Your gums are red around the margins and bleed whenever you brush or floss but there's minimal to no pain... You: (select the most appropriate answer[s])

1. are brushing or flossing too vigorously
2. have an accumulation of dental plaque where the teeth meet the gums
3. are using a toothbrush that's too firm
4. are experiencing early signs of gum disease
5. should see your dentist if this persists for more than 6 months

Kudos if you picked b) and d). The most common cause of bleeding gums is the accumulation of dental plaque (bacterial deposits) at the gum line, which is an early sign of periodontal (from the Latin “peri” – around, and the Greek “odont” – tooth) disease. It is usually painless so people tend to underestimate the risk of allowing gum disease to progress and become a more significant problem.

It's a common misconception that bleeding gums are caused by brushing or flossing too vigorously or using a toothbrush that's too firm. This is sometimes the case, but the abrasion would probably cause noticeable pain. Instead, it's likely that you're not brushing and flossing effectively enough, allowing bacterial deposits to accumulate at the gum line and feed on food particles that haven't been adequately flushed from your mouth.

The bacterial deposits form a whitish film that is hard to detect when you look in the mirror. But you will notice bleeding and redness and eventually inflammation of the gums — an immune response to disease-causing bacteria that flourish in the plaque. As the biofilm grows, with time it also hardens (calcifies), making it increasingly difficult to dislodge. Eventually, only professional cleaning can remove it and sometimes antibiotics are needed. If no action is taken, gum disease will progress, and eventually cause loss of the underlying bone that anchors the teeth.

There are other reasons that gums may bleed, such as elevated hormone levels in women, a side effect of certain medications, or a systemic (bodily) disease. Whatever the cause, it's important to get a professional diagnosis promptly and take appropriate therapeutic action as needed. Optimally, with good oral hygiene and regular checkups, you can avoid this problem entirely!

If you would like more information about preventing or treating bleeding gums, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bleeding Gums.”

What do burnt eggshells, crushed bones, brick dust and ox-hoof ashes have in common? Are they things you discovered in your kid's pocket? Ingredients in a witches brew? Funky organic compost materials?

It may be hard to believe — but they're all substances that were once used to make toothpaste, from ancient Egyptian concoctions through 18th century British blends. But don't worry: You won't find any broken crockery or ashes inside a modern tube! Today's toothpastes are scientifically formulated to be effective in removing plaque, which helps prevent tooth decay and gum disease (not to mention bad breath.) So what makes them work so well?

One class of ingredients found in all toothpastes is abrasives — also called cleaning and polishing agents. These slightly grainy substances make the mechanical action of brushing more effective. But unlike crushed bones, or the harsh, gritty particles of yore, today's abrasives are designed to remove stains and bacterial films without damaging tooth structure.

Next come detergents, which account for the foam you see when you brush vigorously. Detergents (sometimes called “surfactants”) help to break up and wash away materials that would otherwise be difficult to dissolve. An ingredient called sodium lauryl sulfate, which is also found in many shampoos, is probably the most common detergent used in toothpastes.

Fluoride, first included in toothpaste in 1914, is another common ingredient. In fact, all toothpastes that carry the seal of the American Dental Association contain it, typically in the form of sodium fluoride, stannous fluoride or sodium monofluorophosphate. It has been proven to make tooth enamel stronger and more resistant to decay.

In addition to these primary components, toothpastes generally contain flavorings to make them more palatable, and binders and preservatives to hold them together and keep them from drying out. Special-purpose toothpastes — like those designed to whiten teeth, prevent tartar, or help reduce sensitivity — have added ingredients.

But regardless of what's in your toothpaste, there's one thing you should remember: It's not the paste (or the brush) that keeps your teeth and gums healthy — it's the hand that holds it! Brushing once or twice a day, using a soft brush with the proper technique (and your favorite toothpaste!) is probably the most important thing you can do at home to enhance your overall oral health.

If you have questions about toothpastes or oral hygiene, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine article “Toothpaste — What's In It?”

Do your teeth stain easily? Are you worried that your new white fillings won't remain white for very long? Staining generally falls into one of two categories — extrinsic (external) staining, which affects the outside of the teeth, and intrinsic (internal) staining, which is discoloration of the tooth structure itself. The good news is that both can be treated and, once we determine the exact cause, there are a number of options to remedy it. You can have whiter teeth in almost no time!

External staining is generally caused by beverages or foods like red wine, tea, coffee and some spices, or even substances like tobacco. Stain that is brown, black or gray can become even worse in the presence of dental bacterial plaque and when the mouth is dry. On the other hand, internal tooth staining can make the teeth appear more yellow as a natural result of aging, or after root canal treatment when tooth structure can become more brittle and dry.

Treatment for external (extrinsic) staining includes:

• Lifestyle modification: You can help put a stop to your staining problem by reducing or eliminating the habits that cause it, such as smoking and drinking red wine.
• Practicing efficient oral hygiene: Preventing extrinsic staining can be as simple as brushing twice a day with toothpaste that contains tooth-whitening agents or other solutions to reduce the appearance of stains. Don't be embarrassed to ask our office about brushing and flossing because most people do it wrong until they're properly instructed.
• Professional Cleaning: We can remove some extrinsic staining with ultrasonic cleaning followed by polishing with an abrasive prophylactic paste.

Other treatment options to reverse either intrinsic or extrinsic staining include:

• Whitening by bleaching: Bleaching for extrinsic stains can be performed either in our office or at your home using a whitening kit. Bleaching for internal (intrinsic) stains can only be conducted in our dental office because it typically involves bleaching the tooth or teeth from the inside.
• Fillings and restorations: For teeth that have been stained due to decay, or for fillings that are old and discolored we can remove the decay and restore the teeth, which will restore them to their natural brighter color.

If you are ready to say goodbye to your stained teeth, call our office today to make an appointment. For more information about treating stained teeth, read the Dear Doctor magazine article “Tooth Staining: Getting To The Cause Of Tooth Discoloration Is The First Step Toward Successful Treatment.”

Do you clench your jaw or grind your teeth? Bite your nails? Chew on pencils or toothpicks? Or, heaven forbid, unscrew hard-to-open bottle caps using your precious pearly whites?

Over time, habits such as these — referred to in dentistry as “parafunctional” (para – outside; functional – normal) or beyond the range of what nature intended — can inflict excessive wear and tear on your teeth. Besides the impact damaged teeth can have on your smile, so called “tooth to tooth” and “tooth to foreign object” behaviors can cause physical problems, such as jaw joint and muscle pain, headaches, earaches, and even neck and back pain.

Use of Excessive Force

Parafunctional behaviors exert an abnormal amount of force on your teeth — up to 10 times the amount used for biting and chewing. Tooth grinding or “bruxism” (from the Greek word brykein – “gnash the teeth”) is particularly detrimental and is commonly seen in individuals who are experiencing a stressful time in their life. Some medications can also trigger it. Since bruxism often occurs while people sleep, it's possible to be unaware of it unless a partner comments (it can be noisy!) or a dental professional points out the tell-tale signs of wear.

To counter the adverse effects of nocturnal tooth grinding our office can create a customized night or occlusal (bite) guard. Typically fashioned from a hard, clear “processed acrylic” (wear-resistant plastic), this type of guard is amazingly inconspicuous. It is made to fit over the biting surfaces of the upper teeth only and is thinner than a dime. When it is worn, the lower teeth easily glide over the upper teeth rather than chomping into and gnashing with them, which minimizes the likelihood of erosion, chipping and uneven or excessive wear of the biting surface of the teeth. The guard is so unobtrusive, that some people even wear it as they go about their daily activities.

Remember: In addition to proper dental hygiene, you can help keep your teeth healthy by using them wisely!

If you would like more information about parafunctional habits like bruxism and ways to protect your teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Stress & Tooth Habits” and “How And Why Teeth Wear.”

Your teeth are under constant attack from bacteria that normally live in your mouth. When these bacteria thrive, they create acid that begins to dissolve the minerals in your enamel (the outer layer of your teeth). In your defense, your saliva protects against these bacteria and adds minerals back to your enamel. Let's take a look at this ongoing battle, and what you can do to sway it in a positive direction.

The outer covering of your teeth, the enamel, is made mainly of the minerals calcium and phosphate. The enamel protects the interior layer of your teeth, the dentin, which is similar in composition to bone. Although it is the hardest substance in your body, the enamel is still vulnerable to attack.

Your mouth is normally full of saliva, which washes over your teeth and maintains a balance between acids and bases. The terms “acids” and “bases” refer to a scientific measurement, the pH scale. Your mouth's pH is usually in the middle of the scale — neither acidic nor basic, but neutral. This is important in controlling the bacteria in your mouth.

You may be surprised to know how many bacteria live in everyoneâ??s mouth. More bacteria live in a single mouth than the number of people who have ever lived on earth. Some of these bacteria can cause tooth decay. Let's call them “bad bacteria.”

When the bad bacteria attach themselves to dental plaque — a film that builds up on your teeth every day — they begin to consume sugars that are in your mouth from foods that you have eaten. As the bacteria break down these sugars and turn them into energy, acid is produced as a by-product. This turns the saliva from neutral to acidic.

At a certain level of acidity, minerals in your enamel start to dissolve. This is called “de-mineralization.” It means that more calcium and phosphate are leaving the tooth's surface than are entering it. Early de-mineralization of the enamel shows up as white spots on a tooth.

Fortunately, healthy saliva can return calcium and phosphate to the enamel, or re-mineralize it. De-mineralization and opposing re-mineralization are constantly battling in your mouth. However, if too much enamel is de-mineralized, bacterial acid can go on to attack the next layer of your teeth, the dentin. As this process continues, you develop a dental cavity.

How can you protect your teeth? The first level of defense is regular removal of plaque, so that the bad bacteria do not get a foothold. In an office visit we may also recommend products such as sealants, antibacterial agents, topical fluoride, calcium and phosphate supplements, pH neutralizers, special toothpaste and rinses, which may help your particular situation.

Contact us today to schedule an appointment to discuss your questions about tooth decay. You can learn more by reading the Dear Doctor magazine article “Tooth Decay — The World's Oldest & Widespread Disease.”