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We recommend our patient use only soft or ultra-soft toothbrushes. Stiffness of the bristles of a brush are not as important as the proper brushing techniques are.  In fact, medium and hard bristles can damage the lining of the gums and cause recession, and even damage the root surface at the gumline.  we don’t recommend the use of medium or hard toothbrushes for anyone.  But speak to your dentist about this important topic prior to switching or investing in a toothbrush. We understand ultra-soft brushes are not easy to find on the supermarket shelves, so we provide them for our patients twice per year after their cleaning appointments.

The assortment of toothbrushes is sometimes a blessing, and sometimes a source of confusion.  I recommend you look for the ADA seal on the product whether it is a manual brush, or electric. It is true that if used properly, an electric toothbrush can be very effective in removing plaque.  An electric brush can be of great help specially for those of us who have diminished fine motor skills, and reduced hand dexterity.

Manual toothbrush- use circular motion to move the brush tip gently over an area several times prior to moving on to the next spot.  Do not apply heavy hand, but just enough pressure to remove the soft film on your teeth.  Do not brush in a straight line.  This seems to be the default mode of brushing for most, but we don’t recommend this technique.  Spend 30 seconds on each quadrant.  30 seconds upper right, 30 seconds upper left, 30 seconds lower left, and 30 seconds lower right. 

Electric toothbrush- circular movement just as in the case of a manual toothbrush, but much slower in movement speed, and with reduced hand pressure.  Allow the moving brush head to do the job. The bristles of an electric brush may be medium or hard.  Therefore, do not press hard or use vigorous movement with these brushes. 

Our teeth have 5 sides; cheek side, tongue side, top of the tooth, front, and back.  Brushing can only get to the tongue side, cheek side, and top of the tooth.  We are not able to brush front or back side of the tooth in most cases because they are blocked by other teeth.  The food caught between the teeth and the plaque that accumulates causes gums to inflame, causing gum bleeding.  Food debris caught between the teeth causes cavities to form on these surfaces.  Floss once or twice per day.

Place the floss between the teeth, then wrap the floss around one of the teeth making a C-shape around the tooth.  Move the floss up, and out.  Place the floss in the same spot, and wrap it around the other tooth like a C, and move up and out. Repeat this with each contact area. 

When speaking of sensitivity, we are often referring to temperature sensitivity.  There are many factors that causes a tooth to react to temperature.  These are some of the commons causes of tooth sensitivity:

• Receding gumline- This exposes the root surfaces, which have less insulation against temperature than top of the tooth.
• Fracture lines or cracked enamel- enamel acts like a physical protective barrier over the dentin. Dentin is the inner layer of the tooth and is the sensitive part of the tooth. Without enamel, dentin will react to sweets, cold and hot temperature changes. 
• Grinding and clenching- This common phenomenon will cause wearing away of enamel, and in some cases fracture of enamel. Areas where enamel is thin, or missing will experience temperature sensitivity.  The effect of grinding is often noted at the gumline, facing the cheeks. 
• Leaky fillings- This may happen when a filling is cracked, or the edges of filling are pealing off which allow temperature to reach dentin, the sensitive inner layer.
• Cavities- a lot of the time cavities present no symptoms. But because they damage tooth structure which insulate a tooth, they can make the tooth sensitive to cold, hot, or sweets. 
• Deep fillings- when treating a cavity that is deep, and close to the nerve, the newly placed filling may cause sensitivity to cold, or hot temperatures. This typically can last days to even months.  Although this condition typically will improve over time, it is important to notify the dentist of any changes.
• Acid attack- acid reflux, or high acidic diet will eventually cause thinning of enamel in certain spots and this will lead to tooth sensitivity.

Bad breath, which is also known as halitosis is usually the result of microbial deposits on the tongue, and around teeth which break down food debris and sugars and create compounds causing the bad breath.  Not all forms of bad breath are a sign of pathology, but some are.  Morning bad breath that dissipates as the day goes by are caused by the normal oral flora.  Due to reduced saliva flow at nights, the byproduct of bacterial decomposition does not get washed away and it accumulates causing bad breath.  As salivary flow increases throughout the morning, bad breath also decreases.  In these cases, use antimicrobial mouthwash after brushing and flossing in the mornings.  Since the tongue is a large depository for bacteria, make sure the top of the tongue is brushed also.  Other sources of bad breath that linger may be more serious.  This may indicate the presence of gum disease or periodontitis.  This condition must be evaluated by a dentist and proper cleaning prescribed to treat it correctly.  There may also be a localized or generalized infection in the gums.  This is not going to go away with mouthwash.   Sometimes, the source of chronic bad breath may be a faulty restoration such as a decayed filling, or crown.  This will require replacement or repair of the affected teeth. 

There are many factors which may make a tooth sensitive. The question is formulated in this list as such because I’m aware of how it is normally asked over the internet.  But in my opinion, the real question is “should I treat my tooth sensitivity at home?”  It is not a good idea. Because to treat a tooth sensitivity properly, it is important to find the reason for the sensitivity first.  This can be a challenge even for dentists.  Self-diagnosis at home is not recommended. Depending on the reason, the treatment will be different. Sometimes the treatment may be changing a toothpaste.  At times, if there is a physical defect, it may mean restorative approach.  Do not self-diagnose this condition.  There are over the counter products that could address very specific reasons behind a tooth sensitivity.  But may not be adequate or even appropriate for many other reasons for tooth sensitivity.  I strongly suggest speaking to a dentist in person about this, as this could be a sign of an underlying condition which may worsen if not treated.  Sometimes the reason for sensitivity is simple.  We may simply advise the patient to use over the counter toothpastes containing potassium nitrate, an inorganic salt which is shown to reduce tooth sensitivity.  We then advise them to reduce the intake of acidic foods and drinks.  At times, this is all that is needed to reduce or eliminate tooth sensitivity.  But this only works, if the underlying conditions are properly diagnosed.  There are more serious conditions that give rise to these same symptoms, and cannot be treated by the use of a simple toothpaste.

Dental anxiety is very common.  The important of addressing this issue may mean the difference between a healthy oral cavity, and down right neglect of oral health by the anxious patient due to fear.  The best remedy for this condition is complex and multifactorial.  Before resorting to medication, dentist must take his or her time addressing the source of anxiety in a patient.  Getting to know the patient, and allowing the patient time to get to know the dentist, and their oral conditions.  Conservative approach to treatment is a tremendous relief to an anxious patient, in our experience.  Explaining the areas that need treatment, and explaining the nature of treatment in a simple manner is very helpful.  Starting with a simple and short procedure to help the patient be familiar with the dentist and the style of dentistry, and employing a light-handed approach with a gentle demeanor are a must.  If it is noted that more needs to be done to ease the patient’s anxiety, certain drugs are available, including nitrous oxide. 

First, speak to your dentist about this important topic prior to whitening your teeth.  You may have fillings or crowns on your front teeth that will not get whiter with bleaching.  If you know for sure you don’t have visible fillings, or crowns on your front teeth, and you have no history of sensitivity, then over the counter whitening kits are a good option.  Limiting some foods that tend to increase staining is important as well.  Foods such as red wine, sodas, coffee may stain your teeth.  You may also use whitening toothpaste which may help remove some of the stains on your teeth that are causing your teeth to look darker. But as always, we ask that you discuss this with your dentist.  Sometimes the shade of a tooth has less to do with surface stains, and more to do with internal structure of the tooth.  Intrinsic stains do not respond to external whitening.  Generally, teeth with a gray shade will respond poorly to bleaching.  In cases which staining is internal, or due to aged restoration, it may be necessary to use composites, or porcelains to improve the shade of your teeth.  At our office we use take home whitening kits.  These kits have been effective and affords the patient more flexibility in the process. 

We recommend that your child see a dentist as soon as the first teeth erupt.  Now, this does not mean they will need X-rays, or dental work.  But it slowly and gently introduces the child to his or her dentist and familiarizes them with that environment helping to alleviate future fears and anxieties.  Also, early detection of problems is the best way to ensure a healthy oral cavity for your child, and generally less dental work as they grow.

Usually baby teeth will begin this process around the ages of 6-8.  They will usually fall out in the same order as they erupted.

It is important to replace missing teeth not only to restore function, but also esthetic. Another reason for replacement is to prevent future complications with bite, and shifting of the teeth.  Over time, due to available spacing caused by missing teeth, the remaining teeth may drift and this will cause gaps between teeth.  This will also increase the risk of gum problems.  We have noted that often times when one or more teeth are missing, patients will favor the side of the mouth with less gaps between teeth for chewing.  This increased workload can cause further deterioration of the teeth on the side that patient uses more often. 

Options to replace missing teeth:

• Implants- in most cases this is by far the best option. It may not be the option for every single case.  Implants act like natural teeth.  They can be flossed like a natural tooth.  They do not move or shift.  They last a long time, and restore function and esthetics very well.  But there are certain bone conditions, and underlying health conditions which may not make this option ideal.  Speak to your dentist about implants.
• Bridge- a bridge is like a crown, but with multiple crowns fused together back to back. A bridge is a fixed prosthesis that is cemented in place like a crown and does not move.  However, they require flossing under the bridge to remove debris, and it requires prepping of abutment (supporting) teeth in order to fit properly. 
• Dentures- these removable prosthetics that replace one or all teeth using the same appliance. They are more economical, and have helped patients for decades.  But due to their movable, unfixed nature, they are not ideal treatment for everyone.

Leaving a gap/missing tooth open- this is certainly an option.  But as we discussed this can lead to shifting of teeth, gaps between teeth, gum problems, and possible premature wear of existing teeth. 

• Mouth ulcers, or sores
• Pain in the facial muscles, jaw, teeth, gums.
• Swelling of face or gums.
• Bleeding gums
• Chronic bad breath
• Dry mouth
• Tooth sensitivity to temperature
• Tooth pain when chewing, or pressure
• White spots, or red lesions in the mouth
• Sudden shade change noted on one tooth

Please note, many of other oral conditions do not have any symptoms. This is why it is important to see a dentist regularly.