Oral Health & Hygiene

What Happens to Extracted Teeth?
What Happens to Teeth After They're Extracted? | © iStockPhoto.com/Chalabala

Have you ever wondered what happens to your tooth after it is extracted by your dentist?  Surprisingly, it’s not so cut-and-dry.

When a tooth is removed, there’s not really one specific place it goes.  Some methods of disposal cost the dentist money, others result in a small profit for the dentist, and others are just a little weird.

Read on to find out what happens to extracted teeth.

Eight Journeys Your Extracted Tooth May Take

After a tooth is extracted, the dentist will usually place it on the tray next to the dental chair.  While a lot of people may think that an extracted tooth has hit the end of the road; its journey has just begun.

Extracted Teeth Heaven
All Teeth Don’t Go to Heaven | © Kninwong/Shutterstock.com

Here’s eight different journeys that your tooth may take after it leaves your mouth.

1 – Incinerated with Biomedical Waste

According to the OSHA Bloodborne Pathogen Standard, extracted teeth should be placed in a hazardous waste container.  After that, the teeth are normally picked up by a medical waste management company that takes them and then incinerates them with other biomedical waste.

Normally, teeth that do not have any metal from prior dental work go to an oven to be incinerated.  If the tooth has metal, it will likely follow one of the next two routes of disposal.

2 – Go to a Metal Recycling Center

If the extracted tooth has amalgam filling material in it, then incineration causes mercury to be released into the atmosphere.  Because of this, regulations normally do not permit the incineration of extracted teeth containing amalgam, and they must be sent to a specialized recycling center that can remove the amalgam before disposing of the teeth.

Find out what’s in an amalgam filling.

3 – Go to a Dental Scrap Metal Dealer

The dental scrap metal industry is not well-known.  If your tooth had a lab-made restoration on it, your dentist may very well save it and ship it off to a scrap metal dealer who will melt down the metal, assay it, and cut your dentist a check.

Extracted Teeth Stripped of Scrap Metal
Dental Scrap Metal Refining | © Photo Fun/Shutterstock.com

A simple Google search for “dental scrap metal refiner” or a quick browse through professional dental journals will reveal many advertisements for companies that make their money from buying metal that used to be in someone’s mouth.

This Sun-Sentinel article tells the story of Michael Kutschmende, a man with cerebral palsy who had four gold teeth extracted at the dental office.  His dentist refused to give them back.  This article exposes the world of dental scrap metal recycling and how dentists can profit from extracted teeth.

Below is an interesting video from the company Crown Men that details the process of getting valuable metal from restorations on extracted teeth.  If you head over to their website, you can read testimonials from dentists who have received a free iPod Touch along with a check after their first time using the service.

 4 – Kept by the Patient

Although some dentists believe otherwise, there are no regulations prohibiting a dentist from giving patients back their teeth following extractions.  The American Dental Association, the Centers for Disease Control and Prevention (CDC), and the Occupational Safety and Health Administration (OSHA) all give this practice a green light.  However, many dentists do not return extracted teeth to patients and it remains a controversial subject.

To learn more about this controversy and to find out what some patients do with their extracted teeth, read the post Can You Keep Your Extracted Teeth?

5 – Used for Educational Purposes

Some teeth end up being donated to universities. Many dentists save extracted teeth so that they can be donated to a university and used by dental students for their learning.

In the summer between earning my business degree and going to dental school, I dropped off several empty jars at local oral surgeons’ offices.  They kindly filled them with extracted teeth that I used in learning how to work on human teeth.

While in dental school I wrote a post about how a chipped tooth can be fixed with a filling. I used an extracted tooth for that project!

Extracted teeth aren’t just used by dental students to further their learning. Dentists use them as well for continuing education; some continuing education courses require that a dentist bring extracted teeth to the course so they can practice on them. I went to a thrilling course on how to do better root canals and took a few extracted teeth in order to practice the new techniques that were taught.

6 – Used for Research Purposes

Dental companies are always performing research to determine the best way to bond fillings and crowns to teeth, how to make teeth more resistant to cavities, how teeth react to different forces, and many other things.  When figuring out how to improve their tooth-related product, real teeth work best.

7 – Get Sold to the Highest Bidder

This is probably the least likely path that an extracted tooth takes.  It requires that the patient be famous.

Bill Dorfman Extracted Teeth Celebrities
Dr. Bill Dorfman | © Kathclick/Bigstock.com

Dr. Bill Dorfman, the dentist that was on the TV show Extreme Makeover, has bragged to TMZ that he saves his famous patients’ teeth when he pulls them.

He states, “There have been a few really famous people and I thought one day maybe I could sell this on eBay.”  In a later interview with TMZ, Dr. Dorfman backtracked this claim…

He may be able to get a pretty good price on eBay for a celebrity’s tooth, but it seems likely a lawsuit would follow in order to determine who is rightfully entitled to the cash.

Back in 2011, an interesting piece of Beatles memorabilia went on the auction block.  John Lennon’s tooth was acquired by Canadian dentist Dr. Michael Zuk, who said he was obsessed with it.  He ended up paying over $30,000 for it; a sum that makes the tooth fairy want to bury her head in shame.

John Lennon's Extracted Tooth
John Lennon’s Extracted Tooth Is Worth Over $30,000 | © Netherlands National Archive

In one article, Dr. Michael Zuk said that he plans on taking the tooth on tour, to be shown off at dental schools worldwide.  He also alluded to the fact that we may be able to someday clone John Lennon, since the nerve on the inside of the tooth contains John Lennon’s DNA.

Who knows, maybe Taylor Swift’s wisdom teeth are hidden away in somebody’s attic awaiting the auction house at some future date!

8 – Become Trophies for the Dentist

Painless Parker was a dentist who practiced around 100 years ago.  He once pulled 357 teeth in one day and then had them strung as a necklace that he wore around his neck.  He also had a bucket of teeth he’d extracted that he brought with him when he lectured on dental hygiene.  That bucket of teeth can be seen today at Temple University’s dental history museum.

Although this likely wouldn’t happen today in the United States, there are dentists in other countries who still show off the teeth that they have removed.  Below is a street dentist in Morocco, showing off the teeth he’s pulled, and the dentures that he’s ready to put in his next patient’s mouth.

Extracted Teeth Visible On Moroccan Street Dentist's Table
Extracted Teeth Visible on a Street Dentist’s Table in Morocco | © Philip Lange/Shutterstock.com


As you can see, there most assuredly is life after death for your pearly whites.  There are many paths a tooth can take out of the dental office.

Do you have any questions or comments regarding the wild world of extracted teeth?  Did I miss anything? I’d love to hear what you have to say in the comments section below. Thanks for reading!

Keeping Extracted Teeth at the Dentist
Yes, You Can Keep Your Extracted Tooth from the Dentist | © R. Classen/Shutterstock.com

When I was in dental school, it was “against the rules” to give patients back their extracted teeth.  I never really questioned this rule because I figured that not many people would really want their teeth back.  When a patient would ask for their freshly extracted tooth, I would make up some excuse about how it was against regulations for me to give them their extracted tooth.

I remember a female oral surgeon let me bend the rules once with a teenager who begged for his extracted teeth, but she told me to keep it on the down-low.

So that’s what I learned in dental school and thought was gospel: Patients are not allowed to get their extracted teeth back.

There are many dentists that refuse to give patients their teeth after removal. I know of one that even gives kids a “Tooth Fairy I.O.U.” coupon in lieu of their extracted tooth and tells them to simply put that under their pillow and that the Tooth Fairy will understand.

But is it really necessary to go that far and be a Tooth Fairy Scrooge when it comes to giving patients their extracted teeth?

Let’s find out.

Can You Keep Your Extracted Teeth?

Yes, you can keep your extracted tooth. There are no federal laws or regulations that prohibit, let alone discourage, dentists from giving patients their extracted teeth.

Let’s take a look at some of the excuses dentists use to justify keeping extracted teeth that a patient requests to keep:

  • “It’s infectious waste and could infect other people if I let you take it.  I can’t be held liable for that.”
  • “OSHA prohibits me from giving you back your extracted tooth.”
  • “It’s against the CDC regulations for me to give it back.”

Below, I’ll discuss what the Occupational Safety and Health Administration (OSHA), and the Centers for Disease Control and Prevention (CDC) say about giving extracted teeth to patients.

Give Extracted Tooth Back to Patient
An Extracted Tooth that the Patient Wants Back | © Milo Sljubicic/Shutterstock.com

What the Experts Say About Giving Extracted Teeth to Patients

According to OSHA’s Bloodborne Pathogen Standard, extracted teeth are considered potentially infectious materials and must be handled accordingly.  When a dental office disposes of extracted teeth, they must be placed in medical waste containers.  However, since OSHA only regulates employee interactions, not patient interactions, OSHA has no say in whether a patient can keep their extracted tooth as stated by the textbook, Cottone’s Practical Infection Control in Dentistry:

Extracted teeth can be returned to patients on request, at which time provisions of the federal OSHA standard no longer apply.  Again, some state and local regulations may be more stringent, so it is best to be knowledgeable about applicable regulations in your local area.

In her book, Recommended Infection-Control Practices for Dentistry, (yep – it’s one of those books that you just can’t put down!) Barbara Gooch states the following:

The handling of extracted teeth used in dental educational settings differs from giving patients their own extracted teeth.  Several states allow patients to keep such teeth, because these teeth are not considered to be regulated (pathologic waste) or because the removed body part (tooth) becomes the property of the patient and does not enter the waste system.

The CDC has stated that “Extracted teeth may be returned to the patients upon request and are not subject to the provisions of the OSHA Bloodborne Pathogens Standard.”

So now that we’ve addressed what the CDC and OSHA have to say about extracted teeth, let’s address the other excuse that dentists sometimes use: that the tooth is infectious waste and could pose an infection risk if they carry it out of the office.

Now obviously a tooth that has just been extracted does have some blood and saliva on it.  However, it doesn’t require much time to quickly disinfect a tooth and rinse it off.  Dentists already have protocols in place for disinfecting extracted teeth that need to be sent to dental labs. The CDC, when discussing sending extracted teeth to dental labs, states that:

[Extracted teeth] should be thoroughly cleaned (i.e., blood and bioburden removed), disinfected with an EPA-registered hospital disinfectant with a tuberculocidal claim, and thoroughly rinsed before being handled in the in-office laboratory or sent to an off-site laboratory.

Clearly this is a different scenario since we are talking about teeth being sent home with patients rather than being sent to dental labs.  But I believe that if an office is disinfecting teeth before giving them back to patients, then it is highly unlikely that the teeth pose a greater infection risk than the person that the tooth came from, should they have a disease.

Now that we’ve established that there are no nationwide bans on dentists giving patients their extracted teeth, and that disinfected teeth are highly unlikely to cause infection, let’s explore state regulations.

Do State Dental Boards Allow Dentists to Give Patients Their Extracted Teeth?

I called the dental boards of the four most populous states in the United States as well as the dental board of Virginia, since that’s where I practice.  These five states comprise over 35% of the population of the United States so it’s somewhat representative.

Here’s what the state dental boards had to say:


Unfortunately, California did not return my phone call. I left them a voicemail asking if they had any state regulations that would prevent a dentist from giving their patient a recently-extracted tooth.

Fortunately, I was able to spend some time digging through the laws, rules, and regulations governing the practice of dentistry in California and I am confident that they do not have any laws that would forbid a patient from taking their extracted tooth home.


The dental board in Texas had to research my question and then get back to me.  When they did, they told me that as long as the tooth was sterile, it could be given back to the patient.  I then clarified whether the tooth had to be sterile or just cleaned off, since sterilization would be time-consuming. They then told me that as long as I cleaned it off well, it would be fine to give it back to the patient.

New York

When I called the state dental board of New York, the man I spoke with told me that I could only give baby teeth back to patients but that it’s not allowed to give adult teeth back to patients.  I then threw him a curveball and asked about an adult tooth that had a gold crown on it that the patient really wanted back.  He relented and said it would be fine as long as it was clean.  When I asked him if New York had any written rules regarding this sort of situation, he said there were none.


Florida wins the gold medal for clarity, as they were the only state that actually covers this scenario in their state’s rules and regulations.  The following is from their regulations, 64B5-25.007 Disposition of Biohazardous Waste.

(2) Extracted teeth may be rendered non-biohazardous by disinfection so that they may be returned to the patient or the patient’s legal guardian.


The kind lady that answered the phone at the Virginia Dental Board told me that my home state of Virginia does not have any rule or regulation that would keep a dentist from giving their patient an extracted tooth.

There Likely Are No Laws Preventing Patients from Keeping Their Extracted Teeth

It would be nearly impossible for me to search out every state and local regulation regarding extracted teeth, but I find it highly unlikely that a state or municipality would actually have a rule preventing dentists from giving people their extracted teeth.

I’ve pulled out lots of wiggly teeth for kids at no charge and I can’t imagine telling them that if I pull it out, their tooth is infectious waste, but if they pull it out at home, they can put it under their pillow.

Next let’s take a look at what on earth would compel someone to keep their extracted tooth…this is where things get interesting!

Why Would Someone Want to Keep Their Extracted Tooth?

I’ve extracted hundreds of teeth, but here’s one that stands out:  We had just finished taking out a woman’s remaining teeth; about a dozen or so.  She glared with hateful eyes at the dental tray and growled, “Where’s that brown one?!  I’m taking that little $#@%&! with me.  It’s given me a lot of trouble in my life.”

I smiled underneath my mask and told her she could have it.  I pictured her taking the tooth to her backyard, hanging it from a tree and firing a round at it, blowing it to pieces.

Throughout my dental career, I’ve also heard several other reasons from people who want to keep their teeth:

  • One patient was making a necklace of all her extracted teeth.
  • An elderly lady wanted to show her grandchildren her tooth so that they wouldn’t repeat her oral hygiene mistakes.  I admire her motivation, but hate to imagine the horrific look on that little grandchild’s face when he sees Granny’s rotten tooth!
  • There are quite a few 20-something guys that simply want to show their teeth off to their friends.
  • A gentleman from a foreign country wanted to take his tooth back to his native land and have it buried there.
  • Many people believe that all parts of their body should be buried for religious purposes.  There is quite a debate on Mi Yodela, a question and answer site about Judaism regarding the burial of body parts before and after death.  I also came across a site on Islam burial practices which recommends that “teeth cut off or extracted during lifetime are also buried.”  As I’m not a member of either of those faiths, I cannot vouch for these sites, but it does add an interesting dynamic to this debate.
  • Many people keep a collection of their teeth. While this may be cute for baby teeth (I think my mom still has a 35mm film canister of my baby teeth somewhere), it’s not so cute for ugly, decayed adult teeth that needed to be pulled!
Extracted Teeth Collection
Do You Really Need a Collection of Your Extracted Teeth? | © Korkusung/Shutterstock.com

For whatever reason, many people hang on to their extracted teeth.  According to users on this Ask forum, some people have kept their extracted teeth until they die, when the teeth have been sold at estate sales.  One woman recounted the story of her dad keeping his extracted molars: “My dad has all of his extracted molars in with the tooth washers in his nuts and bolts organizer.”

What to Do When Your Dentist Won’t Give You Your Extracted Tooth

Some dentists may know that they are permitted to give patients their extracted tooth but still have the attitude of, “If you really wanted to keep this tooth, you should’ve taken better care of it, then you could’ve kept it — in your mouth.”

There are many cases reported by the media where patients have been upset that their dentist wouldn’t give them back their teeth.  Here are a couple of those cases for your reading pleasure.

My favorite story has to be of a man who was so upset that his dentist wouldn’t give him back his extracted tooth, that he wrote to his elected representative, North Dakota Senator Kent Conrad.  Senator Conrad wrote to OSHA on behalf of his constituent and OSHA replied that there is nothing in the bloodborne pathogen standard that would prevent a dentist from giving a patient back their teeth.

An Arizona woman, Becky Coty, had a tooth extracted with a gold crown and the dentist would not return it to her.  After she contacted the local news channel, which published her story, the dentist reached out and compensated her for the tooth.

Unfortunately, there’s probably not much you can do (aside from trying to get some publicity) if your dentist doesn’t want to give you back your extracted tooth after it’s been taken out.

How to Keep Your Extracted Teeth

If you know that you want to keep your extracted teeth, it’s best to discuss this with your dentist in advance.  Although there aren’t any laws prohibiting dentists from giving back teeth, I’m not aware of any laws that require dentists to give patients their extracted teeth upon request.  It’s more of a gray area.

How to Keep Your Extracted Tooth
How to Keep Your Extracted Tooth | © leaf/Bigstock.com

I recommend letting your dentist know ahead of time that you want to keep your tooth.  That way the issue can be resolved beforehand.  If your dentist resists the idea, you can always check around and you’ll likely be able find a dentist who will let you keep your extracted tooth.

My guess is that most dentists simply default to what they learned in dental school, which seems to vary.  Unlike my school, New York’s Stony Brook School of Dental Medicine states in their Policies & Procedures Manual, “Return of extracted teeth to the patient is allowed, if the patient requests.”

Do you have any questions about extracted teeth and who they belong to?  Any crazy stories about what people have done with their extracted teeth? I’d love to hear about them in the comments section below.  Thanks for reading!

Dentists and Halloween Candy
©Monkey Business Images/Shutterstock.com

While watching baseball’s American League Championship Series last week, I saw a commercial for Verizon that shows a family out trick-or-treating.

Upon looking at his cell phone, the son says, “Wait guys, we’ve gotta stay away from 32 Elm Street. he’s a dentist… He’s givin’ out floss!”

The dad responds with one word that sums up this crazy behavior: “Weirdo!”

You can view the commercial below, then scroll down to find out why I will continue to give out Halloween candy to trick-or-treaters who knock on my door.

Three Reasons Why Dentists Shouldn’t Give Out Floss for Halloween

Here’s three reasons why dentists shouldn’t be giving out toothbrushes, floss, and other oral hygiene paraphernalia to unsuspecting trick-or-treaters on Halloween.

1 – An Occasional Treat Is Good

Halloween is just once per year.  It’s not like kids are out collecting mass quantities of candy every day!  While it’s true that regularly eating candy and other sugary foods will take its toll on your teeth, the occasional splurge won’t ruin your teeth.  If you are a parent, just remind your kids to brush, floss, and rinse when they are done enjoying their loot.

One of the four things cavities need to grow is time.  If you only occasionally splurge on candy, your chances of getting a cavity from consuming it are slim.

2 – Teeth Are for Chewing

You have teeth to enjoy them.  Having teeth and not enjoying the occasional treat is like having a nice car that never leaves the garage.

Hopefully you are making a consistent effort to take care of your teeth so that they can last you for years to come — so reward yourself now and then!

Read Can Kids Eat Halloween Candy and Have Healthy Teeth? to learn how to have healthy teeth while enjoying Halloween treats.

3 – The Purpose of Halloween Isn’t to Change Behavior

There’s a time and place for everything. Is a child really going to start flossing after they receive floss in their bag of Halloween candy?  They probably won’t change their habits overnight from that simple gesture.  Finding floss among their treats might even lessen their enjoyment of the rest of their candy because it will make them feel guilty for eating so much sugar.

People have their reasons for doing what they do, and there are more appropriate ways — and times — to teach people the importance of oral hygiene.

Enjoy Your Halloween Candy

I’m sure there are plenty of dentists that will be busy handing out floss this Halloween.   Maybe they have noble intentions, but unless they’re careful they could be labeled Halloween’s version of Scrooge.

Me?  I’ll be busy giving out miles of Fruit by the Foot.

Sinus Infection Can Cause Tooth Pain

A couple of years ago, I wrote a post discussing sinus infections, prompted by my wife’s experience.  She had severe tooth pain caused by a sinus infection.  While that post discusses how a sinus infection can cause tooth pain, it never addressed the opposite question: Can a tooth cause a sinus infection?

Sinuses are simply chambers in your head that allow air to circulate to get warm and moist before it travels down to  your lungs.  Normally, the body is able to keep the sinuses clean and healthy, despite the dark, moist environment that bacteria love.

However, when conditions are right, bacteria can grow out of control in the sinuses, causing a sinus infection.  One cause of sinus infections is the common cold.  Interestingly enough, teeth can also cause sinus infections.

Before we get into a discussion on how teeth can cause sinus infections, we’ll talk about where the sinuses are located.

Where Are Sinuses Located?

There are a few different sinuses located in the facial area — around the cheeks, nose, and above the eyes.   The diagram below gives you a little better idea of where the sinuses are, and how they look when they are healthy, versus how they look when they are infected.

How Sinusitis Can Cause a Toothache

If you look at the diagram above and imagine a row of upper teeth, you can see how the roots of the upper teeth come into close contact with those sinuses on each side of the nose.   These sinuses are known as the maxillary sinuses.  While there are several sets of sinuses, the maxillary sinuses are the only sinuses that can also be infected by a tooth-related problem.

How Often Do Teeth Cause Sinus Infections?

Hupp’s Contemporary Oral and Maxillofacial Surgery textbook states, “Periapical or periodontal infections of maxillary posterior teeth may erode superiorly through the floor of the maxillary sinus.  Approximately 20% of cases of maxillary sinusitis are odontogenic.”

Basically, that’s a fancy way of saying that tooth and gum abscesses of the upper back teeth can eat through the bone and invade the maxillary sinus.  It further says that about 20% of all maxillary sinus infections are caused by tooth infections, rather than another cause.

Below, you’ll find a couple of examples of how tooth infections or abscesses can cause sinus infections.

A Case of an Abscess Close to the Sinuses

Here is an x-ray of a tooth that had a root canal and crown done previously, but the infection at the roots had never quite healed.  I have outlined some of the important structures below for those of you who are not accustomed to reading x-rays.

Abscess Near Sinus in a Molar

I colored the sinus blue and the tooth infection red in the x-ray below:

As you can imagine, the infection and the sinuses do overlap, as you can see in the x-ray below.

Abscess Near Sinus in a Molar Abscess and Sinus Outlined

Although it looks like the sinus and the infection are overlapped on the x-ray, it doesn’t necessarily mean that the infection has broken into the sinus and causing a sinus infection.  It could be that the abscess is either in front of or behind the sinus in this x-ray, because the x-ray is simply a snapshot of the whole area and doesn’t tell us if things are closer to the front or the back.

If you take a look at the x-ray above, you can see how close the maxillary sinus is to the upper teeth.  Sometimes there is only a thin membrane separating the roots of the upper teeth and the sinus, making it very easy for an infection to travel into the sinuses.

Although this person wasn’t exhibiting any symptoms of a sinus infection, but the x-rays do a good job of showing just how close the abscess is to the sinus.

A Case of Sinusitis Caused by a Tooth

This person had chronic sinusitis for the last few years, that started shortly after she had a metal post put into one of her upper back teeth.  Upon looking at her x-rays I noticed that the metal post that was put in one of her upper teeth looked like it had pierced through edge of the tooth and gone slightly into the bone.  This caused an abscess that was leaking into her sinus.

Here’s the x-ray of her upper right teeth:

Sinus Infection Caused by a Tooth Abscess

To make the x-ray below easier to see, the tooth is green, the infection is red, and the sinuses are blue:

Sinus Infection Caused by a Tooth Abscess with Abscess, Tooth, and Sinuses Outlined

Sadly, due to the fracture in the tooth caused by the large metal post, the tooth had to be extracted.

The oral surgeon who extracted the tooth told me that the tip of the tooth broke off just above the metal post, causing the root fragment to get pushed into the sinuses during extraction.  He had to open up the sinus to retrieve the root and he was able to suction out a lot of the infection — he said it was a pretty bad infection.

Teeth Can Cause Sinus Infections

While sinus infections can cause teeth to to hurt, hopefully this post has helped you see that infections from the upper back teeth can easily make their way into the sinuses and cause sinus infections.

It is important to remember that unhealthy teeth are just one cause of sinus infections, and that there are several other causes.  If you suspect your sinus infection is caused by a tooth, you should see your dentist to confirm this.

Do you have any questions, concerns, or comments?   Feel free to leave a comment in the comments section below.  Thanks for reading!

Top Image © Lightspring/Shutterstock.com
Sinusitis Diagram © Alila Medical Media/Shutterstock.com
All Other Images © OralAnswers.com

Dental Anesthetic Epinephrine
©Diego Cervo/Shutterstock.com

When you get a dental injection, your body wonders why on earth you’re allowing a sharp metal object to penetrate your gums!  It quickly tries to repair the damage by increasing blood flow to the area so it can carry away the anesthetic, which it views as a foreign substance. As you might have guessed, if your body’s protective response tries to get rid of all of the anesthetic, it’s not going to last very long.

Dental Anesthetic Epinephrine

This was a big problem with anesthetics back over 100 years ago.  Then, something exciting (to dentists anyway) happened!  A guy named Abel discovered adrenalin (a more common name for epinephrine) in 1897.   In 1903 Braun suggested using adrenalin as a “chemical tourniquet” to make anesthetics last for a longer period of time.

This Braun fellow recommended using epinephrine at the very small concentration of 1 part to 10,000.  That may seem weak, but we’ve found that even diluting it to 1 part to 200,000 still retains the beneficial effects of epinephrine while minimizing the side effects.

Epinephrine is what is known as a vasoconstrictor, which is just a fancy word for something that causes your blood vessels to constrict, or get smaller.

Why Dental Anesthetic Has Epinephrine

It is this vasoconstrictor effect of epinephrine that makes it so useful in dental anesthetic.  By constricting your blood vessels, it benefits you and your dentist in the following three ways.

1 – The anesthetic gets absorbed more slowly into your body because blood flow to the injection site is decreased.  Since blood levels of the local anesthetic are decreased, the risk of having an “overdose” of the dental anesthetic is minimized.

2 – Since there is less blood flow, the dental anesthetic stays put right around the nerve for a much longer time, allowing it to work for a longer period of time than it would without epinephrine.  This means that you stay comfortable throughout the entire procedure.  It also means that you might be numb for a few hours after leaving the dentist – a sometimes unwanted and embarrassing side effect!

3 – Minimizes bleeding where the anesthetic was administered.  This is great if the dentist is performing a more involved surgical procedure involving the gum tissue since it makes it much easier to see what we’re doing if there’s hardly any bleeding.

Epinephrine is the most common vasoconstrictor used in dental anesthetic in the United States.  In Europe, a vasoconstrictor called levonordefrine is commonly used.

If you prefer to not have these beneficial effects of epinephrine or if you have had heart problems, your dentist may elect to use a dental anesthetic without epinephrine. If that’s your preference and you want to seem like you know what you’re talking about, just ask your dentist for Carbocaine without epinephrine. That’s the most common brand name of dental anesthetic without any epinephrine.

If you have any questions about dental anesthetic and epinephrine, feel free to leave a comment below.  Thanks for reading!

Dental Anesthetic Makes Your Heart Beat Faster
©Ermolaev Alexander/Shutterstock.com

Back when I was in dental school, the instructors told us to always pull back on the anesthetic syringe before injecting. By doing this, we would make sure that we weren’t injecting the anesthetic into a blood vessel, which would cause the epinephrine in the anesthetic to make the patient’s heart feel like it was beating out of their chest.

They called this the epinephrine reaction, and I blindly believed it. I even wrote a post about why dental anesthetic makes your heart beat faster. Until one day, this belief was questioned by a comment on that article (which actually caused Gavin to post a rather entertaining comment).  I realized that I’d blindly believed what I’d been taught without doing any research of my own.

In this follow-up article, I’ll answer the question: Can dental anesthetic really make your heart beat faster?

People Report That Dental Anesthetic Makes Your Heart Beat Faster

A few weeks ago, a woman told me that she hates getting injections because it makes her heart beat really fast.  I asked her if a dentist had ever offered her the anesthetic brand Carbocaine (a type of dental anesthetic without any added epinephrine).  She told me that she’d never heard of it.  I tried it on her and she told me that it was the first injection she could remember where she didn’t feel like her heart was beating out of her chest.

Naturally, this (along with other similar experiences) made me a believer that regular dental anesthetic with epinephrine can indeed make your heart beat faster.  As a dentist I realize that stories, while fun and exciting, may not be a very good source of evidence, so I decided to do some more in-depth research.

Can Dental Anesthetic Really Make Your Heart Beat Faster?

The main question here is whether or not the small amount of epinephrine inside the dental anesthetic makes your heart beat faster or if it’s simply caused by the epinephrine your body releases in response to being afraid of the crazy dentist that’s about to poke you.

Many years ago, it was thought that the tiny amount of epinephrine in the dental anesthetic made no difference in your heart rate, and any change in your heart rate was simply caused by the “fight or flight” response.

Many studies have since confirmed that the epinephrine in dental anesthetic can cause an increase in your heart rate.

One study states that “intravenous administration of 0.015 mg of epinephrine with lidocaine results in increase in the heart rate ranging from 25 to 70 beats per minute, with elevations in the systolic blood from 20 to 70 mm Hg.”  For your information, one cartridge of dental anesthetic contains 0.018 mg of epinephrine — that’s even more than the amount pharmacy-no-rx.net that has been shown to increase the heart rate by 25 to 70 beats per minute.  Here’s a link to one of those studies that discusses this.

Malamed’s dental textbook on anesthetic even confirms what I’d discovered.  It says, “Contrary to a previously held position that the intraoral administration of “usual” volumes of epinephrine produced no cardiovascular response and that patients were more at risk from endogenously released epinephrine than they were from exogenously administered epinephrine, recent evidence demonstrates that epinephrine plasma levels equivalent to those achieved during moderate to heavy exercise may occur after intraoral injection.”

That simply says that the epinephrine in dental anesthetic can make your heart beat very fast, even tricking it into beating as fast as it would if you were exercising.

The author goes on to state that even if your dentist does inject slowly and “pull back” to ensure that they don’t inject into a blood vessel, your heart can still beat faster: “However, even following usual precautions (e.g. aspiration, slow injection), sufficient epinephrine can be absorbed to cause sympathomimetic reactions such as aprehension, tachycardia, sweating, and pounding in the chest (palpitation): the so-called “epinephrine reaction.”

More Evidence That Dental Anesthetic Can Make Your Heart Beat Faster

Even more evidence that dental anesthetic can make your heart beat faster comes from the American Heart Association.  They recommend that any patients with heart disease receive a maximum of 0.04 mg of epinephrine from dental anesthetic.  That’s usually the equivalent of just two cartridges of dental anesthetic.  For comparison’s sake, a normal person without heart disease can receive up to eleven cartridges of anesthetic.

This shows that the AHA believes that the epinephrine in dental anesthetic can have an effect on the heart, and that’s why they recommend limiting it so strictly.

The textbook Dental Management of the Medically Compromised Patient confirms this by stating “If [a vasoconstrictor] is considered essential, use cautiously (maximum 0.036 mg epinephrine or 0.20 mg levonordefrin).”  Levonordefrin is similar to epinephrine, but it is mostly used in European countries, not in the U.S.

Lastly, the American Acamedy of Pediatric Dentists even has guidelines for dentists telling us what to do when a patient has a reaction to the epinephrine in dental anesthetic.  They say to reassure the patient, ensure they’re breathing well, and to check their vital signs if necessary.

Dental Anesthetic Can Make Your Heart Beat Faster

In summary, the most recent studies and evidence all point to the fact that the epinephrine (or levonordefrin for my European friends) can definitely make your heart feel like its beating out of your chest!

Do you have any questions about dental anesthetic and how it affects your heart?  Feel free to leave them in the comments section below.  Thanks for reading!

How Your Dentist Knows You're Not Flossing
©Cheryl Casey/Shutterstock.com

A recent survey by the American Dental Association found that just under half of all Americans floss their teeth daily.

What about the other half?

My guess is that they’re the ones who floss twice a year — right before their dental checkups.  They think they can pull a fast one on us, but here’s a little secret: dentists can tell when you’ve been  flossing and when you haven’t.

How Dentists Can Tell When You’re Not Flossing

Woman Flossing Before Dental ExamThe way we can tell if you’re not flossing is if your gums are bleeding.  Although there are other, less common conditions that can make your gums bleed, gingivitis is the main cause.  Gingivitis is when the gums are inflamed due to all of the bacteria in your mouth collecting right between the gums and the teeth.

The problem is that it takes about a week of daily flossing for gingivitis to go away and make it so your gums don’t bleed when they are cleaned.

The most authoritative book on the gums — that’s 1,328 pages dedicated to your gums! — states the following:

The presence of plaque for only 2 days can initiate gingival bleeding on probing, whereas once established, it may take 7 days or more after continued plaque control and treatment to eliminate gingival bleeding.

So, if you end up brushing and flossing really well right before your dental cleaning and exam, your teeth will be clean, but your gums will still show the main sign of inflammation: bleeding.

If you really want to trick your dentist into thinking you’re brushing and flossing regularly, you’ll have to do it for at least seven days before your visit. And if you’re gonna do that, why not simply brush and floss every day?

Reasons to Go to the Dentist This Year

It’s been estimated that half of all Americans don’t go to the dentist regularly.  If you find yourself in that half, how about making a New Year’s resolution to make it to the dentist this year?

Here are five good reasons why you should.

Five Reasons to Go to the Dentist

1 – Catch Problems While They’re Small

If you regularly visit the dentist, your dentist will be able to tell you about smaller problems that you can easily and inexpensively get fixed.  The quicker you get a cavity filled, for example, the longer the filling will last.  If you put off getting a cavity filled while it’s small, it could cost significantly more to get it fixed when it needs a root canal and crown a few years down the road.

You won’t feel any symptoms with most dental problems until they are advanced.  If you have gum disease, it’s important that you get it treated.  However, unless you develop a gum abscess or have gum disease that is at a very advanced stage, you likely won’t experience any pain.

2 – Dental Care Is Better Than It Was In the Past

If you had a bad experience in the past, let me assure you that dentistry has come a long way.  There have been many recent advancements in the kinds of materials that we can use to fix your teeth.  Many modern restorations such as crowns and veneers look completely natural and can give you the kind of smile you’ve always wanted.

3 – There Are Ways to Alleviate Dental Fear

There are many drugs that you can take before you go to the dentist to make you drowsy so that you will be less anxious during your procedure.

Also, if needles frighten you, many dentists can fill small cavities using a laser without any anesthetic.  If you do require an anesthetic, there are very strong topical gels that can be placed on your gums before the injection to make the injection nearly painless.

We’ve come a long way since the dark ages when dentists were a little crazy — check out these pictures of old school dentistry if you don’t believe me.

4 – There Are Better Deals Due to the Economy

Many dentists are running new patient specials due to the fragile state of the economy.  They figure it’s better to get a new patient in even if they charge a really low price than to have empty slots.

If you perform an internet search with the terms “dentist the name of your city“, you will likely find some good deals that will allow you to have a free or low-cost exam and x-rays to get an overall idea of your general dental health.

5 – There are Financing Options Available

Also due to the economy, some dental offices are willing to accept payments for dental work performed rather than requiring the full amount at the time of service.

Another excellent option that we offer at my practice is called Care Credit.  This allows patients to have the dental work performed and then make 12 equal, monthly payments over the course of the year without paying any interest.  If you do go this route, just make sure that you make all of your payments on time.  If you don’t pay on time, then they will charge interest, which is how they make a lot of their money.

There’s No Time Like The Present

If you’ve made it this far, go ahead and make that appointment!  If you’re hesitant to make a dental appointment, feel free to leave a comment below and let me know why.  I’ll try to get back to you and resolve any concerns you might have.

Have a great year!

Dental Craze Lines - Hairline Cracks in Your Teeth

Catherine recently left a comment asking about the discolored lines that she has running vertically in her front teeth.  She was curious about what kinds of solutions there are to deal with this cosmetic problem.

Before I talk about the solutions to these lines that can occur in our teeth, I’ll give an overview of what they are, why they happen, and how to get rid of them.

Craze Lines: Vertical Lines in Our Teeth

These vertical lines in her front teeth are actually known as craze lines.  Over years of use, our teeth tend to develop tiny cracks in the hard outer layer known as enamel.  These cracks normally don’t cause any pain, but can easily stain, causing embarrassing discolored lines on your front teeth.

What Causes Craze Lines?

Craze lines can be caused by stress placed on a tooth.  This can happen over the course of a lifetime of chewing or by any other process that causes a lot of stress on our teeth.

Some common causes of craze lines are  biting your nails, grinding your teeth (many people do it in their sleep without realizing it), using your teeth as tools, trauma to your teeth, or simply routine use of your teeth.

In Dr. Cohen’s textbook about root canals, he states, “Craze lines are merely cracks in the enamel that do not extend into the dentin and either occur naturally or develop after trauma.”

This case report describes a situation where craze lines were caused by biting on hard objects such as the top ring of an aluminum soda pop can. Speaking of metal rings, wearing tongue rings can cause craze lines in your teeth.

Interestingly, some research points to temperature changes as a possible cause of craze lines.  That’s a great incentive  to not chew ice cubes (especially after drinking hot coffee!)

One other cause of craze lines that should be discussed is going to the dentist.  This research article states that he process of drilling away a cavity and filling a tooth can cause craze lines.  That’s certainly not a reason to avoid the dentist, though, since craze lines are harmless whereas untreated cavities can lead to significant complications.

Do Craze Lines Mean Your Teeth are Cracked?

Although craze lines are very tiny cracks in the outermost layer of your tooth, you don’t need to worry about your tooth cracking in half.

Porcelain Crazing on Doll

One good way to think about craze lines is to take a look at the above photo of this porcelain doll.  The cracks in the porcelain occurred after years of use.  Although they are cosmetically displeasing, the cracks don’t mean that the doll’s head is about to crack www.health-canada-pharmacy.com/products.html open!

If you suffer from craze lines, you’ll be pleased to know that the way that our teeth forms makes the enamel highly resistant to cracking.

A recent study looked at the crack resistance of the enamel in our teeth compared to a synthetic enamel.  The study concluded, “While enamel is the most highly mineralized tissue of the human body, the microstructural arrangement of the prisms promotes exceptional resistance to crack growth.”

If that isn’t enough, this study says that “The microstructure of enamel is functionally optimized to guide cracks from the more brittle outer enamel inwards where they experience higher growth resistance and are prevented from causing fracture and chipping.”

This study found that enamel is about three times as tough as the naturally-occurring crystals of hydroxyapatite (the crystal that our tooth is made from.)

Craze Lines Appearing on Stained Teeth
Enhanced image of stained teeth to emphasize prominent craze lines

How to Get Rid of Craze Lines

So, what should you do if you have craze lines and you hate how they look?  There are a few alternatives.

The least invasive option is to try teeth whitening.  Many craze lines show up because tiny amounts of debri get into the crack and stain the crack, making it visible.  Teeth whitening can bleach away the stain and make the craze lines very hard to detect.

There are other options that involve actual dental work.  Before trying these options, it’s good to keep in mind that craze lines can be caused by dental work, and that no dental work is better than your natural teeth.

These options include having an aesthetic tooth-colored filling material placed over the crack or having a veneer.  To do the filling, your dentist will simply smooth down the tooth in the affected area and add some filling material that is the same color as your natural tooth.  To do a veneer, your dentist will smooth down the whole face of the tooth and place a thin piece of porcelain over the tooth (kind of like a fake fingernail.)


With these alternatives in mind, it’s worth noting that most dentists agree that there’s no need to treat craze lines since they rarely lead to further breakdown of the tooth.  Some studies (like this one) do argue that the small lines may serve as a future site of a cavity, but if you’re going in for your regular check-ups, your dentist can usually detect potential problems.

Do you have any questions about craze lines or cracks in your teeth?  Leave a comment in the comments section below.  Thanks for reading!

Dental Drill Spraying Water

1 – There are two main types of dental drills: the high-speed and the slow-speed.  The high-speed drill rotates around 250,000 RPM.  That means it spins around more than 4,000 times each second!

Even the relatively slow dental drill rotates at about 8,000 RPM.  By comparison, this DeWalt Drill is three times slower with a top speed of 2,500 RPM.

2 – After using the dental drill on your tooth for 30 seconds, your dentist is subjected to as much bacteria as they would be had you sneezed right in their face (Source).  That’s one of the reasons most dentists wear face masks.

3  – The high-speed dental drill shoots out water as it spins, as you can see in the photo above.  If it didn’t, the friction would cause your tooth to get so hot during a filling that it could possibly damage the nerve inside your tooth.

Diamond Coated Dental Drill Bit

4 – Many dentists now refer to the dental drill as a handpiece to make it seem more friendly and enticing.

5 – The dental drill has to withstand the rigors of sterilization after every use, which means it gets heated to 250° Fahrenheit with pressurized steam for at least 15 minutes.

6 – The very first dental drill appears to have been a bow drill used by an ancient civilization about 9,000 years ago.

7 – The drill bits that dentists use are made of tungsten-carbide.  Some have blades to cut teeth, like in the photo below, and others are coated with diamonds to give a sandpaper-like smoothing effect (see photo below).

Carbide Dental Burs with Cutting Blades

8 – As recently as the early 20th century, many dentists used drills that were powered by a pedal that the dentist would pump with his foot.

9 – The distinct shrill sound that the high-speed dental drill makes can be a major factor in people’s fear of the dentist.  Even for those who don’t have dental fear, the dental drill’s noise can be very unpleasant.

10 – Dental drills can be expensive, with many costing over $1,000.  That’s a lot more expensive than your average home-improvement drill.


Do you have any questions about the dental drill?  Want to share an experience you’ve had with the dentist’s drill?  Leave a comment below.  Thanks for reading!

Dental Office on Airplane
©Mo SES/Shutterstock.com

Update 4/2/2012: Happy April Fools Day 2012 — Unfortunately, in-flight dentistry hasn’t quite taken off yet!

Don’t be surprised if during your next visit to the friendly skies you hear the faint whine of the dental drill. Two major airlines are poised to announce the addition of the DentAir program to their flight services. The program has been in its trial stage since January 1, 2012 and has met with such success that it is now being expanded throughout both airlines. After years of cost-cutting, many airlines are trying to woo back disgruntled fliers by offering extra in-flight services that cater to their frequent travelers.

I hate to be a naysayer, but I did have my doubts when I first heard about this program. I mean, dentistry in the air? But after discussing the idea with both patients and other dentists, I have to admit that being an aerodentist is actually something I could see myself doing after I graduate from dental school.

DentAir: Dentistry on an Airplane

The program is currently offered on about 5% of domestic flights, as well as several international destinations. Patients can requests services while checking in online up to 24 hours in advance or they can request an appointment once they get to their gate. A full range of services are offered, including routine cleaning and exams, custom whitening trays, and restorations.

What Patients Are Saying About the DentAir Program

We all know how difficult it is to fit dental check-ups into our busy schedules nowadays. But with the addition of the DentAir program, people can fly where they need to — and get an exam on the way.

Kerri Zrisk, creator of the DentAir concept, explains, “Whether you are a business traveler or a retired couple vacationing around the world, you probably struggle to find the time to get to your dentist. With this program, the dentist comes to you. We realized that passengers already had time slots open in their schedules — the only problem was that they were flying on airplanes during these lulls in their day. So we started thinking, ‘How can we get the dentists to these people?’ The DentAir program naturally followed.”

Phil Mitewth finds time for dentistry in the air
Phil Mitewth, DentAir Conniseur

Many patients expressed relief that they had access to dental professionals while traveling. After all, dental emergencies rarely occur at convenient times. Phil Mitewth, director of sales for Mardott International, said, “As a busy executive, I simply don’t have time to go to the dentist. With my busy schedule of flights, it’s easy to get my dental work done – and I have to say that there’s nothing quite as exhilarating as having a root canal over the Panama Canal.”

Passenger Joseph Miller was equally excited. “I couldn’t wait to get caps on my badly-stained two front teeth. Getting it done in the air was awesome and I would even say it was the crowning moment of my whole vacation!”

What Dentists Are Saying About the Dental Air Program

View from DentAir Dental Chair
View from DentAir Dental Chair

New York Dentist Dr. Mo Lerr, DDS stated, “Many patients are flying down to Mexico to get their dental work done at a fraction of the cost. By being an airplane dentist, I have some time to persuade them to get their dental work done in-country. I can even offer cheaper prices since there are no taxes in the friendly skies!”

Dr. Daryl B. Payne says, “A lot of my colleagues were skeptical at first, but I will always remember doing my first ‘mile-high’ filling. I just revved up the drill and waited. As an aerodentist, I’ve learned to just hold the drill in the mouth and let the turbulence guide me to the decay. It works every time, and I’ve never had a patient leave.”

Most dentists that were interviewed said they feel like an integral part of the flight team, despite their unique role. Dr. Timothy DeKay chimed in, “Everything has gone fairly smoothly so far. One time the pilot did tell me to lay off the suction since it was decreasing cabin pressure, but other than that we’ve had a pretty good working relationship.”

The Stewardentess: A Fulfilling Career Choice

Meredith Russell, Stewardentess
Meredith Russell, Stewardentess

Aerodentistry, like traditional dentistry, requires specially-trained support staff. After a recent flight, I was able to meet up with long-time Delta stewardess Meredith Russell. She returned to school last year to get her dental assisting degree and has recently been certified the first stewardentess in the nation.

In our interview she mused, “Sometimes it gets really boring during the downtime after I’ve collected the empty drink cups and pretzel bags. I felt like there was something I was missing out on as a stewardess and I wanted more out of my career. In-flight dental assisting was just a natural extension of my duty to make everyone’s flight perfect.”

The Future of Dentistry

Whether aerodentistry will really take off remains to be seen. But one thing is clear: dentists are branching out and considering unconventional treatment venues. It could be the recent economic recession or just a shift away from traditional care models, but whatever the reason, dentistry is expanding to reach more people.

“It’s hard to say what the next 5 or 10 years will bring,” says Dave Capitt, dean of Michigan State School of Dentistry, “but if you ask me, the future of dentistry is up in the air.”

Thanksgiving Thankful for Teeth

It’s easy to take things that we use everyday for granted.  When was the last time you thought about what your teeth do for you?  Whether you think about it or not, your teeth do some pretty amazing things for you that you probably don’t even notice.

5 Reasons to be Thankful for Your Teeth

Reasons to be Thankful for Your TeethOn this Thanksgiving Eve, I thought I would mention a few reasons to be thankful for your teeth.

1 – Your Teeth Help You Chew Turkey

Not just turkey either!  Your teeth tear and grind all the different foods you eat every day.  I vividly remember an experience I had working at a dental clinic before going to dental school.  An older man came in for his final appointment to get his dentures.  He excitedly told me that the first thing he was going to do was to go down to the local grocery store and buy a vegetable tray.  Before that incident, I’d never really taken the time to think about how I would eat without teeth.

2 – Your Teeth Make You Attractive

A smile can go a long way toward improving your appearance.  Without teeth, you wouldn’t be very likely to smile.  Every year, people spend millions of dollars trying to make their teeth look whiter, brighter, and more beautiful.

3 – Your Teeth Help You Speak

Try saying the phrase I’m thankful for turkey.  Notice how your tongue touches your teeth during the th and t sounds and your upper teeth touch your lower lip to say the word fo.

Speaking without your teeth is harder than you might think.

4 – Your Teeth Affect the Shape of Your Face

Here’s a thought exercise: picture a 101 year old man with no teeth in your mind.

You probably saw a man who’s mouth appeared “sucked in” and his face kind of seemed scrunched up and not very tall.  Your teeth support your lips and cheeks and make your face appear longer.  To learn more, read How Your Teeth Affect the Length and Shape of Your Face.

5 – They Keep Your Jaw Bones Strong

Your jaw bones stay as thick and strong as they are because they work hard by holding onto your teeth.  Without teeth, the jaw bones begin to atrophy and shrink from lack of use.  This can make it easy for your jaw to fracture — it’s also a reason why people who have been missing their teeth for a very long time can’t get a lower denture made that fits very well: they simply don’t have enough bone to support it.

Why Are You Thankful for Your Teeth?

Did I miss any reasons why you’re thankful for your teeth?  Speak your mind in the comments section below.  Thanks for reading, and to all of my fellow Americans: Happy Thanksgiving!

Best Mouth Wash for Bad Breath

Mouthwash and Bad BreathDid you know that as many as half of all Americans say that they suffer from bad breath?

Many people have turned to mouthwash to try to curb their oral odor, but does mouthwash really help fight bad breath?  If so, which one is the best?

Mouthwash Can Fight Bad Breath

Many mouthwashes used to simply provide a strong, pleasant aroma to cover up bad breath.  As time passed, mouthwash manufacturers began adding certain ingredients to their mouthwashes to help fight bad breath.

Today, there are many varieties of mouthwash available.  Although most of them have flavors that would appear to freshen your breath, only mouthwashes that contain certain ingredients are able to help fight bad breath.
Researchers wanted to find out whether or not mouthwashes actually helped fight bad breath.  The following quote is from a systematic review that combined the results of five different studies to determine the following:
“This review, which included five trials (293 participants), found that there is some evidence that mouthrinses containing antibacterial agents such as chlorhexidine and cetylpyridinium chloride or those containing chlorine dioxide and zinc can to some extent reduce the unpleasant odour but the use of mouthrinses containing chlorhexidine resulted in noticeable but temporary staining of the tongue and teeth.”

As long as the mouthwash contains an antibacterial agent such as chlorhexidine or cetylpyridinium chloride (CPC) or zinc and/or chlorine dioxide, it may be able to fight bad breath.

Before trying a mouthwash to control your bad breath, try one of these five methods to find out if you have bad breath and then try to find out what is causing your bad breath by learning about some common causes of bad breath.

Which Mouthwash Is Best for Bad Breath?

In the United States, mouthwashes containing chlorhexidine are only available by prescription. The only antibacterial that this review found to be effective against bad breath that is also available over the counter in the United States is CPC. CPC in combination with zinc can be found in many mouthwashes.

Breath Rx Mouthwash
Breath Rx mouthwash can fight bad breath

This BreathRx mouthwash from Amazon contains CPC as well as zinc to neutralize bad breath-causing volatile sulfur compounds. Crest Pro Health mouthwashes are another alternative, but they have been the target of some rather negative reviews.

You may be wondering where other mouthwash products such as Listerine fit in. Listerine contains a variety of essential oils that decrease bad breath. Although Listerine was shown to decrease bad breath in many of the studies that were reviewed, products containing an antibacterial along with zinc were shown to do a better job at fighting bad breath.

Is Mouthwash the Best Method of Fighting Bad Breath?

Although many people use mouthwash because it is easy to simply rinse their mouth out, there are other ways of fighting bad breath.  Good oral hygiene along with cleaning your tongue has been shown to reduce bad breath.  Getting rid of the pl

Do you have any questions or comments about mouthwash and bad breath?  Leave your comments below.  Thanks for reading!

Eruption Cyst Baby Molar
©Oral Answers Contributor

Many parents worry when they find that their young child or baby has a bluish purple bump on their gums.  This is a fairly common development and is known as an eruption cyst or eruption hematoma.  For uniformity throughout the article, I will simply refer to them as eruption cysts.

What Are Eruption Cysts?

Eruption Cyst Upper Baby MolarThe easiest way to describe eruption cysts is by talking about how teeth develop.  Your child’s teeth form inside of a protective enclosure in their jaw bone.   When the teeth are done forming, they start to move through the bone, and then through the gums until they make it into the mouth.  An eruption cyst occurs during the tooth’s final entry into the mouth – after it has already made its way through the bone and is just under the surface of the gums.

The protective enclosure which the tooth developed in can leak and allow fluid to accumulate between the tooth and the gums.  If an opposing tooth touches the gums, it may cause fluid and possibly blood to accumulate between the tooth and the gum.  This causes a bruise to form in the gum tissue between the tooth and the outside surface of your child’s gums.  Depending on the amount of blood that accumulates in the eruption cyst, it can be a translucent color, bluish purple, or even dark red and brown.

Although they are unattractive and often cause parents to worry, most eruption cysts are actually painless.

What Causes Eruption Cysts?

Eruption CystThe most widely-accepted theory is that eruption cysts are caused by trauma to the gums a few weeks before a new tooth comes in.  The trauma doesn’t have to be severe — McDonald & Avery’s Pediatric Dentistry states that the trauma occurs as a result of normal chewing.

Another reason eruption cysts occur is due to thickened gum tissues.  This can result from taking certain medications.  Neville’s Oral Pathology textbook hypothesized that one reason eruption cysts occurred in a young child taking cyclosporin was due to “collagen deposition in the gingival connective tissue that resulted in a thicker, less penetrable, pericoronal roof.”  With thicker gums, it may have been more difficult for the tooth to erupt into the mouth, causing an eruption cyst.

Who Can Get Eruption Cysts?

Any child can get an eruption cyst before their tooth erupts into the mouth.  As far as race goes, they are reported to be most common in Caucasian children and they are just as common in boys as in girls.

How Common Are Eruption Cysts?

Nobody knows.  A scholarly article has state, “Prevalence of eruption cyst has not been thoroughly studied.  Extensive review of literature revealed low prevalence of these cysts.”

Many parents may not notice that their child has an eruption cyst or may simply do nothing about it and then note that it goes away.  Due to the fact that many eruption cysts are not documented very well, it’s hard to pinpoint an exact percentage when it comes to how common eruption cysts are.

In an exam of 1,211 children from a Brazilian hospital, it was found that 2 of them had eruption cysts.  That’s only 0.17% that had eruption cysts at the time that they were examined.  However, many more of these children may have had eruption cysts before they were examined.  This would lead me to believe that eruption cysts are much more common than 0.17%.

Where Do Eruption Cysts Occur?

Although it has been debated, most articles (like this one) state that eruption cysts occur most commonly in the upper jaw.  They most commonly occur with the baby incisors, the baby molars, and the permanent first molars.

How Are Eruption Cysts Treated?

Normally eruption cysts don’t need treatment.  The tooth will usually break through the cyst within a few days come into the mouth on its own.  If the eruption cyst persists in the mouth for more than a few weeks, many dentists will make a small incision in the cyst which will allow the tooth to come through.  Depending on the anxiety level of your child, this procedure can usually be done under local anesthesia.

What Else Could It Be?

When we see a swelling over a tooth that is about to erupt, we usually think of eruption cysts.  It is possible that it could be something else though, such as a calcifying odontogenic cystThis case report states, “Other lesions that can cause gingival swellings include peripheral giant cell granuloma, peripheral ossifying fibroma, pyogenic granuloma, and other less common peripheral odontogenic tumors.”


Do you have any questions, comments, or concerns about eruption cysts?  Feel free to leave a comment in the comments section below.

I want to especially thank Leigh for sharing the above photo of her 8 month old daughter’s eruption cyst.  If anyone else wants to share their photo, you can email them to OralAnswers at Gmail.com or use this contact form.  Thanks for reading!

Photo Credits All photos provided by Oral Answers Readers

Update 1/7/2012: I just wrote a follow-up post to this one that has two high-quality pictures of eruption cysts above permanent teeth that haven’t yet come in.  Click here to check it out.

Dental History Pictures
©Everett Collection/Shutterstock.com

As much as people don’t like the dentist nowadays, things used to be a lot worse!  Take a look at the pictures below to see how far dentistry has come in the past few centuries.

16 Dental History Pictures That Will Make You Love Your Dentist

A Jolly Man with a “Fixed” Missing Tooth

Dr. Shiffman Fixed My Teeth - Dental History

It’s hard to imagine living in an era where people consider their teeth fixed when they are missing.

Teething Trouble?  Give the Kid Some Cocaine & Alcohol

Cocaine Teething and Toothache Drops - Dental History

Many years ago, it was common to give a teething baby all sorts of concoctions to get them to calm down.  My favorite have to be these cocaine drops, followed by Mrs. Winslow’s teething syrup, which would now be illegal for those under 21 years of age!

Mrs. Winslow's Soothing Syrup for Teething Children - Dental History

“Gather ’round, children.  Let’s look at the Mrs. Winslow’s Soothing Syrup advertisement again!”

Don’t want to get your baby drunk?  Here’s some natural teething remedies you can try.

Would You Like Your Wisdom Teeth Extracted?

Martyrdom of St. Apollonia - Dental History

This illustration, The Martyrdom of St. Apollonia, shows the torturous extraction of teeth.  I’m glad that this isn’t how my wisdom teeth were removed!

German Traveling Dentist

German Charlatan Dentist - Dental History

In the picture above, a German dental quack, who looks strangely like Captain Hook,  is holding a large tooth that he supposedly extracted from the little midget next to him.  If you look closely, you will see a necklace of extracted teeth hanging over the edge of the table.

His cute little assistant is mixing up a variety of powders and potions that this dentist claims will cure complications from kidney stones and pregnancy.

Traveling French Dentist & His Monkey

French Quack Dentist with Monkey - Dental History

This French dentist proudly displays a tooth that he recently extracted from the gentleman on the right and it would appear he suffered a great deal.

Perhaps as a marketing gimmick, this dentist has a monkey that imitates his every move!

Although your dentist probably wouldn’t extract a tooth without gloves, you should still evaluate your dentist’s infection control program.

18th Century Persian Dentist Tooth Extraction

Persian Dentist Extracting Tooth - Dental History

Here’s an 18th century Persian dentist engaging in the fine art of a gentle tooth extraction.  The gentleness reflects the subtitle of this picture, which was taken from a passage found in the Quran about the need to be kind to your fellow men.

Traveling Dentist in a Dutch Village

Traveling Dentist in Dutch Village - Dental History

I still can’t get over the fact that people used to gather and watch tooth extractions for entertainment.

A Surprifing Toothache Cure

A Surprifing Toothache Cure - Dental History

If this guy had lived in our day, I am willing to bet he’d be all over the TV on infomercials and all over the internet with affiliate websites peddling his “fmall letter” that would cure a toothache.  I can almost hear his voice pronouncing the letter s like the letter f.

A sufferer comes to him saying, “I come to you to get Relief for a moft violent Tooth-Ache.”  The swindler then responds, “My Letter, that fmells fo very pleafant, when delivered is your Relief.”

Interestingly, there are still people like him on the internet that push dangerous, risky, and unproven treatments for toothaches and gum disease.

Backbreaking Work for this Dental Assistant

Russian Dentist - Dental History

I guess they don’t make dental assistants like they used to!  I feel bad for all three, but probably the dentist the most for his poor fashion sense.  I promise, you’ll never sit in my dental chair and see me wearing pants like that!

An Athletic Italian Dentist

Italian Athletic Dentist Pulling Tooth - Dental History

I can’t believe that in 3 ½ years of dental school, my tuition still hasn’t covered a class covering athletic dental extractions.  Hopefully it’s coming up soon.

The next patient appears to be drinking some extra alcohol in anticipation of her extraction.

Curing a Toothache with Fire

Using Fire to Cure a Toothache - Dental History

A suffering patient bends over this brazier fueled by burning seeds.  The fumes from henbane seeds were believed to drive the worm out of the aching tooth.

Yeah, people used to believe that toothaches were caused by worms that burrowed into the tooth and caused pain.  Even if there were worms, it’s more likely that the henbane would’ve killed the person before it killed the worms, since it is now known to be a very toxic plant.

The Japanese Tooth Extraction: Kneeling Method

Japanese Dentist Kneeling to Extract Tooth - Dental History

I’m betting that she is handling the extractions so well because she knows that she’s got not two, but three black, wooden dentures ready for her when she’s done.

Arabic Dentist Cauterizing Dental Pulp With Acid

Arabic Dentist Cauterizing Dental Pulp - Dental History

Here’s an Arabic dentist injecting acid into the dental pulp of a patient.  He uses a protective syringe to keep the acid from burning his hands.

Not sure what dental pulp is?  It’s the nerve of the tooth – Learn more about the anatomy of a tooth.

The Tooth Drawer

Tooth Drawer - Dental History

This is the picture I featured in my article on tooth drawers not too long ago.  This elegantly dressed dentist advertises himself as the dentist to the Great Mogul.  He wanted everyone to know that even royalty subjected themselves to his charming, yet awful dental skills.

The Italian “Oral Surgeon” That Effortlessly Removes Jawbones

Italian Dentist Extracting Jaw - Dental History

I don’t know how people believed this one.  This Italian “oral surgeon” has just pretended to extract an animal’s jaw from his actor-patient.  The crowd stares in amazement, the way the surgeon looks at us through the picture easily tells us that he’s living a lie.

The main theme in a lot of these pictures is having a crowd admire the dentist’s work.  Now that we have YouTube, people have turned away from the dental office when they seek entertainment.


Hopefully these pictures from the history of dentistry will allow you to gain a greater appreciation for your current dentist.  There’s a lot to be grateful for when you think about dentists of today:

  • We don’t stand on you or tie you down to pull your teeth.
  • We don’t travel from town to town with deceitful publicity stunts.
  • We don’t prescribe medications that could cause serious harm to you or your children.
  • We use local anesthetic so you don’t feel the pain of dental work.
  • We don’t try to sell you questionable cures for your problems and base our treatment on scientific evidence.  Well, most of us do!
  • We don’t hold your head over a burning pot of flames to cure your toothache.
  • We can fix teeth, rather than simply extracting them.
  • We wear gloves and use sterile dental equipment.
  • Questions, comments, or concerns?  Please leave a comment in the comments section below.  Thanks for reading!

Dental Fillings Fix Chipped Teeth
©Steven Frame/Shutterstock.com

Many people wonder why their dentist tells them that they need a filling.  Although having a cavity is the #1 reason we do fillings, there are also many other reasons that people get fillings.

Why You Need a Filling

1 – Cavities

Cavities remain the number one reason that dentists give patients fillings.  Even so, not all cavities need fillings.  Sometimes very small cavities can be “watched.”  When this happens, the dentist monitors the cavity and if it appears to be repairing itself, you won’t need to get a filling.

I’d like to add a word of caution: Only leave a cavity unfilled if your dentist has recommended that your cavity should be watched.  Putting off necessary dental work can complicate your dental health and increase your costs.

If you do have small cavities that your dentist is keeping an eye on, check out these 12 weapons of plaque destruction to see how you can help your cavity heal.

2 – Tooth Fracture

Many times, fractured teeth can be repaired with white composite filling material.  You can take a look at a tooth that I repaired with a white composite filling before I started working with real patients in dental school.

Prevent your teeth from fracturing by wearing a mouth guard during these 16 activities.

3 – A Slow Loss of Tooth Structure

When you fracture your tooth, you lose a lot of tooth structure quickly.  There are other ways that you can lose tooth structure more slowly, such as abrasion, abfraction, erosion, and attrition.  You can learn about those in the article about the four ways you wear away tooth structure.

The best way to prevent this type of tooth loss is by avoiding acidic drinks and acidic candy, not grinding your teeth, and not using your teeth as tools.

4 – Tooth Discoloration

Do I Need a Filling?Another reason that dentists do fillings is to cover up discolored teeth.  Teeth can be discolored for a variety of reasons, such as staining from antibiotics and dental fluorosis.

5 – Replacing Old Fillings

Old fillings may need to be replaced.  Over time, white fillings can discolor and the bond between the filling and the tooth can break down.  Silver fillings may also fracture after many years of service.  One of the first fillings I did in dental school (unbeknownst to my patient!) was the replacement of a silver amalgam filling that had fractured.

Questions About Fillings?

Do you have any questions about why dentists do fillings or why you need a filling?  Go ahead and leave a comment in the comments section below.  Thanks for reading!

Halloween Candy and Teeth

I had a fun time trick or treating tonight with my son and daughter.  The first thing my daughter wanted to eat when she got back was a bag of pretzels she was given.  She eventually moved on to the candy.  When I went to brush her teeth before she went to bed, I got one side done and then she wouldn’t let me brush anymore.

I could see the Kit-Kat stuck to her teeth and told her we needed to clean them.  I took a picture to show her, and then she let me brush.  Here’s what the Kit-Kat did to her back teeth:

Brush Teeth on Halloween

Note that I had already brushed the teeth that are on the right in the photo.  This picture shows why people so often get cavities on the chewing surface of their teeth.

If I had simply not brushed her teeth tonight, that Kit-Kat probably woud’ve been sitting there for many hours, if not all night, since our salivary glands almost shut off while we sleep.  During this time, the bacteria in her mouth would have been enjoying the Kit-Kat and starting a cavity.

Find out how plaque cause cavities.

Hopefully this photo provides a good illustration as to why it is important to brush your teeth after eating sugary snacks.

Do you have any questions about Halloween candy and your teeth?  Write them below in the comments section.  Thanks for reading!

Tooth Drawer Dental History

Imagine living in a remote village 300 years ago.  After suffering with a toothache for weeks, you see an advertisement about a traveling dentist who will be performing in the village square next weekend.  You feel relieved, but somewhat nervous.

Who were these dentists that traveled around the countryside putting on loud, raucous shows whereever they went?

They were known simply as tooth drawers (pronounced draw-ers).

The Tooth Drawer

Tooth DrawerThe tooth drawer would generally travel to different villages and set up shop temporarily.  Usually a tooth drawer would set up a stage with lots of decorations as you can see in the picture above.

Many people had to be in extreme pain before they would dare go to a tooth drawer.  Tooth drawers ended up getting a bad reputation because many of them weren’t very good dentists and simply craved fame and attention.  Also, as you can see in the picture above, someone was picking the pocket of the tooth drawer’s patient.

On stage, they would act like they were great dental surgeons, but they often did this by tricking their audience.

How The Tooth Drawer Would Trick the Audience

Once a tooth drawer set up shop in a town, they would call someone from the audience who was suffering from a toothache.  The tooth drawer actually planted actors in the audience who would pretend to be suffering from a toothache.

After calling the actor up, the tooth drawer would pretend to extract the painful tooth and the patient would then cough out a bloody tooth.  In reality, the tooth drawer would give his actor an extracted tooth with blood on it and tell him to cough it out.  The actor would then exclaim, “I didn’t feel a thing – Thank you for taking me out of pain!”

After the tooth drawer finished with his actor, he would call another toothache sufferer up.  Those who really had a toothache would scream in agony at the tooth drawer’s rough methods.  Unfortunately, by this point, the crowd would be so loud and rowdy that nobody noticed how much suffering the tooth drawer was causing.

Was Every Tooth Drawer Dishonest?

Not every tooth drawer was dishonest.  There were some that truly wanted to help people get out of pain.  The problem was that way back then, nobody knew about local anesthesia.  Nobody knew that teeth could be saved by doing root canals.  The main problem was that there was simply a lack of scientific knowledge in the field of dentistry.

In her book Tooth Worms & Spider Juice, Loretta Ichord states, “Even the honest tooth drawers had limited skills and were capable of tearing large pieces of bone off with a tooth, breaking jaws, and causing facial deformities.”

If you take anything away from this article, I hope that you’ll realize that dentists aren’t as scary as they used to be.  With modern technology, your visit to the dentist no longer has to be painful or dangerous.  And by the way, with the HIPAA privacy act as one of your dental patient rights, you no longer have to worry about dozens of spectators coming to watch you during your dental visit like in the picture below.  Thanks for reading!

Tooth Drawer

Top Image “Le Mal De Dente” by Charles Aubry

Dental Patient Rights
©Candybox Images/Shutterstock.com

I got an email yesterday from a reader named Harris, who stated, “I paid $5000 to replace a broken crown. The dentist did not tell me what the cost would be until he had already started the procedure.”

Harris wanted to know what kind of rights he had as a dental patient when you’re not told the cost of dental treatment in advance.  I told Harris that it is generally accepted that a dental patient has a right to know an estimate of the cost of a procedure before treatment begins.

I’ve received many other questions about dental patient rights in the past, and I thought that it would be a good time to discuss the rights of a dental patient. I have listed below what I believe to be 20 core rights that every dental patient deserves, and I’ll probably use something similar to this as the patient bill of rights in my future dental practice.

Dental Patient Rights

Dental Patient RightsKeep in mind that these are not legally-binding rights, although they are good recommendations for a dentist to establish a positive, successful relationship with his or her patients.

I have provided links to many other dental patient bill of rights at the end of the article if you want to take a deeper look into the world of dental patient rights.

The Right to Choose Your Dentist

You have a right to choose your own dentist.  Many dentists have different philosophies regarding the best treatment and you have the right to choose the dentist with whom you feel most comfortable.

The Right to Quality Dental Treatment

You have a right to receive treatment that meets or exceeds the accepted dental standard of care.

The Right to Know the Education and Training of the Dental Team

You have a right to know about the education and qualifications of the entire dental team, including the dentist, dental hygienist, assistants, and staff.  Many dental practices that believe in lots of continuing education post this information on their practice website.

Most states require that a dentist complete 15-25 continuing education “credits” every year.  You can ask your dentist how many he or she has taken.  Some dentists get by on the minimum, and other dentists take more courses than required.

The Right to a Clean Treatment Environment

The dental team should be using appropriate infection-control and sterilization techniques.

Learn how to tell if your dentist has a good infection control program.

The Right to Confidential Treatment

You have the right to expect that no member of the dental team will discuss your treatment with anyone else unless you authorize it.  This is a right granted under the HIPAA privacy rule.

The Right to Know the Cost of Treatment

You have the right to know how much treatment will cost before treatment begins.  Sometimes we don’t know what we’ll find before we start working on a patient, so it can be difficult to give an exact fee.

If this is the case, the dentist should be able to provide you with an estimate of the fee based on the various outcomes and treatment options.

Curious about dental fees?  Find the average dental fee in your area.

The Right to Know Why You Need Treatment

You have the right to know why treatment is necessary for your particular condition.

The Right to Know Treatment Risks

You have the right to know what risks are associated with treatment as well as the risks of not proceeding with treatment.

The Right to Know Treatment Alternatives

There’s more than one way to skin a cat — You have a right to know what other treatments are available that would also solve your dental problem as well as knowing how long the various treatment alternatives will last.

The Right to Decline Treatment

You have the right to decline treatment if you so desire.  You also have a right to know what may occur if you choose not to accept the treatment that your dentist proposes.

The Right to Know Expected Treatment Results

You have the right to know what the expected outcome of your treatment will be.

The Right to Emergency Dental Treatment

You have the right to receive emergency treatment from your dentist within a reasonable time-frame.  Many dentists set aside a certain amount of time each day to see emergencies.

The Right to Be Treated Respectfully

The dental team should treat you respectfully and considerately.

The Right to Not Be Discriminated Against

You have the right to not be discriminated against.  You should receive quality treatment no matter your ethnicity, sex, religion, disability, or age.

The Right to See the Dentist at Every Visit

You have a right to see the dentist every time you receive dental treatment.  Different states have varying laws regarding this, and thus you can clarify this with your dental office if you wish to see the dentist at every visit.

The Right to Know How to Resolve Disputes

You have the right to know what actions you can take to resolve any disputes that might arise between you and your dentist.  There are many ways to resolve disputes with your dentist.

Dental peer review is one of these means — here’s what it takes to win a lawsuit against your dentist.

The Right to Timely Dental Treatment

If a dentist accepts you as a patient, you have a right to expect that you can make appointments in a timely manner and not have to wait many months before receiving treatment.

Keep in mind that sometimes this is beyond the dentist’s control.  For example, if you require IV sedation or anesthesia in a hospital setting, it may take a long time to schedule your appointment so that you can have all of the health professionals available to provide you with safe, effective treatment.

The Right to a Conversation With Your Dental Team Regarding Your Treatment

You have a right to receive answers to any questions that you may have regarding your current oral health status and your proposed treatment.

You also have the right to discuss any concerns you may have regarding the proposed treatment.

The Right to Your Dental Records

You have the right to have your dental records and x-rays transferred to another dentist of your choice either for free or for a nominal fee.

Learn more about how to get a copy of your dental records.

The Right to Reasonable Accommodations for Your Disability

If you have a disability, you have a right to expect your dentist to make reasonable accommodations.  For example, I have treated patients in their wheel chair when they are unable to move themselves into our clinical dental chairs.

Dental Patient Rights Available Online

There are a number of dental patient bill of rights available online.  My dental school and the ADA have made copies of their dental patient bill of rights available on the internet.  Here’s a few:

It’s interesting to note how Boston University’s dental patient rights differs from the other schools’ since they are a private university and appear to be more selective at accepting patients.

Questions About Dental Patient Rights?

Do you have any questions regarding your rights as a dental patient?  Leave them in the comments section below and I’ll do my best to answer them.

Thanks for reading!

Dental Antibiotic Premedication Common Questions

Many dental procedures cause bleeding in the mouth, which can allow the bacteria in the mouth to enter into the person’s bloodstream.  Certain people are more susceptible to bacterial infections in their bloodstream than others.  In order to prevent bacteria from living in your bloodstream and infecting certain high risk areas of your body, it is important for certain people to take antibiotics before having many dental procedures.  This is known as antibiotic premedication or antibiotic prophylaxis.

Many people have questions regarding antibiotic premedication and dental work.  Here’s a list of ten common questions and their answers.  If you have any other questions about antibiotic premedication that I don’t cover in the following article, feel free to leave a comment down at the bottom.

Dental Antibiotic Premedication: 10 Common Questions

1 – Who needs to be premedicated before having dental work done?

Basically, if you have any of the following, your dentist may consider giving you antibiotics before routine dental work:

  • Artificial joint replacement
  • A previous heart infection (infective endocarditis)
  • A prosthetic heart valve
  • Certain cases of congenital heart disease
  • Heart transplant patients who have developed cardiac vulvopathy
  • Certain immune conditions

For a more in-depth look at who needs to be premedicated before dental work, read the article Why You Might Need to Premedicate with Antibiotics Before Seeing Your Dentist.

2 – If I have artificial screws, pins, or plates in my joints, or if I have had a stent placed in my heart, should I premedicate?

Antibiotic premedication before dental procedures is not required for any of those conditions.  It is only required for the conditions given by the American Heart Association, the American Dental Association and the Academy of Orthopaedic Surgeons (AAOS).  The AAOS has stated, “patients with pins, plates and screws, or other [orthopedic] hardware that is not within a synovial joint are not at increased risk for hematogenous seeding by microorganisms.”

3 – My dentist told me to take 4 tablets of amoxicillin before my dental appointment.  That’s 2,000 milligrams of antibiotic!  That seems like too much, did my dentist really mean 200 mg?  Did he make a mistake on the prescripition?

The American Heart Association guidelines recommend 2,000 milligrams of amoxicillin for antibioitic premedication before dental procedures.  A “normal” dosage of an antibiotic such as penicillin or amoxicillin is 500 milligrams a few times per day.  From that perspective, 2,000 milligrams is simply the amount of antibiotic that you might take in one day if you were using it to fight an infection.

4 – My dentist used to give me antibiotics before dental work but she doesn’t give them to me anymore.  Nothing in my health history has changed.  Why?

The guidelines for antibiotic premedication are constantly changing as new scientific evidence is discovered.  It is likely that your dentist is simply following the new guidelines.  For example, the guidelines changed for heart problems in 2008 and now we do not premedicate many patients that required antibiotic premedication prior to the new 2008 guidelines.

5 – According to question #1 above, I need to be premedicated before getting dental work done.  Do I need to be premedicated for all dental procedures?

No, only certain dental procedures require antibiotic premedication.  You can find a list of the procedures that do require antibiotic premedication in the article Why You Might Need to Premedicate with Antibiotics Before Seeing Your Dentist.

As a general rule, if you expect to be bleeding around your gums during the procedure, you probably need to be premedicated for that procedure.

6 – Even if my condition isn’t listed on the new guidelines, can I still premedicate just to be on the safe side?

If your condition is no longer listed as someone who is at risk for a bacterial infection, then you don’t need to be premedicated before having dental work done.  If there were a substantial risk of you getting an infection, your condition would be listed in the guidelines.

7 – I still want antibiotics, but my dentist won’t give them to me.  What should I do?

Your dentist is doing you a favor.  You really don’t need antibiotics, and the risks (allergy, upset stomach, antibiotic resistance) all outweigh the benefits.

8 – My doctor told me that I still need to be premedicated before dental work, but my dentist won’t give me a prescription for antibiotics because he says that they are not needed.  Who’s right, the doctor of the dentist?

You can have your dentist call your doctor to see if there are any reasons for you to be premedicated.  In my experience, many doctors have not implemented the new guidelines and prefer to do things as they have always done.

For more information on this predicament, read the article Antibiotic Premedication: When Your Doctor and Dentist Disagree.

9 – I am already taking antibiotics for an infection, so I don’t need to premedicate since I am already taking antibiotics, right?

Wrong.  If you are taking antibioitics for one infection and you need to be premedicated, you need to take another antibiotic.  The American Dental Association has said the following: “Another concern that dentists have expressed involves patients who require prophylaxis but are already taking antibiotics for another condition. In these cases, the guidelines for infective endocarditis recommend that the dentist select an antibiotic from a different class than the one the patient is already taking. For example, if the patient is taking amoxicillin, the dentist should select clindamycin, azithromycin or clarithromycin for prophylaxis.”

10 – I forgot to take my antibiotics before my dental appointment, but I lied to my dentist and told him I did because I had already taken the time off work and I can’t take any more time off.  Is this alright?

If you don’t take the antibiotics, you are at an increased risk for developing an infection.  For example, the bacteria in your mouth can travel to your heart and cause a heart infection known as infective endocarditis.

However, there is hope!  The guidelines from the American Heart Association say, “If the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to two hours after the procedure.”  If it hasn’t been 2 hours, you can still take the antibiotics!

Bonus Question 11 – Do I need to premedicate if I have breast implants?

Pat asked this question a while back in the comments section on one of my earlier articles about antibiotic premedication.

Basically, there is only one reported case of a breast implant infection following dental work.  Even that case isn’t very strong since researchers were unable to confirm that the strain of bacteria that caused the infection actually was from bacteria in her mouth.

The California Dental Association has stated, “The prudent dentist should always weigh the risk of prophylactic antibiotic therapy against the potential benefit in a particular group of patients. For the hundreds of thousands of women with breast implants, the decision not to prescribe prophylaxis is clearly justified. If the patient’s plastic surgeon is adamant about the necessity of antibiotic prophylaxis, then that physician should write the prescription.”

Obviously, the risk of getting an infection in a breast implant from a dental procedure is extremely low, and thus it is not necessary to take antibiotics before dental work for a breast implant.

You can read my full response to Pat’s question here.


Do you have a question about antibiotic premedication before dental work that I didn’t cover above?  Go ahead and ask it in the comments section below.  Thanks for reading!

References and further information: Lexi Comp Online, ADA Prophylaxis

Oral Answers Top 10 Lists

First and foremost, I would like to thank all of those who have left comments on this blog.  I read each and every comment and am so grateful for your input and support.  I have learned from your experiences and opinions.  Also, your comments often help me develop ideas for new posts or explanations.  So thank you!

In February 2010 — Oral Answers’ first full month — it had 149 page views.  Last month, September 2011, it had 76,559 page views.  All of those page views each month bring with them hundreds of comments.

When I first started Oral Answers nearly two years ago, it was easy to respond to every comment and email.  Over the past several months, it has become increasingly difficult for me to respond to each and every comment.  I’m several weeks behind, but I do intend to catch up over the next week!

I plan to finish responding to the comments that have been left so far.  However, due to personal time restraints I have decided that I will no longer be able to respond to every comment. My intention with this blog is to help as many people learn about oral health as possible.  I feel that I can most effectively do that by writing new posts about various topics rather than responding to every single comment.  While responding to a comment can directly help the person who commented and a few others who read it, each post has the potential to help many more people.

Oral Answers Top 10Just to be clear — I’m not giving up on answering comments completely.  I will still read them all and plan on responding to many of them.

Top 10’s

I thought it would be fun to make a few lists of the top 10 posts over the past couple of years in a few different categories.

10 Most Popular Posts on Oral Answers

1 – What You Should Do When a Crown Falls Off of Your Tooth

2 – What a Baby’s Gums Look Like While Teething

3 – Adult Permanent Teeth Coming In Behind Baby Teeth: Shark Teeth

4 – Colored Braces: What Colors of Braces Can You Get?

5 – Power Chains: Why Some Colored Braces are Connected

6 – What a Frenectomy is and Why Your Child Might Need One

7 – Why You Get Swollen Cheeks After Wisdom Teeth Removal

8 – Pulpitis: What’s the Difference Between Reversible Pulpitis and Irreversible Pulpitis?

9 – What’s the Best Temporary Crown Cement and Method to Re-Cement Crowns?

10 – What to Do When Your Child’s Baby Tooth Gets Knocked Out

The 10 Most Interesting Search Terms That Brought Someone to Oral Answers

I guess this is a bit subjective, but people do enter some interesting stuff in the search box that somehow brings them to Oral Answers.  Here are ten of my favorite search terms that have brought people to Oral Answers.

I can only say that I hope they found what they were looking for!  And I promise, I didn’t make any of them up.

1 – disappear completely on lying down on dental chair …… – I get more confused each time I read it. I guess it’s a good reason not to go to your dentist if he is also a magician.

2 – for sale chipped tooth composite filling – Sounds like a classic do-it-yourselfer!

3 – does sparkling water erode tooth enamel 2010 – No, but it might in 2011, so watch out!

4 – sexy bitten nails – Well, I had to find out, and just so you know, I am the 193rd result that comes up when someone searches for sexy bitten nails. The embarrassing thing is that toponlinelexapro.com someone just walked by the computer and saw me searching for sexy bitten nails.

5 – can i sue dentist for telling me about my bad odor – They sound pretty offended, but wouldn’t you want your dentist to let you know? I guess it depends on how they tell you…

6 – legal alternative to bad dentistry – I would say that the best legal alternative to bad dentistry is…good dentistry.

7 – why do dentists love wisdom – The simple answer is: It makes us smarter!

8 – if crap falls off tooth and has post in it can you put cap back on – I hope they meant cap both times!

9 – help i’m a horrible tooth fairy – Maybe a post about how to be a better tooth fairy to your children is in order.

10 – 10 ways that meth damages affects relationships – Hopefully they learned something about how meth damages teeth. If only I were a psychologist.

And here’s a bonus:

11 – help! ferret eaten bubble gum – I’m still wondering how on earth this search landed them at Oral Answers.  I’d Google it right now but I’m a little worried that the same guy who saw me search for sexy bitten nails will walk by again.

Top 10 Least Welcoming Posts on Oral Answers

Sadly, around 9 out of every 10 people who looked at the following posts ended up leaving Oral Answers without reading any other posts.  I’d like to think that maybe they found the answer to their question and then just moved on, but perhaps it was something I said?

1 – A Popping Click When You Open Your Jaw Is Pretty Common

2 – Does Teething Cause a Fever in Teething Babies?

3 – Why Teeth Whitening Toothpaste Isn’t Making Your Teeth Any Whiter

4 – Should You Replace Your Toothbrush After You’re Sick?

5 – What Is The Difference Between Dentists with DMD and DDS Degrees?

6 – Natal Teeth: When Your Baby Is Born With Teeth

7 – At What Age Should Your Child Go to the Dentist for the First Time?

8 – Six Reasons Why You Should Wear a Protective Mouthguard

9 – Teeth Whitening: Two Side Effects of Whitening Your Teeth

10 – Don’t Let Your Teeth Get Hurt This Cold & Flu Season

Top 10 Most Engaging Posts on Oral Answers

Here’s a list of the 10 posts that people spend the most time reading, and how long the average reader spends on it.

1 – How to Really Win a Dental Malpractice Lawsuit – 5 minutes, 22 seconds.

2 – What to Do When Your Child’s Baby Tooth Gets Knocked Out – 4 minutes, 25 seconds.

3 – Why People Hate the Dentist, My Theory Part II – 4 minutes, 24 seconds.

4 – Pain Caused by a High Filling: Why It Happens & How to Fix It – 4 minutes, 22 seconds.

5 – Why You Might Need to Premedicate With Antibiotics Before You See Your Dentist – 4 minutes, 19 seconds.

6 – Top 10 Reasons to Oppose Water Fluoridation – 4 minutes, 17 seconds.

7 – Yes the $3 Teeth Whitening Trial is a Scam – 4 minutes, 10 seconds.

8 – Pulpitis: What’s the Difference Between Reversible & Irreversible Pulpitis – 3 minutes, 57 seconds.

9 – An Alternative to Suing Your Dentist: Peer Review – 3 minutes, 55 seconds.

10 – Tooth Traditions Around the World: It’s Not Just the Tooth Fairy – 3 minutes, 53 seconds.

How Can I Improve Oral Answers?

Do you have any suggestions on what I can do to make Oral Answers better?  Please let me know below in the comments. Thanks for reading!

Why Dentists Take X-Rays
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Many people wonder why it’s so important for their dentist to take x-rays of their teeth.  To understand why, let’s take a quick look at what x-rays do.

You can think of x-rays as invisible light that passes through your mouth and is projected onto a sensor.  As the x-rays pass through your mouth, they are absorbed differently depending on what they pass through.  For example, the x-rays pass through teeth differently than they pass through gum tissue.

This difference is what allows dentists to see the different parts of your mouth on an x-ray.  X-rays are able to detect hidden things that your dentist cannot see by simply looking in your mouth.

There are several reasons why your dentist may want to take x-rays of your mouth.  Hopefully the list below will clue you in on why exactly your dentist wants to get dental x-rays taken.

10 Reasons Why Dentists Take X-Rays

Why Dentists Take Dental X-Rays1 – To Check for Cavities

X-rays allow dentists to see cavities that are between two teeth, which might otherwise remain undiagnosed.  X-rays also allow dentists to see cavities that have formed where a previous dental restoration such as a filling (they don’t last forever) or a crown (yep, you can get a cavity under a crown.)

Learn about six common places where you can get a cavity.

2 – To Determine If You Have Gum Disease

Gum disease, also known as periodontal disease is the leading cause of tooth loss for older adults.

3 – To Check for Abscesses and Cysts

An x-ray can show your dentist if you have any abscesses or cysts in your jawbone near the roots of your teeth.

4 – To Monitor Wisdom Teeth

A panoramic dental x-ray is a great way to see all four of your wisdom teeth.  It can help the dentist determine if there will be any problems with them when they come in or if your wisdom teeth need to be extracted.

Learn why dentists extract wisdom teeth.

Lateral Cephalometic X-Ray
A lateral cephalometric x-ray used to evaluate jaw growth

5 – To Detect Oral Diseases & Tumors

Many diseases remain hidden to the naked eye.  X-rays allow dentists to get an inside look at your jawbone to detect any hidden tumors or diseases that may be lurking under the bone.  For example, an odontogenic keratocyst, is a tumor in the jaw bone shows up on an x-ray.

Also, a panoramic x-ray gives the dentist a good view of the sinuses, which can help the dentist determine if the true cause of your toothache is a sinus infection.

6 – To Make Sure They are Providing Quality Dental Work

Dentists take x-rays at various points during certain dental procedures to ensure that you get the best treatment possible.  For example, during a root canal, your dentist may take a few different x-rays to ensure that they have fully cleaned out your infected root canal and put in a root filling that will allow your tooth to remain healthy for many years into the future.

7 – To Evaluate Injured Teeth

When ever a tooth gets knocked loose or even knocked out, it can often be stabilized.  Dental x-rays are a vital part of this process as they let the dentist know whether or not the tooth was stabilized in its proper position.  Dental x-rays also allow your dentist to monitor the injured tooth over the next several years to ensure that it remains healthy.

In the case of an injured baby tooth, dental x-rays can also allow a dentist to see if it’s likely that the developing permanent tooth under the baby tooth was damaged.

8 – To See Developmental Abnormalities of the Teeth

X-rays can help a dentist visualize any developmental abnormalities of the teeth, such as gemination or fusion, commonly known as double teeth.

9 – To Evaluate Jaw Growth

Orthodontists use x-rays a lot to make sure that the jaws are growing to their proper size.  If abnormal growth patterns are caught in time, orthodontists can manipulate jaw growth to a more normal growth pattern through the use of appliances such as head gear.

10 – To Evaluate You For Dental Work

Many dentists take x-rays to ensure that you can receive certain types of dental work.  For example, a dentist wouldn’t want to give you a bridge if the adjacent teeth aren’t strong enough to support it.

Also, x-rays can be used to evaluate patients before they receive dental implants to ensure that there is an adequate amount of bone present and that the bone is healthy.


Your dentist may want to take x-rays of your mouth for a variety of reasons.

I think that the American Dental Association best sums up the importance of dental x-rays when they state, “Finding and treating dental problems at an early stage can save time, money and unnecessary discomfort. Radiographs can help your dentist detect problems in your mouth that otherwise would not be seen.”

Do you have any questions about why dentists take x-rays? Go ahead and leave them in the comments section below. Thanks for reading!

Should You Rinse Your Mouth After Brushing Your Teeth?
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Are you supposed to rinse after brushing your teeth?  That’s a common question that people have about brushing.

At the Maine Dental Association meeting last year, a presenter was talking about the benefits of fluoride and asked his dental audience the following question:

“Does anybody here actually rinse out with water after brushing so that they rinse away the tooth-protecting fluoride?!?”

He said it in a tone that let you know that you would feel like a complete idiot if you raised your hand.  Although I do rinse out with water, I didn’t dare raise my hand!  From my vantage point, it looked like only two or three hands were raised out of the hundreds of dentists that were present.

Does that one dentist’s opinion mean that everyone should stop rinsing out with water after they brush their teeth?  No.  In fact, there are valid arguments on both sides of this issue.

Before I discuss whether or not you should rinse out with water after brushing your teeth, let’s take a look at both sides of the argument and some supporting studies.

The Reason Behind Not Rinsing with Water After You Brush Your Teeth

Should You Rinse After Brushing?As I pointed out above, if you rinse with water after brushing your teeth, then you are rinsing away the benefits that fluoride provides to your teeth.

Since most people only brush for somewhere around a minute, the fluoridated toothpaste doesn’t spend much time in contact with the teeth.  By not rinsing out after you’re done brushing, you give the fluoride more time to protect your teeth, which could translate to healthier teeth with fewer cavities.

This theory has been backed by research.

This study concluded that:

…there might be a relation between the caries activity and the retention of fluoride after toothbrushing, and that mouthrinsing with water after the brushing should be reduced to a minimum in order to get the maximum beneficial effect of the daily fluoride exposure through the dentifrice.

Even rinsing with a tiny amount of water and making a mouthwash out of the toothpaste left in your mout after brushing has been shown to be effective.  The textbook Dental Caries by Fejerskov states that “Clinical studies in which some of the participants have been taught to use a small volume of water and the toothpaste slurry left after brushing as a ‘mouthrinse’ have demonstrated that further reductions in caries are achievable. A 26% reduction in the incidence of approximal caries has been claimed for this method.”

Approximal caries is just a fancy way of saying “cavities between two teeth” (but hey, saying it like that wouldn’t have sounded as intelligent!)

It would appear from these academic sources that not rinsing or minimal rinsing with water after brushing can help prevent cavities from occurring.

The Reason Behind Rinsing with Water After You Brush Your Teeth

Many people who rinse after brushing say things like:

– Swallowing toothpaste will irritate your stomach.

– You need to rinse after brushing so you an rinse away all of the bacteria that you just brushed off of your teeth.

If you’re like me, you’ve been rinsing out with water after you brush for your whole life and you don’t feel like it’s really affected your life for the worse.  For example, Yahoo Answers user Just Me, recently stated the following about her brushing habits:

i always rinse after brushing…and not 2 brag…but i have really nice teeth!! idk good luck!! 🙂

If you’re never had a problem with your teeth and you rinse after brushing, is there really a reason to change what you’re doing?  Probably not, especially when you take a look at studies that contradict the studies above.

This study consisted of a clinical trial that lasted for three years and included 407 children.  It emphatically states:

Previous studies have indicated that rinsing the mouth with a beaker of water after toothbrushing may compromise the caries reducing effect of fluoride toothpaste.

It is concluded that post-brushing rinsing with water, under the conditions of this study, does not significantly affect the caries reducing effect of a fluoride toothpaste.

It looks like there is some scientific disagreement on whether or not rinsing with water after brushing really does improve oral health.

Should You Rinse Out With Water After Brushing Your Teeth?

I think the reason that there is some disagreement on this subject is because not rinsing after brushing appears to be only beneficial if you are at a high risk of getting cavities.

How at risk are you for cavities?  Here’s 25 things that make you more likely to get cavities.

Personally, I rinse out after brushing my teeth.  From time-to-time, I will use a fluoride mouth wash or simply put some new toothpaste into my mouth and use that as a mouth wash.  After brushing, I spit and then rinse.

If at your most recent dental checkup you were informed that you have some incipient lesions (small cavities that are just starting), then perhaps not rinsing your mouth out after you brush could help heal those small cavities and get you a clean bill of oral health at your next visit.

Do you have any questions regarding whether or not you should rinse out after brushing?  I’d love to hear what you have to say — simply leave a comment below.  Thanks for reading!

Flossing in Public - Is it OK?

Did you know that about two months ago at a minor league baseball game in Lowell, Massachusetts an obscure dental world record was set?

Over 3,000 baseball fans simultaneously flossed.  Together.  In public.  In fact, you can see the happy faces of these world flossing record holders here.

Reading this story reminded me of an incident that happened a few months ago.  I was on a subway train riding home from dental school.  I couldn’t help but notice that the woman across from me was busy flossing her teeth.  Perhaps she had read this article on flossing mistakes and was trying to show the world what a good flosser she was, but I doubt it.

Flossing In PublicAs a budding dental professional and a slight germophobe, I was torn.  On one hand, this woman seemed serious about taking care of her teeth and gums.  On the other hand, she was most likely flicking all kinds of bacteria and perhaps tiny pieces of her lunch on those around her and the inside of the subway car.

Flossing In Public: Is It OK?

I can appreciate both sides of the debate regarding flossing in public.  Here’s a quick summary:

Why Flossing In Public is Not OK

In a recent letter to the American Dental Association, a dentist, Dr. Sigurds O. Krolls, said the following in regards to the world flossing record that was set at that Massachusetts baseball game mentioned above:

I looked in amazement at the photograph of the enthusiastic crowd in the Red Sox’s Single-A affiliate ballpark flossing their teeth. Just imagine all the viruses, bacteria, saliva released in the air! As for the food particles: spit out, removed from the floss with one’s fingers or, at best, swallowed.

And I would not be surprised that in their euphoric state, the flossing was followed by high-fives, handshakes or slaps on the back. No “saniwipes” noticed, but it would have been too late.

Dr. Krolls makes the point that we do have a lot of very small junk stuck in our teeth and it’s best not to remove it when you’re surrounded by other people.

Why Flossing In Public Is OK

There are also people who see no problem with flossing in public.  Some arguments that can be made in the public flossers’ favor are:

  • It’s freedom of expression.
  • A sneeze, like public flossing, also spreads lots of bacteria around.  Should we say that it’s not OK to sneeze in public?
  • Some people may be very careful when flossing in public and don’t let anything leave their mouth.  Should they be penalized for the bad behavior of the food-flinging flossers?

What Are Your Thoughts on Flossing in Public?

Most of the people I’ve talked to think that flossing is something that should be done in the privacy of your own home, or in a public bathroom if it needs to be done in public.

I tend to agree that flossing should be done outside of the public sphere since flossing in public can make those around you uncomfortable or even sick.

What do you think: Is flossing in public OK?

Why People Hate the Dentist

Three weeks ago, I wrote about why people hate the dentist.  I promised a second installment that includes my other theory as to why people hate the dentist.  In order to get the point across, I want to share a story about shopping for a new pillow.  Bear with me, I hope it will make sense!

Let’s say your pillow is worn out and you want to buy a new one.  You head on over to your local store and ask for a pillow.  The salesman comes up to you and says:

“Well, son.  I’ve got this pillow over here.  It won’t be as comfortable as your old pillow.  In fact, there’s a good chance it will hurt you when you buy it and it might hurt you while you sleep for the first few nights.

“And I’ve got to be honest with you, it won’t last nearly as long as your old pillow, but your old pillow is history – you can’t use it anymore so just forget about it.

“Oh yeah, and that pillow insurance you paid a lot of money for a few years ago that was supposed to pay for your pillows for the rest of your life?  It’s only going to pay for half of this pillow, so you’ve got to come up with some cash.”

Why People Hate the DentistYou probably wouldn’t want to buy the pillow.  Think about it though: A similar thing happens when you go to the dentist to get a filling.  If you’d like, go ahead and re-read the above story replacing the “pillow” with a dental filling.

Why People Hate the Dentist: Another Theory

My first theory on why people hate the dentist boiled down to the fact that the only sensation that teeth feel is pain.  The second part of my theory can be boiled down to the following:

Dentists can’t create teeth that are better than your natural teeth.

Let’s say you go to the dentist to have some decay removed and to get a new synthetic piece of tooth to replace your old damaged piece of tooth.  The dentist may or may not tell you the following information:

1 – It might hurt when you get it.
2 – It might hurt for the first few days.
3 – It won’t last nearly as long as your original tooth would have lasted had it stayed healthy.
4 – Your dental insurance may not cover all of it.

So you end up hating your dentist. Not only do your teeth only feel pain, but on top of that, the dentist can’t even repair your teeth to be as good as they once were and you have to pay for something that’s not as good as what you originally had.

The best teeth are the ones that your body makes, not the ones that your dentist makes.

Please remember that as dentists, it’s not our fault that your tooth decayed.  We’ll do our best to fix it, but please be aware that a dental restoration is never as good as the natural tooth that it replaced.

What do you think? Is this one of the reasons that people hate the dentist? I’d love to hear your thoughts in the comments section below. Thanks for reading!

History of the Tooth Fairy

I’ve always found the tooth fairy rather fascinating. Why on earth would anyone in their right mind want to pay people for their discarded body parts? When I cut my fingernails, there’s no fairy out there waiting to swoop right in and pay me for my old nails. Nobody comes and takes away your hair after a hair cut, which is kind of a shame, since The Hairy Fairy has such a nice ring to it.

So, how exactly did the tooth fairy come to be?  After doing a bit of research into this fascinating subject, I discovered the following information.

The History of the Tooth Fairy

History of the Tooth FairyIn ancient times, kids used to give their old teeth to some sort of an animal.  For example, in Ancient Abyssinia, children would throw their tooth at a hyena and ask the hyena to make their permanent teeth strong.

This tradition of giving your tooth to an animal continued on for a long time.  In the 1800’s, French children would throw their tooth under the bed and ask the mice to eat the old tooth and bring them a shiny new tooth to replace the one they had just lost.

Somewhere along the line, children started getting a little smarter, or perhaps a little greedier.  I like to picture a young French boy named Jean-Michel thinking to himself:

I’m pretty much guaranteed to get a permanent tooth.  I should start pushing the envelope and seeing what I can really get in exchange for this used tooth.

Author James Wynbrandt speaks of this transition in his book, The Excruciating History of Dentistry.  “A subtle transition began to occur in the late nineteenth century.  In a variation of the ritual in France, the mouse no longer replaced the tooth, but traded it for a small gift.  French children waited for a nocturnal visit from le petit souris, the little mouse, when they wanted to cash in a lost tooth.  The tooth was put in the child’s shoe, and while the child slept, the mouse exchanged it for a coin.  A barter system also developed wherein a sleeping youngster could trade a tooth for candy, not with a mouse but with a good fairy.”

In my opinion, kids like Jean-Michel may have had a hard time believing that a mouse actually came into their house and took their tooth.  My guess is that certain parents, eager to explain how their child’s old tooth magically turned into cash, thought that a fairy sounded like a good explanation.

Do you have any further insights, thoughts, or questions about the history of the tooth fairy?  How do you celebrate the loss of a tooth in your family?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

Good Dentist

Lately, it seems like dentists have been getting a lot of bad press — which in turn casts dentists in a negative light.  While there are certainly dentists that are less-than-ideal, I’d like to think that these recent stories are the exception and not the rule!

Oral Answers LinksWe’ll start with the bad.  There’s this dentist from the UK that used a dead man’s handicap sticker to get a great parking spot for his Ferrari.  A few other dentists in the UK were also recently in the news.  One has been accused of neglecting his patients and the other one apparently pulled the wrong tooth, threw it away, then dug it out of the medical waste bin and put it back in the patient’s mouth.  In the United States, this former dentist was recently charged with drug trafficking and this dentist was sentenced to prison for defrauding Medicaid, and this dentist is being charged with firing an assistant that simply raised legitimate concerns about the dental practice.

Dr. Dove, a pediatric dentist in California, was recently attacked on Facebook by the father of one of his patients who states that Dr. Dove mistreated his child.  The Facebook group now has nearly 300 members.  You can learn more about his story on Dr. Bicuspid or from this news release.  You can also watch a protest that occurred at his office in this news broadcast clip on YouTube.  Flap’s dentistry blog wrote an article from a fellow California dentist’s perspective.

Although parents say that they have filed complaints against Dr. Dove, I found his public records dental license information by using this dental license verification page and saw that no disciplinary action has been taken by the California dental board.  Interestingly, it did show that the status of  his oral conscious sedation certificate is “delinquent.”

Good Press for Dentists

Hiding under all of that bad press were a few news articles that discuss the good things dentists have done.  I would guess that dentistry is like anything else — you often only hear about the extremes, whether good or bad.

This article tells the story of the unselfish dentists that responded after the September 11th attacks.

Many dentists also provide free care to the underserved population.  Here’s one such article about a dentist in Arizona who did just that last Saturday.

Here’s an article that describes the American Academy of Cosmetic Dentistry’s Give Back a Smile program that has helped restore over 1,000 smiles that were damaged as a result of domestic violence.

To redeem the UK, here’s an article that talks about how dentists in the United Kingdom are providing much-needed dental services in Africa.

Most Dentists Are Good People

Most dentists out there want to help you achieve good oral health and want the best for their patients.  One often quoted factoid is that dentists are one of the most trusted professionals in the United States.  I think that most dentists are working to uphold the status of our profession.  Also, it’s important to keep in mind that the many good things dentists do often go unreported, while the media tends to focus on the bad.

What are your thoughts?  I’d love to hear your opinion — simply leave a comment below.  Thanks for reading!

How Much Radiation Do You Get from Dental X-Rays?
©Tyler Olson/Shutterstock.com

In order for dentists to see hidden problems in your jaws and in your teeth, it is necessary to take x-rays.  It goes without saying that the more dental x-rays you get, the more radiation exposure your body receives.  Extensive exposure to radiation can increase your risk of getting certain types of cancer — this is why it is important to only get needed dental x-rays.

How many dental x-rays you need and how often you need them largely depends on your risk for oral disease.  You can find out how often you should get dental x-rays taken here.

The purpose of this article is to simply let you know how much radiation various types of dental x-rays give you.

Radiation from Dental X-Rays

Radiation from Dental X-RaysRadiation is measured in units called Sieverts, named after Rolf Sievert, a highly-regarded medical physicist known for his work on measuring radiation dosage.  It is estimated that people living in the United States receive 3 milli sieverts of radiation per year from background radiation sources.

The radiation dose received from dental x-rays is measured in micro sieverts.  To help you relate the following numbers to your life, the background radiation that someone living in the United States receives per day is around 9 micro sieverts.

Radiation from Routine Dental X-Rays

A regular dental x-ray, like the one being taken in the picture above, exposes the patient to roughly 10 micro sieverts of radiation.  If the dentist is using an old-style dental film, then more radiation is needed and that number can climb to around 22 micro sieverts.  If the dentist is using a newer-style of x-ray unit that has a rectangular end instead of the round end (as is pictured above), then the radiation dose decreases drastically to around 2 to 5 micro sieverts.

If you get a full mouth series of dental x-rays (usually 18 x-rays), then you’ll be exposed to around 180 micro sieverts of radiation.

Radiation from Panoramic Dental X-Rays

A panoramic or panorex dental x-ray exposes the patient to anywhere from 9 to 26 micro sieverts of radiation.

If you went in to your dentist for a visit and they took four routine dental x-rays along with a panoramic x-ray, you would end up getting about 50-60 micro sieverts of radiation, or the equivalent amount of radiation exposure that you get from living on this earth for 6 days.

Radiation from a Lateral Cephalometric Dental X-Ray

Many adolescents get lateral cephalometric (or lateral ceph) x-rays when they get braces.  A lateral cephalometric x-ray exposes the patient to around 5 micro sieverts of radiation, or the equivalent of 1/2 day of background radiation exposure.

Radiation from a Cone Beam CT Dental X-Ray

Cone beam CT scans can be used to visualize the jaw bones in three dimensions. This aids dentists in diagnosing fractures and oral pathology and can also aid in evaluating patients to receive dental implants.

Depending on the brand of the cone beam CT unit, they emit anywhere from 20 to 600 micro sieverts of radiation, or the equivalent of 3 to 75 days of background radiation.

Questions about Radiation from Dental X-Rays?

For the record, I got the numbers above from the textbook Oral Radiology by White.

Do you have any questions, comments, or concerns about the amount of radiation that you get from dental x-rays? I’d love to hear what you have to say in the comments section below.

No Dental Work is as Good as Your Natural Teeth
©Subbotina Anna/Shutterstock.com

Pretend that you’re in your car driving on a freshly-paved road.  Doesn’t it feel nice as your tires effortlessly glide on the smooth, even surface?

A Repaired Pothole Isn't as Good as the Original RoadFlash forward a few years and imagine driving down the same road.  Due to the recent bad winters, the road is now lined with potholes that have been repaired.

When you drive over that filled in pothole, does it feel as good as the road did when it was new?  Probably not.

Dental Work Isn’t As Good As Your Natural Teeth

When you get a cavity, a dentist is able to remove the decayed portion of your tooth and then replace it with a filling.  However, even the best dentist in the world (is there one?!) can’t make a filling that is the same quality as your natural tooth used to be.  This is the reason that many people can keep their teeth for their whole lifetime, yet many fillings last less than ten years.

Teeth last longer than fillings.  One of the best things you can do for your teeth is to avoid needing dental work by keeping your teeth healthy.

To learn more about keeping your teeth healthy, read about the Top 12 Weapons of Plaque Destruction and What Every Human Needs to Know About Plaque.

Do you have any questions or comments about how you can keep your teeth healthy to avoid losing your natural tooth structure? I’d love to hear them in the comments section below. Thanks for reading!

Scary Dentist with Real Drill
©Alan Bailey/Shutterstock.com

One of my professors told me that he has often been told, “Hey Doc, it’s nothing personal, but I hate dentists.”  This professor also shared that he thinks statements like these just come with the job.  I know of another dentist who reacts when his patients tell him that onlineusadrugstore24.com they hate dentists by asking the patient what they do for a living.  He then tells them that he hates their profession.

In my few years of experience in the dental field, I have met more than a handful of people who openly share their dislike of dentists.  My first inclination is to find out why.  Was it a bad experience when they were younger?  Have they had difficulty communicating with their dentist? Have they had procedures done without good pain control?

As a kid, I loved going to the dentist because I would always get a new toothbrush. But I know I’m in the minority, or maybe just weird — probably both.

A lot of people hate the dentist due to dental fear (for example, here’s 15 reasons why people are afraid of the dentist), but I want to dig a little deeper and discover the root cause of all the hate.

Anyway, I’ve spent a significant amount of time thinking about this and I finally have my own personal theory of why people hate the dentist.

Why People Hate the Dentist

My theory actually has two parts. I’ll cover the first part this week, and the second part next week.

According to the first part of my theory, the reason that people hate the dentist is because teeth only feel pain.

Why do so many spouses buy massages for their loved ones on Valentines day?  Because a massage is pleasant — usually people want a back massage because it makes them feel good.

Unfortunately, teeth aren’t quite the same as our backs when it comes to senses. Teeth can only sense pain.  Imagine what it would be like if people craved their dental checkup because they were going to get their teeth massaged, rather than cleaned.  What would life be like if a root canal was called a deep massage and actually felt good?  You’d probably see lines at every dental office filled with people begging to get a root canal done so that they could have a full-tooth massage.

Brushing your teeth might make your mouth feel clean, but it’s more of a necessity than a feel-good experience.  Most people would agree that the only time you really notice your teeth is when there is a problem!

Why People Hate The Dentist

Tooth Massage
“I love a good tooth massage”

The Odds Are Against Us

Many dentists try to make going to the dentist a pleasant experience, but it’s hard when your teeth are capable of only feeling pain.  People usually go to the dentist for one of two reasons.  The first is to have a routine cleaning, which is relatively painless but can be uncomfortable depending on the amount of plaque to be removed.  The second reason people go to the dentist is because they have a problem, and more often than not it is a painful problem.  Either way, if your dentist does his job well, at best you would feel no pain.  But it is impossible for a dental procedure to feel good since teeth only feel pain.  I mean, when was the last time that you said this to your dentist: “That root canal was amazing!  Is there any chance you could do that to another one of my teeth at the next appointment?”

Dentists are in the business of preventing problems (although most of that falls back on the patient) and solving problems.  Most of these problems are painful, and in addition, most of these problems require more pain (from the procedures) in order to be solved.  If only your teeth were able to feel the good things that we do for them, people might not look at dentists with so much fear!

Why Do You Think People Hate the Dentist?

I realize that most people probably don’t actually hate “the dentist” but hate the experience of going to the dentist.  I may be wrong in assuming that, but most dentists I’ve met over the years seem like pretty decent people.  So it seems that people “hate the dentist” because of all they associate with visiting their dentist.  Guilt by association, right?

Do you hate the dentist?  Do you have any other theories?  I’d love to hear your thoughts.  Please leave a comment below and join in on the conversation.

Thanks for reading!

Clean Tongue No Bad Breath
©DPix Center/Shutterstock.com

Before I started dental school, I never used to clean my tongue.  I had always heard that it was good to brush and floss, but I thought that cleaning my tongue was overkill.

A couple of years ago, I decided to start using a tongue scraper to clean my tongue every night before going to bed.  After doing that for a while I noticed that I never had that “morning breath” taste in my mouth when I woke up in the morning.

It turns out that I’m not the only one that experienced better breath due to tongue cleaning — numerous studies show that brushing and/or scraping your tongue can help get rid of bad breath.

How Do Studies Measure Bad Breath?

Tongue ScraperIf you’re anything like me, you’re probably wondering how studies can show that people have better breath.  I wondered if there was a “breath guru” out there that smelled everyone’s breath and impartially declared “That stinks” or “Smells good.”  Although that would make these studies more exciting, they actually use a little device called a “sulfide meter” that detects the amount of stinky sulfur compounds in the participants’ breath.

Scraping or Brushing Your Tongue Can Get Rid of Bad Breath

Your tongue has lots of tiny little projections.  It’s easy for food to get trapped in between them.  This food can decompose and start to smell pretty crazy, giving you bad breath unless you brush or scrape your tongue to clean out the food.

Two systematic reviews combed through the studies that looked at bad breath and tongue cleaning.  Both concluded that tongue cleaning can reduce bad breath.

The first systematic review concluded the following:

This review demonstrated that mechanical approaches, such as tongue rushing or tongue scraping to clean the dorsum of the tongue, have the potential to successfully reduce breath odour and TC.”

(In case you’re wondering, TC was their code word for tongue coating.)

This other systematic review from Cochrane states that bad breath was reduced 40-75% by simply cleaning the tongue.  It said that scraping the tongue gave better results than just brushing the tongue.

Is it Better to Scrape or Brush Your Tongue to Get Rid of Bad Breath?

The studies seem to support that it is better to scrape your tongue rather than brush it to get rid of bad breath.  I do both.

My nightly routine usually consists of flossing, brushing my teeth, brushing my tongue, and then scraping away everything off of my tongue that I loosened by brushing.  Aside from enjoying better breath, I’ve noticed that my tongue no longer has the white coating that it used to have.

Where Can You Buy a Tongue Scraper?

Tongue CleanerMost department stores and pharmacies have tongue scrapers for you to purchase.  You can take a look at a few of these that sell well on Amazon and have 4.5 to 5 star reviews:

This one is less than $2 and has a 5 star review rating: Butler G-U-M Fresh-R Tongue Cleaner

Here’s the best-selling tongue scraper on Amazon: Stainless Steel Tongue Cleaner

Here’s a stainless steel tongue scraper that looks like it might hurt! I included it because it does have 18 reviews and a 5 star average rating, so it must be doing something right. Stainless Steel Tongue Sweeper – Model P

Do you have any questions, comments, or concerns about cleaning your tongue for better breath?  I’d love to hear them in the comment section below.  Thanks for reading!

Types of Sports Mouthguards
©Suzanne Tucker/Shutterstock.com

Did you know that a recent survey by the American Association of Orthodontics found that “70 percent of parents said their biggest fear is that their child will get hurt while playing organized sports, yet 67 percent admitted that their child does not wear a mouth guard during organized sports including football, basketball, soccer and lacrosse.”

I’m guessing that the survey asked parents about their biggest fear relating to their child and sports, not just their biggest fear in general.  If the latter were asked, I’m pretty sure that most parents would’ve said that their biggest fear has something to do with pythons, getting stuck in an elevator, or getting stuck in an elevator with a dentist and his drill.

Back to mouth guards.

While there are a variety of mouth guards out there, they can all be categorized into three basic groups.

The Three Types of Sports Mouth Guards: Which is Best?

In this section, I’ll go over the three main types of sports mouth guards.  If you’re impatient and you need to know which one is best, jump down to the next section where I provide the answer.

1 – Pre-formed or Stock Mouth Guards

Shock Doctor Brand Stock Sports MouthguardThe mouth guard pictured to the left is a Shock Doctor brand sports mouth guard.  It is a typical pre-formed or stock sports mouth guard.

The biggest advantage of stock sports mouth guards is that they are usually fairly cheap — they can usually be purchased for $10 or less.

The biggest draw back of stock sports mouth guards is that they are a “one size fits all” type of mouth guard.  Sure, they have different sizes for children and adults, but they don’t take into account the fact that jaws are all shaped differently.

Stock mouth guards are also usually rather bulky and make it more difficult to speak versus the other two types of mouth guards.

2 – Boil/Heat & Bite Mouth Guards

Boil and Bite Mouth Guard - Brain Pad Pro PlusPictured to the right is a Brain-Pad Pro Plus brand boil & bite mouth guard.  The name may be a bit misleading as it’s still not clear whether or not mouth guards prevent brain injuries.  These mouth guards are generally considered to be a step above the one-size-fits-all stock sports mouth guards.

When you open up a boil and bite mouth guard, it’s not ready to use.  You need to heat it up and bite down on it so that your teeth make an imprint on the inside.  They are usually heated up in hot water, hence the term boil & bite mouth guard.

Boil & bite mouth guards are usually fairly inexpensive.  They can be found in the $20 to $50 range. This particular brand retails for right around $20.

3 – Custom Fit Mouth Guards

Custom Sports Dental Mouth GuardA custom fit mouth guard is pictured to the left.  These types of mouth guards are usually the least bulky (only a few millimeters thick) and they are custom-made, usually by a dentist, to fit your teeth.  My dental school charges $75 for a custom sports mouth guard, but most dental practices seem to charge $100 to $200.

While looking around on Amazon, I did find that both Shock Doctor and Sporting Smiles sell a kit that will allow you to get a custom mouth guard made without setting foot in a dental office.  They are slightly cheaper, but if the fit is poor then you are out of luck.  If your dentist makes a custom fit mouth guard and the fit is poor, he or she can make adjustments (usually at no extra charge to you) if needed.

The Best Mouth Guard for Protection Against Sports Injuries

You may wonder which type of mouth guard is superior in terms of the protection it provides.

One of the main problems with mouth guards is that they’re not “cool” to wear.  Many kids give up wearing their over-the-counter mouth guard because it’s too bulky or it makes it harder for them to breathe.

This study by Bass determined that athletes were much more likely to wear a mouth guard if it fit well and was comfortable.  Interestingly, studies have shown that custom made mouth guards fit better, are more comfortable, are less likely to affect speech, and are less likely to come loose.

Pinkham’s Pediatric Dentistry textbook states the following about the high cost of custom-made sports mouth guards: “Even though the actual cost is higher than that of other types of mouth guards that are available, the relative cost is low compared with other equipment such as athletic shoes.  Furthermore, the actual cost is far more conservative than the fees associated with emergency and long-term management of a traumatic athletic injury.”

While that is true, many parents choose the least expensive option when it comes to mouth guards.  Although any mouth guard is better than no mouth guard, it’s important to get a mouth guard that fits well enough that your child will actually wear it during sports activities.  A well-fitting, comfortable custom-made mouth guard can be a good investment for your child if they plan on playing lots of sports throughout their childhood.

Want to know why mouth guards are important?  Read Six Reasons Why You Should Wear a Protective Mouth Guard.

Do you have any questions, concerns, or comments about which sports mouth guard is best for your child?  Write them below in the comments section.  Thanks for reading!

What Causes Cavities on Teeth
©Sebastian Kaulitzki/Shutterstock.com

If you’re like most people, you may believe that sugar causes cavities.  After all, candy is bad for our teeth, right?

Sugar doesn’t cause cavities.  In fact, this has been known for over 50 years!

In 1954, a man by the name of Frank Orland wanted to see if sugar caused cavities.  He conducted a pioneering research study, in which he raised 22 rats in a sterile environment.  From birth ’til death, these rats never had any contact with any germs.  He fed these rats lots of sugar throughout their entire life.

Guess how many of these rats that ate sugar every day ended up getting cavities?


None of the rats that were raised “germ-free” got any cavities even while they were eating all of the sugary foods that they wanted.  In contrast, 38 of the 39 rats that ate the same foods but were not raised “germ-free” ended up getting cavities.

Part of his conclusion states, “Findings indicated that twenty-two rats reared under germfree conditions remained entirely free of even microscopically demonstrable dental caries. Of thirty-nine conventional control rats, possessing the usual mixed microbial populations, thirty-eight developed various lesions when maintained on the same kind of dietary regime as the germfree animals. It is deduced from this evidence that dental caries in the rat is not possible in the absence of microorganisms.”

If you only looked at Dr. Orland’s study, you may be tempted to say that it must be bacteria, and not sugar, that causes cavities.

More recently, other studies have shown that it’s possible for rats with bacteria to not have any cavities if they are not fed sugar or fermentable carbohydrates.

These studies lead us to believe that bacteria and sugar must be present in order to get cavities.  But even these two elements don’t account for the whole picture.

For example, my wife never had a cavity in the first 25 years of her life.  Like most normal people, she ate sugar and had bacteria in her mouth.

So, what really causes cavities?  There are actually four components that, when present together, cause cavities:

What Causes Cavities?

In order to get cavities, you need to have four main ingredients:

1 – Sugar
2 – Bacteria
3 – A Susceptible Tooth
4 – Time

You can take a look at this relationship in the diagram below.  If you’re interested, you can then read about how you can use this information to prevent cavities.

4 Causes of Cavities & Tooth Decay


1 – Sugar

For simplicity’s sake, I labeled this category as sugar.  In reality, it could be called refined carbohydrates because anything that can be broken down into sugar inside of your mouth is able to feed the bacteria that contribute to causing cavities.

For example, potato chips are made of a simple starch that can be broken down into sugar by enzymes that are found in your saliva.  How often you eat sugar is more important than how much sugar you eat in one sitting.

To learn more, read What Happens In Your Mouth Every Time You Eat or Drink, What Fermentable Carbohydrates Are & How They Hurt Your Teeth, and 50 Names for Sugar that Food Makers Use to Trick You.

2 – Bacteria

Bacteria live inside all of our mouths (unless you’re one of the rats in Dr. Orland’s study!)  It’s really fascinating to me that there are millions of little creatures living inside of everyone’s mouth — this is what first got me interested in dentistry and was the subject of my first article here at Oral Answers, What Every Human Needs to Know About Plaque.

While you can’t completely rid your mouth of all the bacteria, you can destroy the homes they build on your teeth every time you brush and floss.  By regularly brushing and flossing, you can help win the fight against the bacteria in your mouth.

3 – A Susceptible Tooth

Many people who have had their share of cavities say that they have soft enamel or that  bad teeth run in their family.  While there’s no such thing as soft enamel, people can have enamel that may not have been formed correctly.  Also, bad teeth aren’t genetic, but some people’s teeth do have deeper pits and grooves than others.

These pits and grooves can be so deep that even a bristle on a toothbrush can’t reach down to clean them out.  In these cases, these people will almost always get cavities unless they have had sealants placed on these teeth when they were kids.

There are many other factors that influence how susceptible a tooth is to getting cavities.  I will only go over a few of the more common ones.

The first is the quality and amount of the dental enamel.  Pinkham’s Pediatric Dentistry text states that enamel hypoplasia (when not enough enamel forms), even at levels that are undetectable,  increases susceptibility to tooth decay.

Saliva also plays an important role in how susceptible a tooth is to decay.  The more saliva you have, the better.  To learn more about the role that saliva plays in your oral health, read How Saliva Protects Your Teeth and Six Main Causes of Dry Mouth/Xerostomia.

The last factor I will discuss that makes your tooth more susceptible to cavities is the wearing away of tooth structure.  This commonly occurs through the process of acid erosion, which can occur by drinking these nine teeth-dissolving drinks, however there are four ways that you can wear away your teeth.

4 – Time

Darius Rucker sang the following words Hootie & The Blowfish’s hit Time back in the 90’s

Time, Why you punish me? Like a wave crashing into the shore, you wash away my dreams.

Time can in fact wash away your dreams of having healthy teeth if you give the bacteria enough time on your teeth.  In fact, you can have all three elements above and not get cavities if you don’t give the bacteria time to eat away at your tooth.

Plaque eats sugar, which produces acid that slowly eats away at your susceptible teeth.  The key is to not give the bacteria enough time on your teeth.  You can do this by brushing and flossing regularly.

To learn more, read the article Try to Keep Your Teeth Below Freezing.


Cavities don’t just happen spontaneously.  You need four things to get cavities: sugar, bacteria, susceptible teeth, and time.

You can’t really control the bacteria unless you live in a sterile environment.  You also can’t control the genes that sculpted your teeth into their exact formation that might make them hard to clean. You can control how much sugar you eat, your oral hygiene, and how well you treat your teeth (don’t treat your teeth like tools!)

Do you have any questions, stories, comments, or concerns about what really causes cavities?  I’d love to hear them in the comments section below.  Thanks for reading!

How to Reduce Swelling After Wisdom Teeth Removal
©Robert Kneschke/Shutterstock.com

Nobody wants to look like a chipmunk after getting their wisdom teeth out, but when their cheeks get swollen, most people do end up looking like a chipmunk!

While some swelling is normal after this procedure, the good news is that you have some control over your swelling.  Here are a few simple things that you can do to reduce your swelling after wisdom teeth extraction.

How to Reduce Swelling After Wisdom Teeth Extraction

Reduce Wisdom Teeth Swelling1 – Apply Cold & Heat at the Right Time

Many oral surgeons send their patients home with ice packs after getting their wisdom teeth extracted.  There is some controversy over whether or not using ice immediately following wisdom teeth extraction can actually reduce swelling.  Although it may not be proven, it probably wouldn’t hurt to try this method.  Applying heat to your cheeks has been shown to reduce swelling after wisdom teeth extraction, but you have to do it at the right time.

Here’s a time line of when you should apply cold and heat to your cheeks to reduce swelling:

0-24 hours after wisdom teeth extraction: Apply ice for 20 minutes on, then 20 minutes off.

24-48 hours after wisdom teeth extraction: Don’t apply ice or heat.

48 hours after wisdom teeth extraction: Apply heat.

Keep in mind that you shouldn’t apply ice directly to your skin.  It’s a good idea to have a cloth between the ice and your skin to avoid causing damage to your skin.  If you don’t have ice packs, you can use a bag of ice cubes or frozen vegetables.  Along the same lines, you don’t want to use water that is too hot for too long – you don’t want to burn your skin!  Heating pads and hot water pads are good suggestions.

2 – Keep Your Head Held High

Reduce Swelling After Wisdom Teeth Extraction by Keeping Your Head Up
You Can Reduce Swelling After Wisdom Teeth Extraction by Keeping Your Head Elevated

Keep your head held high – literally!  By keeping your head elevated above the rest of your body, gravity will be your friend and cause excess fluid to flow down from your cheeks and back into your bloodstream.  This is the reason why your cheeks are more swollen after a good night’s sleep.  By laying down, you don’t have gravity helping you keep your swelling to a minimum.

To use this principle to your advantage, it would be a good idea to keep your head propped up with pillows rather than laying down so that your head is at the same level as the rest of your body.

3 – Use Corticostroids

Certain studies (such as this one) show that steroids can reduce cheek swelling after your wisdom teeth get extracted.

The textbook  Contemporary Oral and Maxillofacial Surgery recommends the steroid dexamethasone to control “postsurgical edema” (which means swelling after surgery) and said the following regarding using steroids to reduce swelling after wisdom teeth extraction:

Dexamethasone is a long-acting steroid and its efficacy in controlling third molar postsurgical edema is documented.  This drug can then be continued in an oral dose of 0.75 to 1.25 mg twice a day for 2 to 3 days to continue edema control.

There are, of course, several drawbacks to using steroids.  You may want to ask your oral surgeon if dexamethasone is a good choice for you to reduce swelling after you get your wisdom teeth extracted.  He or she will be able to help you weigh the pros and cons.

Wisdom Teeth Extraction - Don't Look Like a Chipmunk!

Why Do Your Cheeks Get Swollen After Wisdom Teeth Extraction?

This article wouldn’t be complete without mentioning the reason for your swollen cheeks.  Swelling after wisdom teeth extraction is simply a natural, healthy response that helps your body heal.  Many times, the oral surgeon has to cut through your gums and drill through bone to remove your wisdom teeth.  You would probably expect to have swelling after any invasive surgery to remove an appendage of your body, and getting your wisdom teeth out is no exception.

To learn more and to find out how long you can expect to have swollen cheeks after wisdom teeth removal, read the article Why You Get Swollen Cheeks After Wisdom Teeth Removal.

Do you have any questions, comments, or concerns about your swollen cheeks and wisdom teeth extraction?  Go ahead and write them in the comments section below.  Thanks for reading!

Tooth Fairy Traditions from Other Countries

Being the youngest child of seven, I’m not sure I really had a chance to believe in the tooth fairy. By the time I started losing my teeth, I think my parents had gone through this process so many times before that they simply gave me money for my lost tooth and then put my tooth in an old 35 mm film canister. I’m not sure what became of that little container of my baby teeth…

Tooth Fairy: Traditions Around the WorldDr. Rosemary Wells, the curator of the Tooth Fairy Museum (yes, it really exists!) in Deerfield, Illinois has stated that the tooth fairy is only known to exist in the United States and in countries with a similar ethnic background.  This made me wonder what exactly happens all over the world when little boys and girls lose their teeth.

After reading some books, I was able to find out that there are several twists on the tooth fairy that include feeding your teeth to dogs, throwing your tooth to the sun or on the roof, and summoning the help of a variety of animals to ensure that your permanent tooth will grow in properly.

Here are some other interesting tooth traditions from around the world arranged in alphabetical order for your reading pleasure.


Kids in Afghanistan throw their teeth in a mouse or rat hole.  They want the rodent to give them a nice, strong tooth like the ones they have.

American Indian Tribes

TLost Baby Teethhe parents of children in the Chippewa tribe use charcoal to make the lost tooth turn black and then throw it to the west while asking the child’s grandma to help the permanent tooth to grow in strong.

The Cherokee Indian children would run around the house with the lost tooth and then throw it on the roof while reciting this phrase four times: “Beaver, put a new tooth in my jaw!”

Navajo Indian children take their tooth to the southeast, away from their house. They bury the tooth on the east side (the east is associated with childhood) of a sagebrush, rabbitbrush, or pinyon tree.

Teton Indian children bury their tooth in the dirt at the entrance to the lodge. Anyone who walks over the spot where the tooth is buried is said to grow a new tooth.

Shuswap and Yupik Indian kids mix their lost tooth in with some meat and then feed the mixture to a dog while saying, “Make my teeth strong.”

The Dene Yellowknives have their mother or grandmother take their lost tooth, put it in a tree, and then have their family dance around the tree. This makes it so that their new tooth comes in straight as a tree.

Howling Hyena Tooth Fairy
Kids in Ancient Abyssinia threw their teeth to a howling hyena.

Ancient Abyssinia

Children used to throw their lost tooth to a howling hyena, asking the hyena for strong teeth.


Children in Argentina put their tooth in a glass of water.  During the night El Ratoncito, a little mouse, will drink the water, take the tooth, and then leave some coins or candy in the empty glass.


Children in Australia put their tooth under their pillow and wait for the tooth fairy to come give them money in exchange for their tooth.


Children in Botswana throw their tooth on the roof and then ask the moon to bring them a new tooth.

Brazilian Tooth Fairy: Birds
Brazilian kids throw their tooth out the window.  It’s for the birds!


Some children in Brazil throw their tooth outside and ask the birds to take it and bring them another one.  The birds will only take the tooth if it doesn’t have any cavities!  Other children throw their tooth out of their window and onto the roof while asking Saint John to take it and bring them a healthy new tooth.


Chinese kids put their upper teeth at the foot of their beds and put their lower teeth on the roof.  It is hoped that this will make their permanent teeth grow in faster.


Colombian children put their tooth under their pillow.  A mouse named El Ratón Miguelito takes their tooth and gives them money.


Danish children put their tooth under their pillow and wait for the tooth fairy to come give them some money.

Egyptian Tooth Fairy Sun
Kids in Egypt Throw their teeth at the sun


Egyptian children wrap their teeth in a tissue and take it outside.  They throw their tooth at the sun, asking the son to take their buffalo tooth and give them a bride’s tooth.  This is similar to most children in middle-eastern countries, who throw their tooth at the sun, hoping that it will give them back a tooth to make their smile brighter!

El Salvador

Children in El Salvador put their teeth under their pillow.  At night, a rabbit comes and takes their tooth, leaving behind money.


In England, kids put their tooth under their pillow and wait for the tooth fairy to come and leave money.

Mice Give Children Their Permanent Teeth in Some Cultures
A mouse, not a fairy, takes a way French children’s teeth.


French children put their teeth under their pillows.  At night le petite souris, a mouse, will take away their tooth and leave a gift.


Children in Greece throw their teeth on the roof for good luck.  Then they make a wish that their adult teeth will be healthy and strong.


Children in Guatemala put their tooth under their pillow and wait for a mouse to take their tooth away and leave them some money.


Children in Haiti throw their tooth on the roof and ask a rat to give them a good tooth in return for their old baby tooth.

Children Throw Their Tooth on the Roof
Kids in India throw their teeth onto their roof.


Some kids in India throw their tooth on the roof and ask a sparrow to bring them a new tooth.  Other children in India throw their tooth at the sun, hoping for a bright adult tooth in return.


Indonesian children throw their tooth backwards over their shoulder and over the roof of their house.  If they throw the tooth straight, their permanent tooth will grow in straight.  If they throw it crooked, they will have crooked teeth.


Jamaican children believe that when their tooth comes out, a Calf will come to take them and their tooth away.  To keep the calf at bay, the children will put their tooth in a tin can and shake it so that it scares the calf.


Children in Japan throw their upper teeth in the dirt and their lower teeth on the roof.  The thought behind this is that their new teeth will grow in straight as they grow toward their old teeth.


Children in Korea throw their tooth on the roof of their house and sing, “Blackbird, blackbird, my old tooth I give to you.  Bring me a new tooth.”


Lithuanian children keep their teeth as a souvenir.


Malaysian kids bury their lost baby tooth in the ground.  They believe that since the tooth was part of their body, it should be returned to the earth.

Nepal Tooth Fairy Birds
Kids in Nepal are careful to not let a bird eat their lost tooth


Children in Nepal are very protective of their lost tooth.  They believe that if a bird sees or eats their tooth, then a new one won’t grow in.  Their goal is to bury their tooth so that it won’t ever be seen or found and eaten by a bird.


Children in Nigeria have an interesting tradition.  If you’re a boy, you hold your tooth and eight stones in your fist.  Girls hold six stones and their tooth in their fist.  The child then closes their eyes, states their name, and counts to the number in the fist.  They then say, “Oh, I want my tooth back!” Next, they throw everything in their fist up in the air and run away as fast as they can.

Pakistani children throw their tooth into a river at sunset
Pakistani children throw their tooth into a river at sunset


Kids in Pakistan wrap their lost tooth in cotton then throw their tooth in a nearby river at sunset for good luck.


Children in the Philippines hide their lost tooth and make a wish.  If they are able to find their teeth after one year, then they can make another wish.


Children in Russia put their lost teeth in mouse holes in the hope that the mouse will give them a strong tooth as a replacement.


Spanish children put their teeth under the pillow.  A little mouse named Ratoncito Perez will take away their tooth in exchange for money or candy.

Sri Lanka

In Sri Lanka, Squirrels Take Away Teeth
Kids in Sri Lanka ask squirrels for a new tooth.

Sri Lankan kids stand outside of their house, close their eyes and say, “Squirrel, Squirrel, take this tooth and give me a new one.”  Then they throw their tooth on the roof and go back into their house.  Then they open their eyes.


Swedish children put their tooth in a glass of water.  In the morning a coin mysteriously takes the place of the tooth in the glass of water.


Children in Taiwan throw their teeth on the roof.


Children in Tajikistan plant their teeth in the ground, hoping that the tooth will grow into a warrior.


The parents of children in Turkey believe that their child’s lost tooth holds within it their future.   If they want their child to become a great soccer player, they will bury the tooth in a soccer field.  If they wanted their child to go to dental school (what kind of parent would?!) then they would bury the child’s tooth around a dental school.

American Tooth Fairy
Our beloved American tooth fairy

United States

Children in the United States put their lost teeth under their pillow at night.  The tooth fairy comes and takes their tooth away and usually leaves a small amount of money under the child’s pillow in exchange for the tooth.


I obtained information for this article from a variety of sources, including:

Any Other Lost Tooth Traditions?

What about you?  Do you do something different than what was mentioned above?  If so, please leave a comment in the comments section below — I’d love to hear about your lost tooth traditions.

Dental Pain Meds Drug Abuse

The United States’ biggest illegal drug problem is marijuana. Can you guess what the second biggest illegal drug problem in the United States is? Prescription painkillers.

Did you know that dentists are second only to general practitioners in terms of the volume of pain medications they prescribe?

A Story of Dental Drug Seeking

Drug Addicts Try to Get Painkillers from DentistsLast week I was volunteering at a community dental clinic in a rural area. We had a few cancellations that day and we agreed to see an emergency patient who stated that her tooth was hurting her.

I brought her back and had her sit down in the dental chair. After performing an exam and taking an x-ray, the tooth seemed in great condition.

I started to get suspicious when she asked me if we gave out pain medication following an extraction. When I told her that we did, she said, “Great – I already know which ones I want!”

Drug Seekers and Dentistry

This article from TIME Magazine’s website talks a little bit more about the problem of prescription drug abuse.  It says that more than 2/3 of people who abuse pain medication get it from a friend or relative’s medicine cabinet.  So many people save leftover pain medication just in case they get severe pain in the future and end up needing something stronger than the typical over-the-counter pain medications.

The article talks about a dentist named Dennis Bohlin who wanted to call in a prescription for one of his patients.  It says:

Bohlin, himself a long-term recovering addict and an expert on addiction in dentists, recently got fooled by a patient requesting an opioid prescription. “I called the pharmacy and they said, ‘We won’t fill that,'” because apparently she was known to them as an active addict, he says.

“We have to respect people’s pain,” says Bohlin, who will treat recovering addicts with opioids if necessary, but will often have a significant other or recovery sponsor take charge of the drugs. “That’s why this is such a complex problem.”

I agree with Bohlin that we need to respect people’s pain.  It is wrong to conclude that someone is not experiencing pain just because they have a history of abuse.  That being said, it’s difficult to remain objective and not be judgmental when you are treating a patient with a known history of narcotic abuse.

Although in the minority, I have had patients tell me that they are recovering addicts and that I shouldn’t give them any prescription painkillers.  Sometimes they will simply ask us to prescribe a stronger version of over-the-counter Motrin [ibuprofen].

Motrin (ibuprofen) is actually very effective in treating dental pain.  I recently read a study for one of my anesthesia courses that discussed the effectiveness of ibuprofen in dental pain relief.  It surveyed patients and found that a few hours after extractions, ibuprofen was stronger than drug mixtures of asprin and codeine.

It said, “Postoperative dental pain typically is caused by tissue injury and inflammation and usually has a short duration; as a result, NSAIDs in combination with acetaminophen should be considered the first-line analgesic regimen for most patients.”

Addicted to Painkillers?  How to Get Help

If you or someone you know has a problem with an addiction to painkillers, you are not alone.  There are treatment programs available that can help you overcome this problem.  This page from the United States Office of National Drug Control Policy gives some helpful pointers on how to report illegal prescription drug abuse and how to help your loved ones that may have succumbed to this sort of drug abuse.

Do you have any questions, comments, or concerns about prescription painkillers and dentistry?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

Teenagers Smoking Cigarettes
©Edyta Pawlowska/Shutterstock.com

I received my first anti-smoking education when I was in 6th grade in middle school. I remember learning about the different warnings that cigarette companies had to put on every pack of cigarettes.

Cigarette WarningsI remember thinking that if I ever manufactured cigarettes, I would use the warning “Cigarette Smoke Contains Carbon Monoxide.”  That warning makes smoking sound so harmless — I figured it was the best warning to use if you wanted to sell more cigarettes.  It doesn’t even mention the bad effects that smoking has on your body; and if someone doesn’t happen to know what carbon monoxide is, then they will smoke in blissful ignorance.

I never did end up in the cigarette industry — and no,  I don’t have any regrets!  Starting on September 22, 2012, all cigarette manufacturers in the United States will be required to place very large warning graphics in their advertising and on every single pack of cigarettes.

One of the graphics discusses a topic that is taught in great detail at all dental schools across the United States — oral cancer.

Cigarette smoking doesn’t just cause oral cancer. Did you know that smokers have less teeth than non-smokers?

How to Look at the Nine New Cigarette Warning Labels

You can view all nine of the cigarette warnings at this page.  The oral cancer one is #5.

If you want to see the new cigarette warnings in high resolution, you can download this PDF file provided by the Food and Drug Administration.

Will The New Cigarette Warnings Make a Difference?

All of my patients that are smokers know that it can harm their bodies.  They know that they shouldn’t do it, but they keep doing it.  I would imagine that even with these new warnings, most smokers will continue their cancer-causing habit.

However, the population that I think these new warnings will benefit are children and teenagers.  By putting a visual aid on every pack of cigarettes, it will make children and adolescents think twice before beginning a habit that can damage their bodies.

Learn about one simple way to reduce your risk of oral cancer.

What’s Your Take?

Do you think that the new cigarette warnings will help fight the war against tobacco?  Do you think they won’t make a difference?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

Cute Little Girl Brushing Teeth
©Oksana Kuzmina/Shutterstock.com

Oral Answers LinksIt’s been a long week, and I’m excited for the weekend!  Two more weeks until the end of the semester, then we’re going to go exploring to find a place where we’ll end up after dental school.

We’ve been to Maine and Vermont.  We’re headed to Maryland in August.

10 more months and I’ll be a dentist.  Time’s passing by fast!

Here’s some interesting links that caught my eye over the past week:

Is Your Dentist Putting Germs Around Your Neck?

I read this Fox News article and was a little grossed out.  It turns out that the little chains dentists use to hook the patient napkin around your neck can harbor bacteria from the previous patient.

Germs on Dental Chains
Does Your Dentist Hang Germs Around Your Neck?

I always thought my dental school was just being cheap — we tape our patient’s napkins to their shirt to hold them on rather than using the standard chain.

Today I did an externship at a community dental clinic and the germophobe in me made me sanitize the chain that we were using there.  Hopefully, it fit into the 80% of “uninfected” chains after I was done with it…

An Eggsperiment to Understand Your Teeth

Crest whipped up a little experiment to help kids understand dental decay.  It involves using an egg, vinegar, and Crest toothpaste (of course no other brand would work!  Any fluoridated toothpaste should fit the bill.) to understand how the bacteria in your mouth eat away at your teeth and weaken them, and how fluoride can make your teeth stronger.

If you don’t want to do the experiment, but want the educational experience, try reading the article Try to Keep Your Teeth Below Freezing.

Fairbanks De-Fluoridates Their Water

The city of Fairbanks, Alaska has stopped adding fluoride to their public water supply.  Given that their water is already naturally fluoridated with 0.3 ppm of fluoride and people are getting fluoride from other sources, it may not be such a bad move to balance out the prevention of dental fluorosis as well as the prevention of cavities.

If you want a closer look into the water fluoridation debate, check out this final report from the Fairbanks Fluoride Task Force.  It is a PDF file, so it may take a bit longer to load.

Questions or Comments?

I’d love to hear what you have to say about any of these articles.  Feel free to leave a comment in the comments section below.  Thanks for reading – have a great weekend!

Comprehensive Dental Exam

Have you ever wondered how thorough your routine dental exams are?

A dentist that I shadowed prior to dental school told me that he used to rush through patient exams trying to get as much done as he could.  Eventually, he got tired of this because he really wanted to spend more time with his patients.  He doubled the price of his exams and spent twice as much time with each patient, being as thorough as he could.  Rather than losing patients, he said that he gained many more patients because his exams were complete and his patients felt they were getting a quality exam at each visit.

What Is a Dental Exam?

At my dental school, we do our exams by-the-book — we’re pretty thorough!  We examine just about every possible thing that a dentist can.  I thought I’d write a post about what our comprehensive dental examination includes, so you can gauge thorough your dentist’s exams are.

What Is a Dental Exam?

A dental exam consists of several different parts.  Each part helps to ensure that you and your dentist understand what is going on with your oral health.  In order to better describe a routine dental exam, I’ve simply written what I do when I see a new patient at the dental school.

I’ve divided it into 10 parts.  You can read over them all to see what we do, or simply jump to the sections that interest you.  If you have any questions when you’re done, scroll to the bottom to leave a comment, and I’ll get back with you.

1 – Introduction

I meet the patient in the waiting area, introduce myself and then ask them a little bit about themselves to get to know them better and put them at ease with me as their student-dentist.

2 – What Does the Patient Want?

I ask the patient why they came to the school for treatment.  I also ask what they expect from their treatment and what kind of dental work they want to have done.

3 – Medical History

I next obtain a very detailed health history, including which medications they are taking and any past or current medical conditions.  I then take a blood pressure and pulse.  It’s important to get the patient’s health history because certain things, like joint replacements and certain heart conditions can affect your dental treatment.  Also, there are over 300 medications that can cause dry mouth, affecting dental health.  Finally, an accurate health history is important because the dentist needs to ensure that there are no systemic problems that will affect the dental treatment that will be provided.

4 – Dietary Survey

We then complete a dietary form that indicates whether their diet places them at a high risk of getting cavities.  Although there are many things that can influence your risk of getting cavities, (here’s 25 things that increase your risk of cavities), diet is one of the most important factors.

5 – Risk Factors

We complete a “risk factors” form that tells us the patient’s risk for developing certain diseases, such as periodontal disease and oral cancer.  This form also gives us a general idea about the patient’s risk for fracturing or knocking out a tooth.

Another part of the form discusses the patient’s dental phobia.  We ask what kinds of things make the patient anxious about their dental treatment.  If you want to pinpoint your dental phobia, take a look at 15 common reasons why people are scared of the dentist.

The “risk factors” form also discusses other risk factors.  For example, this is the form I talked about in a previous article about how wearing your seat belt affects your dental health.

6 – Head and Neck Exam

6 – After that, we perform what we call a head and neck exam.  We feel the neck to note any enlarged lymph nodes or any suspicious lumps or bumps that could be cancerous.  We also feel the TMJ to evaluate whether or not the patient has any joint problems.  We note any popping or clicking in the jaw, which is fairly normal but which can cause problems.

7 – Oral Soft Tissue Exam

Next, we move on to the intraoral soft tissue exam.  The soft tissue exam consists of looking at every area in your mouth.  We look at the lips, the cheeks, the gums, the roof of the mouth, every side of the tongue, under the tongue, in the back of the mouth, the throat and the tonsil area.  Your tonsils can tell us if your body is fighting off a disease and sometimes your tonsils can cause bad breath if there is a tonsillolith present.

It is necessary to perform a very thorough soft tissue exam because this is where dentists check for oral cancer.  If your dentist isn’t very attentive during the soft tissue exam, he or she may miss the beginning stages of oral cancer.  It is important to catch cancer early because it improves your chances of beating it.  If something looks suspicious, your dentist may biopsy the area and/or refer you to an oral pathologist, one of the nine types of dental specialists.

8 – Periodontal (Gum) Health

Another part of the dental exam is periodontal probing.  This consists of sticking a little instrument between your teeth and your gums to see how healthy your gums are.  We measure the space between the top of the gums and where your gums attach to your teeth.  If it’s too deep, you won’t be able to clean it out well and it could indicate that you have periodontal disease, which is a leading cause of tooth loss in people over age 30.  If you do have periodontal disease, your dentist may recommend getting a deep dental cleaning, which is technically known as scaling and root planing.

9 – Hard Tissue Exam: We Finally Check Your Teeth

Next we perform a hard tissue (teeth) exam where we look at every side of your teeth and note any existing fillings, crowns, implants, root canals, cavities, fractures, or if there are any problems with your bite.  We also look at all of your dental work to make sure that it is still in good shape.  Depending on the health of your teeth, we may order x-rays to better diagnose any problems with the teeth and the area around the tooth.  Want to know if you need x-rays?  Read the article How Often Should You Get Dental X-Rays Taken?

During the hard tissue exam, we will also evaluate the patient’s bite.  If we will be making any crowns or dentures for the patient, we usually take dental impressions as part of the dental exam so that we can evaluate the patient’s bite and make sure we don’t cause any problems with the way that their teeth come together when we place crowns.

 10 – Treatment Planning

After gathering all of the above information, we create a treatment plan with all of the dental work that we recommend having done.   Sometimes this is as simple as getting a regular cleaning and providing instructions on how to maintain better oral hygiene or it can be as complex as getting dentures, crowns, bridges, root canals, implants, veneers, braces, and other dental treatment.


This is the comprehensive dental exam that each patient receives initially at my dental school.  Your dentist may choose to do things differently.  For example, some patients hate the “risk assessment” form and the dietary questionnaire.  At my dental school, we are required to complete these forms with the patient.  If you don’t seem interested in those things, then your dentist may choose to omit those parts of the exam.

Remember, all dentists are different, and most dentists want what’s best for their patients and will try to provide you with optimal dental treatment.  However, some dentists aren’t thorough, and hopefully this list will help you evaluate what you want your dentist to address during a dental exam.

If you have any questions, comments, or concerns about your dental exams, feel free to leave a comment below.  Thanks for reading!

Five Ways to Get Better Teeth
©Syda Productions/Shutterstock.com

Many people think they’re taking great care of their teeth. They brush and floss, but they still end up having problems.

I wrote this post with those people in mind: the ones that want to have better, healthier teeth, but don’t know quite where to start. Even if you know that you’ll end up needing crowns or veneers on your teeth, it’s important to have excellent oral hygiene so that your future dental work will last a long time.

Here’s five simple things you can do to get better teeth.

How to Get Better Teeth: 5 Things You Can Do Today

How to Get Better Teeth1 – Floss

Many people don’t want to floss because they think it’s too hard. Before I talk any more about flossing, go ahead and read the following quote from Kevin McCallister in Home Alone:

I took a shower washing every body part with actual soap; including all my major crevices; including inbetween my toes and in my belly button, which I never did before but sort of enjoyed.

Neglecting to floss is like simply taking a shower without cleaning all of your major crevices!

Learn more about the right way to floss by reading these 10 flossing mistakes.

2 – Brush for At Least Two Minutes

How long do you spend brushing your teeth every day? A lot of people only brush for 30 seconds or so.  By brushing for two minutes, you will allow the fluoride in your toothpaste to spend more time providing your teeth with its many benefits.

When you brush, do you remember to brush all sides of your teeth?

3 – Only Eat Sugar with Your Meals

Every time you eat, the pH in your mouth drops to a level where it can hurt your teeth. You can see a graph of this process in the article What Happens in Your Mouth Every Time You Eat or Drink.

The more times you eat in a day, the more times your teeth get hurt.  By eating your sugary snacks with a meal rather than on their own, you will be reducing the number of times that your teeth come under attack.

You can try substituting fruit or vegetables for a sugary snack or simply have a great-tasting chewing gum.

4 – Don’t Sweeten Your Coffee & Tea With Sugar

Try sweetening your drinks with xylitol or an artificial sweetener.  The bacteria in your mouth would love to get their hands on some sugar so they can hurt your teeth.  If you starve them, you’ll have better teeth!

Learn more about what xylitol is and how it protects your teeth.

5 – Don’t Drink Soda Pop In Between Meals

The main theme of the last three items on this list is that sugar is an enemy to your teeth.  Soda pop combines sugar and acid to wreak havoc on your teeth.

If you’re thirsty between meals, water and milk are good choices, and I’m not the only one saying that: the textbook Dental Caries by Fejerskov agrees with me.  It says, “Water and milk are safe drinks between meals.”

Ideally, you would cut soda pop out of your diet, but who wants to do that?!  If you absolutely must have your sugary, carbonated fix, check out these guidelines on how to drink soda pop and keep your teeth happy.


Hopefully you can try at least one of these five suggestions so that you can be on your way to having better teeth.

Do you have any questions or comments about how to get great teeth?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

Lemon Citrus Can Cause Tooth Acid Erosion
©Silvia Bukovac/Shutterstock.com

I got the following email from an Oral Answers reader asking about the difference between acid erosion and tooth decay.  He writes:

“What is the difference between acid erosion and tooth decay?  How to I ensure that I minimise both of these.  Also which is the best toothpaste to use to prevent this, I have heard of duraphat (Note from Tom: Duraphat is a fluoride product marketed as Duraflor in the United States) which i know helps with decay and pronamel which helps with erosion but I do not know if both help with both.”

Preventing Tooth Decay and Acid Erosion

The Difference Between Tooth Decay and Acid Erosion

Both tooth decay and acid erosion involve your tooth structure getting dissolved. The main difference between tooth decay and acid erosion is the source of the acid.

In acid erosion, your teeth are dissolved by acidic foods, drinks, or environmental sources of acid that come into contact with your teeth.

To learn how to spot acids that eat away your teeth, read How to Identify Acidic Foods and Drinks.

Tooth decay, however is caused by millions of tiny bacteria that live on your teeth that excrete acid, which eats away at your teeth.

To learn more about these bacteria, read What Every Human Needs to Know About Plaque.

Preventing Tooth Decay and Acid Erosion

The second part of this reader’s question involved preventing tooth decay and acid erosion.  The best way to prevent tooth decay is by getting rid of the bacteria on your teeth regularly through brushing and flossing.  You might also want to learn about 12 weapons of plaque destruction and these 25 things that increase your risk of getting tooth decay.

 Preventing acid erosion is as simple as not eating or drinking too much acid.  You might be surprised to learn that many of the drinks we enjoy made this list of 9 acidic drinks that can dissolve your teeth.

As far as strengthening your teeth, most any toothpaste contains fluoride, which protects your teeth.  It probably doesn’t matter which type of toothpaste you’re using as long as it contains fluoride and you’re brushing regularly.


Tooth decay is caused by acid from bacteria that live on your teeth.  Acid erosion is caused by acids that you eat, drink, or otherwise expose to your teeth.

You can prevent tooth decay and acid erosion by brushing and flossing regularly and minimizing your intake of acidic foods and drinks.

Do you have any questions about tooth decay and acid erosion?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

More Likely to Get Cavities

Many people come into the dental school and tell us things like, “I just have bad teeth” and “My parents and grandparents all had soft teeth – and my teeth are soft too, so I get lots of cavities.”

Cavity In a ToothWhile it may be true that some people do have teeth that are more susceptible to cavities, there is usually another reason that these people have cavities.

As dentists, we can remove the tooth decay and make your tooth look shiny and new again, but we can’t prevent you from getting cavities in the future – that’s up to you.

The tooth pictured probably doesn’t look too glamorous.  Since most people don’t see what their dentist sees, I thought I’d put this picture up so you can see what an extensive cavity looks like.

If you’ve had a lot of cavities and want to know why, the following list just might give you some answers!

25 Risk Factors for Getting Cavities

1 – Cavities

I listed cavities first because if you’ve had cavities in the past, that’s usually one of the best predictors of whether or not you’ll get cavities in the future.  It makes sense that if you already have lots of cavities, that you’re more likely to keep getting cavities until you make some changes.

Also, if you have white spots on some of your teeth that have recently appeared, that could be the sign of a beginning cavity, which also puts you at risk for getting a cavity.

2 – Having Lots of Cavity-Causing Bacteria

There are millions of little bacteria in your mouth that eat your food every time you eat.  They make acid and smear it on your teeth.  The acid eats away at your tooth until a cavity develops.

Needless to say, if you have an abundant amount of cavity-causing bacteria in your mouth, you’re at a high risk for getting a cavity.

3 – Eating Sugar Frequently

If you eat sugar a lot, you give the bacteria exactly what it wants to eat: fermentable carbohydrates.  The more often you feed them, the more cavity-causing acid that they will produce.

Learn more about What Happens In Your Mouth Every Time You Eat or Drink.

4 – Bad Crowns and/or Fillings

If you have a poor quality filling or crown in your mouth, it may actually cause you to get a cavity by allowing plaque to hang out where you can’t reach it with routine brushing and flossing.

5 – Bad Oral Hygiene

If you don’t brush away the bacteria often, you will allow them to grow and destroy your teeth.

6 – High Acidic Foods Intake

Eating or drinking acidic foods can eat away at the hard, outer layer of your teeth known as the enamel.  Since the enamel is the layer of your teeth that is most resistant to cavities, if you wear it down, you will be putting yourself at risk for cavities.

Learn more about acidic drinks in the article,  Nine Drinks that Can Dissolve Your Teeth.

Another source of acid in your mouth is gastric reflux or even vomiting intentionally, which occurs in those with bulimia.

7 – Not Getting Enough Fluoride

Fluoride makes the enamel of your teeth stronger.  You can get it by brushing your teeth longer or using a fluoride mouthwash.

Curious about how fluoride works?  Learn about the three ways fluoride protects your teeth.

8 – Nursing Too Long (Bottle and Breast)

If you weren’t weaned from the breast or bottle until you were a toddler, this could have put you at a higher risk for getting cavities.  Most research points to the bottle, but I have heard conflicting reports regarding prolonged breastfeeding.

9 – Cavities Under Fillings

Getting a cavity under a filling means that there was a problem with the filling (age, done incorrectly, fractured, etc.) or that you weren’t taking very good care of the filling.  Either way, if you get a cavity under a filling, it puts  you at high risk for getting cavities in other teeth.

10 – Bad Family Dental Health

If your family has bad dental health, chances are that you will as well.  This could be related to lack of oral hygiene being taught in the home, genetic abnormalities in the teeth, or high numbers of the bad bacteria in your mouth.

11 – Exposed Root Surfaces

Receding gums will expose the root of the tooth, which does not have a protective enamel covering.  Consequently, the dentin that makes up the roots of your teeth dissolves at a higher pH than the enamel.  That means that weak acids that wouldn’t affect your enamel can eat away at the roots of your teeth and cause a cavity.

12 – Defect In Your Enamel

If you have a defect in your enamel, it could make you more susceptible to cavities.  Some examples might be enamel that didn’t form correctly, congenital defects like amelogenesis imperfecta, or a defect in enamel formation that can happen to a permanent tooth when its corresponding baby tooth gets knocked out.

13 – Having a Disability

If you have a disability, it can be more difficult for you to take care of your teeth.  Also, many caregivers may not pay very much attention to the oral hygiene of those under their care.

14 – Dry Mouth

When you don’t have enough saliva in your mouth, it is known as dry mouth or xerostomia.  Saliva helps your teeth in several ways.  If you suffer from dry mouth, your dentist may be able to help by prescribing you medication to help increase your salivary flow.

Are you taking one of these 348 medications that cause dry mouth?

15 – Genetic Abnormality of Your Teeth

The anatomy of a tooth can vary greatly.  Some people have deeper grooves in their biting surface that are hard to clean.  Some people’s enamel may not completely cover the whole tooth.  This can create pockets where bacteria can hide out and cause cavities.

There are many other genetic abnormalities that can affect the teeth, such as localized microdontia, which can make some teeth smaller than others and possibly make them harder to clean.

16 – Having Lots of Large Fillings

Many large fillings can put you at risk for developing cavities.  Having lots of large fillings increases the amount of tooth:filling interfaces that are present in your mouth.  If bacteria get in between the filling and the tooth, they can be nearly impossible to clean out and can cause cavities.

17 – Chemotherapy and Radiation Treatment

Having chemotherapy or radiation treatment in the head and neck area can reduce salivary flow and cause other oral problems which increase the risk of getting a cavity.

18 – Eating Disorders

Eating disorders can increase the risk of a cavity in a couple of ways.  Those with eating disorders tend to not have a very balanced diet, which may contribute to cavities.  Also, bulimics bathe their teeth in acid each time they purge.  This wears away the tough enamel surface of the tooth which makes the tooth mores susceptible to cavities.

19 – Drug and/or Alcohol Abuse

Those that abuse drugs and/or alcohol put themselves at a greater risk for developing cavities.

Take a look at what drug abuse can do to your teeth.

20 – Irregular Dental Care

By not going to the dentist regularly, you avoid learning about the condition of your mouth.  The dentist can point out small problems before they turn into cavities.  By avoiding your checkups, you lose out on the opportunity to take care of small problems before they become big.

21 – Not Knowing What Plaque Is

Many people don’t know what plaque is.  If you don’t know what’s happening inside of your mouth, you probably won’t do anything about it.

Avoid this risk factor by reading: What Every Human Needs to Know About Plaque and How Plaque Disclosing Tablets Can Help You Brush Better.

22 – Not Knowing How to Remove Plaque

Even if you know what plaque is, if you’re not removing it then you will probably end up getting some cavities.

Learn about these 12 Weapons of Plaque Destruction.

23 – Being Poor

People with a lower socioeconomic status tend to get more tooth decay.  There are exceptions to this rule, but this is one of the main reasons that so many states provide free dental care to low-income children.  Unfortunately, these programs haven’t eliminated the gap in dental health between the rich and the poor, and many poor parents simply don’t find the time to take their kids to the dentist.

Interestingly, our computer software at my dental school tells us to ask each patient if they have a “low socioeconomic status.”  It can be an awkward question, and almost everyone skips over it.

24 – Dental Anxiety

If you have a dental phobia, chances are that you will neglect getting dental work done.  If you want to try to understand your dental phobia, take a look at these 15 common reasons people are scared of the dentist.

25 – Braces

Although braces can straighten your teeth and make them look great, they do increase the risk of getting cavities.  Braces make it harder to brush your teeth and make it nearly impossible to floss.  In order to floss with braces, you have to use a floss threader to get under the wire – I know I didn’t do that when I was a teenager!

I hope you enjoyed the list and it helped you pinpoint the cause(s) of your cavities.  I compiled the above list from my own experience as well as information from the following textbooks:

Do You Have a Lot of Cavities?

Did anything on this list ring a bell for you?  Although I tried to include everything I could think of that would cause cavities, I may have missed something.  I’d love to hear about what you think is causing your cavities whether it’s on the list or not.  Feel free to leave a comment in the comments section below.

Thanks for reading!

Should You Floss Before or After Brushing?

One night, shortly after my wife and I got married, we were getting ready for bed and she noticed that I brush my teeth after I floss.  She had always brushed before flossing. We probably would’ve discussed this fascinating subject in more detail if we hadn’t been so tired…

Do You Floss Before or After Brushing?Interestingly, we had both been brushing and flossing in a different order for twenty-some years of our lives before we met each other and we both had pretty good results to show for it.

My thought process goes like this: it wouldn’t make sense to wash your hands, and then pick out all of the stuff under your nails because that would just get the dirt all over your freshly-washed hands.  So why would anyone in their right mind floss after brushing?

Well, here’s why: Those who advocate flossing after brushing state that when you floss first, you don’t brush the plaque away, you simply push it back into the spaces between your teeth where it can grow and cause cavities.

So who’s right?  Should you floss before brushing your teeth?  Or should you brush your teeth before flossing?

Should You Floss Before or After Brushing?

After plowing through several dental hygiene-related textbooks, I couldn’t find any information on whether you should brush or floss first.

After reading online, I noticed that there are people who are very passionate about this subject — as this forum post demonstrates!

I think the reason that there’s not really any concrete recommendations about whether you should brush or floss first is because it really doesn’t matter whether you brush or floss first.

The main reason we need to brush and floss is because every time we eat or drink fermentable carbohydrates, the little bugs that live in our mouth grow, reproduce, and build homes on our teeth.  Their waste products are what harm our teeth.

Learn more about plaque by reading What Every Human Needs to Know About Plaque.

The best way to combat plaque is to disrupt it, or destroy the intricate colony that it has built on your teeth.  When the bugs are floating around in your mouth, they don’t harm your teeth.  They only harm your teeth when they have attached to your teeth and grown into a layer on top of your teeth.  By brushing and flossing, you remove the bugs from your teeth temporarily.  They will re-attach, but then you can simply brush and floss again to disrupt their little home once again and put them in their place.

As long as you are disrupting the bacteria that live between your teeth regularly, they won’t be able to cause cavities. When you floss, you scrape them away from their home and it will take them a some time to regroup, get organized, and start growing again between your teeth.

Does It Matter If You Brush or Floss First?

It really doesn’t matter!  In fact, you don’t even need to brush and floss at the same time.  As long as you’re eating good foods, brushing twice a day, flossing once per day, and avoiding these ten common flossing mistakes, you should be fine.

Want more tips on how to combat the plaque in your mouth?  Read about these Top 12 Weapons of Plaque Destruction!

Do you have any questions, comments, or thoughts on whether you should brush or floss first?  In what order do you brush and floss?  Feel free to leave your opinions below in the comments section.  Thanks for reading!

Dessert Gum

When I was in college, I worked at a Texaco gas station.  One of the job perks was that the owners would let us take $2 worth of stuff during our shift.  I would always get two packs of gum and I ended up with a nice stockpile of chewing gum.

Extra Dessert Delights Mint Chocolate Chip GumTo this day, I still love gum.  Whenever I see new flavors at the store, I just can’t help myself.  A couple of weeks ago, my wife and I were at the grocery store and a pack of Extra mint chocolate chip gum, just as tantalizing as the one in the picture to the left caught my eye.  We bought it and I had my first stick last night after dinner.

Why You Should Chew Gum for Dessert

Chewing this gum after dinner last night satisfied the sweet tooth that I get after dinner.  I noticed my wife open the cupboard door and grab some chocolate, but I didn’t really crave any – I was too preoccupied with the mint chocolate chip party going on in my own mouth!

Also, chewing gum after dinner can help clean food out of your mouth.  Chewing gum stimulates your salivary glands and helps you make more saliva.  After all, spit is good for your teeth!

The only downside with this particular brand of chewing gum is that it doesn’t have any tooth-protecting xylitol.  It looks like it’s mostly sweetened with sorbitol and aspartame.

Most Chewing Gum Is Good For Your Teeth

Pretty much any chewing gum is good for your teeth as long as it doesn’t contain sugar.  Just to make it clear, Extra didn’t pay may anything to write about them – I just happened to really like this type of gum and I’m excited to try the orange creme pop, the key lime pie and the strawberry shortcake flavors.  If another sugar-free gum floats your boat, by all means chew that one!  Some other great flavors of chewing gum are Orbit’s mint mojito and maui melon mint as well as Trident Layers cool mint melon.

Although what brand of gum you choose depends on your personal preferences, there are certain types of gums that are better than others.

To find out what types of chewing gum are best for your teeth, you can read the article Is Chewing Gum Good or Bad for Your Teeth?

Have You Tried Chewing Gum for Dessert?

Have you tried chewing gum after eating?  I’d love to hear what you have to say in the comments section below.  What’s your favorite type of gum?  Let me know so I can try it.

Thanks for reading!

Dental Antibiotic Premedication Doctors Dentists Don't Always Agree

Many people need to take antibiotics before certain dental procedures.  To learn why, you can read my previous post about when you need to take antibiotics before dental work.  You can also read the general guidelines from the American Heart Association and the American Association of Orthopaedic Surgeons regarding antibiotic premedication before dental work.

Dental Antibiotic PremedicationAlthough there are clear guidelines concerning who needs antibiotics before certain dental procedures, there are certain gray areas that arise.

Patients have come to my dental school and insisted we prescribe antibiotics before we do dental procedures on them simply because they have received them in the past.  When I dig a little deeper, I sometimes find that many of these patients don’t need the antibiotics according to the latest guidelines.

It is more common for patients to request antibiotics when they don’t really need them, however that’s not always the case.  For example, a few weeks ago Diane left a comment on Oral Answers saying that she got in an argument with her dental hygienist because she didn’t want to take the antibiotics and her dental hygienist said she needed them.

When Your Doctor and Dentist Disagree About Antibiotic Premedication Before Dental Work

Suppose for a moment that you had a congenital heart defect that was completely repaired when you were a child.  You didn’t have anything artificial implanted in your heart, and you healed well and haven’t had any problems since.  Let’s say that your doctor has made it very clear to you that you need to take antibiotics before getting any dental work done.  You then go to your dentist and then your dentist tells you that according to the latest guidelines, you don’t need antibiotics before getting dental work done.

Not only does this leave you confused, but you wonder who is right.  Do you follow the advice of your physician and demand that your dentist prescribe you antibiotics, or do you simply decide that the dentist must know what he’s talking about?

Dr. Michael A. Siegel, a dentist and professor at Nova Southestern University’s Dental School said the following regarding this dilemma in an editorial in the Journal of the American Dental Association:

Certainly, this is a “no-win” situation for the dentist. On the one hand, the dentist is held professionally and legallyaccountable for his or her treatment decisions. On the other hand, the dentist does not want to be placed in an adversarial relationship with the patient’s physician. Unfortunately, this also becomes a problem for the patient, because he or she is potentially placed in a situation of choosing between the advice of dentist and of physician.

Dr. Siegel goes on to state that in these situations, he simply talks with the patient’s physician and discusses the issue, reiterating that the current guidelines don’t require antibiotic premedication.  In the end, if the physician still insists that the patient receive antibiotics before getting dental work done, then Dr. Siegel says that the physician should be the one writing the prescription for antibiotics, not the dentist.


In conclusion, it can be confusing when your doctor and dentist disagree regarding whether or not you should be getting antibiotics before dental work.  You can take comfort in knowing that both the dentist and the doctor are probably doing what they feel is best for you and just want you to be healthy.

The best thing you can do in these situations is do the research yourself by reading the general guidelines from the American Heart Association and the American Association of Orthopaedic Surgeons that discuss whether or not you really need antibiotics before certain dental procedures.

Do you have any questions, comments, or concerns about antibiotic premedication before dental work?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!


Swimming Pools Stain Teeth

Is it possible that spending a lot of time in the swimming pool can stain your teeth or even slowly dissolve your teeth?

Swimmers TeethIn this article, I will take a look into two different questions that many swimmers have regarding their teeth:

1 – Can swimming pools stain my teeth?

2 – Can swimming pools dissolve my teeth?

Let’s get started with the first question.

Can Swimming Pools Stain Your Teeth?

An interesting discussion on this topic came up in a thread on the U.S. Masters Swimming Forum.  The user ensignada led off with the following question:

I took my 8 year old to the dentist today for a check-up. One of our concerns was the brown discoloration on her two front teeth. The first question the dentist asked was “Is she a tea drinker?” (No). The second question stunned me, “Is she a swimmer?”

Apparently a few of his swim team patients over the years have experienced discoloration. It’s not permanent (he was able to scrap her’s off). He didn’t explain the chemical reaction taking place.

According to eHow, the optimum pH level in a pool is 7.2 to 7.6.  This pH is considered to be basic.  In general, solids dissolve in acid and then precipitate (or become solids again) in bases.  This means that in a basic swimming pool, the calcium and minerals present in your mouth will harden onto your teeth rather than dissolve (as they would if the pH were acidic – this is why your teeth dissolve slowly when you eat or drink anything acidic.)  The higher pH of the swimming pool, in combination with the antimicrobial compounds that the pool water contains, causes proteins in your mouth to break down and get together with minerals in your mouth to form a hard, yellowish-brown mineral deposit on your teeth.

Swimming and Teeth

This article from the Academy of General Dentistry states the following regarding this phenomenon: “Athlete swimmers, who often swim laps more than six hours a week, expose their teeth to large amounts of chemically treated water. Pool water contains chemical additives like antimicrobials, which give the water a higher pH than saliva, causing salivary proteins to break down quickly and form organic deposits on swimmer’s teeth.  The result is swimmer’s calculus, hard, brown tartar deposits that appear predominantly on the front teeth.”

To answer the question, swimming a lot can cause you to get yellow to dark brown stains on your teeth that your dentist or dental hygienist should be able to remove for you at a routine cleaning appointment.

Can Swimming Pools Dissolve Your Teeth?

As I mentioned above, the optimal pH level in a pool is 7.2 to 7.6.  If you read my article about drinks that can dissolve your teeth, you might remember that teeth start dissolving at a pH below 5.5.

So… could a swimming pool really dissolve your teeth if it is kept at the optimal pH of around 7.4?  The answer is no.  However, if the pH of the swimming pool finds a way to become acidic, then swimming pools can start dissolving your teeth.

This usually occurs in gas-chlorinated pool systems.  When swimming pools are gas-chlorinated, hypochlorous acid is formed.  Normally swimming pools counteract this acid with a strong base, such as ash.  If the swimming pool doesn’t get enough base to counter the acid from the chlorine, it can become acidic and start to dissolve the teeth of those who swim.

This case report tells the story of a competitive swimmer who swam in a gas-chlorinated swimming pool and experienced notable dental erosion within 27 days!  It says,  “Several reports indicate an increased prevalence of dental erosion among intensive swimmers due to low pH gas-chlorinated pool water…[A] case report is presented which describes the very rapid occurrence of excessive general dental erosion of a competitive swimmer due to gas-chlorinated pool water within 27 days. The observation of several authors as well as this case underscore the significance of a regular pH monitoring of chlorinated swimming pool water. The high incidence indicates that dental erosion due to frequent swimming is of considerable diagnostic and therapeutic significance. Furthermore, it is recommended to fluoridate the teeth of intensive swimmers regularly to prevent dental erosion.”

This scholarly article even directly mentions that swimming pools can be a cause of tooth erosion, right along with diet and other factors.  It says that “Swimming pools with a low pH due to inadequate maintenance have…been implicated [in dental erosion].”

For further reading on dental erosion and swimming pools, you can take a look at the CDC’s Morbidity and Mortality Weekly Report from July 22, 1983.  One interesting statistic that they mention is that only 15% of frequent swimmers displayed enamel erosion while only 3% of infrequent or non-swimmers experienced enamel erosion.

I assume that within the past 30 years, swimming pools are much more careful about testing the pH of their water to ensure that it is not too acidic, but it can still happen due to “inadequate maintenance” as the article above states.


If you notice that you are getting stained teeth due to swimming, you may want to ask your dentist about coming in for more frequent cleanings.

If you notice that you are losing some enamel on your teeth due to swimming, you may want to check with your swimming pool to make sure that their pH is within the normal range. Also, it may be a good idea to get frequent fluoride treatments from your dentist.

Learn about the three ways fluoride protects your teeth.

Are you a swimmer?  Do you have any experiences to share or any questions/comments about this article?  I’d love to hear what you have to say in the comments section below. Thanks for reading!


Dental Fluorosis
©Josconklin/Wikimedia Commons

Dental fluorosis is caused by ingesting too much fluoride while the teeth are developing.  Dental fluorosis discolors the teeth.  The staining can range from white flecks to deep brown stains.

In this post, I will talk about the various treatments for dental fluorosis.  If you’re interested in how dental fluorosis occurs and want to see a couple different pictures to see what dental fluorosis looks like, check out my previous article, Dental Fluorosis: Too Much Fluoride Stains Teeth.

Dental Fluorosis Treatment: Four Ways Dental Fluorosis Is Treated

Dental Fluorosis Treatment

There are a few different ways that dental fluorosis can be treated.

1 – Porcelain Laminate Veneers.  One of the most esthetic ways is by placing porcelain laminate veneers over the affected teeth as shown in the picture to the right.  In this procedure, less than 1 millimeter of the front surface of the tooth is shaved away.  The dentist takes an impression, and then a dental lab makes a veneer that looks great and fits perfectly into the spot that was shaved away by the dentist.

2 – Enamel Microabrasion. This is the least invasive method of treating dental fluorosis.  In this method of fluorosis treatment, the dentist treats the tooth with acid and then sands away a tiny layer of enamel off of the tooth using pumice.  After this is completed, the dentist then applies topical fluoride and a solution to help remineralize the teeth.  It is important to note that the topical fluoride that is applied simply helps to make the enamel stronger.  Topical fluoride will not cause fluorosis — fluorosis is caused by ingesting fluoride systemically.

Not sure what remineralization means?  Read the article Try to Keep Your Teeth Below Freezing to find out.

The book Dental Fluorosis: A Handbook for Health Workers states the following about this technique, “In reality the improvements in appearance are primarily the result of abrading the outer porous enamel with pumice after it has been partly demineralized by the acid.”

This procedure may need to be repeated several times to obtain satisfactory results.

3 – Direct Composite Veneers (Also Known as Composite Bonding).  This procedure is similar to the porcelain laminate veneers mentioned above.  However, after shaving down the front of your teeth, the dentist doesn’t take an impression to send to the lab.  The dentist simply repairs the tooth using white composite filling material.  This covers up the affected tooth with an aesthetic tooth-colored filling.

The drawback of this procedure is that direct composite veneers sometimes only last a few years and then may need to be replaced with a crown or porcelain laminate veneers.

Interested in direct composite veneers?  See a picture of how a front tooth can be repaired with composite filling material in the article, How a Chipped Tooth Can Be Repaired with a White Composite Filling.

4 – A Dental Crown. During a dental crown procedure, the dentist shaves down around the whole tooth and then places an aesthetic crown over the tooth.  This is the most invasive treatment that is normally done for the treatment of dental fluorosis.

To learn more about what  dental crown is and how the teeth are prepared, read the article Dental Crown Procedure: What Is a Crown or Cap?

Although it would be possible to remove teeth affected by fluorosis and then place dental implants, I didn’t include that here because it is not normally a treatment option.  Most teeth affected by fluorosis are healthy and more resistant to cavities.  Their downfall is in their appearance.  I don’t believe that removing healthy teeth for aesthetic reasons is the best option when there are other less invasive options.


In summary, the least invasive way to treat dental fluorosis is through enamel microabrasion.  After that, the dentist can shave down the front of the tooth and either place a composite filling material or a porcelain laminate veneer to cover up the front surface of the tooth.  The most invasive treatment of dental fluorosis involves placing a crown around the whole tooth.

Do you have any questions, comments, or concerns about dental fluorosis and its treatment?  I’d love to hear them in the comments section below.  Thanks for reading!

Weapons of Plaque Destruction

About five years ago, I was sitting in the first lecture of an Introduction to Dentistry class.  The professor, a local dentist, was talking about how plaque forms on our teeth and how it causes our teeth to decay.  Something clicked inside of me that day, and that lecture helped solidify my desire to become a dentist.

Weapons of Plaque DestructionI summarized that lecture in my first post ever on Oral Answers back in January 2010 entitled What Every Human Needs to Know About Plaque. If you haven’t read it and you’re curious about how tooth decay begins, you might want to take a look at it.

Because plaque can eventually cause you to lose your teeth, it is important to remove it and try to minimize its formation.  Here are 12 easy ways you can do that: The Top 12 Weapons of Plaque Destruction.

Top 12 Weapons of Plaque Destruction

Weapon #1 – Brushing Your Teeth

Brushing your teeth not only removes plaque, but some toothpastes also contain antimicrobials, such as Triclosan in Colgate Total. Toothpaste also contains abrasives which can help mechanically remove plaque from your teeth.

To find out what else is in toothpaste, read The 10 Main Ingredients In Your Toothpaste.

Weapon #2 – Flossing

Flossing helps remove plaque that is stuck between your teeth.  Cavities between teeth are so common that the two fillings required by the most popular dental board exam both have to include a cavity that is between two teeth.

Think you could use some tips on flossing?  Start by reviewing these 10 common flossing mistakes.

Weapon #3 – Fluoride

Fluoride has three different ways that it makes our teeth stronger and more resistant to the bad effects of plaque.  Fluoride is the only active ingredient in most toothpastes sold in the United States.  Fluoride is also added to many municipal water systems.  There is a strong, ongoing debate about whether or not it’s okay to add fluoride to everyone’s water.

Weapon #4 – Xylitol

Xylitol is a sugar alcohol that somehow helps fight plaque.  Xylitol is found in many chewing gums and you can also buy it in solid form from many health food stores or from Amazon.  Then you can use it to sweeten drinks like tea and coffee.

To learn more about this valuable plaque-fighting sugar alcohol read the article, Xylitol: What It Is and How It Protects Your Teeth.

Weapon #5 – Anti-Plaque Mouthwash

Many plaque-fighting mouthwashes contain ingredients such as cetylpyridinum chloride (CPC) which can kill the bacteria responsible for causing cavities.

Weapon #6 – Water

Drinking water or rinsing your mouth out with water after eating sugary foods can help wash away food that sticks around in your mouth. Since the bacteria live off the food you eat, you will be starving them by rinsing out your mouth.

Weapon #7 – Saliva

Saliva helps protect the teeth in many ways.  You can read about the six main ways that your spit protects your teeth in the post, How Saliva Protects Your Teeth.

If you suffer from dry mouth, you may be losing the war against plaque in your mouth.  Learn about six causes of dry mouth and 348 medications that can cause dry mouth.

Weapon #8 – Plaque Disclosing Tablets

If you don’t know where the plaque is, it’s hard to destroy it.  Plaque disclosing tablets work by coloring the plaque on your teeth so that you can make sure you’re removing it all when you brush and floss.

To learn more about plaque disclosing tablets, including the best places to buy them, read How Plaque Disclosing Tablets Can Help You Brush Better.

Weapon #9 – Chewing Gum

Chewing stimulates your salivary glands.  Some types of chewing gum are better than others.  Make sure you’re chewing the right type of gum for your oral health by reading about which of the three types of chewing gum is best for your teeth.

Weapon #10 – Your Tongue

Your tongue is a big weapon of plaque destruction.  Your tongue (with the help of your saliva – see weapon #7) can help clean sugary food off of your teeth so that you swallow it rather than letting it sit on your teeth and feed the plaque.

Weapon #11 – Certain Foods

Certain foods can actually help your teeth repair themselves after you eat a sugary snack.  Cheese contains phosphates and calcium that your saliva can utilize to help remineralize your teeth after they get “attacked” by the acid from plaque.  To appreciate this effect, you might want to read about what happens in your mouth every time you eat or drink.

Not sure what to eat for healthy teeth?  Learn about 16 delicious foods that you and your teeth will enjoy.

Weapon #12 – Sealants

Sealants are mainly used on children’s permanent molars.  Sealants are a strong plastic material that dentists can flow into the small grooves on the biting surfaces of your children’s teeth.  By covering up these grooves, you remove a nice, hard to brush place where plaque loves to hide.  Sealants are very effective at preventing tooth decay on the biting surface of molar teeth.


Hopefully this article gave you some good ideas about how you can help win the war against plaque in your mouth and help your teeth to live a long life.

Do you have any questions or anything you’d like to say about oral health or hygiene?  I’d love to hear your comments below, and I’ll try to personally respond to each one.  Thanks for reading!

Brush All Sides of Your Teeth
©Dean Bertoncelj/Shutterstock.com

Not long ago, I did a cleaning on one of my patients and found something very similar to what I find in most of my patients — that this particular patient takes a lot better care of the side of the teeth that he can see in the mirror than the back (tongue) side of the teeth.

Brushing TeethMaybe you do the same thing.  Many years ago, some researchers spied on 85 adolescents brushing their teeth.  They found that people spent the most time brushing the sides of the teeth that you can see, a moderate amount of time brushing the biting surfaces, and the least amount of time brushing the tongue-side of the teeth!  Interestingly, the kids also spent more time brushing the lower teeth than the upper teeth.

Another study videotaped tooth brushing behavior in people aged 5 to 22 and found that less than 10% of the time was spent brushing the tongue-side of the teeth.

Why Do We Not Brush the Tongue Sides of Our Teeth?

I think we spend less time brushing the tongue-side of our teeth for a couple of reasons:

1 – We tend to focus more on cleaning the sides of the teeth that we actually see.
2 – It’s easier to brush the front side of the teeth without the obstruction of a tongue.

It seems that the more difficult something is to do, the less likely people are to do it. I think this goes along with the two reasons most people don’t floss: It’s too hard and they can’t see in between their teeth.

Speaking of flossing, are you making one of these 10 common flossing mistakes?

Do You Really Need to Brush the Tongue Side of Your Teeth?

Brushing the tongue-side of the teeth is very important.  If you don’t brush this surface of your teeth, you let the bacteria in your mouth grow on your teeth.  This can eventually cause cavities or destroy the bone that holds your teeth in your mouth.

If you’re not brushing away the plaque daily, then it can harden.  Once the plaque has hardened into tartar or calculus (click to see a picture of tartar), it can only be removed by a dental professional.  More often than not, we have to spend a lot more time removing tartar from the tongue side of the teeth when patients come in for their dental cleanings.


If you’re not sure if you brush the tongue side of your teeth, you can ask your dentist how you’re doing.  It might also be helpful to get some plaque disclosing tablets (be careful, some plaque disclosing solutions don’t actually highlight plaque!) and a dental mirror at a pharmacy and check for yourself.

Another helpful hint is to time how long you spend brushing the front side of your teeth and then make sure you spend just as much time brushing the tongue-side of your teeth.

Do you have any questions about brushing your teeth or dental hygiene in general?  I’d love to hear your questions, comments, and concerns in the comments section below.  Thanks for reading!

Dental License Verification
©Tyler Olson/Shutterstock.com

Have you ever wondered how long your dentist has been licensed or if they’ve ever had any public complaints?

Each state dental board provides certain public record information about dentists.

Dentist License VerificationA lot of information about your dentist is available on the internet. In fact,  as of late 2013 (Thanks Iowa!), all 50 states in the U.S. provide access to license information about all of their dentists online free of charge.

Some of the details that state dental boards allow you to view are:

  • How long the dentist has been licensed
  • If the dentist has ever had any disciplinary action taken against them
  • If the dentist has a permit for sedation or general anesthesia
  • What dental school and in what year the dentist graduated
  • If they are board certified in one of the nine dental specialties
  • Their main address where they engage in the practice of dentistry

All of these links work as of today! Over time, I am sure that some of the state dental boards will change the addresses of their license verification pages. If that happens, please send me an email or leave a comment at the bottom of this page and I’ll update the broken link.

Here’s the list:

Dentist License Verification Information for Each State in the United States


The Alabama Board of Dental Examiners provides an online directory of all practicing dentists in the state that tells you the address of every dentist in the state, when they first got licensed, when their license expires and from which dental school they graduated.  It’s a Microsoft Excel file, if you have any trouble opening it, let me know and I can convert it.

The Alabama Dental Board states that “The directories posted on this website are not intended for license verification purposes.”

Interestingly, they don’t seem to provide any other way for the public to verify licenses.  Although first in the alphabet, they’re near the bottom when it comes to information disclosure regarding practicing dentists.  If you find a better way to verify dental licenses in Alabama, please leave a comment below!


The Alaska Board of Dental Examiners allows you to download a .csv file (you can open it with Microsoft Excel) that contains the address of every dentist in the state, when they first got licensed and when their license expires. You need to go to this page and then click on “Dental” then click “Continue.” On the next page click on “Dentist” and then type in your email address and you will get a copy of the .csv file emailed to you with the information.


The Arizona State Board of Dental Examiners makes this form available to allow you to search for your dentist and find out their address, license number, issue date, expiration date, their dental school, and graduation date.


The Arkansas State Board of Dental Examiners has a form available that tells you the dentist’s address, phone number, when they first became licensed, and if they have ever had any disciplinary action taken.


The Dental Board of California provides this form you can use to search for your dentist.


Colorado’s Department of Regulatory Agencies provides this dental license verification tool.   Select “Dental: Dentist (DEN)” from the list and then input the information you know to perform a search.


The Connecticut Department of Public Health provides a form to search for your dentist here. Be sure to select “Dentist” from the drop-down list.


The Delaware State Board of Dentistry provides this form. Select “Dentistry” from the drop-down menu.

District of Columbia

Here is the link to the District of Columbia Dental License Search page.  You have to choose “Dentistry” then “Dentist” from the top two drop-down boxes.


The Florida Department of Health provides this form. Select “Dental” from the “Profession” drop-down menu.  Try this link if the top one doesn’t work.


The Georgia Board of Dentistry has made this form available. Select “Dentistry” under the profession box.


The Hawaii Department of Professional and Vocational Licensing doesn’t appear to allow you to search online, but they do offer a telephone number for you to call to obtain information on licensed dentists and previous complaints filed against dentists. They provide two numbers: (808) 587-3295 or (808) 587-3222.


The Idaho State Board of Dentistry provides this form to search for a licensed dentist.


The Illinois Division of Professional Regulation provides this license lookup form.


Indiana Online Licensing provides this form to search for dentists.


The Iowa Dental Board provides this form for you to perform a dental license search.


The Kansas Dental Board provides this license verification form. By using it, you agree to the Kansas Open Records Act.


The Kentucky Board of Dentistry provides this Dentist License Search form.


The Louisiana State Board of Dentistry provides this License verification page.


Maine provides this slightly confusing form. You need to select “All” under “Department”, “Dental Examiners” under “Agency” and “Regulator” then select “Dentists” under “Profession.” Then you can search!


Maryland provides the Maryland State Board of Dental Examiners License Verification Site which you can use to verify your dentist’s license.


Go to the Massachusetts Division of Health Professions Licensure License Verification Site to verify your dentist’s license.


The Michigan Department of Licensing and Regulatory affairs provides this online dental license verification page.  Simply select “Dentist, Hygienist, Dental Assistant” category from the profession selection box.


The Minnesota Board of Dentistry provides this Licensee Search page.


The Mississippi State Board of Dental Examiners provides this search page for licensed dentists.


The Missouri Division of Professional Registration provides this licensee search page (scroll down in the drop-down box to the “Dentistry” category. Alternatively, you can download a complete listing of all dental professionals from this page.


Montana has a state-wide licensee look-up system. It requires a few steps and has a captcha form. I put in the name of a recent graduate of my dental school who went to Montana to practice dentistry, and it didn’t find him… Hopefully it works for you!


The Nebraska Department of Health and Human Services provides this license look-up page.


The Nevada State Dental Board provides this licensee search page.

New Hampshire

The New Hampshire Board of Dental Examiners provides this license verification page.

New Jersey

The State of New Jersey provides this license verification service.

New Mexico

New Mexico provides this licensee search page. Click on “Dental” under profession, and then “Dentist” under license type.

New York

The New York Office of Professions has a license verification page here.

North Carolina

The North Carolina State Board of Dental Examiners provides this license verification database search page.

North Dakota

The North Dakota State Board of Dental Examiners provides this license verification page.


The Ohio License Center provides this license search page.


The Oklahoma State Dental Board provides this easy-to-use directory of licensed dentists. The link goes to dentists with last names starting with “A.” You can click on a different letter at the top of the page.


The Oregon Board of Dentistry provides this licensee look-up page.


The Pennsylvania Department of State provides this license verification site.

Rhode Island

The Rhode Island Department of Health provides this license look-up page.

South Carolina

South Carolina provides this dental license look-up page.

South Dakota

The South Dakota State Board of Dentistry provides this license verification page.


The Tennessee Department of Health provides this license verification page. I have to say it is one of the most in-depth license lookup systems out there! It gives you a LOT of information about the dental professional that you look up. For example, it will tell you if a dentist was fined for not renewing his license on time.


The Texas State Board of Dental Examiners provides this license verification page.

You can select dentists, hygienists, or registered dental assistants and then it will take you to the search page.


The state of Utah provides this licensee look-up and verification system.


Vermont provides this state license look up page.


The Virginia Department of Health Professions makes this license look-up page available to the public.


The Washington State Department of Health has this provider credential search page which will allow you to verify your dentist’s license.

West Virginia

The West Virginia Dental Board provides this page where you can search for a dentist and find their licensing information.


The State of Wisconsin Department of Regulation and Licensing provides this page for you to search for your dentist’s license details.


The Wyoming Board of Dental Examiners provides this licensee search page.

Questions or Broken Links

Do you have any questions about finding public records information about your dentist? Did you find that one of the links above didn’t work? Please leave a comment below and let me know about it and I’ll fix it right away!

Thanks for visiting Oral Answers!