Dentists give us the lowdown on some of the biggest trends in oral health today.
Illustration by Shaw Nielsen
In this age of selfies, teeth are pretty important—the healthier and more gleaming they are, the better. Straightening and whitening are consumer priorities, and hand-held home dental devices such as waterpicks and air flossers have earned fans among patients and professionals alike for their ability to reach those hard to get in-between spaces. As we grow increasingly knowledgeable about oral health, more and more specialized toothpastes are crowding the market, and consumers who doubt the safety of fluoride are driving a natural toothpaste movement. And these days, third molars, also known as wisdom teeth, are more likely to come out by high school graduation than stay in. The link between dental health and overall health is more widely known than ever. So, how do a handful of Virginia dentists view the latest developments in their field? We asked, and here is what they had to say.
Are we as a culture obsessed with teeth whitening? How much is too much?
Illustration by Shaw Nielsen
“Teeth aren’t supposed to be the color of paper,” notes Dr. Gina M. Kaiser of Berryville Dental Associates. “There are healthy ways to go about whitening, but we have to draw a line. Whitening is safe if you do it in moderation, but the products [both over-the-counter products and procedures in the dental office] are made of chemicals and our pulp is living—all living tissues exposed to chemicals can undergo changes such as increased sensitivity.”
How does it work? “There are three layers to the tooth—the enamel, dentin and pulp,” explains Dr. Monica Neshat of Reston Family & Cosmetic Dentistry. “Enamel is actually translucent, so a tooth’s color is dictated by the dentin. That’s where the whitening agent comes into play. It goes through tubules to whiten the second layer of your tooth.”
“Oral health is the gateway to your whole body. What a lot of people don’t understand is that a cavity is actually a bacterial infection in the tooth, essentially eating away at your tooth. If it were on your skin you’d be on it right away.”
— Dr. Monica Neshat, Reston Family & Cosmetic Dentistry
A visit to the dentist before whitening teeth at home helps ward off other issues, including cavities and gum problems, suggests Dr. Shari Ball of Kittrell Family Dentistry in Richmond. “Teeth whitening is really one of the most conservative and cost-effective things to improve your smile, and research doesn’t show any long term systemic risk,” she says. “There are things that can cause discoloration that aren’t because of superficial whitening, so you need to get a dental exam to make sure there are no underlying health problems. “If you overuse it, you can over time damage your teeth and cause irritation and damage to your gums, but it’s safe if you use it properly,” Ball says of over-the-counter whitening.
Dr. Douglas Wright of Harrisonburg Family & Cosmetic Dentistry agrees: “There’s a certain immediacy and everyone wants it now. The fact of the matter is, the more quickly we try to get them lightened the more likely we will see side effects. A lot of times patients want whitening but they have cavities. You really should have all of the restorative work done before the lightening phase.” That way teeth are evenly whitened and underlying issues are treated.
Need to Know
- White fillings and crowns can make the effects of whitening appear uneven.
- Teeth whitening is not for children because their tooth enamel is not fully hardened.
- Use of fluoride when bleaching helps remineralize the enamel surface.
Are non-fluoride toothpastes as effective as toothpastes that contain fluoride?
Illustration by Shaw Nielsen
It’s a controversy that won’t go away: Is fluoride toothpaste harmful to health, or is the potential for cavities and other dental problems a worse risk?
“I have a lot of health conscious patients who are concerned about fluoride,” says Ball, because of questions they have about potential toxicity or dangers to brain and bone health. “The fear has been around a long time. Is it bad not to use fluoride? No, but I get concerned about any [toothpaste] that doesn’t have the ADA certification because you don’t know what’s in it.”
Products such as Tom’s and Himalaya toothpastes do not contain fluoride and are not certified by the ADA but are prevalent in many countries, including the U.S., where fluoridated municipal water is prevalent.
Ball notes that toothpastes without fluoride don’t do any harm—but they also don’t prevent decay. “Even in the first stages of decay with stages of demineralization, use of fluoride will actually help strengthen the tooth enamel.”
“Everyone has their opinion on fluoride,” agrees Neshat. “I am pro-fluoride. It’s a naturally occurring element and is important for keeping your teeth strong. It remineralizes your enamel. Why wouldn’t you want that?”
There seems to be consensus on this point.
“I’m a big proponent of fluoride, and that goes against the grain of some of the natural world right now, but I can look at a patient and can tell whether they are using a fluoridated toothpaste or not,” contends Wright. He notes that some patients are very vulnerable to tooth decay, so while non-fluoride toothpaste may work for those who have a “naturally low incidence of decay,” for those prone to it, a cavity “can become a big deal.”
The Facts
- Some natural toothpastes are abrasive and can erode enamel. Read and research products before assuming that natural is healthful.
- For information about medical problems that may be exacerbated by overconsumption of fluoride, particularly as a topical application, go to MayoClinic.org
- Alternating between non-fluoride and fluoride toothpastes for twice-a-day brushing is a compromise some patients accept.
How useful is a water pick and can it replace flossing? And what about air flossers?
Illustration by Shaw Nielsen
“For at least 20 years I was very rigid in my thinking about dental floss,” says Wright, who graduated from dental school in the 1980s and was a staunch proponent of daily flossing. “But I’ve seen other things that work very well for my patients, so I’ve changed my thinking through observation in the practice.” He says a water pick can be an effective tool—some patients just like it, he explains, and are willing to use it twice a day: “Once a patient finds something that works for them, that’s three quarters of the battle right there.”
“Water picks are wonderful, actually,” says Kaiser, “but you should still brush and floss, so use it in conjunction with that because the floss helps break up the plaque that’s right against the teeth and the water pick flushes it out, so it helps remove some of that bacteria. And it’s great for braces.”
“We like to prevent things, not wait until something hurts.”
— Dr. Shari Ball, Kittrell Family Dentistry Richmond
Neshat notes that the design of water picks has changed a great deal over the years. “The button is on the handle now, so you don’t have to do this dance to not get water everywhere,” she says. “It’s easier to use once you get through the learning curve. If you have an implant or gum disease or if you can’t floss, it’s better than nothing. It never replaces flossing, but with water picks there’s nothing left behind.”
Air flossers are newer to the market, using micro-droplets of water and air pressure to remove particles. But, “I haven’t seen much in the way of results from them,” says Ball. Traditional flossing methods, when done regularly, remain the gold standard, with water picks a recommended complement. For people with gaps in their teeth, braces, missing teeth or bridges, or for those with dexterity problems, Ball says water picks can be particularly helpful.
Best Advice
- If you purchase a water pick, use it. No one needs an unused appliance cluttering the vanity.
- If the how-to booklet leaves questions, there are helpful YouTube videos that will show you how to use the device.
- Water picks can enhance, but shouldn’t replace traditional methods of brushing and flossing.
If wisdom teeth don’t hurt, is that a reason to keep them in? Why are they so frequently removed?
Illustration by Shaw Nielsen
The rite of passage of having wisdom teeth, or third molars, removed usually takes place during the teenage years. Mouth x-rays reveal their presence before they erupt through the gums, and it is during this phase, when roots are not mature, that many dentists and oral surgeons recommend their removal.
“We evaluate each case independently,” says Dr. Scott Goodove of Goodove Oral Surgery & Dental Implants in Virginia Beach, looking at “the way they are coming in, if they’re symptomatic. If you take them out when you’re older a lot more complications can come about, so a lot of it is preventative to avoid future issues.”
“Science is finding more and more that everything is connected—your oral cavity health affects your heart, your muscles, your brain, everything from A to Z, so it’s really important to maintain healthy, intact teeth.”
— Dr. Gina Kaiser, Berryville Dental Associates
Complications following third molar removal can include nerve injuries to the mouth and tingling of the lips, teeth and tongue. “That’s why we get them out before they’re symptomatic,” Goodove adds. “Healing is pretty quick and recovery is straightforward if we catch them early enough. If you start to have symptoms or pain or pathology associated with them, that’s when they are much harder to get out and there are more complications, so the sweet spot for evaluation is usually the teenage years.”
“Most people don’t have room for them,” adds Neshat. “A lot of people think if they’re not feeling any discomfort they don’t need to do anything about it, but dentistry is all about prevention, and you always want to be proactive, not reactive. Some people will come in with a lot of pain and be really uncomfortable. It’s not convenient to drop everything in an emergency and get your wisdom teeth out. I like to plan for things—don’t we all?”
Did You Know?
- Third molars that are partially erupted can become infected or damage adjacent teeth and can be difficult to clean.
- Older patients may be resistant to third molar removal until pain is present, but complications can be worse.
- Not all wisdom teeth come in fours. Some patients have fewer, and a few may have more than four.
This article originally appeared in our August 2018 issue as part of the Dental Health special section.
