To Floss or Not to Floss?

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Ann Clark, RDH
To Floss or Not to Floss?
Since the Feds removed flossing from their dietary guidelines I still get a lot of patients asking if they really need to floss.  The answer is simple:  only the floss the teeth you wish to keep.  How did something so basic and assuredly easy to understand become the subject of debate?  Does anyone really believe that after years of hearing your hygienists request you to floss that we had it wrong?  No.  It is one of the most universal recommendations in all of public health.
So, how has this happened?  Why would the Federal Government remove a guideline so firmly endorsed by the American Dental Association?  The Associated Press reported that the Federal Government removed the recommendation to floss from its dietary guidelines which was first recommended by them in 1979.  Long story short: when asked, they reported that the research supporting its effectiveness didn’t meet their standards.  Any recommendations recommended in its guidelines must, by law, be based on scientific evidence.  They focused on 25 studies over the past decade.  They found the evidence to be “weak/very unreliable”.  The studies sadly used outdated methods or tested too few subjects.  Some lasted only two weeks, too short for a cavity or dental disease to manifest.  One, actually tested people after a single use of floss.  The research focused on warnings signs like bleeding and inflammation, not dealing with gum disease or cavities. Unfortunately there just hasn’t been any great research done on flossing and it’s effects.  There is not only a lack of research done in this area but also it’s actually a difficult subject to produce clear research on for a number of reasons.  So, weak scientific evidence and brief duration of studies has gotten us into this mess.  When the Associated Press failed to get the research to back their recommendations and kept pursuing it…the Feds gave in and removed it from their latest guideline postings.  It’s respectful that they require evidence-based research, and until someone does the work, it just is what it is.
As a dental hygienist of long-standing who sees the difference of a flossed mouth and  a non-flossed mouth on a regular basis, I highly recommend flossing.  Regular flossers can attest to changes in their oral health for the better.  24 hours a day we build a fuzzy film of plaque bacteria in the mouth.   Above the gumline we can clear them with a toothbrush on 3 of the 5 sides of your tooth.  These bacteria also grow below the gumline where the toothbrush can not reach.  Then, let’s say you have deeper pocket depths, places for bacteria to hide?  And what about the 2 sides of the tooth where teeth touch?  How will you get those cleaned?  What small, flexible aide would make sense to use under the tissues to remove that thicker, smelly film?  Unremoved plaque is known to cause redness and inflammation.  Unremoved debris after a period of time lets those conditions fester away eventually eating its way to the bone and subsequently:  causing boneloss…the root of periodontal disease.
The American Dental Association still recommends that you floss.  Regular flossers can attest to changes in their gum health and tooth health.  There are just common sense benefits to flossing.
Questions that I have heard:
     -Can I just use my water pick? ( Or water flosser?) This is another great aide but does not replace floss.  Plain and simple the bacteria on your tooth above the gumline are mechanically disrupted by the motion of the toothbrush.  You need the same between the teeth and below the gumline.  Floss is small enough to go under the gum and extend down the side of the tooth, bend into a “C” shape, stay tight against the tooth structure and physically disrupt the plaque in it’s formation.   Also the very small spot where the 2 sides of your tooth touch together is usually the exact spot where cavities form.  The only way to clean it?? Yes! With floss.   Always floss in conjunction with this great aide.
     -Do I still have to floss?  Lack of strong evidence does not equal lack of effectiveness.
The dept. of Health and Human Services reaffirms the importance of floss in an August 4th statement to the ADA.  “Flossing is an important oral hygiene procedure.  Tooth decay and gum disease can develop when plaque is allowed to build-up on the tooth and along the gumline.  Professional cleaning, tooth brushing and cleaning between the teeth (with aides) have been shown to disrupt and remove plaque.”
Sources:
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Fluoride: It’s Not Just for Kids

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Andra Mahoney BS RDH
Fluoride: It’s Not Just for Kids
 

When someone says fluoride, most of us automatically think children.  While it is true that fluoride is an important part of our children’s oral health, it is also a necessity for adults as well.  Adults, just like children, get cavities. So adults, just like children, should receive fluoride.  In fact, there are many age related problems that increase our need for fluoride.  Some examples include:

  • Eating disorders
  • Drug or Alcohol abuse
  • Lack of regular professional dental care
  • Poor Oral Hygiene
  • Exposed root surfaces of teeth, recession
  • Decreased salivary flow, resulting in dry mouth
  • Poor diet
  • Existing fillings
  • Tooth enamel defects
  • Undergoing head and neck radiation therapy

I’d like to address recession and dry mouth specifically, since those are very common problems.

 

Recession

Recession is when the gums have receded below the crown of the tooth, exposing the root to the tooth.

This creates two main problems. First, the roots of the teeth do not have enamel, they are covered by cementum.

As we all know, enamel is the hard material that protects the surface of the tooth. Enamel is 70 times stronger than cementum.  This, unfortunately, means that the roots of the teeth are more prone to decay than the crowns of the teeth.  The best recommendation for recession and the prevention of decay is fluoride.  Make sure you are using a soft bristled brush with soft brushing (to prevent further recession) in combination with fluoride toothpaste.  Also, you may received fluoride treatments at your dental appointments.  The most beneficial would be fluoride varnish.  Your hygienist is able to apply this for you at each appointment.  The varnish coats the tooth in a protective layer of fluoride to aid in the prevention of decay.

The second problem that recession creates is sensitivity.  When the root is exposed tiny little tubules open up on the tooth and the chances for sensitivity increase.  This makes eating or drinking cold or sweet things painful.  You will often notice a sharp zing when the area of recession comes in contact with cold or sweet items.  The best recommendation for sensitivity due to recession is fluoride.  Sensitivity toothpaste, such as Sensodyne, contain an increased amount of fluoride (as opposed to regular toothpaste) to assist in the prevention of sensitivity (and decay).

Fluoride varnish is also helpful as it coats the tooth and temporarily closes the tubules decreasing the sensitivity. 

Xerostomia

The last topic that I wanted to address is dry mouth, also known as xerostomia.  Many adults take medicine and the most common side effect of many medications is dry mouth.  A decrease in saliva increases your risk for decay.  Saliva is important in washing away bits of food, neutralizing acids created by bacteria, as well as containing minerals that help prevent tooth decay.  If you are having problems with dry mouth, try rinsing with a fluoride mouth was or a saliva substitute.
    

All these reasons and many more show the importance of fluoride use for adults.  If you have any other questions about the other problems that fluoride can help with, feel free to make an appointment with us and we’ll answer all your questions! 

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

Fluoride Treatments in the Dental Office ADA: http://www.ada.org/sections/scienceAndResearch/pdfs/patient_72.pdf

Can Fluoride Help Adults? Colgate: http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/Oral-and-Dental-Health-at-Any-Age/Adults/Adult-Maintenance-and-Care/article/Can-Fluoride-Help-Adults.cvsp

Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States CDC: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm

Adverse Effects of Not Replacing Missing Teeth

KatieM

Katie Sias, BS RDH

Adverse Effects of Not Replacing Missing Teeth

According to the American College of Prosthodontists, more than 35 million Americans do not have any teeth, and 178 million people in the United States are missing at least one tooth. Tooth loss occurs due to a number of issues such as decay, gum disease, injury, cancer, or wear. Your teeth are designed to work together to help you chew, speak, and smile. There are several tooth replacement options your Dentist may suggest depending on your needs such as implants, bridges, or dentures. However, do you know the risks of not replacing those missing teeth?

Bone Loss:

When a tooth is extracted or missing, bone loss can occur. The jawbone is preserved through the pressure and stimulation of chewing. When a tooth is missing, the bone resorbs and results in less density and width/height of the bone. Unfortunately, if left untreated for a long amount of time, the bone can start deteriorating around the adjacent teeth as well.

Shifting Teeth:

When a tooth is missing, the opposing tooth that is still there can often shift and super-erupt because it does not have a tooth to occlude with. Adjacent teeth can start drifting forward in the place of the missing teeth. These can cause a change in bite that will eventually affect your chewing and lead to more serious side effects.

TMJ Problems:

When your teeth shift out of alignment and your upper and lower jaws do not meet properly, it strains and damages the jaw joint. Muscle soreness may occur as you will tend to favor the other side of your mouth for chewing.

Periodontal Disease:

Missing teeth increase the risk of periodontal disease. When teeth shift out of alignment, it makes it harder to properly brush and floss those teeth.

Esthetics:

Missing teeth can affect the esthetics of your face. Many people feel less confident about their smile when they have gaps from missing teeth. If you are missing many teeth, the skin around your mouth loses support and will start to droop, which can make you appear older than you are.

Speak and Eat:

Missing teeth can alter the way you speak and eat. Depending on which teeth are missing, it may become difficult to bite and chew certain foods. Often times, you will most likely being overusing the other teeth to compensate for the missing tooth or teeth. You may develop a lisp or change in your ability to clearly pronounce certain works.

Most patients are unaware of the adverse effects of not replacing their missing teeth. Now that you know some of these risks, please consult your Dentist for the best replacement option for you!

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

https://www.gotoapro.org/facts-figures/

http://crowncouncil.com/why-replace-lost-teeth

https://www.perio.org/node/222

https://www.nobelbiocare.com/content/patient/international/en/home/missing-teeth/why-is-it-important-to-replace-missing-teeth-.html