After being so serious for a while it is time to lighten up for a moment.
People are funny creatures. You can tell all sorts of tales of them and their funny ways. This time I will tell you about people’s creativity when they put a blame on so many other things than their own indolence when it comes to oral hygiene routines.
I’ve collected a list of the answers we get to two of the very common questions we ask. Let’s see if you recognise yourself?
So Are You Using Your Electric Toothbrush?
lost in a house move
it’s still in an unpacked box after a house move (moved a year ago)
it’s still in an unopened box after buying it a year ago
out of battery and haven’t got around to charge it
it’s malfunctioning
can’t find brush heads from the shops
I don’t have a plug-in in the toilet
it makes me feel dizzy
it’s too vigorous.. I’m nervous about loosing a filling
dropped it and it broke
the manual toothbrush is quicker
the manual toothbrush is easier to use
it takes too long
it’s too noisy.. I’m afraid of waking up the kids/wife/neighbour/partner
I don’t like the feeling in my head
it tickles too much
it makes my gums bleed
it hurts
the bristles feel too hard
don’t have batteries in the house (battery operated electric toothbrush)
How About Are You Cleaning Between The Teeth?
too difficult
too tired
floss gets stuck/shreds
my gums bleed
I lost a filling once
it hurts
my teeth are so close together that the floss/interdental brush/toothpick is impossible to use
I use a mouthwash instead
I use the water pick
I rinse with water after every meal
I use chewing gum
my gaps between the teeth are so wide that nothing gets stuck there
I push the bristles of the toothbrush between the teeth
I use a toothpaste that says it cleans between the teeth
I run out of floss/interdental brushes/toothpick (last year) and never got round to buy new ones
can’t be bothered
it makes the gaps between my teeth wider
I don’t have time for it
don’t know which one to use
is it harmful?
is it needed? I never see anything coming out when I floss
The reason I chose this topic for my next post is that I was reading a dental blog that gave homemade teeth whitening tips to people. I’m sure the intention was good when they listed all known household items than can whiten the teeth. You see people love to get self-help tips on their health – especially on their teeth to avoid seeing the dentist. But dental professionals should know better not to advice certain things as they can very quickly cause permanent damage to the teeth.
(This is a reminder for all of us not to believe everything you read from the net especially regarding your health)
Stains
There are two types of stains on your teeth. Surface stains and deep stains.
Surface stains build up from coffee, tea, red wine, smoking and certain spices, mouthwashes and vitamin supplements (iron in a liquid form).
Deep stains are those that will make the natural colour of your teeth (which you will see after scale and polish when the surface stains have been removed) yellower. The older you get the yellower the teeth will get (or have you seen elderly people with pearly white teeth? If you have they are false).
So what will damage your teeth? I will tell you. Starting from the worst. But at first for clarification
I will not give any instructions on how to use these substances
it won’t be a comprehensive list of the substances that is advised to use for teeth whitening purposes but a list of most common ones
Whitening Toothpaste
There are normally two types of whitening toothpastes. Toothpastes with increased abrasivity (normally all most common brands’ whitening toothpastes e.g. Crest, Golgate, Arm&Hammer) have high RDA level (higher than RDA 100) and if used regularly, it can lead to toothwear. This toothwear is permanent. I never advice anyone to use these toothpastes on regular basis.
Safer types of whitening toothpastes are the ones that do not have high RDA level but are based on papain enzyme which whitens the teeth. Examples of these toothpastes are brand Youtuel (RDA 40) and Glodent. When I used Youtuel for the first time somewhat 20 years ago, it was impressive how well it removed surface stains.
If you are interested to read a study about papain enzyme as whitening ingredient, click here.
Lemon
Would you love to get white teeth with practically no money spent at all (as you get the lemons anyway for cooking etc) plus super sensitive teeth and eroded enamel to go with the deal? Yes? Use lemon.
An advice to use lemon for teeth whitening isn’t under any circumstance acceptable by a dental professional. Lemon is highly acidic fruit and can erode the teeth when used regularly. Erosion will result in sensitive teeth. Imagine if you already have thinned enamel for any reason and you start to use lemon for whitening purposes. You will soon find out it wasn’t a wise move as your teeth will become so sensitive to the cold that even breathing through your mouth hurts. Also the thin enamel will make you more prone to decay.
In 2005 BBC had to apologise publicly for a lemon tooth whitening tip when one of its programmes recommended lemon as a money saver to families. I happened to watch this programme and couldn’t believe what I was seeing. Thank goodness British Dental Health Foundation soon found out about the programme as well and complained to the BBC.
I’m not convinced that the apology reached everyone who watched the programme.
Strawberry and Baking Soda
Now combination of these two used daily for longer period of time will damage your enamel. Baking soda works as abrasive and strawberry as an acid. A very bad combination.
Safe frequency of use is once a week.
Baking Soda
It is slightly abrasive to teeth and can damage the teeth especially if used with vigorous brushing technique.
Do not use baking soda if you have braces. It can soften the glue.
Salt
Salt crystals can scratch the enamel. Make sure to let the salt dissolve in the water before using it (kinda looses the point of using it, doesn’t it?).
Hydrogen Peroxide
Hydrogen Peroxide is the only known substance that removes deep stains. It doesn’t remove the surface stains so scaling and polishing is normally needed prior the whitening.
There are products over the counter (OTC) that contains hydrogen peroxide but these should be used under a supervision of a dentist as the excessive use of hydrogen peroxide will weaken the enamel permanently.
After Words
If you cause damage to your enamel by these abrasive or acidic home whitening products, it will be permanent. Thin enamel not only make the teeth sensitive to cold and prone to decay but it also makes the teeth look darker or yellower in colour. The dentin under the enamel is more yellow than the enamel and it will start to show through when the enamel gets thinner.
Important facts to remember
you can never ever change the natural colour of your tooth by lemon, baking soda, strawberry, whitening toothpastes etc. You may be able to remove the stains from the surface of the tooth but not the actual colour that is different with every individual
you should never replace fluoride toothpaste with any of the above means. Thinning of the enamel together with lack of fluoride will speed up sensitivity and decaying
all the means of whitening the teeth will result in damage of the enamel at certain level
any of the whitening products do not whiten fillings or crowns
the surface stains will carry on building up after the whitening if you carry on smoking and drinking coffee/tea/red wine. Also the new whitened natural colour of your teeth (whitened by hydrogen peroxide) will little by little get more yellow for the same lifestyle reasons
An impartial information about the risks of teeth whitening is almost impossible to find. The internet is full of practices advertising themselves and saying it’s all fine and dandy to do the whitening. So be cautious!
If you are interested in reading reliable article click here.
Be careful next time you open your mouth in the bus. I might be sitting next to you.
Many people have gum disease without knowing it and it often comes as surprise when they are told about it at the dentist. Even bigger surprise would be if they knew how many dentists do not recognise the gum disease or know what a comprehensive treatment is for it.
I have seen countless amounts of patients in my career whose gum disease has gone undetected. It’s astounding! I’ve had patients who have visited the hygienist and the dentist every six months but still there is massive amounts of subgingival calculus around every teeth. And it is deep and tough to remove.
Just guess the surprise of the patient when instead of having a 15 minute check-up and 30 minute hygienist visit like normally, she will now need three 60 minute visits to remove the calculus thoroughly and a 4th visit in three months time. To be honest, this upsets me often. It’s not that difficult to diagnose the gum disease. It’s not rocket science for crying out loud!
I have spent way too many hours explaining why my colleagues have not noticed the gum disease. And my efforts for not sounding too annoyed at my fellow professionals sometimes fail miserably. Luckily, most of the patients take it relatively easy and do not demand compensation from the previous dentist. Instead they are normally very grateful that somebody caught the condition.
There will be information for professionals next but the patients benefit of reading it too. If you are a patient you can move on to the end of this post if you want to skip the professional part.
So Why Don’t You Recognise the Gum Disease?
There are five probable reasons (add more to the comment box if you wish).
Lack of time. In 15 minute check-up the dentist should go through the medical history of the patient, check the teeth (loose fillings, decay, fractures etc.), the soft tissues (inside the cheeks, tongue, lips, roof and floor of the mouth and the throat) and the gums. Plus there might be need for the x-rays. Fifteen minutes simply is not enough for this considering that the disinfection business before the next patient should be done as well. Even 30 minute appointment might not be enough.
The X-factor. By X I mean money and it is related to the time issue. Dental practices have 15 minute check-ups because instead of having two patients in an hour that pay X amount for the visit they can have four. Four times X is better than two times X. At least for the practice.
Lack of basic skills. We have an instrument which finds any gum disease from any patients mouth when used correctly. Or when used. It is not by default that this instrument, perio probe finds it’s way to the check-up tray. I have seen dentist doing the check-up by using the sharp explorer only. And even if the perio probe is used, it is used incorrectly and the gum disease goes undetected. Even a gum specialist (periodontist) has failed at this and I will tell you more about it later in this post.
Lack of experience. When you are an experienced dental professional (either a dentist with a great interest in the gum disease or a hygienist) you can recognise gum disease from a distance. I will give you an example.
You sit in a bus on your way home and somebody sits next to you. He yawns and 3 seconds later your nose detects an odour you rather not smell on your free time. Periodontitis (aka gum disease)! Thank goodness the bus has a good ventilation and the odour is soon gone and you hope he keeps his mouth closed for the rest of the journey. Then the guy’s phone rings and it’s his mother…
I can often recognise the gum disease by just looking at the patients mouth. The gums have a certain look on the sites of the pockets. Even if there is only one deep pocket in a healthy mouth, you can spot it out by the looks of the gum. It is difficult to explain how they look so I won’t even try. Anyone experienced know what I mean. The point is that the more you examine the gums and find the sites where the deep pockets, subgingival calculus and gingivitis (bleeding of the gums) are, the more you learn to tell what looks normal and what doesn’t.
But do not worry if you are a newbie. Just learn to use the perio probe correctly and you will be fine!
Forgetting how smoking hides the gum disease. Heavy smoking can make the gum disease invisible to the eye and often the dentists and hygienists are misled by the looks of the heavy smoker’s gums especially if the oral hygiene is good at that very moment. Heavy smoker’s gums look healthy and pale. There’s no sign of the red and swollen gums. No sign of the bleeding after probing. And yet the disease is there.
Even if the gum disease is not visible to the eye with the smoker, it is still there for the perio probe to find but with the smokers you really need to master the technique. Often the smokers gum line is very tight and it is difficult to find access to the pocket (once you do, don’t let it out until you have probed the whole side of the tooth).
Use of the Periodontal Probe
When I was at dental school learning the arts of the dentistry, one of our teachers (a periodontist) said one day annoyingly “They didn’t even know how to use a perio probe!” At that moment we were practicing scaling in the school’s clinic but this outburst was not addressed to us students (thank god as the teacher was scary as hell) but to a group of dental hygienists who had come to revise perio skills at the dental school. This one sentence has stayed in my memory for some reason and only until now I understand what she meant and why she was so annoyed.
Not only the hygienists fail in the technique of the perio probe but also the dentists and even the periodontists. I will tell you about one periodontist who saw one of my patient.
I had referred the patient to the specialist with all the relevant documentation (x-rays, perio chart etc). When I saw the patient 6 months later a course of treatment was finished with the periodontist. I examined the patient’s gums and found a 10 mm pocket on one of the molars. The depth was the same as before referring. The patient told me she was going to have a control visit soon with the periodontist so I wrote letter about the persistent pocket.
Three months later I saw the patient again and nothing was done to it. A periodontist had said to the patient that there is no pocket.
No pocket! I’m going to show you the pocket!
I took my DSLR and put a perio probe into the pocket and fired away. The patient got the photo on cd and gave it to the periodontist on the next visit. I’m afraid my story ends there. I never saw this patient again as she got retired and was not able to see me as we were too expensive.
Ten millimetres deep pocket and it went unnoticed by the specialist even when the location was pointed out. What chances do the rest of us less-educated ones have if the one wearing the black belt in our industry is not able to do it?
Note to all dental professionals who examine patients gums: Please check your perio probe technique. There are plenty of information about the use of the perio probe on the internet plus hands on courses at the dental schools. And those who are not using a perio probe, shame on and start now!
What Is the Gum Disease?
I won’t go much into details about the gum disease but I will tell you the warning signs when you should visit your dentist:
your gums bleed when brushing/flossing/eating or they bleed spontaneously
your gums hurt when brushing/flossing/eating
your teeth have become longer over the years or they have tilted/rotated/moved
your teeth feel loose
you have wider gaps between the teeth than before
somebody has told you often that your breath smells. Gum disease doesn’t always produce bad breath especially in the early stages. It is the advanced periodontitis when the smell can be obvious to everyone else except to the bearer. But how many of you tell the other person that their breath stinks? Not many, unless it is your spouse in concern
The gum disease is always caused by the bacteria in your mouth. When the bacteria is removed effectively and regularly the chances for you getting a gum disease are minimal. But even if you are looking after the teeth well (brushing thoroughly twice a day and cleaning between the teeth once a day with a product that was recommended by the hygienist) go to see your dentist if:
If the gum disease is left untreated it will result in loss of tooth. It is also associated with certain illnesses so your general health is to be concerned as well.
The gum disease is treated by simply removing the bacteria (both soft bacteria, plaque and hardened bacteria, calculus) and teaching the patient the correct techniques for removing the soft bacteria regularly by themselves.
Anyone can start better oral hygiene routine at home without seeing a dentist. Getting rid of the daily build up of bacteria effectively may cure the gum disease. This means brushing twice a day with electric toothbrush and cleaning between the teeth preferably with something else than a floss (floss is better than nothing of course). You could try Gum Soft Picks at first. Aim to the size that feels slightly tight between the teeth.
But remember, you are not able to remove the hardened plaque (calculus). Also if the calculus has build up below the gum, you will need to see dentist (for an assessment) and hygienist (for scaling) to stop the gum disease progressing.
A revelation:
There is no easy way out of the gum disease. It will most probably hurt like hell and the gum will bleed (in some cases heavily) in the beginning when you brush and clean between the teeth. If you at this point stop e.g. using an interdental brush that was recommended to you or you use it every second night because you think you are harming the gums, the gums will keep on bleeding and hurting. You will never get out of the vicious cycle. So persevere, be brave and have a faith on us professionals.
Sometimes if the gum disease has advanced to severe stage, you might need surgery on your gums (performed by the periodontist).
Dental Revelations 