Oral Health & Hygiene

Flossing Mistakes

It seems so simple to just slide some string between your teeth to clean those hard-to-reach areas.  While the idea is simple, there are a few techniques that you need to master in order to maximize the return on the time you spend flossing.

Here are ten common mistakes that people make when they floss:

10 Common Flossing Mistakes

1 – Not Flossing the Sides of Both Teeth

Flossing MistakesIf you just slide the floss down, and then pull it up, you are only getting 50% of the job done.  When you move the floss up between two teeth, you need to make sure that you are cleaning the side of both teeth.  One of the favorite places for plaque to hide is between teeth. If you’re only removing plaque from the side of one of the teeth, you could easily get a cavity on the tooth that you’re not flossing.

Find out about six common places where you are most likely to get cavities.

2 – Using the Same Section of Floss Between All of Your Teeth

When you floss you are removing bacteria from between your teeth and below the gum-line.  If you use the same section of floss for all of the teeth in your mouth, you are spreading around a lot of bacteria.  Of course you still are loosening the plaque, which has its benefits, but if you use a new section of floss each time you floss between two teeth, you will be loosening the plaque without putting plaque that you’ve already removed back in between your teeth.

3 – Snapping the Floss Down Hard Between Your Teeth

To get the floss to go between a tight contact between two adjacent teeth, try working the floss back and forth applying a firm but controlled downward pressure.

Snapping the floss down between the teeth can not only injure your gums in the short-term, but the trauma can cause your gums to recede.  Do it enough, and you’ll cause gum disease.

4 – Not Flossing Behind the Very Back Teeth

Even though there isn’t a tooth next to it, it is still important to clean behind the four teeth that are all the way in the back of your mouth (two teeth on each side in the upper and lower jaws.)  This can help remove bacteria that has made its way  between your tooth and gums.

5 – Flossing Aimlessly Without a Plan

When you floss, you need to have a road-map of what order you are going to floss your teeth in, or you can quickly become confused and miss some teeth or even a quadrant of your mouth.  It may be easiest to start in the upper right and go to the upper left, then come down to the lower teeth in the bottom left and move across to the bottom right.

However, as long as you have a plan, it really doesn’t matter which teeth you floss first.  Personally, I start right in the middle of my upper teeth and work my way back on one side and then on the other.  Then I do the same thing on the lower teeth.  Just find a “floss order” that works for you and stick to it so that you don’t forget to floss any teeth.

Dental Floss

6 – Not Flossing Around Dental Appliances

Many people don’t know that if they have fixed dental appliances in their mouth, they need to floss around them.  For example, if you have a bridge, it is necessary to use a floss threader, or get something similar to Oral-B Superfloss.

I had braces on my lower teeth when I was a teenager.  After I had them removed, the orthodontist cemented a wire that connects to each of my six lower front teeth.  This stabilizes them, but also makes it impossible to use conventional floss due to the wire.  Because of this, I have to use Superfloss or floss threaders to get under the wire so I can floss and maintain my gum health.

7 – Quitting When Your Gums Bleed

Blood may scare some people when they floss because they think that they are hurting their gums if they bleed.  You are not hurting them as long as you’re not flossing too hard (see mistake #3.)

Most likely, the reason they bleed is because they haven’t been flossed in a while and the gum tissue has become red and inflamed.  This is a condition known as gingivitis and it occurs because the body is sending more blood to the gum.  This is to help the tissue fight all of the plaque that is accumulating.  When you floss, you are removing that plaque, and since the tissue is inflamed and engorged with blood, you are causing some of the blood to leak out.  After a few days, your gums should return to health and you can floss normally without any bleeding.

8 – Not Spending Enough Time With Your Floss

Most people have 28 teeth if they’ve had their wisdom teeth extracted.  When you floss, you need to get both sides of the teeth (even the most posterior teeth – see mistake #4.)  That means that there are 56 sides that you need to get.  You should be spending a couple of seconds with each side, scraping up and down against the tooth a few times before moving onto the next surface.  That means that it will probably take you around two minutes to floss your entire mouth if you have a full set of teeth.

9 – Not Applying Pressure to the Tooth Surface

When you floss, you want to be careful to avoid using too much downward pressure so you don’t damage your gums.  However, when you are flossing against the side of a tooth, you want to make sure that you are pushing the floss against the tooth surface enough to be able to remove the plaque.

10 – Only Using Floss to Remove Food

Unfortunately, lots of people think that the only reason for flossing is to remove food that has gotten wedged between their teeth. I think many people end up doing this because they can see the food between their teeth — they can’t see the plaque.  An easy solution to this problem is to use a plaque disclosing tablet/solution to visualize the plaque on your teeth.

When you floss, your primary goal should be to scrape against each tooth to remove as much plaque as you can.  As long as you are doing this, you should be getting rid of the food between your teeth without even thinking about it.

Floss Correctly and Keep Your Teeth For Your Whole Life

By avoiding these ten common mistakes, you will be able floss more efficiently which will lead to greater oral health.  Since many cavities start out between two teeth, you will be able to prevent many cavities by regularly flossing and avoiding these ten flossing mistakes.

Do you have any questions or comments about flossing?  I’d love to hear them!  Just leave them below in the comments section.

Tongue Piercing with Needle
©Charles Knox/Shutterstock.com

I remember vividly a lecture that I had last year in one of my pediatric dentistry classes.  My professor told us a story about how she went down to one of the local piercing parlors and asked if she could take pictures of a tongue piercing.  They let her take some pictures and she showed them to our class.

She commented that if parents actually knew what happens when their kid gets their tongue pierced, there would be a lot less pierced tongues.

I debated about whether or not I should put an image of an actual tongue piercing in this article, but I think it may be too graphic for some people.  If you’d like to see what a tongue looks like as it’s getting pierced with a needle, you can see a photo with an explanation by clicking here.

Keep in mind that there are many risks with piercing your tongue, so I would advise against getting your tongue pierced.  In this article, I’ll simply focus on the process of getting your tongue pierced.

Tongue Piercing Procedure

The Tongue Piercing Procedure

First of all, the person piercing your tongue will use a marker to mark the spot on the taste-bud side of the tongue where the piercing will be.  If you look closely at the photo above, you’ll see a dark blue mark where the ring enters the tongue.

Next, the piercer will hold onto your tongue with some sort of a clamp so that it doesn’t move when it is pierced.  If the tongue moves and the needle goes through the wrong part, it could hit a blood vessel or cause damage to a nerve.

As they are holding onto the tongue, the piercer will stick a thick needle through your tongue without using any anesthetic.  (See a picture of this here – not for the faint of heart!)  Some people say this hurts, others say that as long as you find the right person to pierce your tongue, it shouldn’t hurt.  Since piercers are not licensed medical professionals, they are not permitted to give you any anesthetic to numb your tongue and prevent you from feeling pain.

Then, the piercer will put a long barbell through the hole that was made in the tongue.  Usually the barbell is 18 millimeters (about ¾ inch) long.  The initial barbell needs to be long because your tongue will swell a lot after the piercing.  If a short barbell is used, the tongue could swell around it and trap the barbell inside the tongue.  If this occurs, surgery will be needed to remove the barbell from the tongue.

If your tongue piercing is done in a clean, sanitary environment and doesn’t become infected., the initial 18 mm barbell can be replaced with a shorter barbell.


After your tongue has been pierced, you must leave the barbell in place or the hole can close up.  It can be removed for very brief periods of time without this occurring but there is always a risk.  It’s a good idea to remove any tongue jewelry when you’re playing sports so that you don’t damage your teeth.

Do you have any stories or experiences with tongue piercing?  I’d love to hear about your stories, questions and comments in the comments section below!


Functions of Different Teeth In Mouth

Have you ever looked in the mirror and noticed that all of our teeth are unique in their size and shape?

There’s a reason that all of our teeth have a unique shape and size.  It is because all of our teeth have a unique function in our mouth.

Big Smile Showing TeethA lot of times we eat in “auto pilot” mode.  We don’t really have to think about what our teeth are doing since we’ve been chewing for so long.

Have you ever paid attention to what your teeth do when you take a bite out of an apple, or crush a tortilla chip into small pieces that are easy to swallow?

Each tooth plays a valuable role in your mouth.  This is one of the reasons that dentists try so hard to save your natural teeth rather than pull them when you get tooth decay.

The Functions of Incisors

The incisors are the eight front teeth (four on top and four on the bottom) in your mouth.  They have many functions, such as:

1 – Incisors cut and slice through food when you take a bite. The incisors are the main teeth that you use to cut pieces of food, for example when you are eating a whole apple, your incisors are the teeth that slice through the apple and help you get the piece of apple into your mouth to be fully chewed by your other teeth.

2 – Incisors support the lips and face. Right now as you read this, the side of your lips that face your teeth are probably resting right up against your front teeth.  Because of this, your teeth help form the overall appearance of your face.  A reader, Eric, recently left a comment describing how after losing some of his front teeth, his nose and upper lip have started to sag.

3 – Help you speak. If you try to say the word tooth, you’ll notice that your tongue touches your upper incisors twice.  It touches near the top of the incisors for the “t” sound and near the bottom for the “th” sound.  This is just one example of the many sounds that your teeth help you make; it’s also why denture wearers have to re-learn how to speak clearly when they get their dentures.

4 – They can make your smile beautiful. When you smile, the first thing that most people notice will be your teeth.  Since your incisors are your eight front teeth, they have a tremendous effect on how your smile looks.  This leads many people to whiten their teeth, get braces, fix chips, and get dental work done.

5 – Incisors help guide your jaw when you close your mouth.

The Functions of Canines

Smile Showing Incisors, Canine, and PremolarsThere are four canines present in a full set of teeth.  They are the teeth right next to the four front incisors.  These are the sharp, pointy teeth that are sometimes called fang teeth. Canines are also known as the cornerstone of the dental arch as they are a big part of forming the curve that leads to the back teeth.  Canines are also the longest teeth in the mouth.  Because of their length, they are commonly used to anchor prosthetic teeth, such as removable partial dentures.  They are also some of the last teeth lost in the mouth due to periodontal disease.

Canines also have a variety of functions:

1 – Their sharp point allows them to pierce through and tear food. Some animals that hunt for food have very sharp canines.  This helps them to catch their prey.  Most humans don’t run around hunting with their teeth, so we simply use our canines to pierce through food and tear it as we take bites.

2 – The canines support the lips and face. See #2 in the incisors section.

3 – The canines help you talk. See #3 in the incisors section.

4 – They help guide your teeth when you chew. Canines act as the guideposts when you move your jaw to the left or the right.  If you slide your jaw to the left right now, you’ll notice that both the upper left and lower left canine teeth are sliding against each other.

The Functions of Premolars

There are a total of eight premolars in the mouth — two behind each canine tooth.  Premolars are kind of a mix between canines and molars.  They are also the tooth most often extracted when someone with severe crowding gets braces and there’s just not enough room in the mouth for all of the teeth.  They also have varying functions:

1 – They help the canines to pierce and tear food. The premolars have a couple of sharp points on them.  They aren’t as sharp as the canines, but they can still help pierce and tear food.

2 – They help the molars to crush and grind food during chewing. The premolars also have a broad biting surface, but not as broad as the molars.  This helps them to crush and grind food.

3 – They help with aesthetics and speech, but not as much as the canines and incisors. If you take a look at the girl pictured above, you can see both of her upper premolars.  The premolars can show more in some people than others.  For example, when I smile my premolars don’t show very much.  In people with wider smiles, their premolars show.

4 – Support the facial muscles at the corners of the mouth. The premolars keep the corners of your mouth from sagging inward.

The Functions of Molars

There are a total of 12 molars in the mouth, 3 behind each set of premolars.  The last molar in the very back of the mouth is commonly referred to as the wisdom tooth.  These teeth are usually extracted — to find out why, read the article Why Dentists Extract Wisdom Teeth.

Molars are the biggest and strongest teeth in the mouth.

1 – Molars Crush and grind food. Like I mentioned above, when we take a bit out of an apple, we get it into our mouths using our incisors.  When it gets in our mouth, our tongue pushes it toward the premolars and molars so that they can crush it and grind it down into tiny apple bits.

2 – They support your cheeks. Without your molars, your cheeks would appear to be sunk into your face.  Your molars play a vital role in making your cheeks appear full and vibrant.

3 –  The molars play a small role in speech. Molars do help you talk, but it is a more subtle role than the other teeth in your mouth.


I hope that helped you learn about the differences between each tooth.

Note that there are some functions that all of the teeth participate in, such as making your face look as tall as it is.  I’ll cover the many functions of teeth together as a group in a future post.

Do you have any questions about what your teeth do all day?  If so, leave them in the comments section below.  I’d love to hear what you have to say!

Water Fluoridation: Where I Stand

This is the final post dealing with water fluoridation in my week-long series discussing both sides of the water fluoridation debate.

Is Water Fluoridation Good?Hopefully you enjoyed the articles this week.  If not, don’t worry!  I’ll be back into my regular oral health writing routine next week.

If you missed the two previous articles, each of them explored one side of the water fluoridation debate.  You can read them by following the links below:

Top 10 Reasons to Support Water Fluoridation

Top 10 Reasons to Oppose Water Fluoridation

In this article, I’ll share a few of my own thoughts on the water fluoridation issue.

Where I Stand on Water Fluoridation

I do see valid arguments to both sides, and to be quite honest, I’m torn.  I think that the best way to express my feelings on the water fluoridation issue is to talk about two children — first, my son, and then someone else’s son.

Water Fluoridation

My Son and Water Fluoridation

I brush my children’s teeth every night before they go to bed.  When I started using fluoride toothpaste with my son, I made sure he spit it out.  I feel like my wife and I are in charge of his oral health, and that he wouldn’t have any cavities with or without water fluoridation.  With that said, I think that the only thing that would happen to my son as a result of drinking fluoridated water would be mild dental fluorosis.

We get fluoride from a number of sources.  I sometimes wonder if water fluoridation will provide enough extra fluoride to push him over the edge and cause his teeth to have the white speckled appearance characteristic of mild dental fluorosis.

Contrast this with the story below.

Another Child and Water Fluoridation

Now, imagine another child who grew up with parents who don’t really care about oral health.  We’ll call him Leroy.  Leroy’s parents let him eat candy all day and they are too busy to worry about brushing his teeth.  Water fluoridation is the only thing that Leroy has working in his favor when it comes to oral health.  His parents don’t even take him to the dentist.

In Leroy’s case, water fluoridation could potentially keep his baby teeth in good enough shape that he doesn’t get an infection from a tooth with a large cavity.  In this case, water fluoridation is a great thing!  The fluoride he receives every day when drinking could keep that little boy from having to go to the hospital due to a dental infection.

Should Both Kids Drink Fluoridated Water?

When you look at my son and Leroy, you can see that some people would benefit greatly from fluoride while other people could end up with enamel fluorosis and be embarrassed because of their teeth.

In an ideal situation, my son wouldn’t have to drink the fluoridated water.  In fact, he would probably give his fluoridated water to Leroy so that he could get a double dose of dental protection.  Unfortunately, water fluoridation is an all-or-nothing deal.  You can’t selectively fluoridate certain people’s water because that would be construed as discrimination.

This problem has led me to a lot of thinking.  It made me wonder if water fluoridation is the best way to get fluoride to kids like Leroy.

Is Water Fluoridation the Best Method?

There are alternatives.  Switzerland has had some success fluoridating the salt.  This would be relatively easy to do.  In 1924, Morton started putting iodine in salt.  They did this because iodine deficiency is the leading preventable cause of mental retardation.

In the book Fluoride in Dentistry, author Ole Fejerskov states, “Water fluoridation reaches everybody, a major advantage in terms of oral health and a problem in terms of social policy for those who dislike the overtones of compulsion. When domestic salt with added fluoride appears along-side non-fluoridated salt on the supermarket shelves, consumers have a choice. This makes fluoridated salt more palatable from the social policy viewpoint, but weakens its caries-preventive impact across the whole population.”

Salt fluoridation does have its drawbacks, which I will discuss in another article, but it is something to think about.

Since we began adding fluoride to water over 60 years ago, a lot has changed.  We are now surrounded by toothpastes with fluoride, mouth rinses with fluoride, and floss that is coated in fluoride.  Fluoride is even found in many of the packaged foods and drinks we consume.  I think we are ingesting too much fluoride.  Apparently that is the prevailing opinion, one which brought about the recent recommendations to reduce the amount of fluoride in our drinking water.


As you can see from what I’ve written above, I am both for and against water fluoridation.  One might say that although I’m in favor of using fluoride in appropriate doses, I see some definite problems with the mass water fluoridation that we see across much of the country.

Where do you stand?  Please share your thoughts in the comments section below.  Thanks for reading!

How Teeth Affect the Length and Shape of Your Face

Most people know that teeth help us speak and chew food.  However, an important, often overlooked function of teeth is that they help keep your face as long as it is.

Shorter Face Due to Lost TeethHave you ever noticed how older people sometimes look like their face was compressed together?  Often this is because they have lost teeth, and their jawbones have gradually gotten smaller over time.

If you open your mouth all of the way and then close it, you’ll hit on your teeth.  If you didn’t have any teeth, you would be able to close down much further, which would make your face appear to be shorter.

The picture above shows an elderly man who removed his dentures for the picture.  As you can see, without any teeth to hold his jaw bones apart, the space between the tip of his nose and chin is shorter than you would see in someone with teeth.  Also, you can see that his mouth area appears to be slightly puckered inwards because he doesn’t have any teeth to support the his lips and the area around his mouth.

Here’s a couple more photos to demonstrate this point. Here’s a profile view of an older man missing his teeth:

How Teeth Affect Shape of Face Side View
A Side view showing lower jaw coming forward and space between nose and chin getting smaller | ©Eclypse78/Shutterstock.com

And here’s a front view of the same man:

How Teeth Affect Shape of Face Front View
A Front view of the same man showing a small VDO | ©Eclypse78/Shutterstock.com

The technical name for the space between the jawbones when the teeth are touching is called the vertical dimension of occlusion or VDO for short.  If you’re curious about the relative lengths of a face with a normal VDO, look at this image on Google Images.

Ways Your Face Gets Shorter When You Lose the Vertical Dimension of Occlusion

Anything that causes you to lose teeth or tooth structure, can alter your VDO and thus make your face look shorter.  Here’s a list of a handful of things that can cause you to lose some VDO and make your face look shorter:

1- Losing teeth, especially the back teeth that bear a lot of the force when you bite down.

2 – Grinding your teeth. As you grind, you wear away tooth structure and your teeth get shorter, which causes your whole face to get shorter!

3 – Getting cavities. Cavities also eat away tooth structure and can cause your bite to collapse.

4 – Having Your Teeth Drift. This goes hand-in-hand with losing teeth.  Sometimes when you lose teeth, the neighboring teeth will drift into the empty spot (this is why spacers are important in kids!)  As the teeth drift, the top teeth and bottom teeth don’t come together like they used to, which can cause you to have a deeper bite and a shorter face.


As you can see from what I’ve written above, the main causes of losing facial height are due to preventable dental diseases.

By regularly going to your dentist you can treat cavities so that you don’t lose your teeth and you can also get appliances to help you stop grinding your teeth so that you don’t grind them away.

Do you have any questions or comments about this article?  I’d love to hear them in the comments section below – Thanks for reading!

FYI – This was supposed to be yesterday’s article, but my hard drive crashed Thursday night, I got a replacement yesterday at Best Buy and now I’m up and running again!

Ingredients in Toothpaste
©Ruslan Guzov/Shutterstock.com

Ever since antifreeze chemicals were discovered in toothpaste produced in China several years ago, people have been increasingly concerned about the ingredients found in toothpaste.  Luckily, anti-freeze is not found in toothpaste sold in the United States as it is illegal.

Toothpaste consists of several different ingredients that leave our teeth feeling fresh and clean.

So if you’ve ever wanted to know what’s inside that gooey paste that you smear against your teeth everyday, read on.

Toothpaste on a Toothbrush

The Ten Main Ingredients In Your Toothpaste

1 – Fluoride

Fluoride is the only active ingredient found in all toothpastes.  It wasn’t until about 50 years ago that fluoride was first added to toothpastes.  Fluoride only makes up about 0.15% of most toothpastes, although prescription-strength fluoride toothpastes contain more than 1% of fluoride.

To learn why fluoride is so important, read about the three ways fluoride protects your teeth.

2 – Abrasives

The abrasives found in toothpastes are what help scrape the plaque off of our teeth.  I think it’s important to mention that many whitening toothpastes contain too many abrasives, which can wear down the enamel or cementum on your teeth and cause your teeth to be sensitive.

Read this article to learn why whitening toothpaste isn’t making your teeth any whiter.

Some examples of abrasives in toothpastes are mica, calcium carbonate, calcium pyrophosphate, dicalcium phosphate, sodium bicarbonate, and hydrated silica.  The mineral mica not only acts as an abrasive, but can add an exciting glitter effect to toothpaste, making the urge to brush almost irresistible!

3 – Detergents

Detergents make people feel like the toothpaste is working by creating bubbles and making the toothpaste foamy.  The main detergent in toothpaste is known as sodium lauryl sulfate (SLS.)  Some researchers believe that sodium lauryl sulfate causes canker sores, but that’s a topic I’ll discuss in a future article.

4 – Flavors

Flavors are added to most toothpastes.  Some common flavors are bubblegum, fruit, mint, and cinnamon.  The purpose of the flavors are to mask any unpleasant tastes in the toothpaste and they can also help to freshen your breath by masking the bad odors in your mouth.

5 – Moisturizers and Humectants

A humectant is something that keeps a substance moist.  Humectants in toothpaste are what keep the toothpaste nice and smooth and help keep it from drying out.  Some commonly-used humectants are glycerin, sorbitol, and water.

Toothpaste Ingredients

6 – Antibacterial Agents

Certain toothpastes contain Triclosan, which is an antibacterial and antifungal agent.  It is commonly found in antibacterial soaps.  Not too long ago, Colgate started adding it to its toothpaste to create the Colgate Total brand that claims to protect teeth from plaque for up to 12 hours.

7 – Preservatives

Preservatives are added to toothpastes so that microbes don’t grow in the toothpaste and spoil it.  It would probably be frustrating if you had to refrigerate your toothpaste — especially if you have teeth that are sensitive to cold temperatures!  Thanks to preservatives, toothpaste is safe for many months at room temperature.

8 – Colors

Colors can give toothpaste an attractive appearance.  When I was a teenager, I remember my mom had bought some “natural” toothpaste.  Being a toothpaste junkie, I decided to try it just for fun to see how it worked.  It was a dark brown color and looked pretty gross and tasted even worse.  I never used that toothpaste again.  A little bit of color could have gone a long way in improving that toothpaste!

9 – Sweeteners

Toothpastes usually contain a substance to make them taste sweet so that we enjoy brushing.  Most toothpastes contain saccharin, aspartame, or xylitol to add a bit of sweetness.

10 – Thickeners

In case the toothpaste is too runny, manufacturers can add ingredients that thicken the toothpaste to form a nice, smooth consistency.  Carageenan and xanthan gum are common thickeners added to toothpastes.

Bonus Ingredients

Those are the main ingredients in toothpaste.  However, some special formulations of toothpaste can include other ingredients such as the ones listed below:


Toothpaste requires many ingredients to work the way it does and to have the appearance and taste that it does.  The ingredients I have listed are those common to toothpaste sold in the United States, however international brands may vary.  If you know of any ingredients I missed or have any questions or comments, I’d love to hear about them below.

Thanks for reading!

New Year's Resolutions for Oral Health
©Becky Stares/Shutterstock.com

Dental New Years ResolutionsYou’ve probably made a lot of New Year’s resolutions in your life — but I’m willing to bet that you’ve never made a New Year’s resolution for your teeth!  Here are a few goals that will improve your oral health, as well as your overall health:

1 – Eat Healthier

I’ve written about food and drink more than 20 times on this blog.  Fresh fruits and vegetables are generally not harmful to your teeth whereas sugary, processed foods will probably cause you problems with your teeth if eaten frequently.  A healthy, well-balanced diet will not only help your teeth and gums, it will also improve your overall health by providing your body with vital nutrients and keeping your weight in a healthy range.

2 – Floss Every Day

As people age, the main reason that they lose their teeth isn’t because of cavities, it’s due to periodontal disease.  Flossing removes the plaque between your teeth that you simply can’t remove by brushing your teeth alone.  One of the most common reasons that my patients tell me they don’t floss is because it’s difficult.  Fortunately, there are many simple devices that can make flossing easier.  Here are a few products that have 5-star reviews on Amazon:

3 – Lose Weight

If you have some extra pounds to lose, you’re in good company — according to a recent poll, about 63% of American adults are either overweight or obese.  Unfortunately, being overweight puts you at risk for many diseases, including type II diabetes.  Type II diabetes has been shown to increase the risk of getting periodontal disease.

You can learn more about the link between diabetes and oral health at this oral health portal from the American Diabetes Association.

4 – Go to the Dentist

There are many reasons that people avoid going to the dentist.  The key is to figure out the reason that you’re not going.  Once you know why, it is easier to make a plan to get in for your dental checkup.

If you’re already going to the dentist every six months, then you are not only having regular cleanings and getting existing problems taken care of — your dentist will also be able to tell you if new problems are starting so you can prevent them.  Many people are unaware that they have dental problems until they become painful.  By that time, there if often little the dentist can do other than removing or filling the problem tooth.  By going in for regular checkups, you will be able to have these problems diagnosed early and treated.

What Do You Think?

Can you think of any other new years resolutions that will benefit your teeth?  If you have any questions or comments, please leave them below in the comments section.  Thanks for reading!

Tooth Decay Serious Disease

Deamonte Driver was a typical twelve year old boy growing up in Maryland.  In January 2007, he complained that he had a headache to his mother, Alyce.  Then he said his tooth hurt.

Emergency RoomAlyce, his concerned mother took him to the emergency room at the local hospital where the doctors found that bacteria from decayed teeth had traveled through his blood into his brain, causing a serious infection.

Fast forward six weeks to a Saturday near the end of February.  Deamonte underwent two operations and it looked like he would recover.  His mother spent all day Saturday with her son, then went home.  The very next day the hospital called his mother and told her that he was unresponsive.  By the time she made it to the hospital, Deamonte, her son of only 12 years had passed away.

To learn more about the tragic story of Deamonte Driver you can read about it in the Washington Post or watch a video report from MSNBC.

Tooth Decay: A Serious Disease

Deamonte’s story is an extreme one.  Tooth decay doesn’t always kill people.  My purpose in sharing this story was to let you know that tooth decay is a disease and it can be serious.  It has many of the same traits as more well-known diseases.  Here are a few lesser known facts about tooth decay:

1 – Tooth decay is contagious — you have to “catch the disease.” The bacteria that cause tooth decay can easily be transmitted from one person to another.  When babies are born, their mouths are sterile.  If they had teeth, they could eat lots of sugar without any detrimental effects on their teeth.  Babies usually catch the bacteria that cause tooth decay from one of their parents or siblings.

2 – Tooth decay can cause pain. If a cavity progresses without pain, it can cause a painful toothache.

3 – Tooth decay can cause children to miss school. This can be either due to pain or multiple dental visits to take care of the diseased tooth.

4 – Tooth decay is the most common disease of early childhood! The American Academy of Pediatric dentistry has stated, “Caries is the most common chronic disease of childhood.  Approximately 60% of children experience caries in their primary teeth by age 5.”

5 – Tooth decay can cause developmental problems and nutritional deficiencies. Here’s another quote from the American Academy of Pediatric Dentistry:

Rampant caries is one of the factors causing insufficient development in children who have no other medical problems.  Children with early childhood caries (ECC) may be severely underweight because of the associated pain and disinclination to eat. Nutritional deficiencies during childhood can impact cognitive development.


Hopefully you can see that dental caries isn’t just a small problem.  It affects over half of all children under age 5!

Whether you call it tooth decay, cavities, or caries – an infection of your teeth can be a serious problem.

Do you have any questions or comments to share about dental cavities?  Please leave them below in the comments section.  Thanks for reading!

Tongue Piercing Licking Lips

Oral piercing is a practice that seems to be gaining popularity in the United States.  The most common places to get a piercing in your mouth are the lips, tongue, cheek, and the uvula (the “hangy-ball” thing in the back of your throat.) Tongue Piercing Can Hurt Your Teeth!People want to get their tongue pierced for a variety of reasons.  One of the biggest reasons is to make them look trendy — people want to fit in, and if they can be seen as cool for getting their tongue pierced, then they’ll go for it. Unfortunately, not many people are aware of the many risks associated with getting your tongue pierced.  I think if people understood the dangers of tongue piercing, fewer piercings would be performed. I’m planning on writing a couple of articles about the risks of tongue piercing.  This first article will focus on ten ways that tongue piercing hurts your mouth and teeth.  The next one will talk about the negative effects that oral piercings have on the rest of your body.

The Risks of Tongue Piercing: 10 Ways Tongue Piercing Hurts Your Mouth and Teeth

1 – Tongue piercing causes chips, cracks, and/or fractures in your teeth. Wearing tongue jewelry can not only damage your teeth, but it can damage expensive dental work that you may have already had done. The effect of tongue jewelry on teeth is especially important when participating in exercise and athletic activities.  When in doubt, take the barbell out!  It is important to note that if you leave out your tongue jewelry for more than a few hours, it may be next to impossible to get the jewelry back in.

Tongue piercings are just one of the many ways you can chip or crack your teeth.  To learn more,read 10 Easy Ways to Chip or Crack Your Teeth.

2 – Tongue piercing causes gum recession, also called localized periodontal disease. If you wear a barbell in your tongue, it can rub up against and irritate the gums on the tongue side of your teeth.  This has led to gum recession in many people who have their tongue pierced.  In older adults, periodontal disease (not cavities) is usually the most common cause of tooth loss. 3 – Tongue piercing can wear down your teeth. Out of habit, many tongue-ring wearers often rub their tongue ring up against their teeth. Over time, this can wear down the enamel. Over time, you could expose dentin or experience increased sensitivity or cavities. If you insist on having a tongue piercing, trying out a shorter barbell may reduce the damage that it inflicts on your mouth — although it would be best to get rid of the tongue jewelry altogether!

Concerned about wearing down your teeth? Learn more about the four ways we wear down our teeth.

4 – Tongue piercing can cause speech impediments. Tongue piercing can make it more difficult to talk.  You use your tongue for making a lot of sounds when you talk.  If you get a tongue ring, it makes it a lot harder to speak correctly. 5 – Tongue piercing can cause nerve damage. An inexperienced piercing parlor worker may inadvertently cause permanent damage to the nerves in your tongue or other areas of the mouth depending on how the tongue is pierced.  The person doing the piercing needs to have a sound knowledge of the anatomy of your tongue.  If you do get your tongue pierced, it’s important to find a reputable, high-quality piercing parlor to cut a hole in your tongue. You probably wouldn’t enjoy having parts of your tongue permanently numb.  Many people hate having their tongue numb for a couple of hours after getting a filling — just imagine how hard it would be to not fully enjoy the taste of your food or constantly have your tongue give you that numb, tingling sensation. 6 – Tongue piercing can cause bad breath. Tongue jewelry is a good place for the plaque in your mouth to live.  It’s harder to brush if you have tongue jewelry.  Also, if you don’t regularly clean your tongue jewelry, it can accumulate bacteria that make your breath smell pretty disgusting! Tongue Piercing Damages Your Mouth! 7 – Tongue piercing can cause a space between your two upper front teeth, also known as a diastema. Although this isn’t very common, it does happen as evidenced by this case report written by orthodontists. 8 – Tongue piercing can cause excessive drooling. Tongue piercing can cause an increase in the amount of saliva you make.  Although saliva is good for the teeth, too much can be a problem.  You probably won’t look too cool with a tongue ring if you leave a puddle of spit everywhere you go! 9 – The metal tongue jewelry can cause a metal hypersensitivity reaction. You could end up being allergic to the metal in your tongue jewelry. If you were excited about having metal tongue jewelry and then end up having to wear a plastic barbell, you may be disappointed. 10 – Tongue piercing can cause pain and infection. The tongue piercing itself could cause pain and other complications.  Many people who have had their tongue pierced say that it was quite painful.  Here’s one story about how much tongue piercing hurts from Yahoo! Answers. You might get an infection depending on how sanitary the piercing parlor is. Most people have some degree of swelling after their tongue piercing. If you have a low tolerance for pain, you may want to reconsider.

More Reading on the Negative Effects of Tongue Piercing

I read a LOT of great articles while researching for this post.  Here are a couple you might be interested in:


Keep in mind that of all of the negative effects listed above, the most common are damaging a tooth and causing gum recession. If you’re thinking about getting your tongue pierced, please re-think your decision.  You may look cool around some of your friends, but the damage that tongue piercing does to your mouth isn’t worth it. Although I didn’t mention this above, because it’s not a huge consequence of tongue piercing, think about how much you love tasting your food —  especially with Thanksgiving tomorrow.  Do you really want to damage some of your valuable taste buds by getting your tongue pierced? For all of the Americans reading this, have a great Thanksgiving day tomorrow!  If you have any questions or comments about tongue piercing and oral health, please leave them in the comments section below.

Dental Crown Procedure: What Is a Dental Crown?

Have you ever been unable to fall asleep at night, staring at the ceiling and wondering what a dental crown was?  Maybe you’ve wondered what the difference between a crown and a cap was.  If so, this one’s for you!

Some teeth develop an unstable structure as a result of cavities or trauma (such as cracking a tooth.)  When a tooth has become broken down and is basically falling apart, sometimes a filling just won’t work.  Teeth that are broken down often need to get crowned or capped.

What’s the Difference Between Dental Crowns and Caps?

There really isn’t a difference between a crown or a cap.  A cap is simply a less technical name for a crown, kind of like chompers is a less technical name for teeth!

What is a Dental Crown?

A dental crown is like a glove that covers the tooth and holds it together, protecting it from further damage.

In order for a tooth to get a crown, the dentist will need to shave it down on all sides, take an impression of your teeth, send the impression to a lab, and have them make the crown.  In the meantime, the dentist will send you away with a temporary crown to wear.

That’s a simple written definition of a crown, but pictures are probably a lot easier to understand.  A little over a year ago, I was taking the first of three classes in making crowns and bridges.

Below you’ll find the crown I cut and the temporary crown I made for my first practical exam in that course.

What a Dental Crown Looks Like

Here’s what the tooth looks like before getting a crown.  I tried to photo-shop in a couple of cavities.  As you can see, the tooth is practically begging for a crown.

Dental Crown Tooth Before Being Prepared for Crown

Below, you can see what the tooth looks like after preparing it for a crown.  I cut around the whole buy xanax cheap tooth.  I had to cut away a specific amount of tooth (measured in tenths of a millimeter!) in order to do well on the practical exam.

Tooth Prepared for Dental Crown Cap

Below is the same tooth after being prepared.  This is what it looks like from the tongue side of the mouth.

Dental Crown Tooth Prepared Tongue Side View

In the picture below, you’ll see what the temporary crown looks like.

Tooth with a Temporary Crown

In case you are concerned about the lovely green color of this temporary crown, it is dyed that color for a purpose.  Our instructors have the students dye their crowns a different color each year to prevent upperclassmen from handing their old work down to classes below them.   Your temporary crown will match the color of your teeth, although it will not be quite as high-quality as the permanent crown since it is only intended to be used for a short period of time.

The next step would be to take an impression, pour it up in plaster and send that model off to the lab to have a permanent crown made.  I didn’t feel like footing the lab bill so that my plastic teeth could have a real crown, so there are no pictures of the permanent crown here.

Update: Extra Images of What a Dental Crown Is

Update 9/8/14: Now that I’m out of dental school I’m trying to spruce up the site a little more.  Here’s a few more images to demonstrate what happens when you get a dental crown:

Dental Crown Getting Cut

Dental crown getting tried on tooth and then cemented:

Dental Crown Getting Seated and Cemented


In summary, a crown simply covers the surface of the tooth to help protect it from further damage.

I hope that better explains to you what a dental crown is.  If you have any questions, comments, or suggestions, please leave them below in the comments section.  Thanks for reading!

Newer stock images of crowns ©Alex Mit/Shutterstock.com

Meth Mouth Destroys Teeth
©Roby Byron/Shutterstock.com

Methamphetamine, like many other illicit drugs can harm your teeth fairly rapidly.  Back in September, I wrote an article entitled Seven Ways Crystal Methamphetamine Ruins Your Teeth. That article gave seven main ways that crystal meth damages your teeth.

Drug DealThis article, on the other hand, will show you in pictures exactly what methamphetamine can do to your teeth.

FYI, if you have a weak stomach, you may not want to look at the pictures as some may find the teeth a bit gross.

Meth Mouth: The Effects of Methamphetamine On Your Teeth

The picture below is of a patient that came to a dental school who was suspected of using methamphetamine.  All of the brown and dark brown on his teeth are cavities.  The methamphetamine has helped the bacteria in the mouth eat away at the teeth.

Meth Mouth

The photo below is a close-up view of the left side of the picture above.  You can clearly see that a lot of the tooth structure has been destroyed due to a simple methamphetamine addiction.

Meth Mouth Closeup

Not Just Your Teeth — Methamphetamine Affects Your Whole Body

In dental school, we are learning more about the mouth-body connection.  This article wouldn’t be complete without showing that methamphetamine not only affects the teeth, but it affects the body in many ways.

The diagram below lists about three dozen ways that methamphetamine adversely affects your body, including high blood pressure, heart attack, and kidney damage.

Methamphetamine Effects on Body


Methamphetamine can damage your teeth and create a condition commonly known as Meth Mouth.  Methamphetamine also can damage your whole body in a variety of ways.

Do you have any questions or comments on methamphetamine and dental health?  Leave them below in the comments section.  Thanks for reading!

Dental Tartar and Calculus

Earlier this week, one of my friends told me a joke that made me groan. She asked, “What is a dentist’s favorite subject in high school?”  I told her I didn’t know, and then she blurted out “Calculus!”


So what exactly is calculus?  Calculus, commonly known as tartar (as in tartar-control toothpaste) is plaque that has hardened.  In the picture below, the calculus looks like a thick, creamy coating sticking to the teeth between the teeth and the gums.

Tartar / Calculus

Here’s two other photos of the same mouth shown in the photo at the top of this article.  Before a dental cleaning:

Dental Tartar and Calculus Before Cleaning

And the same set of teeth after a good scraping by the hygienist:

Dental Tartar and Calculus After Dental Cleaning

What Is Tartar / Calculus?

Tartar and calculus are the same thing.  Tartar is the more common term and most dentists and dental hygienists will call it calculus.  No matter what you call it, tartar is simply plaque that has sat on your teeth for a while and hardened.

A while back, I talked about how saliva helps our teeth by repairing teeth with calcium to undo the damage done by eating sugar.  Unfortunately, that same calcium can get incorporated into plaque, turning it into hard tartar.

The book Carranza’s Clinical Periodontology describes calculus by saying, “It is usually white or whitish yellow in color, hard with claylike consistency, and easily detached from the tooth surface.  After removal, it may rapidly recur, especially in the lingual area of the mandibular incisors.  The color is influenced by contact with such substances as tobacco and food pigments.”

Where Is Tartar Usually Found?

Tartar can be found on any tooth surface and even below the gumline.  A common hideout is on the tongue side of your lower front teeth.  The salivary glands under your tongue put out a lot of calcium, which helps the plaque harden into tartar rather quickly.

How Can You Prevent Calculus and Tartar from Forming In Your Mouth?

The best way to prevent calculus from forming is by brushing twice a day and flossing.  The book Carranza’s Clinical Periodontology says that plaque can start to mineralize (the process that helps it turn into tartar) in as little as a couple of hours!

How Is Calculus Removed from Teeth?

Once plaque has hardened into calclulus, you need to have it removed by a dental professional.  Your dentist or dental hygienist removes calculus using metal instruments or with an ultrasonic dental instrument.

It’s important to visit your dentist regularly so you can get any calculus or tartar build-up removed.

What Happens If You Never Get Calculus Removed From Your Teeth?

If you don’t go to the dentist to get calculus removed from your teeth it can start to irritate your gums and over time may cause periodontal disease, a major cause of tooth loss.  If you look again at the picture above, you can see that the patient’s gums appear to be falling down, because they are irritated from all of the tartar.

Chances are that if you have calculus visible on your teeth then there is also some below the gumline.  It’s important to see your dentist so that you can keep your teeth clean and free of periodontal disease.


In summary, bacteria cling to your teeth and grow, forming plaque.  If you don’t remove the plaque by brushing and flossing, it can get hard and turn into mineralized plaque known as tartar or calculus.

If you don’t get it cleaned off, tartar can irritate your gums, contributing to periodontal disease.

If you have any questions, comments, or good jokes to share about tartar or calculus, feel free to leave them below in the comments section.  Thanks for reading!

Easy Ways to Crack or Chip Your Teeth

Many people end up cracking or chipping their teeth at some point in their lives. A majority of cracked and chipped teeth injuries are preventable.

Tongue Rings Can Crack Your TeethTo illustrate that point, I’ve come up with 10 easy ways that you can crack and chip your teeth.  A lot of the ways don’t even involve doing anything.

Here’s a tip: If you want to keep your teeth crack and chip free, don’t do anything on the list below!

10 Easy Ways to Crack or Chip Your Teeth

1 – Get your tongue pierced and wear a hard metal object in it.  The hard metal will constantly bump up against your teeth and can chip and/or cause cracks.  A major cause of chips in front teeth is from tongue barbells.

2 – Don’t wear a protective athletic mouth guard when playing sports.  This one’s pretty easy, since it involves doing nothing.  Just don’t go to your dentist and get a custom mouthguard made, and you’ll be at a much higher risk for getting a cracked or chipped tooth.

That’s not all mouth guards do!  Here’s six reasons to wear an athletic mouthguard.

3 – Chew on ice or any other hard object.  To read more about the damage that chewing on ice does to your teeth, read How Chewing on Ice Affects Your Teeth.

Another common culprit of cracked teeth is popcorn kernels.  For some reason, people like to finish the whole bag of popcorn, and if some kernels didn’t pop like they were supposed to, they feel like they need to get eaten too.  If your popcorn bowl looks like the one below when you’re done, then congratulations!

Cracked Teeth Can Occur from Chewing Unpopped Popcorn Kernels

4 – Use your teeth as tools – to open things, use them as scissors to cut tape or cut tags off of new clothes.  Pretty much any way you use your teeth as tools, you will be putting excessive wear on them that could cause small cracks.

5 – Grind your teeth and don’t do anything about it.  If you grind your teeth, you could end up cracking them or even wearing your teeth down to almost nothing.  If you think that you may be grinding your teeth while you sleep, it’s best to talk to your dentist about it.  Most dentists will make an appliance you can wear to help stop teeth grinding.

6 – Don’t brush, make sure you get a big cavity, then go to your dentist and have a really big filling put in your tooth.  By losing so much tooth structure to tooth decay, it will be a lot easier to get your tooth to crack.

7 – Don’t get braces.  By not having the teeth in proper alignment, it is easier to put stresses on them when you bite, which could lead to worn down teeth, or cracking in more extreme circumstances.

8 – Clench your teeth often.  A lot of people clench their teeth when they’re stressed out.  Well, clenching can also stress out your teeth!  That’s alright if you want to crack or chip your teeth, but if you want to keep your teeth nice and healthy for a lifetime, try to stop clenching.

9 – Keep on getting older.  After a lifetime of wear, teeth can get pretty worn down and cracked.  Some experts believe that as you get older, your teeth become more brittle, which makes them more prone to cracking.

10 – Eat rocks or bones.  It does happen.  A lot of people find rocks in a can of re-fried beans or don’t sort out rocks from dried beans.  Another culprit is finding a bone in a fast food hamburger or chicken sandwich.  When you unexpectedly bite into something hard with a lot of force, it can easily crack or chip a tooth.


Ideally, you should try to not do anything on the above list.  Alright…  Unless you can live forever like the Tuck family in Tuck Everlasting(4th grade reading assignment), you probably can’t avoid #9.  #10 is also pretty hard to avoid, but the rest of the list involves choices that we make that can wear down our teeth over time.

Do you have any questions or comments about cracked or chipped teeth?  Leave them in the comments section below!  Thanks for reading!

Ways Your Teeth Get Worn Down
©Steven Frame/Shutterstock.com

When teeth first come into the mouth, they are in pristine condition and come complete with mamelons, remnants of the tooth’s development.  Over time, our teeth get worn down.  Some people wear their teeth down more than others.

There are four main ways that we wear down our teeth: Abrasion, Attrition, Erosion, and Abfraction.  If you’re not sure what those words mean, keep reading and I’ll explain!  The man in the picture below is wearing down his teeth in one of those four ways.

Wearing Away Teeth: Abrasion, Erosion, and Abfraction


Abrasion happens when objects come into contact with our teeth that mechanically wear them away.  A common way people wear away teeth is by using their teeth as tools, like chewing through tags on clothes or using your teeth to open packages.  Some other examples of abrasion are:

  • When you brush your teeth, the grit in the toothpaste can slowly wear away tooth structure.  Under normal circumstances, this won’t wear away enough tooth structure to be noticeable, but some people who brush their teeth a LOT will wear away a noticeable amount of tooth structure.  This is one of the reasons that our teeth get more yellow as we get older, we are slowly wearing away the enamel and seeing the yellow dentin underneath.
  • Chewing on pencils or any other foreign object.
  • Chewing on food.
  • Chewing tobacco.


Attrition is defined as wearing away tooth structure from tooth-to-tooth contact.  Some attrition is normal, it’s how mamelons get worn away.  Attrition gets to be a problem if you are routinely clenching and grinding your teeth.  Many people grind their teeth at night, often without being aware.  We make night guards at our dental school which people can wear to prevent them from grinding their teeth at night.  If you grind your teeth, talk to your dentist about getting a night guard.

In Peter Dawson’s book Functional Occlusion he states, “When wear penetrates enamel into softer dentin, wear increases seven times faster.”  That means that it’s best to get your grinding problem taken care of as soon as possible, because it will only get worse once you grind through the enamel.


Erosion occurs when you eat or drink acidic beverages.  The reason we get cavities is because plaque living on our teeth produce acid that over time can dissolve our teeth.

Any time acid comes into contact with our teeth, it can dissolve the crystals that make up our teeth.  Here are some ways that acid comes into contact with our teeth:

  • Eating or drinking acid-containing foods and beverages.  If you’re interested in some related reading, here’s 9 drinks that can dissolve your teeth, and a guide to identifying acids in foods.
  • When we throw up, either from the flu or from an eating disorder such as bulimia, the acidic contents of the stomach wash over our teeth and slowly dissolve them.
  • If you have gastroesophageal reflux disease (commonly known as GERD), your mouth will become acidic due to the acids from the stomach making their way back into your mouth.
  • Putting acidic pills or medications in your mouth.  Some people suck on vitamin C tablets.  Others try to put aspirin on a toothache to make it feel better.  Both of these pills are acidic and can cause tooth erosion.


Abfraction is wear at the gumline that has a controversial origin.  Some dental experts say that it comes from stress on the tooth when biting and others say that it comes from abrasion due to the grit found in toothpaste.  In Dawson’s book mentioned above he says, “What we have been calling abfraction lesions are really the result of toothpaste abuse.”

Abfraction lesions are wedge-shaped and usually appear on the cheek/lip side of the teeth.  The book Oral and Maxillofacial Pathology by Neville describes abfraction lesions as “defects that are deep, narrow, and v-shaped…often affect[ing] a single tooth with adjacent unaffected teeth.  In addition, occasional lesions are subgingival, a site typically protected from abrasion and erosion.”


As you can see, there are many ways that we wear away our teeth.  Many of the causes of excessive wear — consuming acidic foods and drinks, using our teeth inappropriately, and using abrasive toothpastes — are preventable.  Even attrition, which results from grinding your teeth, is easily treated by your dentist.   Hopefully, you can take steps to reduce the wear on your teeth now that you are aware of the causes.

If you have any questions or comments, please leave them in the comments section below.  Thanks for reading!

Oh, and if you’re wondering how the man in the photo above is wearing away his teeth… it’s by abrasion!

Prescription Medications that Cause Dry Mouth

Did you know that many prescription and over-the-counter medications we take every day can cause dry mouth?

As I mentioned in my previous article about the causes of dry mouth, the main types of drugs that can cause dry mouth are anti-depressants, sedatives, beta-blockers, high blood pressure medication, antihistamines, and cold/flu medications.

Many medications have been implicated in dry mouth, such as Viagra, Cialis, and 346 other medications all listed below.

348 Medications & Drugs That Cause Dry Mouth / Xerostomia

Drugs that Cause Dry Mouth

The drugs are listed in alphabetical order by the generic name.  If you want to search for a specific drug, just press Ctrl + F (Command+ F on Macs) to open the find dialog and type in the generic or brand name of a specific drug to see if it’s on the list.

  1. Abciximab – Marketed buy levaquin under the brand name Reopro.
  2. Acamprosate Calcium – Marketed under the brand name Campral.
  3. Acetaminophen with Tramadol – Marketed under the brand name Ultracet.
  4. Acetaminophen with Butalbital with Caffeine with Codeine Phosphate – Marketed under the brand name Phrenilin.
  5. Adenosine – Marketed under the brand name Adenoscan.
  6. Albuterol Sulfate with Ipratropium Bromide – Marketed under the brand name Combivent.
  7. Albuterol Sulfate – Marketed under the brand names Proventil and Ventolin.
  8. Almotriptan Malate – Marketed under the brand name Axert.
  9. Alprazolam – Marketed under the brand names Niravam and Xanax.
  10. Alprostadil – Marketed under the brand name Caverject.
  11. Amantadine Hydrochloride – Marketed under the brand name Symmetrel.
  12. Amiloride Hydrochloride – Marketed under the brand name Midamor.
  13. Amiloride Hydrochloride with Hydrochlorothiazide – Marketed under the brand name Moduretic.
  14. Amitriptyline Hydrochloride Amlodipine Besylate with Atorvastatin – Marketed under the brand name Caduet.
  15. Amlodipine Besylate with Benazepril Hydrochloride – Marketed under the brand name Lotrel.
  16. Amlodipine Besylate – Marketed under the brand name Norvasc.
  17. Amoxicillin with Clarithromycin with Lansoprazole – Marketed under the brand name PREVPAC.
  18. Amphetamine Aspartate with Amphetamine Sulfate with Dextroamphetamine Saccharate with Dextroamphetamine Sulfate – Marketed under the brand name Adderall.
  19. Amphotericin B. Liposomal – Marketed under the brand name Ambisome.
  20. Anastrozole – Marketed under the brand name Arimidex.
  21. Aripiprazole – Marketed under the brand name Abilify.
  22. Arsenic Trioxide – Marketed under the brand name Trisenox.
  23. Aspirin with Caffeine with Orphenadrine Citrate – Marketed under the brand name Norgesic.
  24. Atenolol with Chlorthalidone – Marketed under the brand name Tenoretic.
  25. Atenolol – Marketed under the brand name Tenormin.
  26. Atomoxetine Hydrochloride – Marketed under the brand name Strattera.
  27. Atorvastatin Calcium – Marketed under the brand name Lipitor.
  28. Atropine Sulfate – Marketed under the brand name Motofen.
  29. Atropine Sulfate with Benzoic Acid with Hyoscyamine with Methenamine with Methylene Blue with Phenyl Salicylate – Marketed under the brand name Urised.
  30. Atropine Sulfate with Hyoscyamine Sulfate with Phenobarbital with Scopolamine Hydrobromide – Marketed under the brand name Donnatal.
  31. Azatadine Maleate – Marketed under the brand name Trinalin.
  32. Azelastine Hydrochloride – Marketed under the brand name Astelin.
  33. Balsalazide Disodium – Marketed under the brand name Colazal.
  34. Beclomethasone Dipropionate – Marketed under the brand names Beclovent and Vanceril.
  35. Belladonna Alkaloids with Phenobarbital – Marketed under the brand name Donnatal.
  36. Belladonna Alkaloids with Hyoscyamine Sulfate with Methenamine with Methylene Blue with Phenyl Salicylate with Sodium Biphosphate – Marketed under the brand name Urimax.
  37. Benazepril Hydrochloride – Marketed under the brand name Lotensin.
  38. Bendroflumethiazide – Marketed under the brand name Corzide.
  39. Benztropine Mesylate – Marketed under the brand name Cogentin.
  40. Bepridil Hydrochloride – Marketed under the brand name Vascor.
  41. Betaxolol Hydrochloride – Marketed under the brand name Kerlone.
  42. Bevacizumab – Marketed under the brand name Avastin.
  43. Bexarotene – Marketed under the brand name Targretin.
  44. Bicalutamide – Marketed under the brand name Casodex.
  45. Biperiden Hydrochloride – Marketed under the brand name Akineton.
  46. Brimonidine Tartrate – Marketed under the brand name Alphagan.
  47. Brinzolamide – Marketed under the brand name Azopt.
  48. Brompheniramine Maleate – Marketed under the brand names Bromfed and Dimetane.
  49. Brompheniramine with Phenylpropanolamine with Codeine – Marketed under the brand name Dimetane-DX.
  50. Budesonide – Marketed under the brand names Pulmicort and Rhinocort.
  51. Bupropion Hydrochloride – Marketed under the brand names Wellbutrin and Zyban.
  52. Buspirone Hydrochloride – Marketed under the brand name Buspar.
  53. Butabarbital with Fluoxetine Hydrochloride with Hyoscyamine Hydrobromide with Phenazopyridine Hydrochloride – Marketed under the brand name Pyridium.
  54. Cabergoline – Marketed under the brand name Dostinex.
  55. Calcitonin-Salmon – Marketed under the brand names Fortical and Miacalcin.
  56. Calcitriol – Marketed under the brand name Calcijex.
  57. Capecitabine – Marketed under the brand name Xeloda.
  58. Captopril – Marketed under the brand name Captopril.
  59. Carbamazepine – Marketed under the brand names Carbatrol, Equetro, and Tegretol.
  60. Carbidopa – Marketed under the brand name Lodosyn.
  61. Carbidopa with Levodopa – Marketed under the brand names Parcopa and Sinemet.
  62. Carbidopa with Entacapone with Levodopa – Marketed under the brand name Stalevo.
  63. Carbinoxamine Maleate with Dextromethorphan Hydrobromide with Pseudoephedrine Hydrochloride – Marketed under the brand name Balamine.
  64. Carvedilol – Marketed under the brand name Coreg.
  65. Cefdinir – Marketed under the brand name Omnicef.
  66. Cefditoren Pivoxil – Marketed under the brand name Spectracef.
  67. Cefpodoxime Proxetil – Marketed under the brand name Vantin.
  68. Celecoxib – Marketed under the brand name Celebrex.
  69. Cetirizine Hydrochloride – Marketed under the brand name Zyrtec.
  70. Cetirizine Hydrochloride with Pseudoephedrine – Marketed under the brand name Zyrtec-D.
  71. Cevimeline Hydrochloride – Marketed under the brand name Evoxac.
  72. Chlorothiazide Sodium – Marketed under the brand name Diuril.
  73. Chlorpheniramine Maleate – Marketed under the brand name Chlor-Trimeton.
  74. Chlorpromazine – Marketed under the brand name Thorazine.
  75. Chlorthalidone – Marketed under the brand names Thalitone and Hygroton.
  76. Ciprofloxacin – Marketed under the brand name Cipro.
  77. Cisapride – Marketed under the brand name Propulsid.
  78. Citalopram Hydrobromide – Marketed under the brand name Celexa.
  79. Clonazepam – Marketed under the brand name Klonopin.
  80. Clonidine – Marketed under the brand names Catapres and Catapres-TTS.
  81. Clonidine with Chlorthalidone – Marketed under the brand name Combipres.
  82. Clorazepate Dipotassium – Marketed under the brand name Tranxene-SD.
  83. Clozapine – Marketed under the brand names Clozaril and Faxaclo.
  84. Codeine
  85. Cyclobenzaprine Hydrochloride – Marketed under the brand name Flexeril.
  86. Cyclosporine – Marketed under the brand names Gengraf and Neoral.
  87. Darifenacin – Marketed under the brand name Enablex.
  88. Delavirdine Mesylate – Marketed under the brand name Rescriptor.
  89. Desipramine – Marketed under the brand name Norpramin.
  90. Desloratadine – Marketed under the brand name Clarinex.
  91. Desloratadine with Loratadine with Pseudoephedrine Sulfate – Marketed under the brand name Clarinex-D.
  92. Dexmethylphenidate Hydrochloride – Marketed under the brand name Focalin.
  93. Dextroamphetamine Sulfate – Marketed under the brand names Dexedrine and Dextrostat.
  94. Diazepam – Marketed under the brand name Valium.
  95. Diazoxide – Marketed under the brand name Hyperstat.
  96. Diclofenac Potassium – Marketed under the brand name Cataflam.
  97. Diclofenac Sodium with Misoprostol – Marketed under the brand name Arthrotec.
  98. Diclofenac Sodium – Marketed under the brand names Voltaren and Voltaren-XR.
  99. Dicyclomine Hydrochloride – Marketed under the brand name Bentyl.
  100. Diethylpropion Hydrochloride USP – Marketed under the brand name Tenuate.
  101. Diflunisal – Marketed under the brand name Dolobid.
  102. Dihydroergotamine Mesylate – Marketed under the brand name Migranal.
  103. Diltiazem Hydrochloride – Marketed under the brand names Cardizem, Dilacor, and Tiazac.
  104. Diphenhydramine – Marketed under the brand names Dramamine and Benadryl.
  105. Disopyramide Phosphate – Marketed under the brand name Norpace.
  106. Divalproex Sodium – Marketed under the brand name Depakote.
  107. Donepezil Hydrochloride – Marketed under the brand name Aricept.
  108. Dorzolamide Hydrochloride – Marketed under the brand names Cosopt and Trusopt.
  109. Doxepin Hydrochloride – Marketed under the brand name Prudoxin.
  110. Doxercalciferol – Marketed under the brand name Hectorol.
  111. Doxorubicin Hydrochloride Liposome – Marketed under the brand name Doxil.
  112. Duloxetine Hydrochloride – Marketed under the brand name Cymbalta.
  113. Eletriptan Hydrobromide – Marketed under the brand name Relpax.
  114. Enalapril Maleate with Hydrochlorothiazide – Marketed under the brand name Vaseretic.
  115. Enalapril Maleate – Marketed under the brand name Vasotec.
  116. Enalaprilat
  117. Enfuvirtide – Marketed under the brand name Fuzeon.
  118. Enoxacin – Marketed under the brand name Penetrex.
  119. Entacapone – Marketed under the brand name Comtan.
  120. Ephedrine Sulfate with Hydroxyzine Hydrochloride with Theophylline – Marketed under the brand name Marax.
  121. Eprosartan Mesylate – Marketed under the brand name Teveten.
  122. Escitalopram Oxalate – Marketed under the brand name Lexapro.
  123. Esmolol Hydrochloride – Marketed under the brand name Brevibloc.
  124. Esomeprazole Magnesium – Marketed under the brand name Nexium.
  125. Estazolam – Marketed under the brand name Prosom.
  126. Eszopiclone – Marketed under the brand name Lunesta.
  127. Etanercept – Marketed under the brand name Enbrel.
  128. Famotidine – Marketed under the brand name Pepcid.
  129. Felodipine – Marketed under the brand name Plendil.
  130. Fenofibrate – Marketed under the brand names Antara, Lofibra, and Tricor.
  131. Fenoprofen Calcium – Marketed under the brand name Nalfon.
  132. Fentanyl – Marketed under the brand name Duragesic.
  133. Fentanyl Citrate – Marketed under the brand name Actiq.
  134. Fexofenadine Hydrochloride – Marketed under the brand name Allegra-D.
  135. Flecainide Acetate – Marketed under the brand name Tambocor.
  136. Fluocinolone Acetonide with Hydroquinone with Tretinoin – Marketed under the brand name Tri-Luma.
  137. Fluoxetine Hydrochloride – Marketed under the brand name Prozac.
  138. Fluoxetine Hydrochloride with Olanzapine – Marketed under the brand name Symbyax.
  139. Flurazepam Hydrochloride – Marketed under the brand name Dalmane.
  140. Fluticasone Propionate with Salmeterol Xinafoate – Marketed under the brand name Advair.
  141. Fluvoxamine Maleate – Marketed under the brand name Luvox.
  142. Formoterol Fumarate – Marketed under the brand name Foradil.
  143. Foscarnet Sodium – Marketed under the brand name Foscavir.
  144. Fosinopril Sodium – Marketed under the brand name Monopril.
  145. Frovatriptan Succinate – Marketed under the brand name Frova.
  146. Furosemide – Marketed under the brand name Lasix.
  147. Gabapentin – Marketed under the brand name Neurontin.
  148. Galantamine Hydrobromide – Marketed under the brand name Razadyne.
  149. Ganciclovir – Marketed under the brand name Cytovene.
  150. Gemifloxacin Mesylate – Marketed under the brand name Factive.
  151. Glatiramer Acetate – Marketed under the brand name Copaxone.
  152. Glycopyrrolate – Marketed under the brand name Robinul.
  153. Goserelin Acetate – Marketed under the brand name Zoladex.
  154. Grepafloxacin Hydrochloride – Marketed under the brand name Raxar.
  155. Guanadrel Sulfate – Marketed under the brand name Hylorel.
  156. Guanfacine Hydrochloride – Marketed under the brand name Tenex.
  157. Guanidine Hydrochloride – Marketed under the brand name Guanidine.
  158. Haloperidol – Marketed under the brand name Haldol.
  159. Hydrochlorothiazide
  160. Hydrochlorothiazide with Triamterene – Marketed under the brand name Dyazide.
  161. Hydrocodone Bitartrate with Ibuprofen – Marketed under the brand name Vicoprofen.
  162. Hydromorphone Hydrochloride – Marketed under the brand names Dilaudid and Dilaudid-HP.
  163. Hyoscyamine – Marketed under the brand names Cystospaz, Levbid, and Nulev.
  164. Ibuprofen – Marketed under the brand names Advil and Motrin.
  165. Ibuprofen with Oxycodone Hydrochloride – Marketed under the brand name Combunox.
  166. Imipramine Pamoate – Marketed under the brand name Tofranil.
  167. Interferon Alfa-2b, Recombinant – Marketed under the brand name Intron.
  168. Interferon Alfacon-1 – Marketed under the brand name Infergen.
  169. Interferon Alfa-N3 – Marketed under the brand name Human Leukocyte Derived. – Marketed under the brand name Alferon.
  170. Interferon Beta-1a – Marketed under the brand name Rebif.
  171. Ipratropium Bromide – Marketed under the brand name Atrovent.
  172. Isosorbide Mononitrate – Marketed under the brand names Imdur and Monoket.
  173. Isotretinoin – Marketed under the brand names Accutane and Amnesteem.
  174. Isradipine – Marketed under the brand name Dynacirc.
  175. Ketoprofen – Marketed under the brand name Orudis.
  176. Ketotifen Fumarate – Marketed under the brand name Zaditor.
  177. Lamotrigine – Marketed under the brand name Lamictal.
  178. Lansoprazole – Marketed under the brand name Prevacid.
  179. Leflunomide – Marketed under the brand name Arava.
  180. Leuprolide Acetate – Marketed under the brand names Lupron and Viadur.
  181. Levalbuterol Hydrochloride – Marketed under the brand name Xopenex.
  182. Levofloxacin – Marketed under the brand name Levaquin.
  183. Levomethadyl Acetate Hydrochloride – Marketed under the brand name Orlaam.
  184. Levorphanol Tartrate – Marketed under the brand name Levorphanol.
  185. Lisinopril – Marketed under the brand names Prinivil and Zestril.
  186. Lisinopril with Hydrochlorothiazide – Marketed under the brand name Zestoretic.
  187. Lithium Carbonate – Marketed under the brand names Eskalith and Lithobid.
  188. Lomefloxacin Hydrochloride – Marketed under the brand name Maxaquin.
  189. Loperamide Hydrochloride – Marketed under the brand name Imodium.
  190. Lopinavir with Ritonavir – Marketed under the brand name Kaletra.
  191. Loratadine – Marketed under the brand name Claritin.
  192. Loratadine with Pseudoephedrine – Marketed under the brand name Claritin-D.
  193. Losartan Potassium – Marketed under the brand name Cozaar.
  194. Losartan Potassium with Hydrochlorothiazide – Marketed under the brand name Hyzaar.
  195. Lovastatin with Niacin – Marketed under the brand name Advicor.
  196. Lovastatin – Marketed under the brand names Altoprev and Mevacor.
  197. Loxapine Hydrochloride – Marketed under the brand name Loxitane.
  198. Mecamylamine Hydrochloride – Marketed under the brand name Inversine.
  199. Meclizine Hydrochloride – Marketed under the brand names Antivert and Bonine.
  200. Mefenamic Acid – Marketed under the brand name Ponstel.
  201. Megestrol Acetate – Marketed under the brand name Megace.
  202. Meloxicam – Marketed under the brand name Mobic.
  203. Meperidine Hydrochloride – Marketed under the brand name Mepergan.
  204. Mesalamine – Marketed under the brand name Asacol.
  205. Metaproterenol Sulfate – Marketed under the brand name Alupent.
  206. Methadone Hydrochloride – Marketed under the brand names Dolophine and Methadone.
  207. Methamphetamine Hydrochloride – Marketed under the brand name Desoxyn.
  208. Methyldopate Hydrochloride – Marketed under the brand name Aldomet.
  209. Metoprolol Succinate – Marketed under the brand name Toprol-XL.
  210. Metronidazole – Marketed under the brand names Metrogel-Vaginal and Noritate.
  211. Metyrosine – Marketed under the brand name Demser.
  212. Midodrine Hydrochloride – Marketed under the brand name Proamatine.
  213. Mirtazapine – Marketed under the brand name Remeron.
  214. Modafinil – Marketed under the brand name Provigil.
  215. Moexipril Hydrochloride – Marketed under the brand name Univasc.
  216. Molindone Hydrochloride – Marketed under the brand name Moban.
  217. Mometasone Furoate – Marketed under the brand name Elocon.
  218. Moricizine Hydrochloride – Marketed under the brand name Ethmozine.
  219. Morphine Sulfate – Marketed under the brand names Avinza, Kadian, MSIR, and Roxanol.
  220. Moxifloxacin Hydrochloride – Marketed under the brand name Avelox.
  221. Mupirocin calcium – Marketed under the brand name Bactroban.
  222. Mycophenolate Mofetil – Marketed under the brand name Cellcept.
  223. Nabumetone – Marketed under the brand name Relafen.
  224. Nadolol – Marketed under the brand name Nadolol.
  225. Nalbuphine Hydrochloride – Marketed under the brand name Nubain.
  226. Naltrexone Hydrochloride – Marketed under the brand name Revia.
  227. Naproxen – Marketed under the brand names Aleve and Naprosyn.
  228. Nedocromil Sodium – Marketed under the brand name Tilade.
  229. Niacin – Marketed under the brand name Niaspan.
  230. Nicotine – Marketed under the brand names Habitrol, Nicorette, and Nicotrol.
  231. Nifedipine – Marketed under the brand name Adalat.
  232. Nisoldipine – Marketed under the brand name Sular.
  233. Nizatidine – Marketed under the brand name Axid.
  234. Norfloxacin – Marketed under the brand name Noroxin.
  235. Octreotide Acetate – Marketed under the brand name Sandostatin.
  236. Ofloxacin – Marketed under the brand name Floxin.
  237. Olanzapine – Marketed under the brand name Zyprexa.
  238. Omega-3-Acid Ethyl Esters – Marketed under the brand name Omacor.
  239. Omeprazole – Marketed under the brand names Prilosec and Zegerid.
  240. Ondansetron – Marketed under the brand name Zofran.
  241. Orphenadrine Citrate – Marketed under the brand name Norflex.
  242. Oxaliplatin – Marketed under the brand name Eloxatin.
  243. Oxcarbazepine – Marketed under the brand name Trileptal.
  244. Oxybutynin – Marketed under the brand name Oxytrol.
  245. Oxybutynin Chloride – Marketed under the brand name Ditropan.
  246. Oxycodone Hydrochloride – Marketed under the brand name Oxycontin.
  247. Oxymorphone Hydrochloride – Marketed under the brand name Numorphan.
  248. Palonosetron Hydrochloride – Marketed under the brand name Aloxi.
  249. Pantoprazole Sodium – Marketed under the brand name Protonix.
  250. Paricalcitol – Marketed under the brand name Zemplar.
  251. Paroxetine Hydrochloride – Marketed under the brand name Paxil.
  252. Peginterferon Alfa-2a – Marketed under the brand name Pegasys.
  253. Peginterferon Alfa-2b – Marketed under the brand name PEG-Intron.
  254. Pemetrexed – Marketed under the brand name Alimta.
  255. Pentazocine Hydrochloride – Marketed under the brand names Talwin and Talwin Nx.
  256. Pergolide Mesylate – Marketed under the brand name Permax.
  257. Perindopril Erbumine – Marketed under the brand name Aceon.
  258. Perphenazine – Marketed under the brand name Trilafon.
  259. Phenelzine sulfate – Marketed under the brand name Nardil.
  260. Phendimetrazine Tartrate – Marketed under the brand name Bontril.
  261. Phentermine Hydrochloride – Marketed under the brand names Adipex-P and Fastin.
  262. Pimozide – Marketed under the brand name Orap.
  263. Pirbuterol Acetate – Marketed under the brand name Maxair.
  264. Piroxicam – Marketed under the brand name Feldene.
  265. Pramipexole Dihydrochloride – Marketed under the brand name Mirapex.
  266. Pregabalin – Marketed under the brand name Lyrica.
  267. Procarbazine Hydrochloride – Marketed under the brand name Matulane.
  268. Prochlorperazine – Marketed under the brand names Compazine and Compro.
  269. Progesterone – Marketed under the brand names Crinone, Prochieve, and Prometrium.
  270. Promethazine Hydrochloride – Marketed under the brand name Phenergan.
  271. Propafenone Hydrochloride – Marketed under the brand name Rythmol.
  272. Propofol – Marketed under the brand names Diprivan and Propofol.
  273. Propoxyphene Hydrochloride – Marketed under the brand name Darvon.
  274. Protirelin – Marketed under the brand name Thyrel.
  275. Protriptyline Hydrochloride – Marketed under the brand name Vivactil.
  276. Quetiapine Fumarate – Marketed under the brand name Seroquel.
  277. Rabeprazole Sodium – Marketed under the brand name Aciphex.
  278. Ramipril – Marketed under the brand name Altace.
  279. Rescinnamine – Marketed under the brand name Moderil.
  280. Ribavirin – Marketed under the brand names Copegus and Rebetol.
  281. Riluzole – Marketed under the brand name Rilutek.
  282. Rimantadine Hydrochloride – Marketed under the brand name Flumadine.
  283. Risedronate Sodium – Marketed under the brand name Actonel.
  284. Risperidone – Marketed under the brand name Risperdal.
  285. Ritonavir – Marketed under the brand name Norvir.
  286. Rivastigmine Tartrate – Marketed under the brand name Exelon.
  287. Rizatriptan Benzoate – Marketed under the brand name Maxalt-MLT.
  288. Ropinirole Hydrochloride – Marketed under the brand name Requip.
  289. Salmeterol Xinafoate – Marketed under the brand name Serevent.
  290. Saquinavir Mesylate – Marketed under the brand name Invirase.
  291. Scopolamine – Marketed under the brand name Transderm.
  292. Selegiline Hydrochloride – Marketed under the brand name Eldepryl.
  293. Sertraline Hydrochloride – Marketed under the brand name Zoloft.
  294. Sevoflurane – Marketed under the brand name Ultane.
  295. Sibutramine Hydrochloride Monohydrate – Marketed under the brand name Meridia.
  296. Sildenafil Citrate – Marketed under the brand name Viagra.
  297. Sodium Ferric Gluconate – Marketed under the brand name Ferrlecit.
  298. Solifenacin Succinate – Marketed under the brand name Vesicare.
  299. Sparfloxacin – Marketed under the brand name Zagam.
  300. Sucralfate – Marketed under the brand name Carafate.
  301. Sulindac – Marketed under the brand name Clinoril.
  302. Sumatriptan Succinate – Marketed under the brand name Imitrex.
  303. Tadalafil – Marketed under the brand name Cialis.
  304. Telithromycin – Marketed under the brand name Ketek.
  305. Telmisartan – Marketed under the brand name Micardis.
  306. Temazepam – Marketed under the brand name Restoril.
  307. Terazosin Hydrochloride – Marketed under the brand name Hytrin.
  308. Terbutaline Sulfate – Marketed under the brand name Brethine.
  309. Testosterone – Marketed under the brand names Androgel, Testoderm, Striant, and Androderm.
  310. Thalidomide – Marketed under the brand name Thalomid.
  311. Thiabendazole – Marketed under the brand name Mintezol.
  312. Thioridazine Hydrochloride – Marketed under the brand name Thioridazine.
  313. Thiothixene – Marketed under the brand name Thiothixene.
  314. Tiagabine Hydrochloride – Marketed under the brand name Gabitril.
  315. Tigecycline – Marketed under the brand name Tygacil.
  316. Timolol Hemihydrate – Marketed under the brand name Betimol.
  317. Timolol Maleate – Marketed under the brand names Timoptic and Timoptic-XE.
  318. Tinidazole – Marketed under the brand name Tindamax.
  319. Tiotropium Bromide – Marketed under the brand name Spiriva.
  320. Tizanidine Hydrochloride – Marketed under the brand name Zanaflex.
  321. Tocainide Hydrochloride – Marketed under the brand name Tonocard.
  322. Tolcapone – Marketed under the brand name Tasmar.
  323. Tolterodine Tartrate – Marketed under the brand name Detrol.
  324. Topiramate – Marketed under the brand name Topamax.
  325. Tramadol Hydrochloride – Marketed under the brand name Ultram.
  326. Trandolapril with Verapamil Hydrochloride – Marketed under the brand name Tarka.
  327. Tranylcypromine Sulfate – Marketed under the brand name Parnate.
  328. Triamcinolone Acetonide – Marketed under the brand names Azmacort and Nasacort.
  329. Triamterene – Marketed under the brand name Dyrenium.
  330. Triamterene with Hydrochlorothiazide – Marketed under the brand names Maxzide and Dyazide.
  331. Triazolam – Marketed under the brand name Halcion.
  332. Trifluoperazine Hydrochloride – Marketed under the brand name Stelazine.
  333. Trihexyphenidyl Hydrochloride – Marketed under the brand name Artane.
  334. Trimipramine Maleate – Marketed under the brand name Surmontil.
  335. Trospium Chloride – Marketed under the brand name Sanctura.
  336. Valproate Sodium – Marketed under the brand name Depacon.
  337. Valproic Acid – Marketed under the brand name Depakene.
  338. Valsartan – Marketed under the brand name Diovan.
  339. Valsartin with Hydrochlorothiazide – Marketed under the brand name Diovan HCT.
  340. Vardenafil Hydrochloride – Marketed under the brand name Levitra.
  341. Venlafaxine Hydrochloride – Marketed under the brand name Effexor.
  342. Verapamil Hydrochloride – Marketed under the brand names Covera-HS and Verelan.
  343. Voriconazole – Marketed under the brand name VFEND.
  344. Zaleplon – Marketed under the brand name Sonata.
  345. Ziprasidone Hydrochloride – Marketed under the brand name Geodon.
  346. Zolmitriptan – Marketed under the brand name Zomig.
  347. Zolpidem Tartrate – Marketed under the brand name Ambien.
  348. Zonisamide – Marketed under the brand name Zonegran.
Source: The American Dental Association / Physician’s Desk Reference Guide to Dental Therapeutics


Hopefully you found this list helpful.  Keep in mind that even if you are taking one or two drugs from the list above, you may not experience dry mouth.  I’ve seen patients that are taking a few drugs that supposedly cause dry mouth, but they don’t seem to have any problems… However, some people who are taking just one of the drugs on the above list could have significant dry mouth.  We’re all different!

If you know of any other drugs that cause dry mouth or want to share your experiences with any of the above drugs and if it caused your mouth to get dry, please leave a comment below.

Thanks for reading!

Teeth Getting Hurt This Cold and Flu Season

Three weeks ago I got a cold. I was just getting over it when we went up to Maine, and right when we got back I got sick again.  I’m finally getting better, but my oral hygiene has been less than stellar over the past few weeks!

Fever Can Affect Oral HealthNow that the days are getting colder and shorter here in the northern hemisphere, it’s a good time to talk about how the common cold can affect your oral health.

I’ve actually come up with a variety of ways that the cold and flu can mess up your oral health.  Here they are.

6 Ways the Common Cold & Flu Can Hurt Your Teeth

1 – We tend to drink acidic beverages when we’re sick. Water doesn’t sound very good when you’re sick.  Many people drink lots of orange juice and soda pop (such as ginger ale) when they’re sick.

When I was little, my mom would always make me nice hot cups of what we called honey lemon water.  It’s a slight variation on this recipe of  honey lemon tea.  I still drink it when I’m sick!

You can lessen the effect of acidic drinks on your teeth by drinking them quickly and then either drinking or rinsing your mouth out with water when you’re done.

Read more about which drinks are acidic and can dissolve your teeth here.

2 – When you’re sick, you really don’t feel like brushing or flossing. When you’re sick, the first thing on your mind is getting better, not brushing and flossing.  However, by taking a couple of minutes each day to take care of your teeth, you can prevent the build-up of tartar, which is a type of hard mineralized plaque that forms on your teeth if you don’t remove plaque daily.

3 – Inflammation of the sinuses can make your teeth and gums hurt.  If you’ve got a cold and you’re stuffed up, your sinuses might not feel very good!  The maxillary sinus is located right above your upper back teeth and can make them hurt.

There have also been reports of people’s gums hurting when they’re sick.  This probably occurs because many people breathe through their mouths when they’re sick because they have a stuffy nose.  This dries out the gums and irritates them.  Another possible explanation is that your immune system is so busy fighting your cold that it’s harder for it to fight the bacteria in your mouth, thus causing your gums to get irritated.

4 – When you’re sick, your mouth gets dry.  As I mentioned above, your mouth gets dry because you breathe through it more than usual when your nose is stuffy.  Coughing can also dry out the mouth.  A dry mouth allows sugar to hang around in your mouth and contributes to tooth decay.

Try to stay hydrated when you are sick as much as possible!  When possible, reach for plain water instead of juices or soda pop.

To see why a dry mouth is bad for your teeth, read about how wonderful spit is!

Cough Syrup Can Damage Your Teeth5 – Cold medicine isn’t very friendly to your teeth.  Cough syrups such as Dayquil syrup can stick to your teeth and cause cavities.  Here’s an article that talks about how you can reduce the damage that cough syrup does to your teeth.

Cherry Alka Seltzer Cold MedicineMany cold medicines, such as Alka-Seltzer, are acidic.  Acidic drinks can dissolve the calcium that makes up the enamel of your teeth.

Cough drops are another culprit, but they don’t have to be.  Just eat sugar free cough drops and you’ll be fine.  Both Hall’s and Ricola make great tasting sugar-free cough drops that are much better for your teeth than regular cough drops, which contain a significant amount of sugar.

Rather than taking cough syrup, try substituting something in pill form.  For example, DayQuil is available in a gelcap form that doesn’t contain all of the sugar that the syrup does.  If you must have Alka-Seltzer, you might want to rinse out your mouth or drink water afterward to get the acid off of your teeth.

6 – Vomit is acidic and dissolves your teeth.  Hopefully you don’t have to toss your cookies this cold and flu season.  The stomach is the most acidic place in your body and when it’s contents come back up, they will dissolve your teeth.

After vomiting, the best thing to do for your teeth is to rinse out with water.  You might be tempted to brush your teeth with toothpaste to get the acidic taste out of your mouth, but brushing can damage the enamel because it’s already been weakened by the exposure to your stomach acid.


Having a cold can hurt your teeth.  Remember to continue your regular oral hygiene routine even when you don’t feel well.

Try to avoid cold and flu medicine that are syrups or contain lots of sugar.  Pills and sugar-free cough drops are excellent alternatives.

If you do happen to throw up, remember to rinse your mouth afterward with water to wash away the acid.

If you have any other suggestions or any questions, feel free to add them in the comments section below.  Thanks for reading!

Most Likely Places to Get a Cavity

Imagine you are in the dental office and the dentist is showing you on a screen where in your mouth you are most likely to get cavities, much like in the picture below.

Where Cavities Occur on TeethWouldn’t that advice be invaluable?  It would probably help you know where to concentrate when you brush.

Although you’re not sitting in my dental chair, I can still tell you in general the six most common places where you’re most likely to get a cavity.

Six Common Places Where You Can Get Cavities/Dental Decay

1 – In the grooves on the chewing surface of your back teeth. There are many grooves that run in the teeth.  These are called fissures.  There are also pits.  Some molar teeth have pits on the side of them that commonly get cavities.  You can find these pits on the tongue side of your upper molars and on the cheek side of your lower molars.

2 – In between your teeth. In a normal mouth, all the teeth touch each other on each side except for the ones all the way in the back.  In the area between the teeth, it is hard to fit a toothbrush and easy for plaque to grow and create a cavity, especially if you’re not flossing daily!

3 – At the margins of fillings, crowns, bridges, and other dental work.  Sometimes the tooth/restoration interface isn’t as smooth as we’d like it to be.  This area between the restoration and the tooth is an easy place for plaque to grow.  White fillings don’t last as long as silver fillings, so if you want a long-lasting filling, ask your dentist if you can have a silver amalgam filling.

4 – On the tooth just above the gumline. This is a common place for cavities.  I have seen it a lot in people who drink lots of energy drinks and soda pop.  It is believed that acids can pool around the gumline and attack the teeth, creating a cavity.

Here’s a list of nine drinks that can dissolve your teeth if you drink them frequently!

5 – On the roots of teeth. When you have periodontal disease (commonly known as gum disease — a leading cause of tooth loss), the bone and gums that surround the teeth gradually fall down.  This exposes the root surface of the teeth.  The root surface is much softer than the hard enamel shell that encases the tops of our teeth.  It is much easier for cavities to occur on the root surface, which is why it’s important to catch periodontal disease in its initial phases and treat it.

6 – Teeth that are right next to a partial denture. It is easy for food to get trapped between a partial denture and the natural teeth.  Plus, there’s usually a metal appliance that fits around the tooth making it easy for plaque to grow.  If you have a partial denture, ask your dentist or denal hygienist for methods to help you keep your remaining teeth healthy.  They can come up with an oral hygiene program tailor-made for you.


Hopefully that gives you some new ideas on how you can better take care of your teeth.  Make sure you’re brushing the grooves and pits of your teeth and flossing to get between them.  If you find that when you floss around a filling, you can’t get the floss to go down or come back up from between the tooth, you should go visit your dentist so that he or she can fix the filling so you don’t get a new cavity around it.

Do you have any questions or comments about how and where cavities occur?  Type them below in the comments section.  Even if you have a story to share about your cavity, go ahead and leave it below in the comments.  Thanks for reading!

Biting Nails Teeth
©Diego Cervo/Shutterstock.com

It’s been estimated that about half of all humans bite their nails.  At ten fingernails per human (and maybe some toenails thrown in for good measure), that adds up to billions of fingernails that are chewed on everyday.

Fingernail biting has been linked to genetics and occurs more often in females than males.  I bit my nails frequently from the age of 5 up until about 25, when I kind of grew out of it.

Our teeth can do many amazing things, like helping us speak, making us look more attractive than we really are, and allowing us to chew a variety of healthy foods.  One thing that teeth aren’t good for though is biting our nails!

In fact, biting your nails can actually cause harm to your teeth and other structures inside of your mouth.  Here’s a breakdown of some of the negative effects that biting your nails can have on your oral health.

6 Reasons Why Biting Your Nails is Bad for Your Teeth

Nail Biting Can Harm Your Teeth

1– Biting your nails can cause your teeth to get chipped. This is definitely the biggest reason to not bite your nails.  Chewing on hard fingernails can take its toll on your teeth.  Sometimes when bite through a nail, your teeth hit together pretty hard, which could chip a tooth.

Repeated flexing of your teeth’s enamel occurs when you bite your nails and can cause the enamel to fracture or chip.

To find out more about enamel and the other layers of your teeth, read The Anatomy of a Tooth.

For most people, chipping a tooth is the only negative effect that biting your nails might have on your teeth.  In fact, the book Pediatric Dentistry by Pinkham states:

There is no evidence that nail biting can cause…dental change other than minor enamel fractures.

However, various studies have shown that nail biting can cause other oral problems.  Keep in mind that some of the following negative effects are very rare and won’t always occur with everyone, so you might want to take them with a grain of salt!

2 – Biting your nails can cause a diastama — a gap between your two front teeth. If the nail biting habit begins when the child is very young, it has been reported to cause a gap between teeth.  While I was unable to find a study to confirm this, I did find a dentist has a a picture of it on his website here.  While this can occur, it probably won’t unless someone is constantly shoving their nail up between their teeth.

3 – Nail biting can cause the roots of your teeth to become weaker. Nail biting during orthodontic treatment (braces) has been shown to cause root resorption, which is when parts of the roots of your teeth get dissolved by the bone surrounding them.  This causes the roots of the teeth to become weaker.  Here’s one study and another one that explain this phenomenon.

4 – Biting your nails can cause you to lose your teeth. This study claims that biting your nails can cause you to lose your teeth.  Remember — this is the only study that I’ve found that claims this, and we definitely would need more studies to be done in order to verify this.  See my disclaimer above!

5 – Biting your nails can cause TMJ problemsThis study tells how biting your nails can cause disk displacement in the temporomandibular joint.  If you have pain in your TMJ, perhaps it is being caused by your fingernail biting habit.

6 – Biting your fingernails can cause gingivitis. This case report (PDF file) details the story of a young child that bit his fingernails and then shoved them up between his gums and teeth.  The report even has pictures if you’re curious.  You would think that this would be pretty rare but it might not be as uncommon as you’d think.  Here’s another report here and one more here! It does go to show that kids can think of anything to do with their fingernails after they’ve chewed them off of their fingers.


I have talked about some of the extreme cases of biting your nails.  Obviously, many people do bite their nails without any dental problems.  Sometimes, however, people do develop problems.

One interesting fact I found while researching for this article is that biting your nails actually contaminates your mouth with interesting varieties of bacteria that are found on your hands.  Since I’m a slight germophobe (as mentioned here and here), this tidbit encourages me keep my nail biting habit in remission.

Hopefully the information provided above can give you the encouragement you need to help you to kick your fingernail biting habit.  Or, maybe you’re willing to take the risk and keep on biting your nails.

Have you ever hurt a tooth or had any dental problems due to biting your nails?  Please share your comments below!

Teeth In Old Age

A couple of weeks ago, Karen, a reader from Colorado Springs emailed me with the following question:

Older Couple with Teeth“Since our average life expectancy is getting longer, what’s the likelihood we’ll have any of our original teeth if we were born in the 50’s before better dental care was available. Do our children have a better chance of maintaining their teeth into their later years?”

Over the past few decades, the number of people keeping their natural teeth has steadily increased.

In fact, a researcher by the name of Hugoson did a study in Sweden spanning 40 years.  It showed that over time, people are keeping their teeth much longer, and dentists are providing higher quality fillings than they have in the past.  I’ll recap some of that study’s most interesting findings later in this article.

Karen is right, better dental care is much more widely available now than it was in the past.  Many factors have contributed to this improvement of oral health, some of which are still being studied.

Fewer Elderly People Need Dentures

The graph below shows the percentage of elderly adults that are missing all of their teeth.  The data is taken from two different studies, the first study defined the elderly as those aged 65 to 75 and the second study defined the elderly as anyone over the age of 60.  Despite this minor difference, both sets of data demonstrate the same trend — the American elderly are keeping their teeth longer.

Percent of Elderly Without Teeth

As you can see, about 50 years ago, over half of the U.S. elderly population were missing all of their teeth.  Recently, that number has dropped below one quarter of all U.S. elderly adults.

Americans of All Age Groups Are Keeping Their Teeth Longer

The graph below shows the number of teeth that people in different age groups had circa 1990 and 2000.  I made it using the data from this study.

For the purposes of this study, a full set of teeth is defined as 28 teeth.  This does not include the wisdom teeth, since they are often extracted.

Average Number of Teeth Remaining In U.S. Adults

Between 1990 and 2000, the number of natural teeth that adults across all age groups had noticeably increased.

Swedish Study Confirms Tooth Loss Trends

As mentioned above, one of the most in-depth studies on the subject of age and oral health was done over the course of 30 years in Jönköping, Sweden.  Researchers measured the oral health of Swedes of all ages (from 3 to 80.)  Here are some of their most important conclusions:

  • The number of [people missing all their teeth] in the age groups 40-70 years was reduced from 16 per cent in 1973 to 8 per cent in 1993, and to 1 per cent in 2003.
  • The average number of teeth people kept increased.  Up to the age of 60 years, people generally kept all of their teeth.
  • During the 30-year period,the number of carious lesions and restorations generally decreased.
  • During this time, the overall quality of fillings increased.  In the 1990’s, only 5-10% of fillings had a critical error, and in the 1960’s, 40% did.
  • In 2003 the bone level at the age of 60 years corresponded to the bone level at the age of 40 years in 1973.  Bone level is an important measurement used to determine gum health.
  • The comparison of the four studies shows that there has been a great overall improvement in oral health over this 30-year period.

Gum disease is the main cause of tooth loss.  I found it interesting that the gum health of those who were 60 years old in 2003 was equivalent to a 40 year old’s gum health in 1973.  This trend helps to explain why more and more elderly people are keeping their natural teeth.


Oral health is improving.  It could be because of the increased availability of fluoride, better oral hygiene, higher quality dental care, or a combination of many factors.

Returning to Karen’s original question, the evidence shows that we are not doomed to lose our natural teeth when we get older.  Keep in mind that those who are elderly now grew up before the 1950’s and they are keeping their teeth longer.  In fact, the chances are better than ever that with proper oral care, you can keep your natural teeth for a lifetime!

Do you have any questions or comments on oral health and aging?  Please leave them in the comments below.  If you liked this article, share it with a friend!

Smokers Have Less Teeth Than Non-Smokers

It’s common knowledge that smoking has many awful effects on your health.  Since I try to deal with oral health on this blog, I won’t go into all of the systemic health risks of smoking.  I’ll just talk a little bit about the oral health risks.

Smoking Isn't Good for Your Oral HealthSmoking puts you at greater risk for oral cancer, such as lip, mouth, tongue, and throat cancers.  Smoking is strongly associated with gum disease, a leading cause of tooth loss.

Cosmetically, smoking can discolor your teeth (causing some smokers to fall for online teeth whitening scams) and cause bad breath.

What many people may not know is that smokers, on average, have less teeth than non-smokers.

Smokers Have Less Teeth, On Average, Than Non-Smokers

This study published in the April 2007 issue of the Journal of Dental Research looked at 43,112 male health professionals in the United States.  It found that those who smoke 5 to 14 cigarettes per day are two times more likely to lose teeth than a non-smoker.  People who smoke more than 45 cigarettes per day have three times the risk of losing teeth than a non-smoker.

An interesting conclusion of that study was that if you used to be a smoker, but hadn’t smoked in ten years, you still were 20% more likely to lose teeth than a non-smoker.  Quitting smoking can lower your risk of losing teeth to nearly that of a non-smoker.

A Study of Americans’ Oral Health Found That Smokers Are Missing More Teeth

The National Health and Nutrition Examination Survey (NHANES) conducted from 1988 to 1994 and from 1999 to 2002 found that on average, smokers had lost more teeth than former smokers, and former smokers were missing more teeth than those who had never rouched a cigarette to their lips.

Here’s a graph I created using the data from the NHANES study:

Smoking Is Associated With Tooth Loss

As shown above, smokers are missing more teeth.  Interestingly, people are keeping their teeth for longer, as shown by the lower numbers at the turn of the century as compared to the numbers from 1988 to 1994.

Why Do Smokers Have Less Teeth than Non-Smokers?

The reason that smokers have less teeth is probably due to multiple factors.  It could be an interaction with the chemicals or smoke from the cigarettes and the mouth.  Some say that because smoking decreases bone density in the whole body, it decreases the strength of the bone that holds the teeth into place, thus causing more smokers to lose teeth.

The National Health and Nutrition Examination Survey found that “[Adults with teeth] who were current smokers had a higher prevalence of untreated tooth decay (35.0%) than did those who never smoked (18.6%) and former smokers (17.7%).”

Perhaps those who smoke aren’t as concerned about taking care of their teeth.

What are your thoughts?  Please leave any comments and/or questions that you may have below in the comments section.  Also, if you know someone who might like this article, please don’t hesitate to share it with them.

Meth Ruins Teeth
©Sylvie Bouchard/Shutterstock.com

Before I came to dental school, I worked at a dental clinic that served those with little or no financial resources.  I remember vividly a young woman in her twenties who had to have all of her teeth extracted.  All of her teeth had extensive decay.  She had used methamphetamine for years before coming to see us.  We were able to make her dentures.  While the dentures worked great, they simply aren’t the same as natural teeth.

Commonly known as crystal meth, meth, crank, speed, glass, or over 100 other different names, methamphetamine can literally ruin your mouth in a very short time.

Seven Ways Methamphetamine Ruins Your Teeth

Blue Crystal Methamphetamine1 – It dries out your mouth. -Methamphetamine directly inhibits saliva flow from the salivary glands.  The saliva offers a lot of protection to the teeth, something I recently wrote about in an article called How Saliva Protects Your Teeth.   In short, when the saliva stops flowing, the teeth are left without many defenses.

2 – Crystal meth gives the user a prolonged “high,” which often causes them to pass out. Meth users have a tendency to pass out frequently.  When they pass out, they are breathing through their mouth, which dries out the mouth.  And without saliva circulating in the mouth, the teeth are at risk.

3 – Meth is acidic by nature. This has been debated.  Some people say that meth isn’t acidic.  Some say it is. Pure methamphetamine is NOT acidic, but most street meth contains acidic byproducts.  For example, the most common method of manufacturing meth in the United States is the Red, White, and Blue Method.  This method of methamphetamine synthesis produces hydroiodic acid.  Other acids can be made as byproducts depending on how the methamphetamine is synthesized.

If only those that manufacture meth knew about the devastating effects of acid on the teeth — they’d probably be sure to only sell you pure methamphetamine!

4 – Meth users clench their teeth a lot. Many meth users are anxious and paranoid, mostly due to the effects of the drug on their body.  When they clench their teeth, they are grinding away valuable tooth structure that has already been weakened due to the other effects of meth mentioned in this article.

Blue Crystal Methamphetamine

5 – Meth gives the user a craving for sugary, carbonated drinks. Since the methamphetamine buydiazepamsite.com dries out their mouth, meth users often try to alleviate this side effect by reaching for soda or energy drinks.  This only adds insult to injury for their teeth, as pointed out in the article Nine Drinks That Can Dissolve Your Teeth.

6 – Meth destroys the enamel. It does this by causing cavities to form and by releasing toxic chemicals that damage the teeth.  In the book Treatment Planning in Dentistry by Stefanac and Nesbit it says:

“Meth mouth” typically begins with the yellowing of the user’s teeth and rapidly deteriorating enamel “flaking” off from the underlying tooth structure. Repeated use of the drug eventually leaves the user’s teeth looking grayish-brown or black stained, decayed to the gum line, and often nonrestorable. The rapid destruction of tooth enamel is thought to be a result of the heated vapors released by toxic chemicals produced while smoking methamphetamine.

7 – Meth Addicts are concerned about how to get their next high, not about their oral health. If you’re addicted to meth, then you probably spend a great deal of time, energy, and money supporting this habit.  Those with addictions of this nature are unlikely to be seeking routine dental care or even brushing and flossing regularly.


Methamphetamine causes significant harm to the teeth no matter how it is taken.  If methamphetamine is smoked, it is much more harmful for the teeth than when injected.  The book Primary Preventive Dentistry by Norman Harris says this about how methamphetamine is used:

It is thought that smokers [of methamphetamine] have worse dental effects, because the chemicals are brought in direct contact with the oral cavity, causing sores and infections. Injectors of methamphetamine do not experience the same severe tooth decay; however, they do experience more severe clenching and grinding. The increased bruxism is attributed to the more powerful effects of the injected drug.

If you or someone you know is addicted to methamphetamine, try to get help as soon as possible.  Methamphetamine doesn’t just affect the teeth, it affects the whole body.

Here’s a good article from Minnesota Public Radio about Ryan Hintz, a recovering meth addict, about how he is overcoming the addiction.

If you have any questions or comments about methamphetamine and dental health, please leave them in the comments below.  Thanks for reading!

How Saliva Protects Teeth

A couple of years ago, my wife and I were on a walk near our community’s park. A baseball game was taking place on the baseball field and we stopped to watch. I noticed that some of the players were constantly spitting into the dirt near the dugout.

It tooThe Importance of Saliva - Overlooked by Little League Playersk almost all of the self-control that I had to stop myself from yelling, “What’s wrong with you!? Don’t you know what great things that spit could do for your teeth? Why would you waste it like that?”

Okay, I might not have actually thought that, but the fact remains that saliva doesplay many important roles when it comes to keeping your teeth in optimal condition.

Luckily, the average person produces about one liter of saliva each day, so there’s still enough to spit out during a baseball game.

Six Ways Saliva Protects Your Teeth

1 -Saliva neutralizes acids that can erode your teeth. Plaque produces acid that causes cavities.  Acids can also be found in many of the foods we eat and lots of different beverages that we drink.  Another way that we can get acid in our mouth is through acid-reflux from the stomach or by vomiting.  Luckily, saliva has molecules called buffers that can neutralize the acid, reducing its effect on our teeth.

2 – Saliva inhibits demineralization of the tooth surface and promotes remineralization. That means that when acids try to dissolve the outer layer of your teeth (the enamel), your saliva is right there, super-saturated with extra calcium and phosphate to prevent the acid from demineralizing your teeth.  When the acid is so strong that it does demineralize the tooth, your saliva will neutralize the acid as soon as possible, and then replace the lost tooth with calcium and phosphate.

Saliva can even contain fluoride when people drink fluoridated water or use a fluoride mouthrinse and/or fluoride toothpaste.  This extra fluoride in the saliva can help remineralize teeth with the fluoride ions and make them more resistant to future attacks from plaque.

For more information on how fluoride can protect the teeth, read the article The Three Ways that Fluoride Protects Your Teeth.

3 – Saliva cleanses the mouth. After you eat a satisfying meal, your saliva goes to work to rinse away any extra food that may be stuck on your teeth.  When the food sticks to your teeth, it can feed the bacteria that live on your teeth, helping them to hurt your teeth.  By washing away the food, your saliva is getting rid of the food source for the bacteria, ensuring that your teeth remain in good condition for a long, long time.  Saliva can even wash away actual bacteria, preventing them from grabbing onto your teeth and residing there until the time when a toothbrush scrapes it away.

Spit Can Protect Your Teeth

4 – Saliva can kill bacteria. Saliva has many different antibacterial agents in it that can destroy bacteria.  This is helpful not only for your teeth, but for your whole body.  Specific components in saliva have been shown to slow the growth of a cavity-causing strain of bacteria known as streptococcus mutans.  Here’s one study that demonstrated saliva’s antibacterial effect that was published in the Journal of Dental Research.

5 – Saliva strengthens newly-erupted teeth. When teeth first come into the mouth, their enamel isn’t fully developed.  Saliva fills in the weak parts of the new tooth with calcium, phosphate, and fluoride to make these new teeth strong and ready for battle against your teeth’s worst enemies.

6 – Saliva can form a protective coating on teeth. Proteins in the saliva bind to the tooth surface.  The book Essentials of Dental Caries by Kidd, “Salivary proteins could increase the thickness of the acquired pellicle and so help to retard the movement of calcium and phosphate ions out of enamel.”

By keeping calcium and phosphate in the tooth, the salivary pellicle could aid in preventing cavities.  Ironically, the salivary pellicle is a sticky coating that helps cavity-causing bacteria adhere to the tooth surface.  In a way, it can be both a good and bad thing.

Further Reading & Conclusion

There are a couple of good reports about saliva, such as  Saliva — The Defender of the Oral Cavity by Amerongen and another study by Amerongen about salivary proteins.  You’ll probably need a subscription from a major university to get to them, but I thought I would link to them anyway for those of you who are able to access them.

Do you have any questions or comments about how saliva protects your teeth?  Leave them below in the comments section!

Dental Plaque Disclosing Tablets Solution
©Rob Byron/Shutterstock.com

Would you vacuum your carpet if it didn’t look dirty?  Probably not. Unfortunately, many people look in the mirror and don’t see anything on their teeth so they assume that their teeth are clean.  If only they knew the truth! There are millions of bacteria that live in our mouths and cling to our teeth.  You can read more about dental plaque here.

Plaque Disclosing TabletsThe problem is that plaque is very hard to see for the untrained eye. Luckily, there are products such as plaque disclosing tablets and plaque disclosing solutions.  This is a type of dye that adheres to plaque in your mouth allowing you to easily visualize it – and remove it. If you see plaque on your teeth, you will want to remove it!  Once you have used plaque disclosing tablets and/or solution a few times, you will figure out where the plaque tends to hide in your mouth, thus increasing your brushing efficiency.

Our Plaque Disclosing Experiment

A few days ago, my wife and I didn’t brush all day.  At the end of the day, we took pictures of our teeth, and then chewed a plaque disclosing tablet and took another set of pictures.  Here’s a photo montage  showing how our teeth looked:

Seeing the Dental Plaque on Our Teeth

My wife didn’t rinse out as well as me, so only the very dark pink areas are plaque on her teeth.  Also, we don’t usually smile like this…we were trying to show more of our teeth for the picture 🙂

Where Most Plaque Lives On Teeth

Pink Dental Plaque on a Single ToothAs you can probably tell, most plaque accumulates between our teeth.  The area between our teeth is an area where plaque are less likely to be swept away by our tongue when chewing or by our toothbrush when we brush.  The best way to remove the plaque between our teeth is by flossing. To the right is a close-up of one of my upper pre-molars, clearly showing all of the plaque living between my teeth.  Pretty gross, right?

Where to Get Plaque Disclosing Tablets

Do you want to find out where the plaque is on your teeth?  Or do you need help motivating your toddler to brush?  Try showing him or her where the “bugs” are living on their teeth. Actually seeing the plaque will motivate children and adults alike. Young Dental Plaque Disclosing SolutionYou can find plaque disclosing tablets at most local pharmacies. If you’re into buying things online, here are a few options from Amazon: 1 – Butler GUM Red-cote Dental Disclosing Tablets Pack of 250 tablets – Name brand chewable tablets. 2 – Young Dental 2 Tone Disclosing Tablets Pack of 40 – Great chewable tablets. 3 – Young Dental 2 Tone Disclosing Tablets Pack of 250 – Large pack of chewable tablets. 4 – Young Dental 2 Tone Disclosing Solution 2 Fl Oz [Pictured] – This is the same liquid that most dentists and hygienists use. You can easily swab it onto your (or your child’s) teeth with a q-tip to find out where the plaque is lurking. Do you have any questions or comments about plaque disclosing tablets or solution? Feel free to leave them below in the comments section. Thanks for reading!

Ultrasonic Dental Instrument for Cleaning Teeth

Recently, an anonymous reader sent me a question asking about the differences between the instruments that dentists can use for cleanings.  It reads: For cleanings, my dentist uses a plaque scraper and the rotating buffer thing. Other dentists in the area advertise ultrasonic cleanings. What is an ultrasonic cleaning? Does it provide any additional advantage, or have any disadvantages?

Hand Instruments Used for Dental CleaningsFirst of all, there are two main techniques for removing plaque and tartar from your teeth – manual and ultrasonic.  A manual cleaning is done using hand instruments such as those pictured to the left.  An ultrasonic cleaning means that the dentist is using a special instrument that vibrates at a very high frequency to remove the plaque and tartar.  The ultrasonic instrument also sprays a stream of water toward your teeth.  Here are two examples of ultrasonic instruments: the Cavitron and the BlisSonic.

Dental Tooth Polishing - Photo Courtesy of Wsiegmund
Polishing the teeth after removing plaque and tartar.

Regardless of the technique your dentist uses, the dentist will still use the rotating rubber cup with dental cleaning paste to smooth out and polish the teeth, as shown in the picture to the right.

Which Is Better, Ultrasonic or Hand Instrument Cleanings?

When I am preparing to clean a patient’s teeth, I consider how much plaque and calculus (calculus is the dental term for tartar, or plaque that has hardened onto the teeth.) that particular patient has on their teeth.  If they have a lot of plaque and tartar,  I will usually use an ultrasonic instrument to remove it.  This is mainly because the ultrasonic instrument can remove tartar much faster and easier than the hand instruments. However, after using the ultrasonic instrument, I always examine the teeth to make sure that I didn’t miss anything.  If tartar and plaque remain, I usually remove it with the hand instruments at that point.  I do this because it is easier to remove very small amounts of tartar with the hand instruments as it is easier to visualize the tartar with. This study suggests that ultrasonic instruments may be better because they have a steady flow of water that comes out of them and that can help to dislodge tartar that may have accumulated below the gumline. That study also talked about micro-ultrasonic instruments and how they are easier to maneuver below the gums due to their small size.  They can also reach down into the grooves better on tooth surfaces to remove more plaque. This study that compared the effectiveness of ultrasonic instruments and hand instruments concluded the following: [emphasis added]:

Evaluation of residual plaque and calculus after instrumentation with hand- and power-driven scalers showed sonic and ultrasonic scalers to be equivalent, and in some cases, superior to hand scaling. When modified ultrasonic inserts were compared with unmodified ultrasonic inserts and hand curets, the modified ultrasonic inserts produced smoother roots with the least amount of damage, better access to the bottom of the pocket, better calculus and plaque removal, less operator time, and less operator fatigue than did hand scaling…

Another thing that studies have looked at is how much good tooth structure the various instruments remove.  When a hygienist is cleaning your teeth and roots, they have to scrape hard to remove the plaque and tartar.  They unavoidably remove some good tooth structure when they do this. The final study we’ll take a look at involved the amount of healthy tooth structure ultrasonic instruments removed compared to conventional hand instruments.  Here’s what the researchers found:

Based on the results of these two comparative studies, the power-driven inserts or the various ultrasonic scalers tested did not remove more tooth substance than conventional hand instruments. They may thus be a useful alternative for the debridement of root surfaces.

They found that the ultrasonic scalers may not remove as much tooth structure as the regular hand instruments. In summary, the ultrasonic instruments do have many advantages when compared to the hand instruments.  When a patient has lots of plaque and tartar build-up, the ultrasonic instruments are great at quickly cleaning the teeth.  However, many dentists prefer to simply use hand instruments when there is only a small amount of tartar on the teeth.

Why Dentists Might Not Use Ultrasonic Instruments for Your Dental Cleaning

Dental Cleaning with Hand Instruments.  Courtesy of Walter Siegmund
Using hand instruments to remove calculus

Many people go to the dentist twice a year to get cleanings.  When I see a patient with excellent oral hygiene and excellent teeth, it doesn’t make much sense to use an ultrasonic scaling instrument for their cleaning because there is such a minimal amount of calculus to remove.  Some patients have very little calculus because they floss regularly and brush with tartar-control toothpaste. When someone has just a small amount of calculus to clean off, I find it easier to just quickly use the hand instruments and then polish the teeth.  Using the ultrasonic instrument requires setting it up as well as sterilizing it afterward, so it makes more sense to quickly grab a tool to take care of a small problem. Perhaps a simple analogy will illustrate this point.  Suppose you use a drinking glass and need to wash it.  You could either wash it by hand or put it in the dishwasher – but you have no other dirty dishes to wash.  You would most likely wash it by hand rather than run it through a cycle in the dishwasher, right?  Well, for similar reasons, your dentist may elect to take care of small amounts of tartar with hand instruments.

A Video Showing an Ultrasonic Dental Cleaning

Here’s a video showing the difference between ultrasonic cleanings and hand instrumentation:

What Do You Think?

Have you had an ultrasonic cleaning?  Did your mouth feel cleaner afterwards?  Did you think it was more comfortable?  Some people prefer the ultrasonic cleaning, some don’t. If you have any questions or comments, feel free to leave them in the comments section below!

Why Extract Wisdom Teeth?
©Milos L Jubicic/Shutterstock.com

Sometimes, wisdom teeth come in normally and provide the mouth with another set of  powerful, food-crushing molars.  Unfortunately, that is the exception and not the rule.

Why Dentists Extract Wisdom TeethIt seems like pretty much everyone has their wisdom teeth (third molars) extracted before they come in around the age of 18.  A lot of people wonder why our bodies even bother to make wisdom teeth if we just end up removing them.  That’s a good question.

One theory is that a long time ago people lost teeth a lot earlier due to poor oral hygiene and the third molars came in later in life to provide fresh, healthy teeth.  Since some teeth had already fallen out, there was room for the wisdom teeth.

Currently, wisdom teeth are usually extracted as a preventive measure so that other problems do not occur later in life.

The reasons dental professionals remove wisdom are many, but they all boil down to one main reason – there is simply not enough room in the mouth for wisdom teeth.

There Isn’t Enough Room for Wisdom Teeth

Here are a few reasons why dentists normally extract wisdom teeth:

  1. There isn’t enough room in the jaw for them to come in.
  2. There won’t be enough room in the mouth for them to come in.
  3. Due to lack of space, wisdom teeth often come in at an awkward angle and can damage adjacent teeth.
  4. If they never break through into the mouth, they can cause big problems later on.
  5. Since they are so far back, they are harder to clean.  This increases the likelihood of developing cavities and gum disease.

There Isn’t Enough Room in the Jaw for Wisdom Teeth

Wisdom Tooth Soft Tissue Impaction
You can barely see the wisdom tooth poking out of the gums. There is not enough room for it to fully erupt.

Some people have smaller bones than others.  Sometimes, the jaws are not big enough to contain all of the teeth that our bodies produce.  After taking a diagnostic x-ray, your dentist can best advise you as to whether or not you will have enough room in your jaw to allow the wisdom teeth to erupt normally.

There Won’t Be Enough Room in the Mouth for Wisdom Teeth

Sometimes wisdom teeth can’t come up far enough into the mouth to serve as functional teeth.  In some cases, the wisdom teeth only partially erupt into the mouth and can result in severe pain in the gingiva (gums) when biting.

You can see an example of this in the photo to the left.

Wisdom Teeth Come in at an Awkward Angle

Wisdom teeth usually have a tendency to be abnormal.  They sometimes look very different and often they come into the mouth at different angles due to a lack of space.

Impacted Wisdom Teeth
This x-ray shows two wisdom teeth that are coming in at very awkward angles. The upper wisdom tooth is pointing toward the back of the mouth and the lower wisdom tooth is pointing directly at the molar in front of it, which can potentially damage that tooth.

As you can see in the x-ray to the right, the upper wisdom tooth is pointing backwards and the lower one looks like it is going to run into the tooth in front of it.

Many wisdom teeth try to erupt into the mouth by pushing on the molar right in front of it.  This can make it easy for the adjacent molar to get a cavity.  It can also cause the gums to recede around that tooth.  This can sometimes severely damage the adjacent molar that both it and the wisdom tooth need to be extracted.

Wisdom Teeth Can Cause Big Problems Later On

One of my professors at dental school showed me an x-ray of a patient that never had his wisdom teeth extracted.  Even though this patient was in his 50’s, an infection had started around his impacted wisdom tooth.  This resulted in a necessary surgery that cost thousands of dollars.  This surgery could have been prevented by simply removing the wisdom teeth at an early age when the tooth and roots were small and still forming.

When a tooth is just sitting inside the jawbone for many years, it can form what is called a dentigerous cyst.  This cyst can eventually turn into cancer.

Wisdom Teeth Are Hard to Clean and Often Get Cavities

Cavity on Wisdom Tooth - Courtesy of Ildar Sagdejev

Some of the patients that I see at the dental school have their wisdom teeth.  In many cases, they complain that they are very hard to clean.  They say that it is almost impossible to brush and floss way back there.

Because of this, many wisdom teeth develop cavities.  If someone can’t clean their wisdom teeth, then it’s a good idea to get them taken out before they cause pain and problems.

In the picture to the left, you can see a young man’s teeth.  The last tooth in back is the wisdom tooth.  It looks like the very back of the wisdom tooth was very hard for this young man to clean.  Because of this, he developed a cavity and it looks like the tooth probably was extracted.


Do you have any questions about getting your wisdom teeth out?  Do you still have your wisdom teeth?  If so, have you had any problems with them?

Please leave any questions or comments below in the comments section, and I’ll get back to you.  Thanks for reading!

Using Teeth as Tools

This past weekend I went shopping with my wife and got a couple of new shirts.  The tags were stuck onto the shirts with a thin plastic string.  I usually rip them off, but only the tag came off.  With no scissors nearby, I almost used my teeth to get the rest off.  Luckily, I caught myself and was able to remove the annoying plastic string without using my teeth.

Many people damage their teeth by using them inappropriately.  Here’s a few things that you should avoid doing with your teeth in order to keep them as healthy as possible:

Don’t Use Your Teeth To Open Things

Swiss Army KnifeWhether it’s a beer bottle, candy bar, or one of those waterproof FedEx envelopes – resist the urge to use your teeth to help you open it.  Your teeth were not meant to open these things!  Using your teeth on foreign objects, especially bottle caps, can crack them, chip them, or cause malocclusion (poor jaw alignment) by wearing down your teeth unevenly.  Malocclusion can eventually lead to a type of jaw pain called temporomandibular disorder (TMD, commonly known as TMJ.)

Don’t Use Your Teeth As Scissors or Wire Cutters

Like I mentioned in the opening paragraph, I was tempted to use my teeth to cut a plastic tie.  While my teeth are poorly suited for this task, scissors are the perfect tool for such tasks.  I was simply too lazy to go and find a pair.

Do not Use Your Teeth as ScissorsAnother one of my bad habits is using my teeth to cut clear packing tape when the packing tape doesn’t come with a built-in cutter.  I’ve made an effort recently to find scissors when using this type of tape, but I still catch myself using my teeth occasionally.

Believe it or not, some people even use their teeth on wire.   As a kid, I often used wires, batteries, light bulbs, and small electric motors to build fun, not-very-useful contraptions.  The easiest way to remove the insulation from the copper wiring was to bite on it with my two front teeth.  I got to the point where I could do it very efficiently.  Luckily, my dad caught me doing this one day and told me I would ruin my teeth if I persisted.  He was right!  Fortunately, no permanent damage occurred and I started using wire cutters.

Don’t Use Your Teeth as a Third Hand

Try not to Use Your Teeth as a Third HandMy oral pathology teacher once showed us a picture of an elderly woman that had used her front teeth to hold pins while she was knitting and sewing.  Over time, she had worn small holes in her teeth where the pins were placed.  Every time she smiled, very small holes were visible on the bottom of her upper teeth.  A similar thing can happen when construction workers hold nails in their teeth.

Using your teeth to hold things can damage your teeth in the long run.  Also, if you had to hiccup or yawn, holding objects with your teeth  might cause you to choke.

Don’t Use Your Teeth To Chew On Foreign Objects

When I was in third grade, I noticed that lots of the cool kids were chewing on their pencils.  Being a conformist, I started chewing on my pens and pencils.  Sometimes during boring assignments, my classmates and I would compare our writing utensils to see who had inflicted the most damage with their teeth.

Similarly, many children get in the habit of biting their fingernails.  If they continue, it can damage their permanent teeth.

Although addicting, stress-relieving, and sometimes “cool”, biting on foreign objects can weaken or crack your teeth, chip them, and cause you to lose tooth structure.

Don’t Use Your Teeth as a Nut Cracker or Seafood Opener


Don’t use your teeth to crack open nuts.  As good as the nut tastes, you need to use something other than your teeth to crack the shell.  A nutcracker, perhaps?

Over time, the shell will act like sandpaper on your teeth, sanding away bits of enamel each time you open a nut.  If you do this regularly you will eventually be able to visibly see where you’ve worn away your teeth.

Using Teeth To Open Seafood
We can only hope that this boy didn’t open that shell with his teeth!

Another common misuse of teeth occurs when eating seafood.  In many places, seafood is served in the shell.  Although it may seem natural to use your teeth to remove the shell, the shells are often quite hard and could easily damage your teeth.


Teeth serve many functions.  They were designed to chew food, support our lips and cheeks structurally, and help us speak properly.  A healthy set of teeth also adds to your overall appearance and gives you an attractive smile.

If you want your teeth to function properly, you have to protect and take care of them.  As long as you use your teeth for their intended purpose, and don’t abuse them, you will be able to keep your teeth working well for a long time.

Cold Sensitive Teeth
©Jan Mika/Shutterstock.com

Does the thought of eating ice cream or any cold foods make you cringe because you know how bad your teeth will hurt? You could be one of the millions of Americans that suffer from sensitive teeth. While the causes of sensitive teeth can vary, there are some toothpastes that can help alleviate the symptoms.

Ice Cream Sensitive TeethIf your teeth are sensitive and you don’t think that it is caused by reversible or irreversible pulpitis, then you may want to try a toothpaste that is made especially for sensitive teeth.

Toothpastes made for sensitive teeth usually contain two extra ingredients that help decrease painful tooth sensitivity.  These two extra ingredients are:

Potassium Nitrate and Strontium Chloride.

Both of these ingredients work by acting on the dentin tubules.  In order to understand how these ingredients work, I will first give a brief explanation of dentin tubules.

What Are Dentin Tubules?

The dentin tubules are tiny tubes that go from the outside of your teeth (when dentin is exposed to the outside surface, which usually happens with gum recession) to the dental pulp.  If the dentin tubules are openly exposed to the inside of your mouth, then it is easy for sensations to be transferred to the nerves in the dental pulp.

It is this transmission of various stimuli, such as heat, cold, and sweets, that cause the nerves to send the message of pain to your brain.  After all, the only sensation that the dental pulp can send to the brain is the sensation of pain.

Jessica Simpson Doesn't Brush Teeth
©Everett Collection/Shutterstock.com

Last Wednesday during an interview with iHeartRadio, Jessica Simpson proclaimed to the world that she doesn’t brush her teeth.  You can see a video of that part of the interview at the bottom of this article.

Jessica Simpson's Teeth by jvh33 on Flickr!Here’s how it came out of the pop-turned-country singer:

I don’t brush my teeth! No really! I just use Listerine and sometimes I’ll use my sweater.  No— I do brush every now and again, but my teeth are extremely powerful.  I mean, find me when I’m 60 and they’ll probably be all out.  But, I still like put on my face creams — they’re next to my bed.

After that, she exclaimed that she loves fried food.

I can only hope that there is fluoride in her face creams.  But in all seriousness, how can Jessica Simpson have such great teeth if she doesn’t even brush them?

Toothbrush Sanitizers Toothbrush Germs

When I was a kid, one of my teachers once told our class that bacteria from human waste in the bathroom could find its way on to our toothbrush.  Later that day, I went home and moved my toothbrush as far away from the toilet as I could.

Toothbrush SanitizerIt has also recently been shown that bacteria can grow on our toothbrush when it’s just sitting in the bathroom and not being used.

It is reasons like these that many people are looking into purchasing toothbrush sanitizers.

I’ve often wondered if they are really worth it.  Sure, there is bacteria on my toothbrush.  Has it ever made me sick?  Probably not.  That is why I personally don’t use a toothbrush sanitizer.  I figure if it’s not broken, there’s no point in fixing it.  However, I’ll be the first to admit that I sometimes do things the wrong way.

In looking at the effectiveness of toothbrush sanitizers, we need to ask ourselves two questions:

  1. Do toothbrush sanitizers kill bacteria?
  2. If they do kill bacteria, does it really make a difference?

How Often to Replace Toothbrush

Are you one of the millions of Americans that only changes their toothbrush when your dentist gives you a free one at each check-up?  If so, you could be denying your teeth the cleaning they so desperately deserve for working tirelessly for you everyday.  Toothbrushes were meant to be replaced more often than once every six months.

How Often Should You Replace Your Toothbrush?

Old ToothbrushesThe American Dental Association recommends replacing your toothbrush every 3 to 4 months.  You may want to replace your brush more often if you notice that the bristles are fraying.  Not only are frayed bristles unable to clean between your teeth, they can also cause damage to your gums.  Besides that, there are a couple more scenarios where you would want to replace your toothbrush more often that every 3-4 months.

Replace Your Toothbrush If Someone Else Has Used It

You might also want to consider changing your toothbrush before 3-4 months have passed if someone else has used it.  Scientific studies have shown that bacteria can live on our toothbrushes.  When you put your brush back in your mouth, you’re just exposing your mouth to bacteria that it put on your brush, which doesn’t do any harm.

However, if someone else has used your toothbrush, they have contaminated it with all of the bacteria in their mouth.  If you then use that toothbrush, you will expose yourself to any disease or sickness that they may have.

Replace Your Toothbrush When It Tells You To

Most modern toothbrushes and brush-heads for power toothbrushes have colored indicators that let you know when you should change your brush.  Often the bristles start to stress and develop micro-cracks before we can even see them.  The manufacturer of the brush knows when the brush will start to fail and not provide an optimal brushing experience for you.


You should be replacing your toothbrush at least once every 3 to 4 months.  You may want to do it more often than that if:

  1. The bristles are visibly frayed.
  2. Someone else has used your brush.
  3. If the indicator says to replace it.

If you want to experience the maximum benefit of brushing, you need to brush with a brush that is in good condition.