Friday, January 25, 2013

10 Toothbrushing Mistakes

Toothbrushing is such an ingrained habit, few people think twice about it. But as with any habit, you can get sloppy, and that can lead to cavities and gum disease.

Toothbrushing Mistake No. 1: Not Using the Right Toothbrush

Consider the size of your mouth when picking a toothbrush, says Richard H. Price, DMD, the consumer advisor for the American Dental Association. "If you are straining to open wide enough to let the brush in, the brush is probably too big," he says.
''The handle has to be comfortable," he says. It should feel as comfortable as holding a fork when you eat.
"The more comfortable it is in your mouth and your hand, then the more likely you will use it and use it properly," he says.
Which is the better toothbrush: Electric or manual?
"It's an individual preference," says Michael Sesemann, DDS, president of the American Academy of Cosmetic Dentistry and an Omaha dentist.  "A person who brushes well with a manual will do as well as a person who brushes well with an electric."

Price agrees. "It's not the toothbrush, it's the brusher."

Toothbrushing Mistake No. 2: Not Picking the Right Bristles

Some toothbrushes have angled bristles, others straight. So is one type better? Dentists say no.
''It's more related to technique than the way the bristles come out," says Sesemann.
What is important when buying a toothbrush? Bristles that are too stiff can aggravate the gums. The ADA recommends a soft-bristled brush.
''Bristles should be sturdy enough to remove plaque but not hard enough to damage [the teeth] when used properly," says Price. He doesn't recommend "natural" bristles such as those made from animal hair or boar bristle.

Toothbrushing Mistake No. 3: Not Brushing Often Enough or Long Enough

Softly brushing your teeth at least twice a day is recommended. ''Three times a day is best," says Sesemann.
With too much time between brushings, he says, bacterial plaque will build up, boosting the risk of gum inflammation and other problems.
Brushing should last at least two minutes, says Sesemann. Three minutes is even better, says Price.
Most people fall short of both time lines, says Sesemann. "It's an arbitrary number, but it's just so people take the time to clean all the surfaces." He often recommends people divide the mouth into quadrants and spend 30 seconds a quadrant. Some electric toothbrushes include built-in timers.  
To make the two minutes go faster, Sesemann says he ''multitasks,'' fitting in a little TV viewing as he brushes.

Toothbrushing Mistake No. 4: Brushing Too Often or Too Hard

While brushing your teeth three times a day is ideal, more may not be, says Sesemann. "More than four toothbrushings a day would begin to seem compulsive."
Excessive brushing could expose the root of the tooth to irritation, and that could in turn irritate the gums. Brushing vigorously can also erode tooth enamel. The trick is to brush very gently for two to three minutes.

Toothbrushing Mistake No. 5: Not Brushing Correctly

''Long horizontal strokes along the gumline can lead to abrasions," says Sesemann. "Aim your bristles at the gum line at a 45-degree angle and do short strokes or vibrations." Softly brush up and down your teeth, not across your teeth. The strokes should be vertical or circular, not horizontal.
Be sure to brush outer and inner tooth surfaces, the chewing surfaces, and your tongue.

Toothbrushing Mistake No. 6: Starting in the Same Place Each Time

Many people start brushing the same part of their mouth over and over, dentists find.
"Start in a different place so that you don't get lazy in the same area of your mouth," says Price. He reasons that by the time you get to the last quadrant of your mouth, you're bored with brushing.

Toothbrushing Mistake No. 7: Skipping Inner Tooth Surfaces

Most people forget to brush the inner surfaces of teeth -- the surface that your tongue presses against.
"The plaque you can't see is just as important to remove as the plaque you can see," says Price.  
The most commonly skipped area, dentists say, is the inner surface of the lower front teeth.

Toothbrushing Mistake No. 8: Not Following Up With a Rinse

Bacteria can grow on an un-rinsed toothbrush. Then, the next time you brush your teeth, you may actually put old bacteria back in your mouth, says Laurence Rifkin, DDS, a dentist in Beverly Hills, Calif.
Rinsing the toothbrush after you brush will help remove any leftover toothpaste, too.

Toothbrushing Mistake No. 9: Not Letting the Toothbrush Dry

"If you have a toothbrush that's perpetually moist, it will cultivate more bacteria," says Sesemann.
"If the bristles stay soggy, you can misshape them as you use the brush," Price says. "Or it might be a breeding ground for bacteria."
It's a good idea to shake out the moisture, then recap it with a cap that allows air in, he says.

Toothbrushing Mistake No. 10: Not Changing the Toothbrush Often Enough

The American Dental Association recommends getting a new brush every three or four months, or even sooner if the bristles look frayed.
But rather than go by a strict timeline, Price says a visual inspection of the bristles is better. "Once the bristles lose their normal flexibility and start to break apart, change your toothbrush," he says.
"Look more at the state of the bristles than the time period," he says.
Some brushes have colored indicators that alert you when they need replacing, says Price.

Robert G. Dernick, DDS
1001 Medical Plaza Drive Suite 300
The Woodlands, TX 77380

Friday, January 18, 2013

The Daily Grind: What Wears Down Your Teeth

Teeth are built tough. With regular care they can last a lifetime. Still, the daily grind of chewing, brushing, and grinding, along with accidental injuries, can take a toll. Here are three of the biggest threats, and what you can do to avoid them.

Chipped, Fractured, or Broken Teeth

Teeth can sometimes chip or fracture when you bite down on something hard, such as a popcorn kernel or stale bread. “But that kind of injury is actually quite uncommon,” says Steven E. Schonfeld, DDS, PhD, a dentist in private practice and spokesman for the American Dental Association.  
Teeth that have fillings or root canals are at highest risk, because they aren't as strong as intact teeth. “But even intact teeth can chip or fracture if you happen to bite down in just the wrong way on something hard,” Schonfeld says.
More often, teeth are damaged as a result of accidents or sports injuries. When researchers surveyed athletes competing in the Pan American World Games recently, they found that almost half showed signs of tooth fractures believed to have occurred over time during training or competing. In that study, sports most commonly associated with tooth injuries included wrestling, boxing, basketball, and karate. But even non-contact sports such as in-line skating or skiing can result in damage to teeth.
What you can do: If you have fillings in your back molars, it's wise to avoid biting down on hard foods such as bones, hard candies, and ice. Wear a mouth guard if you play sports that pose a risk of injury, and get them for your kids that play sports, too. A 2002 survey of college basketball players found that mouth guard wearers significantly reduced their risk of dental injuries. Simple mouth guards are available at most sporting goods stores. Your dentist can also make a custom-fitted mouth guard.
A dentist can repair chipped teeth. Fractures are harder to fix, especially if the crack extends below your gum line. If you have a badly fractured tooth, your dentist may remove it.

Bruxism: Grinding Your Teeth

Teeth are built to chew and grind food. But unconscious grinding or clenching of teeth, over time, can damage the chewing surfaces. “Chronic tooth grinding, called bruxism, can cause micro-cracks in the enamel, making teeth more susceptible to decay, and even wear down the pointed surfaces of molars,” says Anthony M. Iacopino, DMD, PhD, dean of the University of Manitoba Faculty of Dentistry.
Tooth grinding can also cause headaches, muscle pain, and jaw injury. In many cases, people with bruxism don't realize they have a problem until a dentist notices tell-tale signs on their tooth surfaces. That's one more good reason to get checkup every six months, Iacopino says.
Researchers suspect that stress or anger may lead to tooth grinding. A 2010 study found that people with sleep bruxism were more likely than people who don't grind their teeth to report trouble at work, daily problems, and physical problems.
What you can do:  Stress management techniques may help. “I tell my patients who have signs of tooth grinding to find ways to relax,” Declan Devereux, DDS, says. “Take a walk. Learn to meditate. Avoid stressful or frustrating situations if possible.” For some patients, that may be enough to ease tooth grinding. If not, dentists may prescribe a mouth guard or splint, which fits over the upper or lower teeth, protecting them from becoming damaged.

Acid and Tooth Enamel Erosion

As tough as teeth are, they become vulnerable when acid levels in the mouth are too high. Acid erodes enamel, making teeth more susceptible to decay. Acidic foods and drinks, and acid-producing bacteria in the mouth are prime culprits. Enamel erosion may also be due to other conditions such as bulimia, chronic gastritis related to alcoholism, or frequent vomiting related to pregnancy. Researchers have recently recognized another threat: gastroesophageal reflux disease (GERD).
GERD causes the highly acidic contents of the stomach to back up into the esophagus, sometimes even into the mouth, where it can erode teeth. Anyone who suffers GERD is at risk. In a study of 117 patients with GERD, 28 had dental erosion. Another study of 20 patients found evidence in about half of the patients.
What you can do:  Ask your doctor for support and referrals to treat bulimia or alcoholism. If you’re pregnant and vomiting a lot, it might be a good time for you to get a dental checkup (one is recommended during pregnancy).
If your dentist notices signs of enamel erosion and suspects that the problem may be GERD, she is likely to recommend you see your doctor. The only way to prevent further damage is to control your GERD. In addition to taking a prescription acid-blocker medicine, make some changes to what and when you eat to reduce the frequency of reflux. Start by avoiding foods that make GERD worse: chocolate, peppermint, fatty foods, coffee, and alcoholic beverages. Eating smaller meals helps prevent GERD. Also, don’t eat for at least two hours before bed so your stomach has time to partially empty before you lie down.

Robert G. Dernick, DDS
1001 Medical Plaza Drive Suite 300
The Woodlands, TX 77380

Thursday, January 10, 2013

Flossing Teeth -- No More Excuses

Do you floss? Or, like many people, do you always seem to find a reason not to?
A 2008 survey found that only 49% of Americans floss daily, and 10% never floss. That’s most unfortunate, dentists say, because flossing is even more important than brushing when it comes to preventing periodontal (gum) disease and tooth loss
"If you were stuck on a desert island and a boat could bring only one thing, you’d want it to bring floss,” says Samuel B. Low, DDS, professor of periodontology at the University of Florida College of Dentistry in Gainesville, and president of the American Academy of Periodontology. “But I’m convinced that the only time some of my patients floss is an hour before showing up in my office.”
Dentists say they hear all sorts of excuses for not flossing. Yet they insist that simple workarounds exist for just about all:
Excuse #1: Food doesn’t get caught between my teeth, so I don’t need to floss.
Flossing isn’t so much about removing food debris as it is about removing dental plaque, the complex bacterial ecosystem that forms on tooth surfaces between cleanings. Plaque is what causes tooth decay, inflamed gums (gingivitis), periodontal disease, and eventually tooth loss. Flossing or using an interdental cleaner is the only effective way to remove plaque between teeth.
Excuse #2: I don’t know how to floss.
Flossing isn’t easy.  Low calls it “the most difficult personal grooming activity there is.” But practice makes perfect.
Here’s how the American Dental Association describes the process:
  • Start with about 18 inches of floss. Wrap most of it around the middle finger of one hand, the rest around the other middle finger.
  • Grasp the floss tightly between your thumbs and forefingers, and use a gentle shoeshine motion to guide it between teeth.
  • When the floss reaches the gum line, form a C shape to follow the contours of the tooth.
  • Hold the floss firmly against the tooth, and move the floss gently up and down.
  • Repeat with the other tooth, and then repeat the entire process with the rest of your teeth, “unspooling” fresh sections of floss as you go along.
Don’t forget to floss the backs of your last molars. “By far, most gum disease and most decay occurs in the back teeth,” Low says.
Excuse #3: I’m not coordinated enough to floss.
Many tooth-cleaning options exist for people whose manual dexterity is compromised by poor coordination, hand pain, paralysis, and amputations -- or simply by fingers that are too big to fit inside the mouth.
One option is to use floss holders. These disposable plastic Y-shaped devices (some equipped with a spool of floss) hold a span of floss between two prongs to allow one-handed use.
Another option is to forgo floss and clean between teeth using disposable toothpick-like dental stimulators (Stim-U-Dents, Soft-Picks, and so on); narrow spiral brushes (interproximal brushes); or the conical rubber nubs (tip stimulators) found at the end of many toothbrushes or mounted on their own handles. 
Excuse #4: I don’t have time to floss.
Effective flossing does take a while -- once a day for a “good three to five minutes” according to Low. But even 60 seconds of flossing is of enormous benefit. As with exercise, bathing, and other daily activities, the key is to make flossing a habit.
“If you make time for your personal hygiene, you can find time to make for flossing,” says Maria Lopez Howell, DDS, a dentist in private practice in San Antonio.
She recommends keeping floss in plain view, alongside your toothbrush and toothpaste. If you’re too tired to floss before bed, floss in the morning or afternoon. Or keep floss on hand and use it when you find the time.
Mark S. Wolff, DDS, PhD, chairman of the department of cardiology and preventive medicine at New York University School of Dentistry in New York City, keeps a stash of dental stimulators in his car. “I use them when I am stuck in traffic,” he says.
Excuse #5: It hurts when I floss.
If flossing causes gum pain or bleeding, odds are you have gingivitis or gum disease -- precisely the conditions for which flossing is beneficial.
“Flossing should not be a painful experience,” Wolff says. “But stopping flossing because of bleeding [or pain] is just the opposite of what you should be doing.” The good news? With daily brushing, flossing, and rinsing, gum pain and bleeding should stop within a week or two. If either persists, see a dentist.
Excuse #6: My teeth are spaced too close together to floss.  
If unwaxed floss doesn’t work for your teeth, you might try waxed floss or floss made of super-slippery polytetrafluoroethylene.
If the spacing between your teeth varies (or if you have significant gum recession), yarn-like “superfloss” may be a good bet. It stretches thin for narrow spaces and fluffs out to clean between teeth that are more widely spaced.
If you’re having trouble finding a workable floss or interdental cleaner on your own, your dentist should be able to offer guidance -- and may even offer free samples.
Excuse #7: The floss keeps shredding.
In many cases, broken or fraying floss is caused by a cavity or a problem with dental work -- often a broken or poorly fabricated filling or crown. Consult your dentist.
Excuse #8: I have dental work that makes flossing impossible.
Try floss threaders. These monofilament loops make it easy to position floss around dental work.

Robert G. Dernick, DDS
1001 Medical Plaza Drive Suite 300
The Woodlands, TX 77380

Tuesday, January 8, 2013

What is Gingivitis?

What Is It?

People with gingivitis have inflamed gum tissue around their teeth, caused by bacteria found in dental plaque. Normal, healthy gums should be firmly attached to the teeth and underlying bone. They are pale pink in light-skinned people and brown, gray or mottled in people with darker complexions. If you have gingivitis, your gums are inflamed, red and swollen. They will bleed easily and may be tender. Mild gingivitis causes little pain and may be overlooked. If left unchecked, however, it can become severe. In some people, gingivitis progresses to periodontitis, which can lead to tooth loss.
Gingivitis is caused by plaque, a sticky film of bacteria that collects on your teeth, especially in crevices and spaces or around rough or broken fillings. The bacteria produce substances that can harm the gums. If plaque is not removed, it hardens into a deposit called calculus, commonly called tartar. Calculus irritates the gums and provides more surfaces for bacterial growth. 
Gum disease in general and gingivitis in particular are common. Almost three in four adults over the age of 35 have some form of gum disease. People with poorly controlled diabetes and pregnant women are especially at risk. People taking oral contraceptives or systemic steroids are at increased risk of gingivitis. Certain prescription drugs — including anti-seizure medications, cyclosporin (Neoral, Sandimmune) and calcium channel blockers — can cause gum overgrowth and inflammation.


You will notice red, swollen, gums that bleed easily.


Your dentist will examine and probe your gums and ask you if they bleed when you brush or floss your teeth. He or she will look for calculus deposits on your teeth and under the gum line.
Make sure your dentist knows the medications you are taking, in case some of them may be contributing to your gingivitis.

Expected Duration

Gingivitis can disappear within several days once a program of good oral hygiene is started. If oral hygiene remains poor, gingivitis likely will remain and could worsen to become periodontitis, which can lead to significant loss of tissue and bone around teeth.


Brush your teeth regularly, preferably in the morning and before bed, and floss your teeth at least once a day. Make sure that you use a soft toothbrush and that the bristles reach the gum line when you brush. Have your teeth professionally cleaned every six months to one year to prevent plaque from becoming calculus and to remove any calculus that may have already formed.


Gingivitis can be reversed if you remove bacteria from your teeth every day. At your dental office, you will receive a thorough cleaning, which will include scaling (removal of plaque at and just below the gum line). Your dentist or dental hygienist can instruct you on the most effective methods of brushing and flossing. Controlling medical conditions, such as diabetes, can make gingivitis easier to treat.
If gingivitis advances to periodontitis, additional treatment is necessary.

Robert G. Dernick, DDS
1001 Medical Plaza Drive Suite 300
The Woodlands, TX 77380

Friday, January 4, 2013

Electric Toothbrushes -- Are They For You?

Elizabeth Turkenkopf has been using an electric toothbrush for more than seven years, and has been impressed with the results -- cleaner teeth and minimal plaque build-up, which translates into less scraping at her regular dental check-ups.
She hasn’t had a cavity since she made the switch from a hand-powered toothbrush, and her gums are in good shape. Although she can’t say for sure her pristine oral health is the result of her electric toothbrush, she’s not messing with success.
It’s your technique -- not the toothbrush -- that makes the difference. It’s really a matter of preference. And, of course, no matter what brush you use, you still need to floss properly, use a mouth rinse each day, and see your dentist every 6 months. 
“Power toothbrushes have come a long way,” says Terrence Griffin, DMD, an associate professor and chair of the department of periodontology at Tufts University School of Dental Medicine in Boston.
Your personality, your teeth, or your affinity with technologies may make one type more appealing to you.

Power Toothbrushes: Electric and Sonic

Electric toothbrushes were first introduced in the U.S. in 1960 by a company called Squibb, and marketed under the name Broxodent. Today, there are dozens of different brands available, with a myriad of features, including re-chargeable batteries, compact designs, and bristles built for optimal cleaning.
The two main types of power toothbrushes are electric and sonic -- the difference between the two really comes down to numbers.
Electric Toothbrushes: With 3,000 to 7,500 rotating motions a minute, electric toothbrushes are powered to replicate the motion of your hand -- doing the muscle work for you. The bristles on these toothbrushes either rotate or move back and forth to help remove plaque and reduce gingivitis.
Sonic Toothbrushes: Offering 30,000 to 40,000 strokes per minute, sonic toothbrushes rotate in a back and forth vibrating motion. The rapid motion is the sonic toothbrushes' claim to fame. But ultimately, it also aims to remove plaque and keep teeth and gums healthy and clean.
For a little bit of perspective, the old-fashioned way of brushing your teeth rings in about 300 strokes per minute -- if you brush properly. So over the two-minute recommended brushing time, your teeth are hit with 600 strokes … a far cry form the thousands you might get with the high-tech variety.

Benefits of Power Toothbrushes

Several studies have shown that sonic and electric toothbrushes are better at reducing plaque and gingivitis, in the short and long-term. For example, a 2003 Cochrane Oral Health Group study concluded that, compared to hand-powered toothbrushing, electric toothbrushes with rotational-oscillation action result in less plaque and fewer bouts of gingivitis. But the study also found that when used properly, manual and powered brushes can be equally effective.
“Electric or sonic toothbrushes may be easier for people with dexterity problems, like arthritis, to handle and control, resulting in cleaner teeth and gums,” says Gary D. Hack, DDS, an associate professor at the University of Maryland Dental School in Baltimore.
Sonic and electric toothbrushes may motivate people to brush regularly by eliminating the “work” of handheld brushing.
The one drawback to power toothbrushing may be cost, Hack says. Most models range from about $15 to more than $100; old-fashioned toothbrushes cost just a few dollars.

Practice Proper Toothbrushing

No matter your toothbrush preference, good technique makes the difference in your oral health.
“You need to brush a minimum of twice a day, for about two minutes each time, every morning and at night before you go to bed to avoid food sitting on your teeth and gums for long periods of time,” says Griffin.
Quality is as important as quantity when it comes to brushing. Hack offers these tips for good toothbrushing technique:
  • Angle the brush at about a 45 degree angle up onto the tooth and into gum line.
  • Use a soft-bristled brush, and use a gentle brushing motion.
  • Don’t over scrub or use too much pressure.
  • Make sure you brush every tooth and cranny.
“The most important thing is to brush effectively,” Hack says. “This will help you avoid periodontal disease, minimize gum and bone loss, and keep your mouth healthy and clean.”

If you live in The Woodlands, TX area and are currently looking for a dentist, please do not hesitate to contact us for an appointment today. 

Robert G. Dernick, DDS
1001 Medical Plaza Drive Suite 300
The Woodlands, TX 77380