To floss or not to floss?!

flossI couldn’t quite believe my eyes when I woke up on Wednesday morning to find my social media accounts had gone crazy over the breaking news that we no longer need to floss. The story had broken across all media outlets, everyone was talking about it!

I had a sinking feeling as I realised that all the hard work that I had put in to my patients oral hygiene over the past few years, including advice on routine flossing, would undoubtedly come under question and I could already envisage the deterioration in their gum condition as patients change their habits in reaction to the report.

These claims were made following an investigation by the Associated Press that looked into various studies that were carried out over the past decade comparing the benefits of toothbrushing and flossing versus toothbrushing alone. The evidence used to promote flossing was found to be weak and of poor quality. The individual studies were not carried out for any great length of time and using a small sample of people. As gum disease can take years to develop long term studies with large samples need to be conducted to gain reliable data in order to realise the true impact of flossing

I have personally seen many instances when the gum between the teeth is inflamed and bleeding (gingivitis) and it is evident that after the patient has been flossing that the inflammation has reduced. As gingivitis is a precursor to the more sinister second stage of gum disease – periodontitis, where teeth can be lost, I think it is important to try to do all we can to prevent it.

An important point to stress is that the findings are not stating that you should not floss, only that the evidence gathered about the benefits of flossing in these studies was insufficient.  Neither are they telling you that you shouldn’t clean the spaces between your teeth via alternative means and therefore this should still be an important part of your daily routine. Toothbrushing alone does not access all the surfaces of your teeth but the potentially harmful biofilm of bacteria knows as plaque does form on all these surfaces and therefore needs to be removed on a daily basis.

When the spaces are larger it is unlikely that you would be able to remove all the plaque and food debris from between the teeth with floss alone and it is then that alternatives such as interdental brushes are needed. There are many varieties on the market but two well known effective brands are TePe and Vision. These come in a variety of sizes and your dental clinician will be able to advise you on the correct size to use and cleaning technique

Escaping the minefield of dental products!

As I was in Boots this weekend purchasing some essentials I came across a couple scouring the ever growing and exhaustive range of dental products that are on offer. They lo20160719_224126oked beyond baffled as they tried to make sense of the display in front of them. There was a variety of toothbrushes with many gadgets and gizmos, mouthwashes and toothpastes that claim to have an array of amazing qualities and healing powers, not to mention the multitude of items available to clean the spaces between your teeth. It really is a minefield and I can completely understand why people feel at a loss to know what to buy. In the dental profession I am sure we all have our own favourites but here are some basic tips to help try and see through the marketing and find effective and value for money items.

TOOTHBRUSHES

Manual toothbrush – go for a small/compact head with medium bristles. Some good  examples are Sensodyne 3.5 or Oral B 35

Pulsing style manual toothbrush – more gimmick than substance, so no need to spend your extra pennies on these.

Battery-powered toothbrush – these are cheaper than electric toothbrushes but less effective and often come without a timer. They can however be handy for travelling. I appreciate budgets vary but the best long term investment and value for money is an electric toothbrush.

Electric toothbrush – clinical evidence suggests the oscillating rotating brush is the best one to buy. A timer is essential and one that times you every 30 seconds is more beneficial to achieving an even clean. A pressure sensor can also be useful. Good electric toothbrushes such as the Oral B 2000 can start from £30.

Electric toothbrush heads – small single headed brushes are best as they make it easier to access the whole mouth and are often cheaper. Don’t be fooled by fancier brush heads that say things such as ‘flossing action’, they do not floss between your teeth and you will still need to clean those areas separately.

Generally speaking with both manual and electric toothbrushes the more gadgets a brush has the higher the cost and these are rarely necessary. They end up not being used so keep it simple.

TOOTHPASTE

The clinical guidelines recommend to use a toothpaste with 1,350-1,500ppm fluoride. This information can be found in the ingredients listed on the back and the majority of toothpastes on the market will contain this.

It is the action of your brush that removes the plaque rather than the toothpaste so the toothpaste choice largely comes down to personal preference of flavour and texture.

Sensitive toothpastes – these can really help with sensitivity but when you stop using them usually the sensitivity will return.

Whitening toothpastes – these do not whiten your teeth but can remove surface staining making the tooth appear whiter, but be cautious with these as they can be abrasive and may cause damage to your enamel over time.

MOUTHWASH

This is not usually necessary as part of your ongoing daily routine as it is good brushing and effective cleaning of the spaces between your teeth that removes the sticky plaque, however many people like the fresh feeling that a mouthwash gives them and there are times when a mouthwash can be beneficial.

Fluoride daily mouthwash (0.05% or 225ppm) – this is good for people that have a high decay rate as well as people with orthodontic appliances, limited dexterity and certain medical conditions but in order for it to be beneficial it should be used at a separate time to brushing.

Gum irritations, tenderness and inflammation – One of the most well-known mouthwash brands to help with these symptoms is Corsodyl which contains an active ingredient called Chlorhexidine but follow the instructions carefully as this can cause staining. Curasept is an alternative that contains the same active ingredient but includes an anti-discoloration system to help reduce the staining potential. One of my personal favourites is a mouthwash called Peroxyl which contains hydrogen peroxide. This is good for minor irritations, inflammation and ulcers as well as relieving discomfort from erupting wisdom teeth. These are all medicated mouthwashes and are not designed for long term use, so again follow the instructions for all these products carefully.

Bad Breath (Halitosis) – mouthwashes on the market such as Ultradex or CB12 work by eliminating and preventing the volatile sulphur compounds linked to bad breath.

Remember with any mouthwash use it a separate time to brushing and if using a mouthwash for a fresh feeling then a cheaper one will suffice.

FLOSSING AND INTERDENTAL BRUSHES

Your toothbrush does not clean the spaces between your teeth so it is important to use something to clean this area to reduce the risk of decay and gum disease.

Floss – great for cleaning the tighter spaces between teeth. If you struggle with using string style floss then try a tape style floss as an alternative.

Flossettes/Floss Picks –  these provide an alternative to traditional floflosettess but are not as effective. I only recommend these  if a patient struggles with regular flossing and interdental brushes. The catapult style tend to be easier to use than the saw shape variety.

Superfloss – this is designed to clean beneath bridges where regular floss/tape will not access.

Interdental brushes – these are ideal for removing plaque and debris from the larger tepe_idbpage_header2_19spaces or if you struggle with floss. They come in a variety of sizes and you often need more than one size. One of the most well-known brands is TePe. A longer handled version called TePe Angle is good if you find it tough to access the back teeth. Some of my patients do not like the feel of this particular make between their teeth and have found the Vision brushes a good alternative.

 

 

 

Top tips for preventing bad breath

Patients often come to me concerned that they might have bad breath (halitosis). It’s a bit of a social taboo, people feel uncomfortable pointing it out to us and unfortunately it can be hard to detect for ourselves. A useful tip is to lick the back of your hand or wrist and wait until it dries, if it smells unpleasant then it is likely you have bad breath.

Woman covering mouth

There can be many causes, whether it be related to dental conditions, medical conditions, foods or habits. Here are a few examples;

  • Poor oral hygiene, periodontal (gum) disease, dental abscesses, diabetes, stomach and digestion problems, sinus and throat infections, fungal infections, dehydration, food odours, smoking.

These are my top tips to help prevent bad breath:

  1. Good brushing – for at least 2 minutes twice a day and change your brush every 3 months.
  2. Cleaning between the teeth with dental products such as floss or interdental brushes once a day removes the food and plaque which contributes to bad breath.
  3. Tongue Cleaner – the tongue is a great place to harbour bacteria so a tool such as a tongue scraper or alternatively a tooth brush is a good way to reduce the build up.
  4. Stop smoking – as well as other health implications it also causes bad breath.
  5. Chew sugar free gum after meals as an alternative to mints to help stimulate saliva flow thus reducing food particles and plaque.
  6. Mouthwashes and sprays – products on the market such as Ultradex or CB12 work by eliminating and preventing the volatile sulphur compounds linked to bad breath. Mouthwashes should be used at a separate time to brushing.
  7. Maintain a healthy balanced diet.
  8. Avoid or reduce foods/drinks that are known to cause odours; garlic, raw onion, alcohol, coffee
  9. Keep hydrated – drink plenty of water to help lubricate the mouth.
  10. See your dental clinician to help determine the cause of the problem as it may be something that can be treated.

Oral Cancer on the rise

As a dental clinician we are trained to look for and identify oral cancer. Although not common it is on the increase and it is important to be aware of the key risk factors as well as signs and symptoms to look out for.  151113-Mouth-cancer-rates

The two biggest risk factors linked to oral cancer are smoking and alcohol. The two combined more than double your risk. It is estimated that more than half of mouth and throat cancers in the UK are caused by smoking. Chewing tobacco will also significantly increase your risk, similarly will chewing betel which is popular in Asian and Oceanic cultures.

A third of diagnosed mouth and throat cancers are attributed to the consumption of alcohol. It is therefore important to drink responsibly and within the current NHS recommendations (currently 14 units per week for both men and women). This should be spaced out through the week and not consumed in one go. The link below provides a quick method of calculating your alcohol unit intake.

Alcohol Unit Calculator

There are several other notable risk factors;

  • Diet – a poor diet, lacking in vitamins and minerals has been linked to almost half of all diagnosed oral cancer.
  • HPV (human papillomavirus) – a sexually transmitted disease which has been linked to certain oral cancers. All girls aged 12 to 13 are offered HPV vaccination as part of the NHS childhood vaccination programme.
  • Sun over exposure/sunbed use increase the risk of lip cancer so it is important to protect lips with a high SPF sunscreen.

Symptoms

These are possible symptoms of oral cancer:

  • Ulcers that do not heal
  • Continued pain or discomfort
  • Red or white patches
  • Lump in neck, mouth, throat or lip
  • Change in voice or difficulty speaking
  • Difficulty moving jaw

The key with any cancer is early detection. Visit your dentist and hygienist regularly  so that routine oral cancer screening can be carried out. If you notice any of the above symptoms especially lesions that do not heal within two weeks make an appointment to see a dental clinician or your GP so they can be checked out.

 

 

My Gums Bleed, HELP!

Many people will have experienced bleeding when brushing or flossing at some point in their life and this will have been to varying degrees from mild to severe. Others will have been aware of this bleeding for their entire life and just accepted this as normal but it is important to act on this warning sign rather than choosing to ignore it.

The most likely cause for this bleeding is gingivitis which means inflammation of the gums and is primarily caused by plaque, a sticky film of bacteria, which forms on our teeth. Gingivitis is the first stage of gum disease but the good news is that it is reversible.

gumdisease

The bad news is that if it is not reversed then this inflammation can lead to the second stage of gum disease which is periodontitis. This is where tissues and bone around the tooth are gradually destroyed and can ultimately lead to tooth loss. Gum disease has overtaken decay as being the leading cause of tooth loss. It often goes unnoticed by the individual as many symptoms may not appear until it is in its more advanced stages, however, some people may experience one or more of the following:

  • Tenderness
  • Swollen/puffy gums,
  • redness
  • halitosis (bad breath)
  • receeding gums
  • Tooth movement
  • Pus

The way to reverse any inflammation is to remove the plaque which is the source of the irritation. The key to this is a good home care regime. I covered some of the basic steps to good brushing techniques in my previous blog Back to Basics: Brush up on your skills but to recap you need to brush for two minutes twice a day brushing all tooth surfaces as well as where the tooth and gum meet. A small and medium textured toothbrush head is best.

Your toothbrush cannot reach the areas between your teeth so these need to be cleaned with additional aids such as floss for tighter spaces and interdental brushes for larger gaps, this is known as interdental cleaning.

Mouthwashes are often what people reach for first when they notice bleeding, especially with hard hitting marketing campaigns for products such as Corsodyl. Although these can offer some immediate relief and seem like a quick fix, they do not resolve the issue and should not be used as a replacement for good brushing and interdental cleaning. If you do choose to supplement brushing with mouthwash it is important to ensure that you do not do so directly after brushing as this allows the fluoride in the toothpaste to stay in contact with the teeth reducing tooth decay.

It is also important to visit your dentist/hygienist if you notice bleeding or any other symptoms so that a thorough assessment of your gums can be carried out and an appropriate treatment plan can be made. Advice will also be given on the best home care regime and dental aids for your mouth. This will help to stabilise the situation after which regular hygiene visits should be scheduled to monitor and maintain your gum health long term.

 

 

 

Back to Basics: Brush up on your skills

Couple brushing teeth in the bathroom

Brushing our teeth is something the majority of us do and have done for as long as we can remember. It sounds a straight forward task, but this doesn’t mean it isn’t a struggle to get it right and many have not been educated in the art of good brushing.

‘I can’t understand it, I brush my teeth at least 3 times a day..’ is something I regularly hear from patients when I highlight issues with their brushing, but as I always say if you keep missing the same area it wouldn’t matter if you brushed them 100 times a day.

The key as with many things in life is quality over quantity so here are a few key tips to ensure your brushing is more effective:

  1. The timed brush – whether this be using a manual or electric toothbrush it needs to be for at least two minutes to effectively brush all the surfaces of all your teeth. Don’t try to guess how long you are brushing for as you will undoubtedly fall short; I have tested this with my patients and they rarely brush beyond 40 seconds. This is where an electric toothbrush has a real advantage as nearly all come with a timer. Many patients are unaware the timer exists so if you find yourself in this situation look out for a vibration or flashing light, some will even alert you at 30 second intervals to indicate moving to the next quadrant of your mouth so that each receives an even clean. If you are unsure take your toothbrush to your next hygiene visit, they will be more than happy to help you to find out.
  2. Brush twice a day – one of these brushes should be last thing at night.
  3. Small compact head – a smaller head is usually easier to access all areas of the mouth.
  4. Slow – slow and steady definitely wins the race. With a manual toothbrush slow and circular movements and with an electric toothbrush hold the brush still on each tooth surface before moving on to the next.
  5. Change your brush regularly – every 3 months as a guide or sooner if the bristles appear frayed.
  6. Spit don’t rinse – this is key as it allows the fluoride in the toothpaste to stay in contact with the teeth for as long as possible helping to reduce the risk of tooth decay.

 

Hygienist vs Therapist: What’s the difference?

When I introduce myself as a dental therapist I am often greeted with a slightly vague look so I often revert to using the title dental hygienist as it is a term people are more familiar with. I thought I would kick things of by explaining briefly the role of both a hygienist and a therapist.

A dental hygienist is a registered dental professional who helps both children and adults maintain their oral health by preventing and treating gum (periodontal) disease and promoting good oral health care. You will often hear the term ‘scale and polish’, but this is very much an over simplified description of what a hygienist does.

To provide more details and without getting too technical, a hygienists role primarily includes (but is not limited to), educating patients on the best oral hygiene practices, assessment and monitoring of gum health, oral cancer screening, routine and deep scaling, fluoride application and fissure sealants, dental impressions, teeth whitening

The role of a dental therapist is less commonly understood but encompasses everything  of a hygienist whilst also being able to perform additional procedures such as child and adult fillings and extractions of primary (baby) teeth.

This is a very brief overview of each role. A more detailed list of the full scope of practice can be found at the following link:

General Dental Council – Scope of Practice (September 2013)