Temporomandibular joint- A joint used everyday

By Aishwarya Jayadeep

A few years back when I had my third molars extracted the healing didn't happen as anticipated. So while eating I started chewing on one side. As it took a while to heal, chewing on one side became a practice which I continued, may be for another six months without really noticing it. But like any overused or say abused joint my Temporomandibular  joint decided to bring my bad chewing habit into notice; you may ask how? I started experiencing a feeling of gnawing pain in my temporomandibular joint area. Luckily, I knew what was the reason and started chewing food on both the sides and soon I got rid of the pain for ever. Now you would be wondering what this "mouth full" of a joint is.. to know more keep reading....

The temporomandibular joint (TMJ) is the area directly in front of the ear on either side of the head where the upper jaw (maxilla) and lower jaw (mandible) meet. The TMJ is used throughout the day to move the jaw, especially in biting and chewing, talking, and yawning. It is one of the most frequently used joints of the body.
The temporomandibular joints are complex and are composed of muscles, tendons, and bones. Each component contributes to the smooth operation of the TMJ. When the muscles are relaxed and balanced and both jaw joints open and close comfortably, we are able to talk, chew, or yawn without pain.

What are TMJ disorders (TMD), and how are TMJ disorders caused?


TMJ disorders are a group of complex problems of the jaw joint. TMD are also sometimes referred to as myofacial pain dysfunction and Costen's syndrome . Because muscles and joints work together, a problem with either one can lead to stiffness, headaches, ear pain, bite problems (malocclusion), clicking sounds, or locked jaws. The following are behaviors or conditions that can lead to TMJ disorders.

1. Teeth grinding and teeth clenching (bruxism) increase the wear on the cartilage lining of the TMJ. Those who grind or clench their teeth may be unaware of this behavior unless they are told by someone observing this pattern while sleeping or by a dental professional noticing telltale signs of wear and tear on the teeth. Many patients awaken in the morning with jaw or ear pain.
2. Habitual gum chewing or fingernail biting
3. Dental problems and misalignment of the teeth (malocclusion). Patients may complain that it is difficult to find a comfortable bite or that the way their teeth fit together has changed. Chewing on only one side of the jaw can lead to or be a result of TMJ problems.
4. Trauma to the jaws: Previous fractures in the jaw or facial bones can lead to TMJ disorders.Or even I have come across people with TMD because of biting into a bone or stone in the food unknowingly.
5. Stress frequently leads to unreleased nervous energy.It is very common for people under stress to release this nervous energy by either consciously or unconsciously grinding and clenching their teeth.
6. Occupational tasks such as holding the telephone between the head and shoulder may contribute to TMJ disorders.

What are common TMD symptoms?


TMJ pain disorders usually occur because of unbalanced activity, spasm, or overuse of the jaw muscles. Symptoms tend to be chronic, and treatment is aimed at eliminating the precipitating factors. Many symptoms may not appear related to the TMJ itself. The following are common symptoms.

• Headache: Approximately 80% of patients with a TMJ disorder complain of headache, and 40% report facial pain. Pain is often made worse while opening and closing the jaw. Exposure to cold weather or air-conditioned air may increase muscle contraction and facial pain.
• Ear pain: About 50% of patients with a TMJ disorder notice ear pain and do not have signs of ear infection. The ear pain is usually described as being in front of or below the ear. Often, patients are treated multiple times for a presumed ear infection, which can often be distinguished from TMJ disorder by an associated hearing loss or ear drainage (which would be expected if there really was an ear infection). Because ear pain occurs so commonly, ear specialists are frequently called on to make the diagnosis of a TMJ disorder.
• Sounds: Grinding, crunching, or popping sounds, medically termed crepitus, are common for patients with a TMJ disorder. These sounds may or may not be accompanied by increased pain.
• Dizziness: Of patients with a TMJ disorder, 40% report a vague sense of dizziness or imbalance (usually not a spinning type vertigo). The cause of this type of dizziness is not well understood.
• Fullness of the ear: About 33% of patients with a TMJ disorder describe muffled, clogged, or full ears. They may notice ear fullness and pain during airplane takeoffs and landings. These symptoms are usually caused by eustachian-tube dysfunction, the structure responsible for the regulation of pressure in the middle ear. It is thought that patients with TMJ disorders have hyperactivity (spasms) of the muscles responsible for regulating the opening and closing of the eustachian tube.
• Ringing in the ear (tinnitus): For unknown reasons, 33% of patients with a TMJ disorder experience noise or ringing in the ears (tinnitus). Of those patients, half will have resolution of their tinnitus after successful treatment of their TMJ disorder.

What can I do to treat TMD?

The majority of cases can be treated by unloading (resting) the joint, taking a nonaspirin pain reliever and practicing stress management and relaxation techniques. It's important to break bad habits to ease the symptoms. Most treatment for TMD is simple, often can be done at home, and does not need surgery. For example, control clenching or grinding during the day by sticking your tongue between your teeth. If you still experience pain, you may be grinding or clenching your teeth at night. So see your dentist for a nighttime mouth-guard.

Most people will experience relief with minor treatment. More severe cases may be treated with physical therapy, ice and hot packs, posture training and orthopedic appliance therapy (splint). Eating soft foods and avoiding chewing gum also help relax the muscles.

Is TMD permanent?

The condition is often cyclical and may recur during times of stress, good or bad. As the patient, you should be active in your treatment, by being aware of the causes of your jaw problems after seeing a dentist for a diagnosis regime. Make routine dental appointments, so your doctor can check TMD on a regular basis

Pregnancy and Oral Health

By Aishwarya Jayadeep

When I was practicing, I had seen many pregnant ladies in their last trimester coming for emergency dental treatment, having ignored simple care of the teeth during the early stages. As with any other treatment, it is not advisable to undergo dental treatment too during the last stages of pregnancy as taking antibiotics or other medication at this stage may be bad for the baby's health. So here are some tips for a pregnant woman for better oral health.
It's a myth that calcium is lost from the mother's teeth and "one tooth is lost with every pregnant".The calcium your baby needs is provided by your diet, not by your teeth. If dietary calcium is inadequate, however, your body will provide this mineral from stores in your bones . But you may experience some changes in your oral health during pregnancy. The biggest  change is a surge in hormones  particularly an increase in estrogen and progesterone which is linked to an increase in the amount of plaque on your teeth. If the plaque isn't removed, it can cause gingivitis-red, swollen, tender gums that are more likely to bleed. Gingivitis during pregnancy is called "pregnancy gingivitis" affects most pregnant women to some degree, and generally begins to surface in the second trimester. But if you already have gingivitis, the condition is likely to worsen during pregnancy. If untreated, gingivitis can lead to periodontal disease, a more serious form of gum disease and may even lead to teeth loss.
Pregnant women are also at risk for developing pregnancy tumors,which are inflammatory, benign growths that develop when swollen gums become irritated. Normally, the tumors are left alone and will usually shrink on their own after pregnancy. But if a tumor is very uncomfortable and interferes with chewing, brushing or other oral hygiene procedures, the dentist may decide to remove it.


How  to take care of your  teeth during pregnancy to prevent the above said problems?

You can prevent gingivitis by keeping your teeth clean, especially near the gumline. You should brush with fluoride toothpaste at least twice a day and after each meal when possible. You should also floss thoroughly each day. If toothbrushing causes morning sickness, rinse your mouth with water or with anti-plaque and fluoride mouthwashes. Good nutrition-particularly plenty of vitamin C and B12-help keep the oral cavity healthy and strong. More frequent cleanings from the dentist will help control plaque and prevent gingivitis. Controlling plaque also will reduce gum irritation and decrease the likelihood of pregnancy tumors.

When and how often should I see my dentist?

If you're planning to become pregnant or suspect you're pregnant, you should see a dentist right away. Otherwise, you should schedule a check- up in your first trimester for a cleaning.  A visit to the dentist also is recommended in the second trimester for a cleaning, to monitor changes and to see how  effective your oral hygiene is. Depending on the patient, another appointment may be scheduled early in third trimester, but these appointments should be kept as brief as possible.


What are the procedures I should avoid?

Nonemergency procedures generally can be performed throughout pregnancy, but the best time for any dental treatment is the fourth through six month. Women with dental emergencies that create severe pain can be treated during any trimester, but your obstetrician should be consulted during emergencies that require anesthesia or when medication is being prescribed. Only X-rays that are needed for emergencies should be taken during pregnancy Radiation from dental X-rays is extremely low. However, every precaution is taken to minimize radiation exposure. A leaded apron minimizes exposure to the abdomen and should be used when any dental radiograph is taken. Lastly, elective procedures that can be postponed should be delayed until after the baby's birth.

Is there a connection between my diet during pregnancy and my babies oral health?

Eating a balanced diet is necessary to provide the correct amounts of nutrients to nourish both you and your child. What you eat during the nine months of pregnancy affects the development of your unborn child -- including teeth. Your baby’s teeth begin to develop between the third and sixth month of pregnancy, so it is important that you receive sufficient amounts of nutrients – especially calcium, protein, phosphorous, and vitamins A, C, and D.

Mouthwash -To use or not?

By Aishwarya Jayadeep

Whenever I take my daughter to the dentist, they suggest that she use anti-cavity mouth wash. Though we have bought it, none of us are really regular about using it. We typically use it only when we eat something with a strong odour - like garlic. or onion. But in spite of this, I am proud to say that after my little one has got her permanent set of teeth, she doesn't have a single cavity or plaque on her teeth. This I attribute to the habit of brushing and flossing regularly with a fluoride toothpaste. So from my personal experience what I realized is that if you are brushing regularly with a fluoride toothpaste, you may not need to use the mouthwash at all; but if your brushing habits are a little slack, this may help you a bit.
The most often asked question about mouth wash is whether it is as effective as advertised. The simple answer is that it depends upon your need. Studies have shown that most over-the-counter antiplaque rinses and antiseptics aren't much more effective against plaque and periodontal disease than rinsing with plain water. Most dentists are skeptical about the value of these anti plaque products, and studies point to only a 20 to 25 percent effectiveness, at best, in reducing the plaque that causes gingivitis. However anti-cavity rinses with fluoride,  have been clinically proven to fight up to 50 percent more of the bacteria that cause cavities. Nevertheless, many dentists consider the use of fluoride toothpaste alone to be adequate.
The U.S. Food and Drug Administration (FDA) has divided the entire range of mouthwashes in three broad categories:
-Cosmetic
-Therapeutic
-A combination of the two
Cosmetic
Cosmetic rinses are commercial over-the-counter (OTC) products. They are typically used after brushing to help remove oral debris. They provide a temporary solution that lasts from at least 10 minutes to maximum three hours. However, by reducing bacteria from the mouth, they suppress bad breath and leave your mouth with a pleasant taste after eating. These are mostly fluoride based mouthwashes.
Therapeutic
The therapeutic grade mouthwashes are stronger in their action; in addition to serve all the purposes of OTC mouthwashes, they are empowered with other active ingredients that fight against some oral diseases. In order to obtain the therapeutic grade, the product must obtain the FDA approval. These mouthwashes such as Peridex or PerioGard are prescribed by dental professionals to treat oral diseases causing inflammation, swelling, and bleeding of the gums.
The therapeutic mouthwashes are again divided into two types depending on their uses:
-Antiplaque/antigingivitis rinses
-Anticavity fluoride rinses
Combination
However, there is another category of mouthwash and that incorporate the features of both the cosmetic and therapeutic products. These multi-action mouthwashes came to be known as total care or combination mouthwash. These products contain a variety of anti-bacterial ingredients that work against oral bacteria responsible for producing unpleasant odors and plaque.
Now the question of the hour would be  should I use a rinse?
That depends upon your needs. Most rinses are, at the very least, effective oral antiseptics that freshen the mouth and curb bad breath for up to three hours. Their success in preventing tooth decay, gingivitis (inflammation of the gingival gum tissue) and periodontal disease is limited, however.
Rinses are not considered substitutes for regular dental examinations and proper home care. Dentists stress a regimen of brushing with a fluoride toothpaste followed by flossing, twice a day. If done consistently and properly, the brushing and flossing, along with routine trips to the dentist, should be sufficient in fighting), tooth decay and periodontal disease.

Flossing for Flawless Dental Health

By Aishwarya Jayadeep

I always had problem flossing, as my teeth are all tight together. But now with the waxed flosses that are available, flossing is a breeze. I didn't  know anything about flossing until I went for dentistry. So you can guess how popular flossing was fifteen years back, where I come from. I still remember the first time I tried flossing  and how much I hated it; as it was not something I was used to, growing up. Still, I try to find excuses for not flossing. But it is different with Aishwarya. As she has always flossed  regularly since childhood, flossing comes as second nature to her. So friends, if you are someone like me who didn't floss growing up, my advice is to start flossing as it is never too late and you will get used to this with time. And if you have a little one, make sure you imbibe this habit in him or her so that flossing becomes a breeze to him /her.

Flossing removes the bacteria that escape the toothbrush by hiding in the tiny spaces in between teeth. Brushing without flossing is like washing only 65% of your body. The other 35% remains dirty! The American Dental Association recommends that you floss at least once a day. Plaque (the complex bacterial ecosystem that forms on tooth surfaces between cleanings) is what causes tooth decay, inflamed gums (gingivitis), periodontal disease -- and, eventually, tooth loss. Flossing or using an interdental cleaner is the only effective way to remove plaque between teeth.
Effective flossing does take a while -- once a day for a “good three to five minutes”. But even 60 seconds of flossing is of enormous benefit.
If flossing causes gum pain or bleeding, odds are you have gingivitis or gum disease -- precisely the conditions for which flossing is beneficial.With daily brushing and flossing, gum pain and bleeding should stop within a week or two. If either persists, see a dentist.

Dental floss comes in many forms: waxed and unwaxed, flavored and unflavored, wide and regular. Wide floss, or dental tape, may be helpful for people with a lot of bridgework. Tapes are usually recommended when the spaces between teeth are wide.They all clean and remove plaque about the same. Waxed floss might be easier to slide between tight teeth or tight restorations. However, the unwaxed floss makes a squeaking sound to let you know your teeth are clean.
You may prefer a prethreaded flosser or floss holder,these disposable plastic Y-shaped devices (some equipped with a spool of floss) hold a span of floss between two prongs to allow one-handed use. which often looks like a little hacksaw. Flossers are handy for people with limited dexterity, for those who are just beginning to floss, or for caretakers who are flossing someone else's teeth.I recommend this for kids too.

How to floss?
Here’s how the American Dental Association describes the process:

Start with about 18 inches of floss. Wrap most of it around the middle finger of one hand, the rest around the other middle finger.
Grasp the floss tightly between your thumbs and forefingers, and use a gentle shoeshine motion to guide it between teeth.
When the floss reaches the gum line, form a C shape to follow the contours of the tooth.
Hold the floss firmly against the tooth, and move the floss gently up and down.
Repeat with the other tooth, and then repeat the entire process with the rest of your teeth (“unspooling” fresh sections of floss as you go along).
Don’t forget to floss the backs of your last molars. “By far, most gum disease and most decay occurs in the back teeth,”

Sealants: A way to seal cavities

By Aishwarya Jayadeep

I still remember vividly the first caries that I ever had. It was on the biting surface of my first lower left  molar  when I was about 10 years old. Now I realize that had I treated my teeth with sealants (and not taken chocolates before going to bed..or had brushed my tooth afterwards as my parents had asked me to :-) ), I could have avoided the onset of caries. I can't blame my parents for not giving me sealant treatment. I am sure they would have done it had that been available then. But in this time and age when there is this option, I still find parents who don't take this as an effective measure to prevent caries; that too even when the dentists suggest doing it. This posting is for those of you who are in two minds about getting sealants for their little ones or for those who haven't heard of this wonder method to prevent caries on the biting surfaces.

Studies have shown that sealants are very effective in preventing dental decay. Studies suggest that dental sealants can lower the risk of cavities by up to 90%.
Sealants are applied to the chewing surfaces of molars to act as a barrier between the tooth and harmful bacteria. They are most effective when applied to decay-susceptible biting surfaces on the grooves and  pits of the teeth as soon as the teeth come out. Here's how sealants work: The sealing material is applied to the tooth surface using an "etching" fluid. The sealant partially penetrates the tooth enamel, ensuring that it is firmly attached to the tooth. Once applied, the sealant fills in the tooth's grooves, hardens and creates a thin plastic barrier that keeps cavity-causing bacteria out of the pits and fissures. There is no drilling and no discomfort.
A dental sealant can only provide adequate protection when it is fully intact. If you notice that even a small portion of the entire sealant has come off you should let your dentist know.

Not all teeth require the protection that dental sealants can provide. .

1. It is the shape of their grooves (pits and fissures) that can place some teeth at greater risk for cavity formation than others. Those people whose grooves are deep and narrow will have a more urgent need for dental sealants than those people whose grooves are naturally shallow and rounded as tooth brush bristles will not be able to reach the food lodged in the narrow deep groves hence providing a breeding area for the caries causing bacteria.
2. Beyond pit and fissure anatomy, your dentist will consider other variables that might indicate that a tooth is at risk for developing decay and thus a candidate for a sealant. They will evaluate the amount of dental plaque they find present, the amount of decay the patient has experienced in the past, and the patient's current exposure to an appropriate amount of fluoride.

Molars, the first of a child's permanent back teeth to come out, are typically sealed at around age 6. Other permanent teeth can be treated when they too first appear. Usually the last teeth to be sealed are the permanent second molars, which comes out at around age 12. Of course, teeth that don't yet have this protection can be sealed at any point or age.
An adult's teeth also can be sealed, although this procedure is typically utilized as a preventive measure for children so to help protect their teeth during those years when they are most likely to experience tooth decay. The need for dental sealants for either a child's or an adult's teeth should be considered on a case by case basis.

Selecting the Right Tooth Paste

By Aishwarya Jayadeep

As a small kid I used to insist that my parents buy only that brand of toothpaste that had  a miniature toy that came with it. When I grew up a little more, I fancied the more colorful gel toothpaste with sweet, clove flavor only. Now a days this cycle is repeating itself through my daughter. But as a parent, I am not that lenient as my parents used to be on this matter. Ever since I studied dentistry, I started looking into the ingredients and basing my buying decisions on that. So let me discuss with you what to look for in your toothpaste, that most used item in your toiletry kit.
What is the role of toothpaste in keeping up good dental health?
Brushing with toothpaste is recommended due to the following reasons.
 1. A toothpaste along with a correct brushing technique helps  remove plaque, a sticky, harmful film of bacteria that grows on your teeth that causes caries, gum disease, and eventual tooth loss if not controlled.
2. Fluoride contained in the tooth paste  makes the entire tooth structure more resistant to decay and
promotes remineralization.
3. Gentle abrasives in the toothpaste help to clean and polish the teeth and remove stains over time.
4. Toothpastes help freshen breath and leave your mouth with a clean feeling

Toothpaste need not always be in the paste form. It can be a gel, powder, or paste that you brush onto your teeth and gums to help get rid of accumulating plaque and improve your oral health.
What are the typical ingredients of toothpaste?
In general, toothpastes include the following ingredients:

• Gentle abrasives,to polish the teeth and remove stain
• Humectants ,to keep the toothpaste from drying out.
• Thickeners to give the toothpaste a homogeneous appearance and texture.
• Fluoride to help make tooth enamel stronger and more resistant to decay.
• Flavoring agents that do not cause tooth decay, such as saccharin.
• Detergents,  to make the toothpaste foamy.

With so many toothpastes in the market, it is natural for you to feel confused about which toothpaste to buy, when shopping for a tooth paste. Here are some useful tips:
Most experts said that as long as your toothpaste contains fluoride which is the most crucial ingredient in toothpaste, the brand you buy really doesn't matter. All toothpastes with fluoride work effectively to fight plaque and cavities. Some toothpastes offer tartar control pyrophosphates to prevent the build-up of soft calculus deposits on teeth, while others offer whitening formulas to safely remove stains making teeth brighter and shinier. But, contrary to clever advertising and popular belief, fluoride is the true active ingredient that works the hardest to protect your teeth. Some other considerations while selecting your toothpaste are:
1. If you have sensitive teeth, desensitizing toothpaste should be used as the key ingredient, strontium
chloride or potassium nitrate protects the tubules in the teeth that are connected to the nerves.
2. In tartar-control toothpaste, the key ingredient is sodium pyrophosphate. This type of toothpaste will not remove tarter but only keep it from forming above the gum line. Prolonged use of this type of
toothpaste may cause sensitivity in some people.
3. In antimicrobial toothpaste such as Colgate Total, the key ingredient is triclosan which is an antibacterial agent. This type of toothpaste is supposed to remove bacteria that can cause gum disease but it will not remove existing tartar.
4. In baking soda toothpastes, the key ingredient is baking soda. Baking soda is a mild abrasive and may cause gum irritation after prolonged use. The only benefit to this type of toothpaste is that it leaves you with a fresh feeling in your mouth which can be an incentive to brush longer.
5. Whitening toothpastes contain abrasive ingredients that lighten teeth. These ingredients may cause
gum irritation and sensitivity to teeth. They are also not as effective as the bleaching kits found in your
dentist’s office.
6. Children's Toothpaste. These toothpastes have been developed to meet the special needs of children. As children are extremely susceptible to dental cavities, their toothpastes often contain fluoride. Younger children should only use a small amount of toothpaste to avoid ingestion and prevent dental fluorosis and should be always supervised during brushing.
7.Tooth Powders. Dry powders are also available to clean your teeth but they are often more abrasive
than toothpaste.
So now you can know which kind of toothpaste is right for you. Anyway, it would be a better idea to change the type of toothpaste you use often  enough in order to have clean, healthy and white teeth.
As important as the type of toothpaste you use is the way you use it. Adults usually only need a pea-sized amount of toothpaste nothing more or nothing less.

All About Cavities

By Aishwarya Jayadeep

What harm can possibly come from eating some delicious fresh fruit? Well, we experience it the hard way, over and over again. Whenever it is the season for "Cuties", the delicious California Manderins (these are cute, sweet, little cousins of oranges), we buy them in bulk. And we eat loads of them. But in two to three weeks time, we would invariably end up having sensitivity on our teeth! Even though I had studied all the theory about what is bad for your teeth, it is difficult to put everything into practice -as whenever I see those cuties, I can't resist myself. This is just to illustrate my point that even some of those foods that you would consider healthy otherwise, could harm you if taken in larger quantities.
But having said all this, I am not sure if I could ever resist a cutie any time :-)
I thought of talking to you all about cavities, sensitivity and some foods that can contribute to that.
Tooth enamel is much like bone; a kind of lattice skeleton with minerals packed in between the lattice. (It would be easier to visualize  it like a honeycomb with the honey being the minerals packed between the structure).
Many of the common food that we take can damage the enamel and trigger cavities. Anything acidic will dissolve the minerals out of the lattice structure(demineralize). Some fruit juices like apple juice are extremely acidic and contains sugars that feed harmful bacteria in the mouth. Sodas are also very acidic - this is true even for the diet ones. Fruited waters, vitamin waters,wine, pickles ,honey,sports drinks- all these are very acidic. It may come as a surprise to many that even our own saliva could turn acidic sometimes. All these can cause tooth enamel to wear away and teeth to become sensitive, cracked and discolored.
People with acidic saliva are usually those under stress, those with some kind of hormonal imbalance or anyone with a dry mouth. As we age our bodies become more acidic and this can be reflected in our saliva. When it comes to cavities, bacteria are public enemy number #1. Our mouths, teeth and toothbrushes are full of bacteria which settle on our teeth in plaque, a goo of proteins, saliva, and food debris.  Bacteria devour food particles left on our teeth. Ungrateful guests, these bacteria produce acid as a by-product of their feasting. It is this acid which eats into the tooth enamel creating cavities.
However teeth have a moderate ability to repair tooth enamel by remineralizing the affected enamel with minerals from saliva. Unfortunately, in most cases the rate of destruction by acid exceeds this rate of repair.
But it is not all bad news.
Some foods may actually help defend against tooth decay in special ways. For instance, recent studies have indicated that fresh cranberries interrupt the bonding of oral bacteria before they can form damaging plaque. Other foods that have beneficial effects on oral health include:

• Calcium-fortified juices, milk and other dairy products, which are rich in calcium and vitamin D, help promote healthy teeth and bones, and reduce the risk for tooth loss
• Cheese, which unleashes a burst of calcium that mixes with plaque and sticks to the teeth, protecting them from the acid that causes decay and helping to rebuild tooth enamel on the spot
• Crisp fruits and raw vegetables like apples, carrots and celery, which help clean plaque from teeth and freshen breath
• Tannins found in coffee,cocoa and tea  helps in your fight against caries ,though they stain  pits and grooves of tooth enamel, producing a rough,stained surface

Timing is everything
A diet that promotes good oral health is not just about the foods you eat or avoid — when and how you eat them is equally important.

• Foods that take a long time to chew or that you hold in your mouth (such as cough drops) can damage teeth as they hold sugar against teeth longer than do other foods
• Instead of snacking on sugary, carbohydrate-rich or acidic foods throughout the day, eat these foods just during meal times in order to minimize the amount of time the teeth are exposed to acid

Brushing the Effective Way

By Aishwarya Jayadeep

During my fourth year of dentistry, while in the preventive dentistry class, my professor asked the class how many times a day does each of us brush our teeth.  It was almost a tie between those who brushed twice a day and those who did it only once. Her subsequent questions about the reason of why we were brushing once or twice a day and what time of the day  were we brushing were all eye openers for a discussion on the right frequency of brushing and the best times of the day to do it. Even being dental students, most of us had not thought about these things much - so you can imagine how it would be with most people.
So for today's post I thought of discussing about the brushing techniques, timing and the frequency of brushing that would help keep that smile on your face longer.

What is the right brushing technique?
There are different methods of brushing teeth. But the key to an effective brushing is cleaning every exposed tooth surface in a gentle, massaging motion. If you are squashing the bristles, you're brushing too hard.
One effective, easy-to-remember technique involves using a circular or elliptical motion to brush a couple of teeth at a time, gradually covering the entire mouth. Place a toothbrush beside your teeth at a 45-degree angle and gently brush teeth in an elliptical motion. Brush the outside of the teeth, inside the teeth, your tongue and the chewing surfaces and in between teeth. Using a back and forth motion causes the gum surface to recede, or can expose the root surface or make the root surface tender. You also risk wearing down the gum line.

How long do you take to brush your teeth?
Most people think they brush for at least a minute or two, but in reality they brush for 30 seconds or less.Time yourself and see how you do. An effective brushing takes 2 - 3 minutes.Using the technique I have described above brush your entire mouth and see how long it takes. That is the average time you will need.

How many times should I brush my teeth?
Brushing twice each day is what the experts recommend. Although there is research indicating that brushing once a day is sufficient to disrupt the formation of plaque that feeds the bacteria that cause decay, this may not be enough for some people, depending on factors such as their diets and the efficacy of their brushing technique.
So now many of you would be thinking when to brush if you are going to brush only once. If you can only brush once then the best time to brush would be before going to bed,because while we sleep our salivary flow is low hence there would be a higher susceptibility to cavities and plaque. So for your health reasons burshing in the night is a must and brushing in the morning is suggested if you want to keep your near and dear one's close to you :-)

Caring for your Child's Teeth

By Aishwarya Jayadeep

Many believe that caring  for a child's teeth isn't as important as caring for secondary or permanent teeth. As they think that milk teeth or primary teeth are going to be replaced by nature with another set of teeth soon.If that's what you  thimk that's one big mistake on our part as parents. I believe that Milk teeth or primary teeth is that set of teeth kids get to practice on how to take care of  permanent teeth . That way, when the time comes for them to take care of  their permanent teeth they are well practiced in tooth care. Thus, they won't make any mistakes and can  have  them life long .
Ways to care for your babies teeth
1. Clean your infant's gums with a clean damp cloth.
2. As soon as the first teeth come in, begin brushing them with a small soft-bristled toothbrush and a pea-sized dab of fluoride toothpaste.
3. To avoid baby bottle tooth decay and teeth misalignment due to sucking, try to wean your child off of the bottle by one year of age and monitor excessive sucking of pacifiers, fingers and thumbs.  Never give your child a bottle of milk, juice or sweetened liquid as a pacifier at nap-time or bedtime.
4. Help a young child brush at night- the most important time to brush due to lower salivary flow and higher susceptibility to cavities and plaque.  What I advice is to let the child brush by themselves in the mornings to build self-confidence. This is so, as in the mornings there won't be any food debris or plaque to remove as the child was given a brushing by the parent in the night.  Usually by age five or so, the child can learn to brush his or her own teeth with proper parental guidance.
5.I also have found dental floss with holders very helpful in flossing a  child's little teeth with your big hands.
6.  Finally, the best way to teach a child how to brush is to lead by good example. Allowing your child to watch you brush your teeth teaches the importance of good oral hygiene. Yet another reason for you to brush twice a day.

Selecting Toothbrushes

Cartoon by Aishwarya Jayadeep

Selecting a tooth brush is something that should be done with utmost care. Or else, a tooth brush that's supposed to help you retain that pretty smile of yours would do you more harm than you can imagine. My mom and my mother in law are the two people I have seen who take a serious interest in the maintenance of their pearly whites, but sadly their ignorance of this crucial aspect led to the deterioration of their gum's health. Both these ladies used to vouch on their hard-bristle tooth brushes for doing a better cleaning job than any other. What they ended up with are receded gums and tooth sensitivity because of exposed dentin. To make it more clear how it happens, please look at the figure. Usually, the exposed part (Crown) of the tooth is protected with enamel. But this protection is not there from the point the gum starts. So what happens when one uses hard-bristled toothbrush is that it pushes the gum back, thus exposing that part of the sensitive dentin. This would make it painful if you were to take hot or cold liquids. But more than the pain, once the dentin part is exposed, if you continue using the hard-bristled brushes, the brushing would erode the dentin itself (as these are not as resistant to abrasion as the enamel is). What this means is that you could even end up having fresh cavities.

Now the question is how to select a toothbrush that is best suited for you.
Tooth brushes have different bristle firmness ratings – soft, medium, and hard. This tells you how firm the bristles are and how much pressure they put on your teeth and gums when you brush. This can be very confusing when you select a toothbrush. Most people, like my mom and MIL , select toothbrushes with firmer bristles, believing they’ll do a better job of cleaning their pearly whites. Then these zealots would brush their teeth vigorously to clean it to a fault. As I mentioned earlier all of that brushing causes gum irritation and aggravates sensitive teeth. or even ends up making new cavities in some cases. So to select the right toothbrush that does the right work without causing more harm make sure that:

1. Any toothbrush you choose have soft bristles. Soft toothbrush gets the job done without gum irritation or contributing to receding gums.
2. Select a toothbrush head size that can easily fit into the mouth and can brush one to two teeth at a time (the general size is 1" long and ½" wide) with end-rounded bristles
3. Powered toothbrushes are better choices than manual toothbrushes for anyone who needs assistance brushing teeth, including seniors, people with arthritis (or any condition that may limit mobility), anyone wearing braces or people with misaligned or uneven teeth surfaces that make a thorough cleaning more challenging. These would be a good choice for kids who has teeth that are a mix of baby teeth and adult teeth.

Now the next question is when to replace your tooth brush.

1. Replace your toothbrush as soon as the bristles begin to look worn or frayed (usually every three months). A worn toothbrush does not do a good job of cleaning your teeth. 
2. Remember always to replace your toothbrush after an illness. Otherwise, your brush will be retaining the germs that caused the illness and you may fall sick again.

For children, most of the above holds good. And specifically select a brush that has:

1. Soft bristles (for gentle cleaning)
2. Very small heads (designed for baby teeth)
3. Large handles (easier for children to grip)

And from my experience, when the child is having mixed teeth (some adult and some baby teeth), a powered toothbrush with soft bristles, specially for kids would work best.


Keep Smiling!

Baby's First Dental Visit

Cartoon by Aishwarya Jayadeep

Let me take you people a few years back to when my little girl was a baby.  Aishwarya,my bundle of joy and apple of my eyes, had her first teeth at the age of around 6 months. They were small milky white; and to me, her mother, the prettiest little teeth. Before I go on with my story I want to let you people on some facts. Babies can have their little chompers as early as 3 months or as late as 14 months, depending on their genes and depending on weather or not the baby was a preemie (preemies tend to teeth late). In short, what I am trying to convey is that there could be differences between one baby and another with regard to their teething patterns.
Now, back to where I started. Soon Aishwarya had a full set of teeth and she was flashing her pearly whites and making all of us dance to her tunes. I didn't feel it was that important to take her to the dentist  for a check up (I had stopped practicing  dentistry by then). I always thought her teeth were safe with me being there and that she was not losing anything by not having her formal dental checkup. How wrong I was!
When she turned 4 her dad Jai had to take up a position in the US. So Aishwarya and I had to stay for about 4 months at my parents and inlaws before we joined him. During that time Aishwarya was eating her share of chocolates and chips as if there is no tomorrow, mostly without me knowing. She had her grandparents around her little pinky and used to play her cards so well that they danced to her tunes. During that same time I myself was not keeping that well. So I trusted Aishwarya, who I now considered to be a big girl, to brush by herself. My! My! That was the second mistake. In short, by the time we both landed in the US, Aishwarya had her first cavity. We took her to a pedodontist(Dentist specializing on kid's teeth). Aishwarya being a shy kid didn't even open her mouth,so the dentist suggested oral sedation. I being a mom who wanted only the very best for my baby didn't want to try this on my baby when I looked into the possible side-effects of the sedation. I tried consulting two other dentists who were just after my money only. That is a story for another day. In the end I consented for the oral sedation and got Aishwarya's tooth filled without much ado. Only then I realized that had I taken Aishwarya to a dentist before, she would have been more comfortable with the dental office experience and wouldn't have needed the oral sedation. With this experience behind me, here I am stressing the importance of early dental check-up for kids, not just as a dentist, but as a mom as well.

Now questions would be when should the child first see a dentist; how to find a good dentist; what you can do to make it an easy experience and how often you need to take the child to the dentist.

The ideal time is six months after the first tooth erupts or approximately at one year of age. This is an ideal time for the dentist to carefully examine the development of your child's mouth.
Even though many general dentists do take-up children as patients, my suggestion would be to find a Pedodontist ( one who is trained and is specialized in treating kids). They would know how to deal with kids better and would be more knowledgeable about issues specific to kids.
Try to schedule a morning appointment when the child is in a good mood. Don't ever portray the dental office as a bad place to be and always give them an idea about what to expect there.Bring with you to the appointment any records of your child's complete medical history. Ideally ,children, like adults should see the dentist every six months.
Hope this will retain a lasting smile on your babies teeth.

Dental Visits: How Important?

Cartoon by resident artist Aishwarya Jayadeep

I myself is a person who has a white apron phobia, and is still struggling to overcome this. So this post is for people like me who always want to reschedule or avoid a dentist's or doctor's visit as much as possible. The three main reasons that I feel prevents a person from visiting a dentist's office are:

1. Past bad experience
2. Ignorance
3. Cost

Past bad experience:

One reason may be that you had a bad experience with one particular dentist and now is scared of all of the class. I am in this category. It does happen sometimes to those of us who are unlucky. Growing up, didn't we all had some good teachers and some really bad ones? But did we quit school because of one bad teacher. (Well, if you are one of such a rare breed, I am sure, by now you would know the consequences). So let us not take this as an excuse. Let us move forward and find that perfect dentist; and schedule that long overdue visit immediately.

If you are still in doubt, remember this: DENTAL PROBLEMS DO NOT GET BETTER OR JUST GO AWAY -  if only a toothache would take you to a dentist, then it is already too late, and it would probably take a root canal treatment or crown - which means more visits. As the saying goes: " A stitch in time saves nine"

Ignorance:

The other day I was talking to a friend of mine. She was ranting about her recent visit to the dentist. As we talked more and more, I realized that her last dental visit had been 5 years ago, and when she made it to the dentist's yesterday, her so called "greedy" dentist suggested 6 fillings, 1 root canal treatment and a crown to follow! According to her, all these years she was perfectly fine without seeing a dentist. So feels that she would be fine without making any more scheduled visits.

I had to have a long talk to convince her that the cavities were probably not felt previously as those were not deep enough, but as a matter of fact, they might have been there all along. And if not treated now, would do her more harm in the long run. This wouldn't have happened if she had kept up her bi-annual check-up.

Cost:

Many of us including me had seen stars on receiving a treatment plan for a dental work, because of the  high costs involved. This again is something that could have been avoided with regular check-ups. If the cavity was detected early enough, you would have needed only a filling; but gone undetected it would need a root canal treatment and a crown - almost 10 to 15 times the cost. 

Your teeth are made to last you a lifetime. It is up to you to help them stay healthy and strong.  For miles of smiles, I have 3 secrets to share with you:

1. Brush twice a day
2. Floss daily
3. Routine dental check-ups

I hope I convinced you to schedule that long overdue visit; I am off to schedule mine.

Ciao! Keep smiling till we meet again!