Can too much whitening hurt your teeth? Is there a difference between toothpaste formulas? Do you have to floss every day, really? Practitioners from around the state answer some of our most pressing dental health questions.
So, you’re sitting in your dentist’s waiting room, flipping through the glossy pages of a magazine, when you hear it—the distinctive ZZZZZZ-t of a dental drill.
Suddenly, your imagination goes wild. You’re just here for a routine cleaning, but you touch a protective hand to the side of your face: Will the hygienist find the tooth that’s been a little sensitive lately and discover you haven’t been flossing every day? What if the dentist tells you your tooth enamel is beyond repair because of the bubbly Prosecco and seltzer you drink every chance you get? And what about the five (ok, maybe six) rounds of over-the-counter teeth whitening you did last year, was that too many? Or worse, if you lost the tooth and had to get an implant, would you set off the metal detector every time you go to an airport? The possibilities are terrifying.
There is certainly no dearth of dental horror stories. But what’s real and what’s myth? To help separate fact from fiction, we went to the experts. Here’s what they had to say.
Are bubbly drinks like Prosecco and seltzer bad for your teeth?
It depends. “Not all bubbly beverages are created equally with regard to your dental health,” says Dr. Louis Formica of Virginia Family Dentistry in Prince George. Sugar and acidity can both affect enamel. Champagne, Prosecco and other fizzy spirits all have varying levels of sugar—though much less than a soft drink. Nonetheless, they “are still on the acidic side of the spectrum,” he says. While most sparkling waters and seltzer do not have sugar, their levels of acidity can vary significantly.
Bottom line? “If you are enjoying these bubbly drinks on an occasional basis, don’t worry,” he says. “But if seltzer is a way of life you may want to consider flat water to avoid any dental problems.”
There is something bubbly drinkers can do to mitigate the damage. Formica suggests waiting about 30 minutes before brushing your teeth after eating or drinking to allow the mouth return to a neutral acid level. “Toothpastes can be abrasive, which helps remove stain,” he points out, “but if the teeth just had an acid exposure they are more prone to having enamel breakdown.”
Is it true that there’s nothing you can do to replace enamel?
“Enamel is the strongest substance our bodies produce, but unfortunately is not replaceable,” says Formica. “Many components of our diet can be acidic and start to soften enamel making our teeth more susceptible to dental decay.” But, he says, “The good news is that it is possible to strengthen existing enamel through a process of remineralization.”
Products like topical tooth crème MI Paste can restore minerals though a milk-derived protein called Recaldent. Additionally, Sensodyne Pronamel and Colgate Enamel Health “have lower amounts of abrasives,” explains Formica, “which in softened enamel layers can lead to further loss of tooth structure.”
Can you become addicted to whitening? How much is too much?
Toothpastes, strips, gel trays and in-office sessions make whitening increasingly accessible. But do some of us go overboard in our quest for movie star perfect teeth?
“It is conceivable that an individual could certainly become preoccupied with the shade and appearance of their teeth and their smile, to the point where they wanted to use tooth whitening products excessively,” says Dr. Jennifer Hankle, an assistant professor at Virginia Commonwealth University School of Dentistry. “Use of any product, whether over the counter or prescription, has the potential to cause damage or sensitivity to teeth and gums.” Sorry teeth whitening devotees—looks like the answer is yes.
The best course is to look for products with an American Dental Association (ADA) seal of approval, says Hankle, and most importantly, consult your dentist before starting any regimen: “There are many safe and effective ways to whiten and/or improve your smile, and the safest and healthiest way to go is to get individualized advice from a licensed professional.”
Why am I hearing so much about dental implants these days? Are they harder to take care of than regular teeth? Will they set off metal detectors at airports?
There’s been a surge in the popularity of dental implants in recent years. “Dental implant technology has greatly improved over the last decade, allowing us to perform procedures with minimally invasive surgery, resulting in less swelling and less downtime than in the past,” says Dr. Craig Vigliante, an oral, maxillofacial and facial cosmetic surgeon with Potomac Surgical Arts in Lansdowne.
Dental implants are artificial roots that are attached to the jawbone. They provide a permanent solution for those with tooth loss—from single tooth replacements to dentures and bridges. Contrary to what many believe, implants are easy to care for. “They can be brushed and flossed as recommended for natural teeth. The main difference is that dental implants are not subject to cavities as are natural teeth,” says Vigliante. However, like real teeth, implants are prone to gum disease, “so it is very important to see your dentist every six months for regular cleanings just as you do for natural teeth.”
And as for concerns about traveling, he notes: “Most dental implants are made of titanium alloy and they do not set off airport metal detectors.” Good news.
Do you really need to brush twice a day and floss every day?
Yes. Three times a day is actually recommended for brushing your teeth, but twice a day will suffice, according to Joan Ignacio Katabian, a registered dental hygienist with Konikoff Dental Associates in Hampton Roads and faculty member at Old Dominion University School of Dental Hygiene. “The goal is to remove the soft plaque and bacteria that can cause cavities and gum disease.” Flossing once a day is essential because it removes the plaque in between the teeth where your toothbrush can’t reach. “If that plaque is not removed, it can cause gingivitis, cavities in between your teeth and halitosis—bad breath.”
When your hygienist asks if you floss, you might as well tell the truth. “We can usually tell when one doesn’t floss on a regular basis,” she says. Inflamed, red gums that bleed easily—classic signs of gingivitis—are a dead giveaway.
Does it matter which toothpaste you use—are the formulas that different from each other? Can I just use baking soda?
“All toothpastes are not the same, but they do have common ingredients,” says Dr. Dave Sarrett, dean of VCU School of Dentistry. These include a mild abrasive to remove plaque and stains from your teeth, plus flavorings and breath-freshening agents.
“The most important and critical ingredient is fluoride” for preventing tooth decay, he explains, because “fluoride counteracts the damage caused to your teeth by plaque germs.” Typically, over the counter toothpastes contain .24 percent sodium fluoride, though dentists can prescribe a higher amount for patients with tooth decay.
Brushing with plain old baking soda, a mild abrasive, is not a bad thing to do, he says, “but the missing fluoride will increase your chance of developing tooth decay.” To be sure you’re getting the fluoride you need, Sarrett recommends using toothpaste that has the ADA seal of approval as an anti-cavity agent.
Additional ingredients to look for include calcium phosphate that can help repair the damage caused by plaque, and pyrophosphate that prevents tartar buildup. Although some patients have reported tooth sensitivity or irritation to the gums and mouth lining when using the latter, it “can be helpful for patients that tend to develop heavier calcifications between dental cleanings,” says Sarrett.
Toothpastes that lay claim to whitening, he says, “do so by removing surface stains with little or no change in the actual color of your teeth.” To actually whiten your teeth, you must use a product that contains bleaching agents such as hydrogen peroxide applied by strips or by using dentist fabricated trays.
Is bleeding the only sign of gum disease?
No. According to Dr. John Ruffin Wheless III, a Martinsville periodontist, sometimes a patient may also notice soreness, swelling or loose teeth: “The problem is, sometimes there is no outward sign of disease. The patient will not notice any signs or problems.” Fortunately, x-rays and probing can help reveal any hidden issues, he says.
When the plaque builds up beneath the gum line, making removal difficult, the patient may require the services of a periodontist, a dentist with special training in gum disease and implants. The deep cleanings offered by this specialist can stem the progression of gum disease from gingivitis to periodontitis to tooth loss.
Can an infected tooth cause heart disease?
According to Dr. Harvey Schenkein, chair of the department of periodontics at VCU School of Dentistry, there are two categories of heart disease that are associated with one’s dental condition or with dental treatment: bacterial endocarditis and periodontal (gum) disease.
“The first, bacterial endocarditis, is a life-threatening infection of previously damaged, congenitally malformed or prosthetic heart valves due to the presence of bacteria in the circulation,” he says. These “bacteremias,” as they are known, are usually harmless, and can arise during chewing, brushing, flossing and certain dental procedures.
However, in individuals at high risk—those with damaged, prosthetic, or malformed heart valves—“there is a better chance of infection of the heart valves following the entrance of oral bacteria into the bloodstream during dental procedures.” As a result, antibiotics are often recommended to prevent endocarditis.
As for the second, “there is an association between periodontal disease and increased risk for cardiovascular diseases such as atherosclerosis,” he says. “There is research showing that certain oral bacteria can cause atherosclerosis in animal models.”
However, with clinical trials on humans still possibly years down the road, “There is not yet definite proof that periodontal infections are a cause of cardiovascular diseases.”
What is the best age for a first dental visit?
“Age three seems to be the most common age parents begin taking their children to the dentist. [But] in order to prevent dental problems, your child should see a dentist when the first tooth appears, or no later than his or her first birthday,” says Dr. Shepherd Sittason of Children’s Dentistry & Orthodontics of Lynchburg.
Parents should begin cleaning their children’s gums shortly after birth, using a soft infant toothbrush or cloth along with water.
Once teeth erupt, parents should use a small, soft toothbrush with “a tiny smear of fluoride toothpaste to brush baby teeth twice daily,” says Sittason. “Once children are 3 to 6 years old, then the amount should be increased to a pea-size dollop.”
It’s important to assist in the brushing. “Remember that young children do not have the ability to brush their teeth effectively,” Sittason explains. “Children should spit out and not swallow excess toothpaste after brushing.”
Is there such a thing as being “tongue-tied”?
Yes. “There is a ligament that connects the tongue to the floor of the mouth. Sometimes this ligament is attached too high on the lower jaw and causes the patient to be ‘tongue tied,’” causing speech problems, says Dr. Daniel Barton of Beach Dental Center in Virginia Beach.
Additionally, “Sometimes there are ligaments in the mouth that connect the upper and lower lip to the jaw of the mouth.” Both situations can lead to complications and require surgical removal known as a frenectomy.
In the past, these surgeries could be time-consuming, and involve bleeding and sutures. “Now, instead of a surgical blade, a laser can be used. With the Picasso Dental Laser, these procedures take just a few minutes with no bleeding and no need for stitches,” says Barton. “Patients tend to heal quicker and in most cases there is no need for a follow up visit.”
Will wisdom teeth ruin orthodontic work?
“The old tale is that erupting wisdom teeth—third molars—can cause crowding of the anterior teeth. This is not true,” says Barton. “As wisdom teeth erupt, they can exert some pressure on the second molars and can cause pain, but this force does not transfer all the way towards the front of the mouth causing the front teeth to shift and become crowded.”
However, late crowding of the front teeth can result from a late growth spurt of the lower jaw as well as bruxism, the unconscious habit of grinding your teeth, he says. “As the teeth rock back and forth against each other they are actually producing forces on the teeth similar to the forces created through orthodontics.”
Are you ever too old to get braces?
“Never! Are you ever too old to have healthy teeth and smile with confidence? As long as your teeth and gums are healthy, you can have orthodontic treatment,” says Dr. Deirdre Maull, an orthodontist in McLean.
She recalls the story of a female patient in her 70s. “Her bridge friends poked fun at her for getting braces. Once her braces came off, however, all of her friends were envious of how good she looked. She was so thrilled.”
Braces require a time commitment of usually one to two years, she says. “And then you will enjoy the results for the rest of your life.”
