Author: Adam R. Pershing, DMD

Preventive care is one of the best—and easiest—ways you can maintain your healthy smile for a lifetime. Practicing good oral hygiene helps prevent tooth decay and gum disease. Protecting your teeth helps prevent dental trauma. Seeing your dentist regularly helps you discover any dental issues, and early treatment prevents them from becoming more serious. Best of all, proactive care requires only a few simple practices:

• Brush your teeth at least twice each day. Use a soft-bristled brush to protect your enamel and gums, and replace your brush every three months, or whenever it begins to fray. Use a fluoride toothpaste to reduce your risk of cavities. Don’t forget to brush the top of your tongue to remove plaque and food particles and to keep your breath fresh.
• Floss at least one a day. Flossing helps remove plaque and bacteria from between the teeth and near the gum line where brushes can’t reach. Dentist-recommended mouthwashes can also help remove plaque in those hard-to-reach spots.
• Eat a balanced, tooth-healthy diet. Proteins build bone and help the body repair damaged tissue. Dairy products provide calcium and vitamin D for stronger enamel. Fruits and vegetables contain vitamins and minerals that are essential for overall oral health. Foods that harm tooth enamel should be kept to a minimum, such as sugar-filled treats and acidic sodas and energy drinks.
• Talk to your dentist about dental sealants. During this easy, comfortable procedure, a thin plastic coating is applied to the chewing surfaces of the back teeth, protecting them from bacteria and plaque. Sealants are especially helpful for children, because it can be hard for them to brush the irregular surfaces of the molars thoroughly, but adults can benefit from sealants as well.
• Protect your teeth with custom-fitted appliances. Mouthguards should be used in any activity where contact with someone or something is a possibility. Nightguards protect teeth from the pressures of nightly tooth grinding. Retainers make sure teeth stay aligned while the bone and ligaments around the roots strengthen, stabilizing the teeth and holding them in place.
• Pay attention to your body’s signals. Tooth pain, swollen, red, receding, or bleeding gums, chronic bad breath, a sore that doesn’t go away—any symptom that causes you discomfort or concern should be evaluated promptly by your dentist or physician.
• Schedule regular checkups and cleanings. Most people benefit from a visit to the dentist every six months to make sure their teeth, gums, and mouth are healthy and to remove any accumulated plaque and tartar. Check with your dentist to discover the perfect schedule for your needs, and for other tips to keep your smile healthy and bright for a lifetime.

Due to changes in hormones, pregnant women might be more susceptible to oral health conditions, like gingivitis, tooth decay, and pregnancy tumors.

Pregnancy gingivitis affects nearly 40% of pregnant women and looks like:

• Red and swollen gums
• Sensitivity of gums and teeth
• Bleeding after brushing or flossing

Gingivitis is early-stage gum disease, and without proper care, it can lead to more serious conditions like periodontitis. Periodontitis is a bacterial infection that attacks the tissue and bones supporting the teeth and, though the connection is unclear, is associated with adverse pregnancy outcomes like low birth weight and preterm births. With a little extra care in your oral health routine, you can keep pregnancy gingivitis at bay. Recommendations include:

• Spending more time brushing, focusing on the gum line
• Using an antimicrobial mouthwash after brushing

Pregnant women might also be more susceptible to tooth decay, especially if they suffer from nausea or morning sickness. The acidity of vomit can weaken tooth enamel, so it’s important to rinse your mouth before brushing to make sure the acid is gone. It’s best to wait 30 minutes after rinsing before brushing your teeth, so that acid isn’t pushed further into the teeth and gums.

Another effect of pregnancy hormones on oral health is pregnancy tumors. They affect about five percent of pregnant women and are completely benign, but can cause discomfort. Symptoms include:

• Small, berry-colored lumps at the gum line or between teeth, between .5 and 2.5 centimeters in size
• Sometimes painful

Though these tumors go away on their own, and are not cancerous or harmful, they might be painful and can be removed, typically with a laser or cryosurgery.

Our bodies keep our bones strong by absorbing old bone cells and replacing them with newer and stronger bone material. Osteoporosis is a condition that occurs when we absorb more bone than we replace, resulting in weakened bones. Osteoporosis can affect any part of the body, including the jawbone, and can lead to dental issues like loosening teeth

Osteoporosis medications, like denosumab or bisphosphonates, attempt to bring the reabsorption rate into balance, and can greatly improve bone density and health.

In rare cases and for reasons unknown, these medications can have adverse effects specifically on the jawbone, so it’s important to get a dental exam before starting treatment, especially if you have any existing oral health issues.

Common medications include:

• Alendronate (Fosamax, Binosto)
• Ibandronate (Boniva)
• Risendronate (Actonel, Atelvia)
• Zolendronic acid (Reclast, Zometa)

In most cases, people taking medication for osteoporosis can proceed with dental procedures like implants and extractions after careful examination and evaluation of the jawbone. The presence of osteoporosis might influence the type of implants used, and the amount of healing time needed after the procedure.

One possible side effect of bisphosphonates is something called medication-related osteonecrosis of the jaw (ONJ or MRONJ), which happens when isolated areas of the jawbone lose their vitality and die.

You might have an increased risk to develop MRONJ if you:

• Have been on medication for osteoporosis for over two years
• Have periodontitis or dentures
• Have been receiving high doses of anti-reabsorption agents (usually for cancer or for preventive osteoporosis treatments)

Over 90% of people who suffer from MRONJ receive high doses of the medication intravenously, in most cases to treat cancer. Rarely does this problem occur in people who take the medication orally.

If you are a candidate for a tooth extraction or implant placement, it’s important to speak with your dentist and healthcare professional about the use of osteoporosis medication.

Oral piercings can be found on the tongue, lip, cheek, or other soft tissue around the mouth. It’s important to consider potential complications stemming from oral piercings so that you can maintain your best oral health.

Common problems associated with oral piercings:

• Swelling, bleeding, or infection

Piercings can make it more challenging for infections to go away on their own, and might require antibiotics. Also, open wound infections might discharge pus, creating an unpleasant experience.

• Chipped teeth

Chipped teeth might require veneers or crowns, which can also be damaged from the piercing.

• Cuts and scars in the mouth

The piercing might create lacerations in the mouth that take time to heal and can reoccur.

• Jewelry can get stuck in soft tissue

If a piercing becomes impacted, it sometimes requires surgical removal.

• Hypersalivation

Excess salivation can lead to issues like drooling.

• Palatal erythema

Palatal erythema is an inflammatory condition and is marked by bright red, irritated tissue that occurs due to the accumulation of blood in dilated capillaries.

• Oral lichenoid lesions

These lesions are often an allergic response, and a chronic inflammatory condition affecting the mucous membrane lining of the cheeks, lips, and tongue. It is considered a precancerous condition.

• Keloid formation

Keloids are a thick, raised scar.

If you have or are considering an oral piercing, it’s important to be aware of these potential issues and schedule regular cleanings to maintain your best oral health.

Fluoride is a naturally occurring mineral that strengthens tooth enamel and helps prevent tooth decay. We can get these benefits from fluoridated drinking water and by using over-the-counter fluoride toothpastes and rinses. For superior protection against cavities, your dentist might recommend a professional fluoride treatment.

How does fluoride work?

The enamel in our teeth is largely composed of calcium and phosphate ions. These elements combine to form hydroxyapatite, mineral crystals, which makes tooth enamel the strongest substance in the body. But enamel isn’t indestructible. The oral bacteria in plaque create acids that strip away calcium and phosphate minerals, a process called demineralization. Demineralization leaves the tooth surface weaker and more vulnerable to decay.

Fluoride helps remineralize tooth enamel. Fluoride works on the surface of the tooth to attract calcium and phosphate ions found in saliva, rebuilding tooth structure and reversing early decay. Even better, it joins with these ions to create fluorapatite. Fluorapatite crystals are larger, stronger, and more resistant to acids than hydroxyapatite. Fluoride not only remineralizes teeth, it leaves them stronger than they were originally.

Finally, studies have shown that fluoride inhibits both the growth of cavity-causing bacteria and their ability to produce acids.

Systemic and Topical Fluoride

Fluoride works internally and externally. Systemic benefits come the fluoride we consume in our diets, and topical benefits come from applying fluoride directly to the tooth surface.

Fluoride in drinking water has been shown to reduce the risk of childhood cavities by 25% or more. Fluoride bonds with the minerals in a child’s developing teeth, creating stronger, more cavity-resistant enamel even before the permanent teeth erupt.

Topical fluoride can be found in over the counter toothpastes and mouthwashes. Fluoridated drinking water strengthens the natural cavity-preventing properties of saliva. For the most effective topical fluoride protection, your dentist can provide a professional fluoride treatment.

Fluoride Treatments Are an Easy Addition to Regular Checkups

Fluoride treatments aren’t difficult or time-consuming. Fluoride can be administered as a gel, a varnish, a rinse, or a foam. It can be applied with a swab, brush, as a mouthwash, or in a tray. Aftercare generally only requires avoiding food and drink for 30 minutes.

And while fluoride treatments are especially important for children, adults can benefit as well. Dexterity issues which make brushing difficult, receding gums which expose parts of the roots, and conditions like dry mouth can leave the teeth more vulnerable to cavities as we age.

Professional fluoride protection lasts for months, and the treatment can be repeated as needed every three to 12 months.

Fluoride treatments strengthen teeth, help prevent tooth decay, and are easy to schedule with your regular checkups. Talk to your dentist to discover how fluoride treatments can benefit you and your family.