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February is Gum Disease Awareness month, a timely reminder that preventing gum disease is one of the best ways to protect our oral health. 

Gum disease is easily treated in its earliest stages. Left untreated, the progressive nature of gum disease makes it one of the leading causes of tooth loss in adults. 

And while we often think of gum disease as an older person’s disease, the fact is that teens and young adults can suffer from gum disease, too. Irregular brushing and flossing habits, hormone fluctuations, family history, and even orthodontic treatment can make people of any age more vulnerable to gum disease.

Let’s take a moment in this shortest month of the year to discuss how understanding, treating, and, above all, preventing gum disease can help us enjoy long-lasting healthy smiles.

How Gum Disease Develops

Gingivitis is the first, mild stage of gum disease. 

• Gingivitis begins with plaque. 
• Plaque irritates gum tissue, causing inflammation, which is the body’s reaction to injury or infection. 
• Typical symptoms include gums which are swollen or red. The gums might feel tender or bleed easily when you brush or floss. You could develop persistent bad breath. 

With proper care, gingivitis is reversible. Because gingivitis symptoms can be very mild, they’re sometimes overlooked. That’s why it’s important to keep up with regular checkups to discover and treat the disease in its earliest stages. 

Periodontitis is a serious gum disease which is destructive to the structures which support our teeth: gums, connective tissue, and bone. 

• Plaque, when it’s not removed, hardens into tartar, which can form on the tooth above and below the gumline. 
• The gums pull away from plaque and tartar deposits, creating a space between the gum tissue and tooth roots. 
• As the gums continue to recede, pockets form between the teeth and gums.
• Infection-causing oral bacteria thrive in these pockets. Gum infections can lead to painful abscesses—but gum disease is not just an infection.
• The body normally responds to bacterial infection with inflammation. With periodontitis, this inflammation becomes destructive chronic inflammation. 
• Over time, chronic inflammation and infection break down the gum tissue, bone, and connective tissue holding teeth in place. Teeth become loose or shift out of alignment.

The tooth’s support structure eventually becomes so compromised that extraction is the only option. That’s why prompt treatment is essential.

Treating Gum Disease

Several options are available to treat gum disease, depending on its severity.

Treatment for gingivitis can be as simple as paying more careful attention to your brushing and flossing and, if necessary, seeing your dentist for a professional cleaning. In some cases, your dentist might recommend an antimicrobial mouthwash or rinse.

Periodontitis requires specialized treatment from your dentist or periodontist, and this treatment will be based on how advanced the condition is:

• Topical, oral, or time-release medications treat infection.
• Non-surgical deep cleaning procedures called scaling and root planing remove plaque and tartar above and below the gumline, allowing gum tissue to reattach to the tooth. 
• Flap surgery treats more advanced gum infection by reducing pocket depth and re-securing the gums snugly around the teeth.
• If needed, bone grafts, gum grafts, and other regenerative procedures are available which help repair and restore damaged tissue.

Preventing Gum Disease

What many people aren’t aware of is just how preventable gum disease is! Because wearing braces can make brushing and flossing more challenging, it’s especially important during these months to stay on top of your dental hygiene and be on the lookout for signs of gingivitis.

• Brush twice a day for two minutes each time, after every meal, or more often if your orthodontist recommends it. 
  • Use proper brushing technique, angling your brush toward the gums to gently clean around and below the gum line. Be sure to brush around your brackets and under your wires. Use a soft-bristled brush to protect both gum tissue and tooth enamel.
• Floss once each day, after every meal, or as directed by Dr. Kathleen Tavarez. 
• There are specialized brushes and flossers available to make cleaning around brackets and wires much easier. Electric toothbrushes and water flossers can also be helpful in removing hard-to-reach plaque. Ask Dr. Kathleen Tavarez to recommend the flossing tools and techniques which will work best for you.
• See your dentist regularly. Gum disease can be invisible in its beginning stages. Discovered early, treatment is simple and effective. 
• Having your teeth cleaned every six months, or as recommended, will remove tartar buildup which brushing alone can’t handle. 

Your dental hygienist is experienced in cleaning teeth when patients wear braces. And you can get tips for better brushing and flossing techniques from the team at Tavarez Orthodontics in Menlo Park or San Carlos, CA, too!

Even when it seems like there aren’t enough days in the month or hours in the day, it takes just a few minutes daily to care for your gums and teeth. And when you’re aware of just how much those few minutes mean to a healthy smile, it’s time well spent!

It seems like the ads are everywhere these days—repair your enamel and reverse tooth decay with a tube of toothpaste! Are these claims too good to be true? Let’s dive into the science of tooth decay—how decay develops and how (and if!) it can be reversed.

Teeth can stand up to the powerful pressures of biting and chewing because over 95% of our enamel is made up of minerals. Calcium and phosphate ions in our teeth bond to form a crystal structure called hydroxyapatite. Because of the strength of this crystalline design, tooth enamel is the hardest substance in our bodies, even stronger than our bones. 

But bones, like most other parts of our bodies, are living tissue, which means that they can create new cells to replace old or damaged cells. Tooth enamel can’t regenerate new cells to repair itself. This means that when a cavity has made a hole in the tooth, the enamel can’t grow back. And, while enamel structure is very strong, it’s also vulnerable to damage—specifically, damage from acids. 

Our teeth are exposed to acids throughout the day, whether they are acids created by plaque bacteria or the acidic foods and drinks we consume. Acids dissolve mineral bonds, stripping calcium and phosphate minerals from the enamel and leaving weak spots in the tooth surface. This process is called demineralization. Demineralization is the first stage of tooth decay.

The good news? Our bodies are designed with a built-in defense mechanism to prevent demineralization from causing lasting damage. All through the day, saliva helps wash away acids in the mouth and bathes our teeth with new calcium and phosphate ions. These ions bond with the calcium and phosphate in our enamel, restoring enamel strength. This protective repair process is called remineralization. 

Now for the bad news. In the tug of war between demineralization and remineralization, saliva can only do so much. If your diet is heavy with acids, if you don’t brush away acid-producing plaque bacteria regularly, if you eat a lot of the sugars and starches which feed plaque bacteria, the remineralizing effects of saliva can’t keep up with the demineralizing effects of acids.

The first visible sign of demineralization is often a white spot on the tooth where minerals have been stripped from enamel. Studies have shown that enamel-strengthening toothpaste can be effective in this very first stage of tooth decay. Toothpastes which advertise enamel repair generally contain one or more of these ingredients:

• Calcium Phosphate
• Hydroxyapatite
• Fluoride 

Toothpastes with calcium phosphate or hydroxyapatite contain calcium and phosphate minerals, the building blocks of tooth enamel. Studies have suggested that these minerals can replace the calcium and phosphate ions stripped from enamel. These toothpastes may or may not contain fluoride, which is something you should discuss with your dentist before deciding on a specific toothpaste.

Fluoride toothpastes remineralize enamel—and more! Fluoride ions are attracted to the tooth’s surface, and, when fluoride ions join with the calcium and phosphate ions there, they form fluorapatite. Fluorapatite crystals are larger, stronger, and more resistant to acids than hydroxyapatite crystals. And, once bonded with tooth enamel, fluoride attracts the calcium and phosphate ions in saliva to remineralize the teeth more quickly. 

Why consider enamel-repair toothpaste? 

Once enamel is gone, it’s gone for good. If excess demineralization isn’t treated, a weak spot on the tooth surface will continue to erode, growing bigger and deeper until it becomes a hole in the enamel. This is a cavity, and your dentist will need to treat and repair your tooth to prevent the cavity from growing and potentially exposing the tooth’s pulp to bacteria and infection. 

If you wear braces, you want to be especially careful about excess demineralization. Because it can be hard to brush and floss effectively with braces, white spots and discolored patches are a common concern for those with braces, especially on the enamel around brackets.  

Talk to Dr. Kathleen Tavarez at our Menlo Park or San Carlos, CA office about which toothpastes can help restore a healthy balance between the ongoing cycles of demineralization and remineralization when you have braces. While tooth-repair toothpaste can’t fix cavities, these products can often strengthen demineralized enamel and reverse this earliest stage of tooth decay.

Now that you are working hard to improve your dental health and appearance with your braces, it might seem like a logical time to whiten your teeth as well. But should you go ahead with home kits or a professional whitening? The answer might be yes, but not quite yet!

Toothpaste

The easiest way to whiten teeth is regular use of a whitening toothpaste. But these do not make a major difference in tooth color and may also contain abrasives which can damage ceramic brackets and make them more likely to stain. And, whether you have metal or ceramic braces, the brackets used are bonded to your teeth. Any part of your tooth covered by a bracket will not be affected by the whitening paste. Ask our office if you are thinking of using one of these products. We will be happy to recommend the best toothpastes to use while your braces are in place.

Whitening Strips and Trays

Whiteners can be applied at home with strips or tray kits. Strips are coated with a whitening gel and then pressed around your teeth. Tray kits provide a mouthguard-like appliance, which is filled with whitening gel. But neither strips nor tray solutions will whiten any area covered by brackets. When your braces come off, there might be noticeable differences in color on each tooth. Strips are difficult to apply with braces, and trays need to be custom-designed to fit your braces and make sure they don’t disturb your orthodontic work. One size most definitely does not fit all! Finally, these whitening agents can cause tooth and gum sensitivity, especially around the time of adjustments. Many manufacturers do not recommend using their products while you have braces. Please talk to us if you are thinking of using them.

Professional Whitening

A dental professional can whiten your teeth in office for the best possible results. The most effective treatments for your unique teeth are combined with protective care of your gums and mouth. Whether this treatment is appropriate while you have braces is something we are happy to discuss.

The best way to keep your teeth bright is to keep up your regular dental routine! Brushing and flossing are more important than ever now, because plaque builds up around brackets. Avoid foods that stain teeth and rinse or brush after every meal and snack. Dr. Kathleen Tavarez will show you the best way to take care of your teeth while your braces are on—and that includes the best way to keep them white and bright. Talk to us about the perfect time to whiten your beautiful smile during your next visit to our Menlo Park or San Carlos, CA office. And if you have to wait a few extra days for the smile you’ve been working toward, truly, the wait will be worth it!

During the second week in April, we recognize and celebrate the expert care dental hygienists provide. Let’s take a moment this week to explore how the special skills of this valued member of your dental team in Menlo Park or San Carlos, CA enrich your dental health.

Regular Cleanings

Dentists typically recommend routine dental examinations twice a year, and these visits will almost always include an in-office cleaning by your hygienist.

Dental hygienists are highly trained healthcare professionals who are specialists in caring for your teeth and gums. The hygienists who work with Dr. Kathleen Tavarez know how to work with orthodontic patients, and because braces and appliances can make brushing and flossing trickier, cleaning appointments are especially important while you’re in orthodontic treatment.

• Plaque and tartar need to be removed from tooth enamel to help prevent cavities and gum disease. While you can brush away plaque, it takes a dental professional to remove tartar, which is plaque which has mineralized over time.Your hygienist might use a hand scaler, an ultrasonic scaler, or both tools to carefully scrape hardened tartar from your tooth enamel.
• Your cleaning will also include polishing, where surface stains on the enamel are removed using a gentle abrasive. This cleaning might be done with a special toothpaste applied with a small rotating cup or with an air polisher, which removes stains with a stream of fine abrasive powder, water, and pressurized air.
• An expert flossing will remove any remaining plaque from between the teeth.

Deep Cleaning

Hygienists help prevent gum disease. Plaque and tartar on tooth surfaces below the gum line increase your risk of gum disease. Irritated gum tissue gradually pulls away from the teeth, creating pockets of bacteria and causing inflammation and infection.

• Your hygienist will use a probe to gently measure the depth of the space between the teeth and gums. Deeper than normal spaces or bleeding could be a sign of gum disease.
• Tartar on the tooth surface below the gum line will be removed using a treatment called scaling, a non-surgical procedure where your hygienist uses hand scalers or ultrasonic tools to carefully scrape hardened plaque from the tooth.
• Root planing might be done to smooth the root surfaces so that gum tissue can attach snugly around the teeth again, protecting the roots from plaque buildup and bacteria.

Preventative and Cosmetic Care

Some hygienists work with dentists to provide additional diagnostic, preventative, and cosmetic services:

• X-rays and digital imaging.
• Oral cancer screenings.
• Sealants, thin plastic coatings which protect the top surfaces of molars—the most likely places to develop cavities—from accumulating food particles and plaque.
• Fluoride treatment, if recommended, applied in varnish, foam, or gel form.
• Professional whitening treatments.

Education

Finally, your dental hygienist is an educator!

• When it comes to brushing, there are effective techniques and . . . not so effective techniques. Your hygienist can teach you the best way to clean away food particles and plaque, as well as the best tools for the job. This is especially important when you have braces or appliances, which can make it harder to keep your teeth their cleanest.
• During a cleaning, your hygienist will point out any spots where plaque has built up, which can be common around brackets and wires. Discovering the spots where you tend to leave plaque behind allows you to do a better, more thorough cleaning job at home, and will help make sure you have a healthy smile when your braces come off!
• Flossing can be difficult for some patients because they have braces, or because of the way their teeth are aligned, or because of dexterity issues. Your hygienist can show you the best way to floss, as well as recommend products such as specially designed flosses or water flossers which will make flossing around braces and appliances easier and more effective.

The dental hygienists at Tavarez Orthodontics are skilled professionals who work to create cleaner, brighter, healthier smiles for their patients every day. This week, we appreciate them for helping us achieve the beautiful smiles we get to appreciate all year long!