We have entered a new phase of the COVID-19 pandemic. A phase that is not only critical but that also offers great hope. It encompasses the monumental task of vaccinating hundreds of millions of Americans with the newly available COVID-19 vaccines. And, to do it as rapidly and safely as possible in order to get this crisis under control. To accomplish this enormous task, we must produce enough vaccine to cover the population. Equally important, we need to ensure the vaccine is readily available to everyone who wants it. This article explores the role that dentists can (and should) play in COVID-19 vaccine distribution and administration.

States are just now finalizing plans for vaccine distribution. The Centers for Disease Control and Prevention’s Advisory Committee on Immunizations recommends that dental professionals be included in the first group of health care personnel to receive the vaccine.[1].  This same group of health care professionals stands ready to serve as an essential part of vaccine distribution plans. However, this important resource is at risk of being overlooked.

The role of dentists in vaccine administration

Dentists administering vaccines during public health emergencies is not a groundbreaking idea. It’s common sense. In fact, it’s been done in the past.

Dentists in states like Massachusetts and New York were deputized as vaccinators during the H1N1 swine flu pandemic in 2009-10 [2]. Other states like Illinois [3] and Minnesota [4] currently allow dentists to administer flu vaccines. Oregon [5] goes even further, by allowing dentists to prescribe and administer vaccinations including the annual flu shot, the human papillomavirus vaccine, and more.

Dentists and dental hygienists have foundational training and capabilities to administer these vaccines. They already routinely give injections in the mouth, a procedure that is much more precise than injecting a person’s arm.

Additionally, dental offices typically have the equipment, storage, and medical office space that can easily be adjusted to house and administer vaccines in a condensed time frame. This is especially true for dentists and dental practices in public health settings like Federally Qualified Health Centers (FCHQs).

Dentists have access to a wide range of patients

Dentists provide something else critical to distributing this vaccine as comprehensively and equitably as possible.

ADD_THIS_TEXT That is access to a wide range of patients. On a yearly basis, more than 18 million people visit the dentist even though they haven’t visited a primary care physician or another medical professional.

Many dental professionals, especially those operating in community health settings like Federally Qualified Health Centers, are well-positioned to serve as a trusted public health access point to traditionally underserved populations.

These FQHCs operate more than 12,000 locations across the nation and are intentionally located to be accessible to communities of color, which have been among the most impacted by COVID-19.

Similarly, dentists can be crucial in rural communities, another area severely impacted by the pandemic. And, where the number of health care professionals is often more limited compared to densely populated urban areas.

Some states – even those beyond rural America – are facing difficulties in finding enough health care workers to administer vaccines. MaineHealth, Maine’s largest health care system, for instance, is facing a significant challenge [6] in identifying a sufficient number of doctors and nurses to vaccinate Maine residents. As a result, MaineHealth has been recruiting retired doctors and nurses for vaccination for weeks.

Dentists possess a crucial factor in the vaccination process: Trust

Beyond the necessary expertise and access to a greater number of patients, dentists possess what may be viewed as the most critical factor in the vaccination process: Trust.

Related Content: Fear of COVID-19 Keeps Patients From Seeking Medical Care

Dentists often have a lifetime relationship with their patients, seeing their patients from their childhood years throughout their adulthood. Visiting the same health professional, staff, and office over many years establishes a level of comfort and trust which is important when receiving a vaccine.

According to a recent American Dental Association survey [7], when asked if they would get any vaccine from a dentist, 60 percent of people said yes. More specifically, 59 percent said they WOULD get the COVID-19 vaccine from a dentist.

The movement to empower dentists to administer the COVID-19 vaccine

Thankfully, there has been some positive movement to empower dentists to administer the COVID-19 vaccines when they become more widely available.

In October, the federal Centers for Medicare and Medicaid Services recommended that states expand their list of vaccine providers. [7] Oregon’s law permitting dentists to administer vaccines more broadly was passed in 2019.

Dentists in that state are currently undergoing specialized training. So far, more than 200 dentists and dental students have completed the training courses. Sixty others expected to finish by the end of this month. Once they pass an exam, they can register with the Oregon Health Authority and begin getting their staff trained to handle vaccines and procuring a fridge to store them.

The Executive Director of the Oregon Dental Association says dentists in Oregon could be administering the COVID-19 vaccine as soon as February or March 2021.[8] States like Arkansas and Massachusetts have already moved to allow dentists to administer COVID-19 vaccines.

More than half of states are considering using dentists to vaccinate

More than half of states are similarly considering allowing dentists to administer the vaccine. [9] That consideration shouldn’t take long. Allowing dentists to perform a service that they are able and qualified to perform could increase the number of health care professionals administering the vaccine by the tens of thousands. This would expedite getting shots into arms. This is exactly what public health experts say will save lives and ultimately bring the pandemic to an end.

In California, the state’s dental association has been lobbying lawmakers to pass a law that allows dentists to administer the vaccine. The association estimates that vaccinating every resident in the state would require 200,000 shots a day for one year. [10]

Adding dentists to the list of those who can administer the COVID-19 vaccine could mean adding 36,000 immunizers to the workforce. This could significantly speed up the vaccination process in places where COVID-19 cases have remained particularly high throughout the pandemic.

Some states have failed to include dental professionals in the distribution plans that list those authorized to administer the COVID-19 vaccine. Whether by oversight or intentional exclusions, we urge states to reconsider this.

We must recognize that to beat this virus we need all hands on deck. Excluding these qualified providers may result in prolonging the crisis we are in.

The bottom line

For too long, oral health has been treated as an afterthought to overall health care. But the fact is that oral health is overall health.

Poor oral health has a direct link to higher risks of chronic illnesses and mental health diseases.  Further, there is even evidence that preventive oral health care mitigates some of the greatest risks associated with the treatment of COVID-19. [11] It’s why dentists took extraordinary steps to ensure that they could return to offering safe, preventive oral health treatment during this pandemic.[12]

Now, they are poised to play another essential role — distributing the vaccine to those who need it.

Let’s just hope public health leaders will let them.

References:

  1. Garvin J. ADA urges CDC to include dentists in COVID-19 vaccine plan, 2020 Nov. 20, ADA News. https://www.nbcsandiego.com/news/local/your-vaccine-appointment-could-be-set-at-dentist-or-eye-doctors-office/2472635/. Accessed 12/22/20
  2. Association of state and territorial health officials. ASTHO Legal Preparedness Series. Scope of Practice Toolkit, 2012 https://www.astho.org/uploadedFiles/Programs/Preparedness/Public_Health_Emergency_Law/Scope_of_Practice_Toolkit/03-SOP%20H1N1%20State%20SOP%20FS%203-12%20Final.pdf Accessed 12/22/20
  3. University of Illinois College of Dentistry CE Course: Influenza Vaccination 12/1/2017. https://dentistry.uic.edu/calendar/ce-course-influenza-vaccine. Accessed 12/22/20
  4. Minnesota Department of Human Services, Provider Manual,  Immunizations, and Vaccinations, revised: April 6, 2020  https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_136660 Accessed 12/22/20
  5. OHSU News, Get the flu shot, your teeth cleaned in one visit: F. White, 5/7/2019 https://news.ohsu.edu/2019/05/07/get-the-flu-shot-your-teeth-cleaned-in-one-visit Accessed 12/22/20
  6. Bangor Daily News, Maine dentists offer help to administer COVID-19 vaccines, E. Pendharkar, 12/16/2020 https://bangordailynews.com/2020/12/16/news/maine-dentists-offer-help-to-administer-covid-19-vaccines/ Accessed 12/22/20
  7. NBC San Diego News, Your Vaccine Appointment Could Be Set at Dentist Or Eye Doctor’s Office, 12/16/2020 https://www.nbcsandiego.com/news/local/your-vaccine-appointment-could-be-set-at-dentist-or-eye-doctors-office/2472635/ Accessed 12/22/20
  8. CMS, Coverage and Reimbursement of COVID-19 Vaccines, Vaccine Administration, and Cost Sharing under Medicaid, the Children’s Health Insurance Program, and Basic Health Program Toolkit, Updated 12/17/20  https://www.medicaid.gov/state-resource-center/downloads/covid-19-vaccine-toolkit.pdf  Accessed 12/22/20
  9. ABC News KATU 2, Portland, Oregon, Dentists will be able administer COVID-19 vaccine in Oregon, w. Ogle, 12/17/2020 https://katu.com/news/local/dentists-will-be-able-administer-covid-19-vaccine-in-orego  Accessed 12/22/20
  10. Brian Z. Dentists’ Role in Vaccination: An Opportunity for Public Health Impact. NC Oral Health Collaborative, 2020 Aug 25. https://oralhealthnc.org/dentists-role-in-vaccination-an-opportunity-for-public-health-impact/  Accessed 12/22/20
  11. NBC San Diego News, Your Vaccine Appointment Could Be Set at Dentist Or Eye Doctor’s Office, 12/16/2020    https://www.nbcsandiego.com/news/local/your-vaccine-appointment-could-be-set-at-dentist-or-eye-doctors-office/2472635/ Accessed 12/22/20 
  12. DentaQuest Partnership for Oral Health Advancement, Best Practices Issued to Ensure Re-opening for Dentists and Patients, 6/22/2020 https://www.dentaquestpartnership.org/about/news/best-practices-issued-ensure-safe-re-opening-dentists-and-patients?utm_source=pr&utm_medium=blog&utm_campaign=covid&utm_content=vaccinedistroAccessed 12/22/20

Pregnancy is one of the most wondrous phases of a woman’s life. The plans and dreams for the baby are endless. The focus of the mom-to-be, rightfully, is concentrated on the needs and care of the growing fetus. So, it is not surprising that no matter how meticulous a woman has been about her oral health before, she may take a step back as soon as she becomes pregnant. 

Meanwhile, morning sickness and gastric reflux, cravings for various appetizing foods, and improper cleaning habits, collectively act to impair your oral health. It is essential, therefore, that women keep an eye on their dental care to avoid any complications during pregnancy and the post-natal period.

Oral health complications of pregnancy

Morning sickness

Morning sickness is related to increased hormone levels and resultant metabolic changes in the body. Despite the fact that morning sickness is not harmful to the baby or the mother’s body, it has a direct impact on dental health.

According to Americanpregnancy.org, more than 50% of women experience morning sickness, usually during the first trimester. It is characterized by nausea and vomiting that can occur at any time of the day but is most common in the morning.

The repeated influx of stomach acid into the oral cavity can lead to a softening of tooth enamel. Persistent exposure may cause tooth decay and sensitivity. Brushing shouldn’t be done immediately after vomiting as the risk of erosion of the softened enamel is high. 

Gestational gingivitis

Gingivitis is a condition where the gums become swollen, red, tender, and inflamed. This happens due to plaque and bacteria building up in the oral cavity. Poor oral hygiene and inadequate cleanings are responsible for gingivitis. Also, pregnancy brings a rush of hormones, including progesterone which elevates the immune response to plaque and bacteria.

Gingivitis is the most common dental ailment of pregnancy with 75% of women falling prey to it. Deep cleaning is recommended even in the second and third trimesters.

If the situation goes untreated, it can lead to periodontitis. This is an advanced periodontal condition where the gums recede from the teeth and create pockets where even more bacteria can build up and lead to outright infection. This condition may require antibiotics and even a surgical procedure.

Pregnant women should do everything possible to maintain good dental health. That means following a good oral regime, brushing, and flossing. Regular dental visits and cleaning, good oral hygiene, avoiding sugar, acids, etc. from the very start of pregnancy can possibly help prevent gingivitis.

Related Content:  Love the Gums You’re With: Preventing Gum Disease

Pregnancy tumors

Severe gingivitis with pyogenic granuloma visible. Wikimedia. This file is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

Pregnancy tumors are soft, smooth, red, berry-like growths that appear on the gums during pregnancy. Other names for pregnancy tumors are pyogenic granuloma, granuloma of pregnancy, and lobular capillary hemangioma.

These lesions affect about 10% of pregnancies and usually appear in the setting of preexisting pregnancy gingivitis. Although they can appear at any time, they are most common in the second trimester. 

Despite the name, pregnancy tumors are not cancerous. Rather, they develop as a result of a strong immune response to local inflammation from plaque and food particles. Interestingly, the intensity of the response correlates with the intensity of irritation in the gums rather than the amount of plaque.

Surgically removing these granulomas is not necessary unless they cause complications, such as pain, bleeding, difficulty eating or speaking. They usually disappear on their own after pregnancy. Lesions may be removed by surgical excision or laser. They recur in roughly half of the cases.

Loose teeth

Pregnancy Myth:  Losing a tooth for each birth is a myth.

In pregnancy the high levels of progesterone and estrogen act on the tissues and bones of the oral cavity. In addition, when gingivitis advances to periodontitis, gums may recede and bone may be lost from the jaw. Infection in the structures around the teeth combined with the loss of bone can result in loose teeth. Good care of gums through deep cleaning, scaling, root planing, and proper oral habits help keep this in control.

 

ADD_THIS_TEXT
 

Oral care during pregnancy

Mother’s oral health impacts the baby

The overall health of a newborn depends on the mother’s overall health. Like a diabetic mother takes a lot of care to make sure her fetus is not adversely impacted by the disease, she should also prioritize proper oral care.

Poor oral hygiene leads to invasion of the mouth by bacteria. If we neglect it, plaque accumulates as tartar in the teeth. This starts with bad breath, swollen and red gums. Proper care at this stage could effectively stop it.

Failure to do so may lead to the worst enemy of pregnancy – periodontitis. This inflammatory condition has serious and direct effects on the fetus.

The immune response to the spreading infection and bacterial flora produces cytokines, prostaglandins, and other substances which act directly on the fetus. This can trigger preterm labor. Periodontitis has also been associated with low birth weight and the development of preeclampsia.

Planning for oral health during pregnancy

Planning for pregnancy needs to include plans to maintain good oral health. Your visits to the dentist should be consistent in the time period surrounding pregnancy.

Consider informing your dentist about your plans to conceive. And be sure to let him know about your pregnancy in the earliest stages. It is easier to handle situations that require more intensive treatment in the early stages of pregnancy as opposed to in the late stages.

It is important to know that dental x-rays with appropriate shielding are considered safe during pregnancy. Further, be sure to ask your dentist if any medications that are prescribed are considered safe in pregnancy. Regular cleaning and checkups of your oral habits are a must. 

FDA warning regarding dental amalgam

On September 24, 2020, the FDA issued updated recommendations concerning dental amalgam. Amalgam is a mercury-containing filling material used to restore part of a decayed tooth.

People who may have a greater risk for potential harmful health effects of mercury vapor released from the device include the following:

  • Women who are planning to become pregnant
  • pregnant women
  • those who are nursing
  • young children
  • people with certain medical conditions  

The FDA recommends that people in those higher-risk groups should have their teeth filled with alternatives to dental amalgam, such as composite resins and glass ionomer cement fillings. Further, they caution that dental amalgam-related mercury vapor release may be highest during placement or removal of the filling.

The FDA does not recommend that anyone remove or replace existing amalgam fillings in good condition unless it is considered medically necessary. This is because removing intact amalgam fillings can cause a temporary increase in exposure to mercury vapor and the potential loss of healthy tooth structure. This could potentially result in more risks than benefits.

While the available evidence suggests that dental amalgam use has generally declined over recent years, due to more alternative products being offered and used effectively for dental restorations, high-risk individuals, such as pregnant or nursing women and women planning on becoming pregnant should discuss alternative products for restoring teeth with their dentist.

Related Content:  How Pregnancy Affects Sleep and What You Can do About it

Conclusion

Pregnancy can have adverse effects on the oral cavity. This requires extra vigilance on the part of the pregnant woman. Further, good oral health is important for good gestation and healthy babies.

Do not hesitate to visit a dentist, get a cleaning and or other dental procedures. And, be sure to follow a healthy oral regime to preserve your dental health. 

Hints for healthy oral care during pregnancy:

    • Quit smoking
    • Avoid sugar
    • Avoid acidic foods
    • Sleep well
    • Maintain regular oral care
    • Proper calcium during pregnancy builds healthy bones

These practices will help take you through pregnancy in good health and good health for your baby.


The Medical Reviewer updated this story to include a recent recommendation from the FDA regarding dental amalgam.

During the past few years, many dentists considered teledentistry as just a new arm of the business with some potential. Amidst the coronavirus pandemic and widespread stay-at-home orders, most have realized that it is the present and future of dental practices.

The truth is, teledentistry has more potential than many have realized. It is the most viable way to cater for most dental patients. In fact, it has already become the primary revenue driver for many practices. 

For practices that are yet to integrate teledentistry, now is a great opportunity to do that. Many people, fearful of getting infected with COVID19 are reluctant to seek dental care in the midst of the pandemic.

However, from what we know, the popularity of virtual dental care will continue to grow. Even when the pandemic recedes, teledentistry will remain the most viable approach to dental care due to the many benefits it offers dentists and their patients. Are you considering integrating teledentistry into your practice? If so, read on.

This article will discuss how you can successfully integrate teledentistry into your dental practice right away.

What Is teledentistry?

Teledentistry is an aspect of telemedicine that deals with dental care. It is not a branch of dentistry, but an approach to dental health that is anchored on telemedicine and medical technology. Before integrating the technology, a perfect understanding of what it is all about is important.

According to the ADA

“Teledentistry provides the means for a patient to receive services when the patient is in one physical location, and the dentist or other oral health or general health care practitioner overseeing the delivery of those services is in another location.” 

From the definition above, we can summarize teledentistry as remote dental care. Like other forms of telemedicine, it is delivering health care (dental care in this case) from any convenient location to the comfort of a patient’s home. It does this through supported channels and devices such as

  • desktop
  • laptop
  • iOS and
  • Android devices

Considering that oral disease affects almost half of the world’s population (3.9 billion people), easy access to teledentistry is critical.

How teledentistry differs from general dentistry

Teledentistry, in comparison with general dentistry, helps dentists and dental professionals expand their services beyond geographical limitations. It enables individuals who have limited or no access to dental professionals to get the right dental care with ease and at an affordable cost. 

Related content:  Teledentistry Makes It Possible to Straighten Your Teeth from Home

What’s more, teledentistry can be synchronous (where consults happen in real-time) or asynchronous (which involves storing and forwarding patients’ clinical information safely and securely).

Regardless of where the dentist or healthcare provider is delivering the service from (terrestrial office or a remote location like home), there must be compliance with HIPAA regulations. 

Teledentistry uses 

Teledentistry dentistry is applicable in many ways. The most significant uses are in the following areas: 

  • Triaging emergency cases 

With teledentistry, it is a lot easier to sort through cases to determine how best to handle each one. This is especially important for busy dentists with a lot to handle at a time.

Through teledentistry, intraoral photos can be collected online to screen urgent needs and schedule office emergency appointments accordingly. The severity of disorders can also be assessed through video consults.

It is also easier for dentists to offer care instructions that can help patients until their scheduled office visits. In times of health crises like the COVID-19 pandemic, patients can be asked to complete questionnaires to determine their health status and suitability for admission to your clinic.

  • Pre-operative evaluation and treatment planning 

With teledentistry, it is faster, safer, and more cost-effective to conduct pre-operative evaluations and treatment planning. In the past, such appointments required patients to visit the clinic physically.

With teledentistry, such appointments can be handled through virtual assessment or collection of intraoral pictures online. Diagnosis and prescriptions can also be offered through the different approved channels of communication. 

  • Multi-provider collaboration 

Prior to the advent of teledentistry, the collaboration of dentists and other healthcare providers from different hospitals and clinics used to be a big deal. Today, teledentistry has made clinical collaborations a lot easier and more efficient.

Videoconferencing and screen sharing makes it easier for every member of a care team to collaborate effectively to deliver the best possible care. The process of referral is a lot easier with telemedicine too. 

  • Post-operative appointments 

Follow-up appointments are super-important in healthcare delivery. However, there is no denying the fact that it puts a lot of pressure on clinics and healthcare providers. With telemedicine, the pressure can be significantly minimized. 

Also, teledentistry will help you conduct post-operative appointments remotely. This will save you time, save your staff the stress, and save your patients the cost and discomfort associated with coming down to your office.

Follow-up appointments and post-op consultation can be performed virtually from your office or another convenient location while the patient is at the comfort of their homes.  

  • Remote patient monitoring 

In a recent study, it was revealed that the Southeast United States has the lowest supply of dentists with only about 40-50 dentists per 100,000 residents. For places like these, continued patient monitoring can best be done virtually. 

In fact, with teledentistry, it is much easier and cost-effective to monitor your patients until they are fully recovered. The scenario can be as simple as patients taking pictures and sharing with their dentist or other oral health practitioners asynchronously. Or, live video visits can be conducted. This way, the dentists can serve more patients within their area.

  • Mobile health 

According to a comprehensive survey, about 14.1% of Americans don’t plan to see a dentist because they don’t have the time. Through teledentistry, dentists are able to help present and potential patients understand oral health better. Continued patient education is important for all aspects of health. 

Dentists can take advantage of cloud videos or personal messages to keep in touch with their patients and guide them towards excellent oral hygiene. Even if you have a busy schedule, teledentistry can guide you on how to improve your oral health virtually, from the comfort of your home.

Setting up the teledentistry process 

Setting up the teledentistry process is quite different from marketing your dental practice online. Just as you need to plan and set up your terrestrial office, you need to take time to set up the teledentistry process to work for you and your patients. Here are a few steps to do that: 

  • Determine the protocol 

Before launching teledentistry, you need to answer important questions, such as:

      • What services will you provide remotely?
      • Which ones must be performed in the terrestrial office?
      • How will a virtual visit look like in your practice?

Set-up your team for teledentistry and test-run your process before launching fully. You can make necessary adjustments with time. 

  • Configure your schedule 

You must define your virtual schedules and help every member of your team understand their roles. It is best to dedicate some hours of the day, every week to virtual dentistry. You can delegate that role to your team when your undivided attention is needed in the clinic. 

  • Set up the space for teledentistry 

It is also important that you set up a space for virtual dentistry in your office. If you intend to conduct virtual visits from your home, set up an appropriate place for it too. 

  • Ensure documentation 

Virtual visits are real visits to your practice and must be treated as such. This means you should document them appropriately. The documentation process from intake to virtual walkouts to online billing/payments must be streamlined. 

  • Carry your patients along 

It is also important that you carry your patients along immediately after setting up your teledentistry practice. Start with your team and get the message out to current patients before targeting potential dental patients. 

Benefits of teledentistry 

In 2019, more than 53 million Americans lived in places with a dental health professional shortage, making them less likely to receive needed dental care. Undoubtedly, teledentistry has many benefits. The most prominent ones you should always keep in mind are: 

      • It’s much more convenient 
      • Concerns of social distancing during health crises ease
      • Shorter wait times in dental clinics are ensured 
      • Overall efficiency is improved
      • Revenues for the dentist and dental clinics are enhanced
      • Clinical collaborations are facilitated
      • Costs of dental care for both dentists and patients are reduced
      • Dental care can be expanded to people in remote areas 

Related Content:  Why Telemedicine IS the Future of Healthcare

Conclusion:  Teledentistry is the present and future of dental care delivery

It has several benefits for dentists, their patients, and the healthcare system. This is a good time to integrate teledentistry into your dental practice and we have discussed how you can do that. Take time to plan the move and carry your patients along immediately after the integration. 

The process of getting a cavity filled can be distressing for children, especially if they display fear or anxiety during dental visits and procedures. While most dental practices do their best to alleviate any anxiety that a child may experience, there are nevertheless always going to be instances related to a child’s oral hygiene which can trigger these negative emotions. One such situation is when a composite tooth filling falls out. This can happen due to no fault of the child.

In fact, it is a fairly common occurrence especially with children who need fillings in their baby teeth. As the adult teeth push down, the baby teeth loosen, become more friable, and sometimes break apart, resulting in the loss of the composite material.

Not only is this a frightening experience, but it can also be a painful one if nerve-endings become exposed. As a parent, it’s important to stay calm so that you can soothe your child as you handle the problem.

Tips for what to do if your child’s filling falls out 

1. Manage the pain

Your first priority is to manage any pain your child is experiencing. The loss of a filling exposes both the decay and the nerve-endings it was helping to cover. This may result in your child feeling a sharp pain in the affected area from merely inhaling cool air, as well as sipping hot or cold beverages.

There are several methods of pain relief that you can employ to help your child. Depending on their age, various over-the-counter treatments are available and should suffice. Ibuprofen and aspirin (or children’s aspirin depending on your child’s age) ought to do the trick. There are also over-the-counter topical analgesics, such as Orajel, that can provide temporary numbness around the tooth.

If you’re seeking a natural remedy, consider applying a bit of clove oil to the affected tooth. This is done by simply dampening the end of a cotton swab in the oil and touching it gently to your child’s tooth.

2. Fill the hole temporarily

By creating a temporary replacement for the lost composite filling, you can help to reduce the pain your child may be experiencing. Dental cement is a relatively affordable option that you can find in most pharmacies and grocery stores.

Use the adhesive or dental tack to fill the hole left by the lost filling. This can keep the tooth from becoming further damaged while covering up the exposed nerves to ease the pain. However, it is important to understand that this is not a long-term solution. Dental cement is no substitute for a proper filling.

3. Dispose of the filling

While a lost crown may be kept and reapplied by your dentist, you will have no such luck with a lost composite filling. Once the filling escapes from the tooth, there’s no way to save that particular filling.

If you or your child suspects that the missing filling has been swallowed, do not fret. Fillings can fall out without your child immediately noticing and it’s not uncommon for a child to swallow parts of or entire fillings. While it’s always best for your child to spit out the filling, swallowed fillings rarely pose any health threat to a child and should pass without a problem.

4. Call your child’s dentist

 what to do if child's filling falls out

Photo source: Pexels.com supplied by the author

The loss of a filling isn’t an emergency, exactly, but dentists should take it seriously. That’s especially true for pediatric dentists. They know that losing a filling can be scary and is often painful. This is why it’s a priority to get in touch with your child’s dentist. Upon calling them, they will likely try to schedule an appointment within a few days to replace the filling.

5. Advise careful cleaning

In the interim, it is essential for your child to keep the affected tooth and area surrounding clean. For the time being, it might hurt too much to brush or floss, but oral hygiene is still important.

Advise your child to brush as gently as possible. Skip the mouthwash, which can burn and irritate the affected area. Depending on the location of the tooth and how much discomfort your child feels, it might be best to avoid flossing in that area as well.

6. Avoid certain foods 

Until your child’s dentist appointment, there are certain foods and beverages you should try to avoid. Tell your child to steer clear of fruits with small seeds, such as strawberries and raspberries. Popcorn is also a no-no as the kernels could get stuck in the exposed cavity. Again, extremely cold or hot beverages are likely to cause pain.

Foods that are difficult to chew, too crunchy, or too hard may damage the tooth, as can any acidic foods. And, as always, foods and liquids high in sugar may hasten tooth decay.

7. Explain what’s next to come

Before your pediatric dentist replaces the filling, he or she will want to examine your child’s exposed tooth. She is explicitly looking for advanced decay which will need to be scraped away before reapplying the composite over the tooth.

Ask your child’s dentist and the oral hygienist to explain to your child what to expect during the procedure to alleviate any aforementioned anxiety.

The bottom line on what to do if your child’s filling falls out

If your child loses a filling, it can be disconcerting, at best. Do what you can to soothe any pain or discomfort that your child feels as a result of the lost filling while also reassuring him or her that this is not uncommon.

Last but not least, to prevent additional cavities in the future, be sure to do the following:

  • reinforce healthy eating habits,
  • teach proper brushing technique
  • schedule regular dental checkups for your child

Find ways to make brushing fun — get them a fun toothbrush, download an app for brushing, or play a song while they’re in the bathroom and praise them when they do make the effort.

Remember, healthy habits established young will really pay off as they get older!


First published on 12/21/18. Reviewed and updated on 4/27/2020

Bad breath or halitosis as it is popularly known, is not a new term for most people. You may have met someone whom you wished was several meters away from you owing to the foul smell emanating from their mouth. Or, you could have been the culprit causing people to back away from you when you open your mouth to speak.  In this article, we will explore the following issues related to bad breath:

  • Common causes of bad breath
  • Possible solutions
  • And, what to do when the bad breath doesn’t go away

Here are 10 reasons why you get bad breath and what you can do about it:

1. Poor oral hygiene

Before we can even blame the bad breath on anything, we start by looking at how good our oral hygiene care has been. If you do not brush and floss your teeth regularly, you are at high risk of developing halitosis. The lack of proper oral hygiene leads to the build-up of bacteria that, in turn, leads to the decay of your teeth. That is how you end up with a terrible smell in your mouth.

Solution: Do the following:

  • Brush your teeth after every meal if possible.
  • If you can’t brush after every meal, you should try to brush them not less than two times a day.
  • You should also replace your toothbrush after several months.
  • In addition, you should visit your dentist every six months for a thorough check-up.

Related Content:
The Water Flosser: A Great Alternative for Floss Haters

2. Gum Disease

Perhaps you just started cleaning your teeth on a regular basis, but the bad breath won’t go away. It is highly likely that you have gum disease, which is responsible for the multiplication of the bacteria in your mouth. Brushing on its own may not be sufficient to get rid of the bad odor; hence you need a better solution.

Solution: You should visit your dentist so that he or she can prescribe the right medication. You should also throw away your toothbrush and purchase a new one, as you begin a new and regular clean up routine.

Related Content:
The Relationship Between Periodontitis and Systemic Diseases

3. Dry mouth

Diseases such as xerostomia lead to the drying up of your mouth. This is troublesome, owing to the fact that saliva is responsible for cleaning up the mouth naturally.

Solution: You should visit your dentist for him or her to diagnose the underlying medical conditions that are causing your mouth to dry up, and then prescribe the right medication for you.

Related Content:
What Causes Dry Mouth and How Can You Treat It?

4. Morning breath

We all hate it when we wake up to bad breath in the morning, or after a daytime nap, despite having brushed our mouths before sleeping. This usually happens due to the slowing down of saliva production while we are asleep. This, in turn, creates a suitable environment for the breeding of bacteria which causes the bad breath.

Solution: Brush your teeth right after waking up in order to terminate the bad breath.

5. Foreign material in the nasal cavity

This cause of bad breath is quite common among children. Children love playing with a wide range of materials that they find on the ground or on any surface. The entry of such foreign materials into their nasal cavity can after some time cause terrible breath.

Solution: If you suspect your child has something stuck in his or her nose, call your pediatrician. They may ask to evaluate the child via an in-office or telemedicine visit. Depending on their assessment, they made need to see the child to remove the foreign material. Or, they may be able to instruct you in how to do the removal. 

6. The food you are consuming

Some of the food that you eat has a very significant effect on the odors that leave your body, including your breath. You may have heard of the term “post-meal” breath. That refers to the bad odor that you get after consuming certain foods, including curries, onions, garlic, as well as a wide variety of spices and herbs. You may be tempted to use breath mints to prevent the post-meal breath, but this only masks the bad breath which will return went the mint has dissolved..

Solution: You should avoid consuming the foods that you have discovered as having a bad impact on your breath.

7. Smoking

Smoking causes a very unique type of bad odor, although this may not be apparent to the smoker himself. Also, tobacco is known to increase the chances of the smoker developing gum disease, which as we have already seen is a major cause of bad breath.

Solution: The ultimate solution, in this case, is to quit smoking. If you are not a heavy smoker, then you can clean your mouth thoroughly right after smoking in order to minimize the chances of eventually developing bad breath.

8. Sinus infections

The bacteria that are responsible for the awful stench in your mouth find phlegm and mucus as a very suitable breeding ground. If you, therefore, have a sinus infection that is leading to you producing more mucus, then you should brace yourself for a bad-breath day.

Solution: If you have a cold or sinus infection, you should take the medication prescribed by your physician, in order to curb the disease. You should also brush your teeth more often to ensure that those who are staying around you do not start avoiding you due to the bad odor.

9. Undiagnosed medical conditions

Medical conditions such as diabetes, gastrointestinal disorder as well as bronchitis are known to cause bad breath. If you have noticed that the bad odor from your mouth is simply not disappearing despite you taking good care of your teeth and tongue, then it is possible that you have a major underlying condition that would need to be treated before the bad breath subsides.

Solution: Visit your dentist so that he or she can determine whether you need to get tested for some other conditions and diseases so that you can address the root cause of the bad breath.

10. Dentures

If your dentist has already advised that you should use dentures, then it is up to you to keep them clean as instructed. The failure to do so will lead to the accumulation of food particles on them, and this will eventually lead to you having a bad breath.

Solution: You should clean your dentures after every meal. This should also be accompanied by the thorough brushing of your teeth and the gentle cleaning of your gum.

Related Content:  Tips To Improve Oral Health In The U.S.

The bottom line for bad breath

Bad breath is common and distressing. However, once you figure out the cause, there are almost always effective steps to take to make go away and prevent it from returning.

***

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The mouth contains one of the most important microbiomes of the human body. It is home to some 700 different species of bacteria that live in different microbial sub-habitats:

  • teeth
  • tongue
  • lip
  • cheek
  • hard palate
  • soft palate
  • tonsils.

While the mouth is one of the most vital body parts for our health, its significance is often overlooked. In fact, despite my background as a clinical dentist, even I was surprised as I delved into the research on the relationship between periodontitis and systemic diseases, such as cardiovascular disease, COPD, and cancer.

The mouth is the first point of contact for microbes

The mouth is the first meeting place between our gut (and immune system) and the outside environment: microbes, pathogens, toxins, and food nutrients. As the first point of contact, the oral microbiome seeds the rest of the GI tract, with a 45% overlap between the microbes found in the mouth and in the colon (1).

However, while a high level of species diversity within the GI tract is correlated with better health, oral disease is associated with higher diversity and richness of microbe species.

Good oral health is ensured by maintaining the homeostasis of a relatively limited number of microbe species living within the mouth.

Periodontal-facts graphic 600 x 423

Disturbing the Balance

A new understanding of the oral microbiome is shaping how we think about oral health and disease in relation to some systemic diseases. So far, three pathways linking oral infections to secondary systemic effects have been proposed.

  1. Metastatic Infection: Transient bacteria from oral infection or dental procedures can gain entrance into the blood and circulate throughout the body. Disseminated microorganisms may find favorable conditions, settle at a given site and start to multiply, colonize and infect the new site.
  2. Metastatic Injury: Certain bacteria can produce toxins that, when excreted or otherwise introduced into a host body, can trigger many pathological manifestations.
  3. Metastatic Inflammation: Proinflammatory molecules that enter the bloodstream from oral tissues may react with circulating antibodies to produce large complexes that give rise to acute and chronic inflammatory reactions. (2)

We can gain a more concrete understanding of these mechanisms by looking specifically at the second most common oral disease in the world: periodontal disease, which also called periodontitis. It may surprise you to learn that this common oral disease has connections to many systemic diseases, such as

  • cardiovascular disease
  • chronic obstructive pulmonary disease (COPD)
  • cancer

Introduction to periodontal disease

Periodontal disease refers to inflammatory processes in tissues surrounding the teeth, in response to bacterial accumulations, aka dental plaque, on the teeth (3).

Anaerobic bacteria found in invasive microbial plaque can penetrate gingival tissues in the gums. When this happens, it can induce tissue destruction as well as inflammatory responses from cells such as lymphocytes, macrophages, leukocytes, and other cells with crazy names that are associated with the immune system. These cells act to protect your body from foreign pathogens.

Now, although it may seem as if the disease is only restricted to the territory of the mouth, periodontal lesions are recognized as continually renewing reservoirs for the systemic spread of bacterial antigens, cytokines, and other pro-inflammatory mediators (4).

In other words, a periodontal lesion is like a rotting fruit hidden in the trunk of your car. At first, you may have no idea that there is an old banana sitting in the corner of your trunk underneath a pile of shoes.

However, if left to sit, the once healthy banana will turn into a brown lump of mush that will attract fruit flies, in the same way that the bacteria in periodontal lesions elicit an immunological response. If the rotting banana is still not attended to, then the normal progression of any food item that is left out will follow. The smell of decay will inevitably permeate the entirety of the car.

Periodontitis and cardiovascular disease

Periodontal disease itself is treatable through surgical procedures that involve removing plaque and tartar from the teeth and root surfaces. Relating back to the rotting fruit analogy, once the source of the smell is found, it too, can be cleaned and managed.

However, the smell will still remain for quite some time after, similarly to the way periopathogenic bacteria will remain in the body due to dissemination via the circulatory system. This can lead to increased risk of certain systemic diseases, including cardiovascular disease, as well as prompt reinfection of the gums.

Researchers have linked periodontitis to cardiovascular disease by corroborating associations between specific bacteria (consistent with periodontitis) and coronary diseases developing as a result of atherosclerosis.

Theories about pathogenic oral bacteria and cardiovascular disease

The exact mechanism by which pathogenic bacteria involved in periodontal disease (such as Porphyromonas gingivalis, Helicobacter pylori, and Prevotella intermedia) influence the thickening of arterial walls is still in the hypotheses stage. It is proposed that the migration of such microbes into the circulation system can lead to a direct invasion of arterial walls.

Another proposed pathway is the release, in response to infection, of systemic inflammatory mediators that produce arterial plaque, one of the early stages of atherosclerosis (3). Periodontal pathogens can also spread into the systemic circulation system by means of dental treatment procedures that allow them to pass directly into the bloodstream. 

Oral microbiome & CVD chart graphic 602 x 429

Source: American Society for Microbiology

Periodontitis and chronic obstructive pulmonary disease

Due to the close proximity of the oral cavity to the respiratory tract, perhaps it is easier to see how pathogens in the mouth can affect the lungs rather than the heart. In fact, recent epidemiological studies have shown that there is an increased risk of chronic obstructive pulmonary disease (COPD) as a result of inflammatory responses to certain periodontal pathogens (such as P. gingivalis).

Despite the numerous shared associations between periodontal disease and COPD, the exact mechanism by which oral bacteria contribute to the pathogenesis of respiratory infections is still unknown. However, studies have suggested that either direct aspiration of oral pathogens into the lungs can cause infection, or periodontal disease-associated enzymes in saliva can alter mucosal surfaces, promoting adhesion of respiratory pathogens further down in the trachea and lungs (5).

Periodontitis and Cancer

A recent follow-up study (over the course of 10 years) was conducted on 68,273 adults in order to determine a possible connection between periodontal disease and cancer, particularly pancreatic cancer (6). The results found that periodontal disease is an associated risk factor for cancer mortality (specifically pancreatic cancer).

Research on this topic is still in the early stages, but the basis on which it stands still traces back to bacteria involved in periodontal disease and, ultimately, an imbalanced oral microbiome.

Related content: Pregnancy and Oral Health: What You Need to Know

The bottom line

Periodontitis is not just a disease of the oral cavity. It has links to serious systemic diseases, such as cardiovascular disease, chronic obstructive pulmonary disease, and cancer. Although, we don’t fully understand the exact mechanisms involved, here is one thing we do know:

Taking care of your teeth and gums is just as important as taking care of the rest of your body.

***

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Resources:

  1. Segata, Nicola, et al. “Composition of the Adult Digestive Tract Bacterial Microbiome Based on Seven Mouth Surfaces, Tonsils, Throat and Stool Samples.” Genome Biology, vol. 13, no. 6, 2012, doi:10.1186/gb-2012-13-6-r42.
  2. Babu, Nchaitanya, and Andreajoan Gomes. “Systemic Manifestations of Oral Diseases.” Journal of Oral and Maxillofacial Pathology, vol. 15, no. 2, 2011, pp. 144–147., doi:10.4103/0973-029x.84477.
  3. Bingham, Clifton O., and Malini Moni. “Periodontal Disease and Rheumatoid Arthritis: the Evidence Accumulates for Complex Pathobiologic Interactions.” Current Opinion in Rheumatology, vol. 25, no. 3, 2013, pp. 345–353., doi:10.1097/BOR.0b013e32835fb8ec.
  4. Kim, Jemin, and Salomon Amar. “Periodontal Disease and Systemic Conditions: a Bidirectional Relationship.” Odontology, vol. 94, no. 1, 2006, pp. 10–21., doi:10.1007/s10266-006-0060-6.
  5. Ramesh, Asha, et al. “Chronic Obstructive Pulmonary Disease and Periodontitis – Unwinding Their Linking Mechanisms.” Journal of Oral Biosciences, vol. 58, no. 1, 2016, pp. 23–26., doi:10.1016/j.job.2015.09.001.
  6. Heikkilä, Pia, et al. “Periodontitis and Cancer Mortality: Register‐Based Cohort Study of 68,273 Adults in 10‐Year Follow‐Up.” International Journal of Cancer, vol. 142, no. 11, 11 Jan. 2018, pp. 2244–2253., doi:10.1002/ijc.31254.

******

Ellen M.Martin and Hailey Motooka were co-authors on this story. Click on the link to learn more about them.


This story was originally published on July 3, 2018. It was reviewed and updated for republication on February 27, 2020.

In an increasingly connected world, access to care should be on the rise. However, according to the American Dental Association (ADA), the majority of the U.S. population doesn’t receive dental care at all. In fact, visits to dental offices started to drop in 2003[i] and have been declining ever since. 

With 40% of Americans lacking dental insurance[ii], the cost of care is largely prohibitive. This is even more prominent when it comes to orthodontic care which is more expensive than general oral healthcare.

Unfortunately, it is often is not covered as an essential health benefit even for those who do have health insurance. Combined with 60% of U.S. counties lacking any orthodontist offices[iii], access to teeth straightening is prohibitive if not impossible for many Americans.

The good news is that teledentistry is changing that. Remote teeth straightening companies are helping open up the world of straighter teeth for those who previously couldn’t afford it or had no way of physically getting to an orthodontist.

Understanding Teledentistry

What is teledentistry? In short, it’s the use of technology for remote dental care, It is a subset of telemedicine. And telemedicine is nothing new. The American Telemedicine Association was first established in 1993.[iv]

In 2015, the American Dental Association defined teledentistry more broadly as: “the use of telehealth systems and methodologies in dentistry. Telehealth refers to a broad variety of technologies and tactics to deliver virtual medical, health, and education services. Telehealth is not a specific service, but a collection of means to enhance care and education delivery.”[v]

 Of course, the ability to employ teledentistry technologies depends largely on the legal and regulatory environment in each individual state. Many states already have a definition in law, including terms for “telemedicine” or “telehealth” services. Within dentistry, local dental boards play a large part as well.

Teledentistry comes in different forms

In practice, teledentistry can range from data sharing between patients and providers to actual remote treatment, like teeth straightening. There are already apps available that push preventative procedure reminders to patients and some providers are actively using real-time video conferencing for oral pathology evaluation.

In the U.S., some insurance coverage now includes teledentistry treatments. One six-year study in California found “virtual dental homes”—a community-based system that uses telehealth—to be safe and effective for oral health care.[vi]

Related content: How to Integrate Teledentistry Into Your Practice

Not only does this provide a solution for places without physical locations for care, but the average cost of doctor-directed teledentistry treatment is less expensive than in-office care. This makes a huge difference for those who lack dental insurance.

Is Teledentistry Safe for Teeth Straightening?

It’s been estimated that 300 million people worldwide[vii] could benefit from straightening their teeth. However, they are unlikely to seek treatment through a doctor’s office. This raises the question of whether teeth straightening can be done safely via telemedicine?

The answer is yes. Teledentistry companies are making it both safe and easy for people to straighten their teeth at home because they provide oversight by licensed dentists or orthodontists. These oral health professionals are committed to bringing teeth straightening to people who previously couldn’t access it. It is important to point out that these types of at-home invisible aligners are not do-it-yourself (DIY) programs. Rather, they are a branch of teledentistry.

The “social six”

When it comes to malocclusion—improperly aligned teeth—98% of patients are treatable via teledentistry methods, such as invisible aligners.[viii] This is in part because the vast majority of treatments are for straightening what’s called the “social six.”

These are the visible front teeth that, in mild to moderate cases, do not affect any major medical conditions. That is why most third-party payers (like insurance companies) view the movement of these teeth as cosmetic and not an essential health benefit.

At least 19 states[ix] have adopted policies related to teledentistry offering oral health services remotely. More are in the works because many licensed dentists and orthodontists are beginning to work with remote invisible aligner solutions. They oversee cases in order to increase overall access to care. 

How Does Remote Teeth Straightening Work?

The process starts with an at-home impression kit and evaluation. Patients follow step-by-step instructions to take molds of their own teeth. This is similar to what they would do in office for invisible aligner treatment. These molds are then submitted along with photos of their teeth using the same angles a dentist or orthodontist would capture in-office.

A licensed dentist or orthodontist then evaluates both the photos and the impressions to determine if the patient is a candidate for remote therapy. If so, they’ll create a treatment plan for moving the teeth. If not, the patient can be referred to a physical orthodontic office for treatment that corrects major medical conditions rather than the more cosmetic movement that invisible aligners treat.

Once patients are approved for remote therapy, their aligners are custom-made and mailed to them. Throughout the course of treatment, the patients switch out their aligners as directed by their physician-approved treatment plan.

High-frequency vibration

Orthodontists have used adjunctive high-frequency vibration (HFV) therapy in their offices for many years. HFV involves transmitting soft micro pulses through the roots of the teeth to the surrounding bone.

An August 2019 study, published in the Journal of Orthodontic Science prospectively examined the outcomes of thirty orthodontia patients who had minimum to moderate crowding of their teeth treated with clear aligners and adjunctive HFV. Their outcomes were compared to a control group that used aligners but did not receive HFV.

The study found the treatment time of the HFV-treated patients was shorter than the control group. The average time to aligner change was 5.2 days in the HFV group vs. 8.7 days in the control group (P=0.0001). The HFV group also had a significantly improved bone density compared to controls. 

Although this study was done in patients receiving traditional in-office orthodontia, it is possible to deliver HFV to patients being treated remotely. My company, byte*, accomplishes this via the use of a proprietary device that we call the Hyperbyte. The safety and efficacy of HFV used in a remote setting have not yet been studied.

Are people happy with the results of at-home teeth straightening?

Thousands of people have already been treated with doctor-directed at-home teeth straightening. However, because remote orthodontics is relatively new, there are not yet any large-scale studies that demonstrate safety and efficacy compared to traditional in-office treatment. However, there are some things that we do know:

  1.  A 2018 systematic review of the research evidence for the benefits of teledentistry found “emerging” evidence suggesting that teledentistry, including orthodontics, appears to be effective and cost-effective. 
  2. A recent review of telehealth by the Agency for Healthcare Quality and Research concluded that “in general, the evidence indicates that telehealth consultations are effective in improving outcomes or providing services, with no difference in outcomes.”
  3. The benefits of a straighter smile can help people feel more confident and get rid of insecurities, improving their overall quality of life.[xiv]
Additional Content on Oral Care:
What Does Fluoride Actually Do for Your Oral Health?
The Water Flosser: A Great Alternative for Floss Haters
Many Surprising Reasons to See an Orthodontist

The future of dental care?

The U.S. Department of Health and Human Services estimates there will be a shortage of dental professionals by 2025[xv]. Teledentistry can help lessen the impact of that shift. Even now remote options are already increasing access to care by bringing solutions to communities—both geographically and economically—that don’t have orthodontic care readily available.

Many health delivery organizations (75%) are already using telehealth solutions or plan to use them in the near future.[xvi] It’s only natural that teledentistry should be a part of this growing adoption of remote care.

***

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***

References


[i]  https://www.americanteledentistry.org/facts-about-teledentistry/
 
[ii]  https://www.dentistryiq.com/practice-management/patient-relationships/article/16350580/survey-reveals-americans-view-dental-care-as-nice-to-have-would-repair-their-cars-over-their-teeth

[iii] https://dentistrytoday.com/news/todays-dental-news/item/3497-teledentistry-provides-orthodontic-treatment-to-those-without-access-to-care

[iv] https://orthopundit.com/diy-medicine/

[v]https://www.dental.pacific.edu/documents/departments/pcsc/DQ_WhitePaper_Telehealth_081816.pdf

[vi] https://www.dentistrytoday.com/news/todays-dental-news/item/3848-teledentistry-virtual-care-for-urgent-oral-health-and-dental-problems

[vii] https://www.usatoday.com/story/money/2018/12/21/invisalign-smile-direct-club-braces-teeth-aligners/2378959002/

[viii] httpss://www.americanteledentistry.org/wp-content/uploads/2018/07/ProOrtho_2018_Q3-2.pdf

[ix]  https://www.ncsl.org/research/health/oral-health-care-in-rural-america.aspx

[xiii] https://www.corvel.com/blog/telehealth-the-wait-is-over

[xiv] https://www.orthodonticslimited.com/teeth/straight-teeth-affects-confidence/ 

[xv] https://www.orthodonticslimited.com/teeth/straight-teeth-affects-confidence/

[xvi] https://blog.vidyo.com/telemedicine/2018-year-telemedicine-becomes-medicine/


*Financial disclosure: Dr. Marashi is the Co-Founder and Chief Cosmetic Dentist at byte.

Ok, I admit it. I hate flossing. I am not exactly sure why. Maybe it is the feel of the string against my gums. Or how hard it is to release the floss when it is forced down between teeth that are very close together. Whatever the reason, I just don’t like to do even though I know that it is “good for me.” So, I don’t. But I have discovered a great alternative to string flossing. It is the water flosser. Let me explain.

Like me, most people don’t floss daily

Evidently, I am not alone when it comes to an aversion to flossing. A 2015 survey found that 18% of respondents would rather wash dishes and 14% would rather clean the toilet than floss! In fact, only 30% of the population flosses daily which is about the same percentage of people who say they never floss. It is also close to the same number of people who admit to lying to their dentists about how often they floss.

A few years ago, after enduring endless “bad flosser” lectures from my dentist, hygienist, and husband, I decided to get my teeth cleaned monthly instead of twice a year. I thought that would make up for my flossing failures, but it did not. The plaque still built up and my gums were still inflamed.

My dentist eventually recommended that I buy a water flosser and I was glad that I did. Warm water pulsing against my gums is ever so much more pleasant than forcing waxy string between my teeth.

So, when I got a pitch to do a story on Waterpik’s Water Flosser having received the American Dental Association Seal of Acceptance, I decided to learn more about water flossing.

Full disclosure: Waterpik sent me a complimentary Aquarius Designer Series Waterpik Waterflosser to try out (clicking on the affiliate link earns TDWI a small commission). As its name implies it is nicer looking, smaller, and lighter than my older water flosser. 

I also interviewed Deborah Lyle, a registered dental hygienist with more than 35 years in the field, who serves as Waterpik’s Director of Professional and Clinical Affairs. You can listen to the interview here.

Why floss anyway?

Plaque is a soft, sticky film containing millions of bacteria that constantly forms on your teeth. Although brushing can remove plaque from the front and back of your teeth, it is not an effective way to remove plaque and food particles that wedge in between teeth and below the gum line.

If not removed daily, plaque can harden into tartar, a thick white substance that you can see and, in some cases, feel with your tongue. Tartar is much more difficult to remove than soft plaque. It may require a trip to the dentist so the hygienist can scrape it away.

The bacteria that live in plaque thrive on sugars in the foods we eat. As a by-product of their metabolism, they produce acids that break down tooth enamel. This can result in those loathsome cavities (also known as caries) that require drilling and filling.

Left unchecked, plaque can cause gums to become inflamed: red, swollen, and prone to bleeding. This is a condition known as gingivitis. It is an early stage of gum (periodontal) disease.

Gum disease not only places teeth at risk of decay or loss, but it has been associated with increased risk of health problems elsewhere in the body, such as heart disease, diabetes, dementia, rheumatoid arthritis, and premature birth.

How do water flossers work?

Water flossers allow users to direct pulses of water under pressure to the areas hard to clean with brushing alone. The flossers come with a variety of attachments including brushes that help people with braces clean between the wires.

You fill up a reservoir with warm water and point the tip of the flosser toward the teeth, systematically aiming at the gum line and in between the teeth.

Usually, you do this after brushing and rinsing, but I have, on occasion, used the flosser first, only to be shocked by the large amount of food particles flushed out of my mouth by the flosser.

Even worse than seeing all that stuff in the sink is the new-found knowledge that had I not water-flossed after eating, all of that debris would be sitting around my teeth, feeding the bacteria that will rot my teeth and ruin my gums. How’s that for motivation?

Are water flossers better than other flossing tools?

In addition to water flossers, there are a variety of other flossing tools (aka interdental cleaning aids) that are available. These include string, waxed string, toothpicks, interdental brushes, and air flossers. How can you figure out which one is best for you?

First of all, the most important success factor for any flossing tool is that you actually use it at least once a day. This is because plaque builds up every day and can harden into tartar within 48 hours.

So, you need to find a technique that fits into your life and that you enjoy (or at least don’t dread). And then you need to establish a routine that you can easily follow. 

I leave my water flosser next to the sink as a constant reminder that I need to use it before I go to bed at night. Tucking it away in a closet is a sure-fire way to skip a floss or two until, the next thing you know, you aren’t doing it at all.

Related content: Oral Health and Pregnancy: What You Need to Know

What does science say about the effectiveness of water flossers?

A systematic review of scientific papers (known as a meta-analysis) was published in the Dentistry Journal in June 2019. The paper, “An Overview of Different Interdental Cleaning Aids and Their Effectiveness,” includes the following findings from the studies that they reviewed:

  • Oral irrigators are able to remove supragingival (above the gum line) plaque. They also flush out subgingival (below the gum line) bacteria and other debris 
  • They reduce pro-inflammatory cytokines (IL-1β and PGE2) in patients with mild to moderate periodontitis and diabetics thus reducing gum inflammation 
  • Further, they facilitate the removal of subgingival biofilm without harming soft tissue 
  • The levels of bacteria found in the blood after water flossing were similar to toothbrushing, scaling and chewing 
  • Oral irrigators may be more effective than dental floss or interdental brushes in reducing bleeding, plaque, or probing depths 
  • Oral irrigators appear to reduce inflammation independent of plaque removal 
  • No special motor skills are necessary. Even, 6 year-olds were able to use them properly

Another meta-analysis published in 2018 in the Journal of Periodontology looked at the impact of a variety in interdental hygiene aids (including oral irrigators) on two different parameters of gum health: 

  • Gingival inflammation (Gingival Index or GI)
  • Bleeding-on-probing (BOP)

They found that oral irrigators and interdental brushes had the highest probability of improving the GI. However, the probability toothpicks and string floss doing the same was “near zero. All of the interdental aids except toothpicks were better than doing nothing at all.

They also concluded that “interdental brushes and water-jets ranked high for reducing gingival bleeding.”

Both papers point out that recommendations regarding which type of interdental cleaning aid to use should be customized to the needs of individual patients instead of insisting on the use of one particular type of device. 

Neither of these studies had industry funding although one of the authors of the second study had received unrestricted research funding from WaterPik in the past.

The Cochrane review – conflicting results

A Cochrane review of the relevant scientific literature, titled “Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries,” was published in April 2019. It found the following:

  • “Very-low certainty evidence suggested oral irrigators may reduce gingivitis measured by GI at one month (SMD -0.48, 95% CI -0.89 to -0.06; 4 trials, 380 participants), but not at three or six months.
  • Low-certainty evidence suggested that oral irrigators did not reduce bleeding sites at one month (MD -0.00, 95% CI -0.07 to 0.06; 2 trials, 126 participants) or three months, or plaque at one month (SMD -0.16, 95% CI -0.41 to 0.10; 3 trials, 235 participants), three months or six months, more than toothbrushing alone.”

It is important to point out two things:

  1.  Cochrane reviews are usually rigorous and therefore reliable
  2.  Only 5 studies on water flossers, each with relatively small numbers of people, were included in the review.

Some interesting industry-funded studies

The first one was published in Compendium of Continuing Education in Dentistry in 2009. Deborah Lyle was the second author of this paper. I am including it here despite the potential bias related to industry funding because the methodology is so interesting.

Extracted teeth were sliced up and then left to stew in saliva for four days. Then, most of the tooth slices were cleaned with one of two different Waterpik tips. Afterward, they were examined with a scanning electron microscope (SEM). Two slices were untreated and served as controls. 

Both of the tips removed more than 99% of the plaque after a 3-second exposure to medium pressure via the device.

Here are the SEM photos from one of the Waterpik websites:

Other Waterpik-funded studies include the following:

  • The Waterpik Water Flosser was 51% more effective than string floss for reducing gingivitis after 4 weeks of use (Again, Lyle is an author on this paper).
  • After 30 days of use, the Water Flosser was more than twice as effective as string floss for reducing bleeding on probing in patients with implants.
  • Two studies published in the Journal of Clinical Dentistry, one in 2012 and another in 2015 showed the Waterpik Water Flosser to be more effective than Sonicare’s Air Floss for reducing clinical signs of inflammation and reducing gingivitis and plaque. Both studies were funded by research grants from Waterpik and listed Deborah Lyle as the second author.

Related content: How Video Technology Can Help Build Trust With Dental Patients

My personal experience with water flossing (this is known as an anecdote)

Shortly after I started using my water flosser, I had a visit with my dental hygienist. To my delight, she couldn’t stop raving about my gums – it made me blush! She told me my gums were now pink instead of dusky color they were previously. And there was no bleeding at all indicating a great improvement in my gum health. My reward? She recommended moving my monthly cleanings to every three months. 

When I use my water flosser faithfully, I have continued to have good results that I am pretty sure I can attribute to the flosser. This is because I don’t take it with me when I travel (which I do a lot). If I get back from a trip too close to my next hygienist visit, she can really see the difference. Water flossing works for me.

Here is a link to the flosser I use. (see affiliate disclaimer in footer) I love it and so does my husband. It is also an Amazon bestseller.

Waterpik Water Flosser Electric Dental Countertop Oral Irrigator for Teeth, Aquarius Professional, WP-660/660C  

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By the way, I have tried several different travel water flossers, but so far have not found them to be a good alternative. They take up a lot of room in my carry-on and the water tanks are too small for thorough cleaning without a refill. I actually packed my regular flosser on my winter vacation this year.

If you have found one that works for you, please share the information in the comment section below.

So, what is the bottom line?

  • You should brush and floss daily no matter what technique you use.
  • There is evidence that suggests water flossing is at least as effective as string flossing.
  • When you factor in low compliance with string flossing, water flossers might be particularly beneficial for floss haters.
  • Water flossing appears to be more effective than air flossing, but the studies showing this are funded by Waterpik.

For flossing haters, water flossing is a great alternative to string flossing.

That’s my opinion. I would love to hear yours.

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Disclosure: I was not paid to write this article, but I did receive a complementary Aquarius Designer Series Waterpik Waterflosser to try out.

Originally published on 5/30/17, this article has been updated for republication.

For years, the debate has raged over the value of fluoride. Although one would assume that the passage of time would bring more clarity to the issue, it still seems that there are more questions than answers.

For patients who are trying their best to care for their teeth, the confusion about fluoride can seem overwhelming. However, by taking some time to understand more about fluoride and how it affects your teeth, you can make a more informed decision that will positively influence your overall health.

Fluoride: An Oral Health Breakthrough

Photo Source: Pixabay

Fluoride is a natural element that’s found in the ground, water, and air. Natural water supplies have varying amounts of fluoride. It is absorbed by the teeth and bones when we drink it.

According to the Department of Health and Human Services, research on the connection between tooth decay and drinking water started around the turn of the 20th century. Highlights from the DHHS article include the following:

  • In 1945, Grand Rapids, Michigan became the first municipality to add fluoride to their drinking water.
  • Children who were born in Grand Rapids after their water supply was fluoridated experienced an astounding 60% drop in cavities over the previous generation of kids.
  • Armed with these results, cities, and towns across the country began adding fluoride to their drinking water in earnest.

According to the Center for Disease Control, almost 75% of public water supplies are fluoridated today.

The Advent of Fluoride Toothpaste

Photo Source: Pixabay

Most people today don’t realize that until the 1950s, toothpaste was fairly ineffective. At best, they were abrasive pastes that attempted to remove plaque from the teeth using sheer grit.

However, in 1956, Crest introduced the first fluoride toothpaste, which revolutionized the industry. In fact, the now-ubiquitous “Seal of Acceptance” from the American Dental Association was first awarded to Crest for its revolutionary formula.

Over a short period of time, tooth decay was reduced to historic levels in the United States. Overall oral health was at an all-time high. Much of the credit for these results were given to the addition of fluoride to drinking water and toothpaste.

The Pros of Fluoride for Oral Health

Photo Source: Pixabay

There’s no doubt that, when you look at the historical evidence, there’s a correlation to Americans’ use of fluoride and their overall improvement of oral health. Those who advocate for the use of fluoride point to these advantages:

    • Fluoridated public drinking water significantly improves overall oral health. According to the American Dental Association, towns and cities with fluoridated drinking water have a 25% drop in tooth decay in both children and adults over municipalities with untreated drinking water. Additionally, the cost of this treatment is extremely low. The same study states that, for every $1 spent on fluoridated water, a city will save an average of $38 on dental costs per person.
    • Fluoride toothpaste can help protect teeth and even heal tooth decay. Fluoride applied topically to the teeth via toothpaste can have wonderful preventative results. Fluoride can help remineralize the enamel, reversing the effects of tooth decay.
    • The addition of naturally occurring fluoride to water and toothpaste is commonplace. Although some may be hesitant when considering an “additive” to their water or toothpaste, it shouldn’t be unusual to our current way of thinking. Many common products we use today are fortified with vitamins or minerals and our health is better for it. Whether it’s iodine in salt, vitamin D in milk, or riboflavin in our cereals, public health has improved thanks to this practice.

The Cons of Fluoride for Oral Health

Photo Source: Pixaby

Although there’s no denying the statistics that show a vast improvement in oral health as fluoride was introduced into the American water supply and dental products. However, some experts draw different conclusions from the same data.

For instance, the Fluoride Action Network, an anti-fluoride advocacy group, points to statistics showing that the rate of tooth decay has fallen across the Western world over the years, regardless of whether countries added fluoride to their water or not.

Those who advocate for a fluoride-free water supply and who buy toothpaste free from fluoride point to several arguments that support their position:

    • The fluoride additive differs from naturally-occurring fluoride. Critics of fluoride are often not critical of calcium fluoride, as it’s a naturally occurring element. Rather, they point to the effects of industrial fluoride, which is what is typically added to the water supply. This type of fluoride reacts differently in the body compared to calcium fluoride and the effects can be pronounced. For instance, since industrial fluoride is completely soluble by the body, there can be side effects to ingesting too much of it, including fluorosis.
    • There’s no method of tracking fluoride ingestion. Ingesting too much fluoride can cause health issues in some cases. You may wonder if there’s a way to monitor how much fluoride you take in on a daily basis. Unfortunately, tracking fluoride use isn’t as simple as counting calories or keeping tabs on your caffeine intake each day. The reason? There is no accurate methodology for testing fluoride levels in the body, leaving people unsure about their actual fluoride absorption level.
    • Safer methods of encouraging enamel growth are now available. Although fluoride may have been the best method to strengthen enamel in the 1950’s, some argue that there are safer alternatives available today. Many anti-fluoride advocates point to toothpastes containing hydroxyapatite particles as far superior to their fluoride-containing counterparts. Also, they argue good oral health practices, like brushing twice a day, scraping your tongue, and flossing once daily are the best preventatives you can implement to keep cavities at bay – much more so than fluoride.

So, What Does Fluoride Actually Do To My Teeth?

Dental Xray

Photo Source: Pixabay

It’s easy to see compelling arguments on each side of the fluoride debate. Each patient has to do their own research and arrive at their own conclusions. However, everyone should agree that no matter your position of fluoride, good oral health is a must. Always make sure you:

  • Have a daily routine of brushing, flossing (consider a water flosser), and tongue scraping to keep bacteria from festering in your mouth.
  • Change your toothbrush every three months, or discard it for a new one even sooner if the bristles show significant signs of wear.
  • Monitor or modify your diet if necessary to ensure that your food and drink choices aren’t damaging your teeth.
  • Visit your dentist every six months for teeth cleaning and an oral health exam.

Questions

If you have questions about fluoride, make sure you talk to your dentist at your next appointment. They will be glad to walk you through fluoride’s pros and cons and help you make a more informed choice.

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As a veteran, you may have questions about what dental care options are available for you. The problem is that veteran dental care benefits can be quite confusing. It can be difficult to make heads or tails of what you qualify for.

As a dentist of two decades, and a veteran myself, I understand the frustration. I’ve worked with countless veterans and have helped them secure the dental care they deserve.

With this article, I hope to detail some of my experience with VA dental benefits and help you determine which types of benefits you may qualify for. And by the end, you’ll hopefully have a good understanding of the VA benefits offered to you, as well as non-VA options that can help if you don’t qualify.

What Type Of Care Does The VA Cover?

Unfortunately, there’s no easy answer to this question. It depends on which classes(s) you qualify for. The amount of care can vary from specific issues to all care needed. It’s difficult to generalize, but most classes cover dental care that deals with some sort of service-related issues and injuries. For more details, read on to learn about different classes.

Understanding the VA Dental Care Classes

One of the more confusing aspects of VA dental is the large number of classes that qualify you for treatment. Each one of these classes has slightly different requirements. Some limit the types of treatment you can receive. Understanding if and which class you fit into is key to understanding which dental benefits you are eligible for.

Below, you’ll find each class along with a brief explanation of who qualifies. Some of these are a bit hard to completely understand, so if you have any further questions don’t be afraid to reach out to your local VA office. They are there to help you and will be able to explain what benefits you might qualify for.

 Class I: If you have a service-related compensable condition or disability then you are eligible for any dental care needed.

Class II: If you were discharged in any other condition than dishonorable, and you did not receive a dental examination upon discharge, then you are eligible to receive one-time care within 180 days.

Class IIA: A non-compensable condition (0%) that resulted from wounds in combat then you may be eligible to receive care to keep your mouth healthy. Per the February 2018 Dental Benefits for Veterans document IB 10-442, a VA Regional Office Rating Decision letter (VA Form 10-7131) or the historical Dental Trauma Rating (VA Form 10-564-D) identifies the tooth/teeth/condition(s) that are trauma related.

Class IIB: If you are a homeless veteran and receive care under VHA Directive 2007-039 then you may be eligible for care to relieve major pain, treat gum disease, or gain employment.

 Class IIC: If you were a former prisoner of war then you are eligible to receive any dental care needed.

Class III: If you have a service-related condition that has been determined to be affected by dental issues then you are eligible to receive treatment of said dental issues. This determination is made by a VA dental professional.

 Class IV: If you have a service-related condition that is rated as 100% (total) disabling then you are eligible for any dental care needed. This only applies to ratings of 100% that are permanent and not for short-term disabilities.

 Class V: If you are currently participating in a VA vocational rehabilitation program under 38 U.S.C. Chapter 31 then you are eligible to receive dental care that helps you participate in and achieve the goals of said program.

 Class VI: If you are receiving or scheduled to receive inpatient care and have dental issues that are determined to be complicating that treatment, then you qualify for treatment of those dental issues. Like above, this is determined by a VA dental professional.

What Are Other Options If I Don’t Qualify?

While there are a lot of ways to qualify for VA dental benefits, the truth is that not all veterans will qualify. It’s unfortunate, but luckily there other options available for veterans. Below are a couple of options that can help veterans afford dental treatment and get the right healthcare they need.

  • National VA Dental Insurance Program:

One very good option is the insurance offered through the National VA Dental Insurance Program. This is insurance, so it’s not free, but it comes at a reduced cost compared to other plans.

This program is specifically offered to veterans, so they understand the issues you’re facing and are looking to help make things easier on you. Check to see if it is available in your area as it is a great way to cut down on the cost of dental treatments.

  • Dental Insurance:

It’s also possible to purchase dental insurance through 3rd party vendors. These are typically a bit more expensive than the VA dental insurance but can help cut down costs on unexpected procedures later.

  • Medicare Benefits:

You may also want to consider looking into Medicare benefits. These benefits can help pay for some dental procedures. Unfortunately, these benefits will not stack with any other VA benefits. Further, Medicare only covers a very select range of dental work.

  • Veteran Specials:

Lastly, there are many dentists around the country that offer special discounts for veterans. This includes things like reduced cost operations or even free services such as cleanings and X-rays.

Many dentists will advertise these services, but it never hurts to inquire if a dentist in your area offers any discounts to veterans. The only downside here is that many of these services will likely be very local and specific to the individual dentist.

  • Veterans Groups:  

Lastly, there are many dentists around the country that offer special discounts for veterans. This includes things like reduced cost operations or even free services such as cleanings and X-rays. Many dentists will advertise these services, but it never hurts to inquire if a dentist in your area offers any discounts to veterans.

The only downside here is that many of these services will likely be very local and specific to the individual dentist. Some military-focused websites might also advertise these specials, so it doesn’t hurt to check them out.

You can also consider reaching out to local VA or other veterans groups to see if they know of any of these specials. They may have contacts with local dentists that offer these types of services to veterans.

Additional Information from Dr. Grillo:  
Veterans Dental Care Resources
Important Questions to Ask Your Dentist

Summary:

With all the above in mind, hopefully, you’ve found a way that works for you to secure affordable dental care. If you’re ever in doubt, reaching out to your local VA is always a great option. They’ll be able to help you navigate the confusing class structures. They may also have additional information that will be useful to you. Work with them, and you may find that you can resolve your dental problems and restore your oral health.

You can find all of our articles on dentistry and oral health here: https://thedoctorweighsin.com/tag/dental-and-oral-health/

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Misaligned teeth are extremely common. It is important to rectify them as they increase the risk of oral health problems. They also affect the appearance of the smile. Braces help rectify improperly aligned teeth. However, the traditional metal braces are bulky, difficult to care for and have a lot of other hassles.

With the advancement in orthodontics, the teeth straightening procedure has become easy, effective and hassle-free. Invisalign – also known as clear aligners – are one of the most popular choices for correcting improperly aligned teeth and achieving a perfectly straight smile.

Related Content:  It’s Now Easier Than Ever to Have a Beautiful Smile

Commonly asked questions about Invisalign

So, let’s find more about Invisalign. Listed below are answers to some of the most commonly asked questions about these invisible aligners.

  • What is Invisalign?

Invisalign clear aligners are a set of removable aligners that are customized as per the patient’s needs. They do not have wires or brackets like the traditional braces. Since they are made from clear material, they are almost invisible.

  • Which problems can Invisalign solve?

These clear aligners can solve the below-described problems:

1.  Poor bites

When the teeth in the upper row are slightly in front of bottom teeth, it is known as an overbite. If the teeth in the bottom row are in front of the teeth in the upper row, it is known as an underbite. When some of the upper teeth come down inside the bottom teeth, it is known as a crossbite. If the mouth is closed and the teeth in both the jaws don’t meet, it is known as an open bite. All these types of poor bites make the teeth prone to cavities, gum diseases, wearing and chipping. Invisalign can help rectify all these types of bad bites by gradually shifting the teeth back to their ideal position.

2.  Spaces Between Teeth 

Sometimes there are excessive gaps between two or more teeth. Apart from being an aesthetic problem, such a situation also increases the risk of gum diseases and cavities. As long as these gaps aren’t extreme, they can be fixed by Invisalign.

  • What is involved in an Invisalign treatment?

These clear aligners are designed to exert gentle force on teeth in order to gradually bring them together so that they are aesthetically and functionally aligned correctly. The orthodontist designs them as per your requirement. They are changed usually around every two weeks. This enables the orthodontist to monitor the progress regularly and alter the aligners if required. The progress is gradual but you need not deal with the hassles and discomfort which comes with traditional braces.

  • How long is the treatment period?

It depends on the nature of your alignment issues. Though generally the treatment for adults is completed within 12 to 18 months and for tweens it usually lasts for about 2 to 3 years.

  • How often are these aligners to be worn?

Even though they are easily removable so there can be a temptation to take them off repeatedly. That is understandable, however, they must be worn for 20 to 22 hours every day. They may be removed to drink or eat, but should be worn right back after rinsing the mouth. If they aren’t worn for the prescribed minimum duration, the progress will be delayed.

  • Do these aligners hurt?

These aligners do exert pressure on the teeth in order to align them correctly. However, a majority of patients hardly notice their presence once they get used to them. In the beginning, a little soreness or discomfort is common. But the discomfort generally goes away within a few days. As the teeth and the mouth get used to the pressure exerted by them, the soreness also fades away. Headaches might be experienced in the early days, but minor pain medication can help.

  • How to care for these aligners?

Since they are made from clear material, they can get discolored or stained if not cared for properly. To ensure that they remain clean and in good condition, the following measures should be taken:

    1. Remove the aligners every morning and clean the teeth and the aligners thoroughly. Repeat this routine before bedtime also. 
    2. After removing them, soak the aligners in the solution prescribed by the orthodontist. Next, rinse them to prevent the buildup of dry saliva and plaque. Brush the aligners with a toothbrush with soft bristles to remove any remaining food debris. Finish by washing them with an antibacterial solution.
    3. Remember to clean the teeth properly before putting the aligners back on. If there are any food particles stuck to the teeth, they will be trapped inside the aligners. This will increase the risk of cavities and other oral problems in the long run.
  • Why prefer Invisalign over traditional braces?

Traditional metal braces have a bulky structure because they are comprised of metal brackets and wires. These can cause discomfort and even pain. The diet is also restricted as only certain types of foods can be eaten to avoid damage to the braces. Since they cannot be easily removed, cleaning your teeth and mouth becomes challenging. Invisalign does not have any of these hassles. Hence they are a good choice as compared to the traditional braces.

Related Content:  The Advantages of Invisalign over Traditional Metal Braces

  • What are the benefits of Invisalign?

Following are the benefits of these clear aligners:

    1. Virtually invisible
    2. Easily removable
    3. Easy to clean
    4. Comfortable
    5. Convenient
    6. Sport-friendly
  • In what cases is Invisalign unsuitable?

Invisalign has certain limitations. They may be unsuitable in certain cases, such as

    • severe underbite,
    • too much gap in between the teeth, gum diseases,
    • weakened jawbones,
    • receding gums,
    • rotated teeth and teeth which are short, pegged, round or have a sharp tip.

In some such cases, Invisalign might be combined with braces for better results. In others, they may be completely unsuitable. It’s best to consult an experienced orthodontist to determine whether or not is Invisalign suitable for your particular case. 

  • Do you have to wear retainers after Invisalign treatment?

In a majority of the cases, orthodontists will recommend that retainers to be worn after the Invisalign treatment. This ensures that the teeth do not move back to the original position. Generally, the more drastic the correction, the more likely that the orthodontist will advise the use of retainers. Mostly, the retainers are to be worn at night.

The bottom line

There are many advantages of Invisalign over traditional braces for achieving a healthy, attractive smile. However, they are not appropriate for everyone. If you are considering Invisalign, it is best to consult an experienced orthodontist to best understand how these advanced aligners can address your needs.

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Some people want their teeth whitened because their pearly whites aren’t so white anymore. It’s no thanks to the food they eat (beets, certain berries), the beverages they drink (think coffee and red wine), and their overall lifestyle choices (for example., smoking) that have led to staining and discoloration.

Some people, meanwhile, undergo teeth whitening procedures or buy teeth whitening products even though the color of their teeth looks perfectly fine. They do it because they want their teeth to be as white as they can be.

Whatever a person’s reasons, there is no denying how popular teeth whitening has become these days. Tooth whitening is a popularly requested dental procedure.  The global market for teeth whitening products, in fact, is projected to reach $7.40 billion by 2024.

Myths about teeth whitening still abound

However, for all its popularity today, myths about teeth whitening still abound. Some of these myths are simply inaccurate or the whitener’s they advocate just don’t work. Worse, however, some of them can do more harm than good.

So, whatever you do, don’t believe the teeth whitening myths listed below:

  • Myth #1. You can whiten crowns, veneers, and fillings

If you already have crowns, fillings, or veneers and you had a teeth whitening procedure, then you can expect unevenly-colored teeth afterward. That’s because crowns and other corrective materials are made of inorganic matter which will never respond to teeth whitening the way your real teeth will. So if you plan to have fillings, veneers, and crowns, it’s best to do the teeth whitening first.

  • Myth #2. Oil pulling can remove stains

Many practice oil pulling, which involves swishing an edible oil, such as coconut oil, inside your mouth for a few minutes. Lifted from Ayurvedic medicine, oil pulling supposedly removes stains from your teeth and therefore leads to whiter teeth. While many may claim that oil pulling does provide certain health benefits, there is still no scientific research confirming that it is effective in whitening stained teeth.

  • Myth #3. You should avoid teeth whitening if you have sensitive teeth

Just because you have sensitive teeth doesn’t necessarily mean you can’t do anything about the stains and discoloration that stop you from showing your full smile to the public. As always, dentists are ready to address any issues you might have about any dental procedure, teeth whitening included. Chances are, he or she will recommend the use of a special toothpaste before the procedure. Your dentist will also likely use a desensitizing gel or even rubber gum guards during the treatment just to make you more comfortable.

  • Myth #4. You can whiten your teeth using acidic fruits

For those who advocate natural means of whitening their teeth, rubbing oranges, lemons, strawberries and other acidic fruits on their teeth is a popular practice. Doing so, however, does not remove stains. In fact, naturally acidic ingredients can cause serious damage by wearing away tooth enamel. Considering the fact that you can’t grow enamel back, you better avoid this teeth whitening practice.

  • Myth #5. Teeth whitening products can harm your enamel

To be fair, some of the teeth whitening products that you can buy over the counter may do some damage on your enamel or gums, especially if you overuse it. However, your teeth and gums will be perfectly fine after teeth whitening if your dentist used a high-strength whitening gel. Such gels are known to be safe and effective. Contrary to what people say, whitening doesn’t involve taking your outer tooth layer off. What it does is open the pores of the outer layer, giving the cleaning agent access to the inner tooth stains.

  • Myth #6. Teeth whitening will give you a picture-perfect smile

It’s true that most people expect a Hollywood smile after a series of whitening treatments, but in reality, results vary from person to person. Some do get that perfect smile because they have teeth that respond well to the whitening agents used on them. Some people, however, just happen to have teeth that are simply too stubborn to give their owners any favorable result despite multiple treatments. If you have teeth that are as stubborn the ones described above, then you might have to explore other options such as veneers since they may be the only way for you to get that Hollywood smile you’ve always wanted.

  • Myth #7. Professional whitening removes all tooth stains

Teeth whitening procedures and products are often advertised as the best ways to remove stains and discoloration. However, the truth is, there are some types of discoloration or stains that whitening treatment cannot eliminate. For example, as we age the enamel on our teeth wears thin. Worse, getting older means the yellow dentin layer underneath becomes more visible. The typical result is teeth take on a gray hue. No amount of teeth whitening procedures and products can make them look whiter.

  • Myth #8. Over-the-counter teeth whitening is just as good as professional whitening

If you’ve decided to DIY your own teeth whitening, then the strips, toothpaste, gum, and other teeth whitening products you can buy over the counter may help. However, comparing their effects and results to a professional whitening treatment is a case of apples and oranges. If you’re only going for a temporary removal of the discoloration on the outside of your teeth, then your store-bought products may do the job. Professional whitening administered by a dentist, however, penetrates your teeth’s deeper layers and addresses the intrinsic staining that keeps them look darker.

  • Myth #9. Teeth whitening is forever

There is no such thing as permanent teeth whitening results.

Teeth whitening is believed to last up to three years. However, the duration may differ depending on the person. For those who eat or drink teeth-staining products such as coffee, tea, and red wine, amongst many other things, the likelihood of their teeth remaining white for such a period of time is low. The same goes for those who smoke.

  • Myth #10 UV light is a safe and effective way to whiten teeth

There is no scientific evidence that UV light helps with whitening your teeth. On the other hand, UV rays may be harmful to not only your teeth but also to other nearby tissues as well including lips, gums, and even eyes. There is no reason to ask your dentist to use this procedure.

The bottom line

These are just some of the many teeth whitening myths that are making the rounds. To make sure you’re getting the facts right, make sure you consult a cosmetic dentist that you trust before starting any whitening treatment on your own.

Other dental care stories you won’t want to miss:

It’s Now Easier Than Ever to Have a Beautiful Smile.

12 Easy Diet Tips for Strong Health Teeth


This post was first published on 11/16/2018. It has been reviewed and updated for republication.