Laurence Stein DDS
Medical Moderator
Hi watergal--
The reason for my comment is that 75% of Americans have some sort of periodontal disease. We constantly try to reinforce the fact that brushing and daily flossing is absolutely necessary to maintain good gum health.
Despite all our efforts, most people seen regularly by the dentist brush for about 10 to 15 seconds, once a day and fail to floss. If they just spent two minutes, twice a day with a toothbrush and floss twice a day and anytime food is caught between their teeth the change in their periodontal health would be enormous. Even flossing just before bedtime would make a great change in their health.
Periodontal disease is caused by...(ready)...GERMS! Somehow people don't get it. Plaque is the accumulation of germs around the necks of the teeth. These germs release a tissue toxin and stimulate a local reaction in the gum tissues which, if unchecked, causes bleeding in the gums. As the toxins penetrate deeper, your body's defenses create inflammation which goes on to cause the lysis of the alveolar bone and penetration of these toxins into the periodontal ligament which supports the tooth. The ligament breaks down, germs go deeper and voila, you have periodontitis.
Each time these patients come in we see the same picture and ask if they floss. They always answer never or sometimes. Flossing must be done at least once every 24 hours if not more. More often if you have any type of restorations in your mouth. After 24 hours, the plaque starts to pick up calcium and you get the formation of tartar or calculus (same thing, different name). The surface of tartar is porous and increases the surface area that PLAQUE can
live on. So even more toxins can now be released.
Anyway, these patients with perio disease invaribly tell us that they brush--they swear--of course their teeth are covered with food debris, plaque and tartar as they are saying it and they have been spitting out a lot of blood during the cleaning. When you ask if they floss the usual answer is either sometimes or "I use a waterpic every day" At which point, I tell them again that a waterpic is not sufficient and does not replace floss. Besides, if you kept your mouth so clean why did you come in with bleeding gums and crud around your teeth (more diplomatically).
We do see improvement in patients who use the new Oral B electric brushes. The "sonic" brushes and rotary brushes are not as effective although they all make claims that they work. Frankly, almost all of todays electic brushes have timers and patients simply spend more time brushing and even that makes a big difference. When I recommend an electric brush I tell to throw their hand brush away. We are always in a rush and when given the choice of a hand brush or a timed electric, the patient picks the hand brush and 10 seconds.
Finally, "tartar control toothpastes" really don't do what YOU think they do. They do soften the tartar above the gum and that's great. But it's the tartar below the gum that counts and the toothpaste mfgs. make no claims for efficacy there. BTW, these toothpastes and "whitening" toothpastes seem to cause more cold sensitivy in some patients who use them. I just recommend a regular fluoride toothpaste with no extras. Baking soda is fine--with fluoride. Peroxide in toothpastes is not ADA approved because peroxide releases oxygen free radicals. The worry is that long term use like daily brushing might cause cellular changes and theoretically could cause damage to DNA and formation of a tumor.
So back to my statement that those who need to floss the worst end up using a waterpic instead is very common and really doesn't do much good toward fighting the disease. They get told about the importance of flossing each time we see them and only a very few are ever motivated--until they are told that the tooth is hopeless and the surrounding teeth cannot be used for restoration. Then they get religion. It is truely frustrating!
As you may be aware, there is now speculation that periodontal disease is implicated in some cases of heart attack, strokes, kidney disease, etc. The pathogens from the mouth have been found in vascular plaques--especially S. viradans.
Right now we are at a point like the Australian MD who postulated that H. pylori caused ulcers. He was laughed at and now he has the last laugh. Ulcers are usually first treated with antibiotics after a gastroscopy and Bx finding H. pylori.
This wasn't meant to be a lecture. You MDs could be VERY helpful is reinforcing the hygiene of the mouth in patients with risk factors for heart disease, stroke, kidney disease, diabetes--and probably a lot more in the future. I often ask my patients if, "when they washed their hands, their cuticles began to bleed would they think it's normal?" Then I tell them it is not normal for your gums to bleed during brushing either--it is a sign that something is wrong.
Have a great holiday season, safe diving,
Laurence Stein, DDS
The "Focal Theory of Infection" seems to be coming around again. It's been poo-pooed for years and now we are seeing local dental infections affecting distant organs.
:doctor:
The reason for my comment is that 75% of Americans have some sort of periodontal disease. We constantly try to reinforce the fact that brushing and daily flossing is absolutely necessary to maintain good gum health.
Despite all our efforts, most people seen regularly by the dentist brush for about 10 to 15 seconds, once a day and fail to floss. If they just spent two minutes, twice a day with a toothbrush and floss twice a day and anytime food is caught between their teeth the change in their periodontal health would be enormous. Even flossing just before bedtime would make a great change in their health.
Periodontal disease is caused by...(ready)...GERMS! Somehow people don't get it. Plaque is the accumulation of germs around the necks of the teeth. These germs release a tissue toxin and stimulate a local reaction in the gum tissues which, if unchecked, causes bleeding in the gums. As the toxins penetrate deeper, your body's defenses create inflammation which goes on to cause the lysis of the alveolar bone and penetration of these toxins into the periodontal ligament which supports the tooth. The ligament breaks down, germs go deeper and voila, you have periodontitis.
Each time these patients come in we see the same picture and ask if they floss. They always answer never or sometimes. Flossing must be done at least once every 24 hours if not more. More often if you have any type of restorations in your mouth. After 24 hours, the plaque starts to pick up calcium and you get the formation of tartar or calculus (same thing, different name). The surface of tartar is porous and increases the surface area that PLAQUE can
live on. So even more toxins can now be released.
Anyway, these patients with perio disease invaribly tell us that they brush--they swear--of course their teeth are covered with food debris, plaque and tartar as they are saying it and they have been spitting out a lot of blood during the cleaning. When you ask if they floss the usual answer is either sometimes or "I use a waterpic every day" At which point, I tell them again that a waterpic is not sufficient and does not replace floss. Besides, if you kept your mouth so clean why did you come in with bleeding gums and crud around your teeth (more diplomatically).
We do see improvement in patients who use the new Oral B electric brushes. The "sonic" brushes and rotary brushes are not as effective although they all make claims that they work. Frankly, almost all of todays electic brushes have timers and patients simply spend more time brushing and even that makes a big difference. When I recommend an electric brush I tell to throw their hand brush away. We are always in a rush and when given the choice of a hand brush or a timed electric, the patient picks the hand brush and 10 seconds.
Finally, "tartar control toothpastes" really don't do what YOU think they do. They do soften the tartar above the gum and that's great. But it's the tartar below the gum that counts and the toothpaste mfgs. make no claims for efficacy there. BTW, these toothpastes and "whitening" toothpastes seem to cause more cold sensitivy in some patients who use them. I just recommend a regular fluoride toothpaste with no extras. Baking soda is fine--with fluoride. Peroxide in toothpastes is not ADA approved because peroxide releases oxygen free radicals. The worry is that long term use like daily brushing might cause cellular changes and theoretically could cause damage to DNA and formation of a tumor.
So back to my statement that those who need to floss the worst end up using a waterpic instead is very common and really doesn't do much good toward fighting the disease. They get told about the importance of flossing each time we see them and only a very few are ever motivated--until they are told that the tooth is hopeless and the surrounding teeth cannot be used for restoration. Then they get religion. It is truely frustrating!
As you may be aware, there is now speculation that periodontal disease is implicated in some cases of heart attack, strokes, kidney disease, etc. The pathogens from the mouth have been found in vascular plaques--especially S. viradans.
Right now we are at a point like the Australian MD who postulated that H. pylori caused ulcers. He was laughed at and now he has the last laugh. Ulcers are usually first treated with antibiotics after a gastroscopy and Bx finding H. pylori.
This wasn't meant to be a lecture. You MDs could be VERY helpful is reinforcing the hygiene of the mouth in patients with risk factors for heart disease, stroke, kidney disease, diabetes--and probably a lot more in the future. I often ask my patients if, "when they washed their hands, their cuticles began to bleed would they think it's normal?" Then I tell them it is not normal for your gums to bleed during brushing either--it is a sign that something is wrong.
Have a great holiday season, safe diving,
Laurence Stein, DDS
The "Focal Theory of Infection" seems to be coming around again. It's been poo-pooed for years and now we are seeing local dental infections affecting distant organs.
:doctor:
