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Winter Park Dentistry- Oral Hygiene Guide

Dr. Ramzi Matar:

Hello. Today we are talking about oral hygiene. We recently talked about dental decay, and of course, oral hygiene kind of curtails right into that. The main objectives of oral hygiene, when it comes to dentistry let’s say, of course, is lowering plaque and tartar. Removing it as best we can, which then lowers gingivitis and gum disease and of course potential for cavities. I will say, being a practicing dentist, it’s always incredible to me to realize that there is such a variant of risk profile, this is something that one of my mentors, Dr. John C. taught me, and it’s so true. Not everybody’s built the same, not everybody has to brush the same. People have different risk profiles. High risk, moderate risk, it’s very patient specific. I have patients that I don’t even think they know which end of the tooth brush to put in their mouth, and they never have cavities, never have tartar, never have plaque, they come in probably because their husband or wife makes them come in, and they’ve never had a cavity and they just simply don’t have much dental need. I will tell you a funny story that hopefully my hygienist or her husband doesn’t get mad at me, but one of my hygienists, I’ve never seen her husband, he never gets his teeth cleaned, and his wife is a dental hygienist, that’s what she does all day long. She could clean his teeth for free, it’s not a financial issue, and I think she just said that he doesn’t get cavities, he doesn’t have problems, so he got lucky. I’ve seen this, and vice versa I’ve seen patients that, boy, they can’t brush or floss enough, they have gum disease, they have cavities, or both, one or the other usually. These people are trying really, really hard, and they’re coming in every three months, and they’re using the fluoride, and everything we can throw at them, and we just can’t seem to keep up. But we do our best.

Let’s get into some of the ways that we try to improve oral hygiene. We mentioned a lot of these in the dental decay podcast. We try to break up the bacteria, that’s going to be your flossing and brushing mainly. When it comes to brushing, the question about electric versus manual… Some of the advantages that electric toothbrushes have, I tell my patients, is that there’s nothing different with the bristle itself. They have timers, some of them move for you, and they tell you how long you should be brushing for. They kind of automate the system. The Sonicare is the most common one that has the sonic vibrations that claims to break up the plaque and tartar. I can’t say that I know that to be true, although I wll tell you that my patients who use Sonicares love them and they just tell me “oh man, my mouth feels so clean”. Usually when people get a good electric toothbrush, like a Sonicare or an Oral B, they almost never turn back. They’re usually sold because they love the way it makes their mouth feel. I’ve used both Oral B and Sonicare. I can’t say that I’ve noticed a huge difference, they’re both great, and definitely when I use those, I tend to brush longer, I don’t have to worry about getting everywhere because the Sonicare does some of the movement for me, so it takes some of the legwork out, and that’s where basically electric toothbrushes are superior to manual toothbrushes, because of the bells and whistles. But I have people that use manual toothbrushes very effectively and that’s more than enough for most.

We can try to kill these bacteria. We have essential oils, like in Listerine, that’s shown to lower gingivitis by killing some of the bacteria with the essential oils, that’s what burns. We also have Triclosen, that’s been the news lately. That’s been in the news recently because it’s the active ingredient in Colgate Total, it has triclosen, and triclosen does in fact help with gingivitis, so with patients that are at risk with gum disease, I do use Colgate Total. I kind of go back and forth, because you’ll get these studies that say Triclosen causes all these problems, and so for a while I was avoiding it, but for that specific knit of patients, I still think the benefits might outweigh the cons. We have stannous fluoride. We also have chlorhexidine that can kill bacteria very well. The problem with chlorhexidine is that it can stay in your teeth, so you can’t be on it for very long.

Another interesting aspect of improving oral hygiene is trying to prevent the bacteria from attaching to the tooth. It basically makes the tooth very slippery, if you will. This is kind of new, I don’t use these products, although the research is very interesting. We have one called Perioshield. The other one that I read about that seems very interesting is called Livionex. You can Google it. It’s an activated edathamil. It seems to make the tooth slippery, and it makes it so the bacteria don’t attach to the tooth, that’s my understanding of the mechanism. Pretty interesting stuff. Then we also have selective beneficial bacteria. That’s going to be the probiotics. EvoraPlus is another one, made by Oragenics, this is going to be trying to populate your mouth with good bacteria, to overpopulate so that the bad bacteria get sort of run out of the field, if you will. Then we have other ways of trying to alter the immune response. Basically we have a low-dose antibiotic, called Doxyciclin, that is given to help reduce the inflammation. Just to be clear, this is such a low-dose that it does not work as an antibiotic. It is an antibiotic, but it’s at a low-dose, where it just helps reducing the inflammation. So these are some of the ways we have in dentistry to help people with oral hygiene, reducing plaque, gingivitis, gum disease, et cetera. Thank you.