Why Does Food Get Stuck Between Your Teeth?
Imagine this scenario. It’s a beautiful summer day and you decided to grill some meat and corn cobs. You take that first mouthwatering bite and… the food is all of sudden stuck in between your teeth!
This isn’t how your cookout was supposed to go! How can you enjoy it if your food gets stuck in between your teeth between every single bite.
Food constantly getting stuck in between your teeth can be really annoying!
Now everyone gets food stuck in between their teeth occasionally. Some of the most common offenders are corn on the cob, apples, and meat. Some people on the other hand get food stuck in certain areas all the time. By all the time, I literally mean anytime they take a bite in that area.
So what actually causes food to get stuck between your teeth?
The primary reason food gets stuck between your teeth is because there is a small gap between them. For the proper function of teeth, they should have a relatively broad area of contact between each other. This area of contact should be tight enough so that floss “pops” down in between the teeth but not so tight that it shreds it. If the contact area isn’t tight enough, this is where you really run into a lot of problems with food getting caught. If floss just drops right in without any “pop”, you can make a pretty good guess that it is an area that will catch food.
Sometimes these small spaces are naturally there. It is just how your teeth came in.
Other times a cavity in between your teeth can cause these spaces to open up.
Sometimes you’ll develop these spaces after dental treatment. If your dentist doesn’t get a great contact between the filling or crown and the next tooth, food will start getting stuck. It happens to every dentist occasionally. If it is a problem, they’ll usually fix it at no charge to you.
There are a couple of solutions to constantly getting food stuck in between your teeth…
Carry floss or toothpicks around everywhere. Not the most pleasant way to go about things but better than having the food always stuck.
Talk to your dentist about fixing the problem areas. There are a couple of different ways they can do this. The simplest is to close the open space with a properly shaped filling or crown. A second way to close spaces is by orthodontics, whether through traditional braces, Invisalign, or a removable appliance.
I’d highly recommend getting those areas fixed by your dentist at some point. Constantly trapping food between your teeth can cause a variety of problems.
Cavities. Food trapped up against your tooth provides a food source for bacteria which will create acid and break down the enamel of your teeth.
Gum irritation. Constantly packed food causes your gums to be highly irritated and bleed easily.
Gum disease. Over time packed food will harden into tartar that is stuck to your teeth. Tartar under the gumline is one of the most significant predictors for gum disease. Gum disease causes you to lose bone around teeth and can eventually lead to tooth loss. Gum disease has also been linked to a variety of other health issues such as diabetes and heart disease.
Do I Floss Before Or After Brushing?
(And Other Questions You’ve Been Dying to Know About Flossing!)
Should I Floss Before Or After Brushing My Teeth?
The best practice is actually to floss before you brush your teeth. The reason for this is that flossing before your brush your teeth opens up the areas in between your tooth by getting the food and plaque out. This allows the fluoride in your toothpaste to work more effectively in those areas when you actually brush. If you’re a stickler about flossing, you could floss both before and after brushing!
How Often Do I Need to Floss?
You should really floss once a day, every single day. If you do it less than that you’ll start to get a lot of food caught in between your teeth. If you do it more often you won’t get much of an additional benefit. Once a day (of good flossing) is plenty in order to keep your gums healthy and your breath fresh. The one exception to this is if you have an area that constantly traps food. You’ll want to floss this area more often (usually right after eating) to get that food out. Food that sits next to your tooth can cause a cavity rather quickly.
What Is The Best Type of Floss?
The best type of floss is one that you’ll use. All things being equal, a Waterpik actually cleans the best in between your teeth but it can make a big mess in your bathroom! I personally use a glide type floss every day and my gums stay very healthy with minimal buildup in between them. If you’ve got tight contacts in between your teeth this is probably the best type of floss for your as it will go between your teeth without shredding. If you’ve got big spaces in between your teeth you should consider using an interdental brush to clean those spaces out better. String floss won’t clean those areas as effectively. If you’re really lazy and don’t mind making a mess, go with the Waterpik like we discussed previously.
Are There Any Types of Floss or Products That I Shouldn’t Use?
Please don’t use a toothpick to clean in between your teeth. A toothpick is hard and can cause more damage than good. I’ve seen several patients lately who’ve gotten a piece of toothpick stuck between their teeth and couldn’t get it out. All they knew was that their gums really hurt! Another type of floss that I really don’t like is the unwaxed string kind. It shreds like crazy and gets stuck in between your teeth. Save your money and buy a slightly more expensive waxed version of the floss.
Are There Really Any Benefits To Flossing?
Flossing has a huge impact on your oral health. Brushing alone only cleans about 60% of your tooth surface while flossing reaches that other 40%. After flossing routinely for a week or two you’ll notice a big difference in the health of your gums. They shouldn’t bleed anymore when you brush and floss.
Healthy gums help you avoid gum disease which has been linked to a variety of other full body health issues such as diabetes, heart disease, and certain types of cancer.
How Do I Make Myself Floss?
This is the hardest thing for most people. They either forget or just don’t want to floss. With flossing it is really important to get into a routine. Force yourself to do it while brushing your teeth at night. If you keep this up for a full three weeks you’ll likely have developed it into a habit and you won’t have nearly as big a problem doing it as you did before. The biggest thing you have to remember to do is to keep flossing regularly or you’ll slip back into old habits.
How Do I Floss With Braces?
It is tricky. I recommend all my patients with braces get a Waterpik. This makes it easy to clean in between the brackets without having to thread floss in everywhere. If a Waterpik isn’t an option then you will need to get a hold of some superfloss or floss threaders. Superfloss has a rigid end that you can slip into small holes . Floss threaders are actually separate from the floss but also help you thread the floss in between your teeth with minimal effort.
How To Prevent Cavities
Many people resign themselves to the fact that they will always develop cavities and that there is nothing they can do about it. Contrary to popular belief, cavities are almost entirely preventable. Even if you are genetically predisposed to cavities, your parents lost their teeth young, or you feel like you’re a lost cause already, you can change change things and never develop a new cavity again. I’m going to give you an easy to follow plan to make sure you never have to hear the dentist say, “You’ve got a cavity!” again.
It’s All About the Diet
You know how in real estate they always say “Location, location, location”? Well in dentistry it is all about “diet, diet, diet”. If you get read nothing else here, please read this section as it will make the biggest difference for you.
Quick story before we get into the specifics… I just saw a new patient in my practice the other day. He’d been living abroad in Shanghai, China for nearly 7 years and had moved back to the United States about a year and a half ago. When he came in, I found several new small cavities. He was quite surprised because he hadn’t had a cavity in quite a while. The last time he had a cavity was when he was still living in the USA. As I do with most patients who have cavities I asked him the question, “Has anything in your diet changed lately?”. His answer? “Well I started eating American food again.”
Ding, ding, ding…
The western diet, made popular here in the USA and promulgated around the globe, is a major reason why many people today develop cavities. A major component of many meals in the western diet are refined carbohydrates and sugar of many varieties. Both of these break down into sugar in your mouth that bacteria feed on and use to create acid that breaks down your teeth.
You know what else is really common in the western diet? Soda, sweetened drinks, and fruit juice. All of these are terrible for your teeth. Almost all of them contain sugar and the ones that don’t are highly acidic (Diet soda, I’m looking at you!).
So what do you need to do? Many people will say cut out the sugars entirely. I don’t think that approach is entirely effective because it is SO difficult to do. My goal for people is to limit how often they consume these sugars and acidic drinks. The best way to do this is to limit anything with sugar, carbohydrates, or excess acid to mealtimes. That means no snacking or grazing on them throughout the day.
I love snacking as much as much as everyone else but unless you get this under control everything else you do will be in vain. If you remember a single thing, remember this… It’s not about how MUCH sugar or acid containing items you have but how OFTEN you consume these items. Try to reduce how often you have them and you’ll see much better results with cavities.
Action Plan:
- Only eat or drink things with sugar or acids at mealtimes.
- Snack on healthy foods like vegetables or at least something that doesn’t contain sugar or acid.
- Drink plain water the rest of the day.
Oral Hygiene
In a close second after your diet, is hygiene. If the sugars, acids, and bacteria aren’t in contact in with your teeth, they can’t do damage to them. The entire goal of oral hygiene is to eliminate all of these common sources of cavities.
When I ask most people how often they brush they usually tell me that they think they brush really well, at least once or twice a day. Really well for most people is about 30 seconds of brushing. OK, first mistake right there. You can’t adequately brush your teeth in 30 seconds. You really need two solid minutes of good brushing with a manual toothbrush to get good results. An electric toothbrush can speed up this process a bit but I’d still recommend sticking to the two minute rule.
One last thing. If you’re not flossing you’re missing 40% of the surfaces of your teeth.Your toothbrush just can’t reach into those areas in between your teeth. Only floss, a waterpik, or interproximal brushes can clean these areas out. I can’t tell you how many patients I see who say, “I’ve been getting food stuck in this one area” and then when I take a look they have developed a cavity there.
So here’s a great example of this. (I got it from a patient of mine who used to each kids about oral health) … Imagine you’re holding your hand up with your fingers together. Now go ahead and dip your hand in chocolate pudding. YUM! With your fingers still together you wipe all the pudding off your hands. Think this cleans up all the pudding? No way! Now take a piece of yarn and thread it through your fingers. Guess what you’ll find? Lots more pudding. This is the same with your teeth. You’ve got to clean out in between your teeth or you’ll never get it all cleaned up.
Action Plan:
- Brush twice a day for two minutes each
- Floss, use a waterpik, or use interproximal brushes at least once a day.
Fluoride
Fluoride is one of the main weapons that dentistry uses to combat cavities. It has been known for a long time that fluoride interacts with teeth in order to create stronger enamel and rebuild areas of enamel that have been damaged by acid attack. The fluoride literally helps build stronger and better crystal structures within the enamel.
Now I’m not a huge fan of fluoride in the water supply because of it’s likely effect on child development and fluorosis. For adults, however, this fluoride likely isn’t harmful and may actually be helpful for the health of your teeth.
I am, however, a big proponent of fluoride containing topical products for your teeth (fluoride rinses, toothpaste, varnishes, etc). The more contact with fluoride your teeth get, the more protection they will get with cavities.
If you’re highly prone to getting cavities I’d highly recommend you ask your dentist about a prescription strength fluoride toothpaste. My personal favorite is Prevident 5000 but there are a lot of other options out there. Prescription strength fluoride toothpastes can significantly reduce your risk of cavities. If you’d like more information about high fluoride toothpastes I’ve got a whole article devoted to that topic here.
Another thing you can ask your dentist about is using a dental varnish every time you see them. This is an extremely high concentration fluoride product that is painted on your teeth. It comes in a very sticky base so that it sticks directly to your teeth and stays there until you brush it off. Ideally you want to leave it on for at least 6 hours so that your tooth has time to take up the extra fluoride and use it to create a stronger tooth structure.
One last source of fluoride is from a mouthwash. There are mouth rinses that contain fluoride from quite a few companies. The major ones are from Listerine and Act. We’ve got a whole section on mouthwash reviews that contains my recommendations for different types of mouth rinses. The big trick with this is that you have to use it at least 30 minutes before or after brushing, otherwise it isn’t terribly effective.
Action Plan:
- Get additional sources of fluoride in your routine.
- Ask your dentist about prescription strength fluoride toothpaste and routine use of varnish.
- Use a fluoride containing mouth wash 30 minutes before or after brushing.
Xylitol
One of the newer oral health products on the scene is Xylitol. Xylitol is what is known as a sugar alcohol. It can be used as a sweetener but isn’t technically a sugar as it can’t be broken down the same way as regular sugar or high fructose corn syrup can.
So why is Xylitol exciting? Xylitol sweetens products quite effectively but has far less calories and can’t be used by the bacteria in your mouth to create cavities. In fact, it actually keeps the bacteria in your mouth from attaching to your teeth. If the bacteria can’t attach to your teeth then they can’t cause major damage to them.
There have been several studies done of school age children who have chewed xylitol sweetened gum. They were compared to cihldren who didn’t chew xylitol gum at all. The children with the xylitol gum experienced significant drops in the amount of cavities that occurred vs the group that didn’t chew xylitol gum.
There are a good number of companies who supply GREAT xylitol products now.
Candy: Dr. Johns Candy (it tastes like real candy!!!) I ordered a sampler pack of these products and couldn’t tell a difference at all between regular candy and this one. The biggest problem with this one is that it ends up being quite a bit more expensive than regular candy up front. Now if this candy keeps you from getting even one cavity, it might end up being a huge bargain over regular sugar flavored candy.
Mints and Gum: Epic Dental and Spry. Their mints and gum are second to none. The biggest challenge with these is that the flavor just doesn’t last very long. Mostly this is because the xylitol just doesn’t stick around very long. If you remember that it is saving your teeth for the rest of your life then it all becomes worth it. Run out of flavor? Chew another stick or pop another mint? It’ll help keep you from getting cavities long term.
Action Plan:
- Order some xylitol gum or mints
- Make sure you get exposure to at least 5 grams of xylitol a day.
Chew Any Gum
Maybe you can’t find any xylitol based gum or don’t like the taste of it…
Good news! The simple action of chewing gum is actually protective against cavities (even if it isn’t as much as xylitol sweetened gum). Chewing gum stimulates your mouth to produce extra saliva which is highly protective against cavities. Saliva contains minerals and enzymes that fight against cavities. It does everything from washing away sugars, to fighting bad bacteria in your mouth, to strengthening your teeth to fight back better against cavities.
Just chewing (sugar free) gum on a regular basis decreases your risk of cavities significantly. Want to start at an easy spot? This is the one!
Action Plan:
- Chew gum, whether sweetened with xylitol or not.
Breaking Bad Habits
You may say, well that’s all well and good but how in the world am I supposed to break all these bad habits? Don’t worry! We’ve got you covered here too.
Ever heard of Pavlov’s experiments? Anyone who has studied psychology is well aware of this. Pavlov wanted to figure out what makes humans and animals tick. Why they do what they do. He studied the concepts of positive and negative reinforcement of certain behaviors. In one study he rang a bell every time a dog would be fed. When dogs know they are going to be fed they start to product a lot of excess saliva and drool all over the place. Eventually the dogs started creating saliva anytime a bell was rung, whether or not they received food.
A lot of this same psychology works on humans. You can pair certain behaviors with something else (either positive or negative) just by doing it at the same time as a behavior.
So here’s the really interesting part. Want to stop a bad habit? You’ve got to pair it with something unpleasant. One guy hired someone to slap him every time he got off track on his work. His productivity, it went through the roof!
So do you need to hire someone to slap you whenever you eat sugar? NO! Fortunately we’ve got some great tech out there that can take the place of this person. A really great tool to help you out with this process is known as Pavlok (named after the famous creator of these experiments). It uses a wristband that will shock you whenever you push it. You can also set up certain triggers that will make it shock you such as using it as an alarm, when you use Facebook too much, or when you raise your hand up to your face.
Want to buy a Pavlok? Click here for a link to Pavlok on Amazon.com.
Action Plan:
- Figure out how to associate bad behaviors such as constant snacking with something negative.
- Consider buying a Pavlok to help you create better habits.
So there you have it. A guide that tells you exactly what you need to do in order to NEVER get a cavity again. Does it take some work? Absolutely! Most good things in life require at least a bit of work. In my opinion, these action items can be easily implemented for most people given a bit of hard work and willpower.
Using TENS For TMJ Pain
Updated 03/19/2018
If you or someone you know has struggled with TMJ pain, you know that finding a correct and effective treatment for you can be challenging. Everyone who has a temporomandibular joint disorder (TMD) has to find what works specifically for them. For some people this takes the help of a dentist or TMJ specialist, while for other people they are able to find out what works on their own. Most people need a combination of medications, rest, heat, cold, exercises, and bite splints.
These aren’t the only treatments for TMJ though. One type of additional treatment for TMJ pain that has gained some popularity is known as TENS…
What is TENS?
TENS stands for transcutaneous electrical nerve stimulation. Translation: A small electrical current is applied to your skin that stimulates nerves and muscles in a specific area. TENS units have been used over the years to treat a variety of different types of pain.
How Does TENS Treat Pain?
It’s isn’t entirely clear how exactly TENS treats pain. There are two major theories though about how it works.
The first is known as the gate theory of pain. This theory states that your body sends pain signals through nerves. If you can overwhelm the nerves with another type of stimulation (such as a small electrical current) then it will block the pain signals.
The second theory says that TENS stimulates your body to produce more pain reducing chemicals known as endorphins.
It may actually be a combination of both of these.
Is TENS Effective for TMJ/Jaw Pain?
There isn’t an easy answer for this one. The honest answer is that we don’t really know. It may be effective for some people and not effective for others. It may be effective with certain placements and electrical settings and not at others. There really hasn’t been enough study to know for sure. What I can tell for sure is many TMJ specialists recommend trying it and many TMJ pain sufferers swear by it. By itself, TENS isn’t a complete solution to TMJ problems but can be a good tool to be used in addition to other TMJ treatments.
Where To Place The Electrodes?
Electrode placement for TENS is not an exact science. There definitely haven’t been any studies done trying to find the correct position. What I personally recommend is that you place one electrode slightly forward of your ear and place the other electrode on the back of your neck on the same side. Do this on both sides. Another option is to place one electrode near the angle of your jaw and the other on your temple.
Try both of these and see what works for you. Depending on the specific location of your pain one may work better than the other.
What kind of settings should I use?
This is another of those questions that we really don’t have a good answer for because it really hasn’t been studied. What we do know about TENS units is that their effectiveness can be highly dependent on the level of current used. Start low and keep increasing the current until you feel that you are starting to get some results. There are several other settings such as frequency that make a difference.
Studies point toward high frequency and high stimulation being the most effective, especially for short term pain. High frequency for a TENS unit is around 100 Hz whereas low frequency is considered to be around the 10 Hz range.
Most studies had patients use it for about 30 minutes, twice a day but again you’ll need to see what works best for you as there was a good bit of variability in how long it was used.
What Kind Of TENS unit should I get?
Most types of TENS units will work just fine for TMJ pain. You can find everything from $30 basic units up to $1000 medical grade units. Personally I’d recommend just using a basic unit. My patients who use TENS units have been satisfied with these basic models. You’ll get all the functionality you need to treat your TMJ pain. Amazon has quite a few different options. The one I personally recommend is the HealthmateForever YK15AB. It currently has over 7000 reviews on Amazon with a 4 1/2 star rating. You can also click on the picture to take you to the listing.
References:
Effectiveness of Transcutaneous Electrical Nerve Stimulation for Treatment of Hyperalgesia and Pain. Curr Rheumatol Rep. 2008 Dec; 10(6): 492–499.
Dry Mouth – Causes and Solutions
Does your mouth often feel like this picture? If so, you may be struggling with dry mouth (medically known as xerostomia). There are a lot of different reasons for dry mouth and an equal number of oral health problems that go along with it. I’m going to show you what causes dry mouth, what some of the dangers of dry mouth are, and how you can decrease your dry mouth and reduce the risk of problems associated with it.
What causes dry mouth?
Medications and Drugs
There are so many different medications and drugs than can cause dry mouth that we can’t possibly list them all. Check pretty much any medicine for it’s list of side effects and dry mouth is usually on there somewhere. Here are list of some of the most common…
- Caffeine
- Alcohol
- Opiate painkillers such as hydrocone or oxycodone
- Most blood pressure medications, especially diuretics
- Antihistamines such as Benedryl or Claritin
- Decongestants for colds
- Common medications for depression and anxiety such as SSRI’s
- Asthma medications.
Like I mentioned, this isn’t anywhere near a complete list. If you’re not sure, check out a list of side effects for your specific medications. Drugs.com is a good resource for this.
Dehydration
Most people don’t drink enough water throughout the day. In fact some people don’t even drink plain water at all. I’ve met a lot of people who only drink sodas, teas, or fruit juices. While they do have water in them, many of these drinks also contain other unhealthy compounds and many are caffeinated. As we just learned, caffeine is a diuretic which actually makes you lose water.
The current recommendation is that you drink eight, 8 oz cups of water a day. This is equal to approximately 2 liters or half a gallon. I know I don’t drink that much every day and I don’t know many people who do. So if you’re struggling with dry mouth, start by drinking enough water!
Diseases / Infections
- Sjogren’s Syndrome – Sjogren’s syndrome is an auto-immune disease where your body attacks your salivary glands and a couple of other areas. The salivary glands are slowly destroyed and you’re unable to produce enough saliva anymore which leads to dry mouth.
- HIV/AIDs
- Alzheimer’s
- Diabetes
- Anemia
- Cystic Fibrosis
- Rheumatoid Arthritis
- High blood pressure (hypertension)
- Parkinson’s Disease
- Stroke
- Mumps
Head and neck radiation or chemotherapy for cancer
Both head and neck radiation and chemotherapy treatments for cancer tend to kill the cells that create saliva. Once they are destroyed they can’t be replaced. The best we can hope to do in these cases is manage the side effects of not having enough saliva.
Smoking and Chewing Tobacco
Both of these reduce the amount of saliva you make and also make the problems that go along with even worse.
Mouth Breathing
Some people always breath their mouth, either just at night or all the time. Your mouth is supposed to be a very moist environment but it dries out very quickly if your mouth is open. This causes the sensation of dry mouth and also is highly related to gum irritation around the upper front teeth.
What are the consequences of dry mouth?
Cavities
Cavities are the biggest problem that goes along with dry mouth. Saliva has a variety of enzymes and minerals that are protective against the bacteria that cause decay. Saliva does everything from washing away food and bacteria, to fighting off bad bacteria, to rebuilding damaged enamel on your teeth. The more saliva flow you have, the better these things can happen.
Gum disease
Gum disease is primarily an infection of the gums surrounding your teeth. The bacteria that cause gum disease are very different than the bacteria that cause decay but they thrive in many of the same conditions that promote cavities.
Bad breath
Bad breath is a combination of rotting food and chemicals release by bacteria and fungi and in your mouth. The most noxious of these are known as volatile sulfur compounds (VSC’s). You know that rotten egg smell? That is the smell of sulfur as well.
Burning and irritated tongue
Many people with dry mouth also develop burning, raw, red, irritated tongues. Many times this is a result of an overgrowth of certain types of fungi in your mouth (primarily Candida).
Thrush
Thrush is the overgrowth of the Candida albicans fungus in your mouth. Most people have a small amount of this in their mouth but it is kept in control by the enzymes in your saliva and competition by bacteria. Dry mouth provides an environment where it can thrive and get out of control. Thrush usually shows up as a white covering on your tongue that goes along with some tongue irritation and a terrible taste.
Difficulty in wearing dentures
Dentures require a nice moist environment in order to stay in place well without causing too much irritation. You are also at a much higher risk of developing infections under your dentures if your mouth is too dry.
What can you do about dry mouth?
Drink more water.
Everyone with dry mouth should start with this one. Aim for eight, 8 oz cups of plain water a day or 2 liters / a half gallon. Some people even need to bring water with them everywhere and take small sips all throughout the day. Many of my oral cancer survivor patients do this religiously.
Ask your physician about using different medications that don’t cause as much dry mouth.
Chew sugar free gum.
Chewing stimulates your saliva glands to work harder. More saliva = less dry mouth.
Use sugar free mints or candy to stimulate saliva flow.
Anything with a strong flavor will also cause your saliva glands to work harder. Make sure they are sugar free otherwise you’ll be causing another problem (cavities) while trying to fix the dry mouth.
Dry mouth mouthrinses
There are a variety of dry mouth mouthrinses out there right now. The most well known is Biotene which contains specific enzymes to help stimulate and replace saliva. There are a lot of other options out there too with more coming out every year. The market has gotten a lot bigger with our society taking more and more medications every year. I’ve got some specific mouthrinse recommendations on our mouthwash product guide page.
Try to reduce or stop smoking.
Work to stop mouth breathing.
Practice every day breathing only through your nose. A good rule of thumb is to practice for 5 minutes at a time, 4-5 times a day. Over time this will become a habit and your mouth breathing habit should start to get better.
Is Vaping Safer For Your Oral Health?
Did you know that one of the single most destructive habits for your oral health (and overall health) is using tobacco products? Cigarettes and other forms of tobacco have been linked to gum disease, oral cancer, heart disease, lung disease, and many other health problems. Quitting just this one habit (easier said than done of course) reduces your risk of all these types of diseases more significantly than just about anything else you can do.
About 4-5 years ago I started seeing more and more of my patients switch to vaping with e-cigarettes instead of smoking regular cigarettes in order to get their nicotine fix. When I would bring up the topic with them they’d always tell me that vaping was a lot safer than smoking because it was just “water vapor” coming out and not smoke.
As usual, I had to do more research to find out.
Finding research on vaping is tough mostly because it is such a new phenomenon. There simply aren’t any long term studies on vaping that are needed to make a definite link between vaping and all the various health conditions. What some of the studies have looked at is what the immediate effect vaping has on different cells in the body.
Study #1: In a study published in Oncotarget in October 2016, researchers compared the cellular effects of regular tobacco smoke to that of a menthol flavored e-cigarette vapor. Their results? E-cigarette vapor was just as damaging to cells as regular tobacco smoke. It appeared that the chemicals that flavor the liquid were especially responsible for the damage.
Study #2: In another study published in the Journal of Cellular Physiology in November 2016, researchers tested e-cigarette vapor on specific cultures of cells that are typically found on the surface tissue of the mouth known as epithelial cells. They pumped this vapor into the culture to simulate about 15 minutes of exposure to the chemicals over the course of a day. Cells not exposed to the vapor only had about 2% of the cells die over the course of three days. Cells exposed to vapor had significantly higher death rates. 18% died on Day 1, 40% were dead on Day 2, and 53% were dead on Day 3. That is a huge amount of damage to the cells.
Study #3: This last study looked at the the levels of toxins and carcinogens present in the body in both regular smokers as well as those who had been vaping alone. They found that the levels of both toxins and carcinogens were much lower in people who only vaped.
So here is what we definitely know…
We’ve known for a long time that nicotine itself (not just all the other chemicals in tobacco) is a risk factor for gum disease. E-cigarettes contain just as much nicotine as regular cigarettes and therefore can help contribute to gum disease.
The combination of flavoring chemicals and nicotine in e-cigarettes appears to be at least as harmful to cells in the mouth as regular smoking and may possibly be even more damaging.
Vapor from e-cigarettes is highly toxic to the epithelial cells that line your mouth. Repeated cell damage is bad not only for the short term health of your gum tissue but also for their long term health. We know that repeated damage to cells can cause them to change and turn into cancerous cells.
The studies are a bit mixed as to what the actual effect of vaping is on your body. We likely won’t know all the long term consequences for several decades. It appears that vaping can do some significant damage to the tissues in your mouth. It also appears that vaping exposes the rest of your body to far fewer harmful chemicals than regular smoking.
Vaping may be somewhat better than regular smoking but it is very likely that there will still be long term consequences from consistent use. I’d highly recommend cutting back or quitting as soon as possible. If you need help quitting, seek out help from a professional, friends, or online communities. There are a lot of resources out there to help you get through it.
How Do I Know If I Need A Root Canal?
I get asked in person or online almost every single day about how to know when someone will need a root canal. Most people are understandably concerned when they start to have sensitivity, biting discomfort, or other unusual symptoms. Quickly your mind can jump to the worst case scenario and all of a sudden you’re thinking “I might need a root canal?!?! Oh no!”.
Let’s go over what your dentist looks for and what you can look for to know whether you need a root canal.
Sensitivity
Sensitivity to hot or cold can be the first sign that something is going wrong with your tooth… or it can be nothing at all.
When you’re ok…
If something hot or cold hits your tooth and you have a quick, painful sensation that goes away in a couple of seconds, this is fairly normal.
When you need a root canal…
If that same hot or cold hits your tooth and it continues to hurt for 15-20 seconds or even minutes, the nerve is likely in the process of dying and you’ll need a root canal.
Pain
Tooth pain comes in a variety of ways. There can be aching, shooting, throbbing, stabbing, electrical, burning, tingling, constant, dull, or severe pains. You can have a combination of these.
When you’re ok…
A dull ache or occasional minor sharp pains aren’t terribly unusual. These can be the sign that you have a cavity, bit on something wrong, or are having sinus problems. As long as it doesn’t become severe, these don’t usually signal the need for a root canal.
When you need a root canal…
Constant severe pain that comes on all by itself or after a stimulus of some sort is not normal. This almost always indicates that you need a root canal. Pain that is strong enough to wake you up at night is a great indicator of this as well. Most of the time, this type of pain comes presents as a throbbing severe pain. Most people say it feels like the tooth throbs along with your heartbeat.
Swelling
Swelling is usually the sign of infection. Figuring out whether it is related to your tooth or not is the big trick in knowing whether you need a root canal.
When you’re ok…
A number of things other than an abscessed tooth can show up as swelling of the gums, lips, or cheek. The most common are related to gum disease of some sort. Gum disease is a chronic, long term infection of the gums around your teeth. Occasionally this infection can get out of control and cause some significant swelling. Other less likely things that can cause swelling include mucoceles, fibromas, other growths, or trauma.
When you need a root canal…
Swelling that is associated with an infection of your tooth (an abscessed tooth) means you most definitely need a root canal. The nerve inside the tooth has died and all this tissue inside has now become infected. The tooth acts as a constant source of infection that affects the bone and other tissues around your tooth. A root canal removes all this infected tissue and allows your body to heal.
If your tooth is abscessed you’ll usually have pain when you touch the tooth or bite with it. The swelling typically occurs next to or around the tooth but can also move further away so that it looks like it is coming from somewhere else.
Biting pain
Biting pain is another one of those tricky ones. Biting pain can be related to an infection, trauma, a failing filling, or a cracked tooth.
When you’re ok…
A failing filling or cracked tooth don’t always mean you need a root canal. You may just need a new filling or crown instead. Cracked teeth are more likely to need a root canal in the future though.
Some people also have trauma to teeth as a result of an accident or from grinding and clenching their teeth. This can lead to pain, especially when biting. If you’ve had recent trauma give the tooth some time to settle down before jumping to the conclusion you need a root canal. If you’re a grinder consider investing in a night guard to reduce the force on your teeth.
When you need a root canal…
An infected tooth means you definitely need a root canal. No way out of this one.
A cracked tooth that has developed significant pain, sensitivity, or in which the crack extends into the nerve means that it would need a root canal.
Large cavities
Cavities are no fun. Large cavities are even less fun, especially when you end up needing a root canal. X-rays of your tooth can show the rough extent of a cavity but don’t tell the whole story. Your dentist will only know it’s full extent once they clean it all out of the tooth.
When you’re ok…
If the cavity doesn’t extend to the nerve of the tooth once your dentist removes it, then you’re in the clear, at least for the time being. If it is really close to the nerve you may develop symptoms in the future that mean you need a root canal. Most dentists try to avoid going into the nerve space when at all possible in order to give your tooth a chance.
When you need a root canal…
If the cavity is removed and the nerve of the tooth is exposed then it will need a root canal. In very rare cases where the opening to the pulp chamber is only a pinpoint your dentist may do what is known as a pulp cap and try to let the tooth heal itself. Long term, you’ll probably still end up needing a root canal at some point.
This can be a good guide of whether you need a root canal, but it is important to know that there are many times when you could need a root canal without even knowing it. I’ve seen plenty of infected teeth or teeth with extremely large cavities in which the person had no idea there was a problem at all. The best prevention for root canals is good oral hygiene, reducing sugar and acid in your diet, and seeing your dentist consistently so they can catch things early.
Everything You Need to Know to Stop Snoring!
Are you ready to finally stop snoring? You’ve come to the right place. I’m a dentist by day, oral health blogger by night, and snorer anytime I manage to squeeze some sleep in. This gives me a unique perspective on the snoring problem as both health care provider and sufferer.
I never realized how much snoring can interfere with someone’s quality of sleep until I started snoring myself. Not only was my snoring waking me up as I was trying to fall asleep, but more importantly it also kept my wife up at night. A new baby at home + a snoring husband can lead to some problems!
I had been helping patients in practice stop snoring using various dental appliances for years. When it came time to help myself though, I was motivated to learn even more about the science of snoring and the best possible ways to treat it. Everything that follows is what I learned from years of clinical experience, my personal experiences, and from the science on the topic. As you’ll see a bit further down, I eventually even came up with my own custom solution that I personally use at home. It’s a unique technique that you won’t find anywhere else. Read on to learn all about it…
Now what is snoring?
Snoring occurs when air passes through your airways and vibrates some of the soft tissues in your nose or throat. Snoring sounds can range from a very light occasional hum to constant loud growls that reverberate through your house. Typically the tissues vibrate more heavily when the passages are narrower than usual.
The causes of snoring are quite varied but most have the same characteristic of narrowed airway passages. The easiest way to break down the causes are to break them down into those reasons that cause occasional snoring and those that cause chronic, long term snoring.
Occasional snoring is most often caused by a cold or the flu. Mucus and inflamed airways narrow the passages and cause the snoring sound while sleeping. Some other triggers can be alcohol, tobacco, or other drug use. Colds usually cause “nasal” snoring, while most other things cause snoring that comes from the throat.
Chronic snoring on the other hand is more often caused by airways that are too small all the time. It can be a result of a tongue that falls backward while sleeping, extra fat tissue from being overweight, or poor muscle tone in the throat. Increasing age also seems to be associated with snoring.
Who Suffers From Snoring?
Anyone who sleeps with someone who snores knows that it usually doesn’t affect the person snoring too much. In fact, they most often don’t even know they do it or that it is a major problem. The person who has to deal with it is the person who really suffers. They typically get broken sleep as they are woken up again and again from the noise. More and more research has shown how important uninterrupted sleep is. Lack of or poor sleep can cause a variety of health problems ranging from daytime sleepiness all the way up to mental health issues and heart disease.
Health problems associated with snoring
One other common health issue associated with snoring is known as sleep apnea. It most commonly presents as someone who chronically snores and also notices that they don’t sleep well or have excessive daytime sleepiness. With sleep apnea, a person not only snores but also stops breathing periodically throughout the night. This can range anywhere from several times an hour up to dozens of times an hour. Sleep apnea has major long term health consequences without treatment. These include excess drowsiness, heart disease, stroke, and even death. Every couple of years you’ll hear about some celebrity who dies in their sleep (think recent Supreme Court Justice Antonin Scalia or comedy actor Chris Farley). Most often these cases are the end result of sleep apnea.
Before you try to cure your snoring, please make sure you don’t have sleep apnea. Sleep apnea needs to be treated more aggressively than snoring because it is much more dangerous. A sleep study with a qualified sleep physician is the best way to tell if you have sleep apnea.
So let’s say you snore but don’t have sleep apnea. How do we make it stop?
For people who suffer from nasal snoring…
If you suffer from nasal / nose snoring you can try Breathe Right Nasal strips. They are a small adhesive strip that attaches to the outer part of your nose. They gently expand your nose where they are attached. This can often open your nasal passages just enough to stop the snoring. If your nasal snoring is a result of a cold or allergies, you should also take cold or allergy medicine to reduce mucus and inflammation in your nose.
Another option to try is known as “nose vents”. They look uncomfortable but aren’t too bad. They are made of soft plastic silicone plugs that go up your nostrils. They gently hold your nasal passageways open and allow you to breathe better.
If your snoring comes from your throat and is chronic, there are a lot of additional options to try.
Change your sleeping position
One of the first things to try is changing your sleeping position. Many people only snore when they sleep on their back. Sleeping on your back allows your tongue to fall backwards, partially closing the tissues around the airway in your throat. Cue the snoring. Sleeping on your side or stomach can help reduce this effect and in some people stops the snoring entirely.
Lose weight
If you’re overweight, another option is to try and lose some weight. Much easier said than done for sure. As your weight increases you gain additional fat tissue around your neck and airway. This again has the effect of partially obstructing your airway and making it so that snoring occurs. Many people start snoring when they reach a certain weight and will actually stop snoring if they decrease their weight below a certain point.
Snoring chin straps are ineffective
Some people like to try wearing a snoring chin strap. Don’t waste your time with one of these. Studies have shown that they aren’t effective for reducing snoring alone.
Dental appliances for snoring
If these fixes don’t work, the next thing to try is a dental appliance. A snoring appliance works by either pulling your tongue or lower jaw forward at night while you sleep. This has the effect of opening the airway passages in your throat enough to keep you from snoring. Done right, these appliances are highly effective at stopping snoring. As with everything else, there are a lot of different types of these appliances and it can be really difficult to know what is the best one for you. I’m going to review each specific type so that you know what you’re getting in to and what is the best solution for you.
Tongue Repositioner – This is the easiest, but least comfortable type of dental appliance that can help relieve snoring. It works by pulling your tongue forward. I would recommend using one of these if you have no teeth, are missing most of your back teeth, or have very loose teeth from periodontal disease. There are a couple of different brands you can find online. One of the easiest to get is on Amazon. It is known as SnoreX. You can also search for “AveoTSD” and it’ll pull up some additional options.
Boil and bite – You can purchase these from several websites online. The most common include SnoreRx, The Good Morning Snore Solution, or the Pure Sleep device. They are effective but tend to be more bulky, more challenging to adjust and get right initially. I’m not a huge fan of these mostly because of their bulk and I personally really struggle to sleep with that much in my mouth. Most people can get used to sleeping with them eventually with a bit of persistence over the course of several weeks.
Professional custom appliance – There are quite a few different types of professional dental appliances to help with snoring (and also sleep apnea). Some of the most common types that your dentist may have recommended include the Silent Nite, Somnomed, or TAP3. All have their benefits but my personal favorite professionally made appliance is the TAP3. It is well constructed, highly customizable, and allows your jaw to slide from side to side while sleeping. All of these are highly effective in reducing or eliminating snoring when customized appropriately. The biggest challenge with these is #1 cost and #2 getting used to wearing them as they tend to be quite bulky even though they are custom made.
If you decide this is the best route for you, make sure you find someone who has had some experience making dental sleep appliances or has had some additional training on the different treatment options. Picking the right type of appliance for you can make the difference between success and failure.
Make your own – This is the route I took. Most professional snoring appliances are bulky and cover all of your top and bottom teeth. They’re also expensive to make and eventually break.
I decided to come up with a better option that worked better for me and would be an easy and effective option for other people too. The graphic below shows the type of appliance I created. I’ve found it to be extremely comfortable and effective for my snoring. It’s easy to make adjustments at home, it’s comfortable, it only covers a couple of back teeth, and it is cheap to replace if you lose or break it.
You may think it sounds really difficult to make your own snoring appliance. In actuality it is really quick and easy and I can guide you through the couple easy steps it takes. You can find more information in my step by step guide.
Alternative treatments
Myofunctional therapy
“Myofunctional” literally means “muscle function”. The goal of myofunctional therapy is to retrain the muscles in your mouth (usually your tongue) to go to a more healthy position when at rest. There have been some interesting studies that have shown that results of myofunctional therapy can rival that of dental appliances. The biggest downside to myofunctional therapy is that it usually requires the assistance of a trained myofunctional therapist, it is expensive (I’ve seen quotes that run around $3000 for a year of therapy), and it takes months of exercises to see long term results. If you are very motivated and can’t or don’t want a dental appliance, this can be a good option. Otherwise, you would probably be happier with the quicker and easier results of a dental appliance.
Surgery
In very rare circumstances, surgery can help relieve snoring. Most of these are in cases where someone has extremely large tonsils that obstruct the airway. Removal of the tonsils can help relieve the snoring (and usually associated sleep apnea). If you’ve tried all the other options with no success and feel that snoring is causing a big problem, it might be time to check with an ear, nose, and throat surgeon to see if surgery could be helpful.
The Ultimate Teething Guide
“So deadly has teething become, that one third of the Human family die before the twenty deciduous teeth have fully appeared.” – Dr. M Thrasher, 1894, Dental Cosmos
For as long as we’re able to trace back in human history, teething has been thought to be the cause of a variety of illnesses. Fever, diarrhea, seizures, vomiting, paralysis, and even death were all thought to be caused by teething. In 1839, 5016 total deaths in England were said to be a result of teething. In 1842, 4.8% of all infant deaths in London were attributed to teething. Even as late as 1910, 1600 deaths in England and Wales were listed as caused by teething. Amazing right?
We’re a little better educated today but many myths about teething still remain and continue to be spread. Before we get to those myths, let’s learn a bit more about teething…
What Is Teething?
Teething is the process by which children’s first set of baby (deciduous) teeth erupt through the gums and into the mouth. Children’s first teeth start forming quite early in the womb and are already quite well developed under the gumline before they are even born. As they continue to develop they start to push upward through the jaw bones and gum tissue until they eventually erupt into the mouth.
When Does Teething Occur?
Teething is a highly variable process. On average it starts around age 6 months and continues until the child is approximately three years old. Some children start teething as early as 2-3 months while others don’t start until they are over a year old. These variations are quite normal and don’t indicate anything wrong with the child one way or another in most cases. In very rare cases, delayed teething can be the sign of certain health conditions including hypopituitarism, hypothyroidism, infantile rickets, Down’s Syndrome, cleidocranial dysostosis, osteopetrosis, Gardener’s syndrome and achondroplastic dwarfism.
Here are some rough ranges of when specific teeth come in. Not all children will follow this exact pattern.
- Lower central incisors 5–7 months
- Upper central incisors 6–8 months
- Upper lateral incisors 9–11 months
- Lower lateral incisors 10–12 months
- First molars 12–16 months
- Canines 16–20 months
- Second molars 20–30 months
Common Symptoms Associated With Teething
Teething can cause some specific problems with children, just not as many as people commonly believe. Most of the symptoms associated with teething are a direct result of the moderate discomfort that occurs when they start to come in. Also, most teeth symptoms start 3-5 days before the tooth erupts into the mouth and go away quickly after it has done so.
- Gum swelling and tenderness
- Excessive drooling
- Chewing of fingers and toys
- Irritability
- Night crying
- Poor appetite
- Rash around the mouth
Health Problems Commonly Associated With Teething That Actually Aren’t
There are quite a few childhood illnesses and diseases that continue to be blamed on teething. Here are the most common ones that actually have nothing to do with teething…
- Fever – This is the most common one I hear from parents. There is some evidence that a child’s temperature will go up very slightly (0.1 degrees on average) while teething, however, it does not increase to anywhere near the level of a fever.
- Diarrhea – Again, all the studies have shown no correlation with diarrhea and teething.
- Pulling on the ears. – Pulling on the ears is far more likely to be related to an ear infection or nothing at all rather than related to teething pain.
- Diaper rash
Unusual Teething Situations
There are a couple of situations with teething that can cause some unusual things to occur.
Eruption cysts – Occasionally when a tooth is breaking through the gums, it will develop a large discolored swelling above it. This is known as an eruption cyst. Most of the time this will resolve on it’s own once the tooth has pushed through far enough. If an eruption cyst is causing significant pain or difficulty in chewing and eating, a dentist or physician can make a small incision in it which will allow it to decompress and go away more quickly.
Natal or neonatal teeth – Natal teeth are present when the child is born and neonatal teeth erupt in the first month of life. Sometimes these teeth are extra and sometime they are the actual baby tooth for that specific spot that has just come in early. If they pose a problem for nursing, sometimes they are removed, especially if they are extra teeth.
Treating Teething Symptoms
Before modern medicine came along, there were quite a few unusual treatments for teething. These included rubbing rabbit or lambs brains on their gums, dogs milk, bloodletting, opium syrup, leeches behind the ears, whiskey on the gums, and lancing the gums over and over again. Aren’t you glad we know better now?
Treatment for teething is mostly aimed at making the child more comfortable. Some things you can do to help (in order from most to least helpful) include…
- Cold teething toys that the child can gnaw on. Get a stash of these and keep them in the freezer until your child needs them. Frozen vegetables such as carrots also work very well.
- Over the counter pain medications. Tylenol and Ibuprofen are the most common.
- Topical anesthetics such as Anbesol that can be rubbed on the gums to provide some temporary numbing.
A couple of things you definitely shouldn’t do include…
- Giving a young child aspirin can cause a very serious reaction known as Reyes Syndrome. Stick to Tylenol or Ibuprofen.
- Whiskey or any other alcohol on the gums. There really isn’t a safe amount of alcohol to expose a child to.
- Give them a teething necklace that can break apart and choke them.
- Use too much numbing gel. The numbing gel is absorbed through their gums and can lead to a dangerous overdose in high amounts.
With teething, it is best to remember that this a perfectly natural process that everyone goes through. In many cases less is more. A cold teething toy is the best and least dangerous way to help ease your child’s teething pain. It also doesn’t carry any of the risk that goes along with giving medications to a young child.
Many thanks to this publication from the British Dental Journal for providing many of the specific quotes and details about teething!
In Network vs Out of Network Dentists
There is a lot of confusion about how in network dentists work vs out of network dentists. What are the pro’s of and con’s of using one vs the other? Do you get better service at out of network? I’m going to try answer all of your questions here.
In Network Vs Out of Network Dentists
In-Network Dentist
- Sign a contract with the insurance that dictates how much they can charge and dictates specific rules that they must “play” by.
- Will bill your insurance.
- You are financially responsible for the contracted amount between your dentist and the insurance company. The specifics depend heavily on your dental plan (which is usually selected by your employer). Your dentist contractually must charge the amount specified in the contract and can’t go up or down.
- Are vetted by the dental insurance companies to make sure there isn’t a history of malpractice or other adverse events.
Out of Network Dentist
- No contract with your insurance company.
- Most will bill your insurance company for you while some will make you pay the entire fee up front.
- You are responsible for the difference between their full fee and what your insurance pays.
Typical Examples
Example #1: Cost for a cleaning
In network: Covered 100% by your insurance. Total cost to you $0.
Out of network: Your insurance pays $50 and your dentist’s full fee is $55. Total cost to you is $5.
Example #2: Cost for a filling
In network: Covered 80% by your insurance. Contracted rate of $100 for that specific filling. Your insurance pays $80 and you pay $20.
Out of network: Your insurance covers 80% of their usual rate and you the pay the rest up to the full fee. If the dentist’s fee is $150 your insurance will pay $80 and you will pay $70.
Example #3: Cost for a crown
In network: Covered 50% by your insurance. Contracted rate of $800 for a crown. Your insurance pays $400 and you pay $400.
Out of network: Your insurance covers 50% of their usual rate and you pay the rest up to the full fee. If the dentist’s fee is $1000 your insurance will pay $400 and you will $600.
We could go on and on with the examples. These are just some of your most likely costs and examples of how a typical dental insurance plan will pay. Not all insurance plans work in this way and may have deductibles, waiting periods, and other exceptions that allow them to pay less or not at all. When in doubt, expect them to pay less than they say they will.
Commonly Asked Questions
Why don’t some dentist’s participate with my plan?
Dentist’s take an enormous hit financially to be in network with a dental insurance plan. On average they only receive 50-70% of their full fee when contracted with a dental insurance company. They do this in exchange for the dental insurance company listing them as in network (and thereby they get new patients). If a dentist has high business overhead, this reduction in revenues can be the difference between making money and losing money.
Do you get better service at an out of network dentist?
This is a hard one to say for sure. The quality of each dentist’s work can vary quite dramatically. I can say that a dentist is out of network for most dental plans SHOULD have more time for each patient. If you’re seeing an out of network dentist and don’t feel like you’re getting top-notch service, it is time to find another dentist. An in network dentist on the other hand will usually need to see more patients in a given time frame in order to make enough money to pay the bills. If you’re seeing an in network dentist, you may have longer wait times and may not receive quite as personalized service. This is often the price to pay for a lower cost. If you’re lucky enough to find an in network dentist who provides excellent service and takes their time, make sure you stay with them.
Why are so few specialists in network?
There are fewer dental specialists than there are general dentists. This means that there is less competition and less incentive to be in network with any dental plans.
Does my in network dentist know all the specifics of my dental plan because they are in network?
Most definitely not. Even with the best insurance verification it is only possible to estimate what your insurance will cover. This is because your dental insurance contract is usually a multi-page book that only you and the insurance company have access to. In many cases there are a huge variety of limitations and exceptions that your dentist can’t possibly know about. Make sure you know what kind of coverage you have so you can make informed decisions at the dentist.
Is it legal for my dentist to charge additional for certain services?
This one can only be answered with a big “it depends”. An out of network dentist can generally charge whatever they like to whomever they like (within state and federal law). An in network dentist must follow state and federal laws as well the specific dictates of their contract with their contract with the insurance company as well as your specific dental plan. Some plans allow for additional fees for certain services while others don’t. Some of the more common (legal) additional fees include those for white fillings (instead of amalgam), more advanced orthodontic options (such as Invisalign or clear brackets), or better materials for making crowns, partials, or dentures.