Motorized toothbrushes...I don't need one of those

As a dentist, I was under the impression I had the hand skills and knowledge of dental anatomy to think that I was doing just fine with a normal toothbrush. I held this opinion for a long time...until recently. My hygienists recommend them to many of their patients and even use motorized toothbrushes themselves. But for me, nah I'm good. I'm a dentist that practices what he preaches, I brush three times a day more often than twice, floss daily, scrub my tongue, use mouth rinse; my mouth is clean, or so I thought.

I recently decided to take the plunge. I got a motorized toothbrush, in fact I got two. In this installment of the blog, I am going to compare and contrast the two most popular motorized toothbrushes on the market: Sonicare Platinum and Oral B Braun Triumph Professional Care. My goal of this is not to endorse one or the other but to give my personal experience with the two for the general public.

So, day one, I brought home The Oral B brush. Like any brave man, I let my wife use it first. After she finished she said, "Wow! My teeth feel so much cleaner." My reply, "Let me see that..." And away I went. This brush has a digital display or an app for your smart phone. It timed me in each quadrant so I would spend the necessary amount of time in each. When I finished each it would beep letting me know it was time to move on. From the beginning it let me know I was brushing too hard, turning red and motoring down, negative feed back I like it. I see a lot of patients who brush too hard or with too abrasive toothpaste. After I finished the display let me know I did a 4 star job, one for each quadrant, and a smiley face for sticking it out for the two minutes. But my tongue is what really let me know, 'man I am an arrogant know it all.' Motorized toothbrushes work better than my manual ever did.
Other features of the Oral B brush: at least five different toothbrush heads for personal preference/needs, 5 different settings (including one for whitening, sensitive teeth, so on), blue tooth connection to digital display or smart phone app (the app keeps stats for you for fantasy toothbrushing)

Two weeks later I got the Sonicare brush. This brush is very different than any other motorized brush. Instead of an oscillating motion, It moves the bristles perpendicular to the handle, over 30,000 times per minute. I don't think my hand was doing that with my manual toothbrush. This brush also makes the claim to sonically move fluids between teeth and disrupt the plaque. In my professional opinion it doesn't replace flossing to prevent cavities, however I do see it as a better therapy for gum disease. The first thing I had to get acclimated to was just how different it felt. After a few uses, I got used to it but I have talked to those who can not get used to it. This brush also has an internal timer, but does not have the display. It is also set at 30 seconds. It has three settings: clean (for normal), whitening (for surface stain removal), gum care (extending brushing time). I did notice more surface stain removal after about 3 uses on the whitening mode. Another feature on this model is a storage mini cabinet for the brush heads that has a UV light to kill bacteria left on your brush head.

So this has been a brief description of these. Bottom line, either one is going to give you cleaner teeth and better checkups. If you have any questions, I would be glad to entertain them. Please fine my contact info below.

Dr. Derrick Gregory is a general dentist in Lebanon, TN. His practice is focused on using the latest technologies and materials in dentistry. For more information visit his website at Gregory Dental Group or call (615) 444-0322.

What is the black line around my crown?

I get this question a lot from patients. The answer is one of two things: It is either decay that has set in under the crown or the patient is seeing the metal that is underneath the porcelain.

Yes crowns can get decay under them. I am still surprised at the number of my patients that believe once a tooth has been crowned that it is fixed forever. However, this isn't the case. The tooth that is under the crown can still become decayed. It is important to brush thoroughly at the gum line and floss as most cavities under crowns occur between your teeth. I recommend some type of fluoride treatment to my patients that have 5 or more crowns. This will help keep the tooth under the crown from decaying.

What about the metal? I thought this was a porcelain crown? Up until recent years, most crowns placed were of a type that the inner portion was a metal appearing silver with porcelain applied on the outer part of it. These can be noticeable if the gum recedes over time. Today, the trend in dentistry is moving towards crowns that are metal free. This is due to a number of reasons I won't get into here. But what is worth noting is that these crowns are metal free, are stronger, don't wear the opposing teeth as severely, and are superior esthetically. The fit can be just as good or better using modern digital technology.

Notice the light blue line and even the blue gum around one of these front teeth. This is a porcelain crown with metal underneath.

These are four all-ceramic crowns. Much more esthetic and even stronger that the metal-porcelain.

Dr. Derrick Gregory is a general dentist in Lebanon, TN. His practice is focused on using the latest technologies and materials in dentistry. For more information visit his website at Gregory Dental Group or call (615) 444-0322.

How do I know if I have gum disease?

There are two distinct types of gum disease. The first affects only the soft tissue, or pink gums. The other is affects both the soft tissue and the hard tissue, or bone that the tooth sets in. It is impossible to correctly diagnose which one you may have without your dentist examining your gums visually, with x-rays, and measuring your gums around your teeth.

Let's talk about the first one:

Gingivitis

This inflammation of the gums caused by plaque. The gums are tender, red, puffy, and bleed easily. This can starts as early as a few days if an area is neglected. The good news is that removing the plaque will allow resolution in just another few days. 

Here is a patient showing healthy gums on the top, but the gums around the bottom teeth have gingivitis. This is a subtle example but shows how different areas of the mouth can be healthy or diseased.

Periodontal Disease

You've heard the saying "long in the tooth?" Well this is it. Periodontal disease is inflammation of the gums has led to loss of the bone that the tooth sets in. Just like bone can be damaged and people need knee, hip or shoulder surgery; the bone in the mouth can be damaged. It occurs when gingivitis progresses unchecked and is influenced by the patient's genes (family history), systemic diseases (diabetes), or habits (all types of tobacco). 

This patient had already lost their top teeth due to mobility. Gum disease is second only to decay for causing loss of teeth and as many as 60% of Americans have it. Most of which are undiagnosed and not getting proper treatment.

Treatment

The treatment of each of these conditions is different and you should see your dentist to determine what may be right for you.

Dr. Derrick Gregory is a dentist in Lebanon, TN. His practice, Gregory Dental Group, is a patient centered practice that provides care for the whole family offering the best and newest treatments for various types of patients.

Why are there so many toothpastes?

Walk into the store, hang a left (at least at the one I shop) and immediately you'll find the healthcare/hygiene/pharmacy section. There will be one aisle completely dedicated to oral health care with anything from mouthwashes to denture care. In that aisle, the largest section will be of toothpastes with upwards of 20 different brands and types.

Which one is best? Should I get the most expensive or just the cheapest? I find my patients' favorite question to ask is about what toothpaste should they be using. My answer is, "Every person is unique in the type of toothpaste they should be using. Let's see what is going on with your teeth and gums and I'll make a suggestion." When I am assessing a patient I look for a few things:

• Does the patient have a history of a lot of cavities?
• Does the patient have signs of gum disease (periodontitis or gingivitis)
• Is there a combination of both?
• Does the patient have sensitive teeth?
• Are there any root surfaces exposed ("long-in-the-tooth" appearance)?

Here are my recommendations for over-the-counter toothpastes:

Patient has 4 or fewer fillings - This patient has a low risk of developing cavities. I recommend a toothpaste that will protect their gums while at the same time effectively clean their teeth and provide some substantivity, or remain on the teeth for an extended time providing protection for gingivitis and a fresher feeling. That toothpaste would be Colgate Total

Patient has more fillings and some crowns - I would recommend this patient have something with more fluoride in it. This protects more against cavities. A good cavity fighting toothpaste is Crest Pro-Health. This has a particular kind of fluoride in it--stannous fluoride. This is also the OTC toothpaste of choice for someone with root surfaces exposed (prescription toothpaste may also be necessary). NOTE: high amounts or long contact time of stannous fluoride may roughen edges of porcelain crowns and bridges.

Patient has sensitive teeth - This is always a hot topic. Sensitivity toothpastes have many different formulations and one may not be the one for you. I tell patients to start with one. If they do not see an improvement in 2 weeks, change. I also instruct them to leave a small dab at the gumline of the effected teeth before bed. I think the best stuff out now is Colgate's new Pro Sensitive Relief.

Gum Disease - for patients with gum disease, the problem is below the gum level. Unfortunately, toothpaste does little to remedy this. Professional cleanings in conjunction with other therapies are the best way to treat gum disease or periodontitis. I would recommend a toothpaste that freshens breath as the bacteria that cause gum disease can have a malodor. These are good ones.

Dr. Derrick Gregory is a dentist in Lebanon, TN. His practice, Gregory Dental Group, is a patient centered practice that provides care for the whole family offering the best and newest treatments for various types of patients.

Can someone with a crown still develop decay?

The answer to this often asked question is yes!

 Below is an x-ray of a tooth that has been crowned and has now developed decay near the margin....

When it comes to teeth with crowns, the area most susceptible to developing decay is the margin, which is where the crown meets the remaining tooth structure. It is already a weak spot where food and bacteria can collect, so that combined with a diet high in sugar and acid, or inconsistent dental hygiene including flossing daily can result in decay near the margin. Crowns are great treatment options for weak or damaged teeth, but they require the same hygiene techniques as any other tooth. With good daily brushing and flossing crowns can last many years and in some cases you may even forget that the tooth was ever damaged!

One of the biggest motivators of patients to seek dental care is pain. There are many types of dental pain that can be experienced associated with dental, gum and muscular structures related to chewing. I often have patients that come to me with what is perceived as tooth pain but after examination turns out to be not necessarily caused by their teeth. I am going to break down the most common types of pain experienced and how they may be treated starting with, of course, tooth pain.

1. Dental pain - dental pain is most commonly caused by two things:

• infection - This is most commonly described to me by patients as an abscess. Oftentimes patients may think they have this condition, but, in fact, do not. Pain that is short-lived (under 30 seconds) caused by hot, cold, or sweets can usually be fixed by removing the decay (infection) present and placing a restoration (filling). Pain that lasts longer than 30 seconds or is spontaneous may indicate that the pulp (nerve) of the tooth has been encroached upon. This type of dental pain requires endodontic (root canal) therapy. An abscess is usually caused by untreated decay, "cavities." Abscesses can range from no swelling to massive swelling. Abscesses mostly only cause pain when biting due to the pressure build up at the bottom of the root. Abscessed teeth are not usually sensitive to hot and cold because the nerve of the tooth itself is long since dead and the pain is actually being felt by the bone socket the tooth is sitting in.
• sinus infections may cause upper back teeth to hurt as a constant ache or pain when biting

• fracture - Tooth pain can also be caused if there is a fracture present. This dental pain is experienced when biting. The tooth will flex when a biting force is placed upon it, thus opening the fracture slightly allowing the nerve to be exposed. Dental fractures can also cause a tooth pain to hot and cold that is quick to go away. Fractures are often seen on back teeth or teeth with large fillings in them, especially amalgam or metal fillings.

           If fractures haven't progressed into the nerve or pulp chamber, these teeth can be fixed with a crown              which holds the tooth together and prevents the flexing upon biting. If the fracture has reached the                  nerve, these teeth are not fixable long term and require extraction.

   2. Gum pain

• Gum pain can often present as tooth pain. There are acute gum infections that are painful, however they have a distinct appearance. Sometimes gums can look fine on the surface yet patients experience an acute dental type pain that isn't caused by a tooth. These gums can be very inflamed and bleed easily. This is often seen in patients that haven't had their dental cleanings and check-ups in an extended time or patients that have had something lodged between their teeth such as a popcorn husk. This type of pain usually has symptoms of hot and cold dental pain or pain upon biting.

   3. Jaw Joint and Jaw Muscle Pain

• • There have been books written on this subject, so I won’t go into too much detail. Most jaw pain is from muscle aches from overuse. The test for this is to massage over the muscles at the corner of the jaw, the temples, and above the ears. If these are painful, then it is a muscle issue. Treatment for this is having the patient relax when he or she notices he or she is clenching or grinding and wearing an occlusal or bite guard at night time. Jaw joint issues generally have a history of trauma, clicking, jaw getting locked open, arthritis, among several other issues. It is more common in women to have joint issues. Oral appliances are the most widely used therapies for joint issues.

   

What are dental sealants? Do my kids need them?

Sealants are a great way to protect against tooth decay and cavities on your back teeth (molars). These are the teeth that are most vulnerable to cavities and decay because they are used in the chewing process, and are the most difficult to reach and clean. Molars first come in at around 5-7 years of age, with a second set coming in between the ages of 11-14. It is best to have a sealant placed when the molars first come in to ensure they are protected early. To place a sealant an adhesive is first applied to the teeth. The sealant is then placed over the adhesive as a liquid, as if it is painted right onto the tooth. The liquid then hardens and creates a barrier between your tooth and any plaque, food particles, and bacteria. Sealants last for about 10 years and can be reapplied if necessary.