Busting More Dental Myths Part II

"It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so." - Mark Twain

April 1st is April Fools Day, rather fitting to be working on a post about dental procedures and protocols that may well be incorrect- a myth.  This is Part II of dental traditions that may benefit from a second look.

"You NEED your teeth cleaned twice a year" Myth
Busted!
There must be scientific reasons to see your dental hygienist every six months... right?  Nope!  It all started with a commercial jiggle from Amos 'n' Andy - selling Pepsodent Tooth Powder.  The commercial talked about brushing your teeth twice a day and seeing your dentist every six months.   No science, just all Madison Avenue.

So, what do you really need?  It depends.
If you have gum disease (and 50% of the US population has some form of gum disease) or tooth decay (91% of folks have active tooth decay!) you really need a much more frequent recare schedule. Sometimes I wish I could see folks once a week or at least every two months.  Plus, these folks need more than "just a cleaning."  (More on this in a moment.)
Then there are folks that have a healthy mouth- no bleeding gums, no decay, no concerning activity on my chairside microscope.  They need a yearly exam, oral cancer screening, and quick appointment.

IMHO, each and every person should have a customized, individualized treatment protocol. (So, more than "just" a cleaning)  My goal is to have you be healthy between appointments. no bleeding gums, no tooth decay, no bacteria related to tooth decay or gum disease.  It can be done - you just need a dental hygiene health coach that'll look more closely at your oral situation and find better tools for you so YOU can get the job done at home.  Getting your teeth cleaned twice a year only means your teeth are super clean for two days a year.  If there's bleeding, no doubt about it, your mouth is NOT healthy.  Customize and individualize treatment rather than doing only what insurance dictates and will pay for.  You can do it!

"Teeth need to be scaled before they can be polished" Myth
This might be specific to dental professionals, but...
Busting that one up too.
Tradition is hard to overcome.  For about thirty years I scaled- scraped and cleaned teeth, then dutifully polished them up.  That's the way it's done in school.  Then, I decided to try something new, I polished first.  Now I don't have to move plaque around to find the tartar, and I feel I'm doing a better job because of it.  Plaque's the soft stuff on teeth, also called biofilm, and tartar's the calcified, petrified plaque, also called calculus.  No research says it's better to do it one way or the other.  I like that it cleans the debris so I can see the teeth, and the remaining tartar.  It sure makes it easier to do a periodontal charting of the numbers around each tooth.  And, it's easier to get the tartar off too.

Tartar and Gum Disease

Do you even need a polishing?  Well, sorta.  The polisher breaks up the plaque biofilm and leaves the teeth surfaces cleaner. Polisher pastes vary so you can request one less gritty.  I use one that starts out gritty and then the particles quickly break down to a fine grain and are thus less damaging to the tooth surface.  Can you do this with a toothbrush?  Absolutely!  Ideally, your teeth should feel like I've just polished them every day.  You can achieve this slickery feeling best with an electric brush (a must) and wet baking soda.  Brush until they feel clean and smooth.   "Slickery" is my new favorite word to describe how slick, smooth and slippery your teeth should feel.  If they don't feel good, get in and have a professional get them clean so that you're then able to maintain them.  Your favorite hygienist will need to remove that tartar though-  that's on there like cement.

Editor's Note:  I have a scaling-related anecdote that's a bit off topic, but I thought I'd share.
Barbara cleans my teeth, so I'm probably a bit spoiled as a patient- she's my mom!  There's nobody I could feel more comfortable with.  Still, I hated when she had to scale my teeth.  It's like nails on a chalkboard to me- just ew.  I finally got it in my head that if I dutifully brushed and flossed daily, to that point of "slickeriness" there would be minimal scraping/armrest gripping.  That was my "a-ha" moment.
It's possible!


"Insurance should cover all your dental needs" Myth
Busted again
Dental "insurance" is actually not really insurance.  It's a benefit, sort of a prepayment for future dental care.  It started in the 1950's and 1960's with a maximum $1,000 benefit.  That'd be enough money to take care of all your dental needs.  Cleanings and fillings cost $5.00 then.  Today, most maximums are still $1,000!  Sixty years later and it sure did not keep up with inflation.  Yet too many people rely on it for "all" their dental needs.  They don't go to the dentist because they don't have insurance.  People!  Please!  Do not wait to have treatment just because you don't have insurance.  It really is all about priorities and values.  If you wait, that tooth may abscess.  It will cost way, way more to have a root canal, crown, and then, eventually, an implant than it is to have a filling.  Dental neglect is what's expensive, really expensive.  Prevention is not!

Unfortunately, dental insurance doesn't pay for Oral Health Coaching and an individualized plan (or, as it's termed- Oral Hygiene Instructions) but that's the best way to keep your mouth healthy and not spend thousands of dollars long term.  Put down that smart phone, buy a smart toothbrush and be smart about oral wellness.


"But it doesn't hurt, so why bother" Myth
Bust

This tooth never hurt but it's just a matter of time. 

Following right up behind the insurance myth, this one's a biggie.  Gum disease and tooth decay DO NOT HURT until your nerve is infected.  Your teeth go into a self preservation mode, making what's called tertiary dentin to shield your tooth's nerve.  It's your body's way of trying to protect you from the coming pain.  It can't last forever though.  It's a gamble- a roll of the dice- to wait, because eventually it will hurt.  At that point it's a crisis.  If you are told you have tooth decay or gum disease, treat it and work with your dental team to figure out why it occurred.  THEN!  fix the "why" so you never have that problem again.  It absolutely will save you more time and more money than the insurance company will give you towards a root canal, crown, and eventual implant.


"Let's 'watch' the tooth" Myth
Sorta busted

Cracks & Broken Down Silver Fillings

Teeth don't always need treatment right away.  There are things worth watching, like cracks in teeth and early decay (as long as there's no sensitivity or discomfort in the tooth).  However, when I see these things I like to send patients home with a prevention plan including home care instructions and tools to help reverse the problem.  Cracks and sensitive teeth-  let's remineralize them and protect the teeth from further cracks!  Is the cracking coming from clenching or sleep apnea?  Is it an airway issue?  Is it a habit or caused by a habit?  Small areas of tooth decay along the gumline need a higher pH and more remineralizing.
We can reverse tooth decay if we catch it early and DO something to address it!  Watching and not doing anything else will just kick the can down the road and ensure a bigger filling or problem later.  Stop watching decay get bigger!  We need to know WHY there are cracks and decay, and then treat that WHY.
One thing not to ever watch though (IMHO), is broken down, old, decayed silver mercury fillings.  These need to be restored now, now, now.  They have decay lurking underneath 'em.



"Deep Cleanings Cure Gum Disease" Myth
Again, sorta busted 
Deep cleanings certainly help start healing the infection caused by gum disease pathogens and your body's immune host response to the bacteria.  However, it only starts the process because the pathogens are still prowling around in the gum tissues and in the tooth tubules.  Scaling doesn't get rid of all the bacteria on the teeth either.  It really is up to you and your oral health coach (that's me!) to put together a plan with the right tools, diet, and medicament to change the plaque biofilm to a healthy environment.  Then keep it that way.  If you don't change your home healthcare habits, you are wasting your money.  If you are not monitoring your bacteria with tools like Oral DNA testing, and the phase contrast microscope or the BANA test, how do you even know if your gums are healthy?!  You or even your dental health professionals can't always just look at your gums and know the gums are healthy.  You have to test, just like your medical doc's do.  When the bacterial level's down, there are products such as probiotics for repopulating your mouth with good bacteria, as well as baking soda products that  raise the pH so your mouth stays healthy.  Read more about other procedures and protocols to help you have a healthy mouth.   Bottom line: deep cleaning's a good start but that's not the whole enchilada!


"Brushing and Flossing are Enough to Prevent Gum Disease and Tooth Decay" Myth
Busted too!

Following a theme here! Just because you brush, floss and use that fancy toothpaste, doesn't always protect your teeth and gums from infection.  It's important to look beyond plaque removal.  In addition to getting all the plaque off, it's even better to look at risk assessment for future decay and gum infection.  Finding the cause involves monitoring bacteria, as well as looking at current habits like sipping those daily lattes or energy drinks, snacking on carbs, or family history of gum disease.  This is vital information in creating the very best, most well rounded oral health program for you.

"Fillings Cure Tooth Decay" Myth
Busted - you betcha! 
The best predictor of future decay is current decay.
 If you have a current cavity, there's a 63 to 88% chance you'll have a new cavity within 12 months.  Now, the bigger issue- even if you get that tooth repaired and the decay drilled out, the decay bacteria are still skulking around.  They're in your mouth, on other teeth, or in the tonsillar crypts.  You kiss your significant other?  They probably have it too, and you pass it back and forth.
The drill does not address the environmental causes of decay.  Low oral pH, carbohydrates that you eat or drink, and dry mouth or mouth breathing all play a role in your risk of getting future cavities.



"Mouthwash Cures Bad Breath" Myth
Wish this weren't busted. 

Morning Breath

Sadly,  mouthwash does not cure bad breath.  I've written an entire post dedicated to cures for bad breath titled, Addressing Kissability.  Mouthwash just makes your bad breath smell like minty bad breath, and it only does so for about, oh, ten minutes...  Then it's back to regular old stinky bad breath.  Find and treat the cause.  Mouthwash just blankets the symptoms and doesn't really even do that very well.



"Baby Teeth aren't Really Important" Myth
Busted again.

Cutie! Have teeth will eat! 

Baby teeth are just as important as permanent teeth.  Yes, Baby'll lose them eventually, but some not until she's 12 or 13 years old.  Baby teeth serve many important, and even vital functions.  Teeth are needed to break down food to start the digestive process.  They are place holders in the jaw for the permanent teeth.  No teeth = no space in the bone for those bigger teeth.  Would you like to have decayed, painful, broken down, or missing teeth for years?  Absolutely not!  Tooth decay can transit from a baby tooth to the developing permanent tooth under the gums, as well as from tooth to tooth.  Beyond being terribly unhealthy, missing or decayed teeth are not appealing or pleasant to look at, and children know it.  Then there's speech - without teeth, Baby and then Child will lisp and not speak clearly.
Teeth are an important part of Baby and Child's self esteem and overall health.  Information on Baby's mouth, teeth development and oral care deserves its own entire post - stay tuned for that!

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Ten more dental myths busted.
When I was thinking about what to write for a post, I started this list, thinking it'd be one post's worth.  Here it is, 20 myths already and Part III is in the works with another seven or eight.  So many things we think of as gospel and truths are, in actuality, fabricated and falsehoods.  When someone tries to tell you that's "the way it is," do your homework.  Know the facts!  You are your best advocate.  Treat the cause, not just the symptoms.  And, of course, prevention is the best medicine!  Ask your dental hygienist to be your personal oral wellness coach and develop a plan to be healthy.  This'll be a personal wellness plan you'll actually stick with every day!


Be well my friends.
Until next time,
Keep smiling,
Barbara