[reino341]

• Dental hygienist told me that you should keep flossing regardless of bleeding, is this true? My gums tend to bleed when I haven't flossed in a while.
• Why do mints (menthol) cause that funny reaction in your mouth making water more difficult to drink?
• What's the bare minimum everyone should do daily to keep their mouth healthy, which things give the best results with least effort?
  

[iknowexactly]

(04-12-2013 05:29 AM)Parlay44 Wrote:  

Which countries would you recommend visiting for dental tourism? No offense but dental work costs a fortune in the US.

Yeah, real world in California they want $1000+ for a crown, so four front teeth... I appreciate the OP offering advice, but to local dentists, come on, I can't buy you a Ferrari when there are smart guys in Mexico or wherever and I will get a vacation for free and still save money.

I've seen ads from guys there who went to post graduate training and continuing education in the US and look legit.

[DVY]

How often do I need to actually go to the dentist to get my teeth cleaned? Do I really need to floss everyday? Why does OJ taste like shit after I brush?

@slubu- Recommended every 6-months. Floss everyday? Well it depends. Short answer- Required? No. Recommended? Yes. I would recommmend at least 1/week flossing and everyday waterpik (water irrigation device) if you hate flossing.

As for the OJ tasting bad after brushing? Why are you drinking OJ after brushing. haha. Probably the mint component mixing w/citrus tastes strange

@G- Honestly they are all about the same. I personally like aquafresh because the tube is cool and its comes out in 3 colors.
Silly how we base our consumer decisions....

Some people do have sensitivity to whitening, tartar control. 2 brands that are highly suspect to a % of the population is Colgate (#1 suspect in toothpaste based sensitivty) and Crest Whitening (close 2).

Floss- Glide is a dope floss, but its un-necessary unless you have very tight contacts. Any floss will do.

[DVY]

Human Physiology of Saliva- Part 2

Xerostomia- Heavily reduced or Non-existent salivary function. In laymen's terms, dry mouth and cotton mouth.

Courtesy of wiki entry Xerostomia, some stats/facts.

Xerostomia is a very common symptom. A conservative estimate of prevalence is about 20% in the general population, with increased prevalences in females (up to 30%) and the elderly (up to 50%).

"Dental caries (xerostomia related caries) - without the anticariogenic actions of saliva, tooth decay is a common feature, and may progress much more aggressively than it would otherwise ("rampant caries"). It may affect tooth surfaces which are normally spared, e.g. cervical caries and root surface caries. This is often seen in patients who have had radiotherapy involving the major salivary glands, termed radiation - induced caries.[8]

Oral candidiasis - a loss of the antimicrobial actions of saliva may also lead to opportunistic infection with Candida species.[8]

Intra-oral halitosis - [1] possibly due to increased activity of halitogenic biofilm on the posterior dorsal tongue (although dysgeusia may cause a complaint of non genuine halitosis in the absence of hyposalivation)"

Causes- You can read up on wiki more.

Here are the big ones-

1) During sleep, your saliva function declines
2) With increasing age, your saliva function declines
3) "Over 500 medications produce xerostomia as a side effect (see table).[8] 63% of the top 200 most commonly prescribed drugs in the United States are xerogenic.[8]

The likelihood of xerostomia increases in relation to the total number of medications taken, whether the individual medications are xerogenic or not"

These include anti-depressants, anti-histamines (allergy meds), opiods, benzodiazapenes (valium, xanax), Anti-reflex meds.

Solutions

Treatment of Xerostomia is very difficult.

Cut un-necessary meds.

Drink more water daily and stay hydrated. (Not a viable option during sleep).

Saliva Substitutes- artificial saliva. time-release lozenges

Saliva Stimulants- chewing gum, drugs, sugar-free mints

Research shows that high-fluoride supplements are a MUST for people suffering from radiation induced xerostomia. Salivary glands are hypersensitive to radiation and shut down. Without high-fluoride topical supplements, people's teeth quite literally get cavities on every teeth. People with perfect teeth prior to radiation have cavities on every tooth within months.

The biggest shame is that due to radiation/chemo you basically can't extract teeth due to osteoradionecrosis (necrosis of bone following radiation). Somebody could lose their whole lower face (not a joke, go look it up).

Taken as a canary in the coal mine, zero salary function implies total shutdown of oral health. Reduced salary function thus means decline in oral health. Its a silent killer of oral health.

Read more on wiki.

[DVY]

(04-12-2013 09:29 AM)iknowexactly Wrote:  

Yeah, real world in California they want $1000+ for a crown, so four front teeth... I appreciate the OP offering advice, but to local dentists, come on, I can't buy you a Ferrari when there are smart guys in Mexico or wherever and I will get a vacation for free and still save money.

I've seen ads from guys there who went to post graduate training and continuing education in the US and look legit.

The prices at our office are lower than this. 500 for PFM crown. Not everybody in CA has super-high prices. 700 seems to be a reasonable rate in West LA.

Our low prices are a direct result of not advertising. Advertising is expensive... I work w/my father, and back when yellowpages was big, I think a full color add was 5-6k/month. Only crappy clients come in off the street. Best and cheapest is referrals.

Edit- We do get around 15 new patients/month from yelp (4.5/5 stars). We only paid (once) to put up pictures. Mostly college-aged kids. This mobile/digital era is changing the dental market. Consumers are getting more saavy and price-shop/dentist-shop online. I believe the statistic is that each year since 2009 has had a 10% drop in overall production for most dentists- bad economy and all.

@Parlay 44- Can't in good mind, recommend dental tourism. Hell if you wanted dental tourism you could go to black-market dentists in the States and never shell out for airfare. This is big in East LA. Its basically unlicensed dentist practicing in a backroom somewhere. Prices are around 1/2- 1/3 normal dental care.

Say what you will about legal liability, USA has some of the better dental care in the world. I have seen some shoddy dental tourism work and I have seen some excellent foreign dental work. Especially shoddy work- Russia, former FSU, Mexico, Honduras, Guatemala. There is very little rhyme or reason. I have a small sample size w/this and never really ran a survey/questionaire. Also big differences between individual dentists capacities. Some dentist do implants, Root-canals, extractions, wisdom teeth. Some only do simple stuff. Its not an apples to apples comparison.

[el mechanico]

Thanks for the other reply I have one more question. How do you find a good local dentist? Everyone says theirs is good

[tjuan]

How can you make a dentist, or periodontist, accountable for their quality of work? Legally, I've learned there is a lot of leeway in what is acceptable, regardless of what they were hired to do.
I had implants placed that everyone shakes their heads at, placed too facial, required bone grafts (when placed they broke through the bone facially), the temp caps are still on because the ceramist does not know how to work with them, temps being thinner than ceramic the temps are aesthetically better.. What I learned through my lawyer is that since the implants do not need to be pulled -- they are functional, but not aesthetic (the reason they were placed, the reason I went through years of orthodontics only to have a botched implant job) -- it is considered "good", the periodontist has fulfilled his roll, there is nothing I can do. So, my understanding is as long as the work is "functional", as long as that implant is not going to wiggle or fall out, it is not malpractice, even though desired goals were far from achieved, the margin of error seems extreme to me. If I ever have a dental work again, I want greater accountability for their quality of work than law finds acceptable.
Interesting thread, thanks for taking the time to answer the posts.

[DVY]

@ iknowexactly -If whiteners suck, what should I do? Get veneers or crowns on badly yellowed front teeth? It seems too bad to leave alone.

Whitening will only go so far. Usually the whitening will lighten your teeth a few shades and then regress back to original shade. Most of those "pearly whites" are crowns/veneers

I'm guessing crowns or veneers on an otherwise intact tooth traumatizes it even more than whitening....
I had mechanical problems with a couple front teeth and had quite white crowsn put on with the idea I will finish the other fronts with vanity crowns or
veneers.

Yes, grinding down a tooth for aesthetic reason is somewhat overkill in most cases. But I guess it comes down to priorities. Whitening is probably better for the tooth than crowns, but crowns/veneers are much more predictable aesthetic-wise.

TBH, its a tossup.

[DVY]

(04-12-2013 02:29 AM)POHammer Wrote:  

Why are you against tooth bleaching?
There are published studies that show no damage to enamel.

No Damage if you define it by their criteria. The truth is not being able to eat hot or cold means that you have disrupted something in the tooth.

Furthermore, the bleaching agent is applied to the front of teeth...not the chewing surface where cavities are more likely to form.

Ok, how about bleaching trays/Crest white strips?

I am not sure if it really is bad for teeth, but white teeth are very important for being perceived as good looking, and the more extreme white the better. Perhaps veneers are good, but seem pricey.

Ahh hollywood, why are you leading the youth astray?


Also, what is your take on xylitol chewing gum for reducing tooth decay?

Gum improves salivary function. Xylitol is likely another BS shtick. Sugar-free gum is important thought. You don't want sugar coating all your teeth for hours.

[BIGBOY]

What are your thoughts on oil pulling and tongue scrappers?

[DVY]

(04-12-2013 06:11 AM)reino341 Wrote:  

• Dental hygienist told me that you should keep flossing regardless of bleeding, is this true? My gums tend to bleed when I haven't flossed in a while.
  
  Bleeding seems to indicate inflammation (gingivitis- swelling of the gums). Flossing technique is important. Dont snap the floss into your gums. You want to hug the tooth as it goes down. It should not hurt. People floss incorrectly all the time. Ill do a post on this soon.
• Why do mints (menthol) cause that funny reaction in your mouth making water more difficult to drink? No idea
• What's the bare minimum everyone should do daily to keep their mouth healthy, which things give the best results with least effort?
  
  Brushing at least 1x/day before bed (no food or drink afterwards except water). Better-2x/day (and before you take a nap).
  Floss at least 3x/week thoroughly at night (or 1x/week and 2-3x/week waterpik) (re- decreased saliva at night/most damage done is at night)
  Drink lots of water (especially after meals. Swish mouth w/water).
  Minimize sugars (Good diet)
  Chew sugar-free gum after food
  
  

[DVY]

(04-12-2013 12:55 PM)el mechanico Wrote:  

Thanks for the other reply I have one more question. How do you find a good local dentist? Everyone says theirs is good

Wish I could answer this properly. Hell, if I knew I would sell an ebook on this or something... =).

Couple factors- Walk through the office. Clean? Modern? How hard is the dentist selling you on random procedures? Tread carefully w/a new dentist.

Some tips on navigating a questionable environment-
Before you commit to any major work, they will need to take X-rays. You can ask them to make a copy/email of these X-rays.
Take this around to various dentist and they should give you a free consultation as long as you bring these X-ray in.
Compare the treatment plans and prices.

A lot of the younger generation use Yelp. You get some idea of the office before you step in.

[DVY]

(04-12-2013 01:36 PM)tjuan Wrote:  

How can you make a dentist, or periodontist, accountable for their quality of work? Legally, I've learned there is a lot of leeway in what is acceptable, regardless of what they were hired to do.
I had implants placed that everyone shakes their heads at, placed too facial, required bone grafts (when placed they broke through the bone facially), the temp caps are still on because the ceramist does not know how to work with them, temps being thinner than ceramic the temps are aesthetically better.. What I learned through my lawyer is that since the implants do not need to be pulled -- they are functional, but not aesthetic (the reason they were placed, the reason I went through years of orthodontics only to have a botched implant job) -- it is considered "good", the periodontist has fulfilled his roll, there is nothing I can do. So, my understanding is as long as the work is "functional", as long as that implant is not going to wiggle or fall out, it is not malpractice, even though desired goals were far from achieved, the margin of error seems extreme to me. If I ever have a dental work again, I want greater accountability for their quality of work than law finds acceptable.
Interesting thread, thanks for taking the time to answer the posts.

@tjuan- I am sorry to hear of your unfortunate experience. This type of behavior really pisses me off. From your case, it sounds like you had a diastema (space in front of central incisors), they moved the teeth to accomodate space for implants.

I wish I could offer advice, but this case sounds like a case failed by poor diagnostic planning. Each specialist took a bite out of your wallet, and yet blame is hard to lay, because each person did "his job".

Heres how I see it. Orthodontic guy did what he was asked. What he didn't warn you about is that bone thickness might not be enough for implant placement. In his mind, he just creating space for the implant.

The periodontist was responsible for placing an implant in a correct orientation but didn't have enough bone, so he placed it at angle. The ceramist didn't have a way to properly restore these implants in aesthetic manner. Fail. Bigger Fail. Forehead Slap.

What is done is done. And there is no use crying over spilt milk. I would go to the periodontist and explain the situation.

"The implants were placed at an extreme angle and the buccal bone fractured. According to the laywer I consulted, I believe this is below the "standard of care". I am fairly upset that I went through this procedure and you failed to mention that I might need a bonegraft prior to implant placement. I believe I am entilted to a refund for the implants placed "

Very often, my father and I refuse to take implant cases because of insufficient bone or insufficient space to restore the case.

One option is to leave everything as is.

Very likely, in your case, the best option for aesthetics and fucntion is a bridge or bridges. You can cheat a little on the dimensions/space limitation because you now involve 3 or more teeth instead of 1. This same principle is why veneers look good- take a little here, give a little there.

Use the money from the periodontist and tell the general dentist that you are upset that this case worked out so poorly, but would like him to fix it. Is their any chance they can give you a break on the work? Usually, theyll give you some kind of break.

Thats how I would play it...

Disclaimer- I haven't neither seen your case personally, nor do I know all the facts. Based on what you have told me, I think this would be the best option for all parties invovled. Send me a PM if you would like to discuss this further.

[DVY]

Edit to above post..."The implants were placed at an extreme angle and the buccal bone fractured. According to the laywer I consulted, I believe this is below the "standard of care". I am fairly upset that I went through this procedure and you failed to mention that I might need a bonegraft prior to implant placement.

Furthermore, now these implants are not able to be restored with permanent restorations.

I believe I am entilted to a refund for the implants placed "

[Genghis Khan]

Hey DVY,

what's your opinion on Dr. Ellie Phillips and her book 'Kiss Your Dentist Goodbye'? (http://www.amazon.com/Kiss-Your-Dentist-...st+goodbye)

[lurker]

I bought a Sonicare the other day. Is this thing as awesome as it feels or is it just an overpriced placebo device that happens to make my teeth feel cleaner?

[Ovid]

What is your opinion of mouthwash? I've heard some people say that you shouldn't use Listerine because it's too aggressive and bad for your gums. If it's OK, what is the correct way to use it? What routines/procedures do you recommend for fresh-smelling breath?

Thanks for this thread!

[Genghis Khan]

(04-12-2013 10:35 PM)Ovid Wrote:  

What is your opinion of mouthwash? I've heard some people say that you shouldn't use Listerine because it's too aggressive and bad for your gums. If it's OK, what is the correct way to use it? What routines/procedures do you recommend for fresh-smelling breath?

Thanks for this thread!

Not an expert, but my understanding is Listerine is acidic. So if you want to use it, you need to follow it up with for example ACT Rinse (a fluoride rinse that isn't acidic).

[michelin]

I used to have great (strong) teeth but was a great consumer of acidity (sodas, citrus, etc.), which seems to ahve destroyed lot of the protection around the gum line.

What would you recommend if hypersensitivity does not go away at one particular area of my teeth? For now, I use sensodine and some sensitive-teeth mouthwash.

[DVY]

@Gengis- Didn't read the book. Seems shes big on prevention (acid-reduction, etc etc). Wish I could give you more information.

@Bigboy- Oilpulling-no thoughts. Tongue scraping- reduces bacteria on tongue

@Ovid- One of the best antiseptic is alcohol. I think it is highly under-rated the benefits of taking shots/drinking straight vodka on the rocks. Listerine is around 20% alcohol w/other ingredients. Alcohol is probably a good reason why it works well.

@Genghis- Listerine is not acidic (to my knowledge). Its around 20% alcohol, and alcohol is a weak base. If anything its around neutral or slightly basic.

@michelin- Do you have notches in your teeth along the gumline? These notches are sometimes filled because of sensitivity. High-fluoride seems to reduce sensitivity.

[MikeCF]

Thanks for this thread.

I have all of my wisdom teeth so my teeth are tight. That's always made it difficult to floss my back teeth. I could get floss back there but it was hard to get all the way to my very back teeth.

I would floss as best as I could, and would floss regularly though not optimally, i.e., around 5 days a week. Sometimes I'd get into the grove of things and floss 2x a day. So I'm not a guy who never flossed or had poor dental care.

I recently got some 45 degree angle dental floss picks. I can now finally reach my back teeth to floss.

Man, it fucking hurts flossing those back teeth. When I floss my teeth, the gums in front of my mouth are fine. The gums at the back of my mouth really hurt. (They don't bleed, though.)

Is that due to my gums receding or something?

Anything I can do?

[DVY]

(04-15-2013 06:45 PM)MikeCF Wrote:  

Thanks for this thread.

I have all of my wisdom teeth so my teeth are tight. You are a good candidate for Glide-floss. Thin, slippery floss will make your life easier. That's always made it difficult to floss my back teeth. I could get floss back there but it was hard to get all the way to my very back teeth.

Wisdom teeth are often problematic.

I would floss as best as I could, and would floss regularly though not optimally, i.e., around 5 days a week. Sometimes I'd get into the grove of things and floss 2x a day. So I'm not a guy who never flossed or had poor dental care.

You are doing better than most, including myself. I am of the opinion that you flossing is most important before you go to sleep.

I recently got some 45 degree angle dental floss picks. I can now finally reach my back teeth to floss.

Yes, manual dexterity is an issue when very far back in the mouth

Man, it fucking hurts flossing those back teeth---flossing should not hurt When I floss my teeth, the gums in front of my mouth are fine. The gums at the back of my mouth really hurt. (They don't bleed, though.) I think its your flossing technique. The issue is that the teeth are oval and the gums circumstantially wrap around it. The floss on the pick is a straight line. The floss on the pick (blue straight line) is likely cutting into your gums at the corners of the wisdom teeth (points of the red arrows-not good)

   

Is that due to my gums receding or something? Probably not. Gum recession is a silent disease (at least pain-wise)

Anything I can do?
I really like the waterpik for cases similar to this. Its perfect for people who have lots of crowns, bridges, implants or manual dexterity problems (older folk and people with hard to reach teeth). Daily compliance is much better because its easier to use. I think the waterpik is an excellent adjunct to flossing.

Waterpik- .

Don't buy the travel-flosser. It doesnt have enough strength.

Tip- How to get a waterpik for 20% discount- Wait for bed, bath and beyond to send you those 20% off coupons in the mail, then go and pick one up.... =)

[DVY]

(04-12-2013 09:41 PM)lurker Wrote:  

I bought a Sonicare the other day. Is this thing as awesome as it feels or is it just an overpriced placebo device that happens to make my teeth feel cleaner?

Sonicare is legit. Makes my teeth feel like glass. 1 issue is that people try to press hard when brushing. Keep in mind that your gums are very sensitive. You only need to hold the sonicare in place with LIGHT pressure. A good tip is to hold the brush at the very back end and lighty press against tooth.

Don't muscle your brushing.

[Joga Bonito]

How long does it take to recover from a wisdom tooth pull and what speeds up recovery? Thanks.

[DVY]

@iwin- It depends. The more traumatic/complicated the wisdom tooth, the longer the healing time. Generally anywhere from 3 days to a week. W/in 3 days, most of the swelling pain will go down. Up to 2-3 weeks for complete 100% healing.



Vertically impacted are extremely tough.

As for reducing symptoms, ice-pack 10 mins on/10 mins off for the first day after surgery. This will help w/swelling. The rest is just time.