The same old story…
Every 6 or so months you go see the hygienist and for as long as you can remember, it’s the same thing. A practiced story about the benefits of flossing and how you should do it more often. Sure, but the problem is it isn’t convenient, it isn’t comfortable, and it doesn’t really seem to make any difference. But just like 6 months ago, the answer is the same. The hygienist asks if you floss and you say “not as often as I should.” Then you promise to get better at flossing every day, even though you kinda doubt you will. Wouldn’t you think that today, when we carry
all the knowledge in the world in our pockets and actually have nanobots in real life, that there just has to be a better answer?!
The better answer!
There’s zero room to argue that you shouldn’t brush your teeth well at least twice a day and floss them well at least once. The bacteria in the mouth and their lifespan supports that approach and the whole key is to minimize the negative impact of bacteria in your mouth. There are both good and bad bacteria, and the goal is to keep the good ones healthy so they can help you ward off the bad ones. The two best tools you have are daily maintenance and nutrition, so it makes sense to pay attention to both! Brushing twice daily controls the buildup of plaque and bacteria on the tooth surfaces that you can see in your mouth. Flossing once a day interrupts the conversion of that plaque into hard deposits called calculus or tartar on the surfaces you can’t see, in between the teeth. Minimizing the acids and sugars in your diet limits the attack on the tooth enamel and makes it harder for decay causing bacteria to fester.
What if you need more?
What a great question! The reality is more than 80% of adults in America have either active periodontal disease, or a history of it. That means that 8 out of 10 adults need more than the simple brushing and flossing to keep the mouth healthy, and that’s where a hygiene coach and health advocate becomes so important! The normal ‘brush and floss’ lecture simply isn’t enough or we wouldn’t see 80% of adults dealing with damage to the bone and soft tissue that holds their teeth in. Periodontal disease is avoidable and we can keep our teeth for life, but not using the same tired message we all grew up with. So what are the other tools and strategies? We’re glad you asked!
But first, the foundations;
Toothbrush
It’s kind of funny that most of us learned how to brush our teeth when we were little kids, and most of us learned wrong! Not funny ‘ha ha’, but funny peculiar. And it’s too bad. There are a few key takeaways that you need to internalize. First, it should have been called a gum brush all along. What it does to clean the gums is way more important than what it’s doing to clean the teeth. Secondly, it should be angled toward the gum tissue at 45° and you should feel it on every side of every tooth. Also, there is a huge step up from using a manual tooth brush and using a power toothbrush as its designed. Each power toothbrush style is a little different, but the data has clearly shown it does more in less time and, the Sonicare tooth brush in particular has excellent data showing it brushes beyond where the bristles touch! Another of we have seen as impressively effective is the new SonicFusion combination toothbrush and water flosser.
Waterpik
Any water flosser will do, and the reality is every one is better than flossing when you use them! It is designed to reach the places your toothbrush can’t, so just like floss, it is a once every 24 hours tool. You only ever have to set it to about halfway, and then point the tip 90° to the tooth just above the gumline and spend a few seconds slowly moving across the tooth. It should take the whole well of water to clean up all the areas in your mouth with a regular Waterpik, and even after flossing, you will be surprised at what it helps clean out! Honestly, if our lecture had always been brush 2x a day and waterpik every day, we probably wouldn’t see as much gum disease!!
What else can you do to keep your teeth for life?
Your hygienist should be acting as a health advocate and working with you to find tools that make the difference. For sure they will say to brush and floss, but it goes so far beyond that, and if your hygienist isn’t talking about how to use those tools and what else you can leverage, then you probably need to change hygienists. No matter how nice she is, if she isn’t first trying to help you attain , then she isn’t in your corner!
If you haven’t had customized instruction on how to use your power toothbrush, that’s a great first step. They do a lot of the heavy lifting for you, but the various styles of toothbrushes mean that the use of them is different. Next, revisit using the waterpik! It truly is a game changer!! Also, you can add some kinds of mouthwash into the water you are water flossing with and see some great results. One of our favorites is Closys. It creates a cleaner and healthier soft tissue foundation for your teeth and gums.
Bacteria in your mouth
There are both good and bad bacteria, and the goal is to maximize the environment for good bacteria and eliminate the environment for pathogenic bacteria. Like so many places in life, the more of the good you have, the less space there is for bad. Fortunately, there is a probiotic designed for the mouth. This has two different strands of active cultures to support healthy gum tissue and one that makes it harder for the decay-causing bacteria to grow. We have seen great results with ProBioraPro in our patients and it is a simple tool to implement.
pH in your mouth
There has been a lot of information about acidity or alkalinity of our bodies. Today we have dozens of highly alkaline waters to help neutralize the acidity in our bodies. In the mouth, one of the big issues we fight is the acids eroding holes in your teeth. Pathologic bacteria release acid as their waste, and finding a way to balance that out is key in helping to keep your mouth healthy. We have several tools to help to accomplish this.
mouthrinses
You should never use a mouthrinse that has alcohol in it. Listerine is a great example of the right plan but wrong execution. With alcohol in the mouthrinse, it actually slows down healing of the very tissues we are trying to get healthy. On the other hand, Closys is a fantastic mouthrinse that has chlorine dioxide which helps eliminate volatile sulfur compounds (the stuff that causes bad breath) and also brings your pH back to about 7.4 where it should be. If you need a little more power, we also have OraCare. This contains active chlorine dioxide that’s about 10x stronger than Closys and also has xylitol. This handy little addition to the mouthrinse is a fake sugar that cavity causing bacteria loves more than real sugar. However, after feasting on the fake sugar, these nasty little bugs can’t process it. In a twist of poetic justice, they die of gluttony and this helps protect your teeth from decay!
Saliva Enhancers
Fortunately, we have lots of amazing medical solutions available to us. Unfortunately, of the 200 most commonly prescribed medications in the United States, 200 of them can cause dry mouth! When the quality or quantity of your saliva is less than optimal, the teeth and gums are at a significantly higher risk of disease. Using a salivary stimulant or a salivary substitute will help bridge the gap and keep your tissues moist and protected.
Balance Point
Another key concept is to simply make sure your not playing catch-up. Once the gums have gotten healthy, it should never be a function of your insurance companies idea of preventive health care. Your mouth and health is way too important to leave it in the hands of an insurance plan. A much better solution would be to work out how long it takes for your gums to get infected again. Then, once you know that, set your next hygiene visit up one day sooner! There’s actually no science that supports cleanings twice a year. All of the data suggests four visits a year is much better at keeping your mouth healthy, and in some cases even more often! What we will do is work with you to find out how long we can stretch out the time between cleanings and still keep your mouth healthy. If you hear us talking about balance point, all it means is to figure out how long can we go before your mouth gets sick, and see you just before that happens.
Addressing the bacteria directly
There are more than 500 different kinds of bacteria found in the mouth, and fortunately most of them are relatively harmless or happen to be easy to deal with. The vast majority of bad bacteria are eradicated with great daily brushing and flossing habits. But for the ones that need a bit more attention, there are some great options there too.
Laser-Perio Therapy
Easily one of the most powerful adjuncts to creating perfect tissue health is the application of laser energy. Using a diode laser, we can apply the energy in the pocket where the bacterial colonies are starting the issues as well as into the gum tissue around the pockets. This is key as that bacterial infection has marinated into that tissue and is breaking down the gums directly. When the laser energy is applied, not only does it stimulate healing, but it also has a dramatic impact on most of the pathologic bacteria. The laser energy denatures the bacteria and destroys it in its tracks. This allows your body to take over and recreate a healthy environment as it heals.
Culture & Sensitivity Testing
While the laser energy is incredibly effective with most bacteria, it isn’t universally successful. In those cases where it doesn’t have the anticipated result, we can actually take a sample of the bacteria and find out just what kinds of bugs are causing the problems. We can also determine what antibiotics are most effective at dealing with the infection. The most cost-effective approach is to assume the bacteria will respond to laser therapy. This is one of those times where ‘when you hear hoof beats, think horses and not zebras’. When that isn’t effective, it is great to have tools to know just how to attack whatever is causing the problems.
Arestin
Arestin is a site specific antimicrobial. As the name implies, it can be used to kill bacteria in very specific areas. While generally speaking, gum infections impact the entire mouth, it isn’t uncommon to have an area or two that is in worse shape than the rest of your mouth. For these areas, we can directly place an antimicrobial that will stay in the pocket and help your body to get ahead of the bacterial infection directly. Simple and relatively inexpensive, this is a great tool in some specific instances.
Perio Protect Trays
There’s no substitute for optimal brushing, waterpiking, and flossing, but there is a solution for when that just can’t fit into life. Whether it’s a matter of manual dexterity or simply a travel schedule that makes packing a waterpik an impossibility, this technology is an amazing tool! With incredibly well adapted trays, you can apply an oxidating gel that pumps down into the gum tissues and into the deeper pockets. This drives oxygen into the area where the deepest bacteria are thriving. The poetry to this technology is that the oxygen is being added into bacteria that cannot live in the presence of oxygen, and they die! It is nice to have tools that directly attack the most aggressive bacterial colonies and reverses the process in just a few minutes a day of wearing a tray – and the bonus is this will gently whiten your teeth over time too!
Your Dental Hygiene Health Advocate
At Aesthetic Dentistry of Georgetown, the hygiene team has made the commitment to be at the very top of their game. To accomplish this, they stay abreast of the many different oral/systemic connections and also all the great adjunct tools that can be used to help you protect your teeth and gums for a lifetime. They may talk about using sealants or fluoride treatment to minimize the risk of cavities if you happen to be more susceptible to decay. Or, they may recommend the simple application of Cervitec, an antimicrobial material that can be applied to your gums. This painless application will allow the antimicrobial to dissolve into your gums and help your body say ahead of the bacterial infections causing problems. The hygiene team is continually advancing their knowledge and working to offer more simple solutions to help you keep your teeth for a lifetime!
If you are interested in a team that takes this kind of attention to helping you stay healthy, give us a call and set up a New Patient Experience. We can’t wait to meet you!