We all know that flossing is important and that we shouldn’t wait until right before our next dentist appointment to begin flossing again, RIGHT? But one question comes up a good bit: Is it better to floss before or after you brush your teeth?
So, because dentists needed proof of what they pretty much already knew, a new study published in July 2018 in the Journal of Periodontology “The Effect of Toothbrushing and Flossing Sequence on Interdental Plaque Reduction and Fluoride Retention: A Randomized Controlled Clinical Trial” (whew, that is a title!) tackles this idea. (https://bit.ly/2EWZ7WM)
Let’s skip to the punchline: The study found what Dr. Sable has been saying to his patients since the time of the cavemen & cavewomen – well, maybe not quite that long… Flossing before you brush your teeth is more effective than flossing after you brush! (But “pretend” flossing does not count at all!)
So, for a few details…the study asked 25 participants to brush their teeth first and then floss. In the second phase, the subjects flossed first and then brushed. The conclusion (which the study write-up listed as quite surprising, but we are more surprised that they are surprised…) is that the research found that individuals who flossed first has significantly cleaner teeth than those who did the opposite. The primary reason is that since flossing is effective in dislodging debris and crud (their word, not ours – yuck) nestled between the teeth, brushing and rinsing
soon after helps clear out the particles and makes the mouth cleaner.
But as if you can hear Dr. Sable whispering in your ear, it is important to note that an effective home oral care routine includes both daily brushing and flossing to keep teeth clean. So, go ahead and give it a try!
We are off to look for a study about the comparison between using floss and a Waterpik! We can’t wait to tell you what we find! What do you think we will find? We can do our own official study! Email our office manager, Sandy Palermino at firstname.lastname@example.org.
November is Diabetes Awareness Month and we are helping to spread the word on how uncontrolled diabetes can affect individuals’ teeth and gums. Below are edited notes from the American Dental Association and related research.
Diabetes and Your Smile
Based on article by Laura Martin, Case Western Reserve University School of Dental Medicine
Did you know that 29.1 million people living in the United States have Diabetes? That’s 9.3% of the population. Approximately 1.7 million new cases are diagnosed each year—and 8.1 million people living with diabetes don’t even know they have it.
Diabetes affects your body’s ability to process sugar. All food you eat is turned to sugar and used for energy. In Type I diabetes, the body doesn’t make enough insulin, a hormone that carries sugar from your blood to the cells that need it for energy. In Type II diabetes, the body stops responding to insulin. Both cases result in high blood sugar levels, which can cause problems with your eyes, nerves, kidneys, heart and other parts of your body.
So what does this have to do with that smile of yours?? If diabetes is left untreated, it can take a toll on your mouth. In fact, one in five cases of total tooth loss is linked to diabetes.
5 Ways Diabetes Can Affect Your Mouth
Notice some bleeding when you brush or floss? That may be an early sign of gum disease. If it becomes more severe, the bone that supports your teeth can break down, leading to tooth loss. Early gum disease can be reversed with proper brushing, flossing and diet. Research has shown gum disease can worsen if your blood sugar is not under control, so do your best to keep it in check.
All people have more tiny bacteria living in their mouth now than there are people on this planet. If they make their home in your gums, you can end up with gum disease. This chronic, inflammatory disease can destroy your gums, all the tissues holding your teeth and even your bones.
Periodontal disease is the most common dental disease affecting those living with diabetes, affecting nearly 22% of those diagnosed. Especially with increasing age, poor blood sugar control increases the risk for gum problems. In fact, people with diabetes are at a higher risk for gum problems because of poor blood sugar control. As with all infections, serious gum disease may cause blood sugar to rise. This makes diabetes harder to control because you are more susceptible to infections and are less able to fight the bacteria invading the gums.
Studies have found people with diabetes have less saliva, so you might find yourself feeling parched or extra thirsty. (Medications and higher blood sugar levels are also causes.) Fight dry mouth by drinking water. You can also chew sugarless gum and eat healthy, crunchy foods to get saliva flowing. This is especially important because extra sugar in your saliva, combined with less saliva to wash away leftover food, can lead to cavities
Change in Taste
Your favorite flavors might not taste as rich as your remember if you have diabetes. It can be disappointing, but take the opportunity to experiment with different tastes, textures and spices to your favorite foods. Just take care not to add too much sugar to your food in an effort to add flavor. Not only can this affect the quality of your diet, it can also lead to more cavities. If you have a persistent bad taste in your mouth, see your dentist or doctor.
Diabetes affects your immune system, leaving you more vulnerable to infection. One common among people with diabetes is a yeast infection called oral thrush (candidiasis). The yeast thrive on the higher amount of sugar found in your saliva, and it looks like a white layer coating your tongue and the insides of your cheeks. Thrush is more common in people who wear dentures and can often leave a bad taste in your mouth. See your dentist if you think you have thrush or any other mouth infection.
Have you ever noticed a cold sore or a cut in your mouth that doesn’t quite seem to go away? This can be another way that diabetes may affect your mouth. Poor control of blood sugar can keep injuries from healing quickly and properly. If you have something in your mouth that you feel isn’t healing as it should, see your dentist.
How We Can Help You Fight Diabetes
Regular dental visits are important. Research suggests that treating gum disease can help improve blood sugar control in patients living with diabetes, decreasing the progression of the disease. Practicing good oral hygiene and having professional deep cleanings done by your dentist can help to lower your HbA1c. (This is a lab test that shows your average level of blood sugar over the previous three months. It indicates how well you are controlling your diabetes.)
Your Diabetes Dental Health Action Plan
Teamwork involving self-care and professional care from your dentist will be beneficial in keeping your healthy smile as well as potentially slowing progression of diabetes. Here are five oral health-related things you can do to for optimal wellness:
Control your blood sugar levels. Use your diabetes-related medications as directed, changing to a healthier diet and even exercising more can help. Good blood sugar control will also help your body fight any bacterial or fungal infections in your mouth and help relieve dry mouth caused by diabetes.
If you wear any type of denture, clean it each day.
Make sure to brush twice a day with a soft brush and clean between your teeth daily.
Do you cringe at the thought of taking a bite of ice cream or a sip of hot coffee because it makes your teeth hurt? Does brushing or flossing your teeth cause pain? If so, you may have sensitive teeth. You may experience discomfort or pain when you eat or drink hot, cold, sweet, sour, or very acidic foods and beverages. You may also experience discomfort when breathing in cold air. Tooth sensitivity may come and go, or it may be continuous.
Tooth or dentin hypersensitivity is a harmless, but sometimes painful, condition that occurs in up to 60% of people. While temporary tooth sensitivity may happen, if sensitivity lasts more than a week, you should call Sandy for an appointment, just so we can help determine the cause and ensure that it is nothing serious. There is no reason to suffer with tooth sensitivity when we can suggest treatments that can alleviate your discomfort.
So, What Exactly is Tooth Sensitivity?
Okay, just remember that YOU asked? A layer of enamel protects the part of your tooth above the gum line, known as the crown. (Yep, here we go with parts of the tooth – did you pay attention to our previous blog? It was riveting. So here’s the link just in case you can’t wait another second – https://wp.me/p84DRh-y) Underneath that gum line, there is a different protective layer called the cementum that protects the roots. And underneath both the enamel and the cementum, there is a less dense layer called dentin. When dentin loses its protective coating of enamel or cementum, hot, cold, acidic, or sticky foods can reach the nerves inside the tooth and cause pain.
Causes of Tooth Sensitivity
There are many possible causes of tooth sensitivity, and some are more serious than others. It is important to check in with us if you are experiencing any sensitivity so that we can help you find the source of the problem. Causes include:
Tooth decay and cavities
Broken or worn fillings
Abscessed tooth – may have a nerve going “bad”
Brushing with abrasive toothpaste
Gum recession that exposes the tooth root surface, whether due to gum disease or naturally occurring with age
Grinding or clenching your teeth which opens the pores in the teeth
Tooth erosion from highly acidic beverages or foods, or due to bulimia or gastroesophageal reflux disease
So, How Do We Treat Tooth Sensitivity?
Depending on cause and severity of the sensitivity, in-home or in-office, we can recommend treatments that will alleviate your discomfort. At-home treatments include:
Desensitizing toothpaste: A specially-formulated toothpaste that can help block the transmission of pain sensation from the tooth surface to the nerve, resulting in reduced sensitivity.
Desensitizing rinses: Usually developed with high levels of fluoride, desensitizing rinses can also help relieve pain.
In-office treatments include:
Fluoride gel or varnish: Your dentist can apply fluoride directly to your sensitive tooth to strengthen the enamel and decrease its sensitivity.
A crown, inlay, or bonding: These dental procedures can correct a flaw or decay in your tooth that may be causing pain.
Surgical gum graft: If you’ve lost gum tissue from the root, you can have gum tissue taken from another area and attach it to the affected area, thus protecting the exposed roots and reducing pain.
Get your bite adjusted: Some teeth may chew with more pressure or force causing trauma leading to teeth being more sensitive. We have patients who have had HUGE benefits from this treatment, for which Dr. Sable has trained for many years!
Okay, Your Teeth Don’t Hurt YET? What Do You Do?
The first step to avoiding tooth sensitivity is to practice good oral hygiene. Gum recession, the leading cause of tooth sensitivity, can be stalled through proper brushing and flossing habits. However, while keeping your teeth clean is critical, harsh brushing or over-brushing can lead to increased sensitivity. To avoid tooth sensitivity, practice the following habits:
Don’t brush your teeth with abrasive toothpastes. Tartar control and “whitening” toothpastes can be very abrasive, opening up the pores in the teeth. If you are concerned with whitening, speak to Dr. Sable about better options than these toothpastes. Don’t do more damage than good!
Avoid foods and drinks high in acid or sugar. The foods and drinks your dentist warned you about as a child still apply. Foods or drinks such as soda, sticky candy (OH NO…JUST IN TIME FOR HALLOWEEN!), or anything high in sugar content can weaken your enamel. Reach for snacks like fruits, vegetables, and low-fat dairy products to keep your teeth and enamel healthy. Not only are these snacks healthier in general, but they also keep your enamel strong by helping you produce saliva – a natural defense against acid and bacteria.
Avoid clenching or grinding your teeth. Grinding your teeth can wear away your tooth enamel. If you clench or grind your teeth (or think you do!) while you sleep, let us know. It is worth having this conversation to prevent longer term damage! We may recommend a custom-fit mouth guard. In severe cases, muscle relaxants may be prescribed.
Stop bleaching your teeth. This popular cosmetic procedure might make your teeth brighter and whiter, but it can be the source of temporary tooth sensitivity. Consider taking a break from bleaching your teeth to see if it improves your sensitivity.
Don’t Live with Pain!
If you have tooth sensitivity, give us a call today. Pain does not need to become part of your life. There are ways to mitigate your sensitivity and get you back to enjoying the foods and drinks you love.
We want you to breath easy and enjoy life with a natural, beautiful smile!
The business world is changing quickly as you all know! Social Media has become a tool for marketing and consumer research! In order to keep up with today’s world, online marketing is a must. We have had fun setting up our Facebook page and sharing tidbits and pictures with our dental family: https://www.facebook.com/sabledds/.
But what we have confirmed recently is that the most powerful marketing tool is doing great work! We thank all of our patients who have taken the time to post a review about their dental experience. We have been asking for reviews using a software program called Birdeye that emails or texts our patients after their appointments and asks for honest feedback.
Guess what? We LOVE hearing from you! Your kind and thoughtful posts motivate us to be our best! We read these posts in our morning “huddle” when we discuss what we need to do to improve our service for you! And boy do these boost us up! If you have not seen any of these reviews, check them out: https://sabledds.com/testimonial.php
“Sleep is an investment in the energy you need to be effective tomorrow” -Tom Rath, author of Eat Move Sleep and Are You Fully Charged
What is Obstructive Sleep Apnea? Obstructive Sleep Apnea (OSA) is a life-threatening condition that affects over 18 million Americans. This commonly undiagnosed syndrome involves the cessation of breathing during sleep. While sleeping, the upper airway muscles enter relaxation and may vibrate against each other (this vibration is what causes snoring). As sleep deepens, muscle relaxation increases and can occlude the airway. This severely decreases the amount of oxygen flowing to the lungs. The body responds to this lack of oxygen by sending a signal to your brain that you are suffocating. The brain compensates by lightening the phase of sleep in order to increase control and contraction of upper airway muscles, ultimately increasing oxygen flow to the lungs. This constant exchange between suffocation and arousal can occur several times throughout the night and many do not recall it happening upon fully awakening the next morning.
Is Treating OSA Important? While studies estimate 1 in 4 Americans over the age of 18 (31% of men and 21% of women) are considered “high risk” for sleep apnea, 90% of those with sleep apnea have gone undiagnosed.1 If left untreated, sleep apnea can increase the risk of health issues, including cardiovascular disease (stroke, high blood pressure, and atrial fibrillation), diabetes, impotence, memory loss, and GERD. Excessive fatigue caused by OSA can affect your safety by increasing your risk of motor vehicle accidents and work-related accidents. Untreated severe OSA also increases your risk of death
According to Dental Sleep Solutions, fewer than 10% of those suffering with OSA have been accurately diagnosed and only 25% of those diagnosed have been successfully treated. This chart indicates the large percentage of Americans who have gone undiagnosed with this condition.1 Screening for Sleep Apnea (Common Signs and Symptoms) During your appointments, your dentist and dental hygienist are examining much more than your teeth. During your head and neck exam and oral cancer screening, we are also analyzing your anatomy to determine your risk of OSA. These anatomical features include swollen tonsils, an enlarged tongue, inflamed sinus membranes, an anatomically small airway, malocclusion, and obesity (excess fatty deposits on the neck and chest)
Health professionals use the Mallampati Classification system to determine your risk of OSA:Patients with Class I and Class II Mallampati scores have lower risks of OSA since their airways are mostly patent (open). Patients who are in the Class III and IV range are at a much higher risk of OSA due to the obstruction of their soft palate.
There are also many symptoms of OSA that you may notice about you or your partner between dental appointments:
Waking up due to gasping or choking
Excessive day time fatigue
Waking up feeling unrefreshed/Restless sleep
Waking up with xerostomia (dry mouth)
As you hopefully know by now, we are here to support your total health – we are invested in you as our patient! If you notice any of these symptoms for yourself or your loved ones, please make an appointment for a consultation. We will work with your physician to help with diagnosis and evaluation of treatment options.
I May Have Sleep Apnea – What Should I Do? One of the first steps in diagnosing OSA is performing a sleep study. From the study, if OSA is diagnosed, there are several routes of treatment depending on a few specifics including the severity. The three common treatment options include a continuous positive airway pressure (CPAP), oral appliance therapy (OAT), and surgery.
CPAP Therapy is the most common treatment method for OSA. It involves wearing a face mask that connects to a machine via plastic tubing. The machine forces oxygen through the mask at a continuous rate, predetermined by your doctor, throughout the night. This was the gold standard for treatment of OSA until recently as it is highly effective in maintaining oxygen intake during sleep. However, its efficacy is often diminished by the lack of patient compliance. Patients often find that it is not comfortable and only wear it for an average of three hours per night.
Advantages: considered most effective treatment of all severities of OSA
Disadvantages: mask discomfort, not easy to travel with, nose/throat dryness
Oral Appliance Therapy has recently risen in popularity as a comfortable alternative to CPAP. It utilizes a custom device that fits similarly to a sports mouth guard or an orthodontic retainer and maintains an open airway by repositioning your lower jaw and tongue slightly forward. Studies have found that OAT and CPAP are both effective OSA treatments. The Journal of Clinical Sleep Medicine reported that patients prefer OAT over CPAP because it is quiet, portable, and comfortable.2
Advantages: least invasive, comfortable, quiet, portable, does not require electricity to work, easy and inexpensive to clean
Disadvantages: may not be as effective with severe cases of OSA
Surgical Options often involve soft tissue and/or jaw surgery to increase airway opening. While these surgeries have varying degrees of success, nonsurgical options are typically recommended prior to proceeding with this route.
Advantages: most surgeries are effective in long-term improvement of airway
Disadvantages: most invasive, requires post-operative recovery
OSA is a life-threatening condition that is grossly undiagnosed in the United States.
Treatment options for OSA include: CPAP, OAT, and surgery.
While CPAP has been deemed the “gold standard” for OSA treatment, its effectiveness is compromised by patient intolerance and unwillingness to wear it. Patients who have tried CPAP and (1) did not have good results or (2) were not able to tolerate it should consider trying OAT.
If you or someone you know may have OSA, contact us today!
1Dental Sleep Solutions. “What is OSA Syndrome?” 2014. Web. 21 Feb. 2017.
2Ramar, K. “Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015.” AASM. American Academy of Sleep Medicine, 2015. Web. 21 Feb. 2017.
Heart disease is the leading cause of death in the United States. The month of February is dedicated to raising awareness about heart disease and increasing knowledge about prevention.
We are dedicated to educating our patients about the mouth/body connection. An increasing number of researchers are finding that there’s a link between common health conditions—like heart disease—and oral health. It’s becoming clear that the body can affect the health of your mouth and vice versa.
So, how is heart disease related to your mouth?
Several studies exist to explain the link between periodontal (gum) disease and heart disease
Oral bacteria can affect the heart via the blood stream and then attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation.
Another possibility is that the inflammation caused by periodontal (gum) disease increases plaque buildup, which may contribute to swelling of the arteries.
More Heart Disease/Gum Disease Connections
The number one cause of death is inflammation.
The number one cause of inflammation is gum disease.
Researchers have found that people with gum disease are almost twice as likely to suffer from coronary artery disease.
One study has shown that gum disease, cavities and missing teeth are as good at predicting heart disease as cholesterol levels.
Dental radiographs (x-rays) allow us to monitor bone levels and rule out any disease processes that might be occurring. Radiographs allow us to see structures that are not visible to the naked eye – the spaces between teeth, under the soft tissue, and inside the bone. All of this really, really helps us work with you on your oral health, especially to diagnosis any potential “danger zones!” In fact, without x-rays, we cannot detect:
Infections and Abscesses
In fact, one of the most important uses of radiographs is to allow us to compare a current x-ray to a previous one. This comparison, side-by-side, helps identify any changes from the previous period. The comparison is important, because it tells us not only what is going on with the teeth on that day, but also the rate of change from the previous period. A slow rate of change, even if not in a positive direction, may allow us to be more conservative in treatment. A faster rate of change may indicate a need to treat in a more aggressive manner.
The American Dental Association recommends that bite-wing oral radiographs are updated annually, and panoramic radiograph (or full mouth intraoral series) updated every three years, to provide for optimal oral care and accurate diagnosis. However, for patients with any risk factors or significant dental work, we may recommend panoramic x-rays to be done annually.
So, even with all that, you may be thinking right now “What about the radiation?” Are you subjecting me to unnecessary or excessive radiation with dental x-rays?
The clear and definitive answer is NO.
If you have wondered about this or expressed this to us in the last few years, you are not alone. We want to let you know that we take your concerns seriously. We are also hearing new and erroneous theories on radiation exposure from dental x-rays. So, to help get you up to (x-ray) speed, we want to share a quick science lesson:
Radiation dosage is measured in units called millirems (mrem). According to the US Nuclear Regulatory Commission (USNRC) U.S. residents, on average, receive 620 mrem every year, with approximately one-half coming from background sources like outer space, radioactive materials in the earth, small amounts of radioactive material in foods and products that we use, etc. The other half come from exposure to mrem in medical procedures. In general, according to the USNRC, a yearly dose of 620 millirem from all radiation sources has not been shown to cause humans any harm.
A typical digital dental x-ray (the kind we take) exposes a patient to less than 0.5 mrem. This compares to mrem of 10, 60 and 72 for chest, abdomen, and mammogram x-rays, respectively. So as you can see, the relatively small amount of mrem from dental x-rays illustrates the American Dental Association’s confidence in the safety of this very important diagnostic tool. And as I mentioned before, without x-rays, we cannot identify disease processes that pose risks to your dental and overall health.
If you have any questions or concerns regarding dental radiographs (x-rays), please call the office and ask Dr. Sable to call you to address them. We care about more than your dental health, we care about YOU!
Does that make you feel crazy? Well…you aren’t! There are actually several reasons why it can be difficult to pinpoint the origin of tooth pain.
Let’s take a step back and consider some of the possible reasons. Tooth decay can cause bacteria to infect the interior of the tooth and then trigger pain from changes in temperature or pressure. This pain is coming from the nerve, but those nerves aren’t tied to one specific tooth. Therefore, it can feel like the pain is coming from a group of teeth or even from the sinus area. (who knew??) This type of pain may decrease over time, even without treatment, but the problem is simply hiding in the wings… and can lead to a root canal and eventually to gum disease.
Going the other direction, gum disease can lead to root canal infection. Common periodontal disease caused by plaque along the gum line can lead to inflammation and infection of the gums. The gum can then begin to detach from the tooth surface and form a “pocket.” As this worsens, the infection can spread to the root of a tooth and then into the tissue inside the tooth. The resulting pain may feel like gum and tooth pain. Since some of these roots can be in the proximity of roots of other teeth, the infection and pain can spread to nearby teeth and gum area.
THEN to confuse matters even more, a broken tooth can cause tooth AND gum pain depending on the location of the fracture in the tooth.
So, clear as mud?? We tried to simplify this as much as possible, but we also recognize that not every dental case fits carefully into one bucket. That is why we are here to help figure it out. If you are experiencing tooth or gum pain, give us a call; we can work together to figure out what exactly is happening and create a treatment plan to make you feel better.
So, there…all better?
(Source: Dear Doctor Dentistry & Oral Health, Issue 20)
While we believe that we can perform dental miracles, we sadly can not make your filling last forever! sigh. A filling is extremely durable and can last for many, many years in most cases, but there may come a time when it needs to be replaced. Sorry.
So, how long will it last? Well, as in life, the answer is… It Depends! In this case, it depends on a number of factors, such as the type of procedure performed, the size or area being treated or replaced, the kind of materials used for the filling and the patient’s level of oral hygiene and care.
And then, despite your incredible efforts, a filling may crack or fall out unexpectedly. Over time, dental fillings can be weakened by:
Frequent jaw clenching and teeth grinding (bruxism),
Chewing on hard items or foods,
Injury or trauma, such as those sustained during sports activities,
Time; no filling lasts forever no matter how well kept!
If you ever have a filling fall out just remember, don’t panic and don’t wait. Even if it falls out after hours, call us immediately–we’re here for you in an emergency! We will get you in as quickly as we can. In the meantime, keep your filling if you can– but don’t try to push it back into place. Make sure to keep the affected area clean and debris-free.
If you don’t experience discomfort after losing a filling, it is still important to come in to have it treated as soon as possible. Not seeking immediate care could result in pain, discomfort and even tooth loss.
Regular dental visits are imperative to maintaining a healthy smile. With that being said, we know not every dental emergency happens during normal business hours. That’s why we strive to make ourselves available to our patients as often as possible. If you need us, email, call or text us! Your health and comfort is our number one priority.