timberlake dental

Activated Charcoal and other DIY Teeth Whitening Trends

You have probably seen it as you scroll through your Facebook, Instagram or Pinterest feed: do-it-yourself teeth whitening.  The trend of attempting to whiten your teeth with “all-natural” or over-the-counter ingredients and without the endorsement of a dentist has gained widespread popularity in recent years.  It’s no surprise that everyone wants whiter teeth.  Our goal at Timberlake Dental is for you to achieve your cosmetic goals while maintaining the best possible health of your mouth. 

There are dangers associated with some of the DIY whitening trends, and it is important to know these dangers before you attempt any of the techniques promoted as “teeth whitening hacks”.

The Two Biggest Dangers: Abrasion and Acid Erosion

  • Abrasion – Abrasion is defined as a wearing away, grinding or scraping by friction.  In dentistry, it is the wearing away of surface tooth structure by friction with another surface or material.  This is one of the dangers of DIY whitening trends that use rough, coarse or abrasive materials to polish superficial stains off of enamel.  Very mild abrasion is the mechanism of action of whitening toothpastes; they contain small, coarse particles that clean the surface stains from the outer layer of enamel.  If the wrong material is used (something that is too coarse), or if an approved material is used in the wrong manner (using an ADA approved whitening toothpaste with a hard toothbrush in aggressive motions), rather than simply removing surface stains, you can actually remove enamel!  Removing enamel will make the teeth thinner, weaker, more sensitive, and ironically, yellower over time.
  • Acid erosion – Acid erosion is the gradual destruction of tooth structure by the chemical action of acid on enamel. Dentists see severe acid erosion on patients who have a habit of sucking on lemons or patients with bulimia.  Acid erosion of teeth can also be a complication of acid reflux or GERD.  Many of the DIY whitening techniques recommend using acidic fruit juices or fruit pieces, which over time, can cause acid erosion on the teeth.

Activated Charcoal Powder and Charcoal Toothpastes

Its rise in recent popularity might make you think this is a new use for charcoal, but charcoal has actually been used in oral hygiene for thousands of years.  Hippocrates documented using it in ancient Greece.  The American Dental Association has responded to the rising interest in charcoal as an oral hygiene product by publishing a literature review of all published scientific research studies regarding charcoal and charcoal toothpastes.  The goal was to find evidence in scientific research for the safety and effectiveness of using this material on the teeth. The results of the literature review state that there is not enough support by scientific research to claim that charcoal is safe for enamel and is an effective tooth whitener.  The literature reviewed showed some mixed results, and the majority concluded that there is a risk of enamel abrasion.  The literature review also included a study of 50 charcoal powders and toothpastes available for purchase on the internet, and none of them has achieved the Seal of Approval by the American Dental Association.

In short, activated charcoal cannot be deemed safe by dentists for use on teeth.

DIY Teeth Whitening using Lemon Juice

Many other home whitening trends advise you to mix lemon juice with baking soda for a homemade whitening toothpaste.  Another technique recommends rubbing your teeth with the inside of a banana peel, and one site calls for a paste made from strawberries.  All of these fruits are acidic (lemon juice = 2, strawberries = 3.0-3.9, and bananas = 4.5-5.2) and are not meant to stay in contact with your teeth for longer than it takes to eat them.

You should never purposefully apply any acid to your teeth. 

The enamel is weakened, increasing your cavity risk, causing tooth sensitivity, and irreversibly damaging the teeth.

Still Interested in DIY Teeth Whitening?

Please discuss your ideas with Dr. Chowning.  He will be able to advise you on which specific techniques may be safe for you and which could be especially dangerous.  He can also answer any questions about the safety and effectiveness of professional teeth whitening offered at Timberlake Dental.  Call 940-382-1750 today to schedule a whitening consultation with Dr. Chowning.

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Aphthous Ulcers (Canker Sores)

If you have never had a mouth ulcer, thank your lucky stars!  They are terribly painful and interfere with eating, speaking, and brushing your teeth.  The most prevalent type of mouth ulcer is an aphthous ulcer, and it is commonly referred to as a canker sore.  Aphthous ulcers are unusual in that, even now in 2018, we still do not know exactly what causes them.  There are many studies showing correlation between certain diets, vitamin deficiencies, hormone changes, and stress levels with the occurrence of aphthous ulcers.  But correlation is not the same as causation.

What are aphthous ulcers?

There are three main types of aphthous ulcers: 1) minor, 2) major, and 3) herpetiform.  They all share similar appearance of a round or oval-shaped ulcer with an inflamed red border around a yellowish-white film that covers the deeper ulceration.

  1. Minor aphthous ulcers are the most common and least painful. They typically are less than 1 cm in diameter and last for 7-14 days.
  2. Major aphthous ulcers are much larger, up to 3 cm, and can last over a month. Due to their increased size and duration, they are much more painful.
  3. Herpetiform aphthous ulcers take their name from herpes lesions (also called cold sores) caused by a Herpes Simplex Virus, which occur in clusters. Herpetiform aphthous ulcers also occur in clusters and can easily be misdiagnosed as viral sores.  Herpes viral sores and aphthous ulcers differ in cause and location.  There is no virus associated with aphthous ulcers, and they only occur on freely movable mucosa.  This includes the inner lining of the lips, cheeks, tongue, floor of mouth and the soft palate.  Herpes lesions, or cold sores, occur on the outside of the lips or any attached gum tissue like the hard palate or gums covering the teeth.  When herpetiform aphthous ulcers form in a cluster, the ulcers often coalesce or blend together to form one very large, very painful ulcer.

What causes aphthous ulcers?

There is currently no scientific data identifying one specific cause of these ulcers.  The research studies have shown a correlation in the occurrence of aphthous ulcers with certain predisposing factors, listed here.

  • Genetics – Some studies suggest a genetic component because children are much more likely (90%) to experience aphthous ulcers if both of their parents have had them.
  • Certain GI problems – There is a high correlation between patients who experience aphthous ulcers and those with gastrointestinal issues like ulcerative colitis, Crohn’s disease and Celiac Disease.
  • Vitamin deficiencies – Some studies show a correlation between patients with aphthous ulcers and low levels of iron, vitamin B12, and folic acid.
  • Hormone levels – Many women experience aphthous ulcers at regular intervals correlating to their menstrual cycle.
  • Stress – Because stress cannot be quantitatively measured, this one is difficult to prove scientifically. But it’s no surprise to people who suffer with these ulcers that stress can make them more likely to appear.

  • Trauma – This is likely the most common cause of aphthous ulcers. Trauma can range from anything as simple as accidentally biting the inside of your lip or hitting your gums with the toothbrush to routine dental treatment or a complicated oral surgery procedure.

How are aphthous ulcers treated?

There are many ways to treat the painful symptoms of aphthous ulcers, but there is no cure to prevent them from recurring.  There are many options available, and it is best to discuss them with Dr. Chowning to figure out which one is best for your specific ulcers.  Some of the possible treatment options are listed here.

  • A topical gel or paste – Usually a prescription product, this is applied to the ulcer with a Q-tip or clean fingertip multiple times a day. It typically contains a steroid, which reduces the severity and duration of the ulcer, but does not change the frequency of occurrence.
  • A prescription mouthwash – Also used to alleviate symptoms only, this can contain an antibiotic, antifungal, steroid anti-inflammatory, antihistamine (like Benadryl), and antacid (which creates a thick coating over the oral lining). When used 4-6 times per day, it can reduce the symptoms of the painful ulcers.
  • Laser treatments – A laser can be used to treat the ulcer, which reduces inflammation and speeds up the healing process by making changes to the surface of the ulcer.
  • Dietary changes – Patients who are afflicted with frequent or multiple aphthous ulcers and have celiac disease or a gluten intolerance show a marked reduction in ulcer occurrence when gluten is eliminated from their diet. A very recent study has also shown an improvement in occurrence of ulcers when a dairy-free diet is observed.  This is based on a new study showing a higher level of antibodies to cow’s milk proteins in patients who have aphthous ulcers.
  • Vitamin therapy – In patients who do show deficiencies in iron, vitamin B12, and folic acid and experienced frequent aphthous ulcers, the ulcer occurrence rate decreased after vitamin therapy to treat those deficiencies.

What can you do about aphthous ulcers?

The most important step you can take is contacting your dentist as soon as you notice the lesion.  All of the above treatment modalities are most effective when started early in the life of the ulcer.

Ulcers are aggravated by acidic foods, spicy foods, and hot temperatures, so avoid them in order to reduce your painful symptoms.  Use caution when eating and talking so that you do not reinjure the area and cause the ulcer to last longer.  Cold can temporarily alleviate symptoms, so we do recommend drinking ice water and holding a piece of ice against the ulcer until you see the dentist for other treatment options.

Do you think you have an aphthous ulcer?

Call our office at 940-382-1750 to see Dr. Chowning for an evaluation.  He will help you get started on the best treatment to reduce the pain and length of your ulcer.

Over-the-Counter Products We Love

At Timberlake Dental, we understand that not all people have the same dental problems.  Because of our unique, individualized approach to risk management in dental care, we often give our patients specific recommendations for dental products that improve oral health in a specific area of risk.  We strongly believe that each person should use a customized oral hygiene regimen aimed at fighting his or her specific risk factors.

We also listen to our patients and seriously consider their complaints and concerns.  We make recommendations for products to alleviate problems or irritations that do not necessarily cause dental disease.  Our goal is to improve the quality of life for every patient we see.  We believe some of these products can do just that.

Biotene

Biotene is a brand of oral health products that we love.  Biotene is hypoallergenic and mild.  It does not contain any harsh chemicals that can irritate sensitive tissues inside the mouth.

The most common condition for which we recommend Biotene is dry mouth.  A dry mouth is usually a sensitive mouth.  Biotene’s gentle formula will not burn, sting or irritate your gums, lips, cheeks and tongue.

Biotene products include toothpastes, mouthwash, dry mouth gel and dry mouth spray.  If your mouth is extremely dry, you should be using the entire line of Biotene products.  The gel helps moisturize a dry mouth and is great for nighttime dryness.  The spray is perfect for periodically moisturizing the mouth throughout the day.

Who Should Use Biotene?

  • People who take multiple prescription medications causing dry mouth as a side effect
  • People suffering from multiple mouth ulcers
  • People who have lost salivary function due to cancer treatments
  • People suffering from Burning Mouth Syndrome or other soft tissue disorders that cause the inside of the mouth to be extremely sensitive

Crest Sensi-Stop Strips

Do you drink room temperature water?  Do you dread taking a bite of ice cream?  If your teeth are sensitive, Crest Sensi-Stop Strips might be your new favorite dental product.

Crest Sensi-Stop Strips treat tooth hypersensitivity through the application of an active ingredient that is different from those of other products aimed at sensitive teeth.  According to Crest’s research, the ingredient oxalate blocks the tiny pores on a tooth surface, which allows cold sensations to reach the nerve inside the tooth.  By blocking these pores, the nerve is insulated from the cold temperature, stopping sensitivity in its tracks.

These strips are also unique in their delivery method.  As opposed to the typical forms of a toothpaste or mouthwash for sensitivity, these strips are applied directly to the sensitive tooth surface.  Studies show that using Crest Sensi-Stop Strips three days in a row for 10 minutes each day relieves tooth sensitivity for over a month!

Who Should Use Crest Sensi-Stop Strips?

Only patients who have seen a dentist recently and ruled out other important causes of tooth sensitivity, including cavities and cracks!

CocoFloss

CocoFloss is a relatively new brand of floss, and it’s just fun!  Not only is it a truly great way to clean your teeth, it comes in a variety of yummy tropical flavors.  CocoFloss’s packaging is bright and stylish; it makes you feel like you have just splurged on a designer purchase.

CocoFloss is so named because it contains coconut oil to soothe and nourish your gums.  It also uses thick fibers to gently scrub the sides of the teeth.  It is great for teeth with small gaps that may be difficult to clean with regular floss.

Designed by a dentist and made in Italy, it is currently available online only.

Who Should Use CocoFloss?

Anyone who wants to up their flossing game!

Any Electric Toothbrush

You know we love electric toothbrushes.  They just clean teeth better than manual toothbrushes do.  We truly believe everyone is better off brushing with an electric toothbrush.

Multiple scientific research studies show better plaque removal with electric toothbrushes.  Better plaque removal means lower risk for cavities and gum disease.

A few of our favorite electric toothbrushes include the Oral B Sonic Complete and the Philips Sonicare.  These two have the best plaque removal by far.  The new quip toothbrush is very small, quiet and affordable.

Who Should Use an Electric Toothbrush?

Everyone!  But seriously, here is a list of people who would greatly benefit from an electric toothbrush.

  • Elderly people who have noticed a decrease in their manual dexterity due to conditions like Parkinson’s disease or arthritis
  • People with special needs
  • Children
  • People with high risk for gum disease

Phos-Flur

Phos-Flur is a mouthwash made by Colgate that has a high concentration of fluoride.  It was originally available with a prescription only, and now is for sale over-the-counter.  It was created to fight the white spots, called demineralization, that often occur around braces.

Phos-Flur’s high concentration of fluoride strengthens enamel and fights the cavity-causing bacteria in plaque.  Because of this ability to combat decay, this mouthrinse is great for anyone who is prone to cavities, as well as anyone wearing braces.

Who Should Use Phos-Flur?

  • Patients wearing orthodontic braces
  • Patients with more than one new cavity at your last dental evaluation
  • Patients with a large amount of dental work (lots of fillings, crowns, etc . . .)

Ice Cubes Gum

This is the one product you won’t find in the dental aisle at Walmart.  It is at the checkout counter.  Ice Cubes gum, by Ice Breakers, is the easiest and most flavorful way to fight cavities.

Research has shown that xylitol, a natural sweetener found in plants, has the ability to kill harmful bacteria in the mouth.  Xylitol is a sugar alcohol that bacteria ingest but cannot digest.  There are multiple dental products containing xylitol, including toothpastes, mouthrinses, mints and gum.

Ice Cubes gum contains 2 grams of xylitol per piece, which is as high as, if not higher than, any other mint or gum on the market today.  Studies show a decrease in cavity risk when you chew 5-6 pieces of xylitol containing gum each day.

Who Should Chew Ice Cubes Gum?

  • Any patient with a high cavity risk
  • Patients with dry mouth problems
  • Children with a moderate or high cavity risk
  • PATIENTS WITH TMJ PROBLEMS SHOULD NOT CHEW GUM!

What OTC Dental Products do You Love?

Is there something we did not mention that you love?  Let us know what your favorite over-the-counter dental products are!  Call 940-382-1750 today to schedule a consultation with Dr. Chowning or our wonderful dental hygienists to discuss what products are right for you.

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Retainers: What You Need to Know

Straight teeth do not stay straight on their own.  They need help to keep their position.  Retainers do just that.  They retain the position of teeth in their correct place.

Why Do I Have to Wear a Retainer?

If your teeth have been straightened, you must wear a retainer regularly to keep them straight.

If your teeth have not been straightened, you might want to consider wearing a retainer regularly.

Here’s why:

It is a natural part of the aging process for teeth to get more crooked over time.  As we chew, the teeth rub against their neighboring teeth, and this friction removes small amounts of enamel over time.  The teeth get skinnier from side to side.

In order to prevent small gaps from opening, the teeth slowly shift forward.  This forward shift is natural, and it results in crowded or crooked teeth.

This happens whether or not your teeth were previously straightened.  The process is usually more obvious to people who had braces when they were young.

How Long Do I Have to Wear My Retainers?

We have a slightly sarcastic, but very true, answer to this question. You only have to wear it as long as you want your teeth to be straight.  Seriously.

Because of the aging process described in the previous section, crowding is inevitable for most people.  If you straightened your teeth, you made a significant investment in your beautiful smile.  Wearing your retainers regularly is the only way to keep it beautiful.

How Often Do I Have to Wear Retainers?

The answer to this question varies.

Some people have teeth that are prone to shifting as soon as the retainer is taken out each morning.  This type of scenario requires wearing retainers every night.

There are others whose teeth move very slowly, and the risk for shifting is less urgent.  A patient like this may be able to get away with wearing retainers twice a week.

No one should ever go more than one week without wearing retainers.

What Types of Retainers are Available?

There are many different types of retainers available today.  At Timberlake Dental, we offer a few select types of retainers, and we help our patients chose which one will best meet their needs.

Removable Retainers:

All of the statements made above regarding how long and how often you should wear retainers are based on the assumption that your retainer is removable.  Removable retainers are the most common type made today.

Pros:

  • Removable retainers are typically less expensive.
  • Retainers you can remove allow you to keep your teeth as clean as possible.

Cons:

  • A removable retainer requires you to cooperate with your dentist’s specific recommendations for how often to wear it. If you do not wear it, it cannot do its job.
  • Removable retainers can be lost or broken more easily.
  • Retainers that are removable will loosen and wear out over time. When this happens, they do not retain the teeth as well and need to be replaced.

In general, there are two different kinds of removable retainers.

  1. Esthetic Retainer – These clear plastic retainers cover all exposed surfaces of the teeth. They are great for maintaining the straightness of the teeth and holding the bite in its exact prescribed position.
  2. Acrylic and wire retainers – Also called Hawley retainers, these removable retainers have an acrylic base with a wire that wraps around the front of the teeth. A Hawley retainer will hold the teeth in their position front-to-back and left-to-right.  It does not hold them in a specific bite.  This allows the teeth to “settle” into a comfortable bite.  The wire can be adjusted to tighten or loosen the retainer as needed.

Glued-In Retainers:

A retainer that is glued to your teeth is called a fixed retainer.  A fixed retainer is composed of a wire that is bent to perfectly line the inside surface of the teeth. This wire is bonded to the teeth with an adhesive material that has a strong attachment to enamel.

Fixed retainers work well for lower teeth, but they are not always appropriate for upper teeth.  In most cases, attaching a metal wire to the backside of upper front teeth would interfere with the bite.  Only in rare cases will a fixed retainer work for upper teeth.

Pros:

  • Fixed retainers cannot be removed so no patient compliance is required. You don’t have to remember to wear them because they are always in place.
  • Retainers that are glued to the teeth are long-lasting.
  • They are unlikely to get lost or broken.

Cons:

  • Fixed retainers create an oral hygiene challenge. The wire prevents normal flossing and requires some extra effort, special tools, and different flossing techniques.
  • Retainers that are glued in typically only cover the front 6 teeth, so they do not prevent movement of the other teeth in the mouth.
  • They are not a good choice for upper front teeth.
  • They do not protect a correct bite relationship.

Do Retainers Last Forever?

No.

Removable retainers often loosen and wear out over time.  Fixed retainers can also break or come unglued to the teeth.

It is important to keep up with the proper maintenance on your retainers, no matter what type you have.  Bring your removable retainers with you to your professional teeth cleaning visits.  We will clean them and ensure the proper fit.  We will also evaluate them for wear and tear to let you know when a new one is necessary.

How Much Do Retainers Cost?

The cost varies based on the type of retainer.  In general, removable retainers are less expensive than fixed retainers.  Some retainers perform additional functions and cost more.  Dr. Chowning will go over the cost of each type of retainer with you and help you select the best one for your needs.

What if I Need a Nightguard for Grinding?

Some nightguards are dual purpose and act as a retainer to maintain the position of the teeth.  When picking out a retainer, make sure to tell your dentist if you’d like one that will function as a nightguard to protect the teeth from grinding.

Need a Retainer?

Call us today at 940-382-1750 to schedule a consultation with Dr. Chowning.  He will assess your retainer needs, discuss the available options with you, and help you choose the best retainer!

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Are Energy Drinks Bad For Your Teeth?

Energy Drinks

Red Bull gives you wings, but it may also give you cavities.  Energy drinks are defined as “any of various types of beverage that are considered a source of energy, especially a soft drink containing a high percentage of sugar and/or caffeine or other stimulant”.  The most common brands of energy drinks sold in the U.S. are Red Bull, Monster, and RockStar.  In 2015, Red Bull had $4.55 billion in sales.  While the soda industry is noticing a slow, steady decline in sales, the energy drink industry is steadily climbing.

What is in an Energy Drink?

  • Caffeine – Energy drinks contain a varying amount of caffeine, some as high as 160mg, which is equivalent to a Starbucks coffee. If you would not let your child drinks a strong coffee at Starbucks, you should not let them drink energy drinks.
  • Taurine – Taurine is an amino acid, present in most energy drinks, that shows no actual evidence of providing any energy at all.
  • Guarana – A plant native to the Amazon region, guarana berries contain a very high concentration of caffeine. Guarana is an ingredient in both Monster and Rockstar energy drinks.  If you see both caffeine and guarana listed as ingredients in your energy drink, it’s a double whammy, and you should proceed with caution.
  • Lots and lots of sugar – An 8-oz serving of Monster energy drink contains 27g of sugar, which is the exact amount of sugar in an 8-oz serving of CocaCola.  The important thing to remember is that most people buy both energy drinks and sodas in 16-oz bottles or cans.  If you drink a 16-oz energy drink, the amount of sugar is doubled to 54g, which is far higher than anyone’s recommended daily allowance.

How Do Energy Drinks Cause Cavities?

Energy drinks cause cavities in the same way sodas cause cavities: high sugar content, and very acidic pH.  It is important for both parents and children to understand that energy drinks offer no health advantages over sodas; in fact, they are more harmful due to the high levels of caffeine they provide.

  1. Sugar – The bacteria which is naturally present in mouths ingests (eats) sugar, and the by-product is an acid. When this acid stays in contact with the enamel surface, it begins to etch or weaken the outer layer of enamel.  This process is the beginning of a cavity.  The more sugar you drink, the more you are feeding the bacteria in your mouth, enabling them to cause damage to your enamel.
  2. pH – All energy drinks, even the sugar-free versions, have a very low pH. Rockstar Sugar Free has a pH of 3.15, Red Bull Sugar Free is 3.39, and Monster Low Carb is 3.60.  These pH measurements are well below (more acidic than) the threshold of 5.5, at which enamel begins to soften and become susceptible to decay.  Consistently drinking very acidic drinks predisposes you to a high risk for cavities.

What if I Can’t Give Up My Energy Drink?

As with sodas and sparkling waters, you can minimize the damage to your teeth by high sugar, acidic drinks if you limit them to mealtime only.  Drink them quickly and while you are eating.  The saliva stimulated by your chewing and tasting food will counteract the acid in the energy drink.

If you have a dry mouth, you are at a much higher risk for developing cavities from energy drinks.  Please ask Dr. Chowning how you can address your dry mouth issues and still enjoy an energy drink from time to time.

After having your energy drink, chew sugar-free, xylitol gum for 20 minutes.  Chewing gum stimulates saliva production and can bring the pH in your mouth back up to neutral more quickly than it can without chewing gum.

Know your cavity risk.  Unfortunately, some people are much more prone to cavities than others.  You should know your risk and take the necessary steps to lower that risk as much as possible.  If you do not know your level of cavity risk, call our office at 940-382-1750 to set up an evaluation with Dr. Chowning.

More Questions about Energy Drinks?

Call our office today to schedule a consultation with Dr. Chowning or one of our awesome dental hygienists.  They can answer specific questions about your teeth, your risk for cavities, and the effect of energy drinks.  It is very important for those who enjoy energy drinks to stay consistent with their dental visits for professional teeth cleanings!  Are you on track with yours?  If not, call today to get scheduled.

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Athletic Mouthguards

People say that having children involved in sports is expensive.  In dentistry, we commonly see one of the most expensive aspects of sports: injuries.  The bad news is that the injuries themselves are sometimes unavoidable.  The good news is that the damage to the teeth, gums, lips, cheeks and jaws associated with sports injuries is largely preventable by wearing an athletic mouthguard.

Sports injuries to the face are very common and very expensive.  A research study on the use of athletic mouthguards cited some interesting statistics.

“The U.S. surgeon general’s report on oral health identified sporting activities as one of the “principal causes of craniofacial injuries.” Studies have linked sporting activities to nearly one-third of all dental injuries, and approximately one in six sports-related injuries is to the craniofacial area.”

Who needs an athletic mouthguard?

Most people associate sports injuries to the teeth with contact sports like football and hockey.  Interestingly, even non-contact sports such as baseball, gymnastics and cycling have a high incidence of injuries to the mouth.  If there is any chance you could be hit in the mouth by another person, a ball, or the ground, then you need an athletic mouthguard.

How do athletic mouthguards work?

Mouthguards work to prevent or lessen the severity of many types of damage to the mouth that can occur during a sports injury to the face and jaws.  They function by covering the teeth, separating the lips and cheeks from the teeth, and separating the upper and lower teeth from each other.  These three mechanisms of action are listed below with which types of injuries they can prevent or lessen the severity.

  • Covering the teeth – This covering prevents or lessens the severity of various injuries to teeth. Examples of injuries to the teeth during sports include:
    • Chipping
    • Luxation (forced movement of the tooth out of its natural position)
    • Root fractures
    • Avulsion (a tooth is knocked completely out with the entire root)
    • Intrusion (a tooth being forced into its socket so that it looks shorter than normal)
    • Necrosis (death of the nerves and blood vessels inside a tooth from blunt force)
  • Separating the lips and cheeks from the teeth – This separation prevents or lessens the severity of various injuries to the soft tissues of the mouth.
    • Cuts or lacerations to gum tissue, lips, cheeks, and intraoral muscle attachments
  • Separating the upper and lower teeth from each other – This separation prevents or lessens the severity of various injuries to the teeth and jaw joints by preventing a harsh impact of upper and lower teeth and jaws.
    • Condylar fractures – The condyles are the “balls” of the ball-and-socket jaw joints. A sharp impact between the upper and lower jaws can cause a fracture of the jaw bone just underneath the condyle.
    • Dislocation of TMJ (jaw joint) disc – The jaw joints each contain a small cartilage disc that separates the ball from the socket. When the lower jaw is hit with an impact, it can force the condyle (ball) off its correct position on the disc.  This leads to TMJ dysfunction and may require surgical intervention to repair.
    • Broken back teeth – Any time the upper and lower teeth are forced together with high forces, the back teeth can crack and break. Sometimes, they can be repaired through dental restorations; in other cases, the tooth has a hopeless long-term prognosis and must be extracted.

An important thing to note is that these problems can have long-term consequences requiring dental treatment for decades after the injury.

What types of athletic mouthguards are available?

There are three main types of mouthguards: stock, boil-and-bite, and custom.  The stock and boil-and-bite type mouthguards are available over the counter, and a dentist makes the custom mouthguard.  Because a custom mouthguard is made from a model of a patient’s teeth, it will have a better fit and should be very comfortable.  There is typically a direct correlation between cost and comfort; i.e. a stock mouthguard will be very inexpensive and very uncomfortable.  The more comfortable a mouthguard is, the more likely the athlete will be to wear it regularly.

How do I take care of my athletic mouthguard?

  • Do not clench on the mouthguard or chew it while you are wearing it. This will speed up the normal wear and tear and cause you to need a replacement much sooner than average.
  • After every use, rinse it. The best thing to do is to clean it with a soft toothbrush and cold water.  You can use liquid hand soap if necessary.
  • When not in use, store it in its vented case in a cool, dry area.
  • Do not allow it to get hot because it will lose its shape. This includes leaving it in your car!

Does your sports-playing child need an athletic mouthguard?

Call 940-382-1750 today to schedule a consultation with Dr. Chowning.  He will discuss which risks go with your child’s specific sport and give you recommendations to reduce his or her chance of injuries to the teeth.

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Is Flossing Really That Important?

Let’s talk about flossing.

We know.  No one wants to floss.  Recent statistics show that Americans can be roughly divided into thirds when it comes to flossing habits.  Just under 1/3 of the population floss every day.  Just over 1/3 of the population floss sometimes.  And the rest admit to never flossing.  Never.  That hurts our dentist-hearts.

Many of our patients have shared that they feel guilty when we ask about flossing.  We do not ever want to make anyone feel guilty.  We simply want to know where you stand on the flossing issue so that we can point you in the right direction.  Our goal is to encourage you to have great oral hygiene habits so that your visits to see us consist of maintenance only, not repair.

What does flossing accomplish?

A toothbrush mechanically removes soft buildup on the exposed surfaces of teeth.  The bristles have to touch the tooth to be effective.  Many areas of tooth structure are not accessible with a toothbrush, namely in between the teeth.  A toothbrush can effectively clean the cheek side, the tongue side, and the biting surface of teeth.  It simply cannot reach the side of a tooth that faces an adjacent tooth (called the interproximal surface).

Flossing removes plaque and food debris that your toothbrush leaves behind.  By physically touching the interproximal surfaces of the teeth, floss does the job that a toothbrush cannot.

Benefits:

Increased life expectancy – Some studies claim an increase of 6.4 years for people who floss daily over those who do not.  This is likely an assumed benefit based on the reduced risk of other diseases, which itself is another benefit of flossing.

Reduces risk of heart disease, cavities, gum disease – It is no surprise that flossing reduces the risk of dental disease.  Anything that keeps the teeth and gums free from harmful bacteria will lower the risk of cavities and gum disease.

Over the last 20 years, new research has shown a significant link between oral health and systemic health.  Patients with periodontal disease are more likely to have cardiovascular disease.  People who suffer from severe dental disease are more likely to develop oral cancer.  There is a proven connection between diabetes and gum disease.  All of these associations make it clear that keeping your mouth healthy is beneficial for the whole body.

Improves bad breath – Bad breath is the product of bacteria and food debris that is left in the warm, moist environment of the mouth.  A good, but gross, analogy is that the mouth is like a kitchen trash can.  Flossing is like taking out the trash.  When you neglect it, it starts to stink.

Gives gums healthy pink appearance – A beautiful smile involves more than just the teeth.  Straight, white teeth surrounded by swollen, red, or receding gums cannot be considered beautiful or healthy.  Flossing removes the source of gum inflammation (called gingivitis), which keeps them healthy.  Healthy gum tissue is light pink in color, flat (not swollen, bulbous, or rounded), and does not bleed when brushed or flossed.

Proper technique:

Not just any old flossing will do.  In order for the floss to actually remove buildup from the teeth, it must touch the teeth.  Simply snapping floss in between each tooth contact and hitting the gums can miss a large portion of the tooth.  For effective flossing, envision the following diagram with a triangle between each tooth.

Holding an end of the floss in each hand, first press back with both hands to wrap the floss around the rear tooth.  Using an up and down motion, rub the floss against the side of the tooth labeled on the diagram as side #1 of the yellow triangle.

Then pull forward with both hands to wrap it around the forward tooth.  Using the same up and down motion, clean side #2 of the yellow triangle.

Before pulling the floss out, use a gentle sweeping motion along the bottom of the triangle (side #3 on the yellow triangle) if there is any open space between the teeth to remove large pieces of debris that may have become lodged there.  This step is necessary when the gum tissue does not completely fill in the triangular area.  If you do not have gum recession or areas between the teeth called black triangles (described below), you may omit this step.

Adjuncts:

In some cases of overlapped teeth or teeth with large gaps, it is necessary to use additional tools to properly clean between the teeth.

Waterpik – A Waterpik is a tool that uses water or mouthwash at high pressure to flush out the areas between the teeth.  This is a great tool for patients with braces, large areas of “black triangles”, or problems with handling floss (such as arthritis).  Black triangles develop when the gums no longer completely fill the space between two teeth, as shown in the diagram.  This open space allows food and bacteria to collect and presents an additional cleaning challenge.  A Waterpik creates a power wash for these hard-to-clean areas.  It is not a replacement for flossing.

Interproximal brushes – Another great tool for black triangles is a small angled brush called an interproximal brush.  Brand names include GUM Soft-Picks, Proxabrush, Go-Betweens, and Interdental brushes.  They look like tiny pipe cleaners or bottle brushes and are made to fit between the teeth and gently scrub the side of each tooth.  Please use caution with these tools.  Aggressive use of an interproximal brush could create black triangles and gum recession.  Only a light, gentle touch is necessary to remove plaque and food debris from between the teeth.

Do you have more questions about flossing?

If you have questions this blog did not answer or would like an in-person demonstration of the proper flossing technique, please call 940-382-1750 to set up a consultation with Dr. Chowning or one of our dental hygienists.  They will create a customized hygiene plan for you to keep your teeth as clean as possible.

 

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Xylitol: A Sugar that is GOOD for Your Teeth

What is xylitol?

Xylitol is a natural sweetener derived from the fibrous parts of plants, and it a healthy substitute for sugar. Xylitol is not an artificial substance, but a normal part of everyday metabolism.  It is widely distributed throughout nature in small amounts. It does not break down like sugar (which turns into acid when the bacteria in the mouth digests it) and can help keep a neutral pH level in the mouth.

Xylitol also prevents bacteria from sticking to the teeth, increases saliva flow, and is shown to stimulate remineralization of teeth. Research studies have shown a reduction in the levels of Streptococcus mutans (the bacteria that causes cavities) in plaque and saliva with a consistent daily dose of xylitol chewing gum. All of these factors promote good oral health.

Who could benefit from xylitol products?

High risk for cavities – Because it helps reduce the levels of cavity-causing bacteria, patients who have a high risk for cavities will benefit from xylitol products.  In addition to reducing bacteria, it also increases the flow of saliva, which is the body’s natural defense against acid, which causes cavities.

Plaque control – Because it helps reduce plaque formation, it is very helpful for patients who lack the manual dexterity to properly brush and floss their teeth.  This includes young children, elderly people, people with special needs or those affected with arthritis.

Dry mouth (or xerostomia) – Due to its salivary stimulation, xylitol chewing gum is a great product for anyone suffering from dry mouth.  It will cause the mouth to naturally produce saliva and alleviate the symptoms of dry mouth.

How can I use it to improve my oral health?

You may see xylitol as an ingredient in many over-the-counter products such as gum and mints. It is also available as a sugar substitute, found at most health food stores.  Read the label to find out how much xylitol is present. Research studies vary in their conclusions as to how much xylitol is necessary to prevent cavities.

An average recommended xylitol intake for reducing your cavity risk is 6-10g per day.   Studies have also shown that chewing xylitol gum has a greater anti-cavity effect than sucking on xylitol mints because the chewing motion also increases your saliva production, which helps neutralize the pH in your mouth.

Ice Cubes gum by Ice Breakers has over 1.5g of xylitol per piece!  It comes in many flavors and is available at most grocery stores, including Walmart.  The only patients that should not use xylitol chewing gum are those with TMJ problems.  If you suffer from clicking, popping or locking of the jaw joints, chewing gum could aggravate your symptoms and cause joint pain.  Ask your dentist if chewing gum could be problematic for you.

IMPORTANT!  Xylitol is toxic to dogs!

Make sure you keep any xylitol products out of reach of your pets.  Xylitol is highly toxic to dogs.  It can cause low blood sugar, seizures, liver toxicity and even death.  If you find that your dog has gotten into a container of any xylitol product, call your veterinarian immediately.

Want to find out if xylitol could help reduce your risk for cavities and gum disease?

Call our office at 940-382-1750 to set up an evaluation with Dr. Chowning.  He will assess your cavity risk and tell you if you should add xylitol to your daily diet.

 

Are Your Hormones Making Your Gums Bleed?

What is hormone-induced gingivitis?

Hormone-induced gingivitis is a type of gingivitis that occurs specifically during changes in hormonal levels .  It is a very common condition that we see frequently in our office.  Hormone-induced gingivitis causes a patient to have gums that are swollen, red, tender, and bleed easily.   The tenderness and bleeding often make oral hygiene routines uncomfortable, and patients sometimes avoid proper brushing and flossing techniques because it hurts.  Healthy, natural gum tissues are light pink, relatively flat and tightly adhered to the teeth.  The appearance of bright red, puffy gums is unsightly, giving a diseased look to the mouth, and may cause embarrassment.

What causes hormone-induced gingivitis?

The name says it all: it is induced by hormones.  Rapid swings in hormone levels (most notably estrogen, progesterone, and chorionic gonadotropin) can have a profound effect on gum tissues.  Research has shown that these hormone levels cause two important changes to occur:

  • Hormone changes affect the tiny blood vessels in the gum tissue, increasing the blood flow in this area (which can cause swelling) and changing the permeability of the blood vessels (which makes the tissue bleed more easily).
  • Hormone changes also affect the types of bacteria present in gum tissues. Research shows that gum tissues in patients with hormone changes such as pregnancy or taking birth control pills have more dangerous bacteria than patients without hormone changes.  By “more dangerous”, we mean stronger and more likely to cause gum disease.

Who is at risk for hormone-induced gingivitis?

Hormone-induced gingivitis is common in children going through puberty, both girls and boys.  It is also prevalent in women at various stages of hormone changes, including menstrual cycles, the use of birth control pills, pregnancy, and menopause.  This higher risk for gum disease makes oral hygiene even more important than it already is.  People with poor oral hygiene are more likely to experience hormone-induced gingivitis than those with good plaque control and consistent oral hygiene habits.  People who have infrequent and inconsistent dental cleanings are also at an increased risk.

What can you do about hormone-induced gingivitis?

  • Practice perfect oral hygiene. Do not miss a single day of flossing!  Use an electric toothbrush; they are shown to effectively remove more plaque than a manual toothbrush.
  • Add a mouthwash to your oral hygiene routine, and use it twice daily. In addition to an over-the-counter alcohol-free mouthwash, you can swish with warm salt water throughout the day.  Some patients require a prescription mouthwash to get the inflammation under control.
  • Stay on schedule with professional dental cleanings. Your dental hygienist is able to remove bacterial buildup from areas you might be missing, even with good oral hygiene.
  • Consider increasing the frequency of professional dental cleanings. Many of our patients with severe gingivitis during puberty or pregnancy have their teeth cleaned every 3 months, instead of every 6 months.  This reduces the severity of gingivitis by reducing the amount of bacterial buildup accumulated between cleanings.
  • Talk to Dr. Chowning about other recommendations he may have to improve your gingivitis. There are many additional oral hygiene products available to help reduce gum inflammation.  He will determine which one will be most beneficial for your unique situation.

Think you or your child may have hormone-induced gingivitis?

Call our office at 940-382-1750 to set up a consultation with Dr. Chowning.  He will provide you with all the tools you need to fight gum disease while your hormones are raging.

Do I Really Grind My Teeth?

Some of our patients are surprised when we tell them that we see evidence in their mouths of teeth grinding, or bruxism.  Many people have no idea that they are grinding their teeth.  And what happens very frequently is they come back in six months and say, “You know . . . I think I might be grinding my teeth.  Ever since you told me that six months ago, I’ve been noticing {insert symptom here}.”

Signs vs. Symptoms

In order to explain this phenomenon of a dentist telling the patient about something they are doing which they are unaware of, it is important to understand signs vs. symptoms.  Signs are objective, observable facts.  This means they are not swayed by opinions or feelings, and they can be shown by a photograph, an x-ray or other type of image, a lab result, etc…  Signs are noted by the dentist during an evaluation of your mouth.  Signs can exist without any symptoms, so it is possible that a dentist can inform you of the signs of a condition without your being aware of any issues.

Symptoms are subjective evidences of a condition or disease of which the patient is aware.  For instance, pain is a symptom because it cannot be observed, and the patient must describe it to their doctor for it to be properly documented and used to aid in diagnosis.  Other examples of symptoms include anxiety, fatigue, or muscle tension.

Bruxism (Teeth Grinding)

Bruxism is a very common condition in which a person closes the upper and lower jaws, creating high pressure on the teeth, gums, supporting jaw bones, facial muscles and jaw joints.  It can include hard squeezing called clenching, or a side-to-side or back-and-forth movement called grinding.  When bruxism occurs, it will manifest in one or more clinical signs and possibly some symptoms.

Signs of Bruxism

  • Attrition – the flattening of the biting surfaces of teeth and loss of enamel caused by clenching or grinding
  • Potholes – a specific type of attrition where the enamel has been worn through, and the underlying dentin is exposed and worn down into a concavity
  • Gum Recession – movement of the gum attachment away from stressful biting forces on the tooth to a position further toward the root, can cause exposure of the root and tooth sensitivity
  • Tooth Abfraction – a loss of tooth structure at the gumline causing a notch or concavity
  • Facial Muscle Enlargement – as with any other muscle in the body, when exercised frequently, they will enlarge
  • Linea Alba – Latin for “white line”, this is a visible line on the inside of your cheeks caused by friction against the grinding teeth, like a callous
  • Scalloped Tongue – the sides of your tongue can be pressed against the inner surfaces of the teeth when clenching or grinding, causing it to conform to the shape of the teeth and have a scalloped appearance

Symptoms of Bruxism

  • Facial pain, including headaches – constant clenching of muscles can create muscle soreness in the cheeks, temples, forehead, and the neck
  • Muscle tightness – a tight or tense feeling in the muscles of the cheeks and temples
  • Joint pain or sounds – the jaw joints, located in front of your ears, can be tender to touch, have sharp shooting pains, or make popping, clicking, or crunching sounds
  • Generalized tooth pain or sensitivity – the pressure of clenching or grinding can cause all of the teeth to be sore or sensitive to temperature

Not everyone who clenches or grinds his or her teeth will exhibit all of these signs or symptoms.  It is important for the dentist to get the whole picture and put together each patient’s specific signs and/or symptoms in order to accurately diagnose the condition of bruxism.

What Can I Do About It?

The most common treatment for bruxism is a hard, custom-made nightguard to protect the teeth, gums, bone, muscles and joints at night.  People who clench during the day can follow some habit-breaking techniques to prevent daytime damage.  If extensive damage is present, you will probably need some dental work to repair it before moving on to the preventive phase.

Will an Over-the-Counter Nightguard Work?

OTC nightguards are typically made of a soft, thermoplastic material that you can heat and shape to fit your teeth.  This material is not great at preventing the damage from bruxism because the soft, squishiness actually increases muscle action and deteriorates very quickly.  The best protection for your teeth, gums, bone, muscles and joints is a hard nightguard that is custom-made for you by your dentist.  These will actually reduce muscle force and provide real protection.

Need More Information?

If you think you may exhibit one or more of the listed signs and symptoms, please don’t hesitate to discuss it with Dr. Chowning.  You can also call the office at 940-382-1750 to set up a consultation.