The beginning of most dental checkup appointments is an assessment of your homecare routines. If I had a dollar for every time I asked about flossing and heard the response “I don’t really floss, but I use mouthwash”, I’d seriously retire.

Let me be clear….Mouthwash does not replace flossing. Ever. Nothing replaces the manual removal of bacteria. 

Now you know the verdict, but here’s why.

One of the most important things to consider is that rinses are only effective up to 2mm below the gumline. Recall when your dental hygienist is measuring your gum health and they’re calling out “3-2-3…3-2-3…4-3-3…”? Even if you don’t remember this process, this is how we measure (in millimeters) the depth of the tissue around each tooth and subsequently check the health of the underlying bone. Very rarely are there patients who only have 2’s and 1’s. I can’t even recall any patient in the last 7 years that would fit that criteria. So, if you’re only using mouthwash, you are missing the base of the pocket, thereby leaving millions of bacteria completely undisturbed and able to continue causing damage to your gums.

Another point of interest is that bacterial colonies are not penetrated by over-the-counter mouth rinses. Plaque that adheres to the tooth surface is an incredible organism, and is extremely protective of the bacteria it houses. Mouth rinses may be able to soften the bacteria on the outside of the plaque barrier, but they’re not able to penetrate the colonies living within it. Colonies of bacteria, not just bacteria itself, is the danger to oral health. Trace amounts of bacteria on their own do not pose significant risks to your gum tissue and teeth, but well established colonies of them do. Only flossing can break up the microcosm that houses bacterial colonies, thereby making them ineffective and removing the risk.

And lastly, if you’ll notice, the recent commercial ads in regards to a well known producer of mouthwash have changed quite a bit. In 2005, a judge in New York ruled against Listerine for making false claims surrounding the efficacy of its products, stating the clinical research did not support the claim that the mouth rinse was “just as effective as flossing”. He found that Listerine’s ads could actually pose a public health risk by turning people away from flossing. This finding by the courts prohibits Listerine from making this claim publicly now.

Nothing replaces good oral hygiene, so be wary when seemingly “easy” shortcuts make their way onto the dental aisle at the grocery store. Always be sure to ask your dental providers before you try any new products so that they can assess what your needs are and how to best meet them.

1. Paige Tscherpel, RDH, BSDH

Consulted Sources Include:

http://www.dental-picture-show.com/tooth-flossing/a-mouthwash-flossing.html

http://www.joponline.org/doi/abs/10.1902/jop.1992.63.5.469?journalCode=jop

The word “toothbrush” used to just refer to regular toothbrushes. The idea behind them hasn’t changed much since the 1930’s, when the toothbrush as we now know it was introduced to the public. In the 1990’s, powered toothbrushes started to gain popularity amongst the dental and public communities. These days you can get a regular toothbrush for free at your dental checkups, or you can drop as much as $250 for the best electric toothbrush available. So, what’s the difference and why do dental professionals prefer the pricey option? Let’s take some time to look at the pros and cons of both.

Manual Toothbrush…

PROS:

–Price: As mentioned, these are cheap/free. Often you can score these at your dental checkups. If dentists recommend electrics, why are they quick to give out a manual freebie? Studies have shown that 23% of people have gone 2 or more days without brushing their teeth, so we go by the mantra of “something is better than nothing.”

–Ease of travel: Toss them in your suitcase and go, there’s nothing to charge. And if you forget them in your hotel room, the price to replace them is minimal.

–You can still get great results: With impeccable technique, you can absolutely get great results from your homecare regimen by using a regular toothbrush.

CONS:

–Recession: People generally tend to believe that more is better. This includes scrubbing their teeth with the same amount of pressure as they would attack bathroom tile grout. This results in fragile gum tissue being scrubbed off. Where there is no gum tissue, the bone supporting the teeth will also dissolve. Therefore, we see gum recession with associated bone loss quite frequently in people who use manual toothbrushes.

–Inconsistent results: Very rarely do people take the time necessary to clean their mouths effectively with a regular toothbrush. Manual toothbrushes don’t have a timer to tell a patient when 2 minutes has passed, so 1 minute 52 seconds is the average most people will spend on brushing between their morning and night regimens, with the result being frequent, persistent gingivitis and periodontal disease.

Electric Toothbrush…

PROS:

–Ease of use with better results:  Electric toothbrushes are more effective and more efficient with less stress on technique. All you truly need is a light touch, aim the bristles at a 45 degree angle into the gumline and let it do the work. In several studies evaluating both electric and battery toothbrushes, there was a 23-62% improvement in gingival health after 1-3 months of use. There was also 82% less stain in those patients using an electric toothbrushes, as opposed to a manual.

–Timer: Electrics take the guesswork out of the chore of brushing your teeth. Not only do they do the work for you, they tell you when to switch sections in your mouth and when you’re done. Both children and adults are proven to spend more time when brushing with an electric, which directly correlates to more plaque removal, thus a decrease in gingival inflammation.

–No more recession: There is a pressure indicator in electric toothbrushes, so when you push too hard, they stop working effectively. This means that you won’t get any more recession of your gum tissue. This makes electrics optimal for those that have recession, have had surgery to correct gum defects, or experience sensitivity caused by recession.

–Smaller heads and more gum care options: Often, the electric toothbrush heads are much smaller than their manual counterparts, which means better access to hard-to-reach areas. And many electrics have different settings to accommodate each patient’s specific concerns, i.e. sensitivity, gum massage, etc.

CONS:

–Price: Electrics and battery toothbrushes can cost anywhere from $10-$200+. The heads need to be replaced every three months, and typically start around $6-$7. However, when you consider that a deep cleaning needed from the onset of gum disease can have a starting cost of at least $100 to upwards of thousands of dollars if periodontal surgery is needed, the initial purchase of an electric toothbrush doesn’t seem quite so daunting, considering the disease it helps prevent. And one electric per family is just fine, as long as everyone has their own toothbrush heads.

–Charging: They need to be charged or have their batteries replaced. Most people these days are also just as concerned with charging their smartphones, so an additional cord doesn’t seem like much to ask when traveling or at home. Add to this, that the newer models typically hold a charge for 2-3 weeks, it’s not a constant need to have the charger laying out in your bathroom.

–More difficult to travel with: You will need to be sure you don’t leave this behind in your hotel room! Fortunately, Sonicare has a model that has a travel case that is extremely compact and doubles as the charging case (and also has the added benefit of being able to be charged via USB cable).

Those “cons” really didn’t add up to much, did they?

Unless your dentist works for an electric toothbrush company (most don’t, you can ask!), they aren’t making any additional money by suggesting you go buy one for you and your family. The benefit is purely to prevent oral disease for the long term. So be sure to ask questions and find out which one they recommend most and why they feel the investment is the best option for you.

Paige Tscherpel, RDH, BSDH

Consulted Sources Include:

http://www.rdhmag.com/articles/print/volume-25/issue-10/feature/five-common-misconceptions-about-power-toothbrushes.html

https://www.deltadental.com/Public/NewsMedia/NewsReleaseDentalSurveyFindsShortcomings_201409.jsp

The controversy over fluoride is not new, but at times it’s hard to make an educated decision when you have so much hype to sift through. Is it helpful or is it poison? Does it cause cancer or prevent disease? Let’s look at the facts, and the recommendations, and see what makes the most sense.

Fluoride is a naturally occurring element, found in most water sources, including rivers and lakes. Originally termed “nature’s cavity fighter”, fluoride helps to strengthen tooth enamel by remineralizing it, to make it more resistant to acid attacks after bacteria has been introduced to the mouth. It is also “bactericidal” which means it kills bacteria. Fluoride has been added to community water supplies for the last 70 years at the rate of 0.7-1.2 parts per million, with the most current recommendation from the Department of Health and Human Services being 0.7ppm.

Studies have shown that children had three times as many cavities prior to community water fluoridation, and currently it is credited with a 25% reduction in childhood tooth decay. Because of these outstanding results, community water fluoridation has been proclaimed one of the ten great public health achievements of the 20th century by the Centers for Disease Control.

Besides being available in the community water supply, there are topical ways to apply fluoride to the teeth to reap the benefits. Any toothpaste with the American Dental Association (ADA) seal has a fluoride content of at least 1000ppm. A typical fluoride varnish applied after a dental cleaning has 22,600ppm. Why the difference in amount of fluoride from the water supply? The water supply is a systemic means of delivering fluoride, and as such needs to be a very minimal amount to deliver benefit and avoid any risks to the body. The toothpaste and fluoride treatments are topical, not meant to be ingested, and work when applied directly to the teeth.

The current recommendations for topical applications of fluoride by the ADA are as follows:

1. Brush twice daily with a toothpaste that contains fluoride and has earned the ADA seal. Children 6 years of age and older, use a pea sized amount. Children younger than 6, use a very small smear of toothpaste to prevent swallowing. Remember, this is a topical application, and is not meant to be ingested.

2. Topical fluoride treatments in the form of varnishes, gels or foams applied once every six months to anyone with a moderate caries (cavity) risk. Risk is assessed per patient and includes diet, family history, medical history and dental history.

Fluoride has not been shown to cause cancer. Studies done in the 1980’s and 1990’s found that there was no way to correlate fluoridated water with a rise in cancer between populations that were both exposed and not exposed to community water fluoridation. Even in studies done on animals, there was no clear risk associated with fluoridation. Studies as recent as 2011 are still showing the same results. 70 years of clear scientific research fully supports the responsible and repeatable use of both systemic and topical fluorides as a method of cavity reduction in at-risk populations.

Please bring your questions about fluoride to your dentist or dental hygienist. We are always more than happy to help you understand your cavity risk and why fluoride may be recommended to help your specific risk be lowered.

1. Paige Tscherpel, RDH, BSDH

Consulted Sources Include:

http://www.mouthhealthy.org/en/az-topics/f/fluoride

http://www.newsweek.com/us-government-recommends-lower-level-fluoride-water-325760

http://www.cdc.gov/fluoridation/fluoride_products/

http://www.ada.org/~/media/ADA/Science%20and%20Research/Files/cavity_prevention_tips.pdf?la=en

http://www.ada.org/~/media/ADA/Science%20and%20Research/Files/report_fluoride.ash

http://m.cancer.org/cancer/cancercauses/othercarcinogens/athome/water-fluoridation-and-cancer-risk

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC180028/