Proms, graduations, vacations and other photo-op moments are on the horizon for you – and spurring you to consider a smile makeover. Whitening today is easier than ever, and you may be motivated by those brilliant smiles on magazine covers and even on your friends and schoolmates.

If you’ve mentioned the idea of having your teeth whitened to your parents, you’ve probably heard this question: Is it safe? You may have wondered about it yourself. So is it?

The straightforward answer: It depends. Although teeth whitening solutions can produce good to excellent results, they can also produce side effects, and may not always give you the outcome you expected. Here are some things to consider when making a decision.

You can be too young – and the issue isn’t safety, it’s appearance. According to the American Academy of Pediatric Dentistry, younger teens who don’t yet have all their permanent teeth (unusual, but it does happen) risk whitening that mix of permanent and primary teeth and ending up with mismatched teeth —artificially whitened next to newer arrivals that are naturally colored. Matching them later can be tricky and expensive.

Also, permanent teeth in younger teens often have not fully emerged from the gums. So you could end up with teeth that are noticeably whiter near the biting surface than near the gum line – not an attractive look. Another concern is that whitening kit instructions need to be carefully followed. If you are not fond of reading directions closely, or tend to use whitening treatments more often than directed, you could cause irritation, painful tooth sensitivity—or even damage to the enamel or pulp of a tooth.

For the most part, these problems are usually resolved by the time you are 16 to 18. So, I generally recommend that you wait until that age before deciding whether or not to whiten. I urge my teen patients who are considering whitening first to come in for a brief (and free) exam. During the exam, our team checks the maturity of teeth; looks for problems, such as irritated gums, that should be resolved before whitening; and offers advice on whitening options.

Healthy young teeth are most often naturally white (emphasis on natural) without artificial brighteners. The friends and schoolmates whose smiles you’ve been studying may be doing nothing more complicated than regular brushing and flossing to maintain those bright healthy smiles. At your next dental exam, ask to check your smile against your dentist’s shade guide. You may be surprised to find that your teeth are naturally right up there on the whiteness scale. If beverages or foods that you favor have actually stained your teeth, try giving them up temporarily. After a week or two, if regular brushing hasn’t brightened your smile, try over-the-counter whitening toothpaste, preferably one recommended by the American Dental Association.

Most importantly, be aware that whitening is not a replacement for brushing and flossing. The same habitual care that keeps your hair shiny and your skin glowing works wonders on your teeth. Here is a routine that will keep your newly whitened teeth healthy and sparkling:

• Clean your teeth well twice a day, after breakfast and last thing before you go to sleep at night
• Use a small toothbrush with soft bristles to protect enamel from scratching and dulling, and gums from damage
• Use fluoride toothpaste. Spit, don’t rinse to keep protection working
• Cut back or cut out enamel-staining drinks
• Choose water as your main drink. Tap water is best because it contains fluoride to harden and repair enamel
• After eating, rinse your mouth with water to stop plaque build-up.
• Definitely don’t smoke! It darkens and stains teeth.

Next Time: Professional Whitening

Last January the team attended the New England Region Yankee Dental Convention in Boston.

We have always strived to learn and grow in order to provide you, our patients, with the latest and greatest dentistry. There are literally hundreds of courses offered. Some very technical, some motivational, some involving personal growth, communication, exercise, nutrition, and so on.

I decided to take a course that mirrored my personal passion of creating a more sustainable world. “Greening Your Dental Practice” was right up my alley!

After hearing the startling statistics of material use and waste, we broke down our office into departments to see how we could best save resources, reduce waste and save money while still maintaining our high level of quality care and sterilization practices for you, our patients.

First some statistics:

100 million trees are forested every year- not all are replanted.

One half of the world’s forests are gone.

25 countries have no forest left at all.

We started our “greening” efforts with our paper consumption.  We only buy office paper with a minimum of 30% recycled content.  When purchasing paper, we look for the highest recycled content possible.  Instead of buying paper for interoffice notes, we cut up sheets of used paper, use it again and then recycle that!  We also recycle all catalogs, magazines and paper scraps.

We also discontinued using paper covers on instrument trays and countertops.  Previously, after each patient we just threw away the paper and sterilized the trays. We save about 70 sheets of paper a day and now wonder why we ever used the covers in the first place!

We recycle all of our empty glove boxes as well as the other boxes supplies come in. We must use 10 boxes of gloves a day. Previously, these were going in the regular trash.  We also recycle all the corrugated cardboard boxes used to ship us our supplies. Most weeks we receive 10-20 boxes. Previously when I went to throw something in our dumpster, it was full of just cardboard boxes.

AbitibiBowater, Inc. collects recyclable materials in many communities with its Paper Retriever^® dumpsters and makes many products with the recycled paper and different community organizations get some income. We use the Paper Retriever^® at the YMCA adjacent to our office.

The sheer volume of materials our office uses is staggering. By recycling at the level we do, the cost savings in trash removal and landfill space is significant.

(Our office complex does not provide recycling, so several team members take our recyclables home where we have recycling pickup).

   Most people don’t even think about what happens to trash (or items that can be recycled) when they are disposing of materials from their home or office. Out of sight, out of mind! We are making every effort to combat this mind-set, while still providing our patients with top-level care.  If everyone were to do a little, it ends up being a lot!  We are trying to do our part.

I have had a number of questions of late regarding mouthrinses, when to use them and what type to use.  Here’s my take on mouthrinses:

Mouthrinses are used for a variety of reasons: to freshen breath, to help prevent or control tooth decay, to reduce plaque, to prevent or reduce gingivitis, to reduce the speed that tartar forms on the teeth, or to produce a combination of these effects. Most mouthrinses are available without a prescription.

What ingredients are commonly found in mouthrinse?

Basic ingredients include water, alcohol, cleansing agents, flavoring ingredients and coloring agents. Active ingredients vary depending on the type of mouthrinse, but they can be placed into four general groups:

• Antimicrobial agents act directly on oral bacteria to help reduce plaque, decrease the severity of gingivitis and control bad breath.
• Fluoride helps reduce tiny lesions (tooth decay) on tooth enamel and make teeth more resistant to decay.
• Astringent salts can serve as temporary deodorizers that mask bad breath.
• Odor neutralizers act by chemically inactivating odor causing compounds.

What’s the difference between cosmetic and therapeutic?

Cosmetic mouthrinses may temporarily control or reduce bad breath and leave the mouth with a pleasant taste. But they don’t deal with the causes of bad breath. They don’t kill the bacteria that cause bad breath or chemically inactivate odor causing compounds. Also, none of the cosmetic mouthrinses helps reduce plaque, gingivitis or cavities.

Therapeutic mouthrinses, on the other hand, can help reduce plaque, gingivitis, cavities and bad breath. Some fight the bacteria present in plaque, a sticky film that forms on teeth and gums. Plaque bacteria create toxins that can damage the gums. Plaque that is not removed with daily brushing and flossing can cause gingivitis, an early stage of gum disease. If plaque is allowed to continue to accumulate, gingivitis can progress to advanced gum disease, called periodontitis, which only a dentist can treat. Plaque can also turn into tartar (or calculus), a hard substance that can only be removed during a professional cleaning. Some therapeutic mouthwashes contain agents that either fight bad breath bacteria or that chemically inactivate odor causing compounds. Some therapeutic mouthrinses that contain fluoride help prevent or reduce tooth decay.

Do I need a mouthrinse?

We can advise you whether you need a mouthrinse depending on your oral health needs. Rinsing helps remove debris from the mouth. It can be done before or after brushing, but it is not a substitute for brushing or flossing. You may consider using a mouthrinse with fluoride or antimicrobial agents as part of your daily oral hygiene routine.

If you have difficulty brushing and flossing, a mouthrinse may provide additional protection against cavities and periodontal (gum) disease. Anti-cavity rinses with fluoride help protect tooth enamel.

The bottom line with these whitening kiosks is that they are not staffed or overseen by anyone trained in the dental health field.  These services are administered without examination to determine if the person receiving the treatment is even a candidate for whitening, or has underlying oral health issues that make whitening ill-advised or even potentially harmful to the patient.

Don’t get me wrong, I believe in the safe administration/application of whitening products where it is deemed appropriate.  That is why it is best to consult a trained dental health professional before embarking on a quest for a whiter, brighter smile.  That being said, if whitening is appropriate, here is a little background about whitening materials and processes and ways to safely and effectively whitening your smile:

Nearly all whitening products will whiten teeth to a certain extent because they all have the same active ingredient, either carbamide or hydrogen peroxide. However, the percentage of the active ingredient in whitening products varies between what a dentist uses and what is contained in over-the-counter products.

Over-the-counter products (Crest White Strips, for example) contain about 5 percent or less of active whitening ingredients, whereas a dentist will use products that have 10 to 35 percent of active whitening ingredients. Because of this, store-bought whitening products may not be as effective and could take a longer time and require a larger quantity to achieve any significant results.

There are two different whitening systems used by a dentist.  In-office whitening takes roughly 60 to 90 minutes per visit. A chemical solution is applied to the teeth and a special light may be used to help activate the bleaching agent. To complete the process, multiple visits may be required.

With at-home whitening, we produce a custom-fitted mouthguard that holds whitening gel. The mouthguard is worn during the day or at night, and the treatment period varies (generally 4-6 hours per day/night for 2-3 weeks).

Those who use the store-bought kits lose the benefit of a custom-made mouthguard to apply the gel, and results may not be uniform. Therefore, anyone with moderate to severe discoloration could be disappointed with the results of the store-bought kits.  Patients with only mild, yellowing teeth, either due to age or food and beverage stains, may benefit from diligent use of a store-bought product.

Teeth may often be sensitive during the period when any type of whitening solution is used. In most cases, this sensitivity is temporary and should lessen or disappear once the treatment is finished.

Those who are thinking about whitening their teeth should understand that only natural enamel will whiten. This means that if you have had any type of restorative procedures done—such as tooth-colored fillings, bonding, crowns, or veneers on your teeth—those particular teeth will not whiten. Plus the restorations, which used to blend in very nicely with the previous shade of your teeth, will now appear much darker and distinct. This could result in additional dental work to fix the problem.

Basically, check with us before you decide which whitening product or system is right for you.

It’s here!  For years, Dr. Brodil and I have talked about how great it would be if, after completing a procedure, we could make the numbness disappear.  Well, we are now using a product that can indeed reverse the effects of a local anesthetic!

OraVerse^TM is now available at our office.  This is an agent that accelerates the return to normal sensation and function for patients who want to avoid the unwanted and unnecessary lingering soft tissue anesthesia (numbness) after routine dental procedures.  The anesthetic we typically use contains vasoconstrictors (epinephrine).  This part of the anesthetic produces prolonged loss of oral sensation and function. On average, it takes 3-5 hours to recover from soft tissue anesthesia, thus the hours of post-procedure numbness.  With the administration of OraVerse^TM, patients can return to normal sensation and function in about half that time.

There are no contraindications for OraVerse^TM. In nationwide comprehensive clinical trials OraVerse^TM was tested in patients able to receive routine dental restorative and periodontal maintenance procedures involving a local anesthetic with vasoconstrictor.  Tests, however, were not conducted with pregnant patients, so Dr. Brodil and I will refrain from using OraVerse^TM with pregnant women.  OraVerse^TM is not indicated for use in individuals less than 6 years of age or weighing less than 33 pounds.

We administer the OraVerse^TM in the same manner, at the same site as the original anesthetic.  The bonus is that the area is already numb, so no injection is felt.

Unfortunately, the cost of OraVerse^TM, as with many new medications when they come on the market, is still quite expensive; for this reason, we charge a modest fee for the use of OraVerse^TM for the time being. 

For many, I can imagine this product will make dental procedures, and the lingering effects, much more tolerable.  We often hear that it’s as much the numbness after the procedure as the procedure itself that is the most uncomfortable.  With OraVerse^TM, we hope to minimize or eliminate one of those aspects of a dental visit. 

Please ask any member of our team for more information about this wonderful advancement in dental pharmacology.

Bleeding gums, dry mouth, fungal infections, and new decay are oral signs which can alert your dentist to a possible serious health issue — diabetes. These are also symptoms that could suggest other serious conditions, such as leukemia and HIV.

Diabetes is one of the fastest growing health concerns in the United States. According to the Centers for Disease Control (CDC), one-third of children born after 2000 will be diagnosed with diabetes during his or her lifetime. Diabetes is also the one condition that can have a direct impact on infections in the bones and gums around the teeth.

Diabetes and your mouth have blood sugar in common. If blood sugar levels are out of control in your body because you are unaware that you have diabetes, the blood sugar levels in your mouth are also out of control. With sugar to feed on, bacteria find a receptive home in which to grow and thrive. The increased bacteria can then attack the protective enamel layer on your teeth. Over time, as the enamel breaks down, cavities develop which can be one of the dental signs of diabetes.

A person with uncontrolled diabetes has more mouth health issues to be concerned about. Uncontrolled diabetes reduces the body’s first line of defense against infection — white blood cells — which can then put a person’s oral health at risk. With bacteria teeming around the gums from high blood sugar levels, periodontal disease can develop more easily.

Because diabetes lowers a person’s resistance to infection, managing periodontal disease is not easy, but is extremely important. Your dental team should be one of your best allies if you are among the 20-plus million Americans living with diabetes.

Frequent professional oral care is important in preventing or controlling periodontal disease as well as diligent home care which requires flossing and brushing after every meal.

Your oral healthcare professionals are extremely important to your overall well-being especially if you are currently one of the more than 50-plus million Americans who is “pre-diabetic.”  Your dental providers can often detect oral signs and symptoms related to pre-diabetes before confirmation of the diagnosis by blood testing and a comprehensive physical examination.

Oral Health & Heart Disease

While follow-up research is ongoing and still to be completed, initial studies from the American Heart Association have linked poor oral health with increased chances of developing heart disease, even more so than the usual suspects such as elevated cholesterol and triglyceride levels. According to the American Academy of Periodontology, a group representing dental professionals who deal extensively with gum and bone health, it has been reported that of major oral diseases, pericoronitis, an infection in the gum tissue around a tooth, is the strongest predictor of coronary disease.

Further, according to the American Academy of Family Physicians, it is the bacteria in your mouth, or the inflammatory response to the bacteria, that may cause inflamation of the heart and more plaque buildup in the blood vessels. Although neither your dentist nor your doctor fully understands the connection between the mouth and the heart, that connection does mean that maintaining proper gum health is very important in helping to prevent possible systemic health issues.

Questions to Ask Your Dentist

Talk to your dentist while you are in the dental chair. When it comes to your health, this is a perfect opportunity to obtain answers to some important questions which could have significant impact on your overall health such as:

How do my oral health habits — how often I brush and — affect the rest of my body, not just my gums and teeth?

What are signs to watch out for in my mouth that might indicate a systemic illness or disease?

What do you need to know about my health history to evaluate my oral health?

Have you seen any warning signs of a possible serious condition that I should relay to my primary physician?

It is a statistical fact that a member of your dental team likely sees you more often than any other healthcare provider. Because of the frequency of your visits, your dentist is often in a better position to look for and detect any early signs of oral disease that may be connected to systemic health problems.

The connection between good oral health and whole body health is one of the most important reasons to maintain a routine of regular visits to your team of dental professionals. You’ll enjoy not only a healthier smile, but a healthier body as well!