teeth yellow and dull.  Sometimes, teeth can become discolored from taking certain medications as a child, such as tetracycline.  Excessive fluoridation (fluorosis) during tooth development can also cause teeth to become discolored.

It’s important to have your teeth evaluated by your dentist to determine if you’re a good candidate for bleaching.  Occasionally, tetracycline and fluorosis stains are difficult to bleach and your dentist may offer other options, such as veneers or crowns to cover up such stains.  Since teeth whitening only works on natural tooth enamel, it is also important to evaluate replacement of any old fillings, crowns, etc. before bleaching begins.  Once the bleaching is done, your dentist can match the new restorations to the shade of the newly whitened teeth.

Since teeth whitening is not permanent, a touch-up may be needed every several years to keep your smile looking bright.

The most widely used professional teeth whitening systems:

Home teeth whitening systems: At-home products usually come in a gel form that is placed in a custom-fitted mouthguard (tray), created from a mold of your teeth.  The trays are worn either twice a day for approximately 30 minutes, or overnight while you sleep.  It usually takes several weeks to achieve the desired results depending on the degree of staining and the desired level of whitening.

In office teeth whitening: This treatment is done in the dental office and you will see results immediately.  It may require more than one visit, with each visit lasting 30 to 60 minutes.  While your gums are protected, a bleaching solution is applied to the teeth.  A special light may be used to enhance the action of the agent while the teeth are whitened.

Some patients may experience tooth sensitivity after having their teeth whitened.  This sensation is temporary and subsides shortly after you complete the bleaching process, usually within a few days to one weak.

Teeth whitening can be very effective and can give you a brighter, whiter, more confident smile!

What Is A Dental Emergency?

Injuries to the mouth may include teeth that are knocked out (avulsed), forced out of position and loosened (extruded) or fractured. In addition, lips, gums or cheeks are often cut. Oral injuries are often painful and should be treated by a dentist as soon as possible.

How soon should I see a dentist?
Immediately. Getting to a dentist with 30 minutes can make the difference between saving or losing a tooth.

When a tooth is knocked out: 
  • Immediately call your dentist for an emergency appointment. 
  • Handle the tooth by the crown, not the root. Touching the root (the part of the tooth below the gum) can damage cells necessary for bone re-attachment. 
  • Gently rinse the tooth in water to remove dirt. Do not scrub. 
  • Place the clean tooth in your mouth between the cheek and gum to keep it moist. It is important not to let the tooth dry out. 
  • If it is not possible to store the tooth in the mouth of the injured person, wrap the tooth in a clean cloth or gauze and immerse in milk.

When a tooth is pushed out of position:
  • Attempt to reposition the tooth to its normal alignment using very light finger pressure, but do not force the tooth. 
  • Bite down to keep the tooth from moving. 
  • The dentist may splint the tooth in place to the two healthy teeth next to the loose tooth.

When a tooth is fractured:
  • Rinse mouth with warm water. 
  • Use an ice pack or cold compress to reduce swelling. 
  • Use ibuprofen, not aspirin, for pain. 
  • Immediately get to your dentist, who will determine treatment based on how badly the tooth is broken. Only a dentist can tell how bad the break is. 

Minor fracture: Minor fractures can be smoothed by your dentist with a sandpaper disc or simply left alone. Another option is to restore the tooth with a composite restoration. In either case, treat the tooth with care for several days. 

Moderate fracture: Moderate fractures include damage to the enamel, dentin and/or pulp. If the pulp is not permanently damaged, the tooth may be restored with a full permanent crown. If pupal damage does occur, further dental treatment will be required. 

Severe fracture: Severe fractures often mean a traumatized tooth with slim chance of recovery.

When tissue is injured:
  • Injuries to the inside of the mouth include tears, puncture wounds and lacerations to the cheek, lips or tongue. The wound should be cleaned right away with warm water, and the injured person taken to a hospital emergency room for the necessary care. Bleeding from a tongue laceration can be reduced by pulling the tongue forward and using gauze to place pressure on the wound.
  • What can I do to be prepared?
  • Pack an emergency dental care kit, including:
  • Dentist's phone numbers (home and office) 
  • Saline solution 
  • Handkerchief 
  • Gauze 
  • Small container with lid 
  • Ibuprofen (Not aspirin. Aspirin is an anti-coagulant, which may cause excessive bleeding in a dental emergency.)
The Academy of General Dentistry is a non-profit organization of more than 37,000 general dentists dedicated to staying up-to-date in the profession through continuing education. A general dentist is the primary care provider for patients of all ages and is responsible for the diagnosis, treatment, management and overall coordination of services related to patient's oral health needs. Learn more about AGD member dentists or find more information on dental health topics at www.agd.org/consumer.  NOTE: Information that appears in General Dentistry, the AGD's peer-reviewed journal, AGD Impact, the AGD's newsmagazine and related press releases do not necessarily reflect the endorsement of the AGD.

Patients’ Top 10 Preventive Dentistry Questions

During your scheduled appointments for dental examination, cleaning, and treatment, your dentist and hygienist routinely ask you questions about your oral health and home care practices. These visits are also the perfect time for you to ask questions about your dental care needs.

1. How often should I have my teeth cleaned?
Research shows that regular professional cleaning may reduce the risk of dental caries (cavities) and periodontal (gum) diseases, and most people like to have their teeth cleaned once or twice a year. Some dental conditions require more frequent monitoring and intervention; some require less. How often you go depends on your personal dental health needs. You should discuss this with your dentist.

2. What type of dental floss should I use – waxed or unwaxed?
Research comparing waxed and unwaxed floss revealed that it really doesn't matter which type floss is used; rather, it's using the proper flossing technique that makes the difference. Proper flossing removes plaque and food particles from areas not reached by a toothbrush. However, studies show we don't floss that well. We have a tendency to floss on the back side of a tooth better than the front side; we floss the front teeth better than the back teeth, and we do better at flossing near the chewing surface of the tooth than at the gum line. So, use either waxed or unwaxed floss, but, be meticulous, practice technique, and floss at least once each day.

3. How often should I brush my teeth? What kind of toothbrush should I use ?
Regular brushing is vital to maintaining optimal oral health. Traditionally, we recommend brushing after every meal to eliminate the cavity challenge. The carbohydrates in foods and drinks feed the bacteria in the mouth, and these oral bacteria produce acids that can lead to dental caries (cavities). By brushing with fluoride toothpaste after every meal, you reduce the extent of acid production and reduce your chances of developing caries. One caution, however – for those patients who eat several small meals (as some dieticians recommend), rather than the traditional three meals per day – brushing more than 5-6 times per day may (for some patients) increase the risk of damage to the enamel of the teeth (“toothbrush abrasion”). For those patients, and the bottom line minimum for all patients, we advise brushing at least twice a day, especially before bedtime, since the saliva flow decreases during sleep, and any remaining food particles provide a great environment for those oral bacteria to thrive.
With so many shapes, sizes and styles of toothbrushes on the market, choosing the right toothbrush can be confusing. Here are a few things to consider when choosing a toothbrush. Be sure to use a toothbrush with round, soft nylon bristles. Toothbrushes with medium to hard bristles can be abrasive enough to damage the enamel. As far as bristle configuration, research suggests that no one particular configuration of bristles is better than another for removing plaque and food particles from teeth. So, go ahead and clip the store coupon and get the best buy on your favorite style and color.

4. Are electric toothbrushes better than manual brushes?
Both manual and power toothbrushes are effective, but studies have shown electric and sonic toothbrushes, if used properly, can perform better than manual toothbrushes. The key is to use the toothbrush that best meets your needs. For example, people with arthritis or limited dexterity may find an electric toothbrush especially helpful. People with orthodontic braces may find it easier to brush effectively with an electric toothbrush; and since the rotating head of a powered toothbrush requires less force and manipulation than a manual toothbrush, the risk of dislodging orthodontic appliances might be reduced.

5. What is a good toothpaste? Do I need fluoride, baking soda, whiteners, and flavors?
A good toothpaste is one that has the American Dental Association (ADA) Seal of Acceptance on the package. This seal signifies that the manufacturer has provided scientific evidence that the product does what it claims to do. The ADA recognizes five categories of toothpastes: “anti-cavity,” “anti-cavity & anti-calculus (tartar control),” “anti-cavity & desensitizing,” “anti-cavity, anti-plaque/anti-gingivitis, & anti-calculus,” and “whitening.”
Toothpaste formulations and chemistry are very complex, and each manufacturer has its own variations, but the primary ingredients remain the same. The most important ingredient is fluoride to prevent dental caries. Over 95% of the toothpastes sold in the U.S. contain an ADA-accepted fluoride formulation. So, in addition to the name brands (Crest, Colgate, etc.), even most store brands (Kroger, Target, etc.) are effective anti-cavity products.
Toothpastes also contain foaming agents, such as soaps or detergents, and mild abrasives, usually silica or a calcium phosphate compound, to help remove plaque and minor stains. In spite of its gritty texture, baking soda is actually an extremely mild abrasive – very kind to tooth structure – that also exhibits some anti-bacterial properties. Toothpastes that advertise improved stain removal (“smokers’ toothpastes”, etc.) usually contain harsher abrasives that, if overused, can damage the enamel. Flavoring agents are important for marketing – people want a product with a pleasant flavor.
Toothpastes that whiten teeth work by chemically or mechanically removing surface stains. The “whitening” agents are special abrasives, detergents, or enzymes. These products should not be confused with bleaching agents (usually peroxide compounds) that work by breaking down pigment to remove color from teeth. This category of toothpastes has received ADA acceptance only within the past three years or so. Currently, there are only seven products that have received the ADA Seal as whitening toothpastes. Each of them contains fluoride as an anti-cavity agent, and five are also accepted for tartar control. As for the whitening properties – there hasn’t been much independent research published yet. These products are safe and appear to be fairly good at removing surface stains. However, they will not change the overall color of teeth. They don’t claim to deliver the “Hollywood smile,” so patients shouldn’t expect too much.

6. Do bleaching products really work?
Yes, they do. But, consult with your dentist first, because the procedure isn't always as simple as many people believe. Tooth color is influenced by many factors, including previous trauma to the teeth, exposure to certain medications, drinking tea or coffee, smoking, and the natural aging process. Not all teeth respond equally well to bleaching. In general, bleaching is more successful on lighter (yellow) colorations than on darker (gray/brown) colorations; and bleaching will not lighten existing dental restorations, such as tooth-colored fillings, bonding, crowns or bridges. Before bleaching, it is important to consider how much of your existing dental work will have to be replaced following bleaching in order to achieve the desired results. Your dentist can determine if you are a good candidate for bleaching.

7. I live on base. Is there fluoride in the water?
This is not a simple yes or no answer. Since the DoD does not mandate fluoridation of base water supplies and military bases in the United States frequently obtain their water from community water supplies, the fluoride content of the base water is often dependent on the local community’s water supply.
If you want to know the fluoride content of the water in your community, contact the Public Works Department on base or the local municipal water commission. They can tell you their required fluoridation level and can provide details on the high, low, and average levels for the year, the month, and the day.
Depending on the geographic area, the level of naturally occurring fluoride in the water supply can range from 0 to more than 5 parts per million (ppm). The ADA recommends one part per million. Keep in mind that not all communities have fluoridated water or adjust their water to optimal fluoride levels. Well water, in particular, can be quite variable even within the same geographic location.

8. Does bottled water contain fluoride?
Fluoride is the single most effective means to prevent dental caries in both children and adults. We get fluoride from many sources, including foods and beverages, professional fluoride applications at our dental visits, and, most importantly, toothpaste and drinking water. However, there is concern that drinking bottled water instead of fluoridated tap water may result in insufficient fluoride exposure, which could increase the risk of dental caries.
The fluoride content in bottled water and beverages (everything from soft drinks to fruit juices) can vary from less than 0.01 ppm to over 5 ppm, and will mirror the level of fluoride in the water at the place of manufacture. So, if a diet soda is bottled in suburban Washington, DC, or any other optimally fluoridated community, it probably contains about 1 ppm of fluoride. Currently, the FDA limits the fluoride content of bottled waters to 2.4 ppm (if no fluoride is added during processing) and 1.4 ppm (if the manufacturer adds fluoride). However, since the FDA has not defined a nutrient content claim for fluoride, bottled water manufacturers are required to list fluoride content on their labels only if fluoride is added during processing.
9. Does my home water filter remove fluoride from the water?
There are many different types of home water treatment systems, and, unfortunately, there is not a large body of research regarding their effects on fluoridated water. Although the research is often conflicting and unclear, in general, the more heavy duty the filter, the more likely fluoride could be filtered out. Several studies have shown that reverse osmosis systems and distillation units remove significant amounts of fluoride, while water softeners and water conditioners do not alter water fluoride levels. With water filters, the fluoride concentration remaining in the water depends on the type and quality of the filter, as well as its age. Some activated charcoal filters containing activated alumina may remove significant amounts of fluoride. Each type of filter should be assessed individually. Testing is available through local and state public health departments and some private laboratories.

10. My fifteen year-old son wants to pierce his tongue. Should I be concerned?
Oral piercing seems to be a popular fashion statement for some young people. Your son needs to be aware of several risks associated with oral piercing. First, the tongue is highly vascular and bleeds when cut, so there is a risk of hemorrhage. There is also a risk of nerve damage, swelling, localized infection, and systemic infection (tetanus, hepatitis, HIV), particularly if the piercing establishment doesn’t follow strict infection control procedures. After the piercing, he must be committed to removing and cleaning the appliance at least once a day to prevent bad breath and swelling and infection from an overgrowth of bacteria and fungi. However, he must also realize that when the appliance is removed, the opening will start to heal and close in a matter of hours, so the appliance may be difficult to reinsert. Most importantly, he must be aware of the substantial risks of cracked and broken teeth, gingival recession, impaired speech, and the possibility that he could swallow or aspirate the appliance. If all this fails to discourage him, remind him that the piercing will probably be done without anesthesia….

Additional information may be found at the American Dental Association’s website (www.ada.org). CAPT Diefenderfer welcomes questions and comments. He may be reached via e-mail at Kim.Diefenderfer@nhgl.med.navy.mil or via telephone at (847) 688-3331 (Fisher Health Clinic, Naval Hospital, Great Lakes, IL).

CAPT Kim E. Diefenderfer, DC, USN, the Navy Specialty Leader for Preventive Dentistry, has noted the questions patients have asked over the years and has come up with answers to some of the most common ones. Combining his interest in patient care and research, CAPT Diefenderfer has shared his Qs&As with military and civilian dentists in MEDNEWS, Navy Medicine Online, and many continuing education seminars throughout the U.S.

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