Bustin' up Some Dental Myths

Don't you just love hearing the phrase "because that's how it's done"??  Yeah, I don't either.  There are so many things in dentistry that are sacrosanct - things that may well have been true at one time, looong ago.  Yet the times, they are a-changin', and these theories need an update, or even need the boot!  I've been busy creating a list and oh boy, is it long.   Dentistry needs a makeover.  It's time to join the 21st century, and change the way some things are done.

Teeth Brushing Myth
Brushing with a manual toothbrush does as good as job as brushing with an electric brush.

The better option if you stick with a manual brush

Busted:  Most folks brush with too much tooth paste (more on toothpaste in a moment) and only brush until they foam up.  Then, they spit and rinse.  Research says that takes approximately 30- 45 seconds.  In my experience, it takes about 10 to 15 minutes to really get all the plaque off with a manual brush.
To illustrate this, while giving a lecture to high school students, I gave disclosing solution to groups of volunteers.  This solution stains plaque hot pink!  I then had them brush until that hot pink plaque was gone.  Took about 15 minutes.  The latest Cochrane report meta-analysis of current research says electric brushes do a better job of removing plaque.  Remember, plaque is super sticky- and becomes more and more difficult to remove as it grows and hardens.  Most people actually brush for two minutes with their electric brushes.  My vote is to buy the very best electric brush you can afford.  We know the modern toothbrush is about 400 years old.  It's time to upgrade folks, it just works better!   (You have a fancy cell phone??  You've probably updated that withing the last two years.  Time to upgrade to a smart toothbrush too!)

The less effective manual option

If you must use a manual brush, use one with multi-levels of bristles, preferably angled. Angled brushes remove 61% more plaque than flat brushes.

I do recommend dry brushing when using  a manual brush- no toothpaste.  This is the best way to tell if you are properly cleaning your teeth.  Toothpaste numbs the tongue, but when dry brushing you can run your tongue over your teeth and feel the clean!  Keep brushing until your teeth feel as silky smooth as they are after your favorite hygienist ;)  is done polishing your teeth.  Yes, you can make your teeth feel that good.  THEN use a dab, and only a dab, of toothpaste, spit, and don't rinse.  Done!


Toothpaste Myth
You have to use commercial toothpaste.
Busted:  Nope, another myth down the drain.  You actually don't even need toothpaste.  We have been led to believe we need toothpaste to help scrub off that sticky, icky plaque but it really is not true.  It's really all in your brushing technique (see above!).  Toothpaste is mostly a yummy cosmetic- it makes your mouth taste better, so maybe you'll brush a little longer.  There are lots of questionable ingredients in toothpaste which deserves an entire blog post at another time.  Meanwhile, click here for more info from a fellow RDH.  She spells it out well.

Too Much Toothpaste! 

Please just use a pea size amount rather than that ribbon of paste the commercials on TV suggest.  Babies get a smear, and children- a dab'll do ya!

There are tooth pastes that are more medicinal.  For more information read my post Creating a Healthy Toothpaste for more information on toothpaste.




"Floss is Floss" Myth
All floss is created equal.
Busted: No, many satiny/Teflon-coated kinds of flosses just glide over the plaque, leaving it on your teeth.  (Maybe that's why your hygienist accuses you of not flossing?)  Floss, in my opinion, needs to be fluffy and absorbent.  It should grip the tooth and disrupt that sticky, tenacious plaque biofilm stuck on your teeth.  Slippery floss has its place- when there's food stuck between your teeth (steak and corn on the cob come to mind), nothing works better than that kind of floss.  But for real, honest to gosh tooth cleaning, woven floss used correctly is, in my opinion, the best floss.
Floss on a stick- it's great for removing food debris, not so great removing plaque.  Sorry :)
Ask your wonderful dental hygienist to help you learn proper flossing technique.  It's really important to do more than remove food debris.  Be the boss with floss!

"Flossing Doesn't Work" Myth 
Floss does not prevent gum disease or tooth decay.
Busted: I know there was a big report out summer of 2016 that flossing was not all it was touted to be and do.  Really, do we need a study?  I promise you, as a professional with 37 years of experience, I can tell right away who's a real flosser, who's a "floss on a stick/food picker-outer type flosser," and who "does not know how to floss properly flosser."  Big difference.  The results show up in bleeding gums, decay between teeth, and from the video screen full of bacteria on my chairside phase contrast microscope.  The bacteria don't lie!  The more plaque is left alone, the more organized and destructive it gets.  It's really all about getting the plaque off.  Check out my post: It's all about the Plaque! (No Tartar)  and then watch the bacteria on this post: It's a Small, Small, Extra Small World, to see what bacteria really look like.  Then, go ahead, stop flossing, if you dare.  (My microscope will tell on you.)  Personally, I floss like my life depends on it, because, quite frankly, it does!

"Fluoride is a Cure-All" Myth
Everyone needs Fluoride.
Busted:  This is a controversial subject that warrants its own blog post.  I will only address topical fluoride today.  At this point, I still recommend fluoride for those that have active tooth decay or are at moderate or high risk of getting a new cavity. (Moderate  risk is defined as one or more new cavities within the last three years.)  In my opinion, every patient should get a dental decay risk assessment, as well as a tooth decay bacterial screening test.  According to the American Dental Association (ADA), if as an adult, you have a low tooth decay risk level, you will not benefit from additional fluoride treatments in the dental office.  Yes, that from the ADA.  Before you spend that extra $45.00 or more (because most insurance companies won't cover adult fluoride treatments) ask about your tooth decay risk level.  Then you can spend your money wisely.  My preference?  Find out what your risk level is, then correct the problems causing your tooth decay and prevent it from going further, don't just mask the symptom.  Before they slap some fluoride on your teeth, ask WHY you need it and what benefit you'll get.  I'd vote for a toothpaste called Enamelon instead of the twice yearly fluoride treatment. Way better use of your money!
 For dental professionals: assess why you treat the way you treat.  What is truly best for the person sitting in your chair?   I've worked in an office that pushed fluoride on every patient, and I just said no, showing them the ADA recommendations.  A better use of the patient's time and money is looking at tooth decay risk level, and treat accordingly.

That being said, there are times I recommend fluoride varnish- it closes the tooth tubules and reduces tooth sensitivity.  That's a great reason for using fluoride.

open tooth tubules

Closed tooth tubules after Fl varnish

"Yearly X-rays for All" Myth
Time for your yearly bite-wing x-rays.
Busted:  Do you really need those x-rays every year?  Dental x-rays, or as I like to call them, diagnostic images, should not be taken routinely.  According to the ADA, if you are a healthy adult with low decay risk levels and without gum disease, no, you need them only once every 18 to 36 months.   Dentists are suppose to practice something the ADA calls  ALARA- as low as reasonably achievable.  Dentists need to assess risk and treat according to each individual.  There's that risk level assessment again!  Save your money, reduce exposure to ionizing radiation, and stay healthy.  I hate to say, but since insurance covers it, some dental offices do yearly x-rays to increase production, not because you really need it.  And, even more important, dental diagnostic images don't always show the true extent of the tooth decay.

This is why we take diagnostic images!

There certainly are times when taking images is definitely necessary, and are an important part of my daily treatment of patients.  I use them to assess bone levels, screen for decay between teeth, look for tartar on teeth and pathology in the bone.  (As an RDH, while not allowed to "diagnose,"  I can certainly see when things are not healthy on the images I take.)

"Dental Silver Amalgam Fillings are Safe" Myth 
Getting a new silver filling is fine.
Busted: This topic also warrants its own blog post.  The ADA stands by their product. Sometimes I agree with the ADA and sometimes I don't... Amalgam (the trade name for a silver filling) has been used for 150 years.  It is cheap to use and quick to place.  However, new research is showing there are health risks associated with exposure to amalgam placed in teeth, as well as the mercury vapors that result when drilling out old fillings.  We know for a fact that mercury is a poison - New research says it effects the brain, heart, kidney, lungs and immune system, and that it can cause damage even at low levels.
Please consider saying no to any silver fillings and really consider removing those you do have safely.  Do your research and make wise choices.
             Alzheimer's
             Antibiotic resistance
             Neurodevelopmental disorders in infants
             Metal allergies

Large, Old, Failing Silver Amalgam  Fillings

"Sometimes Gums Just Bleed" Myth
Bleeding gums are normal
Busted:  This one makes me roll my eyes to rival a teenager.  No, gums don't "just" bleed.  There's always a cause.  Most of the time it's because of gum disease.  Other causes: hormonal changes such as pregnancy or menopause, poor diet, stress and cortisol, smoking cigarettes, tobacco and cannabis, medications, dry mouth, mouth breathing, Vitamin K deficiency , Vitamin C deficiency, Vitamin D deficiency, other health issues such as leukemia, dengue fever, lichen planus, hemostatic (bleeding) disorders, blood vessel disorders, liver disease, rosacea and the more every day ones: improper toothbrushing, poor oral hygiene, crooked teeth, and aggressive flossing.  Find the cause and fix the problem.  As I mentioned before in this blog, I found an early case of leukemia because both the patent and I wanted to heal her bleeding gum problem.  Lucky for her, she took my suggestion to see her MD and found what was the real cause of her bleeding.  She caught it very early and was able to say she's a cancer survivor!  Her doc was impressed that her dental hygienist sent her in to be checked out.  I never thought she had cancer but I did think maybe vitamin deficiency.  It makes my heart so happy to hear she is alive and well.

Mouth Breathing = Inflamed Gums

"Sealants are Good Prevention" Myth
Dental sealants are good.
Busted (sorta):  Properly done dental sealants are great and will last years, preventing tooth decay in the vulnerable grooves of molar teeth.  
The problem arises when corners are cut, and/or treatment is given by those who are not properly trained.  Dental sealants are placed in the pits and grooves of teeth that are newly erupted and theoretically don't have tooth decay.  Proper preparation of the tooth is vital for quality sealants.  The tooth MUST be cleaned by air polishing to get all the plaque and debris out of the nooks and grooves.  Then, the tooth must have the laser cavity detector run over all the grooves.  If there's even a hint of decay it is time to rethink the sealant.  Too often, decay is sealed in under the material because these steps are skipped.  It was originally thought the sealant sealed out the oxygen, vital to tooth decay development.  Unfortunately, time has proven this theory wrong. Decay bacteria can adapt to an oxygen-free environment and thrive under sealants (there's nothing to disrupt them!).  Also, sealants that are not properly "sealed" can start leaking, and decay gets in under the sealant material.  As many as 50% of sealants fail within the first five years.  It's important to select the teeth that need sealants, test them for decay, then- and this is a point where most dental offices will look at you blankly- I recommend spraying the teeth with ozone gas to kill any decay pathogens lurking on or in the tooth.  Continue preparing the teeth, including great isolation- saliva contaminates the sealant, guaranteeing failure, and placing glass ionomer filling material into the grooves.  No overfilling the grooves.  Do it right the first time.  (Please do read the article on ozone and dentistry!)

"Receding Gums are From Brushing Too Hard" Myth
Exposed roots are from scrubbing with a toothbrush
Busted: You're not using that steel bristle brush on your teeth again, are you?  Nope, didn't think so. And you're no longer scrubbing back and forth like you did when you were six years old?  Good, then consider that these other issues may be the culprits:
  Most likely:
 #1. Gum disease and inflammation
 #2. Clenching and grinding
 #3. Orthodontics/bite issues
 #4. Poorly fitting dental appliances or other continuous trauma
 #5. Bone defects missing from birth- resulting in thin bone covering the roots
 #6. Abrasive toothpaste
  #7. Smoking or chew tobacco
  #8. Oral jewelry - see #4
Does all gum recession need to be repaired?  No, as long as it does not hurt or bother you in any way. Ideally I like gums to be snug up to the necks of the teeth but 58% of adults have some level of recession.  As long as the gums are clean, healthy, not sensitive, and no longer receding we can just keep a watchful eye on them.  They are more susceptible to root decay because they are not as strong a surface as tooth enamel.  Working with your dental health provider to keep your teeth healthy and decay-free is a must.

Some people take pictures of great looking food, I take pictures of old, broken teeth.

These sacrosanct ideas need to be put to pasture.  There are so many better ways to treat and prevent dental problems.  These are only my first ten, stay tuned for the next batch!  I have at least 15 more I think worth discussing. (Oh, is that a lot?) If you have any you want to add, please email me.

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It feels good to be back at my computer, writing and researching for you.  Between the holidays, a vacation, and then a trip to Chicago for the Orofacial Myofunctional Congress, I've been away from this computer and blog too long.  I do have lots of things to write about so stay tuned!  I appreciate all the positive feed back I receive form you, my great readers.  This blog has now crested over 101.000 page views.  I'm honored and humbled you take the time to read.  Thank you from the bottom of my heart!
(I'd still rather take great pictures of colorful, delicious food on beautiful plates but, alas, that's not my specialty.)

Please keep smiling!  Spring will get here.
Thanks again for reading,
Barbara