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Instant Cures and Magic Bullets
FAQS



Instant Cures and Magic Bullets

It is human nature to look for a quick and easy solution to any health problem, and treating periodontal disease is no exception. Almost monthly, there is another claim of curing gum disease with a new drug, mouthwash, or pill.

Unfortunately, these “cures” do not work, and by the time the patient discovers that, much more periodontal destruction has occurred. Patients cannot even trust most medical “studies”, which seem to show fantastic results. Often the company selling the new product sponsors these studies, and that same company is paying the dentists who are touting the results. Anecdotal results, or short-term studies, are simply not a sound basis upon which to base treatment. Most serious researchers believe there must be at least two “blind” human studies of 6 months or longer to warrant attention, and longer-term studies to dictate therapy. And beware of claims that periodontists do not want to use a product because it would obviate the need for surgery, and thereby reduce their income. Any ethical dentist looks for the best health solution for his or her patients, regardless of profit margin, and if you do not feel that confidence with your dentist, you need to change health providers.

 

The following treatments often generate claims of cures that are either highly exaggerated or just plain false.

 

Mouthrinses

The gold standard for mouthwashes is chlorhexidene, commonly sold as the prescription mouthwash Peridex. It is extremely effective in reducing plaque, and we prescribe it frequently after active therapy. It is safe, but will stain teeth over time, which is of concern to most patients. (The stain is removed by tooth polishing unless it stains a leaking filling). We would rarely discourage its use by a patient. However, no mouthwash is able to penetrate to the bottom of a pocket, and even when an irrigator is used; a pocket will still contain plaque that produces more disease.

Mouthwashes are good adjuncts to therapy, particularly when flossing and brushing are limited, but they do not cure periodontal disease. Other mouthwashes that are useful include PerioMed, a stannous fluoride mouthwash, and Listerine, a well-studied rinse that helps reduce plaque.

 

Vitamins and Supplements

For years, researchers have studied the effects of diet on periodontal disease. While there are numerous studies that indicate one supplement or another reduces or cures gum problems, none have been reproducible by objective researchers. Patients with normal, healthy diets do not improve their periodontal health with supplements.

 

Antibiotics

While it seems logical that taking antibiotics would be helpful in treating an infection, with periodontal disease the problems tend to return as soon as the antibiotic is stopped. Also, good scaling and root planing seem just as effective as antibiotics without the risks of side effects or the formation of resistant strains. In general, antibiotics are used only for specific cases (see Antibiotics).

 

Low Dose Antibiotics

It has been known for many years that the antibiotic doxycycline not only kills bacteria, but also reduces collagenase, an enzyme that causes breakdown of periodontal tissues. It was found that in low doses, when the antibiotic effect is no longer available, collagenase reduction still occurs. Because of the low dose, it is thought that the problems with side effects and bacterial resistance are greatly reduced, and the drug can be used on a long-term basis. This attempt to increase patient resistance is the first step of what promises to be an important approach to maintaining periodontal health. Unfortunately the research on this specific product (Periostat) is extremely limited, and the results non-conclusive. In the only human study the difference between the control and the product was less than 1 mm change in pocket depth, which is not clinically significant. We use Periostat with certain cases that are resistant to conventional care, but it is not recommended at this time for the typical case.

 

Local Delivery

In the last decade there has been an attempt to place antibiotics (Arestin) directly into the pocket. With newer techniques it is possible to have the product time-release over several days, which helps kill the bacteria in the pocket. These products seem to help in certain cases, although the most recent research indicates that over a 5 year period, no difference is seen with or without the product. We typically use these local delivery antimicrobials in the maintenance (recall) phase of treatment, when specific areas don’t seem to be doing well. They are not used in the original treatment phase.




FAQS

Below are some of the most frequently asked questions patients have about dentistry and oral health issues. 

If you have any other questions, or would like to schedule an appointment, we would love to hear from you.

Click on a question below to see the answer.

 

What should I do if I have bad breath?

Bad breath (halitosis) can be an unpleasant and embarrassing condition.  Many of us may not realize that we have bad breath, but everyone has it from time to time, especially in the morning.

There are various reasons one may have bad breath, but in healthy people, the major reason is due to microbial deposits on the tongue, especially the back of the tongue.  Some studies have shown that simply brushing the tongue reduced bad breath by as much as 70 percent.

 

What may cause bad breath?

  • Morning time – Saliva flow almost stops during sleep and its reduced cleansing action allows bacteria to grow, causing bad breath.
  • Certain foods – Garlic, onions, etc.  Foods containing odor-causing compounds enter the blood stream; they are transferred to the lungs, where they are exhaled.
  • Poor oral hygiene habits – Food particles remaining in the mouth promote bacterial growth.
  • Periodontal (gum) disease – Colonies of bacteria and food debris residing under inflamed gums.
  • Dental cavities and improperly fitted dental appliances – May also contribute to bad breath.
  • Dry mouth (Xerostomia) – May be caused by certain medications, salivary gland problems, or continuous mouth breathing.
  • Tobacco products – Dry the mouth, causing bad breath.
  • Dieting – Certain chemicals called ketones are released in the breath as the body burns fat.
  • Dehydration, hunger, and missed meals – Drinking water and chewing food increases saliva flow and washes bacteria away.
  • Certain medical conditions and illnesses – Diabetes, liver and kidney problems, chronic sinus infections, bronchitis, and pneumonia are several conditions that may contribute to bad breath.

Keeping a record of what you eat may help identify the cause of bad breath.  Also, review your current medications, recent surgeries, or illnesses with your dentist.

 

What can I do to prevent bad breath?

  • Practice good oral hygiene – Brush at least twice a day with an ADA approved fluoride toothpaste and toothbrush.  Floss daily to remove food debris and plaque from in between the teeth and under the gum line.  Brush or use a tongue scraper to clean the tongue and reach the back areas – up to 80% of oral malodor originates from the back of the tongue.  Replace your toothbrush every 2 to 3 months.  If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth in the morning.
  • See your dentist regularly – Get a check-up and cleaning at least twice a year.  If you have or have had periodontal disease, your dentist will recommend more frequent visits.
  • Stop smoking/chewing tobacco – Ask your dentist what they recommend to help break the habit.
  • Drink water frequently – Water will help keep your mouth moist and wash away bacteria.
  • Use mouthwash/rinses – Some over-the-counter products only provide a temporary solution to mask unpleasant mouth odor.  Ask your dentist about antiseptic rinses that not only alleviate bad breath, but also kill the germs that cause the problem.

In most cases, your dentist can treat the cause of bad breath.  If it is determined that your mouth is healthy, but bad breath is persistent, your dentist may refer you to your physician to determine the cause of the odor and an appropriate treatment plan.

 

 

How often should I brush and floss?

Brushing and flossing help control the plaque and bacteria that cause dental disease.

Plaque is a film of food debris, bacteria, and saliva that sticks to the teeth and gums.  The bacteria in plaque convert certain food particles into acids that cause tooth decay.  Also, if plaque is not removed, it turns into calculus (tartar).  If plaque and calculus are not removed, they begin to destroy the gums and bone, causing periodontal (gum) disease.

Plaque formation and growth is continuous and can only be controlled by regular brushing, flossing, and the use of other dental aids.

Tooth Brushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

  • Brush at a 45 degree angle to the gums, gently using a small, circular motion, ensuring that you always feel the bristles on the gums.
  • Brush the outer, inner, and biting surfaces of each tooth.
  • Use the tip of the brush head to clean the inside front teeth.
  • Brush your tongue to remove bacteria and freshen your breath.

Brushing time should be a minimum of 3 minutes per session.  When brushing your teeth, don’t think of it as scrubbing a floor, but as detailing an automobile.

Electric toothbrushes are also recommended.  They are easy to use and can remove plaque efficiently.  New models that can oscillate and pulsate the brush head 40,000 times/min are far superior than conventional manual brushing.  Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.  Many electric toothbrushes have timer features built in, letting you know when you brushed for an adequate amount of time.

 FlossingDaily flossing is the best way to clean between the teeth and under the gum line.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

  • Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
  • Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
  • Curve the floss into a “C” shape around each tooth and under the gum line.  Gently move the floss up and down, cleaning the side of each tooth.

Many patients don’t realize that flossing is more important than brushing.  The areas between teeth are more plaque retentive – tooth decay and gingivitis generally develop between the teeth first!

Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – Mouthrinses are great adjuncts to brushing and flossing, but are not, in any way, a substitute for either modality.  Although not essential in maintaining your oral health, mouthrinses can only aid oral hygiene by decreasing the overall bacteria load in your mouth.  In order for mouthrinses to be effective, they must be held inside the mouth for a minimum of 2 minutes.

 

Order of Hygiene:

  1. Brush in the morning (preferably after breakfast) for a minimum of 3 minutes
  2. Evening (immediately before bedtime) – floss, rinse and then brush

 

How often should I have a dental exam and cleaning?

You should have your teeth checked and cleaned at least four times per year, though your dentist or dental hygienist may recommend more frequent visits.  You periodontal maintenance frequency is customized to your needs based on disease history and clinical & radiographic evaluation.

Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your teeth and gums.  At these visits, your teeth are cleaned and checked for cavities.  Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health.  These include:

  • Medical history review: Knowing the status of any current medical conditions, new medications, and illnesses, gives us insight to your overall health and also your dental health.
  • Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.  X-rays also help determine tooth and root positions.
  • Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
  • Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease – redness and/or puffiness of the gums, bleeding on probing/cleaning and pocket depth.
  • Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
  • Examination of existing restorations: Check current fillings, crowns, etc.
  • Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for some time and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line, and can only be removed with special dental instruments.  Patients who develop tartar more readily are seen on a more frequent basis.
  • Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (poisons) that inflame the gums.  This inflammation is the start of periodontal disease!  Patients who accumulate plaque more readily are seen on a more frequent basis.
  • Teeth polishing: Removes stain and plaque that is not otherwise removed during tooth brushing and scaling.
  • Oral hygiene recommendations: Review and recommend oral hygiene aids as needed (electric dental toothbrushes, special cleaning aids, fluorides, rinses, etc.).
  • Review dietary habits: Your eating habits play a very important role in your dental health.

As you can see, a good dental exam and cleaning involves quite a lot more than just checking for cavities and polishing your teeth.  We are committed to providing you with the best possible care, and to do so will require regular check-ups and cleanings.

 

How can I tell if I have Gingivitis or Periodontist (gum disease)?

Four out of five people have periodontal disease and don’t know it!  Most people are not aware of it because the disease is usually painless in the early stages.  Unlike tooth decay, which often causes discomfort, it is possible to have periodontal disease without noticeable symptoms.  Having regular dental check-ups and periodontal examinations are very important and will help detect if periodontal problems exist.

Periodontal disease begins when plaque, a sticky, colorless, film of bacteria, food debris, and saliva, is left on the teeth and gums.  The bacteria produce toxins (acids) that inflame the gums and slowly destroy the bone.  Brushing and flossing regularly and properly will ensure that plaque is not left behind to do its damage.

Other than poor oral hygiene, there are several other factors that may increase the risk of developing periodontal disease:

  • Smoking or chewing tobacco – Tobacco users are more likely than nonusers to form plaque and tartar on their teeth.
  • Certain tooth or appliance conditions – Bridges that no longer fit properly, crowded teeth, or defective fillings that may trap plaque and bacteria.
  • Many medications – Steroids, cancer therapy drugs, blood pressure medications, oral contraceptives.  Some medications have side effects that reduce saliva, making the mouth dry and plaque easier to adhere to the teeth and gums.
  • Pregnancy, oral contraceptives, and puberty – Can cause changes in hormone levels, causing gum tissue to become more sensitive to bacteria toxins.
  • Systemic diseases – Diabetes, blood cell disorders, HIV / AIDS, etc.
  • Genetics may play role – Some patients may be predisposed to a more aggressive type of periodontitis.  Patients with a family history of tooth loss should pay particular attention to their gums.

Signs and Symptoms of Periodontal Disease

  • Red and puffy gums – Gums should never be red or swollen.
  • Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.
  • Persistent bad breath – Caused by bacteria in the mouth.
  • New spacing between teeth – Caused by bone loss
  • Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone)
  • Pus around the teeth and gums – Sign that there is an infection present.
  • Receding gums – Loss of gum around a tooth
  • Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.

Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

 

Why is it important to use dental floss?

Brushing our teeth removes food particles, plaque, and bacteria from all tooth surfaces, except in between the teeth.  Unfortunately, our toothbrush can’t reach these areas that are highly susceptible to decay and periodontal (gum) disease.

Daily flossing is the best way to clean between the teeth and under the gum line.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (acids) that cause cavities and irritate and inflame the gums.  Also, when plaque is not removed above and below the gum line, it hardens and turns into calculus (tartar).  This will further irritate and inflame the gums and also slowly destroy the bone.  This is the beginning of periodontal disease.

 How to floss properly:

  • Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
  • Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
  • Curve the floss into a “C” shape around each tooth and under the gum line.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Daily flossing will help you keep a healthy, beautiful smile for life!

 

 

What are my options if I have missing teeth?

With many state-of-the-art dental treatments and prevention options available in dentistry today, there are fewer reasons for having to extract (remove) teeth.  When something does go wrong with a tooth, we try to do everything possible to restore the tooth to its original function.  Removing a tooth is the last option because we know that removal may lead to severe and costly dental and cosmetic problems if the tooth is not replaced.

Losing a tooth can be a very traumatic experience and it’s very unfortunate when it does happen.  Injury, accident, fracture, severe dental decay, and gum disease are the major reasons for having to remove a tooth.  If teeth are lost due to injury or have to be removed, it is imperative that they be replaced to avoid cosmetic and dental problems in the future.

When a tooth is lost, the jaw bone that helped to support that tooth begins to atrophy, causing the teeth on either side to shift or tip into the open space of the lost tooth.  Also, the tooth above or below the open space will start to move towards the open space because there is no opposing tooth to bite on.  These movements may create problems such as decay, gum disease, excessive wear on certain teeth, and TMJ (jaw joint) problems.  These problems and movements do not result immediately, but will eventually appear, compromising your chewing abilities, the health of your bite, and the beauty of your smile.

Options for replacement of missing teeth:

  • Removable bridges – This type of bridge is a good solution for replacing one or more missing teeth, especially in complex dental situations where other replacement options are not possible. They are usually made of tooth-colored, artificial teeth combined with metal clasps that hook onto adjacent natural teeth. Removable bridges are the most economical option for replacing missing teeth, but may be the least aesthetically pleasing. This is because the metal clasps on the appliances are often impossible to completely conceal.
  • Fixed bridges – This type of bridge is generally made of porcelain or composite material and is anchored (cemented) permanently to a natural teeth adjacent to the missing tooth site. The benefit of this type of bridge is that it is fixed (not removable) and it is very sturdy. The disadvantage is that in order to create a fixed appliance, two healthy, natural teeth will have to be crowned (capped) to hold the bridge in place.
  • Dentures - This type of tooth replacement is used when most or all of the natural teeth are missing in one dental arch. Dentures are removable artificial teeth that are made to closely resemble the patients’ original teeth.
  • Implants - Are a great way to replace one or more missing teeth. They may also be great to support ill fitting dentures. A dental implant is an artificial root that is surgically placed into the jaw bone to replace a missing tooth. An artificial tooth is placed on the implant, giving the appearance and feel of a natural tooth. Implants are very stable, durable, and are the most aesthetically pleasing tooth replacement option.

If you are missing teeth, ask us if they need replacement and what options are available to you. Together we will select the best replacement option for your particular case. Prevention and early treatment is always less involved and less costly than delaying treatment and allowing a serious problem to develop.

 

What does heart disease and other medical conditions have to do with periodontal (gum) disease?

Many people are unaware that having periodontal disease (the destruction of gum tissue and bone that hold our teeth in place) can affect your overall health.  Periodontal disease is one of the most common infections; often more prevalent than the common cold!  Periodontal disease is not only the number one reason people lose teeth; it can also affect the health of your body!

Periodontal disease is a bacterial infection, and in its earliest stages, it’s called gingivitis.  It starts when an accumulation of plaque (a colony of bacteria, food debris, and saliva) is NOT regularly removed from the gums and teeth.  The bacteria in plaque produce toxins/acids that irritate and infect the gums and eventually destroy the jaw bone that supports the teeth.  When periodontal disease is not treated it can eventually lead to tooth loss!

There are numerous studies that have looked into the correlation between gum disease and major medical conditions.  These studies suggest people with periodontal disease are at a greater risk of systemic disease and indicate that periodontal disease may cause oral bacteria to enter the bloodstream and travel to major organs and begin new infections.  Research suggests that periodontal bacteria in the blood stream may:

  • Contribute to the development of heart disease
  • Increase the risk of stroke
  • Compromise the health of those that have diabetes or respiratory diseases
  • Increase a woman’s risk of having a preterm, low-birth weight baby

Researchers conclude there is still much research to be done to understand the link between periodontal disease and systemic diseases, but enough research has been done to support that infections in the mouth can play havoc elsewhere in the body.

To ensure a healthy, disease-free mouth, we recommend the importance of regular dental check-ups and cleanings, which include a periodontal evaluation.  Also, diligent home care and a proper diet can help reduce the plaque and bacteria in the mouth.

Remember….the mouth body connection!  Taking care of your oral health may contribute to your overall medical health!