Questions My Patients Ask

I seem to be asked the same questions repeatedly by patients so I thought it may be helpful to answer some of them on my blog for anyone else who have the same questions but may not have anyone to ask.

1.    What is the best toothpaste or toothbrush to use?

Well, the short answer is, whatever kind you will actually use! As far as toothpaste goes, any toothpaste that is approved by the ADA is a good choice. I personally prefer Colgate Total. The important thing about toothpaste is not to use too much on your toothbrush. If you read the instructions they tell you to use a pea sized amount, however on advertisements and commercials they show a large swipe of toothpaste on the brush. This is to get you to use too much so that you will buy more. It is an advertisement gimmick that works quite well because humans are visual. Even if you read the instructions, you are going to use the product as pictured on the box.  

Overuse of toothpaste

 The reasons that you should only use the pea sized amount is twofold. First, toothpaste is abrasive. If too much is used you can actually cause damage to your teeth. Second, If you use too much the cleansing effect is actually reduced because the toothpaste acts as a barrier to the bristles of the brush.

Abrasion caused by aggressive brushing or overuse of toothpaste.



This chart shows the different abrasiveness of several popular toothpastes.
If you already have abrasion issues, choose a toothpaste that is not very abrasive.



Toothbrush selection can be daunting. There are so many types. The important things to consider are the size of the head and the type of bristles. For manual brushes, you should always use a compact head with the softest bristles you can find. So brushes marked soft or sensitive are the best choice. Hard brushes with large heads are great for cleaning your bathroom, but have no business in your mouth. The firmer the bristles the less flexible they are and therefore the less effective they are at getting between the teeth, below the gum and into the tiny crevices on the tops of your teeth.



This toothbrush adapts really well into the spaces between the teeth,
you can see that if they were too stiff they would not be able to do this.

Toothbrush replacement should be based on individual wear rather than time.

2.    I have had a root canal on that tooth, how can I have a cavity now? Or, I have a crown on that tooth, how can I have a cavity?

This is a tough one because it seems that many people who have undergone a root canal or endodontic therapy have very little understanding of what that actually means. I have included a photo series that explains the process of a root canal.



In this case they are showing the tooth being restored with a filling,
in general root canal treated teeth are restored with a crown for strength.

Just because the nerve has been removed does not mean the tooth can no longer decay. Even if the tooth has a crown on it, a cavity can still occur at the margin of the crown.

Patients frequently assume that a tooth that has been crowned can no longer get decay. While it is true that the crown or bridge itself will not decay, the crown or bridge will not guarantee that the tooth will never get decay.





This shows how a crown is placed over a prepared tooth.
You can see how the margin of the crown is the area where the edge of the crown meets
the part of the tooth that is shaped like a step.

There is always a segment of exposed tooth between the margin of the crown or bridge and the point where the gum attaches to the tooth. It is in this zone that the tooth is susceptible to decay. The white arrow identifies a half moon shaped dark spot just under the edge of this crown. Decay removes minerals from the tooth allowing x-rays to show a dark spot in the area of decay

A second way to get decay on a crowned tooth is through marginal leakage. If your crown or bridge does not fit well, the margins of the crown or bridge are not properly adapted to the tooth. When margins are poorly adapted, the cement which seals your crown or bridge in place will wash out over time. This allows saliva and bacteria to leak in under your crown or bridge and initiate decay.
If the tooth becomes decayed, the decay may progress up into the portion of the tooth which is covered by the crown or bridge. This will not be visible to your dentist on X-Ray because the metal in your crown or bridge blocks the view of the X-Ray. X-Rays are still important if you have crowns or bridges so that your dentist can see if any decay is present near the margin (edge) of your crown or bridge.

3. I seem to have a lot of issues with my teeth, maybe I should have them all pulled and get dentures.

Ok, I know that is not a question, but it is a statement that I hear a lot! If any of your teeth can be saved, by all means save them! Everyone has a story of their relative or friend that has had dentures since they were 20 and they are 80 now and they love their dentures. The trouble is, I have never met that elusive relative/friend. Most people with dentures if being completely truthful with you would tell you that if someone had a magic wand that could give them their teeth back they would jump at the chance. What most people do not understand about dentures is that they are nothing more than a crutch. They do not really function very well for chewing. They are mostly for esthetics. Sure you can eat with them, and a well made set can work wonderfully. The trouble is that you will never eat the same again. When you switch from natural dentition to dentures your bite force is reduced to 10-20% of what it used to be. That is right, you lose 80-90% of your bite force. You also have to be careful of the size of the bites you take and you have to keep the food even in your mouth otherwise the denture will unseat. Most people get used to this over time and can actually adapt quite well and learn to eat relatively normally. There is also another issue that most people won’t tell you…dentures affect your sense of taste, because they cover your palate (the roof of your mouth). Not to mention, no matter what, you have a hunk of plastic in your mouth.



4. I am missing a few teeth, how can I replace them?

Well there are three ways to replace missing teeth. Implants, fixed partial dentures also known bridges, and removal partial dentures.

What is the difference?? Implants are actually used to replace single or multiple teeth without relying on surrounding remaining teeth for support. They are placed right into the bone. The picture makes it look like you can see the implant thru the tissue, this is not the way it actually looks in the mouth, the artist just wanted to show how far the implant goes.

Implants can also be used to support a denture. There are many ways that implants can be used to improve your esthetics as well as chewing function.

Fixed partial dentures replace missing teeth by being anchored to the adjacent teeth. This requires the adjacent teeth to be strong enough to support the bridge and they have to be prepared just like they would be for a crown. The challenge with fixed bridges is cleaning under them since they cannot be taken out. It is very important to keep them clean so that you do not get recurrent decay at the margins of the abutments. If you get a cavity on one of the teeth, the entire bridge must be cut off and replaced in order to fix it.

Removable partial dentures are similar to dentures because they are removable and they are made out of similar materials. Although they usually have a metal framework that the acrylic is attached to there are some types that have no metal and are flexible.

The teeth are replaced but rely on surrounding teeth that are strong enough to place clasps to hold the partial in. The largest complaint that I hear about partials is that when eating food gets trapped under them easily.

As always, if you have any questions or comments please share them!! Happy chewing!