If you’re about to undergo orthodontic treatment, you’re going to face a challenge keeping your teeth and gums clean wearing braces. That in turn could increase your chances for tooth decay or periodontal (gum) disease, which could diminish your future dental health and disrupt your current orthodontic treatment.
The main hygiene tasks of brushing and flossing are more difficult with braces because of the fixed hardware on the teeth. Your toothbrush or floss can’t always easily maneuver around the wires and brackets, increasing the chances you’ll miss some areas. These neglected areas can then accumulate dental plaque, a thin film of bacteria and food particles that’s most responsible for disease.
But although difficult, effective oral hygiene isn’t impossible. First and foremost, you’ll need to take more time to be thorough with brushing and flossing than you might normally without braces.
Second, there are some specialized hygiene tools to make the job easier. Instead of a regular toothbrush try an interproximal brush. This special brush has a long and thin bristled head (resembling a pipe cleaner) that can maneuver in and around orthodontic hardware much easier than a regular brush.
For flossing, use a floss threader, a device through which you thread floss on one end and then pass the other sharper end between your teeth. Once through, you release the floss from it and floss as usual, repeating the process with the threader for each tooth. Another option is an oral irrigator, a device that emits a pressurized spray of water between teeth to loosen plaque and flush it away. Many orthodontic patients have found this latter option to be quite effective.
Finally, continue seeing your regular dentist for regular appointments in addition to your orthodontist. Besides cleaning those hard to reach areas, your dentist can also provide other preventive measures like topical fluoride for strengthening enamel and prescription mouth rinses that inhibit bacterial growth. You should also see your dentist immediately if you notice signs of disease like spots on the teeth or swollen or bleeding gums.
Keeping your teeth clean while wearing braces is a top priority. Doing so will help ensure your new smile after braces is both an attractive and healthy one.
If you would like more information on dental care during orthodontics, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Caring for Teeth during Orthodontic Treatment.”
April is Oral Cancer Awareness month. In the past year, I personally know two people who were diagnosed with head & neck cancers. Other people you may have heard of that have had oral cancer are: Jim Thorpe, Ulysses S. Grant, George Harrison, Jack Klugman, and Roger Ebert.
Oral cancer includes mouth cancer, tongue cancer, lip cancer and throat cancer. Think it won’t happen to you? I’m sure all the people listed above thought so too. It’s estimated that over 43,000 people in the United States will be diagnosed with oral cancers in 2014, that’s 115 people each day in the United States alone! And 2014 was the fifth year in a row that the reported cases of oral cancer had gone up.
The main causes of oral cancer are the newly discovered link to the HPV-16 virus (the same one that causes cervical cancer in women), tobacco use and alcohol use. Only about 7% of oral cancers come from no currently identified cause. People who use both tobacco and alcohol have a higher risk of developing oral cancer.
Why is this important? The death rate for this type of cancer is higher than most others that we routinely hear about. The survival rate for oral cancers has remained very steady at 57% at 5 years after diagnosis. The death rate associated with this cancer group is high because often the cancer is discovered late in its development.
In the early stages, many mouth cancers can look like other things, such as a burn, a canker sore, or biting your tongue. They can be white in color, red or a mixture of the two; painless or painful. You can see some images online at www.oralcancerfoundation.org The only way to know for sure if it is cancer or not is to have a biopsy and look at it under a microscope. Most traumatic type injuries like burning your tongue on hot coffee or biting your cheek should heal within two weeks—as long as you don’t injure it again. Any area that does not heal within two weeks is an area of concern.
For years, visual screening by your dentist or doctor has been the gold standard in finding potential oral cancer. Recently, many new products have come on the market that claim to find oral cancer. Studies so far have not shown that they are any more effective than the visual screening.
What should you watch for?
- An ulcer or sore that does not heal after 2 or 3 weeks
- Difficulty or pain with swallowing
- Pain during chewing
- Persistent sore throat or hoarse voice
- Swelling or lumps in your mouth
- Painless lumps on the outside of the neck which have been there for several weeks
- Persistent numbness of your mouth or lips
- Constant coughing
- An earache on only one side which lasts for more than a few day
Of course, these may have causes that are not oral cancer, particularly if you only have one, but see your doctor or dentist to be sure.
What can you do to lessen your risk?
If you smoke, chew or dip tobacco products (cigarettes, cigars, snuff, dip, snus, etc.) stop. All tobacco products contain a number of DNA-damaging chemicals. Tobacco damages cells in your mouth and throat and makes it more likely that cancer causing agents can get into those areas. The body also tries to get cells to divide rapidly to repair the area (rapid cell division is one aspect of cancer). Talk to your doctor or dentist if you need assistance with quitting. Many resources are available: nicotine gum or patches, prescriptions like Chantix, online help.
Reduce your consumption of alcohol. Alcohol dries the mouth, which may allow cancer causing agents to gain entry into your tissues. Heavy alcohol use also creates nutritional deficiencies that lower your body’s natural defenses.
Decrease your number of sexual partners. The greater the number of sexual partners you have, the more likely you are to come in contact with someone who has an HPV infection. The HPV-16 virus can be spread by oral sex or by contact with broken skin to an area of infection on another part of the body.
More information on oral cancer can be found at www.ada.org or www.oralcancerfoundation.org or by asking Dr. Robb on Facebook at www.facebook.com/DrJenniferRobb The Oral Cancer Screening is often done as part of your dental check-up (cleaning/exam). Mention this article to get a free Oral Cancer Screening during the month of April 2019 at my office. Call 440-960-1940 to reserve the seat we’re saving for you!
You may think all dental cleanings are the same, but in reality, there are different cleaning types for different circumstances. The type of cleaning you need is determined by how much space there is between your tooth and gum (periodontal pocket) and how much plaque/tartar/calculus you have on your teeth. Your periodontal pockets are measured using a ruler type instrument called a periodontal probe.
The standard dental cleaning by your dentist or hygienist is meant to clean the enamel covered portions of your tooth and slightly below the gumline (usually the 1-3 mm pockets which are considered in the normal range). Surface stains, soft plaque, and hard calculus/tartar are removed. This can be done for adults or children. Your insurance company calls it a PROPHYLAXIS, sometimes abbreviated to pro or prophy. People often call them routine cleaning, regular cleaning or “just a cleaning”. It’s meant for people with good gum health or with slight or localized areas of gingivitis. (If you have widespread gingivitis, you may need scaling in the presence of gingivitis discussed below.)
Since the standard cleaning only cleans to about 3 mm below your gumline, it will not be any help if you have periodontal pockets that are 4 mm or higher. At that point you are considered to have gum disease or periodontal disease, and you need a different type of cleaning. Depending on your insurance, these may be covered at the same level as the prophylaxis or they may be considered under the periodontics section of your insurance. What are the other types of cleanings?
FULL MOUTH DEBRIDEMENT: If you haven’t been to the dentist in a while and if you have so much plaque and tartar/calculus that your dentist doesn’t think he or she can do a complete, full mouth examination because of it, this type of cleaning may be use to remove the bulk of the plaque and tartar/calculus. If you need this, you will need to return to your dentist at a separate visit for your dental exam and treatment plan. You may also need additional types of cleanings once your examination has determined your dental condition. Your teeth will probably not be polished after a full mouth debridement.
SCALING IN THE PRESENCE OF GENERALIZED MODERATE TO SEVERE GINGIVAL INFLAMMATION: For ease of reading, I’m going to abbreviate this long name to scaling with inflammation in this paragraph. Your dentist should perform your dental examination and find that your gums are swollen, inflamed, or bleeding, but you should not have periodontal pocketing that’s over 4 mm. This type of cleaning removes surface stains, plaque, and calculus/tartar from areas both above and below your gumline. (This is where it differs from the standard cleaning where going below the gumline is not as common.) Your teeth will probably be polished after a scaling with inflammation.
PERIODONTAL SCALING AND ROOT PLANING: I’m going to abbreviate this to SRP for this paragraph. SRP is done when your periodontal pockets are 4 mm and higher. It involves using instruments to clean plaque and tartar/calculus from both the enamel-covered portion of your tooth and the root of your tooth. During instrumentation, some soft tissue and bacteria may be dislodged as well. According to the definition, SRP is therapeutic treatment not preventive treatment which may be why many insurances consider it under the periodontics section of your insurance coverage rather than the preventive section of your insurance coverage. Some people will refer to this type of cleaning as a “deep cleaning”. Most times we will focus on half your mouth, or even a quarter of your mouth, at a time in order to make sure we are removing as much of the plaque and calculus/tartar as we can reach. In most cases, the side worked on that day will be polished. Sometimes, we may wait until both sides are done and polish all your teeth at the same time. At this point, you will need to return to your dentist more frequently than the average—usually 3 or 4 periodontal maintenance cleanings a year. (See below for Periodontal Maintenance). It differs from a standard cleaning because it: 1) goes below your gums and 2) is designed to treat your gum problem.
PERIODONTAL MAINTENANCE: This type of cleaning is begun after scaling and root planing or other gum treatment/therapy and continues usually at 3 or 4 month intervals for the remainder of the life of your teeth. It includes removing surface stains, plaque, and calculus/tartar from above and below your gumline as well as site specific scaling and root planing where needed. Periodontal Maintenance differs from a standard cleaning in that it does go deeper below your gumline and in some cases it is treating early recurrences of your gum disease before it can take firm hold, especially if you keep to the recommended time between your visits.
Unfortunately, if you do have gum disease or periodontal disease we cannot do “just a cleaning” on you as it is asking us to be negligent in our treatment—something we can’t ethically do. This doesn’t mean that you must have gum treatment. You can refuse the treatment, but most dentists shouldn’t go ahead with a standard cleaning when they know it is not addressing your problem.
*Note: Information in this article is not meant to replace the clinical judgement of your healthcare professionals.
Dr. Jennifer Robb is a general dentist who sees both adults and children in her dental practice.
1612 Cooper Foster Park Rd., Lorain, OH 44053
If you're the principal caregiver for an older person, you may have already faced age-related health challenges with them. Good preventive care, however, can ease the impact of health problems. This is especially true for their teeth and gums: with your support you're loved one can have fewer dental problems and enjoy better health overall.
Here are a number of things you should focus on to protect an older person's dental health.
Hygiene difficulties. With increased risk of arthritis and similar joint problems, older people may find brushing and flossing more difficult. You can help by modifying their toothbrush handles with a tennis ball or bicycle grip for an easier hold, or switch them to an electric toothbrush. A water flosser, a device that uses a pressurized water spray to remove plaque, may also be easier for them to use than thread flossing.
Dry mouth. Xerostomia, chronic dry mouth, is more prevalent among older populations. Dry mouth can cause more than discomfort—with less acid-neutralizing saliva available in the mouth, the risk for dental diseases like tooth decay or periodontal (gum) disease can soar. To improve their saliva flow, talk with their doctors about alternative medications that cause less dry mouth; and encourage your loved one to drink more water and use products that help boost saliva flow.
Dentures. If your older person wears dentures, be sure these appliances are being cleaned and maintained daily to maximize their function and reduce disease-causing bacteria. You should also have their dentures fit-tested regularly—chronic jawbone loss, something dentures can't prevent, can loosen denture fit over time. Their dentures may need to be relined or eventually replaced to ensure continuing proper fit and function.
Osteoporosis. This common disease in older people weakens bone structure. It's often treated with bisphosphonates, a class of drugs that while slowing the effects of osteoporosis can cause complications after certain dental procedures. It's a good idea, then, for an older person to undergo any needed dental work before they go on osteoporosis medication.
Keep alert also for any signs of dental disease like unusual spots on the teeth or swollen or bleeding gums. Visiting the dentist for these and regular dental cleanings, checkups and oral cancer screenings could prevent many teeth and gum problems.
If you would like more information on senior dental care, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Aging & Dental Health.”
Tooth-colored fillings fix dental decay, but unlike old-fashioned metal fillings, they leave your smile seamlessly restored. Dr. Jennifer Robb, your dentist in Lorain, OH, uses these cosmetic fillings in a variety of treatment situations. If you have a cavity, likely she'll place one in your tooth.
Materials used in tooth-colored fillings
There are a few different materials which are cosmetically pleasing, durable and long-lasting. They bond directly to enamel, are naturally-colored and may be used on the chewing surfaces or cheek-side (buccal) portions of a tooth. They work in interdental spaces as well. Your Lorain dentist will determine which material will work best for your cavity.
Restorative materials include:
- Composite resin, a flexible, yet strong, blend of plastic (acrylic) and glass particles which mimics natural tooth structure in sheen and color
- Glass ionomer, a blend of glass and sustained-released fluoride used to restore decay near the gum line, on tooth roots or other areas of the tooth which are not exposed to the strenuous pressures of biting and chewing
- Porcelain inlays and onlays, or partial crowns, which are formed in the dental lab to restore larger cavities involving the chewing surfaces and cusps, or corners, of larger teeth
All these materials feature a long-shelf life if you take care of your teeth with proper brushing and flossing, six-month cleanings and examinations with Dr. Robb. However, you should avoid hard foods, such as peanut brittle, because these can damage any filling or even dislodge it. Also, people who grind or clench their teeth usually experience excessive enamel wear. If this applies to you, ask Dr. Robb about a bite guard to cushion your teeth and your dental work.
When it's time for a filling...
The American Dental Association says that your dentist is your best ally in the fight against tooth decay. In addition to your diligent oral hygiene routine at home, and your tooth-friendly diet, Dr. Robb will provide you with careful six-month examinations which look for early signs of gum disease, decay, oral cancer and other issues. Your semi-annual cleanings remove the bacteria-filled plaque and tartar which begin cavities in the first place.
Find out more
Modern dentistry has much to offer in terms of preventive, restorative and cosmetic care. Tooth-colored fillings are just one item on a long list of services your family dentist provides so you have your best possible smile. If it's time for your routine check-up and professional cleaning, please call Dr. Robb's office in Lorain, OH, at (440) 960-1940.
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