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Preventive Dentistry & Sealants

Charlotte Dentist Dr. Brian A. McMurtry and his staff's main focus is prevention. If disease can be prevented in the first place, there is no need for treatment.

Preventive services offered in our office include:

Exams, including oral cancer screenings


Oral Hygiene Instruction


Fluoride treatments

SDF, Silver Diamine Fluoride - to help stop decay in its tracks

Nutrition and Diet Analysis

Tobacco counseling

Mouthguard fabrication

Please click on any of the "+" marks on the left to expand the prevention topics listed below.

[] The Importance of Oral Health to Overall Health

Oral health means more than just an attractive smile. Poor oral health and untreated oral diseases and conditions can have a significant impact on quality of life. And in many cases, the condition of the mouth mirrors the condition of the body as a whole. Recent reports indicate a relationship between periodontal (gum) disease and stroke, heart disease and preterm low-birth-weight babies. Likewise, more than 90 percent of all systemic diseases have oral manifestations, meaning your dentist may be the first health care provider to diagnose a health problem.

What problems can poor oral health cause?

According to the Surgeon General's report on oral health in America, released in 2000, a large percentage of the population suffers from a reduced quality of life due to oral and facial pain. This pain is largely due to infections of the gums that can lead to tooth loss. More than 75 percent of the population is affected by some type of gum disease.

Reports show that infections in the mouth can affect major organs. For example, oral bacteria can travel through the bloodstream to the heart, where they can cause bacterial endocarditis, a condition in which the lining of the heart and heart valves become inflamed. Poor mouth care also can contribute to oral cancer. In addition, poor oral health affects the digestive process, which begins with physical and chemical activities in the mouth.

What symptoms of other diseases show up in the mouth?

Mouth tissues reflect symptoms of other problems throughout the body. In addition, many diseases can be diagnosed in their early stages through an oral examination. These diseases may be characterized by swollen or bleeding gums, mouth ulcers or dry mouth. Some of these diseases include diabetes, leukemia, cancer, heart disease and kidney disease.

What can I do to maintain my oral and overall health?

Seeing a dentist every six months can help identify diseases in their earliest stages. It also is important to provide your dentist with a complete medical history and to inform him or her of any recent problems, even if they seem unrelated to your mouth.

A regular exam allows your dentist to keep your mouth in tip-top shape and watch for developments that may point to problems elsewhere in your body. A dental exam also picks up on poor nutrition and hygiene, growth and development problems and improper jaw alignment. Your dentist can also provide counseling on special oral health care needs, such as tobacco cessation.

[] How Can Gum Disease Affect My Cardiovascular Health?

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.

How does gum disease affect my cardiovascular health?

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.

What should I do to protect my heart and arteries?

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.

[] What Is Fluoride?

Fluoride is a compound of the element fluorine, which is found universally throughout nature in water, soil, air and food. Existing abundantly in living tissue as an ion, fluoride is absorbed easily into tooth enamel, especially in children's growing teeth. Once teeth are developed, fluoride makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before the damage is even visible. Two forms of fluoride protect the teeth: systemic fluoride and topical fluoride.

What is systemic fluoride?

Systemic fluoride is ingested into the body when added to public and private water supplies, soft drinks and teas and is available in dietary supplement form. Once systemic fluoride is absorbed via the gastrointestinal tract, the blood supply distributes it throughout the entire body. Most fluoride not excreted is deposited in bones and hard tissues like teeth.

What's topical fluoride, and when should I use it?

Topical fluoride is applied directly to the teeth. It is found in products containing strong concentrations of fluoride to fight tooth decay, such as toothpastes and mouth rinses. These products are then expectorated or rinsed from the mouth without swallowing. Dentists recommend brushing with a fluoride toothpaste at least twice a day or after every meal, combined with a regimen of flossing and regular dental checkups.

Professionally administered topical fluorides such as gels or varnishes are applied by a dentist and left on for about four minutes, usually during a cleaning treatment. For patients with a high risk of cavities, the dentist may prescribe a special gel for daily home use, to be applied with or without a mouth tray for up to six weeks.

Why is most of the water we drink fluoridated?

Fluoridated water protects against cavities and root caries – a progressive erosion of adult root surfaces caused by gum recession – and helps remineralize early carious lesions. Thanks to these preventive benefits, public water fluoridation is considered the most efficient and cost-effective cavity prevention measure available. More than 144 million United States residents in more than 10,000 communities drink fluoridated water, most from public water supplies with artificially added fluoride. A small percentage get water from private wells with naturally fluoridated water.

The Environmental Protection Agency (EPA) has determined that the accepted "optimal" range of fluoride in water lies between 0.7 and 1.2 parts per million (ppm) or milligram per liter. The limit allowed by the EPA in public water is 4 ppm. Backed by results from more than 140 documented studies undertaken in 20 different countries over the past several decades, fluoridated water adhering to these standards has been scientifically established as safe for drinking. Water fluoridation is endorsed by nearly every major health and safety-related organization. Fluoridation of community water supplies is the single most effective public-health measure to prevent tooth decay and to improve oral health for a lifetime.

Are children more sensitive to fluoride?

Developing teeth are sensitive to higher fluoride levels. In young children, excess fluoride intake can cause dental fluorosis, a harmless cosmetic discoloring or mottling of the enamel, visible as chalky white specks and lines or pitted and brown stained enamel on developing teeth. They are at greater risk if they swallow or use too much toothpaste and fluoride supplements or regularly drink water containing excessive fluoride levels.

Parents should monitor the use of toothpaste, mouth rinses or other topical fluoride supplements in young children, checking with a dentist on proper dosage. If you are concerned about the fluoride levels in your drinking water, call the local public water department or your water supplier. If the source is a private well, request a fluoride content analysis taken via a water sample through your local or county health department.

[] What is a Sealant?

A dental sealant is a thin plastic film painted on the chewing surfaces of teeth to prevent cavities.

How effective are sealants?

Studies have proven that properly applied sealants are 100-percent effective in protecting the tooth surfaces from cavities. As long as the sealant remains intact, small food particles and bacteria that cause cavities cannot penetrate through or around a sealant. Sealant protection is reduced or lost when part or all of the bond between the tooth and sealant is broken. However, clinical studies have shown that teeth that have lost sealants are no more susceptible to tooth decay than teeth that were never sealed.

How are sealants applied?

A cleaning solution is applied to the surface of the tooth, including the pits and grooves. After 15 seconds, the solution is thoroughly rinsed away with water. After the site is dried, the sealant material is applied and allowed to harden, sometimes by using a special curing light. Sealant treatment is painless and takes anywhere from five to 45 minutes to apply, depending on how many teeth need to be sealed. Sealants must be applied properly for good retention.

How long will a sealant last?

Sealants should last five years, but can last as long as 10 years. One study reported that seven years after application, an impressive 49 percent of treated teeth were still completely covered. Sealants should not be considered permanent. Regular dental checkups are necessary to monitor the sealants' bond to the tooth.

Who should receive sealant treatment?

Children, because they have newly erupted, permanent teeth, receive the greatest benefit from sealants. The chewing surfaces of a child's teeth are most susceptible to cavities. Surveys show that the majority of all cavities occur in the narrow pits and grooves of a child's newly erupted teeth because food particles and bacteria cannot be cleaned out. Other patients also can benefit from sealant placement, such as those who have existing pits and grooves susceptible to decay. Research has shown that almost everybody has a 95-percent chance of eventually experiencing cavities in the pits and grooves of their teeth.

Are sealants covered by insurance?

Insurance benefits for sealant procedures have increased considerably, especially as companies start to realize that sealants are a proven preventive technique. This preventive measure can help reduce future dental expenses and protect the teeth from more aggressive forms of treatment.

[] Dental Sealants: Is My Child a Candidate?

By age 19, tooth decay affects nearly 70 percent of America's children, according to the Centers for Disease Control and Prevention (CDC). Left untreated, tooth decay, also known as cavities, may result in pain and infection.

One highly effective option to help prevent cavities is dental sealants – a thin plastic film painted on the chewing surface of teeth.

Dental sealants have been proven a safe and cost-efficient dental procedure for patients prone to cavities. Even health care task forces are recognizing the benefits of dental sealants, recommending school-based programs.

However, an article in the February 2006 issue of AGD Impact, the Academy of General Dentistry's (AGD) monthly newsmagazine, cites several reports that explain dental sealants are still underused, despite their advantages in averting tooth decay for an average of five to seven years.

"Studies show that many children are exceptional candidates for dental sealants.," says AGD spokesperson Mark Ritz, DDS, MAGD. "Parents should consider sealants as a preventive measure in their child's oral health and discuss this option with their dentist."

Surveys show the majority of all cavities occur in the narrow pits and grooves of a child's newly erupted teeth because food particles and bacteria are not easily cleaned out. A risk assessment by a dentist best determines if a child is a candidate for dental sealants.

Dental sealants act as a barrier to "seal-off" space between the tooth surface and any small food particles or bacteria that may otherwise cause a cavity in an "unsealed" tooth.

Paired with twice-daily brushing with a fluoridated toothpaste, a healthy diet and visiting the dentist twice a year to monitor the sealants' placement or bond on the tooth, properly applied dental sealants are 100-percent effective in preventing cavities.

"Remember that dental sealants do not protect against gum disease such as gingivitis, oral cancer or many common dental conditions," says Dr. Ritz. "Regular dental checkups are vital to monitor overall oral health."

Benefits of dental sealants:

  • Paired with good oral health care, sealants are 100-percent effective against cavities in teeth that are sealed and properly maintained.
  • Minimally invasive, safe and effective preventive procedure.
  • Costs less than getting a cavity filled.

[] Oral Cancer Screening: An Important Part of Your Dental Visit

The next time you visit your dentist, ask about your oral cancer screening – most people receive one during their regular dental checkup but do not realize it.

The dentist checks about 10 places inside and around the mouth, looking for lumps or irregular tissue changes.

Every year, 35,000 Americans are diagnosed with oral cancer, which accounts for roughly 7,500 deaths each year. "If detected early, oral cancer can be cured," says Academy of General Dentistry spokesperson Fred Magaziner, DDS, "That is why many dentists make this a part of their routine dental examination for their patients."

"Often, patients don't realize the exam is being conducted because it is a quick, comfortable addition to the patient’s regular dental checkup," notes Dr. Magaziner.

Oral cancer is typically painless in its early stages and often goes unnoticed by the patient until it spreads, leading to chronic pain and sometimes loss of function before it is diagnosed. In its later stages, oral cancer can lead to surgery and facial and oral disfigurement. Surgery can include removal of a portion of the tongue and jaw.

Dr. Magaziner recommends that people also conduct a self-examination to look for the signs of oral cancer, which can include any of the following:

  • A sore that persists longer than two weeks
  • A swelling, growth or sore spot in or around the mouth or neck
  • White or red patches in the mouth or on the lips
  • Repeated bleeding from the mouth or throat
  • Difficulty swallowing
  • Persistent hoarseness

[] What is Oral Cancer?

Oral cancer is one of the most common cancers, with roughly 35,000 new cases reported annually in the United States. The vast majority of oral cancers occur in people older than 50 years, with men being twice as likely as women to develop the disease. The most frequent oral cancer sites are the tongue, the floor of the mouth and soft palate tissues in back of the tongue, lips and gums. If not diagnosed and treated in its early stages, oral cancer can spread, leading to chronic pain, loss of function, irreparable facial and oral disfigurement following surgery and even death. Your dentist can perform a thorough screening for oral cancer.

What causes oral cancer?

Scientists aren't sure of the exact cause of oral cancer. However, the carcinogens in tobacco products and alcohol, as well as excessive exposure to the sun, have been found to increase the risk of developing oral cancer.

What are the warning signs?

Oral cancer – represented by red, white or discolored lesions, patches or lumps in or around the mouth – is typically painless in its early stages. As the malignant cancer spreads and destroys healthy oral tissue, the lesions or lumps become more painful. However, oral cancer is sometimes difficult to self-diagnose, so routine dental exams are recommended. See your dentist immediately if you observe: any sore that persists longer than two weeks; a swelling, growth or lump anywhere in or about the mouth or neck; white or red patches in the mouth or on the lips; repeated bleeding from the mouth or throat; difficulty swallowing or persistent hoarseness.

How does a dentist screen for oral cancer?

Your dentist should screen for oral cancer during routine checkups. He or she feels for lumps or irregular tissue changes in your neck, head, cheeks and oral cavity and thoroughly examines the soft tissues in your mouth, specifically looking for any sores or discolored tissues.

How is oral cancer treated?

If your dentist suspects oral cancer, a biopsy of the lesion is required to confirm the diagnosis. Surgery is required to remove the tumors, which may cause disfiguration. Radiation therapy and chemotherapy may be used as part of the treatment.

What can I do to prevent oral cancer?

You can help prevent oral cancer by not smoking, using spit tobacco or drinking excessive alcohol. The risk of oral cancer is 15 times higher in those who both smoke and drink compared to non-users of tobacco and alcohol products. Research suggests that eating plenty of fruits and vegetables may safeguard against oral cancer. Because successful treatment and rehabilitation are dependent on early detection, it is extremely important to regularly check your mouth for changes in appearance and see your dentist for an oral cancer screening and regular checkup at least every six months. Survival rates greatly increase the earlier oral cancer is discovered and treated. During your next dental visit, ask your dentist to do an oral cancer screening.

What do dentists recommend to help stop smoking?

Your dentist can recommend a step-by-step program tailored to your needs or prescribe a nicotine patch in combination with a cessation program. Talk to your dentist about the options suited to your dependency. Your dentist will work with you and your physician and have a consultation to determine your needs.

[] Under 30? Check for Oral Cancer

In the past decade, the dental profession has seen a considerable increase in the number of oral cancer patients under age 30 who have no identifiable risk factors of contracting the disease, such as tobacco or alcohol use, according to an article in the December 2002 issue of AGD Impact, the monthly newsmagazine of the Academy of General Dentistry (AGD).

Although national surveys show that the U.S. adult population is ill-informed about the risk factors of developing oral cancers, as well as its signs and symptoms, most dentists perform oral cancer exams.

"Patients under age 30 need to speak to their dentist if they are not receiving oral-cancer exams, or if they believe they are candidates for oral cancer," says AGD spokesperson Howard S. Glazer, DDS, FAGD.

"The dentist will check the head, neck and mouth for signs of oral cancer and will take swift action if oral cancer is found. Dentists must screen patients who have risk factors and those who do not, since 25 percent of oral cancer patients have none," says Dr. Glazer.

The most frequent sites for oral cancer are the tongue, the floor of the mouth, tissues in back of the tongue, lips and gums. If not diagnosed and treated in its early stages, oral cancer can spread, leading to chronic pain, loss of function, irreparable facial and oral disfigurement following surgery and even death.

In its earliest and treatable stages, oral cancer can appear as a tiny white or red spots that you may not notice. Only your dentist can uncover these painless spots and test them to be certain they are not cancerous. Advanced signs of oral cancer include a swelling, growth or lump anywhere in or about the mouth or neck, repeated bleeding from the mouth or throat and difficulty swallowing or persistent hoarseness.

How to prevent oral cancer:

  • See a dentist twice a year.
  • Ask your dentist to perform an oral cancer exam and to evaluate abnormalities.
  • Quit smoking, using spit tobacco and drinking excessive alcohol.
  • Eat plenty of fruits and vegetables.
  • Perform a self-exam – look for anything abnormal under or on the tongue and in the cheek and lip areas
  • If a sore doesn't go away within two weeks, tell your dentist.

[] Why Are My Teeth Sensitive?

Tooth sensitivity is caused by the movement of fluid within tiny tubes located in the dentin (the layer of tissue found beneath the hard enamel that contains the inner pulp), which results in nerve irritation. When the hard enamel is worn down or gums have receded, causing the tiny tube surfaces to be exposed, pain can be caused by eating or drinking food and hot or cold beverages; touching your teeth or exposing them to cold air.


Exposed areas of the tooth can cause pain and even affect or change your eating, drinking and breathing habits. Taking a spoonful of ice cream, for example, can be a painful experience for people with sensitive teeth. The excessive consumption of acid-containing foods and beverages such as citrus juices and fruits and soft drinks can also put you at risk for tooth sensitivity. Bulimia and acid reflux can also result in erosion of the hard enamel and sensitivity due to acid in the mouth.


Is tooth sensitivity a common condition?


Tooth sensitivity is one of the most common complaints among dental patients. At least 40 million adults in the United States suffer at some time from sensitive teeth.


How can I avoid sensitivity?


Some toothpastes contain abrasive ingredients that may be too harsh for people who have sensitive teeth. Ingredients found in some whitening toothpastes that lighten and/or remove certain stains from enamel, and sodium pyrophosphate, the key ingredient in tartar-control toothpastes, may increase tooth sensitivity.


What can I do about sensitive teeth?


Tooth sensitivity can be reduced by using a desensitizing toothpaste, applying sealants and other desensitizing and filling materials, including fluoride, by your dentist and decreasing the intake of acid-containing foods. Tartar-control toothpastes will sometimes cause teeth to be sensitive as well as drinking soft drinks throughout the day, so these habits should be avoided.


Avoid using hard-bristled toothbrushes and brushing your teeth too hard, which can wear down the tooth's surface and expose sensitive spots. The way to find out if you're brushing your teeth too hard is to take a good look at your toothbrush. If the bristles are pointing in multiple directions, you're brushing too hard.


How do I know when it's time to see a dentist?


If a tooth is highly sensitive for more than three or four days and reacts to hot and cold temperatures, it's best to get a diagnostic evaluation from your dentist to determine the extent of the problem. Before taking the situation into your own hands, an accurate diagnosis of tooth sensitivity is essential for effective treatment to eliminate pain. Because pain symptoms can be similar, some people might think that a tooth is sensitive, when instead, they actually have a cavity or abscess that's not yet visible.


How do I describe my symptoms to my dentist?


Sensitivity may be defined as a short, sharp pain, which is usually initiated by eating hot or cold foods or exposure to cold air. Aching often follows. Because sensitivity may mean different things to a patient and dental professional, be sure to clarify exactly what you feel when you discuss the condition with your dentist. Be sure to tell the dentist when the pain started and if there is anything, such as the application of a warm compress, that helps eliminate the pain.


Do some products help decrease sensitivity?


Toothpastes for sensitive teeth usually contain a desensitizing agent that protects the exposed dentin by blocking the tubes in the teeth that are connected to nerves. In most cases, these products must be used on a regular basis for at least a month before any therapeutic benefits may be noticed.


What can the dentist do for my sensitive teeth?


Dentists have a variety of regimens to manage tooth hypersensitivity, including both in-office treatments and patient-applied products for home use. If you are diagnosed with dentin hypersensitivity, your dentist may apply a desensitizing agent or a protective coating. You may be prescribed a stannous fluoride gel or an over-the-counter desensitizing toothpaste containing fluoride and either potassium nitrate or strontium chloride. These ingredients help block transmission of sensation from the tooth to the nerve. It also might help to massage the special paste onto your gums with your finger after brushing.


What should I do after the dentist has applied a desensitizing agent?


Listen closely to your dentist's instructions. He or she may advise you not to eat or drink for a short period of time, to eliminate all sources of irritation, such as acidic foods or medication or flavored toothpastes. You may also be instructed to change oral hygiene habits that are likely to cause abrasion or use a daily fluoride application (a rinse or brush-on gel).


[] Sensitive Teeth? Check Your Toothpaste?

Some patients may experience tooth sensitivity when using tartar-control toothpaste, but the good news is that when they stop using the toothpaste, the sensitivity goes away.


"Dentists and hygienists often recommend that patients use tartar-control toothpaste, particularly after a cleaning, to help prevent the build-up of tartar, which can lead to gum disease," says Academy of General Dentistry spokesperson William Kuttler, DDS. "But after using tartar-control toothpaste, about 10 to 20 percent of patients complain of tooth sensitivity, so we suggest they stop using it."


"For those with tooth sensitivity, the recommendation is to avoid tartar-control toothpaste and use a regular fluoride toothpaste instead," says Dr. Kuttler. "But for those who do not have sensitivity, tartar-control toothpaste tremendously reduces the build-up of tartar. However, check with your dentist. You may not need a tartar-control paste."


Ingredients found in some whitening toothpastes can also result in tooth sensitivity, which affects approximately 40 million adults in the United States.

[] Wear Sunglasses? You May Have Sensitive Teeth

If you avoid bright light, loud noises, heavy perfumes and itchy clothing, you may find that you avoid hot and cold foods because you have sensitive teeth.


A study that appears in the November/December 2002 issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD), confirms that people with sensitivities of sight, hearing, taste, smell or touch also have sensitive teeth. Lead author Norman C. Bitter, DDS, FAGD, studied 47 patients with sensitive teeth and found a direct relationship between the two, with one of the most notable findings being that all patients expressed a need to wear sunglasses when outdoors, helping to confirm this connection.


Tooth sensitivity is caused by the movement of fluid in tiny tubes located in the tissue found underneath the hard enamel that contains the inner pulp. Hot and cold beverages, grinding or clenching teeth or brushing too hard can irritate the tubes and increase sensitivity.


At least 40 million Americans suffer from tooth sensitivity. Although patients cannot control sensitivity, they can take proactive steps to decrease or even alleviate the pain. "Try over-the-counter products such as specially formulated toothpaste for sensitive teeth and drinking tea, which has tannic acid, to temporarily reduce pain," suggests Dr. Bitter.


The tannic acid in tea clogs the material in the exposed dental tubes, which means hot and cold temperatures will have a harder time seeping in and hitting the pulp of the tooth, which is what triggers the pain.


Often patients with tooth sensitivity are afraid to visit the dentist and feel this condition may lead to a root canal or tooth loss. "There's no need to worry," advises AGD spokesperson David Tecosky, DDS, MAGD. "Sensitivity is a common problem that can be dealt with easily as long as you talk to your dentist."

[] Leisurely Cigar Puffs Have Hidden Risks
Viewed as a glamorous luxury by many men and women, cigars are promoted by everyone from sports superstars to top movie stars to upscale clothing stores and clubs. U.S. consumers lit up 5.1 billion cigars in 2005, and sales continue to rise. As cigar connoisseurs are leisurely puffing, they fail to realize that their habit not only hurts their health and smiles but also is addictive and may be more dangerous than cigarettes.
And cigar smoking is not just a habit of older men, but increasingly, of women and teens. The U.S. Centers for Disease Control and Prevention (CDC) reports 14 percent of high-school students are cigar smokers.

"Cigars provide a false sense of security because many people think that they are a safe alternative to cigarettes," says E. "Mac" Edington, DDS, MAGD, and past president of the Academy of General Dentistry (AGD). "Cigars can have up to 40 times the nicotine and tar found in cigarettes."


Dentists are patients' first line of defense against the adverse effects of tobacco use and nicotine addiction stemming from cigars, cigarettes and spit tobacco. Dentists routinely screen for oral cancer and can help patients with tobacco cessation programs.


"Cigars are marketed as an upscale habit of the wealthy," says Robert Mecklenburg, DDS, MPH, dental coordinator, Smoking and Tobacco Control Program of the National Cancer Institute. "They are portrayed as being related to having money, sophistication and an important social image of which people want to be a part. And kids are aware of what adults partake in."


"People think smoking occasional cigars is fine, but smoking cigars increases nicotine levels in the body," says Dr. Mecklenburg. "And an increase in nicotine means an increase in dependence. In addition, tobacco carcinogens place them at risk of mouth and throat cancer."


Other facts about cigar smoking:


  • Cigar smokers often have badly stained teeth and chronic bad breath.
  • Cancer death rates among men who smoke cigars are up to 40 percent higher than among non-smokers.

[] Is Spit Tobacco Safe?

Spit tobacco affects your dental health as well as the rest of your body. If you use spit (smokeless) tobacco and have thought about quitting, your dentist can help.  


What is spit tobacco?


Spit tobacco includes snuff, a finely ground version of processed tobacco, and chewing tobacco in the form of shredded or pressed bricks and cakes, called plugs, or rope-like strands called twists. Users "pinch" or "dip" tobacco and place a wad in their cheek or between their lower lip and gums.


Isn't it safer than smoking?


Absolutely not. Some wrongly believe that spit tobacco is safer than smoking cigarettes. But spit tobacco is more addictive because it contains higher levels of nicotine than cigarettes and can be harder to quit than cigarettes. One can of snuff delivers as much nicotine as 80 cigarettes.


About 440,000 Americans die every year from various types of tobacco use. The majority of these deaths are from oral cancer. Other cancers caused by tobacco include cancer of the pancreas, nasal cavity, urinary tract, esophagus, pharynx, larynx, intestines and the stomach. Long-term spit tobacco users have a much greater risk of developing oral cancer than non-users, and spit tobacco users are more likely to become cigarette smokers.


Research has revealed an increase in middle-school and high-school students using spit tobacco. Almost 10 percent of high-school students report using spit tobacco. Many boys begin to use spit tobacco when they become involved in sports, particularly baseball, thinking it will improve their performance. Yet scientific evidence shows this is false.


How does spit tobacco harm my dental health?


It causes bad breath, discolors teeth and promotes tooth decay that leads to tooth loss. Spit tobacco users have a decreased sense of smell and taste, and they are at greater risk of developing cavities. The grit in snuff eats away at gums, exposing tooth roots, which are sensitive to hot and cold temperatures and can be painful. The sugar in spit tobacco further contributes to decay. Spit tobacco users also have a hard time getting their teeth clean.


What about mouth sores?


The most common sign of possible cancer in smokeless tobacco users is leukoplakia, a white, scaly patch or lesion inside the mouth or lips, common among many spit tobacco users. Red sores are also a warning sign of cancer. Often, signs of precancerous lesions are undetectable. Dentists can diagnose and treat such cases before the condition develops into oral cancer. If a white or red sore appears and doesn't heal, see your dentist immediately for a test to see if it's precancerous. Spit tobacco users also should see their dentist every three months, to make sure a problem doesn't develop. Studies have found that 60 to 78 percent of daily users of spit tobacco have oral lesions.


How do you kick the habit?


Your dentist can help you kick your spit tobacco habit. In addition to cleaning teeth and treating bad breath and puffy, swollen gums associated with tobacco use, your dentist may prescribe a variety of nicotine replacement therapies, such as a transdermal nicotine patch or chewing gum. Nicotine patches are worn for 24 hours over several weeks, supplying a steady flow of nicotine. Over the course of treatment the amount of nicotine in the patch decreases. Nicotine gum is slowly chewed every one to two hours. Each piece should be discarded after 20 to 30 minutes. 


Make the following goals to quit and never resume chewing or dipping:


  • Pick a date and taper use as the date nears. Instead of using spit tobacco, carry substitutes like gum, hard candy and sunflower seeds.
  • Cut back on when and where you dip and chew. Let friends and family know that you're quitting and solicit their support. If they dip and chew, ask them not to do it around you.
  • Make a list of three situations in which you're most likely to dip and chew, and make every effort to avoid using tobacco at those times.
  • Switch to a lower nicotine brand to help cut down your dose.

[] How Many Teeth Are in That Cigarette Pack?

A one-pack-a-day smoking habit can cost you the loss of at least two teeth every 10 years, reports the Academy of General Dentistry (AGD).


Smokers are about twice as likely to lose their teeth than non-smokers, according to the results of two separate 30-year studies that investigated the relationship between smoking and tooth loss among males and females at Tufts University in Boston.


In one study, 495 healthy men had their teeth examined every three years. The men were divided into three groups: those who never used tobacco products, those who continuously smoked and those who smoked at the beginning of the study but later quit. Smokers lost an average of 2.9 teeth after 10 years of smoking one pack a day, while non-smokers lost an average of 1.3 teeth after 10 years. In men who quit, the tooth loss was 2.4 teeth after 10 years of smoking one pack a day, and this decreased to 1.7 lost teeth after they quit.


"The good news is that the risk of tooth loss decreases after you quit smoking," says AGD spokesdentist Fred Magaziner, DDS, MAGD. "But the bad news is that the risk of tooth loss was still higher among the quitters than among those who never smoked."


Another study at Tufts University, which looked at 583 healthy postmenopausal women, and found that female smokers were twice as likely to lose one or more teeth every 10 years than non-smokers, and that the risk of losing teeth decreases among women who quit smoking.


"The bottom line is that smoking leads to periodontal (gum) disease, which leads to tooth loss," says Dr. Magaziner. "Smoking causes a chain of events in the mouth that eventually leads to tooth loss. The chain starts with plaque build-up on teeth, which is linked to tartar build-up (an even harder, yuckier substance on the teeth), which can cause gingivitis. From there, you step up to periodontal disease, and the final destination is tooth loss."


The chain can be broken by brushing and flossing regularly and by stopping the use of tobacco.


What a puff!


If you start smoking at age 18 and smoke one pack a day, how many teeth will you lose by the time you are 35 years old?


Answer: Between four and five teeth. The Academy of General Dentistry reports tooth loss due to smoking at the rate of 2.9 teeth every 10 years for men and 1.5 teeth every 10 years for women.

[] How to Keep Your Teeth for a Lifetime

It's a common myth that senior citizens are destined to lose their teeth, reports the Academy of General Dentistry (AGD). There is no reason seniors cannot keep their teeth for a lifetime, since tooth loss is simply the result of an oral disease – not the aging process.


The elderly, who make up the fastest growing segment of the U.S. population, are healthier and have kept more of their natural teeth than prior generations. But there's still room for improvement. Many seniors do not visit a dentist even once a year – one of the key preventive strategies in ensuring that teeth last a lifetime.


"Seniors often take long absences from seeing the dentist," says AGD spokesperson Nick Russo, DDS. "Sometimes they stop caring as much because they're not out in the public very much, and they think oral hygiene doesn't matter."


Family members should encourage seniors who are disabled or have trouble getting around to seek dental care, Dr. Russo says. Seniors planning to enter a nursing home should inquire about on-site dental care.


Regular dental visits are especially important for older people since many suffer from dry mouth, which slows down the flow of saliva. Saliva plays a major role in preventing tooth decay by rinsing away food particles and neutralizing harmful acids. Dry mouth often comes with old age, but can also be caused by medications like antihistamines, decongestants, antidepressants and diuretics. Dry mouth can often be treated by a dentist.


Along with regular dental visits, seniors should floss daily and brush twice a day with a fluoride toothpaste. They should also ask their dentist about fluoride rinses and gels, since studies show that seniors who brush regularly with fluoride toothpaste or use a fluoride rinse or gel regularly have fewer cavities. Seniors are most likely to get cavities where old fillings have chipped or where root surfaces are left unprotected by receding gums.


Other suggestions for keeping teeth for a lifetime: snack in moderation and avoid snacks with sugars and starches, and alert the dentist to any change in medication.


Following these preventive measures should help prevent seniors from having to wear dentures. But even seniors with no teeth still need to visit the dentist regularly, since many aspects of oral health, such as adjusting ill-fitting dentures and oral cancer screenings, can be handled at routine dental visits.

[] How Can I Take Care of My Teeth as I Age?

Proper oral care can keep you smiling well into retirement. Brushing at least twice a day with a fluoride toothpaste and a soft-bristle brush are as important as ever. Flossing can help you save your teeth by removing plaque between teeth and below the gumline that your toothbrush cannot reach.


What are some problems I should watch for?


Gingivitis. Most people don't realize how important it is to take care of their gums. Gingivitis is caused by the bacteria found in plaque that attack the gums. Symptoms of gingivitis include red, swollen gums and possible bleeding when you brush. If you have any of these symptoms, see a dentist at once. Gingivitis can lead to periodontal (gum) disease if problems persist. Most adults show signs of gum disease. Severe gum disease affects about 25 percent of 65- to 74-year-olds. In gum disease, your gums begin to recede, pulling back from the teeth. In the worst cases, bacteria form pockets between the teeth and gums, weakening the bone. All this can lead to tooth loss if untreated, especially in patients with osteoporosis. If regular oral care is too difficult, your dentist can provide alternatives to aid in flossing and prescribe medication to keep the infection from getting worse.


What if it's too difficult to brush?


If you have arthritis, you may find it difficult to brush and floss for good oral health care and prevention of disease. Ask your dentist for ways to overcome this problem. Certain dental products are designed to make dental care less painful for arthritis sufferers. You may want to try strapping the toothbrush to a larger object, such as a ball, to make the brush more comfortable to handle, or electric toothbrushes can help by doing some of the work for you.


What are the signs of oral cancer?


Oral cancer most often occurs in people over 40 years of age. See a dentist immediately if you notice any red or white patches on your gums or tongue, and watch for sores that fail to heal within two weeks. Unfortunately, oral cancer is often difficult to detect in its early stages, when it can be cured easily. Your dentist can perform a head and neck exam to screen for signs of cancer.


Should I be concerned about dry mouth?


Dry mouth (xerostomia) happens when salivary glands fail to work due to disease, certain medications or cancer treatment. This can make it hard to eat, swallow, taste and speak. In certain cases, such as radiation therapy, dry mouth can lead to severe complications, which is why it is important you see a dentist immediately before beginning any form of cancer treatment. Drinking lots of water and avoiding sweets, tobacco, alcohol and caffeine are some ways to fight dry mouth. Your dentist also can prescribe medications to fight severe dry mouth.


Maintaining your overall health


Studies have shown that maintaining a healthy mouth may keep your body healthier and help you avoid diabetes, heart disease and stroke. The best way to achieve good oral health is to visit your dentist at least twice a year.

[] Does a Smaller Waist Mean Smelly Breath?

Many people wanting to slim down are jumping on the low-carbohydrate diet trend in an attempt to lose weight. However, as dieters shed pounds, many are saying goodbye to carbs and hello to halitosis. 


Low-carb diets work by limiting the amount of carbohydrates ingested, which allows the body to burn stored fat instead of carbohydrates. When the body burns fat as fuel, chemicals called ketones are produced. These ketones are released in the breath and urine and may result in halitosis. Ketones aren't the only bad breath culprit for this diet. The types of foods ingested also play a role.


“Most cases of bad breath originate from the breakdown of food particles that produce sulfur compounds, and from bacteria on the gums and tongue,” says Academy of General Dentistry spokesperson Bruce DeGinder, DDS, MAGD. “ High-protein foods can produce more sulfur compounds, especially overnight on the surface of the tongue when saliva production is diminished.”


Tips to combat halitosis:


1. Drink water to wash away germs


Drinking plenty of water can help dilute the concentration of ketones, but that isn’t the only benefit. Drinking water throughout the day can help cleanse teeth of excess bacteria and food debris. Bad breath can sometimes be caused by food particles caught in the teeth, and drinking water will help rinse away odor-causing particles.


2. Chew sugarless gum with xylitol


Chewing sugarless gum after meals can help keep bad breath away. Saliva production increases during chewing and this can help neutralize acid production and rinse food particles from the mouth. Chewing parsley can have the same effect because it also increases saliva production.


Sugar-free gum with xylitol can also help prevent cavities. Xylitol is a natural sweetener found in plants and fruits, and research shows it inhibits the growth of Streptococcus mutans, the oral bacteria that cause cavities.


3. Keep a toothbrush handy and brush after all meals


Brushing and flossing at least twice a day can help keep your mouth healthy and prevent odors. An AGD survey found that 75 percent of people eat at the office but less than 15 percent of them brush their teeth after eating. Cleaning the tongue with a toothbrush or tongue scraper after meals can also help alleviate odors.


If halitosis continues, a general dentist or doctor can help determine the source of the odor. Halitosis can sometimes have more serious causes. “Ketone breath is also used to describe a fruity smell on the breath that can be an indication that a person may have diabetes,” says Dr. DeGinder. “This can originate when the body is breaking down fat particles because there is not sufficient glucose present as fuel for energy.”

[] What is Halitosis?

More than 80 million people suffer from chronic halitosis, or bad breath. In most cases it originates from the gums and tongue. The odor is caused by wastes from bacteria in the mouth, the decay of food particles, other debris in your mouth and poor oral hygiene. The decay and debris produce a sulfur compound that causes the unpleasant odor.


What causes bad breath?


Bad breath is primarily caused by poor oral hygiene but can also be caused by retained food particles or gum disease.


Does bad breath come from other sources than the mouth?


Bad breath also may occur in people who have a medical infection, diabetes, kidney failure or a liver malfunction. Xerostomia (dry mouth) and tobacco also contribute to this problem. Cancer patients who undergo radiation therapy may experience dry mouth. Even stress, dieting, snoring, age and hormonal changes can have an effect on your breath. An odor that comes from the back of your tongue may indicate postnasal drip. This is where mucus secretion, which comes from the nose and moves down your throat, gets stuck on the tongue and causes an odor.


Why is saliva so important in the fight against bad breath?


Saliva is the key ingredient in your mouth that helps keep the odor under control because it helps wash away food particles and bacteria, the primary cause of bad breath. When you sleep, however, salivary glands slow down the production of saliva, allowing the bacteria to grow inside the mouth. To alleviate "morning mouth," brush your teeth and eat a morning meal. Morning mouth also is associated with hunger or fasting. Those who skip breakfast, beware, because the odor may reappear even if you've brushed your teeth.


Do certain foods cause bad breath?


Very spicy foods, such as onions and garlic, and coffee may be detected on a person's breath for up to 72 hours after digestion. Onions, for example, are absorbed by the stomach, and the odor is then excreted through the lungs. Studies even have shown that garlic rubbed on the soles of the feet can show up on the breath.


How do I control bad breath?


It is important to practice good oral hygiene, such as brushing and flossing your teeth at least twice a day. Proper brushing, including brushing the tongue, cheeks and the roof of the mouth, will remove bacteria and food particles. Flossing removes accumulated bacteria, plaque and food that may be trapped between teeth. To alleviate odors, clean your tongue with your toothbrush or a tongue scraper, a plastic tool that scrapes away bacteria that builds on the tongue. Chewing sugar-free gum also may help control odor. If you have dentures or a removable appliance, such as a retainer or mouthguard, clean the appliance thoroughly before placing it back in your mouth. Before you use mouthrinses, deodorizing sprays or tablets, talk with your dentist, because these products only mask the odor temporarily and some products work better than others.


What is my dentist's role?


Visit your dentist regularly, because checkups will help detect any physical problems. Checkups also help get rid of the plaque and bacteria that build up on your teeth. If you think that you suffer from bad breath, your dentist can help determine its source. He or she may ask you to schedule a separate appointment to find the source of the odor. Or, if your dentist believes that the problem is caused from a systemic (internal) source, such as an infection, he or she may refer you to your family physician or a specialist to help remedy the cause of the problem.

[] Do You Have Traveler's Breath?
In addition to racking up frequent flyer miles, some travelers may also experience bad breath, and possibly a condition known as "tooth squeeze," while flying the friendly skies.


Bad breath while traveling happens when the salivary glands slow down the production of saliva, which allows bacteria to grow inside the mouth and bad breath to develop. Many travelers alter their food intake while at the airport and on the plane, and then will ignore their oral care hygiene routine. "Many people increase their fast food and soda intake while traveling," says J. Nick Russo, DDS, FAGD, past president of the Academy of General Dentistry. "This leaves food particles in the mouth that produce a sulfur compound and cause bad breath."


On the other end of the spectrum, bad breath can also be associated with hunger or fasting, which is also a common habit of some frequent fliers. "Even if you have brushed your teeth, but have not eaten a meal all day, 'morning mouth' may reoccur later in the day," says Dr. Russo.


Another condition that may happen while traveling but is less common than bad breath is known as "tooth squeeze," or barodontalgia, which describes a toothache or dental pain resulting from any change in barometric pressure during flight. The pain may, or may not, become more severe as altitude is increased, but descent almost invariably brings relief. The toothache often disappears at the same altitude at which it was first observed on ascent.


"Common sources of this difficulty are abscesses, cavities or fillings," says Dr. Russo. He advises any holiday travelers who experience a toothache at high altitudes should see a dentist without delay for examination and treatment.

[] Students: Hitting the Books May Hurt Your Teeth

Behavior changes induced by academic stress may cause gum inflammation, temporomandibular disorder (TMD) symptoms and bruxism for some college students.


During exam weeks, students often pull all-nighters, sleep less, increase caffeine and nicotine intake, neglect healthy eating habits and experience high stress levels, which reduces saliva flow. "The emotional and physical factors involved in studying for exams often force students to abandon their healthy oral hygiene habits," says Academy of General Dentistry spokesperson J. Nick Russo, DDS, FAGD.


Also, the academic pressures students place on themselves will subconsciously surface, explains Dr. Russo, who treats many students for stress-related facial pain. "Sometimes, your roommate may be the first person to identify your bruxism problem because your tooth grinding keeps them up at night."


In a study investigating academic stress and its effect on gum health, participants' gums were assessed four weeks before final exams and on the last day of the exams. Researchers found 23 percent of students developed severe gingivitis (gum inflammation) in relation to at least one formerly healthy tooth throughout the examination period. Researchers also noted that within one day, students were able to remove nearly all plaque accumulated during the 21-day experiment.


Luckily, cramming for exams and ignoring oral hygiene habits is not a long-term behavior. "Academic stress shouldn't take a toll on your oral health," says Dr. Russo. Find ways to relax during stressful periods and pamper your teeth after your exams, suggests Dr. Russo. Return to a normal oral hygiene regimen and schedule a dental cleaning and checkup.


Is stress taking a toll on your mouth? If you have one or more of these symptoms, you may be have a temporomandibular disorder:


  • Sore jaw, especially in the morning
  • Clicking sound or difficulty when opening and closing mouth
  • Locked or stiff jaw when talking, eating or yawning
  • Sensitive teeth
  • Ear pain

[] Fast-paced Lifestyle Eroding Teens' Teeth

As quick meals in the form of "nutrition" bars and carbonated beverages help keep teens alert and on schedule between school, extracurricular activities and part-time jobs, today's fast-paced lifestyle threatens to leave a generation with permanent damage to oral and overall health.


"Premature loss of tooth enamel and weakening of overall tooth structure are two devastating oral effects of teens' poor diet that cannot be reversed later in life," explains Jane Soxman, DDS, author of a study that appears in the January/February 2003 issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD).


Adolescence is the time of peak bone growth, a time when more nutrient-packed calories are essential to fuel growing bodies and strengthen teeth and bones, however adolescence is the same time when soda and sugary, high-carbohydrate foods are rapidly displacing healthy foods such as milk, fruits and vegetables.


"The easy access of sugary beverages and foods from home to school and everywhere in between has compromised the health of teens' teeth and helped fuel the national obesity epidemic," says AGD spokesperson Julie Barna, DMD, MAGD.


Dr. Soxman's report shows drinking carbonated beverages seems to be one of the most significant causes of increased cavities and obesity for today's teens. Fifteen percent of American adolescents ages 6 to 19 are overweight. This number is expected to increase. Why? Ten percent of overweight preschool-age children ages 2 to 5 are becoming addicted to caffeine and sugar, which makes it harder for them to stop unhealthy habits such as drinking soda throughout the day.


The phosphoric, citric, tartaric and carbonic acids in soda are linked to the breakdown of tooth enamel around dental sealants and restorations, further compromising teens' teeth and leading to more extensive dental treatment to prevent total tooth loss.


Soft drinks and bone density


The phosphoric acid in most regular and diet cola drinks limits calcium absorption and has a direct influence on bone density. By age 16, girls have accumulated 90 to 97 percent of their bone mass, making adequate calcium intake vital. However, national statistics show only 19 percent of girls ages 9 to 19 are getting the recommended 1,300 milligrams of calcium a day.


Research also confirms a direct link between soft drink consumption and bone fractures in teenage girls.


"These girls are at an extreme risk for developing osteoporosis, already exhibiting symptoms of this disease in their teen years," says Dr. Soxman. "Early education on the importance of calcium consumption is key to reversing this trend."

[] So You Want to Pierce Your Tongue?

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.




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.




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.

[] A Fatal Fad? Tongue Studs Cause More Problems Than Chipped Teeth

Wearing a tongue stud puts people at risk for chipped teeth, recessed gums and nerve damage.  However, most people don't realize that getting an oral piercing also places them at risk for developing a fatal infection, such as Ludwig's angina or endocarditis, according to a report in the May/June 2004 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal.


Ludwig's angina, a bacterial infection of the floor of the mouth, occurs after a tooth infection, mouth injury, oral surgery or oral piercing. After getting an oral piercing, the mouth has an open wound that allows bacteria to travel through the bloodstream.  Bacteria can cause the floor of the mouth to rapidly swell, which can block the airway or prevent the swallowing of saliva. 


Endocarditis occurs when bacteria travels into the bloodstream through the piercing hole and infects the heart.  People with a history of heart defects are at risk for endocarditis.  At the dentist's office, a medical history is taken that helps the dentist determine who is at risk, and those patients are given antibiotics prior to certain dental procedures in order to avoid this potentially fatal problem.


"Some body piercers are unlicensed, and most are not members of the medical profession," says William J. Dunn, DDS, MAGD, ABGD, author of the study.  "Because of this, health histories are not recorded or reviewed, emergency medical kits are not available, antibiotics are not prescribed and postoperative care is not available."


Postoperative care can also help identify these serious infections before they become fatal. "People are told to expect some swelling from a tongue piercing, but if they don't receive follow-up care, they may not be aware of abnormal swelling," says AGD spokesperson Melvin K. Pierson, DDS. 

Unclean piercing equipment can cause other infections, such as hepatitis. Also, if a patient is not instructed to avoid touching the piercing, they might spread infections with their own fingers.


"I don't recommend piercing," says Dr. Pierson.  "Because of the risks associated with this unregulated procedure, if someone is considering an oral piercing, they should discuss it with their medical or dental professional."

[] To Pierce or not to Pierce

Have you thought about chipped teeth, drooling, gum damage, nerve damage, taste loss, tooth loss or infection? The problems that can arise from an oral piercing might surprise you.


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


"Every time you swallow, the barbell hits the teeth, causing constant irritation that can result in mouth ulcers," says Academy of General Dentistry spokesperson Manuel A. Cordero DDS, FAGD.


Infections are also common. Dentists are learning that oral infections can be linked to other infections. "The tongue is covered with bacteria," Dr. Cordero said. "The moment the tongue is punctured, bacteria are introduced into the blood. When that happens, bacteria can travel to the heart and cause a variety of serious problems."


If you decide to pierce your tongue, take care of it. Once the tongue has been pierced, it takes four to six weeks to heal. Barring complications, the jewelry can be removed for short periods of time without the hole closing. Always remove the jewelry every time you eat or sleep.


To avoid serious infections such as HIV or hepatitis, make sure the piercer sterilizes everything in an autoclave, which uses extreme heat to sanitize surgical instruments. Ask the piercer questions about after-care, cleanliness, equipment and other concerns.


Clean your piercing with an antiseptic mouthwash after every meal and brush the jewelry the same as your teeth to remove plaque.


[] Have Your Teeth Had Their Picture Taken Lately?

The latest technology in dentistry is giving patients an inside look at their teeth and a better image and understanding of the state of their dental health.


The intraoral camera, now used by some dentists, allows patients to see their teeth up close and in color, using a pencil-sized wand with a tiny lens that can be pointed to any area in the mouth. The dentist can zoom in for close-ups and can take snapshots that can be discussed with the patient. Procedures can even be videotaped and later shown to the patient.


"Intraoral cameras definitely improve communication between the dentist and the patient," says Academy of General Dentistry spokesperson Paul Bussman, DMD. "Before, all the dentist could do visually was to use a light and a mirror to show a patient what was wrong. Now, we can take before-and-after shots for patients to compare, and we can even print a color image that you can take home," says Dr. Bussman.


Dr. Bussman reports that an added benefit of the intraoral camera is the way it inspires children to become more interested in their dental care. "Kids are much more relaxed about a procedure when they can see images of the treatment area first and get to take home pictures of their mouth to show family and friends."

[] Why is Oral Health Important for Women?

Women's oral health depends on their different stages of life. For many women, these changes are directly related to surges in sex-hormone levels, such as in puberty, menstruation, pregnancy, lactation and menopause. Women are also more likely to be diagnosed with TMJ, myofascial pain, eating disorders and Sjögren's syndrome (which causes dry mouth).


What types of conditions will my dentist watch for?


As a woman, you need to adhere to good oral hygiene. Make sure to brush with fluoride toothpaste at least twice a day and after each meal when possible, and floss thoroughly each day. To help avoid problems, your dentist may request to see you more frequently during stages of your life when hormone levels are changing. 
Puberty: The surge in hormones that occurs during puberty may cause swollen gums, especially during menstruation. Mouth sores also can develop. Girls may experience sensitive gums that react more to irritants.

Oral contraceptives: Oral contraceptives mimic pregnancy because they contain progesterone or estrogen. Therefore gingivitis may occur with long-term use. Women who use birth control pills are twice as likely to develop dry socket (a complication of tooth extraction) and should consult their dentist before scheduling major dental procedures. 

Pregnancy: Pregnant women have a risk for increased inflammation of the gums because of the surge in estrogen and progesterone. If irritating plaque isn't removed, it can cause gingivitis – red, swollen, tender gums that are more likely to bleed. In some cases, large lumps called pregnancy tumors – inflammatory, non-cancerous growths that develop when swollen gums react strongly to irritants. Usually these tumors shrink soon after the pregnancy is over. Women with periodontal disease may be at risk for preterm, low–birth-weight babies. If a women experiences morning sickness, it is important to neutralize the acid caused by vomiting, which causes tooth erosion. Patients can use a paste made of baking soda and water, rubbing it on the teeth. After 30 seconds, rinse off the paste, then brush and floss. If this is not possible, rinse with water.

Menopause: During menopause, some women can experience dry mouth, a burning sensation and changes in taste. Gums can become sore and sensitive.

Other factors: Diet pills and certain medications (over-the-counter and prescriptions) can decrease salivary flow, which puts patients at risk for cavities, gum disease and discomfort. Patients with eating disorders, such as bulimia (self-induced vomiting) can't hide their symptoms from their dentists because the episodes of binging and purging cause erosion on the backside of the upper front teeth. (An additional sign is sores that appear at the corners of the mouth.) Smoking also creates a higher risk for periodontal disease.

How will my dentist know if I have a problem?


Keep your dentist informed if you experience changes in your oral health or if you are approaching a different life stage. Also, visiting your dentist regularly will help him or her see any physical changes in your mouth. Your dentist should complete a thorough medical history to determine if you are at a higher risk for problems.

[] How Does Pregnancy Affect My Oral Health?

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.


How does a build-up of plaque affect me?


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.


How can I prevent these problems?


You can prevent gingivitis by keeping your teeth clean, especially near the gumline. You should brush with fluoride toothpaste at least twice a day and after each meal when possible. You should also floss thoroughly each day. If brushing causes morning sickness, rinse your mouth with water or with antiplaque and fluoride mouthwashes. Good nutrition – particularly plenty of vitamin C and B12 – help keep the oral cavity healthy and strong. More frequent cleanings from the dentist will help control plaque and prevent gingivitis. Controlling plaque also will reduce gum irritation and decrease the likelihood of pregnancy tumors.


Could gingivitis affect my baby's health?


Research suggests a link between preterm, low-birthweight babies and gingivitis. Excessive bacteria can enter the bloodstream through your gums. If this happens, the bacteria can travel to the uterus, triggering the production of chemicals called prostaglandins, which are suspected to induce premature labor.


When should I see my dentist?


If you're planning to become pregnant or suspect you're pregnant, you should see a dentist right away. Otherwise, you should schedule a checkup in your first trimester for a cleaning. Your dentist will assess your oral condition and map out a dental plan for the rest of your pregnancy. A visit to the dentist also is recommended in the second trimester for a cleaning, to monitor changes and to gauge the effectiveness of your oral hygiene. Depending on the patient, another appointment may be scheduled early in the third trimester, but these appointments should be kept as brief as possible.


Are there any dental procedures I should avoid?


Non-emergency procedures generally can be performed throughout pregnancy, but the best time for any dental treatment is the fourth through six month. Women with dental emergencies that create severe pain can be treated during any trimester, but your obstetrician should be consulted during emergencies that require anesthesia or when medication is being prescribed. Only X-rays that are needed for emergencies should be taken during pregnancy. Lastly, elective procedures that can be postponed should be delayed until after the baby's birth.

[] 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."


[] Why is Oral Health Important for Men?

Men are less likely than women to take care of their physical health and, according to surveys and studies, their oral health is equally ignored. Good oral health recently has been linked with longevity. Yet, one of the most common factors associated with infrequent dental checkups is just being male. Men are less likely than women to seek preventive dental care and often neglect their oral health for years, visiting a dentist only when a problem arises. When it comes to oral health, statistics show that the average man brushes his teeth 1.9 times a day and will lose 5.4 teeth by age 72. If he smokes, he can plan on losing 12 teeth by age 72. Men are also more likely to develop oral and throat cancer and periodontal (gum) disease.


Why is periodontal disease a problem?


Periodontal disease is a result of plaque, which hardens into a rough, porous substance called tartar. The acids produced and released by bacteria found in tartar irritate gums. These acids cause the breakdown of fibers that anchor the gums tightly to the teeth, creating periodontal pockets that fill with even more bacteria. Researchers have found a connection between gum disease and cardiovascular disease, which can place people at risk for heart attacks and strokes. See your dentist if you have any of these symptoms:


  • Bleeding gums during brushing
  • Red, swollen or tender gums
  • Persistent bad breath
  • Loose or separating teeth

Do you take medications?


Since men are more likely to suffer from heart attacks, they also are more likely to be on medications that can cause dry mouth. If you take medication for the heart or blood pressure, or if you take antidepressants, your salivary flow could be inhibited, increasing the risk for cavities. Saliva helps to reduce the cavity-causing bacteria found in your mouth.


Do you use tobacco?


If you smoke or chew, you have a greater risk for gum disease and oral cancer. Men are affected twice as often as women, and 95 percent of oral cancers occur in those over 40 years of age.


The most frequent oral cancer sites are the tongue, the floor of the mouth, soft palate tissues in back of the tongue, lips and gums. If not diagnosed and treated in its early stages, oral cancer can spread, leading to chronic pain, loss of function, irreparable facial and oral disfigurement following surgery and even death. More than 8,000 people die each year from oral and pharyngeal diseases. If you use tobacco, it is important to see a dentist frequently for cleanings and to ensure your mouth remains healthy. Your general dentist can perform a thorough screening for oral cancer.


Do you play sports?


If you participate in sports, you have a greater potential for trauma to your mouth and teeth. If you play contact sports, such as football, soccer, basketball and even baseball, it is important to use a mouthguard, which is a flexible appliance made of plastic that protects teeth from trauma. If you ride bicycles or motorcycles, wear a helmet.


Taking care of your teeth


To take better care of your oral health, it is important to floss daily, brush your teeth with fluoride toothpaste twice daily and visit your dentist at least twice a year for cleanings. Here are some tips to better dental health:


  • Use a soft-bristled toothbrush to reach every surface of each tooth. If the bristles on your toothbrush are bent or frayed, buy a new one.
  • Replace your toothbrush every three months or after you've been sick.
  • Choose a toothpaste with fluoride. This can reduce tooth decay by as much as 40 percent.
  • Brush properly. To clean the outside surfaces of your teeth, position the brush at a 45-degree angle where your gums and teeth meet. Gently move the brush in a circular motion using short, gentle strokes. To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several gentle strokes over each tooth and its surrounding gum tissue. Spend at least three minutes brushing.
  • Floss properly. Gently insert floss between teeth using a back-and-forth motion. Do not force the floss or snap it into place. Curve the floss into a C-shape against one tooth and then the other.

[] What Foods Causes Tooth Decay in Children?

Many different types of food can cause tooth decay in children, not just candy. Foods that are high in carbohydrates, as well as some fruits, juices and sodas, peanut butter, crackers and potato chips are culprits. Factors that cause tooth decay include the frequency in which the foods are eaten and the time they remain as particles in the mouth. 


Are children safe from soda and other beverages?


Dentists believe that kids who consume too much soda and not enough nutritional beverages are prone to tooth decay in addition to serious ailments later in life, such as diabetes and osteoporosis. Drinking carbonated soft drinks regularly can contribute to the erosion of tooth enamel.  Enamel breakdown leads to cavities. If erosion spreads beneath the enamel, pain and sensitivity may eventually result. This can cause nerve infection, which can result in the need for a root canal.


My children rarely drink soda. Are they still at risk for tooth decay?


Yes. Any prolonged exposure to soda can cause damage. Sipping a soft drink all afternoon is more harmful to your teeth than drinking a large soda with a meal and then not drinking any soda for the rest of the day. While many dentists advocate drinking nutritional beverages, such as milk, many agree soda should be consumed from a can rather than a bottle with a replaceable cap to discourage prolonged exposure to soda.


How can children prevent damage to their teeth?


Children at school should rinse their mouth with water after meals, leaving their teeth free of sugar and acid. Children also should seek sources of fluoridation. If you purchase bottled water, be sure that it is fluoridated. Encourage children to drink tap or fountain water. Use a straw when drinking soda to keep sugar away from teeth. Remember, bottled juices are not a good alternative due to the high sugar content. Regular dental checkups, combined with brushing with fluoride toothpaste, also will help protect children's teeth.


How can I help my child prevent tooth decay?


Parents should take their child to the dentist just after the first tooth appears. Brushing teeth after meals, regular flossing and fluoride treatments are the best ways to prevent tooth decay. Children should also be supervised as they brush. A good rule of thumb is that when children can dress themselves and tie their own shoes, then they are ready to brush unsupervised. Children should be supervised in proper flossing techniques until the age of 10. If you have any concerns about your child's dental health or want some tips on preventing tooth decay, ask your dentist.

[] An Apple a Day May Keep the Dentist Away

Although school offers food for thought among the nation's children, school lunches and snacks are not as nutritious for their teeth, reports the Academy of General Dentistry (AGD).


Researchers have concluded that dietary habits of school children encouraged an increase in sugar intake, leading to a greater risk of cavities.


Over a 15-month period, researchers tracked the dietary habits and monitored the teeth of 43 preschool children before and after the start of school. Results of the study show that 59 percent of the students who had consumed sugar four or more times or ate two or more snacks between meals at age 5, increased to 83 percent at age 6, a 24-percent increase.


The average number of decayed, missing or filled teeth and initial cavities of these children jumped from 9.7 to 15.3 cavities, an increase of 5.6 cavities within one year. Over the 15 months of the study, the percentage of cavity-free school children dropped from 23 to 19 percent.


"This study substantiates that diet is an important part of proper oral health," says AGD spokesperson George McLaughlin, DMD, clinical associate professor at the University of Medicine and Dentistry of New Jersey, New Jersey Dental School, who has noticed in his own practice an increase in tooth decay and cavities in teenagers, which may be caused from their preteen eating habits at school.


The easiest way to prevent your children from further decay and cavities at school is to monitor their eating habits, recommends Dr. McLaughlin. "Make sure the children don't squirrel away sugary snacks to take to school or eat snacks between meals." He also advises parents to teach their children the importance of a healthy diet and healthy teeth.


"Also, parents should find out what their child's school lunch program offers," said Dr. McLaughlin. "If programs do not offer healthy alternatives, talk to the school about incorporating healthy lunches or snacks." If this approach is not effective, offer your children healthy snack alternatives such as bite-size carrots, fruits or foods that are naturally sweetened. Avoid candies, chocolate, caramels, soda, chocolate milk and other foods that contain refined sugar.


"Of course, having your child avoid cavity-causing food at all times is nearly next to impossible," says Dr. McLaughlin. If your child is going to eat snacks or candy at school, at least have them abstain from the sticky, chewy candy, which tends to linger on teeth throughout the day. "After eating sugary snacks at lunch, your child should brush and rinse with water or eat a piece of fruit."


Finally, Dr. McLaughlin suggests parents consider sealants as an early alternative to protecting children from cavities. Sealants are a thin coating of bonding material applied over a tooth and can be applied as soon as the child's first permanent molars appear. The procedure is cost-effective, easily applied and a barrier from cavity-causing bacteria.

[] High-Sugar Infancy Can Mean Adult Sugar Dependency

Dental habits start forming at about 4 months of age, or at about the time when a baby switches from breast milk or infant formula to other foods, reports the Academy of General Dentistry (AGD), an organization of general dentists dedicated to continuing education.


This is also the age that a baby's first tooth erupts, and the types of foods that are introduced to the baby at this time can affect a lifetime of dental health. In fact, a strong correlation has been found between the use of sweetened drinks in infancy and the consumption of sugar-containing snacks in later years.


"The eating habits of adults are formed at weaning, so it's important for the baby to develop good eating habits that will affect the dental health," says AGD spokesperson Heidi Hausauer, DDS, FAGD. "Sugar is known to cause cavities throughout a lifetime, and the earlier an infant gets used to sugar, the easier it is to get hooked on high-sugar snacks as an adult."


Fruit drinks are high in sugar and in turn can cause enamel erosion if consumed frequently. A baby should never be allowed to fall asleep with a bottle of fruit juice, because the sugary liquid bathes the newly erupted teeth in a cavity-causing substance that can cause baby bottle tooth decay.


"Drinks other than water should not be continually sipped throughout the day and should be served at mealtimes – never at bedtime," says Dr. Hausauer. "Children given high-sugar medicines regularly at bedtime are also at risk of forming cavities."

[] Schools’ Long-term Soda Deals Kick Kids in the Teeth

Although federal regulations prohibit the sale of soft drinks to students during lunch hours in most schools, soft drink machines often line the hallways, which means the goods are accessible to students all day long. Some students are merely thirsty, and others are looking for an early morning caffeine kick. However, none are looking for tooth decay, though that's what many may get.


Soft drink purchases by teens in schools increased 1,100 percent over the past 20 years, while dairy purchases have decreased by 30 percent, according to a report in the January/ February 2003 issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD).


Since 1995, soda companies have approached schools with lucrative, long-term deals – called "pouring rights" contracts – to exclusively sell their brand in exchange for funding. Citizens' groups and dental care professionals have criticized these companies for pushing their products to kids in school.


Many dentists are worried that the increase in soda consumption is leading to an increase in tooth decay among teenagers. "I think it is easy to lose track of the fact that pop is harmful," says AGD spokesperson William Chase, DDS, FAGD. "A lot of parents just don't ask what their kids are drinking and how much."


Studies show an increase in soda consumption over the last three decades. Soda consumption has increased from approximately 20 gallons of cola per person a year in 1970 to more than 50 gallons per person a year in 2004.


"We are not trying to get schools to ban vending machines...we want to educate people on what soda consumption can do to kids' teeth," says Dr. Chase.

[] Living in a Sugar Culture

Naturally occurring bacteria in the mouth devour sugar, creating acids that attack tooth enamel. This can lead to decay, as well as a host of other problems, including gingivitis.


Living in a culture that moves as quickly as ours, it's easy to bypass a nutritious diet in favor of a diet comprised of fast food and snacks high in sugar. The detrimental effects of this lifestyle are clear. More than 25 percent of children between the ages of 2 and 5 have experienced tooth decay, and almost 80 percent of young people have had a cavity by age 17.


"We live in a high-stress society and fast food offers a quick fix," says Academy of General Dentistry spokesperson Maria A. Smith, DMD, MAGD.


She adds that an overabundance of sugar is not only detrimental to oral health, but also the rest of the body's well-being.


For example, the average 12-ounce can of soda contains 10 teaspoons of sugar; and many manufacturers incorporate sugar into their foods to help ensure a return purchase. Today, the average person consumes approximately 150 pounds of sugar a year, or about 40 teaspoons a day. It's not only our culture that defines the amount of sugar we consume, but also a lack of education on how much sugar we consume every day – especially when it comes to children and the elderly. Dr. Smith says parents may believe they are doing right by feeding their children processed fruit juice or raisins, however products such as these are mostly sugar. Processed foods also can be harmful because of the low-nutrition and high-sugar content. Substituting these products for fresh fruits and vegetables is a better option.


"People don't realize how many high-content sugar products are out there," Dr. Smith says. "Education is the key to creating a nutritious diet." Visiting the dentist twice a year, says Dr. Smith, is a good way to maintain oral health and learn how to curb an excessive sugar intake. Additionally, eating an abundance of fresh fruits and vegetables and carefully reading nutrition content labels can curb sugar intake.

[] Soda Attack: Soft Drinks, Especially Non-colas and Iced Tea, Hurt Hard Enamel

As summer temperatures rise so will people's thirst. Unfortunately, many people will grab a pop or iced tea instead of water. It isn't just cola's empty calories – about 150 per 12-ounce can – you should worry about. Many of these beverages harm enamel, the protective shell around teeth.


A pilot study of the effects some of these beverages had on enamel, appearing in the July/August 2004 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal, found that over time, exposing dental enamel to carbonated beverages and non-carbonated canned iced tea weakens and permanently destroys enamel.


Results from the study, which exposed healthy dental enamel to a variety of popular beverages over a period of 14 days, found that non-colas and canned iced tea were especially harmful. They contain flavor additives, such as malic, tartaric and other organic acids, which are more aggressive at eroding teeth. Root beer, which contains the least amount of flavor additives, was found to be the "safest soft drink to safeguard dental enamel."


About 27 percent of the beverages consumed by Americans are soft drinks, the study notes. Overall soft drink consumption has steadily increased over the years and remains on the rise, contributing to an increase in oral health problems, namely cavities. In 1977, 12- to 19-year-olds drank 16 ounces of soda a day. In 1996, this same age group consumed an average of 28 ounces a day.


Soda consumption has increased from approximately 20 gallons per person per year in 1970 to more than 50 gallons per person per year in 2004. The American Beverage Association has stated that soft drinks account for 28 percent of overall beverage consumption.


Soft drinks and canned beverages are constant features of daily life, and the approximately $50 billion the industry rakes in each year suggests it won't go away anytime soon. However, soda can be enjoyed in limited quantities. J. Anthony von Fraunhofer, MS, PhD, FADM, FRSC, lead author of the study, says that soda consumed "at meal times is less injurious than when consumed alone and continuous sipping is more harmful than the whole drink taken at one time."


According to AGD spokesperson Cynthia Sherwood, DDS, soda's combination of sugar and acidity can be damaging to teeth. Though the level of risk varies from person to person, Dr. Sherwood says, "Repeated exposure of soda through sipping over a long period of time increases the risk of getting a cavity."


Dr. Sherwood adds that drinking soda through a straw may help reduce the amount of soda that comes into direct contact with the teeth. She also recommends that soda drinkers rinse their mouths out with water after drinking and use toothpaste that contains fluoride.



A typical 12-once can of regular soda contains approximately 10 teaspoons of sugar.

[] Fluoride Intake Important for Children

Parents should pay attention to the amount of fluoride their child receives. Too much fluoride can cause tooth discoloration, and too little fluoride can cause teeth to be more susceptible to cavities.


Bottled waters need to be on the list of items that parents must check before giving to their child. Some bottled waters have little or no fluoride at all.


"This is a problem when parents are giving their children only this 'designer' water from a bottle," says Academy of General Dentistry (AGD) spokesperson Heidi Hausauer, DDS. "In my own practice, I've seen an 8-year-old girl come in with eight cavities. The fact that she's been drinking only non-fluoridated water could have been a contributing factor. Most of the tap water in this country is properly fluoridated, so it's best if the child receives most of the water straight from the faucet."


When introducing toothpaste, the AGD recommends using a small pea-sized dab.


"Parents should be brushing their child's teeth with this amount until the child is 6 years old," says Dr. Hausauer. "Until this age, children don't have the dexterity to brush by themselves properly and they tend to swallow the toothpaste and ingest the fluoride, which can put them at risk for fluorosis (tooth discoloration)."

[] Monitor Infant's Fluoride Intake

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.

[] Can't Floss Regularly? Once a Day Keeps Tartar Away!

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.


[] Using Floss Once a Day Helps Fight Decay

Some people loop. Some people spool. Others simply refuse. The verdict is in: Flossing is one of the best things you can ever do to take care of your teeth.


“Flossing every 24 hours to break up plaque is imperative for good oral health,” says Academy of General Dentistry (AGD) spokesperson Gordon Isbell, DMD, MAGD.


An article in the October 2005 issue of AGD Impact, AGD's monthly newsmagazine, describes how floss is the single most important factor in preventing periodontal (gum) disease, which affects more than 50 percent of adults.


Flossing, which is just as important as brushing, helps removes the plaque and debris that stick to teeth and gums between the teeth. It also helps polish the tooth's surface and control bad breath.


Dental floss can be waxed or unwaxed, flavored and unflavored, wide and regular. All floss helps clean and remove plaque. Wider floss, also known as dental tape, may help people with a lot of bridge work and is usually recommended when the spaces between teeth are wide. Waxed floss can be easier to slide between teeth with very little space between. Unwaxed floss makes a squeaking sound, which lets the user know their teeth are clean.


Electric flossers are now on the scene, but most dentists contend there is no substitute for manually flossing one's teeth.


“Electric flossing is no substitute, but if someone has a disability and can't manually floss, it is better than nothing,” says Dr. Isbell.


Similarly, dentists say that waterpicks should not be used as a substitute for brushing and flossing because they don't remove plaque. Dentists do recommend waterpicks for people with braces or dentures or those with gum disease who have trouble flossing because of pain.


Benefits of flossing:


  • Decreased risk of gum disease
  • Better breath
  • Removes plaque between teeth
  • Polishes tooth surfaces

[] Should I Floss?

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. The best way to get rid of plaque is to brush and floss your teeth carefully every day. 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.


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. 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.

[] Q&A - Dry Mouth

Q: What causes dry mouth?
A: Dry mouth is caused by a decrease in the amount of salvia in the mouth when the salivary glands do not work properly. The salivary glands help keep your mouth moist, which helps prevent decay and other oral health problems.

Dry mouth may be a sign of a serious health condition or may occur when a person is upset or experiences stress. Studies show that up to 400 medications, prescriptions and over-the-counter, can contribute to symptoms associated with dry mouth. The most common troublemakers are anti-hypertensives, anti-depressants, painkillers, tranquilizers, diuretics, and antihistamines.

Q: Is dry mouth a problem?
A: Yes, it can cause health problems. You want to prevent dry mouth if possible because it causes difficulty in tasting, chewing or swallowing. It also allows plaque to build up on your teeth faster, leading to a higher risk of cavities. In certain cases, a lack of moisture can make your tongue become very sensitive, causing a condition called burning tongue syndrome.

Q: Why is saliva important?
A: Saliva helps wash away cavity-causing bacteria, provides enzymes to help digest food, protects teeth from decay and keeps oral tissues healthy. Without saliva, you would lose your teeth much faster.

[] Dry Mouth Sufferers Get Sealants Saving Grace

If you have dry mouth, and about one-third of the adult population does, consider asking your dentist to apply sealants to your teeth, reports the Academy of General Dentistry, an organization of general dentists dedicated to continuing dental education.

Dry mouth can be caused by medication, irradiation, stress, autoimmune disease, or neurological factors, and adult patients who experience dry mouth would benefit the most from sealants.

"These patients are especially susceptible to cavities, because the naturally occurring buffering effect of saliva is reduced," explains E. "Mac" Edington, DDS, MAGD, president- elect of the Academy of General Dentistry. "Saliva protects against cavities by breaking down dietary starches, neutralizing and buffering plaque acids, providing ions for tooth remineralization, and by coating teeth with protective proteins."

When saliva becomes diminished in an adult with dry mouth, the patient becomes very susceptible to decay, and sealants can help protect the patient against cavities. The simple procedure involves an application of a light coating in the deep grooves of the teeth. The newest generation of sealants also has fluoride and antibacterial agents to further protect against cavities. Sealants can only be applied to teeth not currently decayed or filled.

[] Spring Clean Your Teeth

Add a dental visit to this year's spring-cleaning list. A professional dental cleaning at least twice a year can improve your oral health, reports the Academy of General Dentistry (AGD), an organization of general dentists dedicated to continuing dental education.


"A prophylaxis, also known as a 'prophy' or professional dental cleaning, reinforces the at-home oral health regimen," says AGD spokesperson Anne Murray, DDS. "It is designed to preserve health, prevent the spread of disease and give the dentist an opportunity to locate other areas in the mouth that may need attention."


It is strongly recommended that a dentist or hygienist perform a dental cleaning every three to six months, says Dr. Murray. She discourages consumer use of over-the-counter tooth polishing instruments.


"People with healthy teeth and gums typically do not experience soreness after a cleaning," says Dr. Murray. Those with less-than-perfect oral hygiene habits may experience discomfort or heightened sensitivity during a dental cleaning. The dentist can use a topical anesthetic before the cleaning to alleviate pain.


What is a dental cleaning?


Diagnostic services may include:


  • Reviewing and updating medical history, including heart problems, cancer treatment, pregnancy, diabetes, joint replacement, medications, surgeries or any other major changes in health history
  • Blood pressure check
  • Oral cancer examination and screening
  • Evaluation of gum tissue
  • Checking biting, chewing and swallowing patterns
  • X-rays, examination of teeth to detect decay
  • Treatment planning
  • Referral to specialists for specific treatment

Preventive services may include:


  • Removal of plaque and tartar
  • Stain removal
  • Fluoride application
  • Sealants
  • Polishing of fillings or crowns

Educational services may include:


  • Tooth brushing and flossing instructions
  • Nutritional counseling
  • Recommendations for future treatment: when to return for following hygiene treatment, periodontal (gum) concerns, restorative options, etc.
  • Evaluation of possible cosmetic enhancements
  • Evaluation of self-care effectiveness
  • Tobacco-cessation counseling

[] Why is Brushing With Toothpaste Important?

Brushing with toothpaste is important for several reasons. First and foremost, a toothpaste and a correct brushing action work to remove plaque, a sticky, harmful film of bacteria that grows on your teeth that causes cavities, gum disease and eventual tooth loss if not controlled. Second, toothpaste contains fluoride, which makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before the damage can even be seen. Third, special ingredients in toothpaste help to clean and polish the teeth and remove stains over time. Fourth, toothpastes help freshen breath and leave your mouth with a clean feeling.


What type of toothpaste should I use?


As long as your toothpaste contains fluoride, the brand you buy really does not matter, neither does whether or not it is in paste, gel or even powder form, or containing a certain flavor. All fluoride toothpastes work effectively to fight plaque and cavities and clean and polish tooth enamel. Your toothpaste brand should bear the ADA (American Dental Association) seal of approval on the container, which means that adequate evidence of safety and efficacy have been demonstrated in controlled, clinical trials.


If your teeth are hypersensitive to hot or cold, consider trying a toothpaste designed for sensitive teeth. These “desensitizing” toothpastes, which contain strontium chloride or potassium nitrate, protect exposed dentin by blocking the tubes in the teeth that are connected to nerves. Desensitizing pastes must be used for at least one month before any therapeutic effects are felt.

Toothpastes containing baking soda and/or hydrogen peroxide (which are both good cleansing agents) give the teeth and mouth a clean, fresh, pleasant feeling that can offer an incentive to brush more, but fluoride is the true active ingredient at work protecting your teeth. Some prefer a tartar-control toothpaste containing pyrophosphates to prevent the build-up of soft calculus (tartar) deposits on their teeth. New pastes offer advanced whitening formulas aimed at safely removing stains to make teeth brighter and shinier, although they can't nearly match the effectiveness of a professional bleaching formula administered or prescribed by a dentist.


How much should I use?


Contrary to what toothpaste commercials show, the amount of paste or gel needed on your brush for effective cleaning does not have to be a heaping amount. Simply squeeze a pea-sized dab of paste on the top half of your brush. If you brush correctly, holding the toothbrush at a 45-degree angle and brush inside, outside and between your teeth, the paste should foam enough to cover all of your teeth. Children under age 6, however, should be given a very small, baby pea-sized dab of toothpaste on their brush.

Is brushing with toothpaste enough to fight cavities and gum disease?


No. Although brushing thoroughly after each meal helps, flossing your teeth every day to remove plaque and food particles between teeth and at the gumline is just as important. Studies show that plaque will regrow on teeth that are completely clean within three to four hours of brushing.

[] What is the Best Technique for Brushing?

There are a number of effective brushing techniques. Patients are advised to check with their dentist or hygienist to determine which technique is best for them, since tooth position and gum condition vary. One effective, easy-to-remember technique involves using a circular or elliptical motion to brush a couple of teeth at a time, gradually covering the entire mouth.


Place a toothbrush beside your teeth at a 45-degree angle and gently brush teeth in an elliptical motion. Brush the outside of the teeth, inside the teeth, your tongue, the chewing surfaces and between teeth. Using a back-and-forth motion causes the gum surface to recede, can expose the root surface or make the root surface tender. You also risk wearing down the gum line.


Soft or hard bristles?


In general, a toothbrush head should be small (1" by 1/2") for easy access. It should have a long, wide handle for a firm grasp and soft, nylon bristles with round ends. Some brushes are too abrasive and can wear down teeth. A soft, rounded, multi-tufted brush can clean teeth effectively. Press just firmly enough to reach the spaces between the teeth as well as the surface. Medium and hard bristles are not recommended.


How long should I brush?


It might be a good idea to brush with the radio on, since dentists generally recommend brushing three to four minutes, the average length of a song. Using an egg timer is another way to measure your brushing time. Patients generally think they're brushing longer, but most spend less than a minute brushing.


To make sure you're doing a thorough job and not missing any spots, patients are advised to brush the full three to four minutes twice a day, instead of brushing quickly five or more times through the day.


Should I brush at work?


Definitely, but most Americans don't brush during the workday. Yet a survey by Oral-B Laboratories and the Academy of General Dentistry (AGD) shows if you keep a toothbrush at work, the chances you will brush during the day increase by 65 percent.  


Getting the debris off teeth right away stops sugary snacks from turning to damaging acids and catches starchy foods like potato chips before they turn to cavity-causing sugar. If you brush with fluoride toothpaste in the morning and before going to bed, you don't even need to use toothpaste at work. You can just brush and rinse before heading back to your desk. If you don't have a toothbrush, rinsing your mouth with water for 30 seconds after lunch also helps.


Tips to improve your office brushing habits:


  • Post a sticky note on your desk or computer as a reminder to brush teeth after lunch.
  • Brush teeth right after lunch, before you become absorbed in work.
  • Store your toothbrush and toothpaste at work in a convenient and handy place.
  • Make brushing your teeth part of your freshening-up routine at work.
  •  When brushing at the office or away from home, it's important to make an extra effort to keep your toothbrush germ-free.

 Tips on how to properly store and care for your toothbrush at work:


  • Always store your toothbrush in a travel container.
  • Dry your toothbrush after use and before returning to its container.
  • Change the toothbrush you take to work more often than your toothbrush at home to avoid bacteria build-up.

[] Is Your Family Sharing too Much?

You wouldn't think of sharing your toothbrush. Not even with a family member. But it takes more than sole proprietorship to avoid partnering infection.


Studies show that toothbrushes can become heavily contaminated with oral bacteria. Because most families store toothbrushes in a common storage space, airborne bacteria can move from toothbrush to toothbrush, passing opportunistic infections such as periodontal (gum) disease and the common cold from one person to another.


Your best defense is to go undercover. "The easiest way to protect your toothbrush is by using a toothbrush cover," advises Academy of General Dentistry spokesperson Howard S. Glazer, DDS, FAGD.


Splattering water, contact with skin and toothbrushes knocking against one another are all circumstances that contribute to the spread of bacteria. Dr. Glazer recommends rinsing bristles thoroughly, then shaking any extra moisture from the brush and storing it upright before placing a cover over the toothbrush head.


Bacteria from food particles and contact with the skin are unavoidable consequences of daily brushing. Dr. Glazer says people should wash their hands both before and after brushing, and soak unused brushes in an antiseptic mouthwash. Having more than one toothbrush makes this process a lot more practical. "The bathroom is usually the most contaminated room in the house," says Dr. Glazer. "Protect yourself by protecting your toothbrush."

[] How Do I Care for My Child’s Baby Teeth?

Though you lose them early in life, your primary teeth, also called baby teeth, are essential in the development and placement of your permanent teeth. Primary teeth maintain the spaces where permanent teeth will erupt and help develop proper speech patterns that would otherwise be difficult; without maintenance of these spaces, crowding and misalignment can occur, resulting in more complicated treatment later. Baby teeth also are primers for teaching your child good oral care habits. It is important to take care of your child's primary teeth. Even though primary teeth last only a few years, decay, cavities and infection can take its toll and may require expensive treatment to repair.


When do baby teeth come in?


Your child's primary teeth generally make their appearance when he or she is 6 or 7 months old, though it can occur as early as birth. There are 20 primary teeth, followed by 32 permanent teeth that will eventually replace them. Your child should have all his or her primary teeth at age 3 and will keep them until age 5 or 6, when they begin to loosen and fall out. This process usually lasts until the child is 12 or 13. Primary teeth fall out because permanent teeth are pushing them, and by about age 14 children have 28 permanent teeth, plus four additional teeth, called wisdom teeth, that grow behind the permanent teeth in late adolescence.


What can relieve my child's discomfort during teething?


Between the ages of 6 months and 3 years, your child may experience sore gums and general oral discomfort as primary teeth erupt. While some lucky children experience no apparent discomfort during eruption, many others do. Signs that eruption is causing discomfort in your child include crankiness, lack of appetite, excessive drooling, restless behavior, pink or red cheeks, coughing, upset stomach and chewing or sucking of fingers and toys. There are ways you can bring your child relief. A cold, wet cloth for your baby to suck on can sooth gums. There are also teething accessories and toys your child can chew on to relieve discomfort. Thumb sucking also brings relief, however, dentists recommend this practice should cease upon the arrival of the first permanent teeth, so it does not interfere with the normal development of a child's oral cavity.


Should loose primary teeth be pulled?


Losing primary teeth before they are ready to fall out can affect the proper positioning of the permanent teeth. If a baby tooth is lost too early, other teeth may tip or fill in the vacant space, forcing permanent teeth to come in crooked. If a baby tooth is knocked out, see your dentist, who may recommend a space maintainer to reserve the gap until the permanent tooth comes in. In instances where a primary tooth is loose because of the emergence of a permanent tooth, have the child wiggle the tooth or eat something hard, such as an apple, to help it along. Once the shell of the tooth is disconnected from the root, the discomfort in extracting a loose primary tooth is minimal.