Pregnancy & Dental Hygiene
October 26, 2018
Pregnancy gingivitis is extremely common and occurs in 30-100% of pregnant women. Many women will notice that their gums are sore, swollen and bleed more easily than usual. If a woman has gum disease prior to pregnancy, chances are, pregnancy is going to make the gum disease worse. Pregnancy hormones have a lot to do with it. Progesterone has been linked to higher concentrations of certain oral bacteria. Another effect of progesterone is increased blood flow, which is why you may notice your gums are swollen and bleed. The immune response is also suppressed during pregnancy, which also contributes to inflammation of the gums. We recommend routine cleanings during pregnancy, because maintaining good oral hygiene is the best way to control these changes and prevent any complications.
We recommend deep cleanings (also known as scaling and root planing) for patients who are past gingivitis and now have periodontal disease, or periodontitis. Periodontal disease is when there is inflammation of the gums, like in gingivitis, but with some degree of bone loss around the teeth. A deep cleaning goes further below the gums than a typical cleaning to get rid of any plaque, bacteria, and infected portions of the gums. The roots of the teeth are also smoothed to prevent plaque and bacteria from adhering to the surface and causing further bone loss. Because it can be a little uncomfortable, most patients will receive local anesthetic. Some patients will also receive local or systemic antibiotics to help control the levels of bacteria.
Ideally, pregnant women with periodontal disease should have deep cleanings done early in the second trimester. Due to some studies demonstrating a relationship between untreated periodontal disease and preterm, low-birth-weight infants, we will consult with a patient's OB/GYN and may treat moderate to severe cases regardless of the stage of pregnancy.
We do not recommend any elective dental procedures during pregnancy. With the exception of infections or abscesses, anything that can wait, should.
March 30, 2018
Now, that we're offering Botox, I thought it would be a good idea to include a blog post about why we're choosing to offer it, things to consider when looking for a provider, some common misconceptions, and other things you should know. Although people don't often think of dentists as providers of Botox or fillers, there are many reasons why dentists are qualified specialists. We are highly trained in facial anatomy and understand the connections between musculature, bony structures, and innervation. Working in a world of millimeters, we are very precise and have an eye for detail. Administering anesthetic day in and day out, we are more than proficient at giving injections. A lot of our work is also cosmetically driven, and improving someone's smile sometimes includes more than just teeth. There are also new applications for Botox, including TMJ therapy and fixing gummy smiles, which are very particular to dentistry. These dental applications are why we chose to offer Botox to begin with, but we knew that our patients would love if we could get rid of their wrinkles too!
When choosing a doctor for Botox, make sure they have medical training in facial anatomy. While Botox is safe for most people, a good doctor will review your medical history with you and ask you about any medications, vitamins or supplements you are taking. They should also take the time to listen to what your concerns and goals are, take photos, and discuss their recommendations with you. Instructions for what to do after you receive Botox injections should be clear, and any potential side effects or complications should be discussed. Botox is the most popular brand of Botulinum Toxin, but there are others on the market. Make sure you know which one you're getting, as each has its own side effects. Most doctors will want to to see you for a follow-up visit after 7-10 days. Because Botox takes a few days to see effects, you may need additional Botox at that time. Avoid any doctors who promise to erase or reverse wrinkles.
Photographs are an important tool for making a plan of where and how much Botox to give. We evaluate your face while contracting muscles (eyebrows raised, smiling, frowning, squinting) to see the extent of muscle activity as well as location and depth of wrinkles. Older patients won't necessarily need more Botox, but will need more subsequent Botox treatments to achieve results similar to younger patients. It's harder to correct 60 years of frowning than it is to correct 30! Someone with stronger or more active facial muscles or larger foreheads will need more units of Botox. Men, for example, will usually require more. We also check for any asymmetries that can be corrected with Botox.
One common misconception is that Botox is only for older adults with wrinkles. While we would never tell a 20-year-old that they should have Botox, it is preventative in nature. By paralyzing the muscles, they will not be activated when making certain facial expressions. No muscle movement, no wrinkles! There are also some new studies that show other benefits like reduced headaches and treatment of depression. The theory is that if we're unable to make sad or angry faces, there's a feedback mechanism that subsequently improves our mood.
Botox only lasts for 3-4 months, so treatment should be repeated to get the desired effects. Some people will find that after several treatments, they've become so used to not using their muscles, that they require fewer treatments or less Botox overall.
Dental Hygiene During Braces
January 19, 2018
Having braces predisposes patients to enlarged and inflamed gums and cavities both around the brackets and in between teeth. That's why you'll sometimes notice white spots on teeth after braces are removed. Just having braces makes its harder to keep the gums clean because there are so many more surfaces to brush and floss around. If plaque is allowed to build up around the brackets, it creates an acidic environment that eats away at the teeth and causes those white spots, which can be permanent. To keep your teeth healthy and clean while in braces, here are some tips:
- Brush with an electric toothbrush - an electric toothbrush is easier to use and more effective at reaching under the gums and between the teeth
- Don't forget the fluoride - using a toothpaste with fluoride can help prevent cavities and white spots. In addition, a mouthrinse with fluoride in it can also be helpful
- Floss & floss threaders - since the archwire gets in the way of regular flossing, it's important to use a floss threader to get underneath and floss all the way up to your gums. Although it takes longer, but it's worth it
- Interproximal brushes - there's a bunch of different ones on the market and they're great for cleaning chunks of debris from in between braces. They're also small enough to take on the go so you can clean up after eating
- Don't skip orthodontic or cleaning appointments! The longer you're in braces, the longer you have to brush and floss around them! Also, when you get your wire changed, it gives you an opportunity to brush and floss really well. Your dentist and dental hygienist can make sure you're not missing any spots.
Foods to Avoid During the Holidays
November 14, 2017
With Thanksgiving coming up next week and Christmas and Hannukah right behind it, our teeth are probably among the last thing on our minds. But making good decisions on which food and drinks to imbibe in and keeping up good oral hygiene will help maintain a healthy smile into the new year. Here are a few of the things I try to avoid during the holiday season.
Hard, sticky candy that you could just suck on, but always gets to a point where you give up and just eat the rest i.e. candy canes, ribbon candy, peanut brittle. Unless I have my dental instruments handy, I tend to avoid these. They tend to stick like crazy in the grooves of molars, where you're most likely to have cavities.
Just plain sticky candy like dots and jujubes. While great for decorating gingerbread houses, they're awful for your teeth. Similar to the hard, sticky candy that you have option to suck on, you have really no option but to chew them. The excessive chewing it takes for these things (longer if they're from a stale gingerbread house) also can lead to some temporomandibular joint (TMJ) pain. For a candy that doesn't even taste that good, it's just not worth it.
Mixed nuts. While typically not the sole cause for a broken tooth (there's usually an underlying cavity or really big filling), I see a lot of patients who break teeth while "just eating nuts". As long as you're avoiding accidentally chomping down on shells, you should be fine. I hope everyone knows better than to substitute their own mouth for a nutcracker.
Overly sugary drinks. There's nothing better than a hot chocolate with marshmallows on a cold day but drinking them throughout the day or sipping spiked eggnog throughout an entire holiday party creates a lengthy exposure of teeth to sugar. I try to alternate with water or choose less sugary beverages.
Staining drinks like red and mulled wines. Here and there is okay, but just as with sugary drinks, duration is important. Sticking to red wines for an evening will have a more staining effect on teeth than just having one. If I'm not able to brush my teeth after, I make sure to have water to minimize the damage.
How Electric Toothbrushes Work
October 4, 2017
Here at Village Dental, we recommend electric toothbrushes to all of our patients based on the current scientific literature. Electric toothbrushes designed to mimic a back and forth brushing technique were invented in 1939 and have come a long way since then.
Now, electric toothbrushes can have all sorts of motions including oscillating and rotating motions, and many use low-frequency acoustic energy. Like manual toothbrushes, electric toothbrushes remove plaque biofilm through direct contact between the bristles and teeth. The low-frequency acoustic energy provides the additional benefit of generating dynamic fluid movement that cleans slightly beyond the bristles. This is the major advantage over manual toothbrushes. Traditionally, people aren't great at cleaning between the teeth. We know toothbrush bristles can't reach in between the teeth, and so we leave that job entirely up to floss. The hydrodynamic shear forces created by the bristles can actually reach and remove interproximal plaque biofilm (some, but not all. There's still an important place for floss), as well as some plaque underneath the gums. The vibrations also interfere with bacterial adherence to oral surfaces. Several studies comparing electric toothbrushes to manual toothbrushes demonstrate a significant decrease in plaque and gingivitis.
There is also the aspect of improving the ease of oral hygiene. Most patients that switch to an electric toothbrush end up preferring it. And most include a 2 minute timer to ensure that patients are brushing for long enough, as many underestimate how long 2 minutes actually is. While they can be beneficial to everyone, they're especially great for children and teens, those with physical or mental disabilities, hospitalized patients who need their teeth cleaned by caregivers, and patients with braces.
We offer the Philips Sonicare DiamondClean in our office as well as brush heads, but there are many other electric toothbrushes on the market that work great. No matter which one you use, make sure you're changing your brush head every three months.
June 29, 2017
A common concern for many jof our patients is the shade of their teeth. Lately, I've been seeing a lot of DIY teeth whitening methods popping up, in large part due to YouTube. When considering whether a "white teeth hack" is something you want to try, I think it's important to ask whether there is adequate research to support it, what the potential damage is, and are there better alternatives. Here are some the ones I've been seeing and have been asked about lately.
-Charcoal: No research that I can find on it as a teeth whitening product. My concern is that the abrasiveness can cause irreversible damage by removing enamel. Once the enamel is gone, teeth are more prone to sensitivity, cavities, and the darker layer below enamel, dentin, will show through more, making the teeth appear less white. Enamel does not grow back and the only way to "replace" it is with a restoration, like white filling material or porcelain. Not to mention the mess it will likely make in your bathroom. The only positive I can see coming from it is making people brush their teeth so it doesn't look like they just ate charcoal.
-Oil Pulling: Again, limited research, which is a bit of a relief. I have a hard enough time convincing patients to floss for a minute a day, let alone trying to convince someone to swish coconut oil around for 20 minutes. If you're dying to incorporate swishing liquids in your mouth into your daily routine, there are plenty of ADA approved rinses, many of which are advertised as whitening rinses. While I don't necessarily think oil pulling is harmful, there are case reports of diarrhea and upset stomach. So pull with caution.
-Fruits like strawberries, oranges, and lemons: While natural and healthy for eating, exposing your teeth to citric acid wears away enamel and I wouldn't recommend it
-Baking soda & hydrogen peroxide: This is a DIY method I would actually approve of in moderation. Making a paste of baking soda & hydrogen peroxide (2 parts hydrogen peroxide to 1 part baking soda), you can brush it onto teeth. Baking soda has some whitening effects and is just abrasive enough to get rid of surface stains, allowing the hydrogen peroxide, the most common ingredient in whitening products, to penetrate and whiten teeth. I would be concerned with doing this every day, but I think a couple times a week is a cheap, easy way to improve your smile at home.
Ultimately the best way to whiten teeth are with the tried and true methods of preventing stains by avoiding things like coffee, tea, red wine, smoking. I love coffee and red wine too much to give them up for the sake of white teeth, so I try to brush my teeth after, or at least drink water or chew gum so that the staining agents don't sit on my teeth. Regular brushing and flossing will also get rid of food particles and bacteria that will cause staining the longer they stay on your teeth. There are plenty of good over-the-counter whitening products including toothpastes, gels, and strips. The American Dental Association just approved Crest 3D White Whitestrips Glamorous White, making it the first over-the-counter whitening to be approved by the ADA. We also offer profession at-home and in-office whitening products that will safely and effectively whiten your teeth. Check out the whitening section of our website or call us to know more!