If you add fluoridated water to your infant’s baby formula, you may be putting your child at risk of developing dental fluorosis, a harmless cosmetic condition manifested by brown, mottled or discolored enamel.

Although fluoride – found naturally in all water and foods – is necessary to prevent tooth decay, in infants and children regular fluoride intake above optimal amounts can cause fluorosis in developing teeth. .

Though breast milk and most ready-to-feed formulas contain infant-safe fluoride levels, parents must be careful with concentrate formulas that require adding water. Community water or well sources often contain fluoride levels higher than 1.2 ppm, the highest amount proven to be beneficial in preventing tooth decay.

When formula concentrations need to be diluted, it is recommended parents use bottled water that is fluoride-free or low in fluoride water or tap water from a reverse osmosis home water filtration system, which removes most of the fluoride.

“If your child’s teeth develop brown spots, visit your dentist to check for fluorosis,” says Academy of General Dentistry spokesperson James Tennyson, DDS. “It also could signal tooth decay, in which case your child may be prescribed fluoride supplements.”

“If you correct a fluorosis problem in your child’s first primary teeth,” says Dr. Tennyson. “Your child probably won’t have a problem when the permanent teeth erupt at age 5 or 6.”

Dr. Tennyson also recommends checking your water source’s fluoride levels by collecting a fresh sample in a sterile container and taking it to your local health or water department. Or, your dentist may be able to test your sample if his office has a colorimeter, which can determine the concentration of fluoride by comparing the sample to a standard.

Despite recommendations and warnings from dentists about the importance of regular flossing, many people admit they still don’t do it, and countless more floss only in the days and weeks before or after their semi-annual cleanings and checkups, reports the Academy of General Dentistry (AGD).

The reasons patients cite for not flossing are many, but lack of time is the most common. Many patients feel guilty about not flossing daily, and some abandon the practice all together.

“I request that my patients floss once a day for control of tartar build-up on their teeth, because plaque is continually developing on your teeth, causing cavities and gum disease,” says AGD spokesperson Barbara Rich, DDS.

Dr. Rich tells people not to give up – flossing even two or three times a week has its benefits, and it’s far better than not flossing at all. “At least get in there and break up those colonies of bacteria and germs so they aren’t accumulating for quite so long.”

“I tell patients they don’t have to make flossing a 20-minute routine in front of the mirror, but floss correctly by sliding the floss against the side surfaces of the teeth – not just sliding it between the teeth. Once you are familiar with flossing, floss when and where you have time. You can even keep floss near your favorite chair and do it while watching television.”

She also tells patients who have trouble fitting it into their routine that they might try flossing earlier in the evening, or even during a break at work. “Although the best time to floss is before bed, getting it done is more important than what time it’s done.”

Some patients report they stop flossing because they noticed that their gums bleed when they floss. “That means there are germs and inflammation in there. Patients should continue flossing, and the bleeding will usually stop within a week or two,” says Dr. Rich. Those who don’t floss due to arthritis or lack of dexterity can try specially designed plastic holders for dental floss.

With as many as 35 million men and women suffering from eating disorders in the United States, more dentists are becoming the first line of defense when it comes to spotting eating disorders in patients, according to the May 2005 issue of AGD Impact, the newsmagazine of the Academy of General Dentistry (AGD).

Bad breath, sensitive teeth and tooth erosion are just a few of the signs that dentists use to determine whether a patient suffers from an eating disorder.

“Purging episodes bring stomach acids up through the mouth. The damage from purging mostly occurs inside the upper front teeth in the form of erosion of the tooth’s enamel, sensitivity, thinning and chipping,” says AGD spokesperson Maharukh Kravich, DDS, AGD.

The National Eating Disorders Association (NEDA) estimates that nearly 10 million women and 1 million men are affected by anorexia nervosa and bulimia nervosa. Another 25 million suffer from binge-eating disorders.

Dentists who detect patients with eating disorders may recommend therapists and teach the patients how to minimize the effects of purging (a clear indicator of bulimia). For example, patients should immediately rinse their mouth with soda water or use a sugar-free mouthrinse. Patients should swish water around their mouth if nothing else is available and brush with a soft toothbrush and fluoride toothpaste.

“This is especially helpful if the signs of eating disorders are caught early,” says Dr. Kravich.

Sometimes, eating disorders may not be discovered until too late, after irreversible damage has been done to the body as well as the teeth. According to NEDA, early detection of the disease may ensure a smoother and successful recovery period for the body and the teeth.

Although parents may not recognize that their children are anorexic or bulimic, they are often still taking the child to a dentist on a regular schedule.

“Parents that suspect a child suffers from one of these disorders should consider visiting a dentist,” says Julie Barna, DMD, MAGD. “He or she should be able to spot the warning signs and help point you in the direction to get help.”

Signs of an eating disorder:

• Bad breath
• Tender mouth, throat and salivary glands
• Eroded tooth enamel
• Teeth that are worn and appear almost translucent
• Mouth sores
• Dry mouth
• Cracked lips
• Bleeding gums
• Sensitive teeth

Allergic reactions are sensitivities to a specific substance, called an allergen, that makes contact with the skin, or is inhaled into the lungs, swallowed, or injected. Some allergic reactions are mild, while others can be severe and life-threatening. Allergic reactions often occur more frequently in people with a family history of allergies. Substances that don’t bother some people (including certain medications) can trigger allergic reactions in others.

What are the Symptoms? 

A person who is allergic can experience a range of symptoms, including itchy, swollen eyes; a runny nose; and sneezing. Hives, dermatitis (skin rash), and asthma also are common reactions. The most severe allergic reaction is the potentially fatal condition known as anaphylactic shock, which is characterized by the following symptoms: generalized flushing of the skin; hives; mouth and throat swelling; difficulty in swallowing or speaking; changes in heart rate; abdominal pain; nausea and vomiting; anxiety; a sudden feeling of weakness (due to a drop in blood pressure); and unconsciousness.

What Causes Allergic Reactions?

Allergic reactions that occur in the dental office may be caused by materials or medications. These allergens may include:

Latex. Latex can be found in many medical or dental supplies and devices, such as masks, gloves, and syringes. Unlike some consumer goods made from synthetic latex, natural rubber latex is derived from a milky substance found in rubber trees. Some individuals have developed hypersensitivity to proteins derived from natural rubber latex, which can cause allergic reactions. If you are allergic to latex, ask your dentist if he or she has latex-safe products available for use during a dental procedure or surgery.

Local anesthetic. Local anesthetics are used to numb your mouth and gums when you undergo certain dental treatments. Although allergic reactions to local anesthetics are rare, they can occur. If you have had reactions to local anesthesia in the past, be sure to tell your dentist before you undergo any treatment. Your dentist can find alternative ways to anesthetize you to prevent any adverse reactions.

What Should I Do if I Am Allergic?

If you have allergies, be sure to tell your dentist and dental staff, and make sure that the information is included in your patient chart. If you have had severe allergic reactions, you should consider carrying an epinephrine kit (EpiPen®) and use a medic alert bracelet that clearly states your allergy. You also may want to carry a letter of explanation from your physician. If you have allergic symptoms following a dental procedure, consult your dentist and physician immediately. If you experience a severe allergic reaction after a dental procedure, you should go immediately to the hospital emergency department where you can be closely monitored and treated. If you have questions about allergies and allergic reactions, talk to your dentist.

Cold sores, also known as fever blisters, are tiny, clear, fluid-filled blisters that form around the mouth and are caused by the herpes simplex virus (usually type 1, or HSV-1) living inside your nerve tissue. Cold sores usually do not last longer than two weeks. However, the sores are highly contagious and tend to recur when the virus is reactivated by a trigger such as stress, sunlight, fever or illness.

What Happens When Exposed To HSV-1

Most people get HSV-1 infections during infancy or childhood and usually catch the virus from an infected family member or friend. Only an estimated 30 percent of those infected actually develop the characteristic blisters. If sores do develop, they can appear anywhere from two to 12 days after exposure to an infected person. Other persons with a primary infection may have flu-like symptoms such as a high fever, sore throat, swollen neck glands and mouth soreness.

What Triggers An Outbreak?
There may be long periods when the herpes virus remains inactive. The following factors can trigger cold sores:

• Illness, such as cold or flu
• Dental treatment
• Physical stress or fatigue
• Menstruation or pregnancy
• Mouth trauma
• An immune-system deficiency
• Sunlight exposure or ultraviolet lamps
• Food allergies

How To Minimize Outbreaks

To prevent transmission of the virus to another person, avoid:

• Intimate physical contact with others
• Sharing eating utensils, toothbrushes, towels and razors
• Touching the blisters (always wash your hands after applying medication)

How to minimize recurrent outbreaks:

• Eat foods high in lysine (an amino acid found in red meats, fish and dairy products) or take supplements
• Apply sunscreen to the face and lips before going outdoors
• Shave with a disposable razor during an outbreak
• Replace your toothbrush
• Engage in relaxing activities to reduce stress

Cold Sore Vs. Canker Sore  
Like cold sores, canker sores ? also known as aphthous ulcers ? can be quite painful and often recur. While cold sores are caused by a virus, the formation of a canker sore may be triggered by multiple factors such as stress, food allergies or a weakened immune system. A canker sore forms in the soft tissues of your mouth and is not contagious, whereas a cold sore usually appears around the lip area outside the mouth and is highly contagious. If a cold sore appears inside the mouth, usually it appears on the non-movable parts such as the roof, rather than the tongue or soft palate.

Stages Of A Cold Sore

Day 1: Prodrome (tingle) stage – Before a cold sore has formed, you may feel a tingling, itching or burning sensation beneath the skin, usually around the mouth or the base of the nose. Applying antiviral medications during this stage can help alleviate cold-sore symptoms

Days 2 to 3: Blister stage – An outbreak of fluid-filled blisters is the first visible sign of cold-sore formation.

Day 4: Ulcer or weeping stage – Typically, the most contagious and painful stage of cold sores is when blisters rupture, leaving a shallow, reddish, open sore.

Days 5 to 8: Crusting stage – After a few days, the blisters dry up and form a yellow or brownish crust, which eventually falls off. During this stage, it is important to care for the scab, which can crack or break.

Days 9 to 12: Healing stage – Usually a series of scabs will form on the lesion, which eventually flake off. Each new scab will be smaller than the previous one, until the cold sore heals completely, usually without scarring.

How Are Cold Sores Treated?

Most cold sores are mild and do not require treatment. Antiviral medications can reduce the frequency, duration and severity of outbreaks. Medications with a numbing agent, such as benzyl alcohol, can help alleviate a cold sore’s burning, itching and pain. Emollients can reduce cracking and soften scabs. Applying aloe vera balm three times a day to the cold sore also can help fight the infection and enhance healing.

If over-the-counter remedies don’t help, ask your dentist for a prescription. A dentist also can accurately diagnose cold sores and base treatment on important factors such as your age, overall health, medical history and tolerance for specific medications.

Dental insurance can be helpful to patients in defraying the costs when paying for dental treatment. Insurance, however, can sometimes be a double-edged sword and it is important for consumers to investigate what plans will keep them and their families smiling in the future, advises the Academy of General Dentistry (AGD). 

Oral health care is extremely important and coverage is typically available to individuals and families through their employers, who will pay a premium to have them covered, according to the August/September 2006 issue of AGD Impact, the monthly newsmagazine of the AGD.  Individuals may also choose to seek out alternative dental insurance plans and pay a monthly premium that would provide basic coverage for exams, hygiene cleanings, root canals, orthodontics, etc.

The down side of dental insurance is that it may limit which dentists a patient can visit and the coverage may not cover costs of all the treatment that needs to be completed.

“Also, it is important that the insurance company not interfere in the doctor-patient relationship by dictating treatment to the dentist or the patient,” explains W. Mark Donald, DMD, FAGD and AGD spokesperson. “The patient should understand that the dentist, not the insurance company, is trained in diagnosing and treating dental disease. When insurance companies interfere in the diagnosis and treatment planning by dictating treatment, optimal oral health care can be reduced.”

While a great dental insurance plan might allow a patient to see any dentist, not all dentists will accept the insurance claim forms as payment. These dentists, also known as “non-participating” or “insurance-free”dentists, may have their patients pay up front and have the patient directly collect payment from the insurance company.

Alternatives to insurance may be a discounted dental plan which allows the patient to pay a yearly flat fee that gives access to the provider dentists.  The plan negotiates a discounted rate for typical dental services and the dentists agree to provide these services to you at the rates which are discussed prior to purchasing the plan.

Two systems of dental plan coverage

• Fee-for service or indemnity: This direct reimbursement system pays the dentist for each service mostly according to fees set by the dentist.
• Managed care: This is a system that controls the fees set for covered services. Managed care can be divided into two categories (capitation/dental health management organizations and preferred provider organization plans).

Frequently consuming foods with a low pH value, such as soft drinks, fruit juices, pickles, fresh fruit and yogurt can lead to irreversible dental erosion, according to a report in the January/February 2005 issue of General Dentistry, the Academy of General Dentistry’s (AGD) clinical, peer-reviewed journal. Dental erosion is the breakdown of tooth structure caused by the effect of acid on the teeth. Dental enamel is the thin, outer layer of hard tissue that helps maintain the tooth’s structure and shape while protecting it from decay.

“A low pH environment in the mouth helps contribute to dental erosion,” says Samantha Shipley, DDS, and lead author of the report.

pH (potential of hydrogen) is a standard way to measure the acidity of a substance. It is measured on a scale of 0 to 14. A lower pH means that a solution contains more acid. The higher the pH, the more alkaline (or non-acidic) the solution. When a solution is neither acid nor alkaline, it has a pH of 7, which is neutral.

When acidic food or drink is consumed the enamel will soften for a short amount of time. Typically, saliva slowly helps to restore the natural balance of the acid in the mouth. If foods high in acid are consumed on an excessive basis, the mouth can’t repair itself and there is a greater chance for dental erosion, says Dr. Shipley.

“As the availability of soft drinks increase so does the amount of erosion in our population,” says Dr. Shipley. “The primary action patients can take to decrease their likelihood of erosion is to reduce consumption of sugary sodas, fruit juices and sports drinks.”

“Vegetarian diets and diets in which fruit comprises more than two-thirds of the total food intake also makes patients more susceptible to erosion,” says Dr. Shipley. “Erosion can also be caused by stomach acids introduced into the mouth through vomiting and acid reflux.”

“These findings are important and suggest that caution should be exercised when consuming certain foods over long periods of time,” says AGD spokesperson Cynthia E. Sherwood, DDS.

Acids found in common foods:

• Soft drinks – phosphoric acid
• Fruit and fruit products – citric and malic acids
• Fermented products (yogurt) – lactic acid
• Grapes and wines – tartaric acid

After eating or drinking:

• Chew sugar-free gum to stimulate saliva flow.
• Rinse with water for 30 seconds.
• Use a fluoride toothpaste.

Dentist Should Advise Vegetarians on Good Oral Health

Health concerns about fat and cholesterol have prompted many people to become vegetarians, and the nutritional deficiencies that can sometimes result may reveal themselves during dental exams.

Academy of General Dentistry spokesperson Ludwig Leibsohn, DDS says he usually asks patients if they adhere to vegetarian or other special diets.

“Most adult vegetarians are very knowledgeable about nutrition,” says Dr. Leibsohn. “They maintain their diets in a proper fashion.”

Children, however, need a well-balanced and nutritionally complete diet for proper growth, and the potential for deficiencies is greatest among children and teenagers who put themselves on vegetarian diets without knowing enough about their nutritional needs.

Although vegetarian diets vary, some vegetarians, particularly those who do not consume any food of animal origin, can experience deficiencies in calcium, vitamin D, riboflavin, vitamin B₁₂ or complete proteins. Studies show that by eating the right amount of fruits, vegetables, grains and legumes, they can get the nutrients they need.

“An adult on a vegetarian diet for a prolonged period can be at increased risk for periodontal (gum) disease from a lack of vitamin D and calcium,” says Dr. Leibsohn.

Dr. Leibsohn recommends that anyone considering adopting a vegetarian diet seek counseling from their dentist or a nutritionist to learn about substituting foods to get all the necessary nutrients. He also suggests taking a multiple vitamin daily.

Teeth may soften when there is a shortage of vitamin D, becoming more susceptible to decay and periodontal disease. Vitamin D is produced in the body with sun exposure, so deficiencies are rare, but it can develop in those who do not consume milk or fish. Adding vegetable margarines or soy milk to the diet may solve the problem.

Diet is an important part of an individual’s medical history, and patients should always inform their dentist if they adhere to vegetarian or other special diets, says Dr. Leibsohn.

Patients become anxious about going to the dentist for different reasons. This may include fear of receiving local anesthetic or concerns about the effectiveness of the anesthesia. Negative past experiences also may play a large role in a patient’s anxiety, as well as financial concerns.    

Your dentist works to reduce your anxiety before you even set foot in the dental office. This process begins when you make your appointment. Your dentist’s office staff has been trained to tell you what to expect and to answer any questions you have to ensure that you will be comfortable during your visit. An understanding of your dental services and treatment can help to relieve dental anxiety. Make sure you ask questions and request informational materials, if desired.

Medications to Help You Relax

Some dentists prescribe and administer medications to help patients relax during the appointment. Talk to your dentist about your concerns and ask him or her about the possibility of using dental sedation. Sedation dentistry involves the use of medications to allow you to relax and feel sleepy during a dental visit or procedure. However, sedation is not pain medication, so you may still require local anesthesia, depending upon the treatment. There are a variety of sedation dentistry methods.

The most common types are inhaled sedation, which involves breathing in a mixture of nitrous oxide (laughing gas) and oxygen, and oral sedatives, which are medications taken by mouth. Another type of dental sedation is intravenous (IV) sedation, which is provided by dentists with specialized training in IV sedation. Sedation is safe when administered by dentists who are trained in its use. However, as with any medication, sedation involves a certain amount of risk. It is important to talk to your dentist about these risks.

How to Relieve Dental Anxiety

In general, avoid caffeine before a dental appointment to make you less anxious. Eating high-protein foods also produces a calming effect, unlike sugary foods. During the procedure, focus on breathing regularly and slowly. When they are nervous, some people tend to hold their breath, which decreases oxygen levels and further increases feelings of anxiety. Knowledge is the greatest defense against anxiety. If you have specific fears, talk to your dentist about them. Your dentist can go a long way to dispel any negative or frightening images you may have.

What to do When Seeing a New Dentist

If you are seeing a new dentist for the first time, schedule an appointment for a visit—a visit that doesn’t require a cleaning or treatment. Take the opportunity to ask the dentist questions and address your concerns. You’ll find that a dentist who takes the time to speak with you about your anxiety will understand when it comes to addressing your other concerns.

Updated: October 2008

How TMD Pain is Caused

The pain associated with TMD is caused when the temporomandibular joint (the joint that connects the lower jaw to the skull) is damaged or has deteriorated or when the muscles surrounding the joint are malfunctioning, causing an imbalance in the movement of the jaw joint. For instance, TMD can be caused by the impact of an auto accident, an improper bite that causes stress on the chewing muscles or by behaviors associated with stress, such as clenching the jaw or grinding the teeth.

The muscle pain and spasms associated with TMD are often compared to that of a “charley horse” in a runner’s leg.

If you are one of more than 10 million Americans who suffer from temporomandibular disorder (TMD), a condition that causes face, jaw and neck pain, relief may be found in a dental procedure called equilibration, according to Jerry Butler, DDS, FAGD. Equilibration involves the selective reshaping of the top surfaces of the teeth to provide normal balance and to stabilize the jaw joint

In our fast-paced lives, many of us may be eating in a hurry, taking giant bites of our food to get done quickly and on to the next task. Fast-food restaurants advertise giant burgers and sandwiches as a selling point, but often those super-sized delicacies are larger than a human mouth. 

Taking bites that are too big to chew could be bad for your jaw and teeth, says the Academy of General Dentistry (AGD), an organization of general dentists dedicated to continuing education. At particular risk are people with temporomandibular joint disorder (TMD), which can restrict the range of acceptable bite size. “People with TMD need to avoid opening their mouths too wide,” says AGD spokesperson Barbara A. Rich, DDS, FAGD. “Taking large bites of food can aggravate their condition.” So, smoosh that hoagie before taking a bite.

Dr. Rich also cautions against biting into hard candies, which can chip teeth. Even apples can cause problems. “If you need to open your mouth more than feels comfortable to take a bite, then you should cut the item into smaller portions that are easy to chew,” Dr. Rich says.

People should always avoid chewing ice, popcorn kernels and opening nuts with their teeth, which can lead to chipping and breakage of natural teeth and restorations.

More than 51 million school hours are lost each year due to dental-related illnesses. Despite these numbers, many children still do not visit the dentist. In addition, almost 50 percent of tooth decay remains untreated in low-income children, according to the Centers for Disease Control and Prevention (CDC).

“The need for dental care cannot be ignored. Dental diseases grow progressively worse without treatment, which influences overall health and may require increasingly costly care,” says Academy of General Dentistry spokesperson Mark Ritz, DDS, MAGD. “However, most oral health problems can be prevented. Regular dental examinations, oral health education and primary disease prevention will dramatically reduce the burden of dental disease in most patients.”

Regular examinations can seem expensive to people without dental insurance, and many children are without dental coverage. The Surgeon General’s office reports that for every child without medical insurance there are 2.6 children lacking dental insurance. These resources are available to help the parents of children in need of dental care:

Federally sponsored programs

Medicaid is the largest source of funding for medical and health-related services for people with limited incomes. More than 40 million people have Medicaid coverage and about half are children. In order to be approved and receive the funding, certain eligibility requirements must be met. Go to http://cms.hhs.gov/ to look up eligibility requirements in each state.

State-assisted programs

A State Children’s Health Insurance Program (SCHIP) is another option for uninsured children. SCHIP is a state-administered program, and each state sets its own guidelines regarding eligibility and services. Go to http://www.insurekidsnow.gov/ for a listing of SCHIP programs.

States also have dental clinics or other charitable programs set up to help children receive dental care at no cost or at a reduced fee. Search online at http://ask.hrsa.gov/pc. Some state dental societies will also list clinics or charities.

Dental schools

A dental-school clinic is another option for reduced fee treatment. Students perform the procedures, which helps reduce treatment costs. Experienced faculty members are on site throughout the process to evaluate the student’s work. State dental societies should have a listing of dental schools in the area.

Updated: February 2007

Men: Looking for a Better Job? Start by Visiting the Dentist

An online poll of 289 general dentists and consumers confirms the traditional stereotype that men are less likely to visit the dentist than their female counterparts, according to the Academy of General Dentistry (AGD), an organization of general dentists dedicated to continuing dental education.

Why? Nearly 45 percent of respondents felt that men don’t see a need to go to the dentist, and about 30 percent of those polled reported that men may not visit the dentist because they are afraid or embarrassed to go. Almost 18 percent revealed that men just don’t have the time for a dental visit, and about 5 percent felt that men don’t even have a regular dentist.

This long-standing trend and excuse, however, may be disappearing as more men are climbing back into the dental chair – for a surprising reason.

“In my practice, more men are coming in and requesting bleaching, veneers and bonding,” says AGD spokesperson J. Nick Russo, Sr., DDS, FAGD. “Many have noticed the positive effects from a colleague’s improved smile and realize that a great smile has a lot of value in the business world.”

Dr. Russo also points to the fact that not long ago, most men worked for one or two employers throughout a lifetime and many did not think about the way their overall appearance affected their professional life.

“That’s not the reality today, with lay-offs and company closings across the board,” says Dr. Russo. “Today middle-aged men are competing for jobs with younger men, making appearance a heightened factor in their lives.”

Taking a back seat to new cosmetic concerns for men is the increased awareness of the overall health benefits of seeing a dentist biannually.

“As a dentist, I want men to come see me because they’re concerned about their health, however I’m glad to see them for whatever reason they come in,” says Dr. Russo. “Many times after men come back to the dentist they realize that proper maintenance and biannual checkups are the key to improving the way one looks and feels.”

Updated: February 2007

Do I Really Need to Floss?

Yes. Floss removes plaque and debris that sticks to teeth and gums in between teeth, polishes tooth surfaces, and controls bad breath. Plaque is a sticky layer of material containing bacteria that accumulates on teeth, including places where toothbrushes can’t reach. This can lead to gum disease. By ?ossing your teeth daily, you increase the chance of keeping them for a lifetime and decrease the chance of getting gum disease.

Why should I floss?

Floss removes plaque and debris that adhere to teeth and gums in between teeth, polishes tooth surfaces and controls bad breath. By flossing your teeth daily, you increase the chances of keeping your teeth a lifetime and decrease your chance of having periodontal (gum) disease and tooth decay.

Flossing is the single most important weapon against plaque, perhaps more important than the toothbrush. A toothbrush cleans the tops and sides of your teeth. Dental floss cleans between them. Some people use waterpicks, but floss is the best choice.  Many people just don’t spend enough time flossing and many have never been taught to floss properly. When you visit your dentist or hygienist, ask to be shown.

Which type of floss should I use?

Dental floss comes in many forms: waxed and unwaxed, flavored and unflavored, wide and regular. Wide floss, or dental tape, may be helpful for people with a lot of bridge work. Tapes are usually recommended when the spaces between teeth are wide. They all clean and remove plaque about the same. Waxed floss might be easier to slide between tight teeth or tight restorations. However, the unwaxed floss makes a squeaking sound to let you know your teeth are clean. Bonded unwaxed floss does not fray as easily as regular unwaxed floss but does tear more than waxed floss.

How should I floss?

There are two flossing methods: the spool method and the loop method. The spool method is suited for those with manual dexterity. Take an 18-inch piece of floss and wind the bulk of the floss lightly around the middle finger. (Don’t cut off your finger’s circulation!) Wind the rest of the floss similarly around the same finger of the opposite hand. This finger takes up the floss as it becomes soiled or frayed. Maneuver the floss between teeth with your index fingers and thumbs. Don’t pull it down hard against your gums or you will hurt them. Don’t rub it side to side as if you’re shining shoes. Bring the floss up and down several times, forming a “C” shape around the tooth and being sure to go below the gumline.

The loop method is suited for children or adults with less nimble hands, poor muscular coordination or arthritis. Take an 18-inch piece of floss and make it into a circle. Tie it securely with three knots. Place all of the fingers, except the thumb, within the loop. Use your index fingers to guide the floss through the lower teeth, and use your thumbs to guide the floss through the upper teeth, going below the gumline and forming a “C” on the side of the tooth.

How often should I floss?

At least once a day. To give your teeth a good flossing, spend at least two or three minutes.

What are floss holders?

You may prefer a prethreaded flosser or floss holder, which often looks like a little hacksaw. Flossers are handy for people with limited dexterity, for those who are just beginning to floss or for caretakers who are flossing someone else’s teeth.

Is it safe to use toothpicks?

In a pinch, toothpicks are effective at removing food between teeth, but for daily cleaning of plaque between teeth, floss is recommended. When you use a toothpick, don’t press too hard, as you can break off the end and lodge it in your gums.

Do I need a waterpick (irrigating device)?

Don’t use waterpicks as a substitute for brushing and flossing. But they are effective around orthodontic braces, which retain food in areas where a toothbrush cannot reach. However, they do not remove plaque. Waterpicks are frequently recommended by dentists for persons with gum disease; solutions containing antibacterial agents like chlorhexidine or tetracycline, available through a dentist’s prescription, can be added to the reservoir in these cases.

Updated: September 2008

Researchers are finding possible links between periodontal (gum) infections and other diseases throughout the body. Current studies suggest that there may be a link between gum disease and cardiovascular disease. In fact, some research suggests that gum disease may be a more serious risk factor for heart disease than high blood pressure (hypertension), smoking, high cholesterol, gender and age. Studies suggest that people who have gum disease seem to be at a higher risk for heart attacks, although no one is certain how this relationship works. Your oral health affects your overall health, but studies that will find exactly why these problems are linked are still underway.

The current theory is that bacteria present in infected gums can come loose and move throughout the body. The same bacteria that cause gum disease and irritate your gums might travel to your arteries. Researchers are unsure what causes the bacteria to become mobile, but it has been suggested that bacteria can be dislodged and enter the bloodstream during tasks as simple as brushing, flossing or even chewing.

Research shows that your risk of developing cardiovascular disease varies according to the severity of gum infection. The worse the infection, the more likely the bacteria are to become blood-borne. Infected gums bleed, making it easier for bacteria to enter your bloodstream. If bacteria become dislodged, the bacteria can enter through cuts or sores in your mouth and can travel to other parts of the body through your bloodstream.

If bacteria reach the arteries, they can irritate them in the same way that they irritate gum tissue. This could cause arterial plaque to accumulate, which can cause hardening of the arteries and decreased or blocked bloodflow. Compromised bloodflow to your heart can cause a heart attack. Also, arterial plaque can come loose and travel to other parts of the body. If a blockage occurs in the brain, it can cause a stroke.

Protect Your Heart

Keep your mouth healthy! Gum disease is a serious gum infection that should always be taken seriously. Although gum disease can often show few or no symptoms at all, watch for gums that are red and irritated or bleed easily. There are many new treatments available to control and help reverse gum disease.

Remember, gum disease is caused by plaque buildup. Brush and floss regularly to remove plaque that you can’t see below the gumline, and remember to schedule regular checkups. If you remove the plaque, you minimize the chance for getting gum disease. If you have any questions about your oral health, ask your dentist.

Updated: October 2008

Radiographic, or X-ray, examinations provide your dentist with an important tool that shows the condition of your teeth, its roots, jaw placement and the overall composition of your facial bones. X-rays can help your dentist determine the presence or degree of periodontal (gum) disease, abscesses and many abnormal growths, such as cysts and tumors. X-rays also can show the exact location of impacted and unerupted teeth. They can pinpoint the location of cavities and other signs of disease that may not be possible to detect through a visual examination.

Your radiographic schedule is based on your dentist’s assessment of your individual needs, including whether you’re a new patient or a follow-up patient, adult or child. In most cases, new patients require a full set of mouth X-rays to evaluate oral health status, including any underlying signs of gum disease, and for future comparison. Follow-up patients may require X-rays to monitor their gum condition or their chance of tooth decay.

Dental X-rays require exposure to very low levels of radiation, which makes the risk of potentially harmful effects very small. All health care providers are sensitive to patients’ concerns about exposure to radiation. Your dentist has been trained to prescribe X-rays when they are appropriate and to tailor radiographic schedules to each patient’s individual needs. By using state-of-the-art technology and by staying knowledgeable about recent advances, your dentist knows which techniques, procedures and X-ray films can minimize your exposure to radiation.

Updated: October 2008

If there’s one thing that all dentists have in common, it’s that they regularly see young patients with tooth decay. Roughly 42 percent of children ages 2 to 11 have had decay in their primary teeth, while approximately 32 percent of children ages 9 to 11 have decay in their permanent teeth. Although it’s vital for all patients to brush and floss every day, children in particular can improve their oral health by adding xylitol to their daily oral hygiene routine, according to an article published in the July 2010 issue of AGD Impact, the monthly newsmagazine of the Academy of General Dentistry (AGD).    

“Sugary foods and sticky candies can be difficult for children to resist, but they are a serious source of tooth decay, particularly when they get stuck in the crevices between teeth,” says Scott Cayouette, DMD, FAGD, spokesperson for the AGD. “Additionally, many children consume large amounts of soft drinks and sports drinks, which are known to have a high acidic pH and sugar content—a recipe for disaster in terms of tooth decay.” These dietary factors—combined with the possibility that children are drinking more unfluoridated tap or bottled water—might explain why the rates of tooth decay are rising.

However, Dr. Cayouette notes that xylitol gives dentists another weapon in the battle against tooth decay. “Xylitol provides a simple solution for tooth decay in children,” he says. “It’s a natural sugar that doesn’t cause cavities and can actually help to prevent them.”

Xylitol is a sugar alcohol found naturally in trees, fruits, and vegetables. It’s also found naturally in the human liver, which is why it is safe for humans to consume. Unlike table sugar, which breaks down in the mouth and creates an acidic, cavity-promoting pH, xylitol does not break down and therefore does not create any harmful acids.

Xylitol can be found in an array of products—including candies, mints, lemonade mixes, all-purpose sweeteners, and certain brands of chewing gum—which can help patients fight cavities without forcing them to drastically change their daily oral hygiene regimen.

Research suggests that patients should consume between six and 10 grams, or three to five servings, of xylitol per day. “It’s also important for patients to consume xylitol throughout the day and not all at once,” Dr. Cayouette says. “The more often that xylitol interacts with the bacteria in your mouth, the better—that way, it’s always fighting cavities.”

While there is no quick fix for eliminating tooth decay, xylitol may offer a realistic way to counteract the problem, especially among the most vulnerable populations.

“Parents may wonder why a dentist would recommend that their young patients consume a sugar-like substance,” says Dr. Cayouette, “but with more education, they will realize that xylitol is a natural product that can help to prevent cavities.”

  Although xylitol is safe for humans, it is important to note that there is one population—a furry one—that cannot tolerate the sweetener. An article published in the February 2010 issue of AGD Impact reports that, even in small amounts, xylitol can be deadly to dogs. For this reason, it’s important to keep xylitol-containing products out of your canine’s reach.   Updated: August 2010

More than 1 million adults in the United States, mostly women in their postmenopausal years, are affected by a poorly understood and difficult-to-diagnose condition known as burning mouth syndrome (BMS).

 The chronic disorder is characterized by pain and a burning sensation in the lips, palate and tongue. It is sometimes accompanied by dry mouth, thirst, altered taste perception, changes in eating habits, irritability, depression and reduced desire to socialize and interact with others.

 ”People who have this condition are often very frustrated and in pain,” says Academy of General Dentistry spokesperson Trey Petty, DDS, FAGD.

Treatment of Burning Mouth Syndrome

Dr. Petty says the first goal in treatment of BMS is to make sure the symptoms are not due to a larger condition, such as anemia, leukemia, severe vitamin deficiency, undiagnosed diabetes or a fungal infection of the mouth. But these causes account for only 20 to 30 percent of those affected, says Dr. Petty. 

In 70 percent of those affected with BMS, in which a cause cannot be established, a dentist can help. First, the dentist may recommend chewing gum, sugarless mints or frequent drinks of water to relieve the discomfort of dry mouth. Second, antifungal medications sometimes provide relief, even when there are no visible signs of a yeast infection in the mouth.

“We’ve found that topical anesthetics don’t help much,” Dr. Petty says. “But we’ve found that getting people to use capsaicin, the natural chemical in cayenne pepper, often does help. Patients can have a pharmacy make up lozenges containing it, or it is available in a prescription cream.”

Patients use the cream on the tongue or under the denture. While it may be uncomfortable for the first couple of days, it often is found effective with continued use. Some experts think the chemical simply distracts the patient’s attention from the original pain, while others believe it actually alters the nerves sufficiently to decrease pain perception.

Other medications used to treat the disorder include antibacterials, analgesics, vitamin and mineral replacements, benzodiazepines, antihistamines and antidepressants. It is also thought that hormonal replacement may be another option.

Despite the mystery surrounding BMS, individuals with even minor symptoms should seek treatment to ensure that it is not a sign of a more serious condition.

Updated: October 2008

Osteoporosis, a disease that decreases bone density and weakens bones, affects 10 million people. In addition, more than one-third of females over age 65 display signs and symptoms of the disease.

Most individuals inflicted with osteoporosis are not diagnosed until a fracture occurs. In addition, they are unaware that oral-health problems, such as tooth loss and gum disease, are early signs that help their dentist to suspect osteoporosis, according to a report published in the May/June 2004 issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD).

Risk factors for the disease are: heredity, calcium deficiency, smoking, menopause, excessive caffeine or alcohol and an inactive lifestyle.

 As the disease progresses, the vertebral bones can become weakened, resulting in a curved backbone. Also, the other bones in the body, such as the hip, will become susceptible to fracture during normal everyday activities.

 ”Early osteoporosis signs can be seen in the mouth,” says report author Aida Chohayeb, DDS, MSD. “When the dentist observes that some teeth are loose, the gums are not attached to the teeth and that dentures do not fit well, dental X-rays will be taken to confirm the diagnosis. The X-rays will reveal the decrease in the density of the jawbone and bone around the teeth, as well as the remaining part of the jaws.”

 Then, the dentist would refer the patient to their physician to confirm the diagnosis its earliest stage.

 Patients with osteoporosis are encouraged to practice good oral hygiene, to maintain regular dental checkups for frequent dental cleanings, to consume calcium and vitamin D and to add weight training to their exercise regimen.

Prevent Osteoporosis 

• Consume calcium daily (1,000 to 1,200 milligrams)
• Exercise and weight train
• Add vitamin D to diet
• Quit smoking
• Decrease caffeine and alcohol intake
• Visit a dentist regularly

Updated: October 2008

The Centers for Disease Control report that nearly 25 million women are infected with some form of the Human Papilloma Virus (HPV).  Of those, more than three million are thought to have one of the four strains known to cause cases of cervical cancer and genital warts.

HPV is linked to oropharyngeal cancer and may be linked to oral cancers as well, and vaccines that have been developed to treat HPV might decrease the risk of these cancers, according to a study in the May/June issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD).

James J. Closmann, BS, DDS, the lead author of the study, found that oral and oropharyngeal squamous cell carcinoma (OOSCC) have been linked to high-risk HPV strains, the same strains that cause cervical cancer.

Recently, a vaccine was developed to treat patients with HPV against cervical cancer, and this could have an effect on women’s oral health.

“More than 100 strains of HPV have been identified,” says Dr. Closmann.  ”They have been shown to cause other benign and malignant disorders, which now include those in the mouth.  Nearly 30,000 new cases of oral and oropharyngeal cancer are reported each year.  It’s possible that oral and oropharyngeal cancers could be reduced if vaccination were more widespread; however, additional research is needed.”

Additional research could result in a comprehensive test for dentists at patients’ semiannual visits.  However, a dentist can perform a head and neck exam to detect early signs, despite the lack of a specific test. A possible connection between HPV and oral cancers, and the stronger link to oropharyngeal cancers, is even more of an indicator that patients should visit the dentist twice a year to identify irregularities early.

“Visiting the dentist on a regular basis is an important factor in the detection of any oral health complication,” says Laura Murcko, DMD, spokesperson for the AGD. “Taking preventive measures is especially important, and your dentist can check for early signs of oral cancer.”

 Updated: October 2008

It’s a myth that calcium is lost from a mother’s teeth and “one tooth is lost with every pregnancy.” But you may experience some changes in your oral health during pregnancy. The primary changes are due to a surge in hormones – particularly an increase in estrogen and progesterone –- can exaggerate the way gum tissues react to plaque.

 If the plaque isn’t removed, it can cause gingivitis – red, swollen, tender gums that are more likely to bleed. So-called “pregnancy gingivitis” affects most pregnant women to some degree, and generally begins to surface as early as the second month. If you already have gingivitis, the condition is likely to worsen during pregnancy. If untreated, gingivitis can lead to periodontitis, a more serious form of gum disease.

Pregnant women are also at risk for developing pregnancy tumors, inflammatory, non-cancerous growths that develop when swollen gums become irritated. Normally, the tumors are left alone and will usually shrink on their own after the baby’s birth. But if a tumor is uncomfortable and interferes with chewing, brushing or other oral hygiene procedures, the dentist may decide to remove it.

Updated: October 2008

Veneers are ultra-thin shells of ceramic (porcelain) or a composite resin material, which are bonded to the front of teeth. This procedure requires little or no anesthesia and can be the ideal choice for improving the appearance of the front teeth. Veneers are placed to mask discolorations, to brighten teeth and to improve a smile. 

Veneers are an excellent alternative to crowns in many situations. They provide a much more conservative approach to changing a tooth’s color, size or shape. Veneers can mask undesirable defects, such as teeth stained by tetracycline and damage due to an injury or as a result of a root-canal procedure. They are ideal for masking discolored fillings in front teeth. Patients with gaps between their front teeth or teeth that are chipped or worn may consider veneers. Generally, veneers will last for many years, and the technique has shown remarkable longevity when properly performed

If you experience frequent headaches and pain in your lower jaw, check your posture and consult your dentist about temporomandibular disorder (TMD), recommends the Academy of General Dentistry (AGD), an organization of general dentists dedicated to continuing dental education. 

Poor posture places the spine in a position that causes stress to the jaw joint. When people slouch or hunch over, the lower jaw shifts forward, causing the upper and lower teeth to not fit together properly, and the skull moves back on the spinal column. 

This movement puts stress on muscles, joints and bones and, if left untreated, can create pain and inflammation in muscles and joints when the mouth opens and closes. 

“Good posture is important, yet many people don’t realize how posture affects their oral health,” says AGD spokesperson Ludwig Leibsohn, DDS. 

Dr. Leibsohn treats patients who have complained of facial pain. “Their posture often is unbalanced, and this rearranges the position of the facial muscles, causing the bumps and grooves on the upper and lower teeth not to fit properly together,” said Dr. Leibsohn. 

An oral appliance can help align the teeth in a position that will reduce facial pain caused by poor posture. The appliance can also prevent future damage to teeth. 

Updated: March 2007

Oral piercing can cause pain, swelling, infection, drooling, taste loss, scarring, chipped teeth and tooth loss. Most dentists discourage oral piercing because of these risks. 

Regulations vary in each state, so be careful if you decide to get any kind of piercing. Make sure that you ask the person performing the piercing about care after the piercing, possible side effects, cleanliness and anything that may concern you. If they are not prepared to answer your questions in a clear, professional manner, go somewhere else. 

Chipped teeth  

Fractured teeth are a common problem for people with oral piercings. People chip teeth on tongue piercings while eating, sleeping, talking and simply chewing on the jewelry. The fracture can be confined to the enamel of your tooth or may go deep into your tooth, which may require a root canal or extraction. 

Swelling  

It is not unusual for the tongue to swell after being punctured, but in some cases the tongue swells so much that it can cut off your breathing. In rare cases, doctors may pass a breathing tube through a patient’s nose until the swelling subsides. 

Infection  

The tongue is covered with bacteria, so any infection can be serious. See your dentist at the first sign of a problem. Dentists are learning that oral infections can lead to infections in other parts of the body. Your mouth has high levels of bacteria. When you puncture any part of the oral cavity, these bacteria may find its way into your bloodstream. Bacteria can reach your heart and cause a variety of health problems. 

There is also a risk of contracting blood-borne infections such as human immunodeficiency virus (HIV) and hepatitis. Ask the person performing the piercing what they do to prevent the spread of these serious infections. Does the piercer use a fresh needle for every piercing? Some may reuse needles to keep down the cost of the piercing. Make sure they completely sterilize all needles and instruments in an autoclave, which uses extreme heat to sanitize instruments.

Allergic reactions   

Make sure that the piercer uses the right kind of metal, such as surgical-grade stainless steel. Some people have allergic reactions to certain metals, which can lead to further complications.

How do I maintain my piercing?  

Once your tongue has been pierced, it will take four to six weeks to heal. The piercer will place a larger, starter ‘barbell’ in your tongue to give it enough room to heal when your tongue swells. If you decide to keep the piercing, make sure to get a smaller barbell after the swelling goes down, which will be less likely to get in the way of your teeth and more difficult for you to chew on.

Barring complications, you will be able to remove the jewelry for short periods of time without the hole closing. Some suggest that you remove the jewelry to protect your teeth every time you eat or sleep. Some parlors sell plugs that you can place in the hole, which should allow you to remove the jewelry for as long as necessary. 

Keep it clean  

Keep your piercing clean. Use an antiseptic mouthwash after every meal and brush the jewelry the same as you would your teeth. After the tongue has healed, take the piercing out every night and brush it as you would your teeth to remove any unseen plaque. Consider removing the piercing before eating, sleeping or strenuous activity.

The average person swallows 2,000 times per day, causing the upper and lower teeth to come together and push against the skull. People who have a poorly aligned bite or missing teeth can have related health problems, such as frequent headaches or sleep disorders, because their jaw muscles must work harder to bring the teeth together, straining the surrounding jaw muscles. 

This strain, know as orofacial pain, is defined as any pain in or around the face. Some people may experience pain in the ears, eyes, sinuses, cheeks or side of the head, while other experience clicking when moving the jaw. 

Orofacial pain can also be caused by temporomandibular disorder (TMD), stress, nerve disorders or muscle spasms. Serious causes of orofacial pain are tumors in the jaw bone area, oral cancer or referred pain from cardiac disease. 

“At the first sign of discomfort, see your general dentist,” says Academy of General Dentistry spokesperson Peter G. Bastian, DDS, MAGD. “He or she knows your mouth best and how you handle day-to-day stress.” 

Sometimes orofacial pain may be difficult to diagnose if its origin is not localized in one area. 

“Your dentist will try to diagnose the pain source by conducting tests to rule out a cracked tooth, the need for root canal, gum disease, clenching or tooth grinding,” says Dr. Bastian. These factors can cause discomfort in the facial region but can be easily addressed.” 

Orofacial pain that lasts longer than 10 days to two weeks or is not related to a specific stressful event, such as a car accident, may signal a more serious problem requiring additional tests. 

Common symptoms of orofacial pain:  

• Pain behind the eyes
• Sore jaw muscles
• Teeth grinding
• Clicking or popping of joints
• Head/scalp painful to the touch
• Earaches or ringing
• Neck, shoulder or back pain
• Dizziness

Updated: February 2007