Question for all you Dental gurus out there...

[DrQuinn]

I know that SDN is not the place for true medical/dental advice, but I thought what the hey, it gets asked all the time on the medical forums (and I got great advice about the OTC whiteners here)...

So I saw my dentist (finally) this past week... but he spent most of the time tryign to convince me to get veneers (sp)... and spent little time on preventive care (which is what I was more worried about)...

Anyways, I got my cleaning today and the dental hygenist did most of the talkign (didn't see the dentist). I asked her questions about what i can do... but I realize her level of education isn't anywhere near a dentist's...

So I'm just wondering your opinions on the OTC Listerine Tartar control mouthwash. Appears I had some mild tartar behind some of my teeth...
A) Does it work?
B) How often shoudl I use it? She said I shouldn't use Listerine every day, just twice or three times a week, as apparently (I will quote) "The alcohol is caustic." Well, so is the Maker's Mark that i drink every once in a while (80 proof) but never heard anything about that.

Thanks for your opinions (and not advice! Legal disclaimer there). If you have any questions about vaginal bleeding or cardiac emergencies, let me know. 🙂

Q, DO

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[ShawnOne]

I'm not a guru (yet), but I posted a thread in the Lounge about the alcohol issue a little while back. On NBC news there was a story stating alcohol is directly linked to periodontal disease. Supposidly, research shows that alcohol kills certain defense/immunity cells in the gums. Actually, it has been a known fact that alcoholics have a higher occurance of gum disease.

Hope this helps.

 

[DrQuinn]

I see it all the time in the Emergency Department... lots of alcoholics (who we know on a first name basis) that are horrible dentition. I'm sure part of it has to do with the ethanol itself but I'm sure most of it is just poor dental hygiene (poor hygiene in general)...

I was just asking about the use of Listerine for tartar control...

Q, DO

 

[UBTom]

I'm almost a dental guru... After May next year I will be a full-fledged licensed-to-practice dental guru (hopefully). 😀

Tartar, otherwise known as calculus to dentists, is calcified plaque.

Plaque starts out as a soft gooey stuff that sticks to teeth. It is a biofilm of bacteria and debris that is found in the mouth. It turns to calculus when the calcium in your saliva precipitates, hardening the plaque into a crusty hard layer on your teeth.

Unfortunately, most people do get calculus behind the lower incisors because the ducts from your sublingual salivary glands empty into your mouth right behind those teeth.

The best way to prevent calculus from forming is to disrupt the plaque while it is still soft. How? By assiduous brushing and flossing!

Brush after every meal. Most importantly, brush before going to bed. And try to floss once a day by developing a subconscious habit to do so. I developed a habit of flossing while relaxing doing stuff like watching TV, right after eating dinner and brushing my teeth-- Productive use of downtime. 😎

Listerine antitartar mouthrinse: It is useful for decreasing the bacterial count in your mouth so plaque does not form as fast, but don't count on it alone to control tartar. And yes, you can develop alcohol burns on the inside of your cheeks and lips if mouthwash is too strong/overused. Remember that when you are doing shots, you usually just toss the alcohol down. Mouthwash you hold in your mouth, and the much longer exposure time can indeed do things to your oral mucosa.

HTH!

 

[DrQuinn]

Thanks for the advice...

How often should one us the OTC mouthwashes?

Your illustration makes a lot of sense (thanks)... is there a difference then in the formulations of the "anti-tartar" mouthwashes versus the "anti-plaque" ones? I read the back of them, and they do indeed have different approvals from the ADA...

Q, DO

 

[UBTom]

Yep, antiplaque mouthwash act through their antiseptic germ-killing effect (which was what the original Listerine does). Antitartar formulations on the other hand has pyrophosphates which is supposed to inhibit crystal growth from the calcium precipitating out of your saliva, but there is a lot of pyrophosphatases in the mouth so that stuff doesn't work for very long-- Which is why the most effective method of tartar prevention is still frequent brushing and flossing.

Use the mouthwash as often as you like, as long as you don't cause mucosal burns. 😀

HTH!

 

[CraigWVU]

I should add on here, if you want the maximum effect from brushing, try brushing with toothpaste that contains triclosan. Most toothpastes are simply fluoride, and in the past, toothbrushes were simply fluoride distributors!!! Now with Triclosan it has an antibacterial property which in clinical trials, has decreased the bug that causes tooth problems "strep mutans" Colgate total is a great toothpaste.

Another good thing to add is get rid of all sugar gum, that stuff is strep mutans cash flow. If you like it start chewing orbit gum. It contains xylitol and that inhibits strep mutans krebs cycle. This will keep the numbers down low in the oral cavity, thus leading to fewer problems.

Just another opinion on flossing, yes it is good to floss everyday but don't get addicted to it. You can over floss!!!! This is a very big problem in the dental area. So UBTOM, don't get addicted!!!!!!!!!! One of my friends had that problem and when he graduated from dental school, his teeth under the proximal contacts showed lots of wear on them, looked like a slight perio problem!!!

I wouldn't go with the veneers or facings unless you have some major problems. Many dentists try to get everyone to get these things just cause its lots of money in their pockets, not for patient benefit. Bleaching trays from your dentist should help if your concerned about your teeth being yellow tinted.

 

[DrQuinn]

Craig-

Thanks for the advice... I really appreciate it. I dont' really have any major problems with my smile... I just have one tooth that is "bent" back a teeny bit, so my smile isn't 100% perfect. I am willing to wait until I am an attending making 8x what i am making now as a resident before I committ to anything to get it fixed. I plan on asking for bleaching options on my next visit.

Q, DO

 

[no2thdk999]

quid:

UBTom is right on with the origin of tartar formation. The secret is to get the "stuff" off of your teeth before it goes from plaque to tartar. It's even better to get it before it goes from bacteria to plaque. It takes about 12 hours for the sticky biofilm to form on enamel so in theory if you meticulously clean your teeth twice a day, that will be enough. Meticulous is the key word and it wouldn't kill most people to brush 3 times/day. I would argue that it's not a good idea to brush right after meals.

The next time you visit your dentist or hygienist, ask him/her to show you how they clean their teeth. A few tips would be to start your brushing routine by "dry" brushing the lingual of the lower anteriors. This is the place where most people get the most accretions and this extra effort will help minimize it. Then instead of "brushing your teeth" try to "brush each tooth". An electric toothbrush like a Sonicare makes this easier but it's possible with a manual toothbrush.

More people are more faithful to their diet than flossing but it really is equally as important as brushing. Proper technique will not result in any damage. Nobody wants to stand in front of the mirror for 5 minutes making those contorted faces flossers do. My tip is to leave floss by the tv, phone, in front of the computer, wherever you might spend a few minutess. Do a couple teeth at a time, there's no rule you have to get them all at once.

As for Listerine Tartar Control mouthrinse, if you do the above, it's kinda like a belt AND suspenders. It probably won't hurt anything but isn't really necessary if you have great oral hygiene. The study about alcohol and periodontal disease mentioned above was based on consumption of alcohol. Unless you are swallowing similar quantities of listerine daily, a 30 second rinse and spit won't yield the same results. You could use it everyday if you like, but like it's been said it's not critical for oral health. I brush twice, floss once, and sometimes use a fluoride rinse, but don't tell NYSCOF.



quo:

My friend an orthopod said as soon as you know you're having a baby today, it's ok to get the epidural, and the wait to be however many cm dilated is more for the convenience of the staff. His wife got the epidural early on and made the comment that "she rather enjoyed labor". Any comments?


Bob

 

[DrQuinn]

Thanks for the great advice!

In regard to the convenience of the staff part, I am not sure where he was thinking then. Some women will dilate to 10 cm in 2 hours, some 2 days. As long as the delivery looks like it is progressing "like normal" its ok to give the epidural. It will also keep the mother comfortable which is of course a major priority as well.

Sometimes if a woman just isn't dilating quickly or looks like she's stuck at 2cm, we'll go ahead and induce... 'member the longer a woman stays with her water broken and hasn't delivered, the likelier an infection and other complications can set in.

Q, DO

 

[Meggs]

Originally posted by QuinnNSU
......... but he spent most of the time tryign to convince me to get veneers (sp)... and spent little time on preventive care (which is what I was more worried about)...

Anyways, I got my cleaning today and the dental hygenist did most of the talkign (didn't see the dentist). I asked her questions about what i can do... but I realize her level of education isn't anywhere near a dentist's...

You do know veneers will need to be replaced every few years, right?

I wouldn't minimize hygenists. I know education is important, but so is experience. They talk based on what they do every single day, cleaning calculus away, seeing all kinds of dirty mouths, etc. They are the ones that notice how much is a patients oral health's improved after following the recommended procedures in oral hygiene. Today most dentists aren't seeing that anymore, I guess that's what hygienist are for...... 😀

btw, alcohol in mouthwashes has been related to oral cancer.

 

[UBTom]

to no2thdk999:

Brushing every 12 hours theoretically should be enough, but it's only a theory.

Gotta remember that physiology varies slightly from person to person. Mouth-breathers for example WILL have faster calculus formation because the calcium will precipitate out of their saliva faster. Xerostomics or even normal people with slightly less serous composition as their baseline will form plaque faster because of their saliva's more mucous consistency and faster pellicle formation rate. For that reason I recommend to all my patients that brushing 3x a day might be a good idea.

Also, people tend to get up pretty durn early (I'm not a morning person yet I'm forced to get up 6:30AM so I can get to class by 7:30) and go to bed pretty late (11PM, 12PM or even 1AM). More than 12 hours would have elapsed between the morning brushing and bedtime brushing. For this reason brushing after meals is a good way to ensure you are disrupting plaque in a timely fashion.

Another argument FOR brushing after meals-- No sense leaving all sorts of nice bacterial culture medium (i.e. food debris) in your mouth after each meal. And you will be kind to those you have to interact with... Especially if your meal included some heavy helpings of onion, garlic or kimchee. 😀

I agree with you that proper technique is important though. If one calls 3 seconds of scrubbing the labial surfaces "brushing teeth," of course he/she will have lots of oral health problems even if that is done 3x a day.

And yes, improper flossing will cause injury... Best ask a dentist to show one the proper technique. Once one gets the technique down, flossing can be done quickly, easily and safely without having to stand in front of the mirror for a long time contorting faces.

Just my (3/4) professional opinion.. 😉

 

[groundhog]

I've posted this before in more detail. I'll make this version short. Took the advise of my RDH and added one step to my daily oral hygiene routine. It did wonders (significant pocket reductions). In addition to brushing with sonic care and flossing, I now use a Waterpik that has been jucied up by adding a cap full of Listerene to the water resevoir. Try it...you'll like it.

 

[no2thdk999]

UBTom your thinking is clear and I will not argue with your reasoning but here is mine.

People are lazy. If I told every patient they must start brushing 3x a day their compliance would be very, very low. If I can educate/motivate them to use the time they're already spending 2x a day to be meticulous their compliance will be low, but better than carting a toothbrush with them to work/school.

Brushing right after a meal is the worst time to brush. All the bacteria is feasting on the sugar, making it's lovely acidic by products, lowering the mouth's pH, demineralizing enamel, and making it more susceptible to abrasion. The well meaning patient comes in and really scrubs their teeth clean, abrading (however slightly) the tooth when it's at its weakest. I see the extreme of this frequently in the 20 yo health nut who drinks juice all day and knows it's bad for his/her teeth so they brush right afterwards. They will present with no decay but erosion of the facials of lower pre's and canines usually, maybe with some dentinal sensitivity.

For my money, a better course of action is to chew sugar free gum for at least 20-30 minutes after eating any snack. This will help loosen sticky food debris and increase salivation. The extra spit will help buffer the pH and keep the enamel from demineralizing.

 

[ItsGavinC]

Rob,

Good to see you back. Check your PMs, I sent you a message earlier today!

 

[UBTom]

no2thdk999,

You do have a point about compliance, and I happen to agree 100% on the sugarless gum-- You will never see me go anywhere without one of those bulk 20-packs of Trident. 😀

Still, I think it's worth the effort to try to educate my patients to brush more than 2x a day. If I can get them to do that on top of the meticulous techniques (which I also agree with), you get a synergistic effect. Each on its own are effective, but the effectiveness triples or quadruples with both. And since I'm not going to make every one of my patients undergo sialography to see if they get plaque faster than 12 hours, I think I'd take the safer route and insist them brush more than 2x a day if they can. It can't hurt to try!

As far as that patient of yours getting abrasion, here's something else you need to do, because their problem is NOT only abrasion-- You should try to get them to modify their diet to avoid the chemical erosion, which is the true etiology of your patient's problem. OJ is good, but you don't want to drink that stuff all day; even without brushing after meals you can still get citric-acid mediated erosion if you drink juice all day.

Where else do you see chemical erosion? People who suck on lemon slices, in anorexics and bulimics and (to a lesser extent) those suffering frequent acid reflux (GERD). I use this illustration on the potency of chemical erosion to try to educate my patients to change from frequent juice intake to bottled water. As is true with everything else, OJ in moderation is good, but too much of a good thing can actually be bad. If a person on a normal diet brushes teeth after each meal (with the proper technique of course) I'm willing to bet you won't find much evidence of abrasion.

Anyhoo, I think we covered all the bases. Pleasure having this discussion with a fellow professional. (well, soon-to-be, anyway LOL)..