A modified toothbrushing technique that reduces risk of cavities

According to a study published in September’10 by the prestigious American Journal of Orthodontics and Dentofacial Orthopedics, the use of a modified brushing technique significantly reduced the incidence of new carious lesions in orthodontic patients when compared to routine oral hygiene instructions with fluoride toothpaste.

The study titled “Modified fluoride toothpaste technique reduces caries in orthodontic patients: A longitudinal, randomized clinical trial” followed 100 orthodontic patients randomly divided into 2 groups. Each patient was examined before starting orthodontic treatment (baseline) and shortly after removal of the appliances in a 2-year study period. The test group patients were instructed to use the modified brushing technique while the control group patients were given routine clinical oral hygiene instructions.

The modified brushing technique that was more effective in preventing caries in orthodontic patients than normal oral hygiene instructions consists of the following steps:

(1) use ¾ of one inch of toothpaste on a wet toothbrush;
(2) spread the toothpaste evenly on both upper and lower teeth;
(3) brush all surfaces of the teeth for 2 minutes;
(4) use a small amount of water, the equivalent of a handful with the dentifrice remaining in the mouth and filter the dentifrice slurry between the teeth by active cheek movements for 30 seconds before expectorating;
(5) avoid further rinsing with water;
(6) avoid drinking or eating for 2 hours;
(7) brush twice a day, after breakfast and at night before going to bed.

Compared with other dental specialists, orthodontists have a great opportunity to emphasize fluoride toothpaste regimens since patients usually visit the clinic every few weeks, giving the orthodontist an excellent opportunity to stress the importance of using fluoride toothpaste and. Although this technique is highly efficient, patients must be aware that slurry rinsing with the toothpaste can cause some oral discomfort and irritation of the oral mucosa. Also, the use of dental floss lessens the risk of dental cavities between the teeth during orthodontic treatment.

In my website you will find a section especially dedicated to how to maintain good and proper oral hygiene during orthodontic treatment, including brushing techniques and how to use dental floss appropriately. http://www.larchmontortho.com/PatientInfo/OralHygiene/tabid/74/Default.aspx

Avoiding cavities during orthodontic treatment

If you thought brushing and flossing were important before you got braces…well, you were right. But people undergoing orthodontic treatment need to be even more dedicated to good oral hygiene.

Braces trap food very easily, which contributes to dental plaque formation. If plaque is not carefully removed from teeth and from around braces, patients run the risk of developing gum disease, dental decay and bad breath."

Plaque is a mixture of bacteria, debris and bits of food. The bacteria feed on sugars and produce acids. The acids can irritate your gums, erode the enamel on your teeth and contribute to bad breath. It's important to remove the plaque thoroughly and often. Then, when your braces come off, the surfaces of your teeth underneath the braces will be healthy and strong and look good.

The very early stages of dental cavities are white, opaque spots on the surface of the teeth. These spots are technically called areas of “enamel demineralization.” They are associated with a rapid process caused by cavity-inducing bacteria that develop around the braces.

Despite improvements in materials and preventive efforts, demineralization can occur around orthodontic appliances as early as only 1 month into treatment. There is a higher risk of demineralization adjacent to brackets at earlier ages, because of the lower resistance of enamel and poorer cooperation by younger patients in the orthodontic treatment process.

Toothbrushing remains the cornerstone of good oral hygiene. Many patients ask me about electric toothbrushes (are they better, is it worth it buying one, etc.). Regardless of brand, I believe an electric toothbrush is an excellent addition to anyone’s set of tools for home dental care.

Today’s electric toothbrushes are both highly effective and reliable. Their efficacy in comparison with that of the manual toothbrush has been evaluated in a large number of clinical studies carried out by academic institutions and contract research companies specializing in dental research. These studies consistently have shown the electric toothbrush to be superior, with results demonstrating greater plaque removal and, as a consequence, more improvement in gingival condition than that achieved with a manual toothbrush alone.

Fluoride toothpaste has been widely used for more than 4 decades and remains a benchmark for the prevention of dental caries. It reduces caries in both permanent and deciduous teeth. For this reason, fluoride toothpaste is important as an effective caries-prevention measure worldwide.

Four factors influence the anticaries efficacy of fluoride toothpaste: 1. frequency of brushing; 2. duration of brushing; 3. fluoride concentration; and 4. postbrushing rinsing. Brushing should be done two or three times daily and patients should be persuaded to brush for no less than 2 minutes each time.

Flossing is an excellent aid to oral hygiene during orthodontic treatment. Dental floss is either a bundle of thin nylon filaments or a plastic (Teflon or polyethylene) ribbon used to remove food and dental plaque from teeth. The floss is gently inserted between the teeth and scraped along the teeth sides, especially close to the gums. Dental floss may be flavored or unflavored, and waxed or unwaxed. Whichever type you choose does not matter. The important thing is to use it at least once daily, preferably before bedtime.

Many people tend to disregard flossing in thinking that brushing is more than enough for their dental care. Brushing but not flossing is like cleaning only 65% of your teeth leaving 35 % dirty. The main role of flossing is to eliminate food particles caught between the teeth. Non-removal of those particles often lead to cavities and other problems. Researchers found that gingival bleeding, gum disease-causing bacteria and halitosis (“bad breath”) were greatly reduced when flossing is done at least once daily.

In my website you will find a section especially dedicated to how to maintain good and proper oral hygiene during orthodontic treatment, including brushing techniques and how to use dental floss appropriately.

Bruxism (Teeth Grinding or Clenching) – part 2 of 2

This is part two of my thoughts concerning tooth grinding. The following entry will focus on treatment of bruxism.

Bruxism is the medical term for the grinding of teeth or the clenching of jaws, especially during deep sleep or while under stress. This affliction occurs in 5% to 20% of adults, and in 30 % of children in the age group of five and six years.

Treating Bruxism
Whether the grinding is caused by misaligned teeth or psychological stress, most kids outgrow it. A combination of parental observation and dental visits can also help keep the problem in check.

In more severe, chronic cases where the grinding and clenching cause facial and jaw soreness and/or damage the teeth, Dr. Martines may prescribe a special night guard. Molded to a child’s teeth, a night guard is similar to the protective mouthpieces worn by football players. Though a mouthpiece may take some getting used to, positive results are often observed.

Helping Your Child
Whether the cause is anatomical or psychological, some kids are be able to reduce dental grinding by relaxing before bedtime. For example: by taking a warm bath or shower, listening to a few minutes of soothing music or reading a book.

For bruxism that is caused by stress, try to find out if there is a specific something that is upsetting your child and find a way to help. For example: a kid who is worried about being away from home for a first camping trip might need reassurance that mom or dad will be nearby if anything happens.

If the issue is more complicated, such as managing a busy school and extra activities schedule, moving to a new town, a new school, making new friends, and especially, discuss your child’s concerns. Try to ease any fears and make changes in his/her daily routine to reduce anxiety. If you’re concerned about your child’s emotional state, talk to your physician or pediatrician.

In some cases, these basic stress relievers may not be enough to stop bruxism. If your child has trouble sleeping or is acting differently than usual, an assessment by a therapist may be beneficial. This can help determine the cause of the stress and an appropriate course of treatment.

How Long Does Bruxism Last?
Childhood bruxism is usually outgrown by early adolescence. Most kids stop grinding when they are done losing their baby teeth. However, a few children do continue to grind into adolescence or until the stress that leads to it is addressed properly.

Preventing Bruxism
Because some dental grinding is a child’s natural reaction to changing teeth and to growth and development, most cases are benign and cannot be prevented. Stress-induced bruxism can be addressed with the basic stress relievers here described and by talking with your children regularly about their feelings and helping them deal with daily-life stress.

Bruxism (Teeth Grinding or Clenching) – part 1 of 2

Bruxism is the medical term for the grinding of teeth or the clenching of jaws especially during deep sleep or while under stress. This affliction occurs in 5% to 20% of adults. Three out of every 10 kids will grind or clench with the highest incidence in children under five. Hyperactive children experience bruxism more frequently.

This is such an interesting and vast topic that I have split it in two parts. In the first part I will concentrate on explaining what bruxism is and what causes it. The next entry will focus on addressing and treating bruxism.

Causes of Bruxism
Though studies have been done, no one knows exactly what causes bruxism. In some cases, kids may grind their teeth because the top and bottom teeth aren’t aligned properly. Others do it as a response to discomfort from an earache or teething, or as a way to ease soreness, just as one might rub a sore muscle. Most kids, however, outgrow these fairly common causes for grinding by the time most or all permanent teeth have erupted.

Stress – usually expressed as nervous tension, constant worry, anxiety and even anger – is another possible cause for grinding the teeth. For instance, your child may be having trouble coping with a busy school and extra activities schedule, worrying about a test at school, or experiencing a change in routine (a new sibling or a new teacher). Even arguing with parents and siblings can cause enough distress to prompt teeth grinding or jaw clenching.

Effects of Bruxism
Generally bruxism does not hurt or harm a child’s teeth. In fact, many cases go undetected with no adverse effects, though some may result in mild morning headaches or earaches. Most often, however, this condition is more bothersome to the parents, caretakers and others in your home because of the grinding sound.

In some extreme circumstances, nighttime grinding and clenching can wear down tooth enamel, chip teeth and cause facial pain and jaw problems, such as temporomandibular joint disease (TMJ). Most kids who grind, however, do not have TMJ problems unless their grinding and clenching is chronic and persistent for many years.

Diagnosing Bruxism
Most children who grind their teeth aren’t even aware of it, so it’s often siblings or parents who identify the problem. Some signs associated with tooth grinding are:
• Grinding noises when your child is sleeping
• Complaints of a sore jaw or face in the morning
• Thumb sucking
• Fingernail biting
• Gnawing on pencils and toys
• Chewing the inside of the cheek

If damage to the teeth is detected, Dr. Martines will ask your child a few questions, such as:
• How do you feel before bed?
• Are you worried about anything at home or school?
• Are you angry with someone?
• What do you do before bed?

In my next blog entry I will write about addressing and treating bruxism, so stay tuned!

Damon Braces

Orthodontic technology is constantly evolving and new forms of treatment are appearing all the time. There are now alternatives to the conventional wire and metal brace which are less noticeable and more comfortable to wear.

One example of orthodontic technology is the Damon braces. The Damon braces are a "friction-free" system which means no metal or elastic ties hold the wires in the braces. Color or metal ties are used in other types of braces which exert a force on the teeth and cause them to move. On the other hand, this also causes friction which can be uncomfortable and make tooth movement progress slowly.

The Damon braces use a clever slide mechanism which holds the archwire in place and allows the teeth to move easily and comfortably. Also, because of the advanced design and the light, biologically sound forces this system applies on the teeth, it allows a gentler correction of bite problems as well as improved facial harmony and smile width.

Other types of braces require adjustments (or tightening) on a regular basis, and that can be painful. The Damon braces have a sliding mechanism which minimizes this problem, meaning less sore teeth and gums.

The color elastic ties used with conventional braces can be a magnet for food debris and are very difficult to clean. Because the Damon braces are free from these ties, it’s easier to keep your teeth clean while in braces.

In my experience with the Damon brackets compared to traditional brackets (with color elastomeric ties) I have observed:
- Improved patient oral hygiene;
- Reduced need to use expanders or remove permanent teeth before or during treatment;
- The fairly unobtrusive nature of the system that for most patients result in a shorter treatment period and more timely alignment of the front teeth;
- More convenience for patients and families due to the possibility of longer intervals between appointments and shorter in-office time for adjustments;
- More comfort during treatment and appointments.

Now you may be wondering that since the Damon System can possibly shorten treatment time, does that mean it is harsh or unsafe? The answer is no. In fact, what makes this system work in a timelier manner for some patients is that it uses far gentler, more biologically sound forces than conventional braces. Very light titanium alloy wires in association with the low-friction nature of these braces gently guide the teeth to their ideal positions and improve the smile and facial harmony.

The Damon brackets are not magic or better than any other bracket system. But they are more efficient, streamlined, comfortable and convenient for both me and my patients, making them superior in my point of view.

For all this, and with the experience I have acquired practicing orthodontics for more than 16 years and teaching at the UCLA Department of Graduate Orthodontics for the last 5 years, I am excited to offer the Damon Braces System in my office.