Cleaning and Exam

It’s a pretty common question we get. It makes sense that a hard bristled brush would do a better job scrubbing your teeth, right?  However, the recommendation is to always use a soft bristled brush. 

The bacterial plaque and food debris that we aim to remove is a thin gel that is lightly attached to your teeth.  It comes off relatively easily with soft bristles.  While the stiffer bristles would remove it as well, the stiffer bristles can be stiff enough to damage your teeth.  

As an example, if you scrub a spot on your floor every day, twice a day, with a wire brush, it will quickly wear away a hole in the floor. On the other hand, a soft brush is much less likely to wear the floor away. The same holds for teeth. Harder bristles will damage teeth over time. 

What about tartar or calculus?

While tartar and calculus are harder buildups that are stuck on teeth, even the firm bristle brushes won’t remove it.  This is why you need to get your teeth professionally cleaned with the sharp instruments that can chip these buildups off your teeth.  Give us a call if it is time to get them professionally cleaned.  Your teeth will thank you for it. 

Before you get the answer, you should know the history. This is a recommendation that changed back in 2014.  Prior to 2014, it was not recommended to use fluoride toothpaste in children under the age of 2.  Because small children don’t know how to spit out toothpaste, the fear was that they would ingest the fluoride, which would possibly lead to fluorosis.  Fluorosis is a discoloration in the teeth due to too much fluoride being deposited in the tooth crystals as teeth form.  They recommended brushing with water, or one of the training toothpastes that have no fluoride. Then from 2 to 6 years old, a pea sized application of fluoride toothpaste was recommended, and children should spit out excess paste as soon as they are capable.  

But in 2014, clinical research prompted changes to these recommendations.  Yes fluorosis was still a concern, but so was the higher rates of decay when fluoride was not used.  The research found that using a small smear of fluoride toothpaste, about the size of a grain of rice, would be enough to help prevent decay, yet not so much that it would result in fluorosis in most cases, even when swallowed.  Then from the ages of 3 to 6, a pea sized application of fluoride toothpaste should be used because children at that age are more capable of spitting out the extra paste.  

So, the answer is, you should use a rice sized smear of fluoride toothpaste from the time the first tooth erupts until age three, and then from three to six, a pea sized application is recommended.

The use of dental X-rays has been a vital component of the diagnostic capabilities in dentistry since they were first invented.   While the first x-ray systems required a lot of radiation to produce relatively poor quality images, modern digital (computer based) x-ray sensors require only a fraction of the radiation that was needed by early X-rays and produce very detailed images that can be manipulated on the computer.  We use these low dose X-rays in our office to produce the best and safest radiographic images possible. To answer the question as to how often you should get X-rays, there are several factors to consider.  First off, there is a general guideline of recommended intervals that has been presented by the American Dental Association.  Second, there is a frequency limitation established by insurance companies.  I will start with the insurance limitations and say that insurance companies each have their own guidelines for the frequency that they will cover X-rays, and we always try to adhere to these limitations so out of pocket costs are minimized; however, the insurance limitations may not be appropriate for every patient’s needs.  Insurance companies are businesses and they help pay for dental treatment, but they don’t always pay for the treatment that best fits your case.  Therefore, it is important to consider what is best instead of what is covered. The ADA’s recommendations are a set of guidelines to use to determine how often X-rays should be taken on adolescents as well as adults.  We use these guidelines to help determine when, which, and how many X-rays should be taken. 

Routine screening X-rays are useful tools to help us catch problems at the earliest stages. It is important for us to utilize them even when there is no obvious problems or pain that a patient may feel. Because every patient’s needs and history is different, we evaluate each patient to determine what is right for them.  When there is a history of decay, or recent active decay, we may opt to take X-rays more often so we can catch problems in their early stages.  On the other hand, for those with little or no decay, we may take X-rays less often. It is still important, however, to take X-rays so that not only tooth decay can be found at its earliest stages, but also to detect signs of periodontal disease, abscesses in teeth and bone, cysts, cancerous tumors, or many other abnormalities that are better caught at early stages. 

Like most things in life, X-rays are not a one size fits all tool, and we will customize our recommendations to meet your needs.  We are always happy to see you to discuss this and help you keep your healthy and happy smile

Through the years, one of the questions that I have been asked the most is whether you should brush first or floss first.  I was always happy when people would ask that question because it made me realize that some people actually do floss at home. However, I never really had a good answer for that question. I would always say that if you flossed first, the spaces between the teeth would be cleaner for the fluoride toothpaste to penetrate between the teeth. But then I would say that if you brushed first, you would have the fluoride toothpaste in your mouth from brushing and the floss would pull the fluoride toothpaste between the teeth where a brush can't reach. And then I would sum it up by saying that there are probably benefits either way and it probably doesn’t matter that much which is done first.  I would always say that I was just happy that patients were attempting to floss. 

However, in May 2018 there was a research article published in the Journal of Periodontology, the publication that focuses on the treatment of gum disease and the tissues around teeth. The focus of this research article was to determine whether there was an advantage to brushing first or flossing first. The research concentrated on the reduction of plaque bacteria, the cause of gum disease and tooth decay, as well as fluoride retention on the tooth surfaces after either brushing first or flossing first. 

What they found was that flossing before you brush resulted in a statistically significant  reduction of plaque bacteria between teeth when compared to flossing after brushing.  So, that meant that flossing first did a better job of cleaning teeth in the research. In addition, flossing first also resulted in a statically significant increase in the amount of fluoride retained on the surfaces between teeth when compared to flossing after brushing. So, again, it is better to floss first because the teeth are left with more fluoride on them to help fight decay.  Here is a link to a summary of the article  https://www.perio.org/consumer/brush-or-floss-first

So now we have an answer based on science. 

It is better to floss BEFORE you brush your teeth.