Can You Get A Cavity Under A Crown Or Filling?
Back a couple of years ago I was talking to my sister in law and she told me that she had recently been to her dentist and he found about 7 or 8 cavities under her old fillings. She asked me how she could possibly have cavities under her fillings. She thought that since the fillings were there that she shouldn’t get any more cavities, right?
After talking a bit more, I found out she was drinking a 2 liter soda every single day. She would sip on it all day long. She didn’t think it was a big deal until she found out about all these cavities.
Here is the deal. I see this all the time! You can absolutely get new cavities under fillings or crowns. In fact this is the single biggest reasons that they fail or need to be replaced. Every crown or filling has an interface where it meets your original tooth structure. Even with the best materials and techniques there is always going to be a microscopic gap in this area. Bacteria, food, and sugar can travel into this gap and cause a cavity over time if you’re not careful.
These cavities can be especially challenging because they are often much larger than the original cavity. In the case of fillings, these cavities usually don’t show up on the x-ray until they are quite large and have already compromised a large portion of the tooth. In many cases of additional decay under fillings a crown is needed to fix the tooth again. For teeth with crowns, new decay can cause you to need a root canal or even loose the tooth. Decay can often creep under a crown and your dentist can’t see it until it is too late. The crowns sometimes block the x-rays so that cavity isn’t visible until is huge or the crown falls off.
So if you’ve got crowns or fillings are you already doomed? Is it just a matter of time?
No! I’ve also seen fillings and crowns that have been in people’s mouths for over 50 years! This is with the old materials that they used 50 years ago. What did all these people have in common? A good diet and good oral hygiene. They avoided consistent exposure to sugar and kept their teeth clean. In most cases they flossed regularly.
Want to avoid more dental work. Doing what all these people did. Limit sugar. Brush and floss your teeth. Avoid bad habits. This doesn’t mean that at some point you won’t need more dental work. Fillings still wear out and teeth break. If you do these things though you increase your odds of keeping those fillings and crowns as long as possible.
Fun Questions About Teeth
What Are Those Bumps On Teeth That Have Just Come In?
Did you ever notice that when front teeth first come in, they have these nice ridged areas on the very top surface? Some parents see teeth come in like this and automatically assume that something went wrong during tooth development. Good news! Nothing went wrong. These areas are called mamelons. The front side of front teeth form from three separate lobes. During development the three lobes merge together but maintain a small amount of that shape when they’re complete. These mamelons wear away very quickly once the teeth have come into the mouth and start to get some work. It isn’t uncommon that they’re gone within several months. This is why you rarely seem them on adult teeth.
My Teeth Have Little Cracks All Over Them. Is There Something Wrong?
If you look closely at your teeth, especially the front ones, you’ll see what looks like hairline cracks running all through the teeth. Some people see these and get really worried that their tooth is cracking apart! Then they come to see me for a check-up and reassurance that everything is OK. Good news here too. These areas are called craze lines. They are tiny cracks in the enamel of your teeth but are usually very superficial. They form over time in most teeth, especially those that are subjected to more force from grinding, bad habits, etc. Occasionally craze lines will stain and become a cosmetic issue. No treatment is necessary for craze lines and they don’t mean your tooth is cracking in half or anything of the sort. Whitening your teeth can help reduce some of the cosmetic issues associated with craze lines.
How Hard Are Teeth?
Tooth enamel is the single hardest structure in your entire body. Your bones come in second but it isn’t really close. Enamel (the outer layer of your teeth) is nearly 96% mineral with only 4% consisting of water and proteins. Enamel is made up of a mineral known as hydroxyapatite. It is super hard but is also very brittle. Bone on the other hand is composed of only about 70% mineral content with about 30% being proteins and water.
What this means is that it is really difficult to scratch your enamel but it is easy to crack it with the right type of force such as getting hit in the mouth, grinding your teeth, or using your teeth to open a bottle or something similarly stupid. Teeth also have very little ability to heal themselves. Bones on the other hand can usually repair themselves if broken.
Why Are Baby Teeth Whiter Than Permanent Teeth?
Did you ever notice that when kids get their permanent teeth in that they look super yellow! I get this comment from parents all the time. They wonder if something is wrong with the permanent teeth. This is another one of those things where there may appear at first to be something wrong but in fact everything is totally normal. Baby teeth are naturally extremely white. They are whiter than most people’s teeth even if they have been whitening again and again. When your permanent teeth come in they are always darker than the baby teeth. This stands out more when they are sitting right next to those pearly white baby teeth. Once all the baby teeth have come out and the permanent ones have come in you don’t notice this big contrast and they don’t appear nearly as dark or yellow.
Why Do People Have Wisdom Teeth?
Great question. Wisdom teeth in most people aren’t very functional and a lot of people end up having them removed at some point in their life. It is thought that wisdom teeth used to be more functional. When people were hunter gatherers and ate a lot of leaves, bark, etc having another set of molars was a big advantage as this type of diet quickly wears down teeth. Skeletons from our early ancestors show that the jawbones were much larger and able to accommodate all 32 teeth. As the size of the brain increased, the size of the jaw actually decreased to make room for it. Unfortunately the wisdom teeth were still there and didn’t quite enough room.
Do Some People Have Extra Teeth?
Yes, it is pretty rare but some people develop additional teeth known as supernumerary teeth. These can develop in just about any location and usually aren’t functional. I’ve seen people with extra teeth between their front teeth, extra impacted teeth, and extra sets of wisdom teeth. There are also some genetic diseases that as a side effect have many many extra teeth that develop.
Why Does My Kid Have Shark Teeth?
When kids first start losing teeth they have a tendency to develop a double row of tooth on the bottom. This is perfectly normal! The permanent teeth almost start coming through on the tongue side of the gums behind the front teeth. For a short period of time, it will look like a double row of teeth. Once the permanent teeth have come through enough, they’ll make the baby tooth loose enough to come out. As soon as the baby teeth come out the tongue starts to put pressure on the adult teeth and this pressure pushes them forward into the correct location.
What Is That Protrusion On The Back Of My Tooth?
Some people have really large protrusions on the tongue side of their teeth. Remember how teeth form from all those separate lobes like we talked about with mamelons? Well in some people those lobes grow much larger than normal. The most common areas for this to happen are the canine teeth or the top molar teeth. On the canine teeth it is called a talon cusp because it looks like a big claw on the back side of the tooth. If it bothers you, sometimes your dentist can remove this area of the tooth but there is a chance of damage being done to the nerve. On the molar teeth this is known as a cusp of carabelli. Most people have a small one but occasionally people will have a really big one.
My Permanent Teeth Came In With Spots All Over Them? What Is Going On?
The most common reason for spots on permanent teeth is a condition known as fluorosis. Fluorosis occurs when you receive too much fluoride exposure when your teeth are developing. This causes discolored white and brown areas on the enamel of the teeth. This can range from very mild to very severe spotting and occasionally pits developing on the enamel. The one benefit to flurosis is that the teeth are usually more resistant to cavities.
Another common reason for spots is that the enamel didn’t form properly during development. This can happen if you were very sick, had a high fever, or any other of several other reasons. We usually call these “dysplastic” areas. These areas sometimes need immediate attention when the teeth first come in and sometimes they are fine for a long time.
Don’t Believe the Sugar and Soda Industries!
In 2015 an interesting article came out in the PLOS Medicine journal that documents how the sugar industry manipulated research as far back as the 1960’s about how best to prevent cavities. Some interesting finds…
- Even in the 1950’s the sugar industry knew that sugar caused damage to teeth and that there was consideration being given to campaigns to reduce sugar consumption
- They sought to deflect attention away from these sugar reduction campaigns and towards other avenues
- They manipulated research towards methods of harm reduction such as vaccines, enzymes, and other methods to reduce decay without reducing sugar
This type of manipulation was going on back then and is still going on today. Here is a current quote from the American Beverage Association…
It is irresponsible to blame foods, beverages or any other single factor for enamel loss and tooth decay (dental caries or cavities),”…”Science tells us that individual susceptibility to both dental cavities and tooth erosion varies depending on a person’s dental hygiene behavior, lifestyle, total diet and genetic make-up.
Sure, that’s all technically true but it misses the point. Consistent acid and sugar in your diet leads to cavities. That is a proven fact. A huge number of people get that exposure directly from sugary beverages that they bathe their teeth in all day long.
The first question I ask a patient who comes in with a large number of cavities is if they drink sodas, sports drinks, energy drinks, or juices on any consistent basis. 90% of them tell me yes.
I see every single day, the massive damage done by the sugar and soda industries. They have expertly marketed and infiltrated their products into just about everything. You can barely find a consumer food product that doesn’t contain some level of sugar or high fructose corn syrup. Don’t kid yourself. The rise of sugar in the typical western diet has almost single-handedly caused the massive rise in cancer, diabetes, heart disease, and many other chronic diseases. Dental decay would be far less prevalent if we were to practice moderation in our sugar consumption. Honestly, I’d probably be out of a job.
So what can you do about it?
- Read labels on food products. Avoid products with added sugar.
- Cook your own food made with real ingredients.
- Limit sugary items to the specific times when you eat. Don’t just graze or sip all day.
- Don’t keep soda in your house or workplace. It should be a treat, not an everyday (or every minute for some people) thing.
- Teach your kids all these things.
The sugar and soda industries aren’t going to change. Their massive profits make it so they can’t and won’t. You, however, can change and protect your health long term. It is hard but it is worth it.
The Best and Worst Candy For Your Teeth
With Halloween coming up, it’s time for the annual roundup of the best and worst candy options for your teeth!
Even though I’m a dentist, I really like candy too! The key with candy is being smart about it. By that I mean you should choose healthier candy options and eat them in moderation. Cavities form when teeth are exposed to sugar and acids for long periods of time. You can either limit or eliminate the sugar or you can limit the amount of time your teeth are in contact with them. There are some really great sugar free options available nowadays that taste almost exactly the same. There is also nothing wrong with eating candy with sugar occasionally. Eat it all at once, once or twice a day at most and you’ll be fine!
Without further ado, here is everything you need to know!
Cream of the Candy
If you’re going to eat candy, these are your best options. The very best ones can even protect you from cavities.
Xylitol sweetened candies (My #1 recommendation)
Xylitol is a low calorie alternative sweetener that helps protect against cavities. The bacteria in your mouth that feed on sugar can’t metabolize xylitol and it actually keeps them from growing effectively. A study that looked at people who chewed xylitol sweetened gum after every meal showed an amazing reduction in cavities. For optimal effects you want about 5 grams of xylitol consumed slowly over the day. Gums and hard candies are best because they slowly release it.
*Don’t binge on xylitol sweetened candy though because in high doses it can cause some gastrointestinal problems. Any more than 10 or so candies in a single sitting will likely give you diarrhea.*
The absolute best xylitol candy I’ve found is produced by Dr. John’s Candies. I have tried just about every product that they have and I’ve been really impressed. I really couldn’t tell the difference between it and regular sugar candy. Not sure what you’ll like? I really like their variety mix which has a little bit of everything (lollipops, hard candies, caramels, and taffy). The lollipops and hard candy have 2 grams of xylitol per serving while the caramels and taffy have 1 gram each.
For gum and mints I really like the flavor of Epic Dental products. The flavor is great and they’ll save you money on dental care if you use them frequently.
One last warning. Xylitol is highly toxic to dogs. Keep this and chocolate out of their reach.
Sugar free candy and gum
Chewing sugar free gum and candy can actually have a protective effect against cavities. Gum helps clean your teeth as well as stimulate more saliva which is good for preventing cavities. Other sugar free candies also help create more saliva. If you’re getting a sugar free candy that doesn’t have xylitol, you should consider finding one made with stevia. It is the most natural (non-chemical) artificial sweetener currently available.
Also be careful of other sugar free candies that contain sugar alcohols as they can have the same laxative effect as xylitol has. Check out some of the Amazon reviews about these sugar free gummy bears. These gummy bears are made with maltitol (another sugar alcohol) and have occasionally been used as a really bad prank! The reviews are also some of the most creative and memorable reviews you’ll find about anything on Amazon.
Dark chocolate
Dark chocolate is not only amazingly delicious but also has a lot of health benefits! There is some evidence that eating dark chocolate can protect you from heart disease. It does have sugar so don’t go snacking on it all day long but as a once or twice a day treat, it is great! Chocolate also tends to dissolve in your mouth far more quickly than other candies that are sticky. You really don’t want sugar sticking in the grooves of your teeth and staying there all day long. A good dark chocolate should have about 70-80% Cacao. Avoid Hershey’s “Dark Chocolate” because it has far less Cacao and far more sugar and fat.
My personal favorite is Trader Joes 72% Dark Chocolate but there are a lot of other good options out there too.
Munch In Moderation
Eating these candies may not be the greatest thing for you, but in moderation aren’t likely to cause many problems.
Straight sugar candy
In this category you’ve got things like Pixie sticks and Smarties. Yes it is sugar but it doesn’t stick around too long in your mouth.
Regular chocolate
Regular chocolate such as M&M’s or Regular Hershey’s Bars don’t have as many of the health benefits of dark chocolate and usually have more sugar. It does melt in your mouth quickly so it doesn’t stick around too long.
Downright Dangerous
Sour candies
Sour Patch Kids, Sour Gummy Worms, Lemon Drops, Atomic Warheads and anything similar have a lot of sugar as well as significant amounts of acid. The combination of acid and sugar is deadly to your teeth. The enamel of your teeth starts breaking down under a pH of 5.5. If you’re sucking an acidic candies for any length of time, you’re exposing your teeth to a really dangerous environment.
Sticky or gummy candies
Sticky and gummy candy has a tendency to get stuck in the grooves of your teeth and stay there all day long. Brushing will usually get it out but even then some pieces are often still left. Bacteria feed on this sugar, creating acid and breaking down the enamel of your teeth. The super sticky ones also have a tendency to pull out crowns or loose fillings.
Some of the worst offenders? Airheads, Sugar Daddies, Tootsie Rolls, and Laffy Taffy.
People don’t usually realize that dried fruits fall in this category too. They have a ton of sugar and are super sticky. They stick in the grooves of your teeth just the same as other sticky candies.
Hard candies
There is a reason why Jawbreakers are called Jawbreakers. Sure they don’t usually break your jaw but they do tend to break your teeth at an abnormally high rate. Teeth can take a lot of abuse but aren’t really a match for hard candy. Even if you can control yourself and don’t crunch down on them, you still have to suck on these candies for long periods of time, exposing your teeth to sugar for a far longer period than they should be.
Lollipops
Lollipops are meant to be kept in your mouth for long periods of time. This constant exposure to sugar is really bad for your teeth. I still remember one little girl I saw years ago. Her mom called her “The Lollipop Queen”. By the time she came to see me at age 7, she had cavities on just about every tooth in her mouth.
Nerve Damage in Dentistry
One of the rare complications of dental treatment is nerve damage. Clinically this is known as a paresthesia or dysesthesia. If you’re one of the people that this happens to, it can be pretty upsetting and you probably aren’t sure what to even expect long term.
In most cases, the nerve damage isn’t your dentist or oral surgeon’s fault. It is just one of those random complications that occurs sometimes. It’s also important to remember that in the vast majority of cases your sensation will return on it’s own.
There are two nerves that are most commonly damaged, both of which supply the bottom jaw.
Lingual nerve – This nerve supplies sensation to one half of your tongue. Approximately 2/3 of cases of reported nerve damage occur specifically with this nerve.
Inferior alveolar nerve – This nerve supplies the sensation to your teeth, gum tissue, and skin on one side of your bottom jaw. Slightly less than 1/3 of injuries occur with this nerve. A small percentage happen to various other nerves.
Dental Injections
The exact frequency of nerve damage after dental injections has been a difficult thing for researchers to estimate due to how rare it is. I’ve seen estimates range from 1 per 100,000 injections up to 1 per 600,000 injections. No matter what the exact frequency is, it is an extremely rare event. In almost every case it is associated with a mandibular block injection (used for bottom teeth to numb the entire bottom jaw on one side). As a comparison your odds of being struck and killed by lightning are about 1 in 70,000.
It’s thought that the damage to the nerve can be due to either physical damage from the needle or from a reaction to the anesthetic used to numb the nerve.
Here is the good news. About 90% of cases of nerve damage associated with a dental injection will resolve all on their own within a couple of months. Even for those cases that don’t heal entirely, some sensation is usually regained. The healing process with nerves just takes some time. As long as nerves haven’t been damaged entirely, they tend to grow back and heal. Nerve growth rates range from about 1-5 mm per day.
Wisdom Tooth Removal
Removal of lower wisdom teeth has a relatively high incidence of nerve damage associated with it. Depending on the specific study it’s thought to occur in between 1-8% of wisdom tooth extractions. The reason for this is that lower wisdom teeth are in close proximity to the inferior alveolar nerve as well as the lingual nerve. The trauma from the extraction can damage these nerves. In most cases the damage is temporary with about 90% resolving in about 8 weeks. It’s thought that somewhere between 2-4% of cases of nerve damage end up being permanent.
Placement of Dental Implants
Dental implants are placed directly into the bone. If the implant comes into close contact with any branches of the nerves, it can cause damage to it. Most of these cases are preventable with proper planning beforehand. It isn’t unusual for oral surgeons and dentists to take a CT scan of the area beforehand to check for the exact location of the nerves so that they can avoid them.
Other Types of Dental Surgery
Nerve damage can also occur after other significant types of dental surgery including orthognathic surgery (breaking your jaw and resetting it for orthodontic reasons), periodontal flap surgery, and cyst or tumor removal. If you’re undergoing significant dental or oral surgery, discuss with your surgeon the risks prior to starting so that you aren’t surprised afterwards.
Treatment
Current recommendations for patients with nerve damage are primarily to monitor the extent of the loss of sensation and follow up for healing over time. As previously discussed, time heals most of these injuries without any additional treatment. For people who have permanent damage that is painful or difficult to manage, certain medications may be prescribed such as anticonvulsants.
Is Xylitol Safe?
Xylitol is a newly popular sweetener that has been steadily gaining traction as a sugar substitute. Most dentists like to discuss how good xylitol is for your teeth (it’s really good!) when consumed regularly. On the other side of things are people who urge caution with xylitol because they have concerns about it is processed and it’s side effects. So what’s the truth?
What Is Xylitol?
Xylitol is what is known as a sugar alcohol. It is the same family as sorbitol, mannitol, or erythritol. These sugar alcohols are used as alternative sweeteners because they have fewer calories and don’t spike your blood sugar like regular sugar does. Many of these types of sugars are naturally found in fruits or vegetables and are known as polyols.
Why Use Xylitol Rather Than Sugar?
- Fewer calories. An equivalent amount of xylitol contains around 40% less calories than sugar.
- Similar sweetness to sugar. You can use approximately a 1/1 ratio if you’re substituting xylitol for sugar.
- Low glycemic index. Xylitol doesn’t spike your blood sugar like regular sugar does. This is especially important for diabetics. Regular table sugar (sucrose) has a glycemic index of 65, Xylitol is 12, and no calorie sweeteners such as Stevia are 0.
- Protects your teeth from cavities. Several studies have shown that consistent daily exposure to xylitol through the use of gum or mints used after eating are highly effective in preventing cavities.
Common Concerns
GI Disturbances
Your body is only able to partially digest xylitol and this happens more slowly than regular sugar. When the large amounts of undigested xylitol make it into your large intestine, it pulls water into your large intestine leading to diarrhea.
In addition to the diarrhea effect, you may also develop some gas and bloating. Bacteria in your gut can feed on sugar alcohols and create gas as a byproduct.
Many of these effects subside within a month or two in people who consistently eat xylitol.
Toxic to Dogs
Xylitol is definitely dangerous to dogs. Just as you don’t want to feed them chocolate, you also don’t want to feed them anything sweetened with xylitol. In fact, you probably shouldn’t feed them sweet items in general. Dogs who eat xylitol develop dangerously low blood sugar and also have been found to have liver failure.
Where It Comes From
Xylitol can be derived from several different sources. Most woody, fibrous type plants can be used to make it. Common sources used today are corn cobs or hardwood trees such as birch. Corn cobs have gained more popularity due to the fact that they are easily available and grow much more quickly than hardwood trees. Most companies today also try to source their corn cobs so that they are non-GMO. With the amount of processing it goes through, it is highly unlikely that this makes a difference but might be something to think about.
How It Is Processed
This is where it gets a bit tricky. While xylitol can be found naturally in small quantities in many fruits and vegetables, the process to create large quantities is quite industrial (as with much of our food today). The initial molecule harvested is actually known as xylan (a cellulose type material). Xylan is hydrolyzed to xylose which is then converted to xylitol by adding a hydrogen atom (hydrogenation). Various chemical processes using acids and catalysts are used to do this. This doesn’t mean that any of these chemicals are actually incorporated into the xylitol but it does mean that everything but the xylitol molecule has been pretty much stripped out.
I’m of the firm belief that the root of many of our dietary issues today is that we process food down to it’s constituent ingredients and lose many of the trace minerals, vitamins, and minerals that make food actually nutritious. This is the same whether it is table sugar or xylitol.
Artificial Sweeteners and Weight Gain
Some studies have shown that artificial sweeteners tend to cause more weight gain than just eating sguar. The mechanism for this isn’t terribly well understood. One theory is that the high levels of sweetness confuse your body. You get the sweetness but don’t get any calories associated with it. This increases your appetite and your body goes into fat storage mode. It is thought that sugar alcohols such as xylitol won’t cause this effect nearly as much for a couple of reasons. The first is that xylitol is only about as sweet as sugar whereas other artificial sweeteners are hundreds of times sweeter. The second reason is that xylitol does contain some calories, just not as many as regular table sugar. This allows your body some feedback (instead of none) when you are eating something sweet.
Long term health problems
People have been burned before with the newest fads in nutrition. One day something is billed as the best and the next day we find out it can cause health problems we never even thought of. With xylitol, it is generally considered to be safe but we really don’t have any great long term studies. The longest studies we have are with people who consumed it every day for about two years. No health problems were noted other than the GI distress we talked about earlier and even this went away for most people within a month or two.
Conclusions
I think xylitol definitely has it’s place in your diet. Xylitol works best when small amounts are consumed throughout the day. The best way to do this is by chewing gum or using mints after eating. You get great cavity fighting benefits by doing this. You ideally want 5 separate exposures to xylitol throughout the day. Small quantities of candy sweetened with xylitol can also be a good option if you’ve got a sweet tooth throughout the day.
I don’t think most people should use xylitol as a straight up sugar replacement. The GI symptoms can be unpredictable and vary from person to person. If you are concerned about the health effects of too much sugar, you are far better off working to limit how much sugar you are using in general or by using a natural, no calorie sweetener like Stevia. Xylitol or Stevia may be healthier than using regular table sugar but they still don’t have much, if any nutritional value.
Ineffective Whitening Products
There are a lot of different products out there that claim to whiten your teeth with almost no effort whatsoever. Do any of them actually work and if so, how well?
Do Whitening Pens Work? – No
Whitening pens contain a peroxide solution that you apply to your teeth. A lot them claim that they can whiten your teeth or maintain your current level of whiteness if you’ve already whitened. These are a total waste of money. The two important things for whitening are the concentration of the peroxide solution and how much time it is in contact with your teeth. Without something to hold the peroxide solution next to your tooth your saliva will very quickly dilute the solution and wash it away. Just putting something in your mouth that tastes funny will increase your saliva flow. This has the effect of washing it away even faster. Don’t waste your money on whitening pens.
Do Whitening Lights Work? – Not At All
I’ve seen a lot of ads recently for whitening lights that claim to be able to significantly whiten your teeth in just 20 minutes a day. They say to just put it in your mouth, turn the light on, and wait. They claim great results with no chemicals, sensitivity, or discomfort. Sounds too good to be true right? That’s because it is.
Most of the products look exactly like this picture. This is a $2 LED light made in China. I’ve taken them apart to check what exactly is inside. It is literally a battery attached to a small LED light. LED lights don’t have any special properties that can whiten your teeth. All it is is a marketing gimmick. They take your money and hope you don’t ask for it back.
The only thing today that is proven to whiten your teeth are the different peroxide solutions (carbamide peroxide or hydrogen peroxide) applied to your teeth with strips or trays.
Some products will package whitening gels with these lights. Does this increase the effectiveness of the actual whitening products? Again, there is no evidence that a bright LED does anything to increase the effectiveness. Even those dental ZOOM lights you see in offices don’t actually do anything. They’re just another marketing gimmick. The best you can hope for with these lights is for them to dehydrate your tooth from the heat of the light which makes them temporarily look slightly lighter. As soon as your teeth have had a chance to rehydrate from your saliva they’ll go back to look exactly the same.
Do Whitening Toothpastes Work? – Minimally
Whitening toothpastes work by abrasion (think sandpaper). They remove any surface stains on your teeth but can’t penetrate deeply into the tooth to remove any of that stain. This works a little bit if you have surface stain but you generally don’t get very noticeable results.
You also run the risk of causing damage to your enamel over time. It is so abrasive that you can wear away your enamel and especially your root surface if it is exposed. This can lead to abfractions.
Do Whitening Mouthrinses Work? – Nope
Another whitening product with claims of a “whiter smile in 5 days”. Does it work? As usual with these novelty products, no it doesn’t. It has hydrogen peroxide as one of it’s ingredients. The manufacturers of these products seem to believe that just by including it you’ll get some whitening effect. As we’ve discussed before it is all about concentration and time. You don’t get a good concentration in the mouthrinses and you definitely don’t get enough time. Most people can’t rinse for more than about two minutes at a time. Even with high concentration peroxides you need at least 20-30 minutes of tooth contact to get noticeable results.
Whitening Gum Products – Minimal effect
This is another one of those marketing ploys. If you’re going to chew gum you might as well get some whitening out of it too right? Bad news though. You’re not going to see much effect if any from these whitening gums. Sure it might remove some very superficial food off your teeth but overall you’re going to see a very minimal effect if any at all.
Electric Toothbrushes With A Whitening Feature – Minimal
The Sonicare DiamondClean electric toothbrush claims to have a whitening mode that will remove stains and lead to whiter teeth. As with other methods that claim to remove stains on teeth for a whiter smile, you’re going to see a very minimal effect if any at all. If your stains are so heavy that they make your teeth significantly darker you’re going to need a professional polishing at the dentist to get those stains off.
What about all those before and after pictures?
All those before and after pictures are either photoshopped or the person bleached with professional products. The results they show definitely aren’t a result of the products that are being sold.
I pay extra special attention to any ad for whitening that I see online. Just last night I saw an ad where the before pictures had heavily stained teeth and the after pictures had veneers on the teeth! They weren’t even the same shape anymore.
I’ve seen other pictures where the teeth aren’t the same teeth or the whitening results are so obviously photoshoppped that you can see where they modified the picture. Don’t believe everything you see online, especially if the claims seem too good to be true.
So What Does Work?
Professional treatments work great as well as a variety of over the counter whitening trays, disposable products, and white strips. Read our page on the different whitening options to find out what is best for you.
Instruments Used To Clean Your Teeth
Dental hygienists use a variety of instruments to clean your teeth. What they use depends quite a bit on your specific teeth, how much build-up you have, sensitivity, what they prefer, or what you prefer.
Scalers
Scalers are the classic instrument that hygienists have used for as long as they have been around. Scalers are those scary looking instruments with sharp tips. The sharp tips are actually really important and helpful! Hygienists use them to remove all those hard deposits that build up on your teeth and below the gumline. This is the stuff that you can’t remove on your own unless you have your own scalers at home, know exactly where to look, and are really good at cleaning teeth! I’d leave this to your hygienist for the most part. When your hygienist uses a scaler you often feel a “scraping” sensation which can be mildly uncomfortable. This can also make your gums and teeth a bit sore and sensitive depending on how healthy your gums are and how much material has built up on your teeth.
Cavitron
A cavitron or piezo scaler is used when there is a lot of build-up on your teeth. It is an electronic device that has a small that vibrates at an extremely high rate of speed. Most of these devices vibrate at somewhere around 25,000-30,000 movements per second. The side of the tip is placed on your tooth and it disrupts and breaks up the build up much more easily than scaler. It also has the added benefit of disrupting any bacteria that may have built up. Some people don’t like the sensation of a cavitron. It makes a high pitch whining noise, can chatter a bit when it hits your teeth, and also has a tendency to build up a lot of heat so it needs a steady stream of water around it cool it off. For people with sensitive teeth this can be an issue.
Polishing Cups
Your hygienist usually uses the polishing cup at the end of your cleaning appointment to remove any remaining plaque and stain on your teeth. They use an abrasive paste that removes more plaque and stain than your typical toothpaste can do. An electric toothbrush gets as close to approximating this as anything at home can do. Some people don’t like this part because of the gritty feeling of the polishing paste. It kind of tastes and feels like flavored sand.
Air Polisher
Air polishers aren’t used in a whole lot of dental offices but can actually be quite helpful. Air polishers use a combination of water and sodium bicarbonate (baking soda) that is shot out in a pressurized stream of air at the tooth. Because of the high pressure it tends to remove plaque pretty easily. It is especially helpful for people with braces or other hard to clean areas such as implants or bridges. Polishing cups don’t do as well cleaning these types of areas. The biggest downside to air polishers is that they make a huge mess. The water and baking soda comes out as a mist and settles on just about everything (pretty much your entire face).
Do Children’s Medications Cause Cavities?
The last thing you’re thinking about when you need to give your child medication is what effect it will have on their teeth. Understandably so! It’s just not something you’d normally think about. Unfortunately, children’s medications especially those that are taken regularly can cause cause some significant damage to teeth if you don’t take certain precautions.
Liquid Medications
Almost every liquid child medication is sweetened with some type of sugar based sweetener. These medications are sticky and sit on the teeth causing the same types of problems that any sugar can cause. I know a lot of parents give children their medication right before bed, oftentimes after brushing, and forget to do so again. If your child does take their medication right before bed make sure they rinse their mouth out with water and brush their teeth again.
Asthma Medications
Asthma medications have a couple of effects that can cause teeth damage. The first is that many of the albuterol solutions that are used in nebulizers come with in a sugar base. When they breathe the mist in it coats the teeth with sugar just as anything else does.
Asthma medications also cause a dry mouth. Dry mouth is another big risk factor for cavities to develop.
After a child uses their asthma medication make sure they rinse their mouth out with water and brush their teeth. If they are thirsty from the dry mouth effect have them drink water instead of any sugary drink such as juice, gatorade, or soda.
Make sure you tell your child’s dentist if they are routinely taking liquid medications or asthma treatments. More frequent professional applications of fluoride may be helpful to prevent cavities and repair any damage that has already been done. If your child is young they may also want you to start using fluoride toothpaste earlier than normal.
Why Smoking Is Bad For Your Mouth (And The Rest of Your Body)
When most people think about the damage done by smoking they first think of lung cancer and other lung diseases. Did you know that smoking can cause a huge number of other problems too? The mouth, being the first place the smoke hits, is one of the areas most damaged by smoking. Let’s find out what all happens.
Oral Cancer Risk
About 2/3 of all cases of oral cancer are related to tobacco use. Oral cancer most commonly occurs in the floor of your mouth, the side of your tongue, or in your throat but can occur just about anywhere. Oral cancer can easily spread to the rest of your body as a result of its close proximity to major arteries and the lymph node system in your neck. Stopping smoking reduces this risk significantly and it continues to decrease the longer it has been since you quit.
Highly Increased Risk of Periodontal / Gum Disease
The most common side effect of smoking that I see is a severely increased risk of gum disease. People who smoke have more bone loss, increased build-up of tartar around teeth, and gums that don’t heal as well. Long term this can lead to you losing your teeth. The majority of tooth loss isn’t related to cavities but to bone loss from gum disease. I had one long term smoker literally bring me a tooth in a bag that had just fallen out on it’s own. He was 45 years old.
Poor Healing After Mouth Surgery
Smoking reduces the ability of your immune system to fight infection and decreases the ability of your body to heal. If you have a tooth pulled it will take longer to heal and has a higher risk of getting a dry socket. If you have an implant placed, you have a much higher risk of it failing. If you have gum disease and need surgery, your results won’t be as good.
Staining Of Your Teeth and Tongue
I can always tell when someone is a smoker because of the staining on their tongue and teeth. It can turn the surface of your tongue a white, brown, or even black color that won’t come off. Your teeth will usually pick up a dark brown or black staining on any surface that isn’t entirely smooth and even sometimes on surfaces that are. Most often this happens right around the gumline. A good professional cleaning can remove some of this stain but won’t get rid of all of it.
Bad Breath
Bad breath always comes along with smoking. The smoke and chemicals smell bad in and of themselves but it also makes it easier for bacteria to grow in your mouth, leading to that typical bad breath.
Smoking causes problems in just about every other part of your body as well. These include…
Lung Cancer
About 90% of cases of lung cancer are related to smoking. The risk decreases significantly after quitting. People who are around you while you smoke also have increased risk of developing lung diseases as well.
Chronic Obstructive Pulmonary Disease (COPD)
Smoking damages the small air sacs in your lungs. Over time this makes it difficult to get enough oxygen to breathe effectively. It starts as bronchitis and progresses to emphysema. Over time this inability to get enough oxygen can cause severe health problems up to and including death. COPD is a leading cause of death in the United States. 80% of these deaths are directly related to smoking.
Heart Disease
Smoking causes your arteries to thicken, leading to higher blood pressure and a variety of other heart conditions. Heart attack risk goes up significantly. The risk of any type of heart disease is increased 2-4 times when you smoke.
Strokes
Smokers tend to develop blood clots at a higher rate than other people. If a blood clot travels to the heart it can cause a heart attack or if it travels to the brain it can cause a stroke. These risks are about 2-4 times higher than in non-smokers.
Diabetes
Smoking is a big contributor to the development of Type II diabetes. Diabetes has its own set of health problems that goes along with it too.
Any Type Of Cancer
Smoking has been connected to just about every other type of cancer. It’s been estimated that a full third of all cancer deaths could be avoided if nobody smoked.
Problems During and After Pregnancy
Smoking increases the risk for preterm birth, birth defects, and a baby with a low birth-weight. All of these can cause significant health problems after a baby is born and sometimes for the rest of their life.
Rheumatoid Arthritis
Smoking has also been linked to the development of rheumatoid arthritis.
How To Stop Smoking
Compared to other addictions such as opiate dependence or alcoholism, smoking may not seem like such a big deal. It may not seem as critical to stop because it doesn’t cause immediate problems. Almost all of the problems with smoking are found after you’ve been doing it for a long time. Unfortunately, stopping smoking is also one of the most difficult addictions to stop. It ranks right up there with heroin.
Going cold turkey occasionally works but for most people it is not an effective strategy. There is too much discomfort when you stop and almost everyone goes back to it.
A better way to stop is by slowly decreasing your usage over time. That means if you’re smoking 2 packs a day then you should work yourself down to 1 pack then to a half pack and then eventually to none. The day that you stop altogether is still difficult but it is much easier this way than when you go cold turkey.
The last way to stop is with the use of various smoking cessation aids such as gums or patches. This is similar to slowly reducing your usage over time because it gives you a set amount of nicotine each day that slowly decreases with time. The rates of success are much better doing it this way.