Teeth
There can be lots of challenges when it comes to brushing the teeth of infants and toddlers. How can you know if you are brushing enough plaque away? A unique method to do daily or periodically can be filling a small glass jar with water and brushing with no toothpaste. After brushing 25% of the teeth, dip the brush in the water, run your fingers over the bristles, and you will see plumes of white plaque come off into the water. Go back and re-brush this area and repeat the brush in the water until no more plumes come off. Then progress to the next 25% of the mouth. At the end of brushing, apply a rice (infant) or pea (toddler) -sized amount of fluoridated toothpaste to the brush and glide it over the teeth for the tooth-strengthening effect of fluoride. Rinse after 2 minutes of application. If you do not believe in fluoride, this step is not necessary – as the only purpose of toothpaste is fluoride application. Otherwise, brush bristles are strong enough to debride all plaque & residue from the teeth, and anything more is abrasive.
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In today’s world, lifelike, tooth-colored restorations are the most popular choice to fix teeth you can see. Many are surprised to learn there are different types of white fillings designed to work in different parts of the tooth. In the current time, lots of big business exists in dentistry and many offices are directing to using one generic type of white filling to treat all teeth. This is not something that has to happen, and the result is your dental work may not last as long as you expect. What more, dentists that work in these offices may not have the knowledge to place restorations that work better, even though it is a professional expectation. It is important to know you get a dentist trained to put the right material in the proper part of the tooth. A screening tip when choosing a dentist is to ask what filling they use for root cavities. Root cavities take place on the yellow part of a tooth next to the gums. While the white enamel of a tooth is dry, the yellow root of a tooth is naturally moist, and standard white fillings rely on being glued in place. You can’t glue very well to a moist surface. The white filling for the root of a tooth is called a “resin modified glass ionomer” or a “glass ionomer”. These are the two correct answers for what fixes a root cavity. If the dentist answers “Resin-based composite” or “composite”, it is the wrong material and it is better to find a dentist that knows the difference. It could save you a lot of time, treatment, and money.
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Kids get their first adult tooth around age 6 – and many soon after. These adult teeth need to last a lifetime and cavities early on lead to many complications. Consider periodically buying plaque disclosing pink dye tablets and using one after brushing to show missed areas in need of attention. These work very well!
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A neat tip to stop cavities: Do you ever feel that floss just wipes the plaque around teeth, especially if you’re trying to floss a dental crown or under a dental bridge? Know this: tie a knot in your dental floss. It will physically take the plaque off hard-to-reach areas of your teeth. It works great for getting stubborn foods out as well, such as popcorn kernels!
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Do genetics influence how your teeth get cavities? Many are surprised to learn that almost no genetic conditions remarkably affect the ability to get cavities. Teeth are almost universally strong and durable. The rare conditions where genetics do contribute are dramatic and there are more problems than just soft teeth. Quite interestingly, our preferences for foods and drinks, such as soda, can be genetic as well! When you save the soda for one time in the day and brush 3o minutes after (because soda temporarily softens the outside of your teeth), the cavities go away. Gum disease, however, can be genetic, and that does cause damage. Very often, ideal dieting and oral hygiene can offset any genetic factor that may contribute.
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Survival tips with dentistry: Americans rate the toothbrush as a top 5 item they cannot live without. If you’re ever in a situation where you don’t have toothpaste, you can use regular table salt as an alternative. It tastes bad, however salt kills bacteria, including cavity-causing bacteria in the mouth. If you don’t have a toothbrush, you can use a strip of cloth over your finger and brush it along your teeth, or you can chew the end of a stick until it has soft bristles and you can use this as a brush as well. Brushing without any toothpaste is completely acceptable, as plaque removal, rather than toothpaste use, is the key. My friend’s mother used this method to save her teeth when fleeing Vietnam as a child. While hopefully never needed, these options may be useful in serious circumstances.
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Some dental offices favor a “one size fits all” approach where they limit the number of materials to fix your teeth. This keeps systems as streamlined and convenient as possible, but it is for the practice, not the patient. A specific material that could perform better in some cases is not available when picking the best option to fix a tooth. Going to a practice that uses ALL restorative materials ensures you will have ALL your options, and the chance for your dental work to last as long as possible. Large dental companies often leave the dentist with little control over the materials purchased, which are often generic options to capitalize on bulk order discounts. Private practices are owned by individual dentists with control over materials and methods, and have a greater range of options to fix your teeth.
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What kind of toothpaste should you use? What you want to look for is anything that says “anticavity”, and pretty much nothing else. Many toothpastes advertise “whitening” and often do this by incorporating microscopic abrasive particles in the toothpaste that wears the outer layer of teeth to expose a new white layer. This may cause you to need lots of dental fillings later from worn tooth structure. Toothpastes that whiten with chemicals don’t often work unless you leave the toothpaste on your teeth as if it were a whitening strip – for ten minutes or more, and that is not practical, nor as effective. Toothpaste is for fluoride and stopping cavities, whitening strips are for whitening teeth. Combining them together can cause problems over time. Colgate or Crest Anticavity are great examples of everything you need from toothpaste.
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Smokers often have aggressive gum disease and plaque buildup on their teeth. This is because any plaque on the teeth gets dried by the smoke, and essentially “smoked” onto the tooth – becoming incredibly hard to remove. For anyone who likes cigars, cigarettes, vaping, or any type of smoking product, brushing and flossing beforehand can reduce this problem tremendously. Brush with water only, as there is some evidence that whitening products, such as those in toothpastes, can increase the risk of oral cancer when used closely with tobacco.
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We are often told to brush for two minutes. This rule is not based off plaque removal, but instead from the amount of time it takes fluoride to begin working: two minutes. Brushing for this amount of time not only can leave a substantial amount of plaque behind, but it also can lead to the fluoride being rinsed out early. Fluoride takes about 5 minutes to fully work. Brushing a full set of teeth successfully can actually take 4-5 minutes, or more to prevent cavities and gum disease.
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Have a problem with morning breath? Plaque also builds up on the tongue. You can see this as a tan color on the top surface when you stick your tongue out – typically at the end of the day. When we sleep, any plaque remaining on the teeth or the tongue can sit for up to 8 hours and flourish – not only causing bad breath, but also increasing your risk for cavities and gum disease. Make sure both the teeth and tongue are sufficiently brushed before bed, and you just might be surprised at the difference in the morning.
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Tooth-colored composites are an exception to traditional metal restorations, but the appearance usually comes with a tradeoff: longevity. Tooth-colored restorations can be more beautiful than the traditional amalgam or gold options, but these tooth-colored restorations do not last as long. Acidic drinks (sodas, citrus juices), acidic meals (tomatoes, etc), or acid from plaque can additionally weaken the surface of these composites and shorten their lifespan. The bond can also be metabolized with time. If you want the most durable, long-lasting choices for your teeth, especially in the back of the mouth where they are less visible or out of sight, ask your dentist about metal-based options. If you want the most esthetic, tooth-colored results, composite and ceramics are the way to go. Just know they will likely require more treatment in the long run. There are now multiple generations worth of options to fix teeth. See my articles to learn more about comparison.
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Flossing should be done BEFORE brushing. The term “brush and floss” is actually backwards: by flossing before brushing, you remove the food, plaque, and debris that would stop the toothpaste from flowing in-between them. This also lets the fluoride contact the surfaces better, since it plaque layers can block it.
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There are numerous different types of brushing techniques, each with their own advantages. In the search for the best option, it is important to try the most generally effective technique first. Horizontal brushing, with the bristles extending gently into the sulcus around each tooth, is a general method that I think is a great place to start. With healthy teeth, one can use this their whole life without concern. Without exceptional circumstances (such as gum disease or varying dental restorations that may require advanced techniques), the horizontal method can serve as a great overall option.
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The value of teeth: Teeth are not disposable. We only get one adult set. In fact, it can take $60,000-100,000 to restore a complete set of teeth when damage has progressed. I like to say, view the teeth as a family heirloom: you’ve inherited something extremely valuable. If the value is preserved, it can be very beneficial and serve you for your whole life.
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Do you have yellow showing through the biting surface of any of your teeth? Or saucer-like divots forming on the cusp tips of your back teeth? This is concerning and a dentist should be consulted. You may be seeing the inner dentin of the tooth getting exposed. This can be due to several things (i.e., grinding, an improper bite, acid reflux, or a restoration that is wearing the opposing natural tooth away). The enamel on the outside of a tooth is strong. It is harder than bone multiple times over. However, the yellow dentin inside the enamel is softer, and is not made to function without enamel over it. This inner structure will wear away fast from regular chewing. If not addressed promptly, extensive and costly repairs with potential root canal treatment may be needed.
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Continuing from the previous tip, teeth are not fixed in place. When ground down from clenching, grinding, or any other source, teeth will lift out of the bone to fill the lost space. The body has incredible mechanisms and one of those is the ability for the teeth to adjust so the natural bite remains the same, thus preserving the health of the jaw joints. This can mask the extent of damage because the teeth occupy the same space that was there before. If this goes on for too long, it can be very difficult and expensive to fix. The same is true for a tooth that doesn’t contact anything on the opposite jaw (if the opposing tooth was extracted). The tooth will continue to erupt until it contacts something, such as the gums where the opposing tooth once was. Similarly, a tooth missing a tooth next to it will migrate into the open space. This is why having a complete set of teeth – be it through implants, bridges, partial dentures, or complete dentures, is so important; otherwise the teeth will rearrange themselves as they try to fill the missing spaces.
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Cavity-causing bacteria are TRANSMISSIBLE, and can be passed on to others. Silverware, cups, kissing… all are vectors for which different oral flora can transfer between people. In fact, one of the ways humans may first become exposed to cavity-causing bacteria is from a parent kissing the child near or on the mouth! As far as science goes, cavity causing bacteria are still not naturally preventable.
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Whitening toothpastes. Be careful. Some can have micro-abrasives that actually sand away the enamel of your teeth, resulting in a whiter color from the exposed, deeper enamel. Over a decade or more, you may brush off some or all of the enamel on your teeth. To simplify the search for whiter teeth, over the counter bleaching products or in-office bleaching are nice ways to reach this goal. To see how abrasive your toothpaste is, look up the Relative Dentin Abrasivity chart by the ADA. You may be surprised!
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Brushing for a long time over fewer sessions can be much more effective than brushing for many sessions for short amounts of time. Brushing once a day and removing all the plaque is more effective than several limited sessions where plaque remains.
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If you are bleaching your teeth at home and need a tooth-colored filling from your dentist within the next two weeks, be sure to tell them you are bleaching. The product will stay in the tooth over this period of time and can weaken the bond of your restoration to the tooth.
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Have you ever wondered how different foods affect your teeth? When you eat, your saliva becomes more acidic, causing the outer surface of your teeth to get a little softer. This happens even more when eating acidic foods (lemons, tomatoes, coffee, etc). It takes 30-60 minutes after eating before your teeth return to their normal hardness. Why does this matter? Any clenching, grinding, or toothbrushing you do within 30-60 minutes of eating will wear away more tooth structure. Over the years, it can add up and cause you to need dental treatment if the enamel gets thin or wears through. Wait about 30-60 minutes after a meal before brushing to allow the surface of your teeth to return to normal. Drinking/rinsing with water, or ending with something non-acidic (such as ice cream after dinner), returns them to normal faster.
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Generally speaking, implants have their crowns retained in one form or another with a small screw. This screw can become loose over time. If you have an implant crown that you notice is starting to move, prompt care should be obtained, as this is concerning regardless of the cause. Even though there is typically no discomfort with a loose screw, if left untreated even for a little while, the screw will deform and become more difficult to remove. It may also damage the inner threads of the implant, or fracture and lead to a trapped screw or the implant becoming unfixable. These are serious and expensive complications best avoided with early treatment.
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Night guards come in many materials and designs. The night guards you can buy in a store, in my experience, perform poorly in the long run. Professionally designed night guards made by a dentist tend to have the best durability and fit to your teeth. These can be soft, hard, or designed with a hard exterior and an elastic interior. If issues with fit happen, the latter design can be a great option to solve that problem.
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If you or a child ever have a tooth knocked out, as immediately as possible (1) place the tooth under your tongue or in a cup of milk. Do NOT place the tooth in water or almond milk, as the water will cause the living cells on the root of the tooth to swell and die. These cells are needed for the tooth to be successfully placed back in the socket. (2) Travel to your dentist immediately. You have a 1 hour window for the tooth to be put back in place before the body may reject it. You have the best odds for success if done within 30 minutes. Pediatric dentists will be better equipped for age 21 and below.
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Back molars in the upper jaw are notorious for getting plaque buildup, gum disease and cavities. This is usually due to lack of brush access – particularly the back surface of the very last molar. This is because when you open fully while brushing, the jaw slides forward and blocks the toothbrush from getting back there. Try closing halfway, which slides the jaw back, and then slide your jaw to the side for extra access. You may be amazed how much more you can brush. Don’t forget to floss the back-most surface as well, even if there is no tooth behind it.
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How long does it take for a cavity to develop? The white enamel on the outside of a tooth is extremely strong. Several times harder than bone. It can take YEARS for a cavity to develop. Once the cavity breaks through the enamel, the inside of a tooth is softer, and the cavity moves quick. That’s how they get big. Don’t let too much time go by between dental checkups, as cavities can stay small and simple.