3 More Reasons to Floss

When it comes to your dental health, floss is arguably the most impactful thing you can use. But, flossing regularly is a common struggle for many of my patients. With so many other things going on, flossing can often fall to the bottom of the priority list.

There are many avoidable problems that can be prevented, and save time and energy in the long-run, by spending a couple minutes flossing your teeth.

Floss can go where no toothbrush has been.

Throughout the day, tiny food particles get lodged between the teeth and gum, forming plaque. This plaque will build up over time to form tartar, a thick build up that must be removed by the dentist. The key is to remove the tiny food particles and plaque on your own. Flossing plays a major role in removing this debris as some of this build-up cannot be reached by a toothbrush. If this build-up is not removed, many dental problems can occur. Tartar buildup can lead to gingivitis and gum disease. Flossing goes the extra mile by getting in the tight spaces and removing much of the food and plaque a toothbrush and mouthwash can’t moving, helping prevent gum disease, cavities and halitosis.


Flossing can save you money.

Health care costs are rising and insurance benefits are diminishing, so it pays to take preventative measures to reduce medical expenses. A container of floss costs around two dollars, and it is free if you visit your local dentist! Flossing regularly will maybe cost you twenty dollars, or less, a year. The costs of not flossing are much, much more. If problems described above are not prevented, the procedures to correct gum disease, cavities, tooth decay and more, are not cheap. By flossing, you can avoid the costly dental procedures that are often not covered by regular dental insurance and can add up to thousands of dollars in bills.

You could lose your teeth (if you don’t).

The bacteria-laden tartar and plaque discussed above can spread even deeper below the gum line, causing severe gum disease and gingivitis. Gingivitis, the mildest form of periodontal disease, is often reversible with diligent home care. If left unchecked, gingivitis can progress into more severe periodontal disease, a leading cause of tooth loss. In layman’s terms, flossing can lead to eventual tooth and bone loss.

What if you are already showing signs of gingivitis or other oral diseases?

If you’re showing warning signs, please go and see your dentist. Mild gum disease may be controlled by routine professional teeth cleanings and more diligent flossing and brushing. Gingivitis and early periodontitis can be kept under control but it is better to act now!

Flossing only takes a few minutes every day and adds little to the cost of toothpaste, toothbrushes and mouthwash. Flossing is a small, simple step that can have huge implications for your mouth, teeth, gums and wallet.

Understanding the Need for an Orthodontic Specialist

Like our pediatrician, many of us are quite particular about our family dentist. We come to trust them with our family’s oral health and get comfortable with their treatment, practices, and advice. But have you considered an Orthodontic Specialist?

While the family dentist is an integral part of the dental system, the reality is that general dentistry doesn’t cover many procedures we’ll encounter. There inevitably comes a time when a decision must be made about the next steps for certain treatments. I’ll relate a story that will help you understand what I mean:

A colleague of mine wanted to take her practice to the next level, and to do it she wanted to generate some marketing collateral to be used in advertisements, on her website, on social media, perhaps even on TV.

She began pricing production companies because she knew she wanted at least one video to promote her practice. She wasn’t sure what to expect from the quotes, but those she was getting were higher than she had in mind. Mulling over the situation, she remembered a photographer she’d worked with to help produce some of her printed promotional materials and gave him a call.

They chatted about the possibility of him helping her produce the videos. Photography was his specialty and my colleague was very happy with the work he’d done for her in the past. Since they last worked together he had taken a few online classes on video editing and felt that his photography instincts would translate seamlessly enough to filming, at least something as simple as a short promo. He didn’t own the necessary equipment, but had friends who would let him rent it at a fair price, and in turn he was able to give my colleague a fair price as well, much less expensive than the professional production companies she’d negotiated with.

It seemed like the shoot went smoothly enough and my colleague was feeling optimistic. Then she received the finished product. It was a perfectly usable video, but she couldn’t help but wonder what kind of video she would have received if she went with the production company. Ultimately, my colleague underestimated the difference a professional production company could make. She was an uninformed consumer and assumed the difference between a photographer and videographer was fungible.

I don’t mean to imply that you need to seek out the most expensive orthodontic provider, or that all family dentists who offer orthodontic work are unqualified. My goal is to help you become informed about what services should fall under the purview of your family dentist, and why a specialist might be the better choice for your needs.

You can’t be too attached. I completely understand the tendency to want to continue working with your family dentist. That comfort level is likely unmatched, regardless of what orthodontist you work with, but you can’t always make that your top priority. Some procedures you need will require the help of a specialist and a family dentist you trust should make that recommendation. They shouldn’t be expected to handle complicated orthodontic work. Many family dentists have close working relationships with orthodontic specialists, and will refer you to their services. Their advocacy should serve as a trusted starting point for the next steps.

You need to know what falls under areas of expertise. Much like your pediatrician, your family dentist’s primary responsibility is the ongoing evaluation of your overall dental care and diagnosing conditions for which seeking the opinion of a specialist is appropriate. All of the family dentists I know are outstanding stewards of their patients’ dental health, and are exceptional at what they do. Diagnostics and overall care is their specialty. Corrective orthodontic procedures aren’t, nor should that be your expectation. Orthodontic work is covered very generally in dental school, but unless your family dentist has received significant specialty training, the two of you should work together to find an orthodontic professional that can best meet the specific needs of you and your family.

Ask the right questions about their training. It’s not uncommon for well-meaning family dentists to add orthodontic work to their list of services in the hope of boosting the bottom line. For the most part, this isn’t a hustle. Many dentists are capable of some simple orthodontic procedures, and if yours is a doctor you trust, it’s worth exploring their service as an option if the procedure isn’t too extensive. However, as a consumer, don’t be afraid to ask them what experience they have with orthodontics. While this still represents a very small number of the profession, I’m noticing a worrisome trend of weekend courses in orthodontics being presented as qualification to perform complex procedures. That being the case, it’s always worth asking about what training your dentist has received. The genuine and forthright professionals whom I have worked with would have no problem being honest about their capabilities and helping you find a specialist.

It’s important to recognize and accept when it’s time to consult with your family dentist about the help of a specialist. Many procedures will demand it. In the meantime, take my quiz to find out what kind of orthodontic provider is best for you and your family: Smile Shopping: Finding the Right Orthodontic Provider for Your Family.

How to Decode Your Bite

Decoding your bite. It’s an odd sounding, but apt exercise in understanding the precision of our teeth. Our teeth fit together like lines of code or details in a story.

If you’re writing code and a symbol is misplaced, that command isn’t going to perform as expected, and will likely have cascading negative effects throughout the program. Think about when you’re reading a story or watching a movie. Something about the character’s motivation doesn’t align or there’s a continuity error within the plot.

Those minor inconsistencies break the suspension of disbelief and gnaw at you for the rest of the movie or story. The experience is ruined. The same is true for minor issues with our bites.

The way our teeth fit together is very complicated. If you’ve ever had a new filling or a crown off by just a bit, you know that having your bite off by fractions of millimeters can be a big pain—literally.

I use the word “decode” because we don’t readily attribute many of the manifest symptoms of a “bad bite” to our bites being off.

If you’re experiencing the five following issues, know that it’s likely a problem with your bite.

Tooth pain. Usually a result of trauma or imperfect dental work, a tooth that is even slightly misaligned can cause severe pain. Improperly adjusted dental work can irritate the nerve. Tooth pain of this kind is common and treatable, and sometimes even intentional. If you’re receiving orthodontic treatment, your tooth might necessarily be misplaced on its way to the proper position. If you’re noticing this kind of pain, it might be wise to seek an opinion from your dental professional to avoid long-term issues.

Jaw joint (TMJ) pain. The temporal bone and the mandible join together to form the temporomandibular joint (TMJ). For the most part, minor soreness, popping or crackling of this joint is normal and nothing to be alarmed about. However, if you’re having a hard time opening your jaw, can’t open it at all, or have pain during jaw movement, it might mean you need to be evaluated for TMJ problems and correct your bite to alleviate the stress on your TMJ.

Headaches. Headaches are mysterious symptoms, but a common cause of unexplainable headaches—even migraines—is muscle pain associated with bite issues. If you’ve tried everything else and have been unable to relieve the pain, seek the consult of an orthodontist. The anatomy and function of the muscles in the head and neck is complex, and orthodontists are exquisitely trained in this area. That combined with their understanding of the intricacies of the bite can help you determine if your headaches are related to a bite problem.

Tooth wear. If your teeth aren’t fitting together properly, they can grind like mismatched gears. Over time, that grinding can wear down the enamel—the hard, outer casing of the tooth—and expose the softer dentin underneath, which is more sensitive and more prone to severe discoloration. If you’ve noticed tooth wear of this kind, it’s probable that you have an issue with your bite. It’s best to take preventative measures immediately. If tooth wear is allowed to persist for too long, simple procedures like fillings and crowns may not be enough, and orthodontic work might also be needed.

Gum wear. Typically, gum wear is a package deal with tooth wear. Notching of the teeth near the gumline (called abfraction), and wearing away of the gum tissue (called gingival recession) are common among people whose bite is off. These conditions can be extremely painful and expensive to correct. The earlier you can identify symptoms like gum wear, the earlier you can take preventative action and correct your bite before even more costly and painful procedures are needed.

So much of getting the treatment needed and knowing when you need to see a professional depends on how comfortable you are with your orthodontic provider. If you have a good relationship with your provider and trust them to care for you and your family, you shouldn’t hesitate to call for advice or consultation. Do you know if your orthodontic provider is right for your family? Take my quiz to find out: Smile Shopping: Finding the Right Orthodontic Provider for Your Family.

How To Avoid Cavities This Halloween

Whenever you eat sugary (highly acidic) foods like candy, baked goods, fruit juices, and soda, it leaves plaque, a sticky film of bacteria, on your teeth. The bacteria in plaque turns into acid that will attack your tooth enamel, eventually breaking down and creating a little hole is your tooth, a cavity.

This Halloween, schools, offices, parties, and neighbors will offer tons of delicious, sweet treats that can wreak havoc on your oral health. To avoid cavities and keep your teeth in the best shape, you don’t have to hide at home and avoid the social gatherings.

Here are my top tips for avoiding cavities this Halloween:

1. Just say no. Before you go to that party, eat a big, healthy meal. Then, brush your teeth, floss, and use mouth wash. Doing this will make it easier to say no to sweets – you’re too full and your mouth feels fresh!

Another option is to bring your own “treats” along. Make a bag of apple slices, berries, or veggies, and snack on them. Trust me, you likely will not be the only one choosing not to eat something sweet.

2. Give your teeth some extra love. It’s best to avoid sugary foods when it comes to your dental health. If, however, you sneak in some sweets, you may want to brush more than you think you should. Added sugar, when it sits on your teeth, turns acidic and can wear down tooth enamel, eventually causing cavities and other problems.

3. Don’t substitute “no sugar added” treats for sugary ones.

Sugar-free diet soft drinks and candies that don’t contain any natural sweetener aren’t necessarily any better for your teeth. While sugar substitutes generally lessen the risk of cavities, sugar-free products still have high levels of acids. These are still potentially damaging to teeth as they strip away layers of tooth enamel. And, citric acid and other acidic food flavorings like  lemon, orange, and other fruit-flavoured sweets, are particularly harmful.

4. Don’t eat candy alone. If you cannot resist that Snickers bar or Reese’s pieces, the best thing to do is eat candy with other foods. If you can, eat your Halloween candy and desserts with meals or shortly after mealtime. During meals, saliva production is increased and it will help cancel out acids produced by bacteria in your mouth, as well as help rinse away food particles.

5. Eat the sweets now and don’t save them for later! This may sound counterintuitive to normal health tips, but go ahead and eat the Halloween candy and desserts now instead of spreading them out across the next couple of weeks (or months).  By continually snacking on those super sugary treats, our teeth will be constantly exposed to these cavity causing acids. Have at the candy rather than saving up and gorging on all the leftovers.

Is the right person straightening your teeth?

Congratulations, you’ve decided to invest in orthodontic treatment! But, before you begin treatment, it’s important to make sure the right person is straightening you or your loved one’s teeth.

There are many providers of orthodontic treatment, but the right providers make up a small percentage.  Many are confused about the type of professionals out there, and who to choose.

The big question is, “Who is the best provider for my orthodontic treatment?” Use these five tips to make sure the right person is straightening your teeth.

1. The treatment is done in-person, not via mail-order.

A new trend in health care are mail-order orthodontics. These companies are run by businesspeople, not doctors, and treatment is not supervised by a professional. As convenient as mail-order or DIY services sound, moving teeth is a complicated process that requires a trained professional. It’s so important for orthodontic treatment to be supervised as dental appliances can get damaged, teeth don’t always move as planned, and correction involves much more than making teeth look straight.

2. The provider attended a full-time, accredited residency.

The ideal doctor will have completed a full-time, accredited residency. Weekend courses are not sufficient training. A truly qualified provider has consistently and continually pursued education and training over the course of years. Specialized treatment after dental school is necessary to provide the highest possible level orthodontic care. Whether a dentist or orthodontist, it is important they attended a full-time residency.

3. If the provider is a dentist, ask some questions to gauge their expertise.

A family, general, cosmetic, or primary-care dentist has completed dental school but has not completed an orthodontic residency. These dentists are responsible for ongoing evaluation of your overall dental care, diagnosing and treating many dental health conditions, and diagnosing conditions for specialists to evaluate and treat.

4. Check their credentials and experience.
It takes years of training to be able to treat orthodontic cases well. It’s important to find a provider who consistently and continually—over the course of years—pursues education and training. During your visit, ask to look at before-and-after photos. Most doctors who have treated many cases will keep books of before-and-after photos and can show you photos of cases like yours. The goal is to determine the training level of your future orthodontic provider.

5. Ask more about their treatment plan.
In addition to straightening crooked teeth, the treatment plan should be focused on correcting your bite. Many patients, and unfortunately many dental providers, do not have a concept of how important the bite is to overall dental health. If you have crooked teeth, you likely also have a bite problem, and you will benefit greatly from having any bite problems corrected. A bite that doesn’t fit well together can result in long-term consequences like tooth pain, TMJ, muscular pain, tooth wear, and gum wear.

Do your research when it comes to orthodontic treatment! Don’t be afraid to ask tough questions and get a second opinion.

Happy World Smile Day! Five steps towards a better smile (without braces)

Many more adults are now seeking orthodontic treatment as we keep our teeth longer and want to create smiles we’ve always dreamed of. The question that comes up often is, “Do I have to be a ‘metal mouth’?” The answer is no—there are several cosmetic, or clear, options towards a better smile without traditional braces.

1. Invisalign. Invisalign has become a household name for good reason. Of all the clear options to move teeth, Invisalign is the most aesthetic.

Invisalign is a series of clear, retainer-like trays called aligners. Aligners can be removed for eating and cleaning teeth. They are typically worn one to two weeks at a time before the patient switches to a new aligner that is slightly different. After a series of these aligners, the teeth gradually become straight. Many treatments are completed in under a year, but more difficult cases can take two years or more.

Invisalign can be done by any licensed dentist or orthodontist. The great advantage of having Invisalign treatment performed by an orthodontist rather than a family dentist is that orthodontists can combine treatment methods with the aligners in tricky cases and get some really great results.

2. Clear braces. Although Invisalign is the most aesthetic option, it has its limitations. On a scale of one to ten, Invisalign tops out with cases that are a five or six in difficulty, even under the care of the most skilled orthodontist. In more challenging cases, the best option may be clear braces. There are many types of these and are virtually unnoticeable in photos.

3. Lingual braces. Lingual braces go on the inside of your teeth. They do work; however, they are technically challenging for even the most gifted orthodontist, so it may be difficult to find a practitioner who offers them.

While braces on the inside of your teeth might have the advantage of great aesthetics, most patients agree that the disadvantages of slurred speech and sores on the tongue far outweigh their good looks.

4. Instant orthodontics. Instant orthodontics has been popularized by reality makeover shows. Ironically, instant orthodontics is not really orthodontics at all. Instead, it is a restorative dental procedure involving a combination of porcelain crowns, root canals, and tooth extraction. Teeth are ground down and replaced by porcelain caps or porcelain bridges to give the teeth a straight appearance.

This method can quickly (within weeks) restore worn, broken, or discolored teeth but is typically the most expensive option and may require several replacements in a lifetime.

5. Accelerated orthodontics. By combining state-of-the-art advancements in orthodontic technology with advanced bone modulation, we can now complete almost all treatment safely and effectively in under a year, and many in just four to six months. Plus, you can use clear braces with these techniques. For more information on accelerated orthodontics, visit www.Brasik.com.

Orthodontic treatment without braces? Yes, please! Contemporary orthodontic treatment offers more options than ever before for those looking to avoid metal braces. Find the right provider and they will create a customized plan that fits exactly what you need.

Four horrific dental health mistakes

Here are four horrific dental health mistakes:

1. Using mail-order orthodontics.

Mail-order service is a new trend in health care. In some cases, it makes sense, for example, mail-order contacts.

However, moving teeth is a complicated process. Each at-home aligner you use creates tooth movement. And, teeth don’t always move as planned. For this reason, using aligners for unsupervised tooth movement can lead to teeth moving in undesired ways .

And, if the aligners are damaged or broken, wearing them can lead to serious problems with your bite, causing long-term damage to your teeth or gums. Have your treatment supervised by a professional so that you get the desired outcome.

2. Do-it-yourself (DIY) treatment.

DIY treatment strikes fear into the heart of any dentist or orthodontist, and this is not because we are worrying about losing market share. We have all seen crazy things happen to people who try at-home remedies for their dental problems.

Believe it or not, it is very difficult to move teeth into a position that is both nice to look at and doesn’t cause tooth problems or headaches. But people really do try to do it themselves. If you don’t believe me, get online and search “DIY braces fail.” Ouch! Just because you can find metal and wire at Home Depot does not mean that DIY braces are a good idea.

3. Not correcting bite.

The best possible scenario (other than being lucky to have naturally perfect teeth) is to correct your bite early. Many times, people with what appear to be very straight teeth need orthodontics more than people with minor or moderately crooked teeth, because their bite is off.

The consequences of a bite being off include jaw joint (TMJ) pain, tooth pain, muscular pain, tooth wear, and gum wear.

Prevention by correcting your bite early is the best option. Your bite is something that can be off for a while and not cause you a lot of problems—until it does. Some people’s bites catch up with them in their twenties and some in their sixties—or at any age in between. Eventually, your bite will catch up with you.

Dealing with bite issues proactively is much less painful, less labor intensive, and less expensive than dealing with bite problems later. Problems with your bite can literally come back to bite you.

4. Just using Google or another online search to decide what treatment you need..
In today’s world, it is absolutely warranted to be skeptical of anyone and everything, including doctors. I get it.

But, Google, blogs, or your friend’s cousin’s uncle who had braces are not the best place for treatment recommendations. These are great places to start when researching which specialist to visit first. However, there is a lot of misinformation about all health care—including orthodontics—on the Internet.

Instead, find an orthodontist. Get your best information in-person at visits with several orthodontic specialists. If you get a few opinions that are consistent, chances are that the treatment is in your best interest.  You will know when you have walked into an office you can trust.

When (Not) to Get Your Permanent Teeth Pulled

This may be the most important warning I give you: think twice before having permanent teeth removed.

Before you read any further, know that extractions are no longer needed in over 99 percent of orthodontic patients. As a prospective patient, you need to advocate for yourself in your own treatment. If you are recommended to have permanent teeth extracted, be sure to get a second opinion.

Orthodontics has changed dramatically in the past twenty years. Most orthodontic cases throughout the seventies and eighties required the extraction of permanent teeth. Unfortunately, extracting teeth can result in long-term detrimental effects on many patients’ facial structures and compromise the health of their gums and bones as well as contribute to the potential for sleep apnea.

Nobody wants to go through having teeth pulled if it can be avoided. A full complement of teeth often results in a fuller, more beautiful smile.

So what has changed to allow orthodontists to avoid the extraction of so many teeth?

  •      The test of time. As more and more people were treated with braces over the years, orthodontists were able to see what happened to these patients as they became adults and aged. What they saw was not encouraging. Orthodontists realized that as people age, their lips tend to flatten out naturally. In patients who had permanent teeth extracted, this flattening was magnified significantly due to reduced support for the lips. As orthodontists began seeing this negative aging process caused by extractions, they began seeking other ways to treat.
  •      Controlled research. In the eighties, the University of Michigan began researching what caused people to have crowded teeth. Many times, orthodontists told people that their teeth were just too big to fit. Were people’s teeth too big? Interestingly enough, research has shown that this was not the case at all. In fact, virtually everyone had the same sizes of teeth, but those who had crowding had much smaller dental arches than those who had no crowding. The conclusion was that orthodontic treatment options should focus more on creating additional room for crowded teeth instead of removing teeth.
  •      Bonds instead of bands. Do you remember those rings around teeth with braces? Until the late seventies, braces included rings around the teeth, called bands. They were the only way to connect braces to the teeth. Bands around each tooth added about five millimeters of material between the teeth. Because of this, even in mildly crowded cases, there just was not enough room to fit all the teeth in the mouth and teeth needed to be pulled. Now, orthodontists use bonding. Bonding is a thin layer of adhesive that connects a brace to the front surface of a tooth.
  •      Better wires. Today’s wires deliver a force on the teeth that is much lighter and gentler on the teeth than that of the stainless steel wires used with traditional braces. Due to this gentleness, teeth are now able to move in a way that allows the bone to adapt and change with the movement, and orthodontists are able to treat more cases without tooth extractions.
  •      Better braces. The final piece to the puzzle arrived on the scene in the new millennium. Braces traditionally have required something to hold the wire in place (also referred to as “tightening” the braces). This was done with either small wire ties or those fun little colored elastics. Although these ties kept the wires in place, they caused friction and kept the teeth from sliding freely. Around the year 2000, a new type of brace was invented that does not require ties to hold the wire in place. Instead, a door or clip opens and closes to hold the wire in place. There is no friction against the wire, so the teeth are free to slide, and the orthodontist does not need to push as hard to get the teeth to move (which means less pain!).

Having permanent teeth extracted is not a pleasant experience, and long-term results have shown that permanent-tooth extractions can result in unwanted aging changes if performed on the wrong patient. The current recommendation is to make more room to accommodate the teeth rather than remove them. The perfect combination of technology has arrived, allowing orthodontists to accomplish the desired nonextraction treatment.

Questions You Should Be Asking Your Orthodontist

Choosing the right orthodontist for your family can be overwhelming, and making a wise decision can seem daunting. Today, finding a provider can be more confusing than ever as the number of options are ever-growing. To help sift through all the choices, you should ask your orthodontist these important questions.

Are your results guaranteed?

Many years ago, orthodontists would tell patients that they could stop wearing retainers a year or two after braces were removed. Then teeth shifted, and the wisdom teeth were blamed. Now we know that to keep your teeth straight for a lifetime, you must wear retainers indefinitely, regardless of wisdom teeth or any other factor. But let’s face it: not all people will do as instructed—dogs may eat retainers, or the retainers may be accidentally thrown away (or lost under the bed). In these cases, some teeth will shift, and, for some former patients, teeth will need to be restraightened. It is important to know what will happen and how much it will cost should you need to repeat braces at some point in the future.

Is the quoted treatment fee all inclusive?

Many offices that seem to cost less at first have hidden fees that pop up during treatment. Broken braces (all patients—kids and adults—have broken braces from time to time), extra visits, treatment that extends past the estimated treatment time, canceled appointments, Invisalign refinements, retainers, and more can trigger hidden fees at many offices, raising the costs to much more than you bargained for. For Invisalign, make sure refinements are included! Read the fine print, and make sure that the fee you are quoted is the only fee you will pay.

Are there affordable payment options?

Braces—even with the best doctors—can and should be affordable. Zero-down, no-interest payment plans should be available for those who can’t afford a large down payment. Extended payment plans should be available to allow for lower monthly payments. For extended plans, you may need to pay a little interest. However, the rate should be low (think 5 or 6 percent), not high like that of a credit card. Also, if you use a third-party financing service, be careful of penalty interest. For example, many companies offer 0 percent financing, but if you miss a single payment, they pile on penalty charges of over 20 percent—of the entire cost of treatment.

Is your office up to date with the latest technology?

The world is changing rapidly. So, too, is the world of orthodontics. Advances in braces technology, clear aligners, and accelerated treatment make straightening teeth more comfortable, more efficient, faster, easier, and less noticeable than ever before. Braces can even be placed behind your teeth, but only if the orthodontist spends considerable time, energy, and effort to invest in learning and mastering the latest techniques. If any doctor suggests extractions, headgear, or more than two years of treatment, make sure to get another opinion.