Interesting (and Sometimes Shocking) Facts from Dental History

Dentures of the Past

Nothing like a look back in the past to see how far you’ve come, am I right? Today’s blog was a request from our fabulous front office coordinator, Becca. Enjoy!

• Dentistry is one of the oldest professions. Early in recorded history, a Sumerian text described “tooth worms” as the cause of dental decay, an idea that wasn’t proven false until the 1700s.

• The first book to be published purely on the topic of dentistry was in 1530 titled, The Little Medicinal Book for All Kinds of Diseases and Infirmities of the Teeth.

• The Etruscans of Italy used gold bands to attach human and animal teeth as far back as 700 BC. In today’s Mexico, they’ve found dentures dating from 2500 BC, made from wolf teeth. . The first recorded wooden dentures in Japan appeared in 16th century. During the 18th century, dentists experimented with dentures made out of human teeth, animal teeth and carved ivory. Dentures were usually made by goldsmiths and ivory turners. United States President, George Washington, was famous for having wooden teeth. While he did wear dentures, they were made with ivory from hippos and elephants, real human teeth, gold, rivets, spiral springs- not wood.

• One of the most common medical practitioners in Europe during the Middle Ages was the “barber surgeon”. In this era, barbers were called upon to not only cut hair with their razors, but also to conduct many surgeries and pull teeth.

• In 1723, Pierre Fauchard, a French surgeon credited as the father of modern dentistry, published a book called, The Surgeon Dentist, a Treatise on Teeth. For the first time, he provided a documented comprehensive system for preventing dental issues and treating teeth. Fauchard introduced dental fillings and proposed that acids from sugar led to tooth decay.

• In 1840, Baltimore College of Dental Surgery, the first dental college opened. Harvard University Dental School was the first university-affiliated dental institution founded in 1867.

• Colgate mass produced the first toothpaste in 1873 and mass-produced toothbrushes a few years later.

• Around 1765, Paul Revere, who would later become famous for warning Colonial troops that the British were coming, was also trained as a dentist by America’s first dentist, John Baker, in addition to being a silversmith.

• Imagine having to feel all your dental work without Novocaine. We take it for granted now, but it wasn’t invented until 1903! We can all thank the German chemist Alfred Einhorn who invented it.

We hope you enjoyed this look back at our adventurous dental history. Don’t worry - if you’re having any dental issues of your own, you can rest assured we have much more advanced and painless procedures to take care of you! Feel free to give us a call anytime at 541-482-4995.

6 Toothbrushing Mistakes You're Likely Making

We’re always thrilled to see patients invested in taking care of the oral health. But there are a few brushing related mistakes that are made quite often - we’re talking every day! A few simple tweaks to your routine may make a big difference, so today we’re sharing these common errors to get to on the right track.

1. You use the wrong brush
   First and foremost, we recommend ultrasonic toothbrushes. We can guess with pretty great accuracy if someone uses an electric toothbrush - the results are that obvious! An ultrasonic toothbrush is one that uses a very high frequency of vibration referred to as ultrasound to remove plaque and bacteria from the teeth. Additionally, anything other than a soft brush has the potential to harm not only the teeth but the gums as well. Always use a “soft” bristled brush.

2. You don’t brush at the right time of day
   The most important time to brush your teeth is before bed. Sleep is the longest period of the day you’re not eating and therefore the best time for the bacteria that cause tooth decay and gum disease to “feed”. Another small change can be made for people who brush their teeth before breakfast - suds up those chompers afterwards instead, for optimal oral health.

3. You ignore the rest of your mouth
   Don’t forget to care for your tongue! The tongue can harbor food and bacteria in the tiny crevices between “papillae” (little bumps on the top of your tongue that help grip food while chewing) . Use your tooth brush lightly on your tongue and then follow with a tongue scraper to get rid of harmful bacteria.

4. Not brushing long enough
   The American Dental Association recommends brushing twice a day for 2 minutes each time. Two minutes feel like a long time when you’re doing something less stimulating (to most … not us of course!). This is one reason we love electric toothbrushes - they keep you honest with their built in two minutes timers.

5. Not using proper technique
   Many people are surprised to find, later in life, that they’ve been brushing the wrong way. But the truth is, proper brushing and flossing can be a little tricky! Don’t hesitate to get exact recommendation from your dentist or hygienist and ask any questions. We love these conversations! Most commonly, mistakes have to do with the angle of the brush, brush strokes and flossing motions.

6. You don’t replace your brush
   You should replace your brush every 3-4 months, more frequently if the bristles become worn. Worn down bristles aren’t as effective. You should also change your brush out after you’ve been sick.

   As always, the Soulsmile team is available to address any concerns you have about the proper way to brush. Don’t hesitate ask us the next time you visit our office. Feel free to give us a call at 541.482.4995. Happy brushing!

Invisalign Lifestyle FAQs

Invisalign has become one of the most popular treatments in the world since its debut in May of 2000. It easily enables patients to straighten their teeth without uncomfortable and unsightly metal. You can learn a lot about the basics of how it works throughout our website, but we’ve noticed most patients are really interested in how it will affect their day-to-day lives. So, today we are answering lifestyle-related questions to help you discover what you can expect during treatment.

Will Invisalign affect what and when I eat?

We joke around at Soulsmile about going on the “Invisalign diet”. In the big picture, eating whatever you want is one of the advantages of Invisalign (compared to traditional braces where food gets stuck easily), but it does take a moment to remove your aligners, eat, and then MOST patient will feel more comfortable if they do a quick brush before putting the aligners back on. Because of this process, many patients find they snack less and thus dub this reduction in food intake the “Invisalign diet”. When I personally did Invisalign, I didn’t eat less food, but I did consolidate my meals a bit more.

A couple more considerations - drinking only water when the aligners are in will keep your teeth clean and your trays nice and clear. Colored beverages can stain them a bit. I was known to occasionally drink white wine with them in, but I wouldn’t say that’s an “approved” tactic.

Will brushing my teeth be the same?

You’ll be able to brush and floss as normal, which is great! You just take your trays out. However, you’ll be adding a bit of time and effort to your routine to clean your aligners. You simply brush them with your toothbrush. My advice is to use an electric toothbrush (which you should already be using on your teeth anyway!). I once traveled with only a manual toothbrush and was shocked at how much more stained my aligners were during that time.

Invisalign also makes some cleaning crystals that you can use to soak your aligners in that work wonders!

Can I whiten my teeth while using Invisalign?

In most cases, patients will need small bumps adhered to select teeth (Invisalign calls them “attachments”) to help move the teeth. Because of this, whitening during treatment is not advised. You can definitely begin your treatment with a round of whitening and we certainly encourage a tune-up after you complete treatment and are ready to show off your beautiful new smile.

What if I have a special event? Can I leave my aligners at home?

Compliance is the number one factor in Invisalign success. It is essential that you wear your aligners for 20-22 out of 24 hours every day. That said, if you have an hour-long job interview, you’ll probably be just fine leaving them out. You can even try to keep your other eating periods shorter that day to make up for it. On the other hand, a day-long wedding may not be appropriate for skipping your aligners. Use your best judgment and wear them as much as possible. The rewards will last a lifetime!

Is Invisalign Comfortable?

Although there may be occasional discomfort due to the snug fit of starting with a new set of aligners, this usually subsides in a couple days and patients find them to be significantly more comfortable than metal braces. The new-aligner discomfort also seems to diminish a bit as treatment progresses.

What Is the Invisalign Treatment Process Like?

• First, a free consultation with Dr. Kivel is scheduled to discuss treatment and ensure that you are a candidate for Invisalign.
• Once treatment has been agreed upon, the Soulsmile team will take X-rays and impressions of your teeth. These will be used to create a 3-D image to map out the exact movements your teeth.
• Next, we will make a customized series of aligner trays from virtually invisible (and BPA-free) plastic that will gradually re-align your teeth!
• You will progress through the series (or change out) about every two weeks.
• You will need to wear your aligner trays for 20 to 22 hours daily, removing them only to eat, brush or floss.
• You will visit Soulsmile about every six weeks to make sure you’re teeth are moving as planned.
• As with braces, you may need to wear retainers after your Invisalign treatment in order to keep your teeth in their new position.

Is there an age restriction for Invisalign?

We only recommend Invisalign for patients 18 and up for compliance issues. Fortunately, there is no upper-age limit! Invisalign is great for adults who previously thought they were “too old” to be wearing metal braces.

More Questions?

Hopefully, this answered questions you might have about Invisalign. If you live in Ashland, or Medford/the greater Rogue Valley, and have more questions, we would love to answer them - in person! Give us a call to schedule your free Invisalign consultation.

The Link Between Childhood Obesity and Poor Dental Health

Lots of studies in recent years have been proving the connection between dental health and overall health. But a study released at the end of last year explored the link between dental health and childhood obesity. The study researched the habits and stats among 271 Swedish children. They found that children with a higher amount of carries bacteria (which is responsible for cavities) also had significantly higher body mass index (BMI) and unhealthier eating habits. Their eating habits more frequently and consumed more foods rich in sugar. 

Because weight can be a sensitive subject, registered dietitian Louise Arvidsson advises focusing the conversation on dental health and the type of foods that can help or harm your teeth. Foods high in carbohydrates (starches and sugars) contribute considerably to the production of plaque and acids that break down tooth enamel which can eventually lead to cavities. 

Food suggestions for dental health AND overall health:

• yogurt
• leafy greens
• apples
• celery
• carrots
• almonds
• lean sources of protein such as lean beef, skinless poultry, and fish
• dry beans, peas, and other legumes
• plenty of water

Tooth decay is actually the single most common chronic childhood disease, but the good news is that we can prevent it and impact children's overall health when we educate them and teach them healthy hygiene habits. Remember to teach children to brush twice a day, floss daily and visit their dentist regularly. If you have any questions or would like to make an appointment for your own child, please contact us or give us a call at 541-482-4995.

The Scoop on Coffee Breath - More Than Just Coffee

Apparently, the five-year-old son of a friend recently confronted her just prior to his school-driveway departure. He said, "Don't even fink about kissing me when you drop me off at school. Your breff smells like coffee."

Unsurprisingly, caffeine is America's drug of choice. We consume a total of 700 million cups in a single day! We at Soulsmile love our coffee. There's always a fresh pot brewing in the team lounge and don't even get us started on all the awesome coffee joints in town (looking at you, Case, Noble and Mix!). Yes, it stains teeth. Yes, added sugar can contribute to cavities. But we are big believers of enjoying life's treats, especially when coupled with a proper hygiene routine. 

We do, however, care about coffee breath. Coffee breath is not simply the smell of coffe. If that were the case, "coffee breath" flavored ice cream would sound just as appealing as coffee ice cream. Any takers? Not here. Coffee breath is actually the smell of sugar-eating bacteria in your mouth laced with coffee. 

So how does your gorgeous cappuccino become a menacing platform for bacteria? It turns out the chemicals in coffee contribute to a slow down in the release of saliva. Saliva production is usually one of our mouth's best defenses, sloshing around to disrupt bacteria. With coffee, this lapse in saliva flow creates the perfect breeding ground for the more than 500 species of bacteria in your mouth. Studies have shown that showing milk in the mix can increase these effects even more.

Not pretty.

So, to keep your pearly whites smelling fresh, there are a handful of tips to offset the effects of coffee after consumption:

• Brush your teeth 
• Chew a piece of gum
• Drink water
• Eat something mouth-watering (think fruit, not bread)

Another factor to consider is your mouth's normal bacterial state. Bacteria grows exponentially. So the more bacteria that's present before coffee will contribute to more after coffee (and a worse smell). Come in for regular hygiene visits with Soulsmile, our Ashland OR dental office, and consult with our awesome team members on the best home care routines to keep your oral health in check at all times. 

Latest Dental Trend: Charcoal Toothpaste?!

You may have seen some pictures on Instagram or YouTubers posting videos of the latest, greatest dental trend - charcoal toothpaste. Move over oil-pulling ... this DIY whitening trend consists of smearing a charcoal-derived black mixture on your teeth and brushing with it. 

Proponents of the technique claim that because these mixtures are highly absorbent they can naturally solve surface stains. In fact, there are already medical applications for charcoal, like absorbing poisons in an accidental poisoning. Many "reviewers" online brush their teeth for 3-5 minutes with the mixture and then have seemingly whiter teeth afterwards. 

Currently, the American Dental Association has not evaluated or approved of charcoal toothpaste. In fact, a representative for the ADA has commented saying the trend is concerning because its abrasiveness is not yet known and could be causing damage to people's teeth. Did you know, teeth are the only part of our bodies that does not replenish or heal itself. Once they are gone or damaged, it's a done deal. Of course, we can help correct any problems, but we'd rather see them avoided in the first place. But this means your teeth are usually not where you want to do any experiments. Fun new hair color or crazy nails? Yes! They grow back. Your teeth - not so much.

Whitening your teeth can happen in two ways. One, by scrubbing surface stains. Or two, by bleaching to actually change the color of the dentin. The later method is many times more effective. Charcoal tooth paste only claims to affect surface stains anyway, so if you're looking for real results, consider a professional whitening systems. These penetrate the enamel making teeth 3-8 times shades whiter, with effects that last years. 

We've concluded that there is not enough evidence available yet to know if the supplement is hazardous, beneficial or benign. Our vote: wait until there are more studies (if that even happens before it falls out of favor). In the meantime, there are plenty of proven techniques and products for whiter teeth. Ask us at your next appointment about whitening options. We offer three levels to meet your needs and budget. As always, if you have any questions feel free to contact us or leave a comment below. 

Is Mouth Rinse a Must-Do?

Walking the aisles of an Ashland drugstore will reveal a plethora of mouthwashes and rinses. These products tout dozens of features like germ eradicating ingredients, fluoride or even teeth whitening. Many of our patients wonder about the benefits and if they should make mouthwash a part of their daily routine. 

Our short answer is that brushing and flossing are the two most critical habits that will affect your dental health. If you're doing a good job of these two, mouth wash is not a necessity. 

On the other hand, it simply doesn't hurt to add an additional aspect to your routine, like mouth wash. While it may not live up to every promise advertised, it can be beneficial. We like to advise mouth rinse after flossing to help wash away any excess particles of food which may have been dislodged during your flossing. 

One thing to keep in mind is that mouth wash will not necessarily help with bad breath. Often, bad breath is a result of dryness and the harsh alcohol content of many mouthwashes can worsen this condition. If fresh breath is one of your primary goals, we'd recommend selecting an alcohol-free variety. Plus, its easier to handle! Additionally, chronic bad breath is often a result of plaque build -up. Ask Jordon (or your own fabulous hygienist) at your next cleaning if she thinks this may be contributing to bad breath. If so, improving your brushing and flossing is much more likely to help. 

The bottom line is that you should never substitute proper flossing and brushing with mouthwash. But feel free to supplement your routine with a little rinse! If you have any specific questions, feel free to contact our Ashland dental office. If you want to make an appointment for a check up, you can call us at 541-482-4995. 

6 Surprising Habits That Can Wreck Your Teeth

We know all the list of things that can be bad for your teeth - soda, gummy candy, smoking, etc. But there are a handful of habits with the potential to wreck your chompers that may not be quite as obvious. Here's the low down ...

1. Chewing Ice

Ice can easily be thought of as harmless - its juts H20 after all. But crunching down on hard, frozen cubes can cause cracks, chips and wear on your teeth. If you chew ice regularly enough, you may even cause aches in the soft gum tissues around your teeth. Often times a habitual ice-chewer gets "shorter" tooth appearance from all the wear. Dr. Kivel can fix this cosmetic issue but will only do so after the patient has curbed their ice habit!

2. Playing Sports (Without Proper Protection)

We love sports! All of us here at Soulsmile not only grew up playing many sports, but still take part in a myriad of outdoor sports including biking (motorized and non-motorized, running, surfing, kayaking - you name it! But we are also huge proponents of mouth protection! Mouth guards are a piece of molded plastic that protects your teeth. Without it, contact sports can easily result in chips or even a full tooth knock-out. We can make these for you or your whole team. Just contact us to schedule an appointment. 

3. Bottles Past Bedtime

Just like adults, a baby's teeth should be cleaned before bed. Putting a baby to sleep with a bottle of milk, formula or juice can put new teeth in harm's way. This can basically bathe the baby's teeth in sugars overnight. Its best to keep them out of the crib and establish a good hygiene routine. 

4. Tongue Piercings

Dentists have long lamented tongue piercings. Accidentally bumping a metal stud along teeth for years can definitely pose a risk to your teeth. In a study published by the Journal of Periodontology, "nearly half of the participants who wore either long or short barbells for four or more years had chipped teeth." The study also found receding gums in up to 50% of participants who had worn long-stemmed barbells for two or more years. Furthermore, the mouth is a haven for bacteria, making tongue piercings a likely candidate for infection and sores. Bottom line - research the health risks before you decide on a tongue piercing. 

5. Grinding

Bruxism (the fancy name for teeth grinding) wears teeth down over time. It is most often caused by stress and sleeping habits, making it a hard habit to control. We just wrote a whole blog on teeth grinding if you want to find out more about diagnosing an treating this condition. 

6. Cough Drops

We'd like to think that anything you find in the medicine aisle is healthy, but that's just not the case. Most cough drops are packed with sugar. We still love them, but recommend that after you sooth a sore throat with a lozenge, break out the toothbrush. Think of them like hard candy! 

Have any questions for us about habits that you suspect may be compromising your oral health? Feel free to write them in the comments section below or feel free to make an appointment with our Ashland, OR dental team here at Soulsmile. We'd love to have you in as a new patient! 

Teeth Grinding and Nightguards

Do you ever wake up in the morning with headaches or soreness in your jaw? Have you or your dentist ever noticed chips or small cracks in your teeth? If so, you may be grinding your teeth while you sleep. Don't worry - you're not alone. Its estimated that about 30 million people in the US do the same. 

This condition, known in dental as bruxism, is not life-threatening, but it can definitely cause damage to your teeth. It is probably also disrupting your sleeping habits. In this blog we'll discuss the causes, symptoms and solutions for bruxism and how the latest dental products can help you. 

Diagnosing Bruxism

Bruxism is not typically hard to spot. Most people suspect they grind their teeth. They usually either looked up their symptoms online or have been told by friends or family that they're grinding. 

During a dental exam, we can usually tell a patient has been grinding. We look for chips and damage to the tooth enamel as well as smoothly worn surfaces. We will also ask questions about jaw pain and/or headaches. One of the most significant concerns related to bruxism is that it often is an indicator of a sleep apnea - a very serious condition. 

Identifying Signs of Bruxing and Clentching

Treatment with Nightguards

The most common way to treat bruxism is with a nightguard. In fact, up to 70% of our regular patients use a nightguard. It's one of the easiest methods of prevention! This appliance is worn in the mouth during sleeping hours to prevent grinding. Nightguards are similar to athletic guards, but thicker and more rigid. These custom appliances are made with acrylic using a professional impression, ensuring a perfect fit. 

Another advantage of a custom-made night guard is the material. Acrylic is hard (opposed to store-bought "boil and bite" type of nightguards that are soft) and discourages further biting, clenching and grinding. These are the behaviors we're trying to eliminate! An over-the-counter biteguard isn’t made specifically for you, it’s meant to fit a wide variety of jaw and mouth sizes. Unfortunately, it will never fit perfectly. 

Ask Us About It!

If you suspect that you’re grinding, ask your regular dentist for help. He or she can confirm a diagnosis and work with you to develop a treatment plan. If you're in the Ashland or Rogue Valley area, contact us at Soulsmile. You can call us at 541-482-4995 to schedule an appointment. We'd love to help you sleep better. 

Recommended Dental Home Care Products

On a daily basis we are making recommendations to patients regarding products to improve their oral health care routine at home. We decided to consolidate our list for patients' easy access. Have any additional questions? Drop us a line!

Toothpaste

Winner: Tom's of Maine
Amazon Link: With Fluoride or Without Fluoride  or Children's

We like the fluoride version to help prevent cavities, but they offer non-flouridated version too. In general, our hygienist, Jordon, recommends looking for the ADA seal when deciding on a toothpaste. She says, "It means the product is scientifically supported. It has met the safety criteria and is proven to be effective." 

Toothbrush

Winner: Phillips Sonicare (Any model! You don't necessarily need all the bells and whistles)
Amazon Link

We love Sonicare toothbrushes! We don't even go on vacation without them. They are great for getting below the gum line which lowers plaque levels. They are also great for people with a loss of dexterity due to age or health conditions, as the toothbrush does most of the work for you through its unique sonic technology.

Go with a soft bristle head. Contrary to popular belief, hard bristles are not more effective and can cause damage to gums.  Remember to replace your toothbrush (or toothbrush head if using Sonicare) every 3 months or sooner if bristles look worn. 

Electric Dental Flosser

Winner: Sonicare AirFloss
Amazon Link

This product is great for flushing out debris. It is a fantastic options for patients with deep periodontal pockets (periodontal disease), complex restorative work, food traps or braces. Just remember that it is not meant to take the place of regular flossing. Another popular option is the brand Waterpik - we like these too, we just happen to prefer AirFloss. 

Mouthwash + Rinse

Winner: Listerine Total Care Zero Alcohol
Amazon Link 

Adding a mouth rinse to your hygiene routine is a great idea. We suggest rinsing after you floss to help remove any debris that was dislodged. Our favorite is the Listerine Total Care Zero Alcohol. It contains fluoride to help fight cavities and getting one that does not contain alcohol takes the harsh alcohol "sting" out of the process which can dissuade a lot of patients from using it regularly. 

Floss

Winner: POH No Wax Floss (great reviews online)
Amazon Link

The bottom line with floss is that any type of floss is better than none! Our recommendations are light in this category as it is mostly up to personal preference. Some tips from Jordon:

• If reaching the back teeth is difficult, try floss with a handle
• If shredding around crowns or fillings, try Glide floss
• Superfloss is great for under bridges, implants and braces
• A floss threader-aid can help get floss under bridges or braces as well. 

Interproximal Brushes

Winner: Interprox Plus
Amazon Link 

Interproximal brushes are great for larger spaces where floss is too thin. Also great for complex restorative areas. 

Periodontal Disease and Treatment

Background and Diagnosis

Periodontal disease is a bacteria-related inflammatory disease of the gums, the cementum that covers the root, the periodontal ligament and the bone around the tooth. Periodontitis can lead to pain, smell and tooth loss; in addition, it has been linked to heart disease and several other dangerous systemic conditions.

To determine if you have periodontal disease, and the extent of its progression, we begin by using a dental instrument to measure the pocket depth between your gums and your teeth. Ideally, the pocket depths around the teeth will range between 1 and 3 millimeters (mm). Gingivitis will appear as swollen gums and reveal pockets up to 4 mm.  Both can be remedied by a simple cleaning.

Periodontitis, however, will be accompanied by red, irritated, bleeding, sometimes sore gums or pus and pockets deeper than 5 mm. Xrays of periodontitis will often show hardened calculus around the teeth and may even show the bone loss itself. A more detailed cleaning is in order to address periodontitis.

A great deal more is learned about the specific causes and circumstances surrounding each patient’s condition during the treatment itself.

Treatment

To treat periodontitis, we remove the deposits of calcified plaque called calculus or tartar and any other bacterial toxins which become ingrained under the gumline and into the root surfaces. The process, known as scaling and root planing (“SRP”), utilizes ultrasonic and hand scaling instruments, ideally while the patient is under local anesthesia. Just a few areas are focused on at a time until a “deep” cleaning is achieved.  

In addition, the placement of a medicine called Arestin into pockets 5mm or greater is recommended. This medicine eliminates the harmful bacteria for 45 days following SRP.

Immediately following SRPs, it is recommended that patients use a Chlorhexidine Rinse, an antibacterial mouthwash that helps to control and kill the bacteria in your mouth that cause gum disease. We recommend that you rinse with chlorhexidine after brushing your teeth for one week following SRP and after future dental visits.

Existing bone loss related to periodontitis will not return with SRP.  But, SRP’s and a few changes to your routine cleaning protocol described below will help you keep your teeth for life.

After Care

Instead of a simple cleaning (“Adult Prophylaxis”), Periodontal Maintenance describes the type of routine office cleanings following SRP.  It is considered a basic service by insurance.

Periodontal Maintenance removes plaque and tartar from above and below the gumline, down the length of each tooth to where the root, gum and bone meet. Rough areas of the roots are maintained smooth, pocket depths are carefully monitored, and inflamed pockets are irrigated with antibacterial medicines if necessary.

After SRP treatment, most patients choose to have their teeth cleaned every 3 or 4 months to match the complexity of their dental condition that led to the periodontitis in the first place.  These factors include their natural plaque and tartar accumulation, bleeding, inflammation, pocket stability, the quality of their anticipated home care and their overall health risk factors.

Lastly, with a few meaningful changes to your at-home cleaning routine, periodontitis can be kept under control.  Brushing for two full minutes twice daily with an Philips Sonicare toothbrush and flossing once a day is usually adequate.  For difficult areas, christmas tree brushes (“proxy brushes”), enlarged floss (“super floss”) and Philips Airfloss are excellent aids. Consistent behavior change is the most important element in maintaining long term periodontal health.  Smoking has also been shown to contribute to periodontitis.

Related Pricing

*Dental insurance plans will often cover all or part of these costs.

More Information

Have more questions? We want you to have a complete understanding of your oral health and how to best maintain or improve it. You may want to do some research on your own.  Here are several internet search terms to help you get started:

• Periodontitis
• Gum disease
• Link of periodontitis to systemic health
• Scaling and Root Planing
• Periodontal Maintenance
• Arestin
• Chlorhexidine rinse
• Philips Sonicare
• Philips Airfloss
• Scaling and root planing and insurance
• Reasons for tooth loss
• Cause of bleeding gums
• Risk of deep periodontal pockets
• Periodontal surgery
• Options for missing teeth
• Dentures
• Implants
• Implants with periodontitis

MI Paste™: An alternative to Flouride

Today's blog post comes from our resident hygienist, Laura Houghton, RDH:

A growing number of patients are seeking a health conscious alternative to fluoride for cavity prevention. One of the products I recommend on a daily basis is MI Paste™. This product uses calcium and phosphate to remineralize teeth. It is a water based, sugar free, and fluoride free paste. It also contains RECALDENT, which is a milk derivative that binds the calcium and phosphate to the teeth. Although standard MI Paste™ does not contain fluoride, MI Paste Plus™ does contain fluoride.

Benefits

There are many benefits to using this product, including non surgical treatment for a handful of dental symptoms. It helps alleviate dry mouth caused by many medications, and prevention of an acidic environment. Using this product during orthodontic treatment has shown to be one of the most effective ways to prevent white spot lesions around brackets, which is caused by lack of calcium. 

Patients seeking tooth whitening frequently have concerns with sensitivity after whitening. We recommend MI Paste™ application before and after whitening procedures to minimize sensitive teeth.

How To Apply

MI Paste™ is easy to use. There two methods we usually recommend,

1. If you have custom-made trays (often used for teeth whitening) you can use a small bit of the paste in them and leave undisturbed for three minutes. You would do this after brushing with your regular toothpaste.

2. Alternatively, you can simply take a small pea-sized dab of the paste on a cotton swap of finger and rub the paste all over the surfaces of your teeth. surface. Allow the paste to absorb into the surface by not touching or rinsing it for three minutes. 

If you have any questions about the product or want to know if it might be right for you, let us know. 

The Reasoning Behind Wisdom Teeth Removal

Most people's "wisdom teeth" (which we call third molars) begin to erupt around the late teens or early twenties. These will be the third and final set of molars to come in. Occasionally third molars can come in correctly aligned and offer more chewing power. In this event, you may decide to keep your wisdom teeth as long as you can maintain proper hygiene. More often, they are misaligned and can crowd other teeth. 

Why Do We Have Wisdom Teeth?

A popular theory suggests that the human diet used to consist of more rough food like leaves, meat and roots which required better chewing power. There has also been a size reduction in the human jaw and face over the past 20,000 years.

More and more people born today never develop third molars. 

Why Remove Wisdom Teeth?

While not every patient needs to have their wisdom teeth removed, the common situations will likely warrant their removal. 

1. Impacted Wisdom Teeth

When a third molar is "impacted" it means that gum tissue is completely covering the tooth and preventing it from erupting successfully through the gum. This is usually the result of a mouth that is too small to allow the room the teeth need. At times, this leads to bacteria or food getting lodged under the gums covering the wisdom tooth and can create an abscess. 

2. Partially Impacted Wisdom Teeth

Partial impaction means the tooth is only partially emerged from the gums. In this case, we almost always advise removing the tooth. Again, bacteria can be lodged underneath and because of the location in the very back of the mouth, a wisdom tooth is more susceptible to cavities and decay. 

3. Additional Reasons for Wisdom Tooth Removal

The following dental issues may also increase the likelihood that we recommend removal for your third molars.  

• Pain at or surrounding the third molar(s)
• Pain or swelling in the jaw or cheek area
• Infections of the soft tissues
• Gum disease
• Tooth decay
• Tumors or Cysts

If you are considering having your third molars removed, we are happy to consult with you on the topic. Dr. Kivel can address the health of your wisdom teeth, whether they have erupted and your overall oral health to determine the best next steps. Contact our Ashland, OR dental office to schedule an appointment with our friendly team. 

Pregnancy and Your Oral Health

Congratulations! If you’re reading this, it's likely that you or someone close to you is pregnant. Your body goes through many changes during pregnancy, including changes related to your oral health. These are primarily due to a surge in hormones like estrogen and progesterone. These same hormones which are integral to your growing baby can exaggerate the way your gums react to plaque. 

If plaque is not properly removed, it can cause gingivitis - marked by swollen, red gums which are more likely to bleed. You may notice an increase of bleeding from brushing or flossing. There’s a condition referred to as “pregnancy gingivitis” which affects most pregnant women and can begin as early as the second month. If you have gingivitis prior to becoming pregnant, your condition is likely to worsen. If left untreated, this can lead to periodontitis, a more serious form of gum disease and, because it is incurable, it will continue to affect you long after pregnancy. 

Occasionally, women also develop inflammatory, non-cancerous growths when their gums become irritated while pregnant. These growths, called “pregnancy tumors”, are usually harmless and can be left alone. They will generally reduce in size, until they disappear completely, after birth. If you have a tumor that is uncomfortable or interferes with your hygiene routine or chewing, let us know. Dr. Kivel may decide to remove it.  

Preventing Problems

Of course, we recommend excellent oral hygiene at all stages of life. But we understand that pregnancy creates additional risks and additional motivation for staying healthy. During this time, you’ll want to keep your teeth very clean, especially near the gumline. Brush at least twice a day, and after every meal if possible. For some women, brushing can contribute to feelings of morning sickness. If this happens to you, rinse your mouth with water or with anti-plaque mouthwashes and brush when you can. Floss thoroughly each day. 

Feel free to book more frequent than normal cleanings with Soulsmile at this time to supplement your own efforts. 

“Can gingivitis affect my baby?”

Unfortunately, there is research that suggests a link between gum disease and preterm, low-birthweight babies. In recent years we’ve come to realize that bacteria can enter the bloodstream through your gums and is linked to many serious issues, including heart disease. So it is not surprising to find that this can affect your pregnancy as well. The current theory proposes that when the bacteria travels to the uterus it triggers the production of prostaglandins, which are suspected to contribute to premature labor. The best prevention for this is excellent hygiene! 

“When should I visit Soulsmile?”

If you are pregnant or suspect you are, we’d encourage a visit right away! A checkup in your first trimester allows Dr. Kivel to assess your oral health and map out a dental plan for the rest of your pregnancy. A second trimester cleaning will let us monitor any changes and make sure the gums are being properly cleaned. 

“Are there dental procedures I should avoid?”

Routine care can generally be performed throughout pregnancy, but the best time for treatment is the fourth through sixth month. Your obstetrician may be consulted for dental emergencies that require anesthesia or if medication needs to be prescribed. Elective procedures should generally be delayed until after birth. 

Congratulations again! Please contact us if you’d like to schedule a visit or if you have any questions about related to your own pregnancy. 

What the floss?! Soulsmile Weighs in on Recent News

Let's Talk About Flossing

Surely you've seen the headlines - "Flossing is Nonsense and My Laziness is Vindicated" or "Flossing: Government's Latest Piece of Bad Advice". All this press about flossing stems from an article published this month by the Associated Press (Read it here). Their report points out the weak evidentiary basis for floss as a method of reducing plaque and tooth decay. The American Dental Association responded saying: Trust us, flossing helps.  

In reality, the AP article is less about floss and more about evidence-based medicine. They are correct in that the published and proven evidence for the benefits of floss is poor. One reason for this is that floss has been around since the 19th-century! Recommendations for flossing are based on pretty obvious assumptions: it removes plaque from in between teeth and because plaque leads to gum disease and decay, flossing will improve these conditions. But because our medical standards have risen so greatly in the last centuries, assumptions are not enough - and understandably so. 

Anecdotal evidence and long-standing traditions have been replaced with evidence-based medicine. This approach is dependent on well-designed, controlled studies. Thus far, nobody has tackled a flossing study with the academic rigor we now expect. Why? We can only speculate. Studies like this are expensive and there is no fame or monetary reward to be found in proving out flossing. Flossing is cheap, easy to adopt and no-risk. This leaves us with anecdotes and weak evidence. Two of our leading dental associations — the American Dental Association and the American Academy of Periodontology — cited other studies as proof, but most of these studies used outdated methods or had relatively small sample size. 

Despite our agreement regarding poor studies and evidence around flossing, this does NOT mean it has been proven ineffective either. Each of your teeth have six surfaces and brushing can only clean four of them. You simply need a method for cleaning in between your teeth to properly remove all plaque causing substances that are proven to cause decay.  

We always hoped more people would talk about flossing - but not like this! At the very least, we hope this exposure will inspire researchers to conduct better studies and counteract these claims made by the AP. Oh, and by the way - even the author of the article admits he still flosses. If you have any questions, feel free to contact us directly or leave a comment. We'd love to hear from you. 

For Further Reading

This 2006 study titled, “Dental Flossing and Interproximal Caries: a System Review,” recruited 808 children age 4-13 and split them into three test segments: kids who were professionally flossed 5 days/week; kids who were professionally flossed once every 3 months; and kids who reported self-flossing at home. The research lasts 18 months and unsurprisingly, the participants who were professionally flossed 5 days/week saw a 40% decrease in the risk of cavities. 

Are Dental X-rays Safe and Necessary?

One of the great things about the Ashland, OR community is the level of health intelligence. Its evident by ready the local publications or driving around town and seeing the many natural food stores and health care providers. We’ve come to realize that concern around x-rays is even greater here than many parts of the country – and rightly so! We hear questions regarding the safety and necessity of x-rays on a daily basis. This is a great question and the answer differs from patient to patient. Let’s dive in a little deeper – we think you’ll be surprised to leave just how safe today’s x-ray practices are.

First of all, there is an ever-changing landscape when it comes to dental x-rays. The American Dental Association (ADA) together with the Food & Drug Administration (FDA) routinely revises their guidelines when advances in technology provide new methods of reducing exposure to radiation. In fact, today’s dental X-ray is already far superior to those of just a decade ago. This is due largely to the advent of digital technology.

The following guidelines come from the ADA and are supported by our practice:

New Patients: 

Full X-rays are generally suggested for new patients to provide us with a full history of your prior oral care and current needs. If you’ve recently had x-rays taken at another office, we’re happy to obtain those on your behalf.

Continuing Care Patient:

One set of X-rays every 6-18 months. We generally aim for 12 unless a patient is at a higher risk or is presenting with an issue.

Continuing Care Patient with Periodontal Disease: 

Dependent upon the professional judgment of Dr. DeCillis.

Patients with, but not limited to, Proposed or Existing Implants and Root Canals:

Also dependent upon the professional judgment of Dr. DeCillis.

In conclusion, it’s important to realize that exposure to all sources of radiation - including the sun, home appliances, minerals in the soil, X-rays - can damage the body's tissues and cells. Fortunately, the dose of radiation you are exposed to from dental X-rays is tremendously small, especially with our use of digital x-rays. Our recommendation is to follow the ADA guidelines. This is because allowing a major dental issue to go undiagnosed can be much more damaging to your health than a small amount of radiation. Please feel free to ask us any questions or voice your concerns regarding x-rays and we will do what we can to accommodate your preferences.

You can also check out our great FAQ Page on Digital Xrays.
 

Gum Disease? Meet Your New Best Friend: Arestin®

Regular brushing and flossing are essential parts of oral home care. But gum disease won’t go away on its own. Because it’s an infection, it needs to be treated professionally. In our office, we often combine scaling and root planing (SRP) with application of an antibiotic medication called Arestin®.

Because of the way gum disease progresses, the longer you wait to take action, the greater the chance you may need painful and expensive surgery to get it under control. Arestin® is a locally administered antibiotic (LAA) in powder form that we place directly into the infected areas—or pockets—in your gums. Arestin® powder is made up of 100,000 tiny microspheres, invisible to the eye. These microspheres contain the antibiotic drug minocycline, which is released over time into the infected pocket. This means Arestin® keeps working to kill bacteria long after you’ve left our chair. 

Moft of the time, our patients are pleasantly surprised to find that their medical insurance's prescription coverage applies to Arestin®. It is typical that a $30 copay will enable our patients to receive $1,000 worth of this medicine. 

How Arestin + SRP Works:

01. Your dental professional removes plaque and tartar above and below the gumline with SRP. 

 02. ARESTIN® microspheres are placed into infected pockets using a special plastic applicator. 

  03. The antibiotic is released over time, helping to reduce bacteria as your gums heal.

If you have any questions regarding gum disease or how Arestin® can help, let us know! We're happy to share some insights or schedule an appointment to help evaluate your unique needs and oral health. 

Images and content courtesy of Arestin®.

Q&A Spotlight: Periodontal Maintenance vs. Prophylaxis

Often times, we get asked by patients, “What’s the difference between a normal cleaning a periodontal maintenance, and why does it cost more?” This is a great question and the answer has a few parts to it. 

First, let's establish that a “normal” cleaning (prophylaxis) is for a healthy mouths. This includes procedures that address plaque, calculus and stains on the coronal portion of the tooth. “Coronal” means relating to the crown of the tooth, above the gumline. The typical patient who should receive prophylaxis comes to routine (every 6 months) hygiene appointments, exhibits excellent home care habits and has healthy tissues with no bleeding when probed or flossed. When they have a periodontal evaluation and charting session, probings are measured at 4mm or less. 

Next, let’s cover periodontal maintenance and scaling. This is an ongoing therapeutic procedure to treat periodontitis, which is a chronic and incurable (but controllable) bacterial infection. The primary objective is below the gumline - removal of dentin that is rough and/or permeated by calculus and contaminated with toxins and microorganisms. Some soft tissue removal also occurs. This type of procedure requires more skill and expertise than a prophylaxis. 

Periodontal disease overwhelms a patient’s defenses and spurs the immune system to initiate a breakdown of supporting tooth structures (bone loss). It is also episodic. These type of destructive episodes can be triggered by stress, disease or other problems unbeknownst to the patient. The three-month interval recommendation for perio maintenance is not arbitrary. It is based on the behavior of the bacteria. After periodontal maintenance therapy, periodontal pathogens aggregate on the biofilm and become the predominant species of bacteria again in three to 12 weeks. This means that by the 12th week, or 3 months, the periodontal “bugs” are flourishing again. That’s when we should reduce their numbers again. After discovery of periodontal disease, it is important to stay vigilant in controlling and monitoring through periodontal therapy. 

To value a periodontal maintenance it is necessary to understand that it is different from a regular cleaning because you are controlling disease with therapy versus simply cleaning teeth. 

The Importance of Athletic Mouth Guards

The benefits of sports and athletic activities are numerous – they improve strength, coordination and reduce stress. Many of these activities also carry with them a bit of physical risk – including potential damage to your mouth. When we think of protective gear, items like helmets and shin-guards come to mind, but athletic mouth guards are just as important when it comes to negating physical risk.

The Journal of the American Dental Association (JADA) reported that as many as 39% of all dental injuries are sports-related, resulting in nearly $500 million spent on replacing teeth due to injury each year. We encourage you to evaluate your sports activities and related risks and consider having a mouth guard made.

The American Dental Association recommends mouth guards for the following sports:

Peter helping create custom mouth guards for our SOU Women's Wrestling team members!

• Acrobatics
• Football
• Martial Arts
• Skiing
• Volleyball
• Basketball
• Gymnastics
• Racquetball
• Skydiving
• Water Polo
• Boxing
• Handball
• Rugby
• Soccer
• Weight Lifting
• Discus Throwing
• Ice Hockey
• Shot Putting
• Squash
• Wrestling
• Field Hockey
• Lacrosse
• Skateboarding
• Surfing

This list is not exhaustive – in fact, we feel that Mountain Biking is an obvious one to add to the list. The point is that many of the sporting activities we all enjoy should be included. Studies show that athletes are at a much higher risk of sustaining orofacial injuries when not wearing a mouth guard. These type of injuries are not just cosmetic. Injuries to the teeth and soft tissue can be very serious, whether it’s nerve damage or eventual periodontal disease.

It just makes sense to protect your teeth. But not all mouth guards are created equal. There are three main types:

1. Stock

These mouth guards are non-custom. They can be purchased at a store for immediate use. For most patients, they feel bulky and uncomfortable, which can affect the willingness of a patient to wear the guard.

2. Boil and Bite

Just as the name implies, these guards can be purchased at a store, then boiled in hot water (to make it more malleable) and then fit into the mouth and bitten down on to form. These guards are usually more comfortable than a stock guard, but they can be hard to get just right. 

3. Custom

Custom mouth guards are creating by a dentist to fit the unique shape of your teeth, which makes them most comfortable and most effective. Even if a patient is in braces, these guards can be formed to fit comfortably around orthodontia. The process is quick, easy and inexpensive.

If you are a patient or a parent of a child involved in any activity with the potential for injury, let us know. We’re happy to create a custom mouth guard to keep those pearly whites protected! Contact us to book an appointment for your fitting. 

Toothbrush Selection

There are so many toothbrushes on the market – how do you choose? Angled heads, electric brushes, ergonomic handles, biodegradable, etc. All these choices can make it tough to decide which brush is right for you. In this article, we’ll decode some of these options and help steer you in the right direction.  

What’s the Difference Between Hard and Soft?

When we talk about “hard” or “soft” toothbrushes, we are referring to the stiffness of bristles on a toothbrush. In theory, stiffer bristles are designed to better remove plaque, food bits and staining. However, our recommendation is to always go for a softer brush. This simple fact is that most people actually brush too hard! Brushing too vigorously is compounded when using a hard-bristled brush and can cause damage to sensitive gum tissue - especially near the gum line.

So next time you come across a hard toothbrush, save it for cleaning the kitchen grout instead!

Natural or Synthetic Bristles?

Most toothbrushes are made from a synthetic material. However, recent advances have been made to promote the production and usage of natural material toothbrushes – for both bristles and handles. Popular materials for these types of brushes are plant or wood fiber. In our opinion, either is fine for your pearly whites, but we love the idea of toothbrushes which are better for the environment! Try a natural toothbrush out when you have the opportunity.

Heads and Handles

There are almost infinite possibilities in brush and head styles. Rather than take too much time describing them all, we’ll get down to business. Here’s what you need to know: It doesn’t matter much. Instead of getting weighed down by the choices, just choose one that’s comfortable to use and inspires excellent hygiene (cheetah print anyone?).

Electric or Manual?

This is where we’ll make our strongest recommendation. We are huge fans of electric toothbrushes! They are powerful and easy to apply the right pressure with. Another great benefit is that many models come with a timer, encouraging people to brush for a full two minutes more often than they normally would. A study by the American Dental Association found that most people brush for only a minute and half.

In addition, the sonic waves emitted by the vibrating brush are proven to be more effective at loosening food and plaque. We had a patient in Invisalign treatment compare brushing her aligners with a manual toothbrush after forgetting her electric brush on a two week vacation. After the experiment, she claimed she would never use a manual toothbrush again! She said the difference, when she could actually see what she was brushing (opposed to the teeth in your own mouth), was an obvious one.

Finding “The One”

Still wondering which toothbrush is best? Don’t worry about it too much. Consistency in your dental hygiene makes a bigger impact on your dental health than any style of toothbrush. Brush two times a day, floss daily and keep your regular hygiene appointments.

If you still have questions about choosing a toothbrush or any other dental care topics, feel free to drop us a line.