Friday, March 11, 2011

Mouthwash

Mouthwash


Mouthwash or mouth rinse is a product used to enhance oral hygiene. Antisepticand anti-plaque mouth rinse claim to kill the bacterial plaque causing caries, gingivitis, and bad breath. Anti-cavity mouth rinse uses fluoride to protect against tooth decay. But, it is generally agreed that the use of mouthwash does not eliminate the need for both brushing and flossing. As per the American Dental Association, regular brushing and proper flossing are enough in most cases (In addition to regular dental check-ups).Mouth washes may also be used to help remove mucus and food particles deeper down in the throat. Alcoholic and strong flavored mouth washes may cause coughing when used for this purpose.
Listerine, an American brand of mouthwash

History

The first known reference to mouth rinsing is in the Chinese medicine, about 2700 BC, for treatment of gingivitis. Later, in theGreek and Roman periods, mouthrinsing following mechanical cleansing became common among the upper classes, and Hippocratesrecommended a mixture of salt, alum, and vinegar. The Jewish Talmud, dating back about 1800 years, suggests a cure for gum ailments containing "dough water" and olive oil.Anton van Leeuwenhoek, the famous 17th century microscopist, discovered living organisms (living, because they were motile) in deposits on the teeth (what we now call dental plaque). He also found organisms in water from the canal next to his home in Delft. He experimented with samples by adding vinegar or brandy and found that this resulted in the immediate immobilization or killing of the organisms suspended in water. Next he tried rinsing the mouth of himself and somebody else with a rather foul mouthwash containing vinegar or brandy and found that living organisms remained in the dental plaque. He concluded—correctly—that the mouthwash either did not reach, or was not present long enough, to kill the plaque organisms.That remained the state of affairs until the late 1960s when Harald Loe (at the time a professor at the Royal Dental College in Aarhus, Denmark) demonstrated that a chlorhexidine compound could prevent the build-up of dental plaque. The reason for chlorhexidine effectiveness is that it strongly adheres to surfaces in the mouth and thus remains present in effective concentrations for many hours.Since then commercial interest in mouthwashes has been intense and several newer products claim effectiveness in reducing the build-up in dental plaque and the associated severity of gingivitis (inflammation of the gums), in addition to fighting bad breath. Many of these solutions aim to control the Volatile Sulfur Compound (VSC)-creating anaerobic bacteria that live in the mouth and excrete substances that lead to bad breath and unpleasant mouth taste.

Usage

Common use involves rinsing the mouth with about 20ml (2/3 fl oz) of mouthwash two times a day after brushing. The wash is typically swished or gargled for about half a minute and then spat out. In some brands, the expectorate is stained, so that one can see the bacteria and debris. It is probably advisable to use mouthwash at least an hour after brushing with toothpaste when the toothpaste contains sodium lauryl sulfate, since the anionic compounds in the SLS toothpaste can deactivate cationic agents present in the mouthrinse. When using mouthwash just remember the 4 S's "swig", "swish", "spit" and "smile".


Active ingredients

OTC mouthwash containing chlorhexidine fromMexico.Active ingredients in commercial brands of mouthwash can include thymol, eucalyptol, hexetidine, methyl salicylate,menthol, chlorhexidine gluconate, benzalkonium chloride, cetylpyridinium chloride, methylparaben, hydrogen peroxide, domiphen bromide and sometimes fluoride, enzymes and calcium. Ingredients also include water, sweeteners such as sorbitol, sucralose, sodium saccharine, and xylitol (which doubles as a bacterial inhibitor).Sometimes a significant amount of alcohol (up to 27% vol) is added, as a carrier for the flavor, to provide "bite", and to contribute an antibacterial effect. Because of the alcohol content, it is possible to fail a breathalyzer test after rinsing; in addition, alcohol is a drying agent and may worsen chronic bad breath. Furthermore, it is possible for alcoholics to abuse mouthwash Recently, some assumptions were made of a possible carcinogenic character of alcohol used in mouthrinses, but no clear evidence was found. Commercial mouthwashes usually contain a preservative such as sodium benzoate to preserve freshness once the container has been opened. Many newer brands are alcohol-free and contain odor-elimination agents such as oxidizers, as well as odor-preventing agents such aszinc ion to keep future bad breath from developing.
OTC mouthwash containing chlorhexidine fromMexico.


Alternative Mouthwash Ingredients

A salt mouthwash is a home treatment for mouth infections and/or injuries, or post extraction, and is made by dissolving a teaspoon of salt in a cup of warm water. However, such mouthwashes have no effect in killing germs.Recently, the use of herbal mouthwashes such as persica is increasing, due to the perceived discoloration effects and unpleasant taste of Chlorhexidine. Research has also indicated that sesame and sunflower oils as cheap alternatives compared to chlorhexidine.Other products like hydrogen peroxide have been tried out as stand-alone and in combination with chlorhexidine, due to some inconsistent results regarding its usefulness.Another study has demonstrated that daily use of an alum-containing mouthrinse was safe and produced a significant effect on plaque that supplemented the benefits of daily toothbrushing.However, many studies acknowledge that Chlorhexidine remains the most effective mouthwash when used on an already clean tooth surface or immeadiately after surgery. As chlorhexidine has difficulty in penetrating plaque biofilm, other mouthwashes may be more effective where pre-existing plaque is present.

Health Risks


In January 2009 a report published in the Dental Journal of Australia concluded there is "sufficient evidence" that "alcohol-containing mouthwashes contribute to the increased risk of development of oral cancer". However, this claim has been disputed by Yinka Ebo ofCancer Research UK, concluding that "there is still not enough evidence to suggest that using mouthwash that contains alcohol will increase the risk of mouth cancer"


List of mouthwash brands
  • Astring-O-Sol
  • Scope (mouthwash)
  • Dentyl pH
  • Sarakan
  • Oral-B
  • Colgate
  • Corsodyl
  • Listerine

Electric Toothbrush

Electric toothbrush

Electric toothbrush, made by Braun.
An electric toothbrush is a toothbrush that uses electric power to move the brush head, normally in an oscillating pattern, though electric toothbrushes are sometimes called 'rotary' toothbrushes.


History


Dr. Scott's 'electric' toothbrush

In the late 1800s in the USA, a man named Dr. George A. Scott claimed to invent an "electric" toothbrush. However, unlike actual electronically-powered bristle brushes, Dr. Scott's brush did not move on its own, and was not actually electrical at all. Like Dr. Scott's other "electric brush" products, the device merely contained a magnet in the handle. The magnetic field was claimed to provide health benefits.

Evolution of the modern toothbrush

The first successful electric toothbrush, the Broxodent, was conceived in Switzerland in 1954 by Dr. Philippe-Guy Woog. Woog's electric toothbrushes were originally manufactured in Switzerland (later in France) for Broxo S.A. The first clinical study showing its superiority over manual brushing was published by Pr. Arthur Jean Held in Geneva in 1956. Electric toothbrushes were initially created for patients with limited motor skills, as well as orthodontic patients (such as those with braces). Claims have been made that these are more effective than manual toothbrushes, as it leaves less room for patients to brush incorrectly.
The Broxo Electric Toothbrush was introduced in the USA by E. R. Squibb and Sons Pharmaceuticals at the centennial of the American Dental Association in 1959. After introduction, it was marketed in the USA by Squibb under the names Broxo-Dent or Broxodent. In the 1980s, Squibb transferred distribution of the Broxodent line to the Somerset Labs division of Bristol Myers/Squibb.
While the Broxodent may have been the first electric toothbrush and a superior product, the electric toothbrush that caught the public's attention in USA was the General Electric Automatic Toothbrush introduced in the early 1960s. Similar to the Broxodent in function, it differed in one major aspect: the cordless hand piece relied on rechargeable NiCad batteries for power, while the Broxodent hand piece was designed to plug into a standard wall outlet and run on AC line voltage. Broxodent USA models were designed for 110v 60Hz AC power; other models were available for European power standards.
This difference in power source was significant for several reasons. In the case of the GE unit, the hand piece was portable but it was also rather bulky - about the size of a two D-cell flashlight handle. NiCad batteries of this period left much to be desired: they suffered from memory and lazy battery effects. The GE Automatic Toothbrush came with a charging stand which held the hand piece upright - most units spent their life sitting in the charger which is not the best way to get maximum service life from a NiCad battery. Early NiCad batteries did not hold much power (not as much power as a comparable alkaline batteries, for example) and it was not uncommon for the GE Automatic toothbrush to run out of power before tooth brushing was complete - particularly if several members of the family used the same hand piece within a short time space. Finally, early NiCad batteries tended to have a short lifespan. The batteries were sealed inside the GE hand piece and the whole unit was frequently discarded when the batteries failed. The GE Automatic Toothbrush was less expensive than the Broxodent which may have contributed to its disposable characteristic. Despite the shortcomings of the GE Automatic Toothbrush, the public was hooked on electric toothbrushing.
In contrast, the Broxodent hand piece was slim and remarkably compact - even by today's standards. Since it was powered by AC line voltage, it never grew tired or slowed down, although it could grow warm after extended use. Early Broxodent models came with a straight power cord - later units with a coiled cord. All Broxodent cords had a small molded strain relief where the cord entered the hand piece, but this was still the likely place for a cord to fail. Since the Broxodent hand pieces were sealed, a cord failure was not repairable and the expensive hand piece had to be discarded. That said, it was not unusual for a Broxodent hand piece to last for 20 years or longer and failures were rare.
The use of an AC line voltage appliance in a bathroom environment was problematic. By the early 1990s, Underwriter Laboratories (UL) and Canadian Standards Association (CSA) would no longer certify line-voltage appliances for bathroom use. Newer appliances had to use a step-down transformer at the wall to transmit lower voltage to the hand-held unit (typically 12, 16 or 24 volts) - modern hair blowers frequently use this approach. Many such appliances also include a Ground Fault Circuit Interrupter in the step-down transformer for added protection against electrical shock. Wiring standards in many countries now require that outlets in bath areas must be protected by a GFCI device (required in USA since 1970's on bathroom outlets in new construction).
By the decade of the 1990s, Broxo's original design was still functional, but problems with safety certification could not be ignored. Further, improved low-voltage design toothbrushes were providing formidable competition. Broxo S. A. still produces and markets a low-voltage model but its public visibility in the USA has been limited in the face of large competitors, such as Philips Sonicare and Braun Oral-B models. Later Broxo models had no major distributor (such as Squibb) in the USA and have only been selling online.
The Broxo low-voltage models used one of several different methods to attach brushes to the hand piece. However, the brushes for low-voltage models would not fit the original line-voltage Broxodent. Brushes were not even interchangeable among various Broxo low-voltage models. By the 1990s, replacement brushes for line-voltage Broxodent models were no longer being sold in the USA (they were available in Europe) so the original Broxodent Electric Toothbrush was rapidly approaching the end of its product life. But this innovative product started a trend and enjoyed 30+ years of product leadership.


Effectiveness

Independent research finds that most electric toothbrushes are no more effective than the manual variety . The exception is the "rotation-oscillation"-models, including many of the electrical brushes in Braun's Oral B-series, but even this brush performs only marginally better than a regular manual brush. The research done indicates that the way the brushing is performed is of a higher importance than the choice of brush. For certain patients with limited manual dexterity or where difficulty exists in reaching rear teeth, however, dentists strongly feel that electric toothbrushes can be especially beneficial . Of course, built into any conclusion in this area is the assumption that persons using a manual toothbrush will, in fact, brush their teeth in an approved manner and for a suitably long period.


Key Functions


Type of motion

Three main mechanics in how the toothbrush head works in electric toothbrushes are vibrating, oscillating, and sonic. Most studies have focused upon the vibrating and oscillating heads, but not the sonic type.

Power source and charging

Modern electric toothbrushes run on low voltage - typically 12v or less. A few units still use a step-down transformer to power the handpiece, but most use power from a rechargeable battery in the hand piece. The electronic compartments in most of the electric toothbrushes are completely sealed to prevent water damage. While early NiCad battery toothbrushes used metal tabs to connect with the charging base, modern toothbrushes charge using a technique called inductive charging. In the brush unit is one half of a transformer, and in the charge-unit is the other part of the transformer. When brought together, a varying magnetic field in one coil induces a current in the other coil, thereby allowing for the charging of a battery. There are no exposed contacts and the handpiece can be completely sealed.
Other electric toothbrushes use replaceable batteries, disposable or rechargeable, storing them in the bottom, generally thicker than a normal toothbrush.

Timer function

Many modern electric toothbrushes have a timer for two minutes - the user is alerted via extra buzzing, noise or a brief power interruption. Quality models may have an incremental timer that buzzes four times or every thirty seconds up to two minutes. Dentists consider the incremental timer to be a key function. The benefit of the timer function is to encourage brushing to last two minutes - the incremental timer alerts the user to brush each quarter of the mouth for a consistent clean in all areas of the mouth. The timer function is also important because brushing too quickly is a significant cause of inadequate oral hygiene. A new release in 2008 was the Smart Guide by Braun Oral-B which provides individuals with a guide to proper brushing via a wireless display.

Visual Stimuli

Some electric toothbrushes use LCD screens, which, in addition to showing how many minutes you've brushed (or the optimal amount of time, usually 2 minutes or more) show smiley faces or other images to encourage optimal brushing. There is minimal evidence to suggest such features add any value. Likewise, there is little evidence to support that such features only serve as gimmicks for the purpose of selling better.

This post is taken from http://nycteeth.blogspot.com/2009/08/electric-toothbrush.html

Miswak

Miswak


The miswak (miswaak, siwak) is a teeth cleaning twig made from a twig of the Salvadora persica tree, also known as the arak tree or the peelu tree.

History

The miswak is predominant in Muslim areas but its use predates the inception of Islam. Its use has spread from the Middle East to South and South East Asia, where it is known as 'Kayu Sugi' (Malay for 'chewing stick'). It is often mentioned that the Islamic prophet, Muhammad, recommended its use.

Scientific studies

A 2003 scientific study comparing the use of miswak with ordinary toothbrushes concluded that the results clearly were in favor of the users who had been using the miswaak, provided they had been given proper instruction in how to brush using it. The World Health Organization (WHO) recommended the use of the miswaak in 1986 and in 2000 an international consensus report on oral hygiene concluded that further research was needed to document the effect of the miswak.
Recent research by Dr Otaybi from Saudi Arabia opened a new area for research on the systemic effects of Miswak (Sewak) after discovering its great positive effect on the immune system. Dr. Rami Mohammed Diabi who spent more than 17 years researching on Miswak effects on health and especially its anti-addiction effects on smokers (curative and preventive sides) had opened a great field of science and researches by his last research: "Miswak Medicine theory" or Sewak Puncture medicine which led him to what is so called Beyond Sewak: World of Science and Research. Miswak also is contributing in the fight against desertification, thereby affecting our environment and global climate.

"Miswak extract" compared to other oral disinfectants

Studies indicate that Salvadora persica extract is somewhat comparable to other oral disinfectants and anti-plaque agents like Triclosan and Chlorhexidine Gluconate if used at a very high concentration.

Religious perscriptions

Although not mentioned in the Qur'an, use of the miswak is frequently advocated in the hadith (the traditions relating to the life of Muhammad). Situations where the miswak is recommended to be used include, before religious practice, before entering one's house, before and after going on a journey, on Fridays, before sleeping and after waking up, when experiencing hunger or thirst and before entering any good gathering.
In addition to strengthening the gums, preventing tooth decay and eliminating toothaches, the miswak is also said to halt further increase in decay that has already set in. Furthermore, it is claimed to create a fragrance in the mouth, eliminate bad breath, improve the sense of taste and cause the teeth to glow and shine.
Supposed benefits not related to the teeth and gums include sharpening memory, curing headaches, creating a glow on the face of the one who continually uses it, strengthening the eyesight, assisting in digestion and clearing the voice. None of these claims, however, have been researched scientifically.

Examples of hadith concerning the miswak

From Sahih al-Bukhari:

Narrated Abu Hurairah:
The Prophet said, "If somebody eats or drinks forgetfully then he should complete his fast, for what he has eaten or drunk, has been given to him by God." Narrated 'Amir bin Rabi'a, "I saw the Prophet cleaning his teeth with Siwak while he was fasting so many times as I can't count." And narrated Abu Huraira, "The Prophet said, 'But for my fear that it would be hard for my followers, I would have ordered them to clean their teeth with Siwak on every performance of ablution." The same is narrated by Jabir and Zaid bin Khalid from the Prophet who did not differentiate between a fasting and a nonfasting person in this respect (using Siwak).
Aisha said, "The Prophet said, "It (i.e. Siwak) is a purification for the mouth and it is a way of seeking God's pleasures." Ata' and Qatada said, "There is no harm in swallowing the resultant saliva."
Narrated Abu Burda: My father said, "I came to the Prophet and saw him carrying a Siwak in his hand and cleansing his teeth, saying, 'U' U'," as if he was retching while the Siwak was in his mouth."
From Sahih Muslim
'Abd al-Rahman son of Abu Sa`id al-Khudri reported on the authority of his father that the Messenger of God said: Bathing on Friday for every adult, using of Miswak and applying some perfume, that is available-these are essential. So far as the perfume is concerned, it may be that used by a lady.

 

Maintenance

A miswak should be one hand span in length when selected. If it becomes dry, it should be soaked in rose water to ensure the end is soft. The end should be cut afresh to ensure hygiene, and should never be stored near a toilet or sink. It can be used by cutting the branches instead of roots (like people of Sudan) keeping in mind that the roots can keep the humidity of miswak more than the branches (longer time usage). There are also toothpaste made from Miswak extract which can be found in the Middle East, South Asia, South East Asia and Europe.

Tooth Whitening

Tooth whitening


Tooth Whitener for Home Use (Brush for Application)
Dental bleaching, also known as tooth whitening, is a common procedure in general dentistry but most especially in the field of cosmetic dentistry. A child's deciduous teeth are generally whiter than the adult teeth that follow. As a person ages the adult teeth often become darker due to changes in the mineral structure of the tooth, as the enamel becomes less porous. Teeth can also become stained by bacterial pigments, foodstuffs and tobacco. Certain antibiotic medications (like tetracycline) can also lead to teeth stains or a reduction in the brilliance of the enamel.
There are many methods to whiten teeth: bleaching strips, bleaching pen, bleaching gel, laser bleaching, and natural bleaching. Traditionally, at-home whitening is done with bleaching gel which is applied to the teeth using thin guard trays. At-home whitening can also be done by applying small strips that go over the front teeth. Oxidizing agents such as hydrogen peroxide or carbamide peroxide are used to lighten the shade of the tooth. The oxidizing agent penetrates the porosities in the rod-like crystal structure of enamel and oxidizes interprismatic stain deposits; over a period of time, the dentin layer, lying underneath the enamel, is also bleached. Laser bleaching uses light energy to accelerate the process of bleaching in a dental office. The effects of bleaching can last for several months, but may vary depending on the lifestyle of the patient. Factors which will decrease whitening include smoking and the ingestion of dark colored liquids like coffee, tea and red wine.
Internal staining of dentin can discolor the teeth from inside out. Internal bleaching can remedy this. If heavy staining or tetracycline damage is present on a patient's teeth, and whitening is ineffective, there are other methods of whitening teeth. Bonding, when a thin coating of composite material is applied to the front of a person's teeth and then cured with a blue light can be performed to mask the staining. A veneer can also mask tooth discoloration.


Methods

There are two main methods of gel bleaching—one performed with high-concentration gel, and another with low-concentration agents. High-concentration bleaching can be accomplished either in the dental office, or at home. Performing the procedure at home is accomplished using high-concentration carbamide peroxide ,which is readily available online or in dental stores and is much more cost-effective than the in-office procedure. Whitening is performed by applying a high concentration of oxidizing agent to the teeth with thin plastic trays for a short period of time, which produces quick results. The application trays ideally should be well-fitted to retain the bleaching gel, ensuring even and full tooth exposure to the gel. Trays will typically stay on the teeth for about 15–20 minutes. Trays are then removed and the procedure is repeated up to two more times. Most in-office bleaching procedures use a light-cured protective layer that is carefully painted on the gums and papilla (the tips of the gums between the teeth) in order to reduce the risk of chemical burns to the soft tissues. The bleaching agent is either carbamide peroxide, which breaks down in the mouth to form hydrogen peroxide, or hydrogen peroxide itself. The bleaching gel typically contains between 10-30% carbamide peroxide (15% is recommended) which is roughly equivalent to 3-10% hydrogen peroxide concentration.
Low-concentration whitening is far less effective, and is generally only performed at home. Low-concentration whitening involves purchasing a thin mouthguard or strip that holds a relatively low concentration of oxidizing agent next to the teeth for as long as several hours a day for a period of 5 to 14 days. Results can vary, depending on which application is chosen, with some people achieving whiter teeth in a few days, and others seeing very little results or no results at all. Whitening is potentially better at a dentist because the strip or mouth-guard does not completely conform to the shape of the teeth, sometimes leaving the tips of the teeth (near the gumline) unbleached. The bleaching agent is typically less than 10% hydrogen peroxide equivalent, so irritation to the soft tissue around teeth is minimized. Dentists as well as some dental laboratories can fabricate custom fitted whitening trays that will greatly improve the results achieved with an over-the-counter whitening method.
A typical course of bleaching can produce dramatic improvements in the cosmetic appearance of most stained teeth; however, some stains do not respond to bleaching. Tetracycline staining may require prolonged bleaching, as it takes longer for the bleach to reach the dentine layer. White-spot decalcifications may also be highlighted and become more noticeable. Bleaching is least effective if teeth have white spots, decay or infected gums. It is also least effective when the original tooth color is grayish. Bleaching is most effective with yellow discolored teeth.
Laser bleaching, also known as power bleaching, uses light energy to accelerate the process of bleaching in a dental office. Different types of energy can be used in this procedure. The ideal source of energy should be high energy to excite the peroxide molecules without overheating the pulp of the tooth, creating an inflammatory response. The use of an argon laser to safely and effectively speed up the whitening process is ideal for laser bleaching. An argon laser is preferred over the use of an arc lamp (the traditional dental method of light-activated bleaching) or infrared laser because it does not exhibit any of the heat or UV ray emissions of the arc lamp. Chemical burns, which are occasionally a side-effect of gel bleaching, or heat-induced sensitivity, are not a factor with argon laser whitening. Most laser teeth whitening treatments can be done in approximately 1 hour, in a single visit to a dental physician, (depending on the condition of a person’s teeth).


Risks

Side effects of teeth bleaching include: chemical burns with gel bleaching (if a high-concentration oxidizing agent contacts unprotected tissues, which may bleach or discolor mucous membranes), sensitive teeth, and overbleaching (known in the profession as "over white teeth") aka "Hyperodonto-oxidation". Rebound, or teeth losing the bleached effect and darkening, is also an issue, with some studies showing the rebound effect over 30 days. A recent study by Kugel et al. has shown that as much as 4 shades of lightness can be lost over 30 days with light-activated/office bleaching.
Home tooth bleaching treatments can very slightly reduce tooth enamel. There have been long term Tetracycline studies done where patients received high concentration bleach, over night, for 6 months. These studies show that even over long term exposure, the amount of reduction in tooth enamel is insignificant.
The side effects that occur most often are a temporary increase in tooth sensitivity and mild irritation of the soft tissues of the mouth, particularly the gums. Tooth sensitivity often occurs during early stages of the bleaching treatment. Tissue irritation most commonly results from an ill-fitting mouthpiece tray rather than the tooth-bleaching agent. Both of these conditions usually are temporary and disappear within 1 to 3 days of stopping or completing treatment.
Individuals with sensitive teeth and gums, receding gums and/or defective restorations should consult with their dentist prior to using a tooth whitening system. People who are sensitive to hydrogen peroxide (the whitening agent) should not try a bleaching product without first consulting a dentist. Also, prolonged exposure to bleaching agents may damage tooth enamel. This is especially the case with home remedy whitening products that contain fruit acids.
Bleaching is not recommended in children under the age of 16. This is because the pulp chamber, or nerve of the tooth, is enlarged until this age. Tooth whitening under this condition could irritate the pulp or cause it to become sensitive. Tooth whitening is also not recommended in pregnant or lactating women.
Tooth whitening does not usually change the color of fillings and other restorative materials. It does not affect porcelain, other ceramics, or dental gold. However, it can slightly affect restorations made with composite materials, cements and dental amalgams. Tooth whitening can restore color of fillings, porcelain, and other ceramics when they become stained by foods, drinks, and smoking, among other activities.


Internal bleaching

Internal bleaching procedures are performed on devitalized teeth that have undergone endodontic therapy but are discolored due to internal staining of the tooth structure by blood and other fluids that leached in. Unlike external bleaching which brightens teeth from the outside in, internal bleaching brightens teeth from the inside out. Bleaching the tooth internally involves drilling a hole to the pulp chamber, cleaning, sealing, and filling the root canal with a rubber-like substance, and placing a peroxide gel into the pulp chamber so that the gel can work directly inside the tooth on the dentin layer. In this variation of whitening the peroxide is sealed within the tooth over a period of some days and replaced as needed, the so called "walking bleach" technique.


Agents

Various chemical and physical agents can be used to whiten teeth. Toothpaste typically has small particles of silica, aluminum oxide, calcium carbonate, or calcium phosphate to grind off stains formed by colored molecules that have lodged onto the teeth from food. Unlike bleaches, whitening toothpaste does not alter the intrinsic color of teeth.
Bleaching solutions contain peroxide which bleaches the tooth enamel to change its color. Off-the-shelf products typically rely on a carbamide peroxide solution varying in concentration from 10% to 35%. Bleaching solutions may be applied directly to the teeth, embedded in a plastic strip that is placed on the teeth or use a gel held in place by a mouthguard. Because the concentration is typically low to avoid toxicity, whitening often takes several weeks. A tooth whitening agent that also remineralizes teeth is under development.
Whitening teeth for aesthetic purposes has been dated back to the Ancient Egyptians, where a mixture of ground pumice and wine vinegar was brushed on the teeth with a rudimentary toothbrush. The ancient Romans used human urine by the belief that it kept the teeth white and firmly in place, a practice that continued into the eighteenth century. Whitening in the middle ages was done by barbers, where the teeth would be filed down and nitric acid applied to the teeth. This was a dangerous procedure, considering the massive tooth damage this practice caused.


Controversy

Generally, consumer organizations, health sector professionals and people who benefit financially from the dental industry recommend that bleaching products should only be used after consultation with a dentist, while the cosmetic industry, its organizations and people who benefit financially from cosmetic sales argue that, since bleaching products are basically safe, they should be freely available over the counter.

This post is taken from http://nycteeth.blogspot.com/2009/08/tooth-whitening.html

Tooth brushing

Tooth brushing



A photo from 1899 showing the use of toothbrush.
Tooth brushing is the act of cleaning teeth with a toothbrush.
Modern medical research has shown that brushing teeth properly can prevent cavities, gingivitis, and periodontal, or gum disease, which causes at least one-third of adult tooth loss. If teeth are not brushed correctly and frequently, it could lead to the calcification of saliva minerals, forming tartar.
Brushing one's teeth has long been considered an important part of dental care. As long ago as 3000 B.C. ancient Egyptians constructed crude toothbrushes from twigs and leaves to clean their teeth. Similarly, other cultures such as the Greeks, Romans, and Indians cleaned their teeth with twigs. Some would fray one end of the twig so that it could penetrate between the teeth more effectively.


Toothbrush

Three toothbrushes
The toothbrush is an instrument used to clean teeth, consisting of a small brush on a handle. Toothpaste, often containing fluoride, is commonly added to a toothbrush to aid in cleaning. Toothbrushes are offered with varying textures of bristles, and come in many different sizes and forms. Most dentists recommend using a toothbrush labelled "Soft", since firmer bristled toothbrushes can damage tooth enamel and irritate gums as indicated by the American Dental Association. Toothbrushes are often made from synthetic fibers, although natural toothbrushes are also known in many parts of the world.


Toothpaste

Modern toothpaste gel
Toothpaste is a paste or gel dentifrice used to clean and improve the aesthetic appearance and health of teeth. It is almost always used in conjunction with a toothbrush. Toothpaste use can promote good oral hygiene: it can aid in the removal of dental plaque and food from the teeth, it can aid in the elimination and/or masking of halitosis, and it can deliver active ingredients such as fluoride to prevent tooth and gum (Gingiva) disease.

Tooth Powder

Tooth Powder or Toothpaste Powder as it is sometimes called is an alternative to toothpaste. In some cases, it is recommended especially in situations where the patient has sensitive teeth. Tooth powder typically does not contain the chemical sodium lauryl sulphate which can be a skin irritant. The function of sodium lauryl sulphate is to form suds when teeth are brushed. It is a common chemical in toothpaste.

This post is taken from http://nycteeth.blogspot.com/2009/08/tooth-brushing.html

10 tips for healthy teeth and gums

10 tips for healthy teeth and gums


Healthy teeth and gums reflect a healthy personality. Poor Oral health damages our self-esteem besides the various other harmful effects it has. Here I have outlined the 10 Commandments which will go a long way in ensuring you have healthy teeth and gums.
1. Brush your teeth twice daily: Brush your teeth twice a day to avoid majority of the dental problems.
cartoon-toothpaste-toothbrush-thumb-150x150 10 Commandments for maintaining healthy teeth and gums

Brushing incorrectly may reduce its effectiveness. It’s important to know HOW TO CORRECTLY BRUSH YOUR TEETH.
2. Use a Dental Floss: Flossing cleans the areas which are harder for a toothbrush to reach. It removes the food debris and plaque accumulated between the teeth. Flossing twice daily is preferable. Do also read the importance of flossing

3. Use of Mouth Washes: Mouthwashes such as Listerine or Chlorohexidine possess effective antiseptic properties. They kill the bacterial plaque known to cause bad breath, tooth decay and gingivitis. Use a mouthwash AFTER BRUSHING as per its directions.

4. Eating right: Maintain a balanced diet but reduce the consumption of foods containing sugars or starch. Sugary Foods( Candies, gums) and Starchy foods(potato chips, snacks) play an important role in causing tooth decay.

5. Avoid in between eating habits: Snacking between meals makes the teeth prone to tooth decay. The bacterial action is greatest at acidic Ph. The Ph is most acidic immediately after meals and gradually reduces and comes to a normal level. Eating in between meals does not allow the acidic level to come down increasing bacterial action leading to caries.

pop causes poor oral health
pop causes poor oral health

6. Avoid Cola and Energy Drinks: Cola drinks contain acids such as phosphoric acid and citric acid which have damaging effect on teeth. Energy drinks contain organic acids in addition to the above which directly damage the tooth calcium. ENERGY DRINKS AND COMMERCIAL LEMONADE ARE 11 TIMES MORE HARMFUL TO TEETH THAN COLA DRINKS. If you must drink, don’t sip on them for a long time and do rinse your mouth after drinking

7. Quit Smoking: Smoking not only stains your teeth but also damages your gums by reducing the blood supply. It also causes smokers breath

8. Chewing Sugar free Gum: Chewing Sugar free gum prevents bad breath and fights tooth decay by washing away the plaque acid resulting in healthier teeth.

9. Regular visits to your Dentist: It is essential to visit your dentist once in 3-6 months to diagnose any oral concerns early. Most oral health problems do not produce any symptoms till they have progressed to a later stage.

10. Oral Piercings: Oral Piercings such as tongue or lip are a no-no for good oral health. Tongue piercings can lead to allergic reactions, infections, nervous damage to tongue and gum disease.
This post is taken from http://nycteeth.blogspot.com/2009/08/10-tips-for-healthy-teeth-and-gums.html

Dental Fear

Dental fear

Dental fear refers to the fear of dentistry and of receiving dental care. A pathological form of this fear (specific phobia) is variously called dental phobia, odontophobia, dentophobia, dentist phobia, or dental anxiety. However, it has been suggested that the term "dental phobia" is often a misnomer, as many people with this condition do not feel their fears to be excessive or unreasonable and resemble individuals with post-traumatic stress disorder, caused by previous traumatic dental experiences.

Incidence

It is estimated that as many as 75% of US adults experience some degree of dental fear, from mild to severe. Approximately 5 to 10 percent of U.S. adults are considered to experience dental phobia; that is, they are so fearful of receiving dental treatment that they avoid dental care at all costs. Many dentally fearful people will only seek dental care when they have a dental emergency, such as a toothache or dental abscess. People who are very fearful of dental care often experience a “cycle of avoidance,” in which they avoid dental care due to fear until they experience a dental emergency requiring invasive treatment, which can reinforce their fear of dentistry.
Women tend to report more dental fear than men, and younger people tend to report being more dentally fearful than older individuals. People tend to report being more fearful of more invasive procedures, such as oral surgery, than they are of less invasive treatment, such as professional dental cleanings, or prophylaxis.

Causes

Direct experiences

Direct experience is the most common way people develop dental fears. Most people report that their dental fear began after a traumatic, difficult, and/or painful dental experience. However, painful or traumatic dental experiences alone do not explain why people develop dental phobia. The perceived manner of the dentist is an important variable. Dentists who were considered "impersonal", "uncaring", "uninterested" or "cold" were found to result in high dental fear in students, even in the absence of painful experiences, whereas some students who had had painful experiences failed to develop dental fear if they perceived their dentist as caring and warm.

Indirect experiences

(1) Vicarious learning: Dental fear may develop as people hear about others' traumatic experiences or negative views of dentistry (vicarious learning).
(2) Mass media: The negative portrayal of dentistry in mass media and cartoons may also contribute to the development of dental fear.
(3) Stimulus Generalization: Dental fear may develop as a result of a previous traumatic experience in a non-dental context. For example, bad experiences with doctors or hospital environments may lead people to fear white coats and antiseptic smells, which is one reason why dentists nowadays often choose to wear less "threatening" apparel. People who have been sexually, physically or emotionally abused may also find the dental situation threatening. The dental situation may be especially difficult for people who have experienced forced sexual intercourse which included oral penetration.
(4) Helplessness and Perceived Lack of Control: If a person believes that they have no means of influencing a negative event, they will experience helplessness. Research has shown that a perception of lack of control leads to fear. The opposite belief, that one does have control, can lead to lessened fear. For example, the belief that the dentist will stop when the patient gives a stop signal lessens fear. Helplessness and lack of control may also result from direct experiences, for example an incident where a dentist wouldn't stop even when the person was in obvious pain.

Diagnosis

Phobia of dental care is sometimes diagnosed using a fear measurement instrument like Corah’s Dental Anxiety Scale or the Modified Dental Anxiety Scale.

Treatment

Treatments for dental fear often include a combination of behavioral and pharmacological techniques. Specialized dental fear clinics, such as those at the University of Washington in Seattle and Göteborg University in Sweden, use both psychologists and dentists to help people learn to manage and decrease their fear of dental treatment. The goal of these clinics is to provide individuals with the fear management skills necessary for them to receive regular dental care with a minimum of fear or anxiety. While specialized clinics exist to help individuals manage and overcome their fear of dentistry, they are rare. Many dental providers outside of such clinics use similar behavioral and cognitive strategies to help patients reduce their fear.

Behavioral Techniques

Behavioral strategies used by dentists include positive reinforcement (e.g. praising the patient), the use of non-threatening language, and tell-show-do techniques. The tell-show-do technique was originally developed for use in pediatric dentistry, but can also be used with nervous adult patients. The technique involves verbal explanations of procedures in easy-to-understand language (tell), followed by demonstrations of the sights, sounds, smells, and tactile aspects of the procedure in a non-threatening way (show), followed by the actual procedure (do).
More specialized behavioral treatments include teaching individuals relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, as well as cognitive, or thought-based techniques, such as cognitive restructuring and guided imagery. Both relaxation and cognitive strategies have been shown to significantly reduce dental fear. One example of a behavioral technique is systematic desensitization, a method used in psychology to overcome phobias and other anxiety disorders. This is also sometimes called graduated exposure therapy or gradual exposure. For example, for a patient who is fearful of dental injections, the therapist first teaches relaxation skills to the patient, then gradually introduces the feared object (in this case, the needle and/or syringe) to the patient, encouraging the patient to manage his/her fear using the relaxation skills previously taught. The patient progresses through the steps of receiving a dental injection while using the relaxation skills, until the patient is able to successfully receive a dental injection while experiencing little to no fear. This method has been shown to be effective in treating fear of dental injections. Cognitive restructuring , if applied in a non-threatening situation, might be a useful alternative as a first step after years of avoidance of dental care and less threatening than immediate exposure to the feared stimuli.
It is interesting to take into account the views of people who have been provided with behavioural treatments for dental fear. From a psychologist's perspective, techniques such as graded exposure, relaxation techniques or challenging catastrophic thinking are important. However, Gerry Kent, a clinical psychologist from the University of Sheffield UK, notes that from the patient's perspective, interventions can be conceptualized quite differently. He argues that high levels of anxiety or phobia should not be considered as residing simply within the individual or in the individual's perceptions of dental care, but more within the relationship with the dentist. For example, when patients who had successfully completed a cognitive-behavioural programme were asked what had helped them to tolerate treatment, they mentioned factors such as the provision of information, the time taken, being put in control by the dentist, and the dentist understanding and listening to their concerns. Such findings suggest that an interpersonal model of anxiety and anxiety-reduction is useful when trying to understand and treat dental fears.
Certain aspects of the physical environment also play an important role in alleviating dental fear. For example, getting rid of the smells traditionally associated with dentistry, the dental team wearing non-clinical clothes, or playing music in the background can all help patients by removing and replacing stimuli which can trigger feelings of fear. Some anxious patients respond well to more obvious distraction techniques such as listening to music, watching movies, or even using virtual-reality headsets during treatment.

Pharmacological Techniques

Pharmacological techniques to manage dental fear range from mild sedation to general anesthesia, and are often used by dentists in conjunction with behavioral techniques. One common anxiety-reducing medication used in dentistry is nitrous oxide (also known as “laughing gas”), which is inhaled through a mask worn on the nose and causes feelings of relaxation and dissociation. Dentists may prescribe an oral sedative, such as a benzodiazepine like temazepam (Restoril), alprazolam (Xanax), diazepam (Valium), or triazolam (Halcion). Triazolam (Halcion) is not available in the UK. While these sedatives may help people feel calmer and sometimes drowsy during dental treatment, patients are still conscious and able to communicate with the dental staff. Intravenous sedation uses benzodiazepines administered directly intravenously into a patient’s arm or hand. IV sedation is often referred to as “conscious sedation” as opposed to general anesthesia (GA). In IV sedation, patients breathe on their own while their breathing and heart rate are monitored. In GA, patients are more deeply sedated.

Self-Help and Peer Support

Recent research has focused on the role of online communities in helping people to confront their anxiety or phobia and successfully receive dental care. The findings suggest that certain individuals do appear to benefit from their involvement in dental anxiety online support groups.
This post is taken from http://nycteeth.blogspot.com/2009/08/dental-fear.html

Oral hygiene

Oral hygiene

Oral hygiene is the practice of keeping the mouth and teeth clean to prevent dental problems and bad breath.

Teeth cleaning

Teeth cleaning is the removal of dental plaque and tartar from teeth to prevent cavities, gingivitis, and gum diseas
e. Severe gum disease causes at least one-third of adult tooth loss.
Generally, dentists recommend that teeth be cleaned professionally at least twice per year. Professional cleaning includes tooth scaling, tooth polishing,
and, if too much tartar has built up, debridement. This is usually followed by a fluoride treatment for children and adults.
Between cleanings by a dental hygienist, good oral hygiene is essential for preventing tartar build-up which causes the problems mentioned above. This is done by carefully and frequently brushing with a toothbrush and the use of dental floss to prevent accumulation of plaque on the teeth.

Interdental brushing

Periodontologists nowadays prefer the use of interdental brushes to dental floss. Apart from being more gentle to the gums, it also carries less risk for hard dental tissue damage. There are different sizes of brushes that are recommended according to the size of the interdental space. It is desirable to clean between teeth before brushing to enable easy access for the saliva fluoride mix to remineralise any demineralised tooth often resulting from food left on teeth after every meal or snack.

Flossing

The use of dental floss is an important element of the oral hygiene, since it removes the plaque and the decaying food remaining stuck between the teeth. This food decay and plaque cause irritation to the gums, allowing the gum tissue to bleed more easily. Acid forming foods left on teeth also demineralise tooth eventually causing cavities. Flossing for a proper inter-dental cleaning is recommended at least once per day, preferably before bedtime, to help prevent receding gums, gum disease, and cavities between the teeth. Interdental cleaning is important before brushing to provide easy access of the saliva fluoride mix to remineralise any demineralised tooth to help prevent tooth decay.

Tongue cleaning

Cleaning the tongue as part of the daily oral hygiene is essential, since it removes the white/yellow bad breath generating coating of bacteria, decaying food particles, fungi (such as Candida), and dead cells from the dorsal area of tongue. Tongue cleaning also removes some of the bacteria species which generate tooth decay and gum problems.

Gum care

Massaging gums with toothbrush bristles is generally recommended for good oral health. Flossing is recommended at least once per day, preferably before bed, to help prevent receding gums, gum disease, and cavities between the teeth.

Oral irrigation

Dental professionals usually recommend oral irrigation as a great way to clean teeth and gums.
Oral irrigators can reach 3-4 mm under the gum line, farther than toothbrushes and floss. And, the jet stream is strong enough to remove all plaque and tartar. The procedure does leave a feeling of cleanliness and freshness, and does disrupt more plaque or bacteria as floss since it cleans deeper.

Food and drink

Foods that help muscles and bones also help teeth and gums. Breads and cereals are rich in vitamin B while fruits and vegetables contain vitamin C, both of which contribute to healthy gum tissue.(8) Lean meat, fish, and poultry provide magnesium and zinc for teeth. Some people recommend that teeth be brushed after every meal and at bedtime, and flossed at least once per day, preferably at night before sleep. For some people, flossing might be recommended after every meal. Some foods like fruit and sugar confection are acid forming. Chewing obviously forces food between teeth generally displacing previously trapped food so it is a good idea to chew tooth friendly foods before and after meals or snacks to reduce acid demineralisation and even remineralise demineralised tooth as when chewing celery that forces saliva into trapped food to dilute sugar, neutralise acid and remineralise demineralised tooth. However over 80% of cavities occur inside pits and fissures on chewing surfaces of back teeth. So it is clear that acid forming foods cause these cavities and if fissure sealants are places over these surfaces to block food being trapped inside pits and fissures, acid demineralisation and tooth decay cannot progress.

Beneficial foods

Some foods may protect against cavities. Fluoride is a primary protector against dental cavities. Fluoride makes the surface of teeth more resistant to acids during the process of remineralisation. Drinking fluoridated water is recommended by some dental professionals while others say that using toothpaste alone is enough. Milk and cheese are also rich in calcium and phosphate, and may also encourage remineralisation. All foods increase saliva production, and since saliva contains buffer chemicals this helps to stabilize the pH to near 7 (neutral) in the mouth. Foods high in fiber may also help to increase the flow of saliva. Sugar-free chewing gum stimulates saliva production, and helps to clean the surface of the teeth.(8)

Detrimental foods

Sugars are commonly associated with dental cavities. Other carbohydrates, especially cooked starches, e.g. crisps/potato chips, may also damage teeth, although to a lesser degree since starch has to be converted by enzymes in saliva first.
Sucrose (table sugar) is most commonly associated with cavities. The amount of sugar consumed at any one time is less important than how often food and drinks that contain sugar are consumed. The more frequently sugars are consumed, the greater the time during which the tooth is exposed to low pH levels, at which point demineralisation occurs (below 5.5 for most people). It is important therefore to try to encourage infrequent consumption of food and drinks containing sugar so that teeth have a chance to be repaired by remineralisation and fluoride. Limiting sugar-containing foods and drinks to meal times is one way to reduce the incidence of cavities. Sugars from fruit and fruit juices, e.g., glucose, fructose, and maltose seem equally likely to cause cavities.
Acids contained in fruit juice, vinegar and soft drinks lower the pH level of the oral cavity which causes the enamel to demineralize. Drinking drinks such as orange juice or cola throughout the day raises the risk of dental cavities tremendously.
Another factor which affects the risk of developing cavities is the stickiness of foods. Some foods or sweets may stick to the teeth and so reduce the pH in the mouth for an extended time, particularly if they are sugary. It is important that teeth be cleaned at least twice a day, preferably with a toothbrush and fluoride toothpaste, to remove any food sticking to the teeth. Regular brushing and the use of dental floss also removes the dental plaque coating the tooth surface.
Chewing gum assists oral irrigation between and around the teeth, cleaning and removing particles, but for teeth in poor condition it may damage or remove loose fillings as well. However gum cannot absorb and expell saliva so cannot force saliva inside pts and fissures or between teeth like chewing celery, so cannot easily dilute sugar, neutralise acid and remineralise demineralised tooth. It seems there is more in depth analysis is needed into the relationship between food, teeth and plaque bacteria.

Other

Smoking and chewing tobacco are both strongly linked with multiple dental diseases. Regular vomiting, as seen in bulimics, also causes significant damage.
Mouthwash or mouth rinse improve oral hygiene. Dental chewing gums claim to improve dental health.
Retainers can be cleaned in mouthwash or denture cleaning fluid. Dental braces may be recommended by a dentist for best oral hygiene and health. Dentures, retainers, and other appliances must be kept extremely clean. This includes regular brushing and may include soaking them in a cleansing solution.

Oral hygiene and systemic diseases

Several recent clinical studies show a direct link between poor oral hygiene (oral bacteria & oral infections) and serious systemic diseases, such as:
  • Cardiovascular Disease (Heart attack and Stroke),
  • Bacterial Pneumonia,
  • Low Birth Weight,
  • Diabetes complications,
  • Osteoporosis.

Dental insurance

Dental Insurance

Dental insurance is insurance designed to pay a portion of the costs associated with dental care.

The most common types of dental insurance plans are Preferred provider organizations (PPO) or dental health maintenance organizations (DHMO). Both types are considered managed care.

Temporomandibular joint disorder


Temporomandibular joint disorder (TMJD or TMD), or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The disorder and resultant dysfunction can result in significant pain and impairment. Because the disorder transcends the boundaries between several health-care disciplines — in particular, dentistry, neurology, physical therapy, and psychology — there are a variety of treatment approaches.
The temporomandibular joint is susceptible to many of the conditions that affect other joints in the body, including ankylosis, arthritis, trauma, dislocations, developmental anomalies, and neoplasia.

Signs and symptoms

Signs and symptoms of temporomandibular joint disorder vary in their presentation and can be very complex. Often the symptoms will involve more than one of the numerous TMJ components: muscles, nerves, tendons, ligaments, bones, connective tissue, and the teeth. Ear pain associated with the swelling of proximal tissue is a symptom of temporomandibular joint disorder.