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.

What is soft tissue management?

Soft tissue management or nonsurgical periodontal therapy is based upon the current concepts of the dental plaque and the nature of periodontal disease progression. It is the initial step in the management of adult periodontal patients. STM can be done by the general dentist and/or the hygienist. When done properly with the appropriate use of the ultrasonic, antibiotics, irrigation (in the office and the home) and regular recalls to the dentist, it can produce marked improvement in the periodontal health of the patients and can be a very rewarding experience for the dentist and the hygienist, and above all the patient

Scaling and root planing is one of the most effective, non-surgical ways to treat gum disease before it becomes severe. Scaling and root planing cleans between the gums and the teeth down to the roots.

Scaling is basically the process of removing dental tartar from the surfaces of the teeth. Root planing is the process of smoothing out the root surfaces and removing any infected tooth structure. If you have gum disease or gum pocketing, the gum pockets around the teeth will have deepened, thereby allowing tartar deposits to form under the gum line.

A careful cleaning of the root surfaces to remove plaque and calculus (tartar) from deep periodontal pockets and smoothing the tooth root to remove bacterial toxins will help ensure that your gum disease is controlled.

Dental Hygiene

Here at Gregory Dental Group our mission is to help you protect your oral health through comprehensive dental hygiene services.  Besides keeping all our patients informed on the significance of diligent brushing and flossing and a healthy diet, we offer complete dental exam services and periodontal care procedures to keep your mouth free of cavities, decay, infection and periodontal disease. We also offer a full selection of restoration services to correct issues that may be interfering with your ability to perform good dental hygiene.If it’s been a while since your last dental exam and you’re in need of a checkup on the effectiveness of your dental hygiene practices, please arrange an appointment with us today.