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