The NobleDentist Blog

This is an article by Lorna MacLaren published recently in The Herald, Glasgow.

To floss or not to floss? It’s a question most of us choose to ignore. Despite countless dental health campaigns and information leaflets, it seems the habit of flossing between teeth is still to catch on.
According to a UK survey by the British Dental Health Foundation (BDHF), 50% of people questioned admitted they didn’t even know how to brush their teeth properly – with a further hefty percentage failing to floss regularly.

While one in two people said they brushed for much less than the mini-mum recommended two minutes at a time, 40% said they never flossed and most answered “yuk, never” when asked about tongue cleaning.
Women came out particularly badly, viewing brushing the tongue – recommended for combating bad breath – and using dental floss or tape between the teeth, as positively stomach-turning.

Bizarrely, some people preferred to pick their teeth with dangerous house-hold implements including needles, keys, screwdrivers and earrings.

But how important is flossing and the practice of tongue-brushing? Isn’t the most important thing to brush teeth regularly and properly?

Dr Nigel Carter, chief executive of BDHF, says: “Lately, when patients talk about oral health it is usually to cover one of two subjects – access to NHS dentistry or tooth whitening. However, as this research shows, people still have plenty to learn about basic oral health care.

“They need to be educated on the importance of flossing, which is a vital part of a good oral health routine, removing food particles from between the teeth and plaque from against the gum line. It should be done once a day before brushing.

“It is very important to be gentle, because jerking or snapping the floss into the gums can damage the delicate tissue. The best thing to use to dislodge food from between the teeth is interdental wood sticks. These are shaped specifically for this purpose. Cocktail sticks or anything else are not, and should be avoided.”
“A good oral health care routine is vital to maintaining a healthy smile and should include brushing with fluoride toothpaste and cutting down on sugary foods and drinks.”

Dentist Kenneth McDonald is a partner at the Allander Dental Care clinic in Milngavie near Glasgow.
He agrees the flossing message is still to be taken on board by some people and says dentists should tell them about the benefits.

“Interdental cleaning, whether with special brushes or floss, and tongue brushing are essential elements of good oral hygiene and prevention of gum disease.”

While painful cavities and nasty breath might spring to mind on the subject of bad teeth, there could also be serious implications for an individual’s general health. According to bodies including the British Dental Hygienists’ Association (BDHA), gum disease, which often manifests itself in bleeding after brushing, could be a contributing factor in conditions such as heart disease and stroke.

Gum disease results in swelling, soreness or infection of the tissues supporting the teeth.

There are two main forms of gum disease: the first stage, gingivitis, and periodontal disease. As the disease gets worse, the bone anchoring the teeth in the jaw is lost, loosening the teeth. If this is not treated, the teeth may fall out. In fact, more teeth are lost through periodontal disease than through tooth decay.

Some research studies have shown a link between heart conditions and certain bacteria found in gum disease.
While further research continues to explore the link, experts say it is important to treat periodontal disease aggressively so its impact on heart disease can be reduced or eliminated.

Additional studies have pointed to a relationship between oral infections and stroke. In one piece of research that looked at potential risk factors, people diagnosed with having a stroke were found more likely to have an oral infection when compared to those in the control group.

Rachel Reid is a dentist at the Pilrig Dental Practice in Edinburgh. She believes people are becoming more aware of how their oral health can affect their general health.

She says: “Links between heart problems and gum disease still have to be fully explored. But I think that through local dentists and messages on television, it is getting through to people that not looking after their teeth can have a knock-on effect.

“Flossing, tongue scraping or brushing, and the use of interdental brushes for the spaces between teeth, hugely cut down on plaque, in a way that tooth-brushing can’t.

“The difficulty comes in patients taking it on board as part of their brushing routine. Some say it is time consuming and fiddly.

“Others still think they are getting their mouths totally clean just with brushing. They are unaware that plaque can be on the tongue too.

“Cleaning the mouth properly is a positive habit to have. After all, it only takes a couple of minutes and will be hugely worth it in the long term.”

Dental care made easy

Brushing twice daily with fluoride toothpaste, using floss or dental tape and visiting the dentist regularly will keep your mouth healthy.

How to brush

Tilt the bristles at a 45º angle towards gum line and move brush in small circular movements, covering all surfaces of the teeth, for two minutes. To avoid bad breath, also brush the tongue.

How to floss

Floss at least once a day before brushing. The basic flossing method involves wrapping about 18 inches of floss around your forefingers with about an inch held tightly between the thumbs. The most important thing is to be gentle. Adopt a slow rocking action to guide the floss between your teeth. Jerking or snapping the floss into the gums can damage the delicate tissue. Remove plaque by holding the floss in a C-shape against the tooth and gently scraping the side away from the gums.

For more advice speak to your dentist or hygienist.

To learn how to save hundreds and even thousands of dollars off dental fees, click on dental cover.

This article by Jervette Ward was recently published in the Health Scene of the Clarion Ledger.

It’s your child’s first birthday, and you have the cake, candles, balloons and presents; but, do you have a dentist?

A child should go the dentist for the first time by his first birthday, said Dr. Neva Penton Eklund, a pediatric dentist at the University of Mississippi Medical Center.

Eklund said she knows this idea strikes a lot of parents as odd because most children have very few teeth by their first birthday.

However, Eklund said it is more about learning about proper nutrition and hygiene.

“It’s really about a parent learning how to take care of that baby’s oral health and teaching the child that it’s (dental visit) not something to be scared of,” said Eklund, associate professor in the Department of Pediatric and Public Health Dentistry at UMC’s Blair E. Batson Hospital for Children.

Some parents pay little attention to baby teeth, thinking they don’t really matter since their child will get permanent teeth later, Eklund said.

Parents often bring in children with rotten baby teeth, she said, and tell her to just pull them out.

However, she can’t do that because permanent teeth develop in stages, and baby teeth stay there to hold a place for the permanent teeth to have later.

If the baby teeth are removed, the permanent teeth will not have a space to fill.

Eklund said first dental visits – like all dental visits – can be hard.

“Some kids are totally well behaved, no issues,” Eklund said. “And, some kids are not at all like that. Sometimes their parents had bad experiences and they impart that to their child.”

The goal at the dental clinic is to stress the importance of good dental health and to coordinate dental treatments for patients with multiple issues.

Dental disease is one of the top three reasons children are absent from school, according to 2004 statistics from the state Department of Health.

An estimated half of third-graders in Mississippi public schools need dental care, and about one in five need urgent dental care because of pain, acute infection or inability to chew food without pain.

Remington Edwards, 12, of Laurel has been a patient at the Children’s Hospital since birth because of a birth defect.

He was born with a condition that causes bleeding on his brain.

Edwards recently had his first dental visit at the hospital’s clinic.

His mother, Tammy Gammage, said she has tried for years to get local dentists to see him, but she said they were reluctant to do so because her son has a history of seizures and is on a lot of medications.

One day she talked to her son’s neurosurgeon, and he suggested the dental clinic right in the hospital.

Many of the patients seen at the hospital are individuals who have been denied service at local clinics, Eklund said.

“I thought I had to go through a lot of processes, but it was easy,” Gammage said. “They sent me the paperwork in the mail.

Most basic dental visits and cleanings can cost about $200.

The service is usually covered by Medicaid and private health insurance.

Gammage said she has always stressed good dental hygiene to her son. “He does really good. I hope we don’t have too many cavities,” she said. “I try to take the candy and sweets away.”

Edwards’ dental visit was a breeze. As his teeth were being cleaned, he laughed and made the dental office staffers laugh with him.

Charles Belknap, a first-year resident at the hospital, said his hope is, by teaching kids like Edwards the importance of dental health early, “they can maintain it the rest of their lives.”

To learn how to save hundreds and even thousands of dollars off dental fees, click on dental cover.

This is a recent release by Fred Peterson of the American Dental Association.

People taking oral bisphosphonates, a type of drug used to treat osteoporosis, osteopenia and Paget’s disease of bone, should be aware of potential risks when undergoing certain dental procedures, according to guidelines published in this month’s Journal of the American Dental Association (ADA).

Relying on a small but growing number of reports linking bisphosphonate drugs to incidences of osteonecrosis of the jaw (dead bone tissue), a panel of experts convened by the ADA believes dental patients who are taking oral bisphosphonate drugs should discuss the risks they face when undergoing procedures that involve the jaw bone, such as tooth extraction or placing implants, with their dentist. Dentists and their patients should carefully consider these procedures, as well as alternative dental therapies. Patients may also want to discuss this information in the context of their overall health and treatment options with their physician.

The ADA recommends that a comprehensive oral evaluation be carried out on all patients about to begin therapy with oral bisphosphonates (or as soon as possible after beginning therapy), and that patients on these drugs be educated on maintaining oral hygiene, which is the best way to prevent oral diseases that may require dental surgery.

The ADA notes that dentists, generally, will not need to modify dental treatments based solely on oral bisphosphonate therapy. Further, patients should understand that the risk for developing osteonecrosis of the jaw is considered very small and that the vast majority of patients taking an oral bisphosphonate do not develop any oral complication.

To learn how to save hundreds and even thousands of dollars off dentist fees, click on affordable dentists.

Dr Kenneth Law of Dr Kenneth Law Dentist has recently become a participating dentist.

Dr Kenneth Law Dentist is located at 71 Falmouth Road, Marayong, New South Wales.

Dr Kenneth Law and the team look forward to assisting members of NobleDentist.

Members wanting to make an appointment can simply click on Dentists in Sydney for contact details.

Surrounding suburbs include St Marys, Oxley Park, Colyton, Whalan, Dharruk, Emerton, Tregear, Lethbridge Park, Blackett, Bidwill, Shalvey, Dean Park, Colebee, Wilmott, Shanes Park, Marsden Park, Riverstone, Windsor Downs, Bligh Park, Mount Druitt, Berkshire Park, and Londonderry.

To learn how to save hundreds and even thousands of dollars off dentist fees, click on dentist.

Dr Kenneth Law of Dr Kenneth Law Dentist has recently become a participating dentist.

Dr Kenneth Law Dentist is located at 111 James Cook Drive, Kings Langley, New South Wales.

Dr Kenneth Law and the team look forward to assisting members of NobleDentist.

Members wanting to make an appointment can simply click on Dentists in Sydney for contact details.

Surrounding suburbs include Bella Vista, Baulkham Hills, Lalor Park, Blacktown, Seven Hills, Arndell Park, Huntingwood, Eastern Creek, Prospect, Girraween, Pendle Hill, Minchinbury, Rooty Hill, Doonside, Woodcroft, Glendenning, Dean Park, Colebee, Mount Druitt, Plumpton, Hebersham, Oakhurst, Hassall Grove, and Bidwill.

To learn how to save hundreds and even thousands of dollars off dentist fees, click on dentist.

This article by Carolyn Poirot recently appeared in the Texas Star Telegram.

Remember the television episode of Friends when Ross bleached his teeth to the point they glowed in the dark?

Theorizing that what’s worth doing is worth doing to excess, some consumers think there is no limit to how white they can make their teeth.

But if you intend to get the most sparkling, movie-star-white smile possible and ignore your dentist’s directions or the labels on the bleaching agents, you could irritate your mouth and make your teeth more sensitive to temperature changes, dentists say.

“With hordes of people doing this, [teeth whitening] is accepted as a very safe thing. ... Of course, there is always the potential for people—usually not the kids, but anyone—to go online and obtain as much of the stronger bleaches as they want to get their teeth whiter and whiter,” said Dr. Bruce Weiner, a Fort Worth pediatric dentist. “I always remind my patients, ‘What you really want people to say is, “My, what a pretty smile you have, not, ‘Oh, you bleached your teeth.’”

Tammy Ratjen, 40, first lightened her teeth in 1982 when take-home bleach was introduced in her dentist’s office.

“I did the trays that you put the bleach into and wore overnight. The bleach wasn’t as strong as the ones we have now, but it worked pretty well,” Ratjen said.

Ratjen liked the results. But she says some of her upper teeth were a little short, and there were some spaces between some of them that she didn’t like. So in 1990, she opted for veneers to make her upper teeth match her lowers. However, she continued to bleach the lower ones “from time to time,” and more recently replaced her crowns and the first veneers with much whiter veneers to better match her now sparkling-white lower teeth.

Ratjen says she has experienced a little sensitivity at various points in the lightening process, but nothing really painful.

“To me, it’s worth it. I think my teeth are natural-looking, but they are about as light as you can go without looking fake. I think you can over-bleach, but most people just want nice, white teeth,” Ratjen said.

Brad McConnell, a busy Fort Worth dentist, estimates that one-third of his patients bleach their teeth.

“Bleaching natural teeth as white as you can get them has created a whole new ballpark of colors for the porcelain manufacturers. We had to throw out our old veneer color guides that only went to the whitest white you could have naturally” so the veneers would match the ultra-whitened teeth, McConnell says.

Wondering whether you’ve gone too far with your whitening or not enough? Then, read on:

So what is the safest, most cost-effective method for bleaching teeth?

At-home bleaching that has a 10-percent carbamide peroxide material in a custom-fitted tray is the most effective thing you can do for the least investment, says Van B. Haywood, professor of oral rehabilitation at the Medical College of Georgia’s school of dentistry, who published the first studies on take-home tray bleaching in 1989 and about 100 papers on the subject since then.

“It provides the best ultimate result with the longest duration. You just have to be patient,” he said.

How long does teeth-bleaching take?

Bleaching with 3 percent to 10 percent carbamide peroxide or hydrogen peroxide takes one to six weeks of two-hour or overnight sessions for most teeth, Haywood says.

Bleaching out nicotine stains will take one to three months, and to get rid of some stubborn stains, including those caused by tetracycline, an antibiotic widely used in the ‘60s and ‘70s, it will take two months to a year, Haywood says.

Higher concentrations (15 percent to 35 percent hydrogen peroxide) are applied in dental offices and take one to two hours over two to four visits, and are sometimes used with lights to “jump-start” the take-home bleaching process.

If it’s faster, why not just use hydrogen peroxide?

Hydrogen peroxide is more likely to cause sensitivity and can irritate gum and mouth tissue. It can also irritate the soft palate tissue, causing a sore throat, says Eric Shapira, a California dentist and spokesman for the Academy of General Dentistry. Shapira says gum tissue around the teeth is tougher and less prone to injury, but it can get inflamed, too: “You can actually get peroxide burns.”

Carbamide peroxide combines hydrogen peroxide with urea, a stabilizing agent that gives it a longer shelf life and causes it to release the hydrogen peroxide more slowly so that it continues working for a longer period—two hours or more.

Is it safe to use whitening toothpaste on my bleached teeth?

Yes, that’s the best way to remove surface stains and keep newly bleached teeth looking white longer, but it does not work chemically from the inside like peroxide bleaches do. It’s like washing a dirty white car and saying it’s whiter when you finish, Haywood says.

Also, try a whitening rinse after drinking red wine, soy sauce, grape juice, cranberry juice, black coffee and colas, especially if you are unable to brush right away.

Why are my teeth sensitive after bleaching?

The American Dental Association says tooth sensitivity is common during early stages of bleaching treatment. Tissue irritation in most cases results from an ill-fitting tray rather than the tooth-bleaching agents, the ADA says. Both of these conditions usually are temporary.

Shapira says over-bleaching can also make tooth enamel more porous, which makes your teeth more sensitive to hot and cold, but especially cold.

Sandy Kinnaman, a Fort Worth dental hygienist, recommends putting a little desensitizing toothpaste or gel in your whitening tray and fitting it to your mouth for 20 minutes or so before or after you bleach your teeth. The special toothpastes and gels for sensitive teeth contain potassium nitrate, which numbs the nerve endings in the teeth and makes them less sensitive to cold.

Can swallowing some of the bleach cause cancer or other health risks, especially in children?

No. Hydrogen peroxide is not a caustic bleach. It is actually used as a healing agent to swab the throats of babies born with thrush, a fungal infection, Haywood said. And it is often poured into open wounds to prevent the spread of germs.

“Numerous studies have found that dental bleaching agents have no detrimental effects. They do not cause softer, weaker teeth and do not damage nerves,” Haywood says. Still, he does not recommend teeth-whitening for pregnant women.

“There is no reason to undergo any elective medical procedures of any kind while pregnant. The trays will last, and you can wait for later—I usually recommend at least six months after the birth of a baby, especially if you are breast-feeding,” Haywood says.

Can I bleach my teeth immediately after taking off my braces?

Chris Sorokolit, a Fort Worth orthodontist, said many of his patients—almost all of them teenaged girls—talk about getting their teeth whitened the day he takes their braces off. But most end up waiting a week or so because their teeth are already a little sensitive from removing all the metal. He refers patients back to their general dentists for whitening advice and products.

Many young people opt for the Zoom! treatment after taking their braces off because it offers immediate gratification, but Weiner recommends they take it slower, using a professional take-home product for three or four weeks because it is more gentle, and the whitening seems to last longer.

What is Zoom! and why is it so popular?

Zoom! is an in-office whitening system that uses a halogen light and light-activated gel to lighten teeth in less than an hour. It was developed by William Dorfman, the Los Angeles dentist famous for restoring beautiful smiles on ABC’s hit series Extreme Makeover.

It is so popular because “marketing sells, not science,” and Zoom! has benefited from TV marketing, Haywood says.

To bleach or not to bleach

Consumers have a lot of options, ranging from whitening toothpastes and gels to powerful quick-fix whitening systems available only in dentists’ offices.

To learn how to save hundreds and even thousands of dollars off dental fees, click on dentist.

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Dr Jonathan Low of Today’s Dental has recently become a participating dentist.

Today’s Dental is located at 7 Beatrice Street, Auburn, New South Wales.

Dr Jonathan Low and the team look forward to assisting members of NobleDentist.

Members wanting to make an appointment can simply click on Sydney Dentist for contact details.

Surrounding suburbs include Lidcombe, Silverwater, Chester Hill, Old Guildford, South Granville, Berala, Regents Park, Yennora, Newington, Villawood, Sefton, Carramar, Fairfield, Liberty Grove, Strathfield, Rockwood, Potts Hill, Bass Hill, Guildford, and Homebush.

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This is an article by Laura Beil that recently appeared in The Dallas Morning News.

Bone specialists have convened a task force to investigate a rare but troubling side effect apparently associated with widely used osteoporosis medications: a jawbone that won’t heal once it is exposed.

Almost 95 percent of the known cases have occurred among cancer patients taking the drugs, called bisphosphonates, prescribed intravenously at doses often more than 10 times that recommended for osteoporosis.

Most of the time, the condition—called osteonecrosis of the jaw—has followed dental surgery or tooth extraction but, in some instances, the problem has emerged spontaneously.

Doctors reported the first case in 2003 and, since then, 400 instances have been described in medical journals. However, no one really knows how often it occurs. Compared with the number of people taking the drugs, the risk appears very small. In 2005 alone, more than 22 million prescriptions were dispensed for Fosamax, the most popular oral bisphosphonate.

“I still feel that they’re pretty safe drugs,” said Dr. Elizabeth Shane, a specialist in bone diseases at Columbia University, and president of the American Society for Bone and Mineral Research. “It’s extremely important to remember that doctors prescribe bisphosphonates for a reason.”

People with cancer use bisphosphonates to help reduce bone pain, protect against overloads of calcium in the blood or help control malignancy that has spread to the skeleton. Those with osteoporosis use them orally, in much lower doses, to help prevent painful and sometimes deadly fractures.

Still, Shane said, some people getting the drugs have become fearful. “My anecdotal experience is that people are terrified, and they’re stopping these drugs,” she said. “The incidence is still very low, especially in patients just taking the oral medicine.”

To address the many unknowns, Shane and the bone and mineral research society have assembled a group of experts in bone diseases, dentistry, epidemiology and other areas to examine the condition.

Although infrequent, osteonecrosis in the jaw can be devastating. Two-thirds of the time, patients are tormented by pain that can be severe, according to a recent summary of knowledge published in the Annals of Internal Medicine. Affected patients can have mouth ulcers that won’t heal and other sores.

Treatment for the condition is unclear.

“There’s really no good management,” said Dr. Jenny He, a specialist in bone metabolism and endodontics at Baylor College of Dentistry-Texas A&M Health Science Center in Dallas. “Patients usually need to go on very long-term antibiotic treatment.”

If doctors know little about treatment, they understand even less about the reasons for the disease. Bisphosphonates work by targeting the cells that constantly remodel internal bone structure. The engines of this turnover are cells called osteoclasts that clear away old bone, and cells called osteoblasts that form new bone in its place. Bisphosphonates slow the work of osteoclasts, but by doing so, also affect osteoblasts because the two work in tandem.

The jaw is particularly abuzz with bone turnover because of microscopic injuries that occur from constant use. One theory is that the suppression of churn from bisphosphonates keeps the jaw from repairing itself after an injury such as tooth extraction. Also, the mouth is teeming with bacteria separated from bone by the thinnest of barriers.

For now, the best guidance physicians and dentists offer is prevention. Patients taking bisphosphonates should be keenly aware of oral hygiene and routine dental care. If someone is about to go on the drugs, dentists say necessary invasive dental work should be done beforehand, if that’s possible. Delaying the drugs for the sake of dental work should also be weighed against the risks of delaying therapy.

If invasive dental work is unavoidable for someone already on bisphosphonates, the advice is less clear. The drugs have a remarkable ability to huddle inside the bone for years, so they will be there long after a person stops taking the pills.

To learn how to save hundreds and even thousands of dollars on dental fees, simply click on Dentist.