One Year Anniversary!
The Healthy Mouth Project is officially a year old!
Thank you to everyone who has visited the site, left comments, signed up for the newsletter, or shared our articles.
There has been a lot accomplished in the last year…
- 203 posts with over 147,000 total words (That’s equal to about a 600 page novel)!
- Many late nights up writing (I run my dental office full time and have a wife and four kids. I just write in my “free” time)!
- Way too many design changes (I think I’m finally settled)!
- Quickly growing numbers of people finding the website and using it to improve their oral health!
Going forward I still have a lot of goals I’d like to accomplish with The Healthy Mouth Project…
- Continue to put out new and useful content on a consistent basis.
- Keep you up to date on new developments in dentistry and how they can help you.
- Increase the numbers of people who find the website and use it to improve their oral health.
- Start a fund that will be used to provide free or low cost dental care to children and adults in need.
How Can You Help?
There are two things I ask of you …
- If you’ve found this website useful, please share it with your friends and families on social media or by word of mouth. It’s easy! See those buttons on the left side of your page or below any post? Click on them to share the article. That’s it!
- Secondly, let me know what additional content you’d like to see on the website. Whether it is additional product reviews or a specific topic, I’m interested to hear what you’d like to see! You can comment on any article or send me an email at info@healthymouthproject.com. I read every single one of them.
Thanks for visiting!
Dr. M
Osteoporosis Medication Dangers
Did you know certain osteoporosis medications, particularly if delivered as an IV injection, can affect your dental health?
I had a patient recently who came to my office complaining of an ulcer on the tongue side of his gums. It had been there for about a month and wasn’t going away. Most normal ulcers will go away within 2 weeks. If we find it isn’t healing by then, then there is likely something else going on. It can range from oral cancer to a drug reaction to various autoimmune diseases. We sent him over to see an oral surgeon who evaluated the area.
The oral surgeon called me a week later to tell me that he had localized osteoncrosis (bone death) as a result of a certain class of osteoporosis medications known as bisphosphonates (which are also used to treat breast cancer and certain types of bone cancer). This patient had been taking them to treat multiple myeloma (a type of cancer). The bone in the area had died and was breaking off. It shows up a big, non-healing ulcer.
Not fun right?
So how do you know if you’re at risk for this?
Most people who’ve taken oral bisphosphonates (pill version) have a slightly higher risk of something like this happening. The risk is very low and generally not something to be concerned about. The benefit of the medications is much higher than the risk to your dental health.
If you’ve taken IV bisphosphonates, you are at a much higher risk of this happening. Your physician will only use IV bisphosphonates if absolutely necessary because of the risks of something like this happening.
How to Avoid Bisphosphonate Related Osteonecrosis:
Many cases of osteonecrosis occur after some type of oral surgery, usually when you have a tooth taken out. If you’ve taken IV bisphosphonates in the past you’ll want to do a couple of things to decrease your risk…
- Make sure your dentist knows that you’ve taken IV bisphosphonates
- Take care of your teeth. Cavities or gum disease can cause you to need a tooth extraction. You absolutely want to avoid tooth extractions or other dental surgery if at all possible.
- If you do need a tooth extraction, consider seeing an oral surgeon or a general dentist who is very experienced with extractions. The less traumatically the tooth comes out, the less risk of osteonecrosis afterwards.
What Does Osteonecrosis Look Like?
Most cases of osteonecrosis in the mouth will show up just like I described, an ulcer on your gum tissue that won’t heal. Sometimes it is painful and other times it isn’t. It happens more often in the bottom jaw than the top due to there not being as many blood vessels that supply the bone there. One of the most common areas is on the bottom jaw, on the tongue side of your gums right below where your molar teeth would be.
If you have a history of taking these medications and have an area that just isn’t healing, you should have it evaluated.
How Is It Treated?
You should see an oral surgeon for treatment. They have a lot more experience treating this condition than a typical general dentist. Whatever happens, you want to avoid any further trauma to the area to give it the best chance of healing. Like I mentioned previously, surgical interventions can actually make it worse.
The usual treatment for something like this is to gently remove some of the dead bone, go on antibiotics, and place a wound dressing over top of it. Additional surgery can actually make the condition worse and cause more bone to die.
One controversial treatment for it is to have hyperbaric oxygen therapy. The jury is still out on whether this helps. It can be very expensive and your medical insurance may not cover it.
Worst Case Scenario: Can My Dental Implant Fail?
Guest Post By Philip L. Fava, DMD, MDSc
Estimates show that as many as 15 million dental implants are successfully placed worldwide each year. Patients benefit from one, two or even an entire mouth of replacement teeth that look and function as good as (or in some instances, even better than!) regular teeth. Today’s dental implants are predictable, with long-term success considered the rule rather than the exception. Placed by a properly trained and certified periodontist, your dental implants should offer increased oral health and overall esthetic, with virtually no problems.
However, just like our natural teeth, implants can fail if not taken care of properly. Poor plaque control can lead to bacteria damaging gum tissue and even causing bone structure beneath the implant to deteriorate. And implants aren’t immune from issues that can result from either improper placement or other overall medical issues that affect oral health.
Peri-implant inflammation (inflammation around an implant), and even worse, peri-implantitis (inflammation and bone loss around an implant), are rare and often preventable complications that can affect a dental implant. This infectious bacterial disease affects both soft and hard tissue and can lead to bone loss. Thankfully, if necessary, modern periodontics can tackle peri-implantitis with both surgical and non-surgical treatments.
Patients at Higher Risk
Dental implant patients most at risk of possibly developing this complication include:
- Patients who don’t adhere to good oral hygiene practice or those who grind their teeth
- Smokers—who are more likely to already have gum disease and whose blood vessels constrict when smoking, leading to bone loss
- Patients with medical issues such as autoimmune diseases, diabetes or osteoporosis
- Those patients with implants placed at poor angulations or implants with poorly designed crowns and prosthetics
Peri-implantitis is not always painful, and often times will be asymptomatic. However, early signs of this implant complication can include bleeding at the gum line and/or purple-looking gums. Some patients may experience pus, plaque build-up, or a puffy looking gum tissue.
Today’s Top Treatment
The periodontist’s long-term goal is to stop the bone loss and help patients maintain healthy implants. Sometimes it’s as simple as prescribing antibiotics. For more difficult cases, surgery was once the only other option, in which the periodontist had to cut out the infected tissue. Today, many practitioners employ modern laser technology to help save failing implants, without surgery. LAPIP® (Laser-Assisted Peri-Implantitis Procedure) is a minimally invasive solution that utilizes laser to focus directly on disease-causing bacteria, thereby sparing healthy tissue. No scalpel or stitches are needed. By removing unhealthy tissue around the implant that’s being rejected, the laser gets rid of the infection and stimulates normal bone growth around the “failing” implant.
If you suspect a problem with your dental implants, we have the ability today to make “sick” implants healthy again without invasive dental surgery. Don’t wait for an implant to come loose or you experience more severe symptoms to have your dental implant assessed.
Philip L. Fava, II, DMD, MDSc partners with Dr. Robert A. Levine at the Pennsylvania Center for Dental Implants and Periodontics, located at Einstein Center One, Suite 211-212, 9880 Bustleton Avenue, Philadelphia, PA 19115. The Center offers “All-on-Four™ dental implants, SameDay Smile®, esthetic (or “Smile Zone”) dental Implants and crown and bridge implant restorations in addition to LANAP® and LAPIP® laser treatment of periodontal disease and reconstructive dental surgery.
Who Is A Good Candidate For Invisalign?
Many people come to me and ask the question, “Am I a good candidate for Invisalign?”. You may be wondering the same thing about yourself. I’ve found that many adults desperately want to straighten their teeth but aren’t interested in going through traditional braces. If this is you, you’re not alone. You may have even been to several dentists who have told you that you’re not a good candidate for Invisalign.
A couple of years back I attended a continuing education seminar for advanced Invisalign treatment. The presenter was a dentist who has done thousands and thousands of Invisalign cases. He related to all of us that he constantly gets that same question of “Am I a good candidate for Invisalign?”.
His reply back?… “Do you have teeth? Then, YES, you are a good candidate for Invisalign.”
Yes, it’s a little bit of an exaggeration but it gets the point across. Invisalign isn’t the same that it was 15 years ago. In an experienced dentist’s or orthodontist’s hands, Invisalign can treat almost anyone. I have an orthodontist I refer patients to who exclusively treats his patient’s with Invisalign. That includes people who are missing teeth, have major crowding, or have large spaces.
I have a lot of patient’s who have gone through Invisalign or are currently in Invisalign. They range from people with minor crowding issues to people who have major bite and cosmetic problems. They range in age from 16-65 years old. Just about every one of them will complete comprehensive treatment in under a year.
If you’ve been told that you’re not a good candidate for Invisalign, you should get a second or third opinion from someone who has a lot of experience treating a wide variety of cases. What many dentists are actually saying is that they personally wouldn’t feel comfortable treating you with Invisalign. It doesn’t mean that it can’t be done.
Who’s Actually Not A Good Candidate?
In truth there are a couple of things that will disqualify you from Invisalign (but they would disqualify you from regular braces too)…
- A mouth full of cavities. You’ve got to get them fixed first.
- Active gum disease. If you’ve been treated for gum disease and your gums are healthy and the teeth are solid, then you can still have Invisalign. If the disease is active or you have loose teeth from gum disease, Invisalign or regular braces aren’t a good idea.
There are also a couple of things that can make Invisalign more difficult but aren’t an absolute disqualifier.
- Dental implants can’t move with Invisalign (or regular braces). If it is in a bad spot, it may need to be redone.
- Bridges, especially long ones as they won’t move very well.
- Current TMJ problems
It’s also important to remember that you may need additional dental restorative procedures after Invisalign to get that perfect result. The most common reasons to need additional treatment are…
- Misshapen teeth
- Teeth that are too small
- Worn teeth
Dental restorative treatment can involve bonding, veneers, or crowns to change the shape or color of the teeth.
Finding A Dentist or Orthodontist
So we’ve learned that almost everyone is a good candidate for Invisalign. How do you go about finding someone who can treat you effectively if you’ve got a difficult case?
Your best option would be an orthodontist who does a lot of Invisalign. They’ll typically have the best training and experience.
Another good option is to find a general dentist who is an Invisalign Premier or Elite Provider. You can look this up on the Invisalign Doctor Finder. There will be different designations next to each dentist or orthodontists. It can get a little confusing so here is what they all mean…
PREFERRED PROVIDER:
• Treats 10 cases per year minimum
PREMIER PROVIDER:
• Has treated at least 50 cases total
• Treats at least 25 cases every 6 months
PREMIER ELITE PROVIDER:
• Has treated at least 300 cases total
• Treats 50 cases every 6 months
TOP 1%:
• Is in the top 1% of all providers in numbers of cases treated.
Most orthodontists will fall in the Premier or Premier Elite Categories. Most general dentists will fall in the Preferred Provider category while you’ll occasionally find one who is Premier.
The Best Toothpaste For Sensitive Teeth
Prescription Strength Is Where It’s At…
For as long as I can remember I’ve had sensitive teeth. There were always a couple of areas that I knew I couldn’t put ice cream or ice cold water. I’ve been a dentist for a quite a while and over the years I tried every solution out there for decreasing sensitivity without a whole lot of success. These included all the different Sensodyne toothpastes, Colgate Sensitive, Gluma desensitizer (professional application only), Fluoride varnishes (professional application only), Crest Sensi-Stop Strips, and using dental bonding agents over the sensitive areas (professional application only). Nothing was really effective.
Then I started using a toothpaste product we sell at our office. I actually started using it to protect my teeth from cavities without thinking it would do much for the sensitivity. About a month after starting to use it I noticed that my sensitive teeth were no longer quite so sensitive. In fact, they were hardly sensitive at all. The wonder product that has reduced my sensitivity to an almost unnoticeable level? Prevident 5000 Sensitive Toothpaste. The bad news… it is by prescription only.
It combats sensitivity in a couple of different ways. The first is by its high concentration of fluoride. Most regular over the counter toothpastes contain around 1000-1500 parts per million (ppm) of fluoride. Prevident contains 5000 ppm. High levels of fluoride are known to decrease sensitivity in teeth.
The second major active ingredient is 5% potassium nitrate. Potassium nitrate is used in many other over the counter sensitivity toothpastes such Sensodyne or Colgate Sensitive. Potassium nitrate is the most common ingredient used to combat tooth sensitivity. It helps plug the small tubes in the tooth where cold sensations can penetrate.
It’s important to note here that I’ve had a lot of patients who have had good success with over the counter sensitivity toothpastes. I just wasn’t one of them. Everyone’s level of sensitivity is different and some people require more desensitization than others. I just happened to be one of those people who needed more help than most. If you’re one of these people, Prevident 5000 Sensitive is something you should try.
How do you get this product?
You’ll need a dentist to write a prescription for this specific product and check the box on the prescription that says not to substitute with a generic. As far as I’ve found, there aren’t any generic products that include a desensitizing agent along with the high fluoride concentration toothpaste. If you find something out there let me know by email or via the comments!
Almost any dentist will be happy to write this prescription for you. The only people who shouldn’t use this product are children under the age of 12 and people with certain types of thyroid issues as fluoride can cause some specific problems for them.
Concerned About The Level of Fluoride?
We’ve got you covered. Check out our article on fluoride where it discusses the difference between fluoride in the water supply vs fluoride in topical products. Everything You Need to Know About Fluoride.
How long does it take to start working?
It takes a couple of weeks of consistent use to start seeing results. The fluoride and potassium nitrate take some time to build up to the levels needed to see an improvement in sensitivity.
Are there any other benefits to using this product?
High fluoride toothpastes like Prevident 5000 decrease your risk for cavities by a significant margin. Fluoride combines with the enamel crystals in your teeth to form an even harder crystal that is more resistant to acid attack. I’ve written before about how I think most people would benefit from a prescription strength fluoride toothpaste.
What if it doesn’t help with sensitivity?
You may have more going on than just sensitive teeth. Failing fillings, cavities, and bite issues can all show up as sensitivity. You’ll need a dentist to let you know for sure.
The Best Over the Counter Sensitive Toothpaste:
If you really don’t want to go to the dentist to get a prescription (you really should though… it is THAT much better and will prevent cavities), then make sure you go with a toothpaste that has maximum strength fluoride and potassium nitrate levels. My favorite over the counter product is Colgate Sensitive. It has one of the better combinations of higher fluoride and maximum potassium nitrate.
Change Invisalign Trays Every Week?
Article Updated April 16th, 2018
Invisalign is always innovating. New materials, new software algorithms, and support for many different digital impression systems are just a couple of the many changes they’ve made over the last couple of years.
None of those changes were nearly as exciting to me as a dentist (and to many of my patients) as when they announced in late 2016 that their aligners could be changed every week instead of every two weeks.
Yep, you read that right. Your treatment time can be halved. No other changes necessary. Just change the trays every week, with the one major stipulation that you MUST wear the trays for the required number of hours each day (a minimum of 20-22 hours a day with more being better). If you aren’t diligent about wearing them, weekly tray changes won’t work.
So how did this happen?
Most people who’ve gone through Invisalign are familiar with the standard rules… Wear your trays 20-22 hours a day and change to the next set every two weeks. In late 2016 Invisalign changed up those rules. They announced that after extensive testing they’d found that trays could be changed every week instead of every two. Individual dentists and orthodontists had been experimenting with this for a couple of years with great results but Invisalign didn’t want to put their rubber stamp on it until they were sure that it was safe and effective. After collecting a lot of data, they found that it was in fact just as effective as the two week change period.
This change has been a result of the Invisalign innovation in materials and software that we talked about earlier. The aligners are made of a proprietary material that creates gentle but consistent force on the teeth. The attachments that are used on teeth are constantly being evaluated to make sure they are creating the most effective force on teeth. The software is continually getting better at predicting how teeth will move. This all adds up to extremely predictable tooth movement and in a shorter time than before.
The Most Important Things To Remember!
Changing once a week only works if you are extremely compliant with wearing your aligners. That means that you wear them for 22 hours a day, only taking them out to eat and brush. If you don’t wear your aligners as often as you should, you’ll have to stay on the two week schedule. Now that is some motivation to wear them consistently!
There are also a couple of products that I highly recommend using (especially if you’re doing 1 week trays changes) that will help make Invisalign treatment easier and more effective for you…
Tip #1:
“Chewies“
Chewies look like a rolled up piece of gauze or cotton but are actually made of a sponge like plastic material. Many dentists and orthodontists recommend them during Invisalign treatment. When you put your trays in you’ll want to chew on them for 5-10 minutes. Invisalign recommends that you do this several times a day and especially before bed.
What this does is pushes the trays up against your teeth more tightly. The closer the fit on your teeth, the faster and more effectively they will move. This is especially important when you first change trays. You can’t get that same pressure using just your hands to pop them in place.
If you’re going to do 1 week tray changes, I highly recommend using chewies.
You can purchase chewies relatively inexpensively on Amazon. It doesn’t really matter what brand you get, as long as you get as long as they are literally “chewy”. Here is a link to the brand that I usually recommend… Orthoband Chewies.
You’ll want to throw away the chewy once it is all smashed up and not as spongy. There are re-usable until then (although you may want to clean them occasionally so they don’t get super dirty!).
Tip #2:
Getting the Trays Off
Changing the trays once a week means that your trays will be tighter on your teeth much more of the time. For some people this isn’t a big problem and they don’t have any issues getting their trays on and off with their fingers. Most people can hook a fingernail around the backside of the tray and pop it off. For other people, especially those who have severely tilted teeth or a lot of “buttons” on their teeth, this can be really challenging! I’ve known some patients who would leave them on for two full days until their teeth moved enough to loosen them.
If you’re one of these people, there are some products out there that can help. None of them is perfect, but it is definitely better than not being able to get your trays off!
What I recommend is a Metal crotchet hook. This is the cheapest and easiest solution for most people. You’ll hook the tip up and around the edge of your tray and pull down to pop it off on one side. Once you get one part off, the rest comes off pretty easy.
There are some other products made specifically for getting the trays off but I’ve found that the metal crotchet hooks work better, are cheaper, and don’t break. The other products are made of plastic and tend to be a bit bulkier and can’t get in between the teeth and tray as well.
Is there any way for Invisalign to work even more quickly?
There are a couple of options that allow for tray changes even more quickly than every 7 days.
Acceledent – This is a FDA approved device that you wear for about 20 minutes a day and it can speed up your treatment 30-50%. You bite on the device and sends out “micropulses” into the bone, stimulating bone cells and allowing them to remodel around your teeth even more quickly than usual. You can typically only get this through an orthodontist who offers it.
Propel VPro5 – This is similar to the Acceledent device in creating small pulses to the bone that accelerate treatment.
Minor surgical procedure – For people who want the fastest treatment, there is a surgical protocol that creates minor trauma to the bone around the teeth. This can be used in combination with the Acceledent or Propel devices to further speed up treatment.
So what’s next for Invisalign?
I wouldn’t anticipate them being able to speed up tooth movement too much more with their aligners alone but I do see them continuing to make technology changes that allow Invisalign to treat more and more types of cases. As it stands now, the vast majority of cases can be treated successfully with Invisalign. Will Invisalign ever replace traditional braces completely? I really doubt it, mostly because some people need braces that are fixed in place and no compliance with wearing them is required (Here’s looking at you teenagers!). I do see it becoming a viable alternative for just about anyone who wants it treatment with Invisalign. I think your dentist saying “You’re not a good candidate for Invisalign” will become a thing of the past.
So now you know. If your dentist or orthodontist tells you that you can change your trays every week, it is actually recommended that you do so by Invisalign. If your dentist or orthodontist is still having you change your trays every two weeks ask them to look up the updated recommendations from Invisalign. They may not have heard about the change quite yet. You’ll be glad you did and they’ll probably thank you too!
Do you have other Invisalign questions? Check out my post with 29 Frequently Asked Questions and Answers about Invisalign.
How to Get Used to Wearing A Night Guard (Or Any Other Dental Appliance)
I’ve made a lot of custom night guards, snoring appliances, and TMJ appliances for my patients over the years. More often than I’d like to admit, I see them back for their six month check-up and when asked they tell me that they haven’t been wearing their appliance. It is on a bedside table or drawer gathering dust.
I always feel like a bit of a failure when they tell me this. They usually spent a good deal of money on the appliance and aren’t getting any benefit out of it.
The truth of the matter is that getting used to wearing a night guard or any other type of dental appliance at night is really challenging initially. Let’s look at some ways that you can make this an easier process so that you don’t end up one of those people who wasted money on a dental appliance.
Objections To Wearing A Night Guard
Most patients tell me they only tried for a couple of nights before giving up. Their most common reasons why they don’t wear it?
- It feels too tight
- It is uncomfortable
- It makes them gag
- They drool too much
- They take it out in the middle of the night without knowing it
Let’s take these objections one by one…
It feels too tight:
People are really worried that a new appliance is going to move their teeth if it is too tight! Fortunately, this really doesn’t happen with these types of dental appliances. That feeling of tightness is actually a good sign that it fits well to your teeth and that it will stay in while you sleep. It is much better that it is tight than loose. Unless the tightness is unusually severe, you’ll get used to the feeling after you’ve worn it for a couple of nights.
If after trying it for a couple of nights, it is making one or two teeth really sore or is still very uncomfortable, go back to your dentist and have them adjust it. They can very easily remove a small amount of material inside the night guard so that it isn’t quite so tight. Whatever you do, don’t give up right away!
It is uncomfortable:
You know what I say to them? I agree with you! When you first start wearing a night guard or other dental appliance it is absolutely uncomfortable. Sticking a hard piece of plastic in your mouth is unnatural and new. It takes an adjustment period to get used to it. Your brain has this wonderful ability to block out sensations that are familiar. If you consistently wear it at night your brain will eventually get used to so that you barely notice it is there. This process usually takes a couple of weeks.
It makes you gag:
Did you know that your gag reflex is mostly mental? With a little time you can overcome the vast majority of your gag reflex.
You know how I know this? Because I used to be the worst gagger that there ever was. When I was a child, I was the one down the hall you could hear gagging repeatedly throughout the appointment. I gagged on my toothbrush while brushing in the morning and good luck ever getting a dental impression on me.
When I was in dental school, we had to take dental impressions on each other. The thought briefly crossed my mind that I wasn’t going to survive this process. The first couple of impressions on me weren’t pretty. I did my usual gagging thing. But then something magical happened! I calmed myself, breathed deeply through my nose, and relaxed. The rest of the impressions (15 in all!) went smoothly. That is when I first realized that a gag reflex is something than can be overcome. If I can do it, you can too!
Try putting it in during the day for short periods of time and work on relaxing while it is in. The key is to breathe deeply through your nose and relax your entire body. Once you get comfortable wearing it for short periods during the day, you can start wearing it at night.
It makes you drool:
Those first couple of nights you wear your night guard you’re going to wake up with a pillow soaked through with drool. I know, I know! Not the most attractive sight, especially if you sleep next to someone else. The good news? The drooling is temporary. Your brain reacts to something new in your mouth by producing extra saliva. It is used to only food going in your mouth and staying there. Once your brain has had a chance to get used to this new appliance it will stop your body from producing all that extra saliva.
You take it out in the middle of the night:
So let’s say you made it past all the previous objections, put that appliance in, and fell asleep. Success right? Then you wake up in the morning and can’t even find it. As you get out of bed, you notice it halfway across the room, on the floor. Apparently you woke up in the middle of the night, took it out, and threw it across the room all without even knowing it.
If you’ve read the rest of this article you probably know what I’m going to say now. Yep, give it some time! Your brain and body needs time to get used to it. Once you start to forget it is there you’ll stop taking it out at night.
Other Options If You Can’t Get Used to Your Night Guard
If you’ve worn your appliance consistently for 2-3 weeks and still can’t get used to it, it is time to look at other options.
Over the counter night guards
If you’re wearing a standard over the counter night guard that you had to boil and bite into in order to form it, you should really consider investing in a custom night guard. Over the counter night guards tend to be extremely bulky and uncomfortable. Custom night guards on the other hand can be made to fit your teeth exactly and are typically much lighter and less bulky.
Have your dentist adjust the night guard
Your dentist may need to adjust your night guard. They can adjust how tight it is, smooth rough or sharp areas, or how you are biting on it.
Try a differently designed appliance
There are several different designs for night guards, snoring appliances, and TMJ appliances. For night guards specifically, they can be made to fit on either the top or bottom teeth. Some people find one or the other to be more comfortable for them. They can also be made where they only cover some of the front teeth. This is especially helpful for people who are major gaggers and just aren’t able to get over it yet.
Another option for design is to use a thinner material. Reducing the bulk of the night guard can really help with getting used to wearing it. The biggest downside to a thinner material is that it will wear out more quickly, especially if you grind heavily. I’ve seen some people chew through them in as little as six months.
In Summary
#1: Keeping trying! If you’ve gotten nothing else out of this article, remember that if you keep wearing it you will eventually used to wearing it. Many people tell me that after wearing a night guard for years, they can’t sleep without one because it feels strange!
#2: Give it at least 2-3 weeks. 3 weeks is about the average amount of time it takes to build a permanent habit.
#3: If it is super uncomfortable or you haven’t been able to get used to it after a couple of weeks, go back and see your dentist for help. It is much better to go see your dentist than just give up and hide the appliance away somewhere. Remember that there is a good reason why you need to wear the appliance and that your dentist wants to see you succeed with it as well. Don’t be afraid to ask about a different design if the current one isn’t working.
Can Your Sinuses Cause Tooth Pain?
Yes, sinus pressure can cause tooth pain, typically in your upper back molars. Sinus pressure is the most common non-dental cause of pain that I see as a dentist. I probably see at least one patient every couple of weeks who has a toothache from sinus pressure. They are always relieved that it is a sinus problem and not a tooth problem!
The roots of the upper molar teeth sit right next to the maxillary sinus. In many cases the only that thing separates them is a paper thin layer of bone or tissue. These teeth have blood vessels and nerves that enter at the end of the tooth. In many cases these vessels and nerves run right through the sinus to get to the tooth. Any pressure or inflammation in your sinuses can irritate these nerves causing a nice sinus toothache.
What does a sinus toothache feel like?
A sinus toothache usually feels like a dull ache ranging in severity from mild to moderate. It is rare to have severe pain from a sinus toothache. This ache will tend to get worse as you move your head around.
Some teeth sensitivity to hot and cold can occur along with a sinus toothache.
It can also be hard to tell which tooth it is coming from (because it is usually making them all ache).
How to tell if it is your sinuses
One of the most classic symptoms of tooth pain as a result of sinus problems is pain when you move your head quickly. A lot of times I’ll have patients bend over as if they’re looking at their feet and then quickly straighten up. If the pain comes right when doing this, it is very likely that it is sinus related.
The movie Legally Blonde gave us a great example of this movement… The Bend and Snap! I’d avoid doing this in public unless you like attention!
Also if you’re struggling with allergies, a cold, sinus infection, or a feeling of fullness or pressure around your cheekbone you may be having sinus issues that could be contributing to the toothache.
How to treat the pain
They key to treating a sinus toothache is relieving some of that congestion in the sinus…
- Try taking a decongestant to relieve some of the pressure in your sinuses. The best decongestant you can buy is pseudoephedrine, which you usually have to purchase directly from the pharmacy counter. I’d avoid any decongestants with phenylephrine as it doesn’t work nearly as well.
- If you think it is allergies, consider starting on an antihistamine such as Benedryl or Claritin.
- If you have a true sinus infection you may also need an antibiotic. Your primary care physician can prescribe this for you if appropriate.
- Place hot compresses on your face several times a day.
- Drink a lot of water to help thin your mucus and allow it to drain more easily.
- Take a really hot shower with a lot of steam.
- You can take Ibuprofen or Tylenol to help with the pain while you’re waiting for the sinus issues to resolve. If you’re able to take Ibuprofen, that would be my recommendation as it works better for pain control.
When to see your dentist?
If you are pretty sure that your toothache is sinus related, try all the different methods we just described. For most people the sinus will clear out and the tooth pain will resolve within a week or so.
If after a week it isn’t getting any better it is probably time to give your dentist a call. There can be a couple of true dental problems that can cause the same types of symptoms as a sinus toothache. The major ones include…
- Large cavities
- A dental abscess
- Periodontal disease
- TMJ problems
Also, if your pain is severe, waking you up at night, or you have swelling of the area, it likely isn’t sinus related and will need to be taken care of by the dentist.
How to Brush Your Teeth With Braces (And Other Tips and Tricks)
Keeping your teeth clean while you’re in braces is challenging, to say the least. Don’t worry though! It is possible to keep them clean and your teeth and gums healthy. I’m going to show you all the tips and tricks here.
How To Brush Your Teeth While In Braces
A lot of people brush their teeth by smearing a bit of toothpaste on their toothbrush and rubbing it around haphazardly for the next 30 seconds. This may be just enough for some people but it definitely won’t cut it while you’re in braces. You need good technique and to spend enough time doing it.
With a regular soft toothbrush you’ll need to modify your technique a bit to clean those braces well. You want to angle your toothbrush at a 45 degree angle to the teeth from both the top and bottom side of the brackets. Vibrate the toothbrush quickly back and forth (small strokes, not big) and continue this all the way around. You’ll want to spend a minimum to 2 minutes twice a day doing this to get a good solid clean.
If you’re able to, I’d highly recommend you invest in a good solid electric toothbrush. They make several different head types for electric toothbrushes and some of them are specially made for braces. They’ll allow you to get in between those teeth and brackets without too much effort. My personal favorite electric toothbrush is the Oral B Professional Series.
Brushing well with braces is good but you also have to find some way to clean in between those teeth…
How to Floss Your Teeth While in Braces
When I was in braces I remember the orthodontist handing me a pack of floss threaders and saying that I’d need to thread the floss around each and every tooth. Guess what I did? I threw the floss threaders out and didn’t give it a second thought. What teenager wants to spend 15 minutes a night flossing?
You’ve got to make the right thing the easy thing to do. I’m going to show you how to do that.
Fortunately we’ve got a lot more options these days for keeping your teeth clean while you’re in braces. In addition to brushing your teeth, this is going to be one of the most important things you can do to keep your teeth and gums healthy while you’re in braces. More on those dangers in a second.
So you can use those floss threaders and go around each and every tooth with the floss, but I wouldn’t recommend it. A FAR better option is to buy a Waterpik. A Waterpik uses a jet of water under pressure to clean around and in between your teeth. Studies have shown that it is even more effective than regular string floss at cleaning between your teeth. It is also a lot easier to use than floss threaders and works faster. That’s a win-win for you. It can be a bit messy with the jet of water shooting around your bathroom if you’re not careful.
Another option is to use interproximal brushes such as a proxabrush. Unless you’ve got really big spaces between your teeth, you’ll want to get the smallest version of these so that you can get them in between your teeth. These look like small, expensive pipe cleaners. You basically take them and gently push them between your teeth to clean all those areas your toothbrush couldn’t get. They are disposable so you’ll end up buying and throwing a lot of these away while you’re in braces. I like these mostly for when you’re on the go and don’t have access to your Waterpik.
The Dangerous Road of Not Brushing Braces
I can remember off the top of my head more than a couple of people who’ve come out of braces with white spots all over their teeth. Yep, they’ve got nice straight teeth with white spots all over them.
These white spots are known as “decalcification”. All that plaque left on their teeth allowed the bacteria to get out of control and start breaking down the enamel. The first sign of this is white spots.
Sometimes these white spots will turn brown over time and become quite an eyesore. There are some treatments to help minimize these white spots but they usually don’t go away entirely.
Another danger of not brushing is that your gum tissue can become very irritated. This will cause your gums to bleed easily and get large and puffy. I’ve seen some kids in braces whose gum tissue grew right over the orthodontic brackets. It’s not an easy fix when it gets to that point. Prevention is far better.If left to go for too long you can even start losing bone around your teeth. That’s definitely not something you want to start while you’re in braces.
If your orthodontist sees any of these things happening while you’re in treatment, they may even take the nuclear option! Occasionally they’ll take your braces all the way off before their finished and send you over to your regular dentist to get your gums and teeth healthy again. As you can imagine this isn’t a whole lot of fun and adds a ton of extra time to your treatment.
Watch That Diet
This applies to everyone, but it is especially important while you are in braces. You’ll want to avoid consistent snacking on sugary foods, carbohydrates such as chips or crackers, and drinking sugary or acidic drinks (that includes diet sodas!).
Remember those “decalcified” white spots we talked about earlier? If you eat or drink enough sugar, carbs, and acidic things these will develop no matter well how you brush and floss.
See Your General Dentist Regularly
Make sure you keep up with those 6 month check-up and cleaning appointments with your general dentist. Dentists have tools that allow them to thoroughly clean all around your braces, especially those hard to get to spots where tartar buildup has occurred. They’ll also be able to catch any early signs of decalcification or gingivitis and help you correct it before it is a big issue. Sometimes they’ll do additional fluoride treatments as a preventative measure against decalcification.
If you’re really worried about decay forming or if you know that you develop cavities faster than other people ask your dentist to prescribe a prescription strength fluoride toothpaste such as Prevident 5000. This has 5000 parts per million of fluoride in it compared to about 1000-1500 that you get in regular toothpaste.
What Is The Difference Between A Regular Cleaning and Periodontal Maintenance?
A really common question I get asked after a patient has had treatment for gum disease is “Why can’t I just have a regular cleaning?”. It’s a good question and the answer is a bit more complicated than you’d expect.
In most cases this question comes down to cost. Regular cleanings are usually covered at 100% by dental insurance while periodontal maintenance appointments are covered at a lesser amount (and are more expensive to start). From your perspective, it can appear like the procedures are identical… thus the confusion. “Why should I be charged more for something that is exactly the same?” is the usual reaction. As we’ll see in just a bit, there is a good bit of difference between the two procedures.
What The Procedures Are:
The American Dental Association (ADA), the organization who sets billing codes for dentistry describes a regular cleaning (or “prophylaxis”) as “A dental prophylaxis performed on transitional or permanent dentition, which includes scaling and polishing procedures to remove coronal plaque, calculus, and stains.”.
Translation: A cleaning that removes any tartar, plaque, or stains above the gumline.
Periodontal maintenance on the other hand is described as, “This procedure is for patients who have completed periodontal treatment (surgical and/or nonsurgical periodontal therapies exclusive of D4355) and includes removal of the bacterial flora from crevicular and pocket areas, scaling and polishing of the teeth, periodontal evaluation, and a review of the patient’s plaque control efficiency. Typically, an interval of three months between appointments results in an effective treatment schedule, but this can vary depending upon the clinical judgment of the dentist. When new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered. Periodic maintenance treatment following periodontal therapy is not synonymous with a prophylaxis.”
Translation: A cleaning that removes tartar, plaque, and stain both above and below the gumline. In addition to this, your hygienists also checks the pocket depths around the teeth (a good indicator of gum disease) and spends more time educating you on oral hygiene.
Removing tartar above the gumline is a relatively easy process. Removing it below the gumline takes quite a bit more skill and time. It is mainly for this reason that periodontal maintenance costs more than a regular cleaning.
When Should They Be Used?
A regular cleaning then, should be reserved for people with a healthy mouth and no signs of gum disease. It typically means you go for your regular 6 month checkups and have mild build-up above the gumline with no other signs of gum disease.
A periodontal maintenance appointment on the other hand is for anyone who has had treatment for gum disease in the past. You really can’t go back to a regular cleaning until you’ve demonstrated over the course of several appointments that there is no sign of gum disease.
Many dental offices will alternate a regular cleaning and periodontal maintenance on three month intervals. I’m asked by a lot of people to do this because it is what their previous dentist did. Unfortunately this is illegal. I personally called several different dental insurance companies that we work with in order to clarify whether this was ok or not. Every single one told us that someone who is a periodontal maintenance patient must stay as periodontal maintenance until gum health is proven. You can’t alternate between them. To alternate the two is actually considered fraud and your dentist can get in a lot of trouble.
How Do You Go Back To A Regular Cleaning?
In order to go back to a regular cleaning you have to demonstrate to your hygienist and dentist that your gum disease is in full remission. You probably know where I’m going here… You hear it every six months at the dentist! Yep, the age old instructions that you need to brush twice a day for two minutes (even better if it is an electric toothbrush), and clean between your teeth with floss, interproximal brushes, or a Waterpik. For most people it really is that easy! If you do these things it is almost impossible to have active gum disease.
Making these things a daily habit can be challenging early on. One thing I’d recommend trying is to floss before you brush your teeth. The vast majority of people brush their teeth on a regular basis because they like the feeling of clean teeth. Flossing on the other hand doesn’t give you that immediate positive feedback. If you wait until after brushing to floss it is easy to blow it off even if you have the best intentions. Pairing the flossing with an already established habit (brushing) makes forming good habits for flossing easier.
How Often Are These Procedures Done?
Most people who are seen for regular cleanings are seen every 6 months. Occasionally we’ll have people come in every 4 months if we know they build up tartar more quickly than other people. A shorter interval in between makes sure that the build-up doesn’t get out of control and cause you to need to treatment for gum disease. Honestly, if your gums are healthy enough for a regular cleaning and you’re doing a half decent job keeping them clean you shouldn’t need to be seen more than every 6 months.
Periodontal maintenance is a different story again. The interval in between maintenance visits can range anywhere from 2-6 months depending on the severity of your gum disease, your oral hygiene habits, and how quickly you build up tartar. More frequent visits are usually better especially early on after having treatment for your gum disease. These regular visits will keep your gums healthy and avoid the need to re-do the treatment. The most common interval is being seen every three months and this is what I what I would recommend for most people initially with re-evaluation done after 3-4 visits to see if a longer interval would be appropriate.