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We have all heard the phrases: “Brush your teeth” and “Floss your teeth”. But, how many times a day should we brush and floss? How long should we brush and floss? Electric toothbrush or manual toothbrush? Do I need to brush every day? Here are the answers to those questions. In general: -Floss once a day (I prefer to floss before I brush, others may disagree, but I don’t think order matters as much as actually flossing) -Brush with fluoride toothpaste. Ideally, for 2 minutes, 2 times a day - in the morning and before you go to bed at night. If you can only manage 1x a day, make sure it is before you go to bed. But really, 2x a day is better. -Use a tongue scraper to remove the bacteria on your tongue. This really, really helps with bad breathe! -If possible, use an electric toothbrush. They really are better than manual toothbrushes! I prefer the Oral B (which I’ll explain why in a later post) but in general the brand isn’t as important as using an electric toothbrush over a manual toothbrush. If you prefer a manual brush, make sure it is a soft or extra soft bristle brush and do not aggressively scrub your teeth which can cause gum recession and sensitivity. Simple! Some special circumstances that can alter the above guidelines If you have periodontal disease (gum disease): add a mouthwash like Listerine with essential oils or a prescription mouthwash like chlorhexidine gluconate (name brand peridex). Be wary of mouth washes in general. Many of the over the counter mouthwashes are flavored water and aren’t helping you. I will do a post in the future on mouthwash to clarify this. I would also consider using a waterpik, which are really helpful in cleaning deeper “pockets” and larger areas in between teeth that develop with periodontal disease. If you have dry mouth or get a lot of cavities: Same as the general instructions, but you can use a prescription toothpaste (like prevident), which provides more protection against cavities, or you can use a fluoride mouthwash like ACT (this is the name brand, any fluoride rinse will help). Again, be wary of mouthwashes in general and check the ingredients. People with dry mouth need fluoride because dry mouth causes an increased risk for large cavities. I just had a patient with severe dry mouth that had been buying a special kind of dry mouth rinse for months. She was still getting cavities regularly, and brought in the mouthwash for me to check out. Wouldn’t you know, even though it was marketed as the #1 mouth wash for dry mouth it didn’t have any fluoride!!! It was basically water. Make sure the mouth wash you use to relieve your dry mouth has fluoride in it. If you are someone with spaces in between your teeth where food easily gets packed, you can use helpful tools like plastic tooth picks such as soft-picks and/or a waterpik. These can be more effective then floss at cleaning the larger spaces.
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The goals of brushing and flossing daily are:
1. To remove left over food and drink particles that feed the bacteria living in your mouth 2. To reduce the overall bacterial load (the amount of bacteria) in your mouth 3. To reduce inflammation Teeth, and your mouth in general, have lots of little nooks and crannies where food and bacteria can get trapped. That’s why thoroughly brushing and flossing daily is important. For example, I was at my friend’s house watching her children while she was getting ready to go out. We were talking while she was getting ready and she started to brush her teeth. I watched as she put the toothpaste on her brush, turned on the electric toothbrush and “brushed” her teeth for 2 minutes. Great! Except, as I watched her, she was talking the entire time and only successfully brushed her lower left teeth, barely touching her top teeth or the teeth on her lower right side. Soooooo…….that 2 minutes of brushing was basically for nothing. She definitely won’t get cavities on her lower left side, but the rest of her mouth is toast! The point of this example is not to judge my friend’s brushing ability. It’s to demonstrate the importance of taking a moment, even when you’re in a hurry, to think about how you’re cleaning your teeth. My friend went through the motions correctly on the surface, and if she were to get cavities I can understand why she might think “But I brush my teeth every day!”. The point isn’t just to go through the motions, but to actually make sure you’re thoroughly cleaning all the surfaces of your teeth. Next time you brush, take a moment during that 2 minutes (which can seem like a really longtime) and pay attention to where you’re brushing and make sure you’re adequately cleaning all of your teeth. Not just your favorite ones! Previously we examined why your jaw bone is so important. Now I’m going to explain how to easily prevent bone loss and maintain that foundation.
Top ways to prevent bone loss 1. Save your teeth! 2. Brush your teeth 2x a day for 2 minutes 3. Floss or waterpik or use gum picks daily (or as many times a week as you can) 4. Wear a night guard! 5. Go to the dentist regularly 6. Don’t smoke 7. Don’t get in any accidents! Easy! Now a little further explanation of the above: 1. Set an intention to save your teeth. You don’t need to save all 32 of your adult teeth, but set an intention to make saving your teeth important. Having teeth to support gives your jaw bone a job and keeps your bone from shrinking. In an upcoming post, I’ll explain your different teeth (molars versus front teeth), explain their different functions, and provide a practical guide to which teeth to save and replace when you need to lose them and why. 2. Brush your teeth 2x a day for 2 minutes. Cavities and periodontal disease (aka inflammation and bone loss) is caused by bacteria. If that bacteria is removed effectively, then those things can’t happen. You don’t need to be perfect and brush 10 times a day. In a future post I’ll get more into brushing, however, here’s the gist of it - you need to remove leftover food and bacteria from your mouth. Sticking your toothbrush in your mouth for 20 sec. twice a day isn’t as effective as brushing for 2 solid minutes before you go to bed at night. Why? Because it’s not really about how MANY times you brush your teeth in a day, but how thoroughly you remove the grime. 3. Floss, waterpik, and/or gum pick daily (or as many times a week as you can). Again, this goes back to effectively removing the grime. Whichever method you use doesn’t really matter, what matters most is removing the leftover food and drink particles and the bad bacteria that use them as fuel to destroy your teeth. 4. Wear a night guard! Almost everyone subconsciously grinds and/or clenches their teeth while sleeping and wearing a night guard is a fabulous way to preserve your teeth and save them from wearing down over time. I wear one every night, again a future post will explain this more in depth. But remember back to my post about how amazing your mouth is, and I explained the masseter (which is in your cheeks and allows you to chew your food) is the strongest muscle based on weight in the body. If you clench or grind your teeth at night you’ll eventually wear down your teeth and potentially your jaw bone. It is impossible to stop because we do it unconsciously in our sleep therefore, you have to prevent the damage with a night guard. 5. Go to the dentist regularly. If you start when you’re young, (other than accidents or rare diseases) there’s no need for you to have a problem maintaining your jaw bone. Getting your teeth cleaned regularly is so important because it removes bacteria and decreases inflammation that causes the breakdown of your bone. Also, it removes the bacteria that causes cavities that can cause you to lose your teeth. When you were young, if you didn’t do a good job brushing your teeth or going to the dentist that’s ok, don’t feel bad, it’s the past, move on and set an intention to start now. Better late than never. 6. Smoking is very bad for gums. It causes inflammation and greatly contributes to periodontal disease. You can read more about the effects of smoking and your mouth here at the CDC. 7. Don’t get into any accidents….that’s so easy. Good luck! In my last post, I explained my priorities as a dentist when I’m examining a patient. Some people were surprised to learn that your actual teeth are lower on my priority list then maintaining the bone structure of your jaws. When most people think dentist they think teeth. Dentists need to do a better job explaining why maintaining your jaw bone is so important. I’m not here to scare you, I’m here to educate you. I still remember where I was the day I learned maintaining structure of your jaw bone was so critical to living a high quality life. The reason I still remember is because it made such an impact on me. As I’ve mentioned before, your jaw bones greatly determine your facial structure, they hold your teeth in place. And, if you don’t have teeth, the more bone you have the better foundation you’ll have to rebuild your teeth, whether it’s with implants or dentures. Did you know that bone needs a job to maintain itself? Like, when you have cast on your arm or your leg and then you have it removed and that body part is much skinner then it was before. That’s because you weren’t using all the muscles and bones while it was in the cast and they start to break down. Your teeth give your jaw bone a job. If you don’t have teeth your jaw bone starts to shrink. Also, periodontal disease, aka inflammation and bacteria break down your jaw bone and it is virtually impossible to get it back. Did you know that if you need implants or dentures the more jaw bone you have the better those will work? Here are some examples to show you the importance of maintaining your jaw bones.  This patient came to my office because they were having pain with their dentures when they eat. The teeth you see are this person’s denture teeth. The yellow line outlines their jaw bone. The red circles shows where their inferior alveolar nerve leaves their jaw bone to send nerves to their lips. The green line is there to indicated how much height of bone this person has. Now compare the yellow, red and green lines to the next person. 
What a difference!!! See where your nerve is supposed to be?! The reason the person on the top was having pain when they ate was because they were literally chewing their denture on to their inferior alveolar nerve. OUCH! Imagine trying to build something on foundation of the top jaw. There isn’t enough structure of bone to maintain implants, to hold teeth, or even hold dentures still enough to eat comfortably. This person would need to undergo major surgeries to regain enough bone to build anything solid in their mouth so they could chew their food correctly. I’m not sharing this example to scare you, I’m sharing it to educate you on the importance of maintaining bone. There’s no need to start having anxiety about losing all your jaw bone, because it can be prevented. Next post I’ll explain how you can prevent bone loss. Growing up, I went to the dentist for a few reasons. First, I didn’t have a choice, my parents made me go. Second, my dad was a dentist, again no choice. Third, I wanted white teeth when I smiled and I didn’t want to have stinky breathe. Now that I’m a dentist, I have a completely different appreciation for regular dental visits. I have a greater appreciation for the complexity of my mouth and all that’s being accomplished during a regular old dental appointment. To give you a better understanding I’m going to list my priorities as a dentist when a patient comes to see me.
My priorities as a dentist are very closely intertwined, but if I had to put them in order of importance it would be this: 1. Making sure your mouth is free of any signs of oral cancer 2. Making sure your mouth is free from active infections 3. Maintaining the bone structure of your upper and lower jaws because this is the foundation of everything 4. Making sure your gums are healthy 5. And finally……………. making sure your teeth are healthy Wait, your teeth are last on my priority list????? What? Well, for me your actual teeth are the lowest on my priority list. Please don’t misunderstand, your teeth are still a HUGE priority, however they’re lower on the list because……….I know I can fix your teeth. Oral cancer, I wouldn’t wish on anyone. Infections need to be handled and treated appropriately so they don’t poorly affect your overall health. Having and maintaining as much jaw bone as possible is paramount. Your jaw bones are the foundation for everything to do with your mouth. They give you your facial structure, they hold your teeth in place. And, if you don’t have teeth, the more bone you have the better foundation you’ll have to rebuild your teeth, whether it’s with implants or dentures. Gum health directly relates to maintaining your bone. If your gums are unhealthy you are losing bone. And bone is everything! If you don’t have enough bone you can’t have teeth and you can’t rebuild teeth. Luckily, we have amazing ways to maintain and fix your teeth. And in the end, if you need to lose a tooth you have a variety of replacement options. So while most people equate the dentist with teeth and only teeth. It’s about so much more. Who knew your mouth was so complex?! When I first started dental school I didn’t, in fact, it still surprises me at least once a week how amazing our mouths are and how much is going on in there. You have teeth, gums, a tongue, bone, muscles, joints, nerves, arteries, and it’s the gateway to your entire body. Stop for a moment and think about how many times a day you use your mouth, and for the variety of tasks you ask it to perform. It allows you to eat food which gives you the energy you need to feed your body and sustain your life. You use it to speak. It expresses your emotions. You use it to kiss your loved ones. It truly is amazing!!!! Did you know, according to the Library of Congress that of the seven strongest muscles in the body two are in/associated with your mouth. The 2 muscles are the masseter and the tongue. In fact, the masseter which is in your cheeks and allows you to chew your food, is the strongest muscle based on weight in the body. (You can check out more about the masseter muscle here.) So going to the dentist isn’t just about your teeth. It’s about your entire mouth and your overall health. Your mouth needs to be maintained in order to allow you to use all of its amazing functions for your lifetime. My dental philosophy is that your overall health is most important. Therefore, the most important part of my day is the oral cancer screening exams I complete on my patients. Followed by making sure there aren’t any active infections in your mouth that could be releasing bacteria to your entire body. So to simplify, your mouth is AWESOME! Give it the love it deserves! Best /best/ adj. 1. Of the most excellent, effective or desirable type or quality.
What is the BEST dentistry? And where can you get it? These two questions are important, and lucky for you, easily answered. What is the best dentistry and where can you get it? At my office of course! Wink, wink. Completely kidding, I swear. Seriously, I’m totally kidding. So what’s the answer? The best dentistry you can ever receive is……. No dentistry. Want even better news? Where can you get the best dentistry? You don’t need to go searching for it. You already have it, you were born with it (in most cases, excluding rare genetic and development influences). Wait, What?!. Did a dentist just say the best dentistry is no dentistry? Yep, I did. But let me clarify. When I say dentistry, what I’m talking about is irreversible work a dentist does to your teeth like fillings, crowns, root canals, implants, periodontal surgery. I’m not talking about preventative care like regular cleanings, fluoride treatments, sealants, having braces to align your teeth in better positions for cleaning. Is all this work needed, absolutely! Many dentists around the world, including myself, do this work daily because there is such a need. But, the point I’m trying to make is most of us (all but a very small percentage) are born with the best. Naturally. We are extremely lucky in this country to have access to amazing dental technology. We can even replace individual teeth now with dental implants (I have one!). But hands down nothing is as good as your original teeth. Every time a tooth gets a filling or a crown or has a root canal it gets weaker from a loss of natural tooth structure. Also, everything has a life, everything breaks down. Meaning, once you have a filling, that filling will breakdown in the future. It will need to be replaced. Your crown will eventually breakdown, as well as your root canal, your implant, and all dental work will need to be replaced in the future. This leads to a cycle of needing work and then replacing that work once it starts to break down. Again, this work is vital to keeping our teeth for a long time, and it’s inevitable that at some point in your life you will probably need some dental work. But less is more. If you can delay your first filling until you’re 22, as opposed to 7, then you’re buying longevity of your natural teeth and pushing out the eventual breakdown even further. None of our fillings or crowns or even implants are as good as natural teeth. It gets better, we know how and can prevent the need for ever needing dental work. If, at starting from a young age, you visit the dentist for regular cleanings, expose your teeth to the recommended amount of fluoride, get sealants and brush your teeth daily we can almost guarantee you will not need extensive dental work throughout your life. The less dental work you need throughout your life because your teeth and mouth are healthy, the better for your teeth, the better for your overall health, and the better for your wallet. In the following posts, I’m going to clarify the different parts of our mouths, talk about their importance, and explain how you can preserve those amazing natural teeth we're given for free! The purpose of this blog is to........you guessed it........simplify dentistry so people without a dental degree can have a better understanding of their mouth, teeth, and dentistry in general. Even though I grew up with a dentist for a father, and I attended fours years of dental school, many dental topics didn't make sense until I witnessed them everyday in my practice. In today's world, we're bombarded by information. So much information, and so much junk information, it can be hard to sift through the bulk and focus on what's important. My goal is to help quiet the noise and give useful, practical information to improve your dental life which will help improve your total life. Everyday patients ask me questions like: "Why do I need to replace that tooth?" or "My tooth doesn't hurt, why do I need to fix it?". Often when I'm asked these questions, I want to say well.......it would take a two year course with hours of instruction and reading to answer your question, but I'll try to explain it in 10 minutes. Over my years of practice, I've come to the conclusion that if patients understood why their dentist was recommending various needed (not elective) treatments they would say yes almost 100% of the time. The purpose of this blog is to do that, to simplify dentistry so everyone can understand it.
If you have a dental question, or a question about the dental profession in general, you can email me at [email protected] and those questions will influence the topics I present here. Obviously, I cannot diagnose anyone's individual dental problem through an email. This is not meant to be a replacement for your dentist. People are unique. Each tooth is unique. Because of those two facts, it makes it virtually impossible to diagnose through email so I won't be answering any of those individual treatment questions. However, if you have a question about fluoride I can answer that......how about silver versus white fillings? How often should people get their teeth cleaned? So feel free to ask. I look forward to hearing from you. |
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