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Author: Adam R. Pershing, DMD

Mouthwash

Written by Adam R. Pershing, DMD on . Posted in Oral Hygiene. No Comments on Mouthwash

Adding an appropriate mouthwash to your dental hygiene routine can be a simple and effective way to improve your overall dental health. Mouthwash helps reduce plaque, control bad breath, and prevents tooth decay and gum disease. There are many types and brands of mouthwash available over-the-counter to choose from, and some are even prescribed. With all the choices out there, how do you possibly choose one?

It’s important to note that while many of the mouthwashes you find on the shelf at your local drugstore may be advertised for cosmetic purposes, some of them actually contain bacteria fighting substances like fluoride and peroxide. However, if your dentist has told you that you are at risk for tooth decay or gum disease, you will want to use a prescribed mouthwash with stronger bacteria fighting substances.

Benefits of Using Mouthwash

There are two categories that mouthwashes fall into: cosmetic, which temporarily combat bad breath and contain fluoride or peroxide to help manage bacteria, and therapeutic, which contain stronger substances that control or reduce bad breath, gingivitis, plaque, and tooth decay.

Cosmetic mouthwash usually contains fluoride and sometimes peroxide. In liquid form, the rinse can reach all around your teeth, even the nooks and crannies your toothbrush can’t reach. It has been proven that fluoride strengthens tooth enamel, in turn protecting against decay. Fluoride can even reduce miniscule lesions on teeth where a cavity might develop.

Therapeutic mouthwash contains ingredients to control and reduce plaque. Plaque is a sticky substance full of bacteria that sits on the surface of your teeth and other parts of your mouth. Studies have shown that therapeutic mouthwash decreases plaque more significantly than brushing and flossing alone.

Active ingredients in a therapeutic mouthwash may include:

  • Cetylpyridinium chloride to prevent the development of bacteria that cause gum disease
  • Chlorhexidine to treat gingivitis by reducing inflammation, swelling, and bleeding of the gums
  • Essential oils to help prevent cavities by reducing bacteria deep in the gums
  • Fluoride to strengthen tooth enamel, allowing it to be more resistant to tooth decay
  • Peroxide to penetrate the surface layer of a tooth in order to remove unsightly stains

Which mouthwash is right for me?

When perusing the mouthwash aisle at your local drugstore, be sure to look for the American Dental Association (ADA) seal on the label. This means that the product has not only been evaluated, but proven effective by renowned dental experts. With prescription mouthwash, you must follow your dentist’s directions carefully. Mouthwash benefits most people, but it should not be used for children under six years of age, as they may accidentally swallow the liquid.

Interdental Cleaning Devices

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Twice a year when you visit your dentist for a checkup and professional cleaning, you are probably given instructions on proper oral hygiene. This will include brushing and flossing your teeth at least twice a day, using a toothpaste containing fluoride, and using a soft bristled toothbrush. Toothbrushes can’t reach every area of your mouth, which is why floss is such an important tool to reach all the nooks and crannies in and around each tooth. It’s important to remove the food particles and residue to prevent tooth decay and gum disease from developing. There are other tools that you can add to your oral hygiene routine, such as interdental cleaning devices.

Interdental Brushes

Some patients don’t like flossing, have difficulty flossing correctly, or don’t floss enough. Interdental brushes are a great alternative to removing extra debris between your teeth, especially near the molars where it may be harder to reach with floss. These brushes look similar in shape to a pencil, with a metal wire core and soft nylon filaments twisted around the brush head. They are easy to use and even improve the amount of tooth surface area they can clean. If you’re suffering from gum disease, interdental brushes are a more gentle approach to flossing. With minimal bleeding of the gums, and ultimately minimal damage, interdental brushes can help to halt the progression of gum disease.

There are different types and sizes of interdental brushes, so choosing one that works uniquely for your teeth may be a hard choice. Here’s what to keep in mind when choosing your interdental brush:

  • The correct size of brush depends on the amount of spacing between your teeth.
  • If you have dental crowns or fillings, consider choosing a brush that has a coating on the inner wire.
  • Decide which type of handle works best for you, a straight handle or a curved handle. Typically, a straight-handled brush works better.
  • If you have sensitive teeth or roots, consider choosing an interdental brush made of rubber instead of nylon.

Oral Irrigation Devices

Also known as a water pick or water jet, an oral irrigation device is another alternative to flossing. It uses a stream of pressurized, pulsating water to clean in between the teeth and around the gum line. This type of device is recommended for people who are unable to tolerate flossing every day. If you have sensitive gums, orthodontic appliances, diabetes, or dental implants, an oral irrigation device might be a better option compared to traditional flossing. Oral irrigation devices are less irritating, easier to maneuver, and can remove more plaque than traditional flossing or for those who only brush.

Toothpaste

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As you know, your dentist recommends fluoride toothpaste because fluoride prevents cavities. Fluoride bonds with the calcium and phosphate ions in our tooth enamel, repairing weak spots. Even better, this new bond is stronger and more cavity-resistant than enamel alone.

When it comes to preventing gum disease as well as fighting cavities, though, not all fluoride formulas are the same. The common go-to ingredient in gum-healthy toothpastes is stannous fluoride. Like the more commonly used sodium fluoride, stannous fluoride reduces the risk of cavities and strengthens tooth enamel.

Whitening Toothpaste

Unlike bleaching products, which contain carbamide peroxide or hydrogen peroxide, whitening toothpaste only cleans the enamel rather than changing the color of your teeth. To obtain the benefits of whitening toothpaste, you need to use it regularly.

If a whitening toothpaste meets the ADA standards and contains fluoride, the next step is to clear it with your dentist. Whitening toothpaste often contains abrasives to remove surface stains. Though abrasives are an effective aid in tooth whitening, they may not be recommended if you have weak tooth enamel.

Specialty Toothpaste

In certain situations, your dentist may suggest or prescribe specialty toothpaste, depending on your oral health needs. For example, patients who are prone to tooth decay and cavities despite frequent brushing and flossing may benefit from prescription-strength fluoridated toothpaste to help prevent the weakening of tooth enamel. Others who suffer from tooth sensitivity may benefit from the use of desensitizing toothpaste.

Toothpaste for Children

Before a child can spit, use toothpaste without fluoride. This is an ideal time to use toothpaste with xylitol. Xylitol should be listed as the first ingredient; this way you’ll get the almost medicinal property of this natural sweetener. After you have found the right type of toothpaste, consider its flavor. The best kind of toothpaste is one that will be used, so choose a flavor that your child will love.

Sedation Dentistry

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Sedation dentistry uses medication to help you feel more calm and relaxed during your dental procedure. Sometimes called conscious sedation dentistry, you will experience forgetfulness and insensitivity to pain all while still being conscious. Sedation dentistry can be used on patients of all ages.

There are a variety of reasons sedation may be requested or required for a dental procedure:

  • Dental anxiety
  • Fear of visiting the dentist
  • Overly sensitive gag reflex
  • Phobia of needles
  • Severe teeth sensitivity
  • Claustrophobia
  • Decreased sensitivity to local anesthesia
  • Difficulty controlling body movements
  • Physical, cognitive, or behavioral special needs

Types of Sedation

Your level of anxiety, length of your procedure, health history, and personal preferences will all be considered by your dentist before the procedure. Common types of sedation include:

  • Inhalation sedation: Nitrous oxide sedation or, “laughing gas,” is one of the most common types of sedation. Though it doesn’t relieve pain very well, it’s a great anti-anxiety option. A mask is placed over your nose, which pumps out a mixture of oxygen and nitrous oxide. Inhaled sedation makes you feel light-headed and relaxed, but the effects wear off quickly after the procedure.
  • Oral sedation: Your dentist will give you a sedative medication in the form of a pill or liquid, about an hour before your procedure begins. The most common medications include triazolam, diazepam, zaleplon, lorazepam, or midazolam oral syrup. Liquid sedation is more often used in pediatric dentistry. Even though oral sedation makes you feel very groggy and sleepy, you’ll still be able to communicate with your dentist. Once the procedure is finished, you will need someone to drive you home since oral sedation affects memory and motor skills.
  • Intravenous (IV) sedation: Out the different types of sedation offered in a dental office setting, IV sedation is the deepest a patient can go while still maintaining some consciousness. The medication is administered directly into your bloodstream through an IV line, much like if you were in the hospital getting fluids. Throughout the procedure, your heart rate, blood pressure, and oxygen levels will be monitored closely, so that the dosage of medication can be adjusted as necessary. Most patients fall asleep with IV sedation and rarely remember treatment when they wake up. This is the best option for those undergoing a lengthy dental procedure or those who suffer from severe dental anxiety. The effects of IV sedation may take several hours to completely wear off, so you will need someone to drive you to and from your appointment.

Oral Surgery Procedures

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Oral surgery refers to any operation on your teeth, gums, mouth, or facial structures, and ranges from routine tooth extractions to more complex corrective jaw surgeries.

While more complicated surgeries require hospital time, the majority of oral surgeries are performed in a dental office setting under local anesthesia with minimal recovery time.

Oral surgery may be recommended to treat pain or infection, or restore facial functioning.

Examples of Oral Surgery

Tooth extractions

Tooth extractions might be necessary in the case of severe tooth decay, gum disease, or to prevent overcrowding. Typically performed under local or general anesthesia, tooth extractions are the most common type of oral surgery and have relatively little recovery time.

Dental Implants

Made to blend into your natural smile, dental implants are a common and preferred way to replace missing teeth. The implant is fused directly to the jawbone, giving the durability and appearance of a real tooth.

Oral diagnosis and biopsies

Some oral diseases require a biopsy to confirm diagnosis. Biopsies are recommended when an abnormal lesion is found in the oral cavity, and involves removing cells from the lesion to be examined under a microscope.

Corrective jaw surgery

Corrective jaw surgery corrects skeletal conditions of the jaw and face for functional and aesthetic purposes. Corrective jaw surgery can treat TMJ, misaligned bites like overbites and underbites, as well protruding or underdeveloped chins.

Snoring and sleep apnea

Snoring and sleep apnea occur when a patient’s breathing is interrupted during sleep often due to excess tissue in the airways. Surgery is used to remove the excess soft tissue to restore proper breathing, so patients can return to a restful night’s sleep.

Facial trauma and reconstructive surgery

Facial trauma happens after any blunt force to the face, including anything from car accidents to sports injuries that result in broken facial bones or damage to soft-tissue. Treatment restores facial structure and functions.

Cleft lip/palate

Cleft lips and palates are congenital conditions defined by an opening in the upper lip or palate. Often affecting feedings, swallowing, and speech, surgery is performed to heal these openings.

If you are a candidate for oral surgery, your healthcare provider will walk you through the procedure, give you options for anesthesia, and answer any questions you may have. Recovery time will range depending on your procedure and any preexisting conditions you may have.

Wisdom Teeth Removal

Wisdom Teeth Removal

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Wisdom teeth are the third molars in your mouth and the last permanent teeth to erupt. They typically appear between the ages of 17 and 25. For the lucky few, some never develop wisdom teeth or they erupt normally and cause no issues. For others, they experience what is called impacted wisdom teeth, which can cause a variety of problems in your mouth.

Complications of Impacted Wisdom Teeth

  • Higher risk for tooth decay: Wisdom teeth are more difficult to clean because of the position in which they erupt. Food and bacteria stay trapped between the gum and the impacted tooth, no matter how thoroughly you brush.
  • Overcrowding and damage to surrounding teeth: If your wisdom tooth applies force against the second molar as it erupts, damage can be done to the second molar, which increases the risk of infection. The pressure from your wisdom tooth can also cause overcrowding of the other teeth or cause an abnormal bite to form, which will require orthodontic treatment to fix. For some, the jaw is simply too small to accommodate all the teeth.
  • Cyst developing in the jawbone: There is a sac in the jawbone in which the wisdom tooth develops. The sac can fill with fluid, forming a cyst that can cause damage to the jawbone, teeth, and nerves. In some serious cases, a benign tumor may even form. At this point, removal of tissue and bone might be necessary.
  • Higher risk of developing gum disease: Since thorough dental hygiene is more difficult with wisdom teeth, there’s an increased risk of developing pericoronitis, a painful and inflammatory gum condition.

Before the Procedure

It’s understandable to feel anxious about extracting your wisdom teeth, but it’s best for them to be removed in order to avoid headaches and consistent pain in the back of your mouth. It is best to have your wisdom teeth removed as soon as they begin to develop. When you’re young, the wisdom teeth roots aren’t yet fully developed. This makes the procedure a bit easier on your surgeon and helps with a quicker recovery time. Before making a decision to remove wisdom teeth, your dentist will first assess your mouth and take X-rays.

After the Procedure

Your surgeon will provide you with post-operative instructions. You will be advised to eat soft foods for a few days and clean out the extraction site after each meal. A syringe will be provided for you to fill with water and flush out any food particles stuck at the extraction site. This is the best way to prevent alveolar osteitis, also known as dry socket. When a tooth is removed from a healthy socket, blood clots form and the healing process begins. Dry sockets happen when the healing process is hindered in some way. If you notice any extreme pain or sensitivity after your procedure, you may have developed a dry socket. This condition requires immediate treatment by your dentist.

Sinus Surgery

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Sinus SurgeryDental implants are a great, innovative way to replace teeth, but sometimes there isn’t enough bone to support the implant. In this case, your doctor might recommend sinus surgery.

Sinus surgery, also known as a sinus lift, is a bone grafting procedure that will augment and strengthen your jaw bone to create a better support for implants. The procedure lifts your sinus floor, creating space for bone growth and an implant. This procedure is commonly recommended if implants are needed in the back, upper jaw as that bone is naturally thinner than the rest of our jawbones.

You might be a candidate for sinus surgery if:

  • You are missing more than one tooth in the back of your jaw
  • Your tooth has been missing for a long time, leading to bone degradation
  • Your tooth was lost due to periodontal disease, leading to bone loss

The surgery is typically performed under local anesthesia, just like a routine filling. Once the area is numbed, an incision is made in the gum to expose the bone. A small opening is made in the bone, to uncover the sinus membrane. The sinus membrane is pushed up and bone grafting material is inserted. The gum is then stitched back up. Typically, healing takes six to seven months before an implant is placed, but in some cases, the implant can be placed during the sinus lift procedure, eliminating the need for a second surgery.

Swelling and minor discomfort last for a few days after surgery, similar to having wisdom teeth removed. Other side effects include sinus inflammation, in which case a decongestant is recommended. Antibiotics are prescribed to prevent infection and in some cases, a non-steroidal anti-inflammatory medication is prescribed to minimize swelling and discomfort.

Oral Diagnosis and Biopsies

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An oral biopsy is a tissue sample gathered from an abnormality in the mouth and is sent to a lab to undergo further testing. The procedure would be required when a dentist cannot diagnose the problem by examination, X-rays, and symptoms alone.

Common Oral Diseases

There are a variety of oral diseases that the pathologist will test for, including:

  • Oral cancer: Appearing as a growth or sore in the mouth that does not go away over time, oral cancer can affect the lips, tongue, cheeks, floor of the mouth, hard palate, soft palate, sinuses, and throat. Early detection is key for treating this disease, though most patients are diagnosed in the advanced stages.
  • Leukoplakia: Thickened, white patches on your gums, inside your cheeks, the bottom of your mouth, or your tongue.
  • Lichen planus: A chronic inflammatory condition that affects the mucous membranes inside your mouth. Lichen planus appears as white, lacy patches, open sores, or red, swollen tissues. The lesions are accompanied by burning or other discomfort. This condition needs to be closely monitored so that it does not turn into oral cancer.
  • Mucous membrane pemphigoid: An uncommon autoimmune disease that may cause oral lesions of the gums, mucous membranes, tongue, soft palate, or hard palate.
  • Pregnancy tumors: Raised nodules that may or may not be painful.

Other diseases, such as diabetes, Crohn’s disease, and heart disease, may produce abnormalities inside the mouth.

Types of Oral Biopsies

Depending on the abnormality in your mouth, there are six different ways to perform an oral biopsy:

  • Aspiration: A needle and syringe removes a sample from within the lesion.
  • Brush: Firm pressure is applied on a circular brush while it is rotated to pick up cellular material. The sample is then transferred to a glass slide for observation under a microscope.
  • Excisional: If a lesion appears benign during an oral exam, and is smaller than one centimeter, this type of biopsy removes the entirety of the lesion.
  • Incisonal: For larger lesions, a sample is taken from more than one area.
  • Punch: Using a circular blade attached to a pencil-like handle, the instrument is rotated through the lesion. The biopsy yields a circular bit of tissue that is then sent to the lab for further testing.

Corrective Jaw Surgery

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Orthognathic surgery, also known as corrective jaw surgery, aims to correct abnormalities of the jawbones in order to realign the jaws and teeth to improve overall function. This surgery can also improve the outside appearance of your face.

If you have problems with your jaw that cannot be corrected with orthodontic treatment alone, corrective jaw surgery may be considered. Your braces will be on before surgery and during recovery, until you are completely healed and proper alignment has occurred. To make sure you are getting the most out of your treatment, your orthodontist will work with your surgeon.

Corrective jaw surgery should only be performed when the jaw has completed its growth. This occurs around 14 to 16 years for females and 17 to 21 years for males.

What does corrective jaw surgery improve?

There are many benefits to corrective jaw surgery, including:

  • Improved chewing and biting
  • Correction of swallowing problems
  • Improved speech
  • Reduced wear and tear on teeth
  • Correction of an open bite, where the molars don’t touch the front teeth
  • Repaired facial imbalance, such as small chins, underbites, overbites, and crossbites
  • Improved ability for lips to close completely and comfortably
  • Relief of pain associated with temporomandibular joint (TMJ) disorder or other jaw problems
  • Repaired facial injuries or birth defects
  • Relief for obstructive sleep apnea

Where can jaw surgery be performed?

There are three sections a surgeon can work on:

  • Upper jaw
    • Receded or protruding upper jaw
    • Crossbite
    • Too much or too little of your teeth showing
    • Open bite
    • Facial growth of the middle of the face
  • Lower jaw
    • Receded lower jaw
    • Protruding lower jaw
  • Chin: Surgery of the chin can correct patients with a small chin. Small chins often accompany a severely receded lower jaw, which can cause many of the problems listed above. Typically, the altering of the jaw as well as restructure of the chin can be done in the same surgery.
Cleft Lip and Palate

Cleft Lip and Palate

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A cleft lip and cleft palate are common birth defects that occur in the very early stages of fetal development. A cleft lip is the separation of the two sides of your child’s upper lip, appearing as a narrow or wide opening that can extend to the roof of the mouth. A cleft palate is a split or opening in the roof of your child’s mouth. These abnormalities can occur separately or together, and can vary in severity. Surgery is the only way to repair a cleft lip or cleft palate.

Problems Associated with Cleft Lip and Palate

Cleft lip and palate repair does a lot more for your child than cosmetically correcting their appearance. Surgery helps restore proper function to your child’s lips and mouth. Cleft lips and palates are also associated with health and developmental problems such as hearing loss, dental issues, and speech issues. With cleft lip and palate surgery, your child will be able to eat, drink, breathe, hear, and speak normally as they develop.

Cleft Lip Surgery

Cleft lip surgery is recommended between three and six months of age. Once your baby is under general anesthesia for the procedure, the surgeon will begin by making incisions on either side of the cleft lip to create flaps of skin. These two pieces are drawn together to close the gap of the birth defect and then sewn together with dissolvable stitches. Cleft lip surgery typically takes less than two hours. Your baby will spend the night in the hospital to make sure that they have tolerated surgery well.

Cleft Palate Surgery

Cleft palate surgery is usually performed when your child is around 12 months old. General anesthesia is used again for this type of procedure. Once your child has fallen asleep, the surgeon will make incisions on either side of the palate, loosening layers of tissue so that they can be stretched over the separation. When the tissue is placed where it needs to be, dissolvable stitches will be used to hold everything in place. Cleft palate surgery takes between two and three hours, though longer depending on the type and severity of the cleft palate. A second surgery in the future may be required to fully repair a cleft palate.

Your child will fully recover from cleft lip or palate repair in about four weeks. Due to the complexity of cleft palate surgery, recovery may take a little longer.