Bleaching of vital teeth has been a great thing for cosmetic dentistry. Teeth can be lightened considerably with out having to do any invasive drilling or bonding of tooth-colored materials onto the teeth. The cost is significantly cheaper than all other cosmetic dental procedures. Discolorations in teeth can come from many sources. Intrinsic stains (ones that are actually incorporated into the tooth structure itself), include antibiotics (especially tetracycline), fluorosis, and enamel hyperplasia. Aging will also naturally yellow the teeth. Foods such as tea, coffee, red wine, and colas and tobacco products will also discolor teeth. Extrinsic stains, stains that reside on the surface of the teeth, are caused by bacterial plaque accumulations soaking up pigmented food and drink. Extrinsic stains can be removed by a professional cleaning or by using a “whitening” toothpaste that has extra abrasives in it. Since intrinsic stains reside within the tooth enamel, they must be removed by chemicals that have the ability to soak into the tooth structure itself.
A dental rubber dam is an extremely useful adjunct to dental treatment. It is an extremely thin sheet of latex rubber usually cut into six inch squares. A latex-free variety is also available for those who are allergic to latex. A rubber dam is used to isolate a patient’s mouth from the various instruments and chemicals that a dentist uses in the mouth. For teeth bleaching, the chemicals that are used are very caustic and would not bode well floating around in someone’s mouth. There are “paint on” dental dams available for bleaching which are more convenient to use for bleaching procedures. Rubber dams are are extremely important for endodontic (root canal) procedures. A sodium hypochlorite solution (the same chemical found in household bleach) is used to flush out the inside of root canals. It is certainly a good idea to keep that confined to the inside of a tooth. The rubber dam also keeps the thin, sharp files from going down the patient’s throat (or worse yet, their lungs). A rubber dam is also very helpful in children’s dentistry. Placing a rubber dam over a tooth on a fearful child can make them feel isolated from the dental treatment being done and can help calm them down.
Brushing one’s teeth is an extremely important part of one’s daily oral hygiene. Coupled with flossing, it removes the plaque that causes cavities and gum disease. There have been a variety of methods for toothbrushing that have been recommended. The main question is usually “Do I brush side to side or up and down?” Either way, if done properly, can be fine. If one wishes to go up and down, it is best to start above (on the upper) or below (on the lower) the gum line and roll the toothbrush head across the surface of the teeth. I will tell patients who wish to use that technique to brush your teeth in the direction that the teeth grow. When going side to side, the bristles should be angled at a 45 degree angle to the surface of the teeth, and then, the handle should be vibrated side to side. With either method, vigorous scrubbing must be avoided. Dental plaque is not very difficult to remove and only requires a gentle hand on the brush. Too much pressure can cause the gums and tooth enamel to be eroded away causing permanent damage.
One of the most common questions that I get asked is “is it worth it to invest in an electric toothbrush?” The answer that I give is that it is a matter of personal preference. A number of different factors must be considered. Cost is probably top on the list. An electric toothbrush will cost significantly more than a manual one. And the brush portion of the electric model will need to be replaced jut as frequently as the manual variety, and usually at a higher cost. Is an electric toothbrush more effective at cleaning the tooth surfaces? Many studies have shown that both manual and electric toothbrushes perform their job equally well. The main thing is that if it is easier for someone to clean their teeth with an electric toothbrush and they can afford the extra expense, then that is what I would recommend that they use. For people with manual dexterity problems, such as arthritis sufferers, an electric toothbrush can be a great help in cleaning one’s teeth. When buying an electric toothbrush, always look for the American Dental Association seal of approval. The ADA does stringent, independent testing so you can be assured that the manufacturers claims have been verified.
In my previous blog, I discussed head size and bristle stiffness of toothbrushes. Toothbrushes can come in a variety of shapes. It can be helpful to have the type that has rounded bristles. Most bristles are made of nylon so they don’t soften when they gets wet like the natural bristles do. Mom always told us to go into the bathroom and scrub our teeth real hard and thorough. Brushing thoroughly is important. Brushing hard was fine for the old days when the natural bristles would soften in saliva, but since the nylon bristles don’t soften, we must be very judicious in the amount of pressure that we use. Only the tips of the bristles do the cleaning work, so a toothbrush whose bristles are all bent and frayed is ready for the trash can or the household cleaning bucket. Another important aspect of choosing a toothbrush is to look for the American Dental Association seal of approval. The ADA puts dental products through stringent, independent testing to make sure that a manufacturer’s claims are valid. This way, you can be sure that whatever it says on the packaging has been verified and is safe for you and your family to use.
Toothbrushing is a vital part of daily oral hygiene to help prevent cavities and gum disease. Choosing the toothbrush that is right for you is an important part of the process. Toothbrushes come in a variety of shapes, sizes, and styles. Head size is important to make sure that all areas of the mouth are accessible. The larger the head of a toothbrush, the more efficient it will be in cleaning the teeth. However, trying to get the sides of the upper molars can be a challenge for some. When you open your mouth wide, the coronoid process of the jaw bone will drop down right next to the upper molars making it a very tight fit. By closing the mouth halfway and moving the jaw to the side will many times allow enough room to get a brush with a bigger head all of the way back into the mouth. The bristles should be no firmer than the “soft” variety. Plaque is actually not that difficult to remove, so a medium or hard brush is not necessary. Use of too stiff a brush can cause damage to the tooth enamel and the gums which can necessitate fillings and gum grafts.
Flossing you teeth on a daily basis is just as important as toothbrushing. To floss, you need to saw the strand of floss between the teeth, then scrub the tooth surfaces to remove the sticky dental plaque. To manipulate the floss, for the upper teeth, I like to wrap the floss around my index fingers then use my thumbs to do the scrubbing. For the lower, again I like to wrap the floss around my index fingers, but I will manipulate the the floss with my middle fingers. It is important to keep the thumbs (for the upper) and middle fingers (for the lower) very close to the teeth that you are cleaning. That way, the proper pressure can be applied in the correct direction in order to do an efficient job of plaque removal. If the fingers aren’t close enough to the teeth, then you will move a lot of floss and do very little work. As far as type of floss, either waxed or unwaxed are fine. It is just a matter of personal preference. If properly used, both do an adequate job. For those who have difficulty reaching their hands into the back of the mouth, there are little floss picks that are readily available at grocery stores and pharmacies that make it much easier to access and clean the molar teeth.
Floss is an important part of a daily oral hygiene program. A toothbrush will reach the sides and chewing surfaces of the teeth, it can not fit in between the teeth. This is where floss comes into play. Just imagine floss as being a bristle from a toothbrush and with it you scrub the plaque off from between the teeth. Dental plaque is a collection of sticky bacteria that is essentially invisible. It takes the sugar that you eat and produces acids which leaches the calcium from your teeth causing cavities and produces exotoxins which causes an inflammatory response leading to gum disease. This layer of plaque requires about 24 hours to organize and do its dirty work. By getting the floss cleaning between the teeth daily, cavities and gum disease can be greatly reduced. The key to flossing is to make sure that the floss is wrapped around the tooth and then the tooth is scrubbed along its side. It’s a common misperception that the floss merely needs too be placed in between the teeth to be effective, however, floss has no magical properties and must be properly manipulated in order to remove the layer of bacterial dental plaque.
Dentists deal with patients in pain every working day. It is our goal to alleviate as much suffering as possible. As part of the process, many times a pain reliever must be prescribed. Although there are some extremely effective anti-inflammatories available for mild to moderate pain, many times, a narcotic pain reliever may be the only type strong enough to relieve the dental pain. Unfortunately, overuse of narcotic pain relievers can lead to addiction. In addition to the pain relieving aspects of narcotics, they also produce euphoria. This can lead to a learned reward experience and can cause a craving to relive the same feeling even after the need for pain control is gone. As more doses are taken, a tolerance is progressively built up, meaning that higher doses are required to achieve the same effect. Dentists need to be aware of patients who experience “pain” with visible source and require heavy doses of narcotics to relieve that “pain”. With the advent of computer networks, dentists now have the ability to check online to see if a particular patient is a “drug seeker”. This allows a dentist to have the piece of mind in prescribing narcotics to provide his patients with proper and adequate pain control.
Constructing a new set of dentures is not always as straight forward as taking a quick impression of one’s mouth. First, the dentist must check the tissues for any pathology. It is certainly not a good idea to build a denture over a tumor or cancer. The next thing to check is the condition of the ridges of the gums themselves. If there is inadequate bone to allow for good retention and stability of a denture, then a bone graft may need to be considered. Artificial bone substitutes, cadaver bone, or pieces of the patient’s own bone can be placed under the gums surgically to add enough bulk to comfortably wear a denture. If there are bumps of bone called tori or severe bony undercuts that rigid plastic could not snap around, then they need to be surgically removed. The dentist peels a flap of gum tissue that is over the bony prominence and grinds the offending piece of bone off and smooth the area. In other cases, there could be flabby, moveable tissue or even extra folds of gums which would make a denture unstable. This would also have to be surgically removed. By properly preparing a good gum foundation, a very well fitting set of dentures can be constructed.