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THE TOP 10 CELEBRITY SMILES by Dr. Peter Boulden

Turning to celebrities for style, fitness, and beauty inspiration, or even a case of lifestyle envy is a move that we all are guilty of committing. You do it, your children do it, your father does it, your grandmother does it, and your future great-great-great-grandchildren will do it, albeit by then it’ll be in the form of holograms instead of magazines or the internet! It’s no secret either that celebrities work with the best in the business when it comes to their appearance, and their smile is usually no exception. With that said, of course some celebrities are truly born with it (or maybe it’s Maybelline).

For the celebs who were blessed with the pearliest of whites, the biggest of mega-watt smiles, and the brightest of grins to light up the big screen, we are showcasing the photogenic winners in our Best Smile Superlative, ten times over.

1 Miranda Kerr

This Aussie model has been smiling for the camera and walking the runways for as long as we can remember. And thank goodness for that! Miranda’s radiant smile and angelic beauty makes it no surprise that she is one of Victoria’s Secret’s leading Angels in all of their holiday campaigns and fashion shows year after year. You do you, Miranda!

2 Jessica Biel

From child stardom, to a leading actress, to the mother of Justin Timberlake’s beautiful baby boy, Jessica Biel has been on the cover of magazines, billboards, and TV screens for well over a decade. This brunette beauty brings a natural glow to every setting she steps in, and she may have the most perfect lips and teeth known to mankind. It’s unfair, really.

3 Michael B. Jordan

This young star has been moving up the ranks faster than you can even blink, it seems. We hear it’s more related to his incredible acting chops rather than his fantastic grin, but that smile certainly doesn’t hurt his case!

4 Rachel McAdams

This Hollywood starlet’s hair may change with every film she is in, but one thing remains constant and that is her big, contagious smile. She is one of those celebrities whose smirk on the big screen makes you light up regardless of what movie theater seat you are stuck in, because even if you are on time there’s still a line for popcorn and candy, am I right? Oh and her dimples?! Can you even? Because we cannot.

5 Dwayne Johnson

Formerly known as The Rock, Dwayne Johnson has landed himself some serious acting roles in the last few years, which is great news for all of us. The more movies and shows he stars in, the more chances we have to see his pearly whites. Win, win!

6 Bar Rafaeli

It goes without saying that this supermodel is the crème de la crème of her trade. Stunningly beautiful on the inside and the out, and her smile is in large part responsible. White, bright, and gleaming, Bar’s grin is undeniably one of our Top Ten smiles of all time.

7 Jon Hamm

Some may know him as Don Draper, others as Jon Hamm. Regardless of his surname, his good looks are what stands out. If Jon had an account on any of the dating apps in this world, “Tall, dark, handsome, and grinning” would be his bio.

8 Kristen Bell

Actress, Comedienne, Lover of Sloths; Kristen Bell is not only a fan favorite when it comes to her work and her personality, but she also has one of the most infectious smiles in the business. I challenge you to find a single blemish within her smile, seriously, you can even zoom in 400%. Spoiler Alert: It’s impossible.

9 Eva Mendes

Three Words: Drop Dead Gorgeous. Eva truly has it all when it comes to the beauty department, and did we mention she’s married to Ryan Gosling? So, of course it’s no surprise that her smile is out of this world. Rumor has it she’s really nice too. She must have been a saint in a former life.

10 Zac Efron

This Hollywood heart throb has made his way onto many hottest actors’ lists, and ours is no exception. Zac’s piercing blue eyes may be the attention grabber for some, but his smile is what brought him into our Top Ten. I wouldn’t be surprised if Nicholas Sparks ends up locking him down for all of his books-turned-feature films from here on out.

Perio Protect Trays

Perio Protect Trays -  therapy that works!

The team at Atlanta Dental Spa works hard to stay on the cutting edge of dental health. We know the health of your mouth is directly related to your overall health, and nothing is more important to us than having HEALTHY, happy patients! One of the ways we achieve this is by offering Perio Protect, a painless, easy, non-invasive, and long-term solution to one of the most prevalent diseases in our nation: periodontal disease. Hygienist Charissa Wood, RDH offers the following Q&A on all things Perio Protect.

PP01 What Sets ADS Above The Rest
PP02 Use With General Dentistry

1 How has Perio Protect® been successful in your office? Can you describe a case or two that stands out in your mind?

Perio Protect has been a huge tool in our practice at providing our patients with a minimally invasive, state-of-the-art option for their periodontal disease. It has offered us an effective scientific approach vs. the old school paradigm of just doing scaling and root planing. We have seen our patients embrace the ease of use and consistent positive results which leads to compliance, trust and confidence in the practice and the referral of family and friends. It has definitely provided a boost in production, but best of all, we are helping our patients achieve healthy smiles that they love! We have many stories of patients who have experienced multiple rounds of scaling and root planing over the course of years but were still experiencing inflammation and bone loss. Once these patients began to use Perio Protect as directed, we saw them achieve and maintain health long-term with reduced pocket depths, no edema, inflammation, tenderness or bleeding. We’ve had so many success stories, it’s hard to narrow them down, but I’ll highlight a few cases to demonstrate how Perio Protect has helped us be successful. One of the best outcomes we’ve had was a 43-year-old male who presented with generalized 4-5mm pockets and moderate localized bleeding after a 6 year absence from professional dental care. He had severe decay and infection around two teeth causing him pain, which were non-restorable. Once the extractions were complete, we did impressions for Perio Protect trays, which he wore 3 times a day for 10-15 minutes for 2 months. When we saw him back for his follow-up evaluation and performed the periodontal exam, we found generalized 1-2mm with no bleeding, edema or tenderness. His tissue was so healthy and stable, we did a cleaning and put him on a 4-month recall wearing his trays once a day. Nothing is more rewarding than helping our immune compromised, high-risk patients step out of danger by removing the threat that periodontal pathogens pose. We had a 51-year-old male who was referred to us by his cardiologist because he had just recovered from a heart attack. This particular patient had struggled with periodontal disease throughout the years, having previous scaling and root planning, but had not been for dental care in the last 5 years. He presented with generalized 4-6mm pockets and localized 7-10 mm with heavy, generalized bleeding and moderate generalized subgingival calculus. Due to his recent heart attack, we did salivary testing and upon results, administered systemic antibiotics. We had him wear his Perio Protect trays for 6 weeks 3 times a day for 15 minutes with Periogel and Vibramycin drops. We then performed scaling and root planing to remove the calculus and flush out the pockets. Now at the five-month point, we have achieved a huge reduction in pocket depths and very minimal bleeding. The patient continues to wear his trays twice a day. We are still working on getting a few stubborn areas resolved, but the patient was recently cleared by us and his cardiologist to have knee surgery! Perio Protect not only works to eliminate periodontal infection and create long term maintenance of health, but as a side benefit - because of the 1.7% peroxide gel - also gradually whitens teeth! Here is Patient C, a 45-year-old male who has been using Perio Protect for the last 4 years. We recently updated some photos to discuss possibilities for restoration of his bite and wear and noted the drastic difference in shade. This, of course, is a big factor for motivating patients to stay compliant!
PP06 Patient Stories

2 Are most of your patients responding well to Perio Protect® treatment? What has surprised you about their responses?

I would say that ALL of our patients on Perio Protect have responded positively. Some patients have an immediate and long term improvement that requires nothing further than a basic cleaning every 4-6 months. Others may require full or limited scaling and root planing followed by periodontal maintenance therapy, and still others may maintain periodontal health for months or years and have an unexpected flare up. We have to keep in mind that although the catalyst of periodontal disease is bacterial presence, it is still a multi-factoral disease governed by the host response. We've got to consider that genetics, the immune system, nutrition, stress levels, environmental factors and home care are a big part of the equation. Perio Protect is highly effective at creating a sub-gingival environment that creates anaerobic cell death and inhibits bacterial colonization and by doing so, we consistently see an immediate improvement in the clinical signs of periodontal disease. For some patients, that's all it takes, but for others, we've got to look deeper and make changes to the other factors that affect the patient's response. It is imperative that we tailor our care to each patient's individual circumstances - there is no such thing as a cookie cutter approach. I can honestly say that when we have Perio Protect as our baseline therapy, I know that by tweaking the other factors, we can obtain sustainable long term health.

3 What does Perio Protect® allow you to do that other conventional treatments do not?

PP03 Non-Invasive Way to Keep Patients Healthy
PP05 Daily Way to Eradicate Bacteria

Perio Protect allows us to offer our patients a successful, painless, simple modality to treat their periodontal disease. It provides treatment for acute and chronic infection as well as long term maintenance of health. I would say the most appealing advantage for me as a healthcare provider is that it provides a way to prevent bacteremia. In a world of patients plagued by auto-immune disorders (cardiovascular risk, diabetes and cancer, just to name a few), coupled by the science pouring out about the direct involvement of periodontal pathogens in these systemic illnesses, I am passionate about not contributing to these conditions or increasing the risks! Perio Protect allows me to eliminate the bacteria directly at the site of involvement so that when I go into the pockets to clean and remove debris and calculus, I am not exposing billions of bacteria into a patient's blood stream in one fell swoop. By the time a patient has been using Perio Protect for 4-6 weeks, we are really dealing with the leftover dead bacteria and calculus which we can confidently remove knowing we aren't increasing any systemic risks. Another unique benefit that only Perio Protect can provide is the rebuilding of bone. By using a liquid form of Vibramycin in the trays as a topical antioxidant, it is able to stimulate osteoblasts to lay down new bone. I realize it sounds too good to be true, but we've seen this happen in our practice multiple times with teeth that were once mobile now fully stable. We've had oral surgeons comment on how difficult it was to extract wisdom teeth that had been treated in this manner because the bone was so solid around the teeth, they were almost impossible to remove. We have found a lot of value in using the therapy to help ensure implant success as well. I will add that the Vibramycin therapy is not recommended if orthodontic work is in the patient's future due to the fact that the teeth are very resistant to movement once the bone has been rebuilt and solidified.
PP09 Brush & Floss Not Enough, Perio Protect is the Solution

4 Have any of your patients not responded as anticipated to Perio Protect® treatment? Have you encountered any problems with treatment?

As mentioned before, with periodontal disease being multi-faceted, there are times when we have not seen the anticipated results initially. But by addressing the issues outside of bacterial assault, we have been able to achieve health. Sometimes we make changes to diet or supplementation so we are supporting the immune system nutritionally, sometimes it's a matter of addressing environmental factors like smoking cessation or a spouse with untreated periodontal infection, it can be as simple as communicating with the patient's physician to try an alternate medication for blood pressure, diabetes or hormone therapy, or helping a patient make a plan for stress management or get tested and treated for sleep apnea. We have found that by using Perio Protect as our main course of therapy and altering what we can of the contributing host response factors, we can count on consistent positive results. As is prevalent in the dental world, I’d say our biggest hurdle when it comes to using Perio Protect is patient compliance. I tell my patients that “I guarantee it works, but only if you use it.” In general this is not a big issue, because the patients can see and feel the benefits of treatment, but it does happen where patients will be slack or drop off their routine. We’ve had a few patients who experienced tooth sensitivity similar to what whitening creates, but were able to adjust their wear frequency to make it work for them.

5 It can be challenging to incorporate a new therapy, how did you begin to implement the Perio Protect Method in your office?

The science of Perio Protect makes so much sense to us considering Dr. Boulden’s background in microbiology. When we first heard about Perio Protect at an ACE conference, it was like a lightbulb went off. All this time, through scaling and root planing, we had been disrupting these complex bacterial communities while assaulting and creating tears in the gingival tissue, thus pushing them into the bloodstream at the highest concentration possible. We weren’t sterilizing anything and knew we weren’t completely eliminating every bacterium present so those left would repopulate and start the process again.

PP10 Skeptics

Perio Protect was presenting a way to address the microbiologic community without creating tissue damage or create further introduction into the bloodstream. It was a simple, easy to use process for the patient and involved taking a set of impressions. It was a no-brainer and so we decided to just dive in and give it a try! We sat down as a team and learned all the steps needed to get trays made. We began to offer it to our patients who presented with perio and they were saying yes. After our first few cases, we saw how beautifully it worked and were thrilled with the results! The more we saw, the easier it became to recommend to our patients and feel confident in what we could expect result wise.
PP08 Building on a Stable Foundation

6 How do you introduce patients to Perio Protect® and present treatment options?

When we see a patient who is a good candidate for Perio Protect, we explain their current condition and what the progression of those conditions can look like. We briefly discuss the science behind perio and how Perio Protect can address their situation to get and keep them healthy long term. We discuss the process as far as timing and expectations of their involvement at home. Because most insurance plans do not yet cover this method, we do also offer full Scaling and Root planning for those patients who are more insurance driven. When we are dealing with immunocompromised patients, depending on their conditions, we will recommend the Perio Protect as our first course of action, so as not to create greater risk to their overall health.
PP07 Who Is A Candidate

7 Do you have any additional information you would like to share with readers?

I think a lot of people hear about Perio Protect and write it off as a gimmick or too good to be true. Even though the science made sense, even we started a bit skeptical, but I have seen it work literally hundreds of times and patients absolutely love you for giving them a pain free option that works!

PP04 About the Trays

I challenge everyone to hear and see the science for yourself, give it a shot and you will be amazed! If the old school paradigm of Scaling and Root planning was all it took, we’d have a much greater healthy patient population!

5 Things That Age Your Smile

We hear a lot of expert advice on how to keep your skin from aging, but in the many websites, editorials, and books there is very little mention of how to sustain the youth of your teeth and smile. In time, a smile will age just as much as your skin and face. Thus, it’s very important to be aware of what causes your smile to age, and avoid adding unnecessary years to your appearance. The upkeep of a long-lasting smile is simple when you are knowledgeable, and keeping your teeth as white as possible is the easiest way to do so.
A Youthful, More Confident Smile (Dr. Creasman)

1. Discoloration

The color of your teeth is the number one factor contributing to your aging smile. When your teeth have gray-ish tones or yellow-ish shades, it can add 5, even 10 years to the age of your smile. In general, whitening is a good option for removing surface stains from teeth. Teeth that have a yellow-ish discoloration are usually good candidates for professional whitening. What about teeth that are gray or brown-ish discolored? Well, in the experience of the doctors at Atlanta Dental Spa, they don’t respond well to professional whitening (in-office or take home). The reason is that the color of these teeth is from deep within, not just on the surface. In these instances, all whitening the teeth will do is cause increased sensitivity. For people with dark teeth with intrinsic discoloration we usually recommend porcelain veneers as the treatment of choice.

2. Chipped teeth

This factor may come across as a “DUH!” upon first sight, but we aren’t only referring to large chips. Chipped teeth includes the minute, itty bitty chips that exist on the edges of your teeth. These not only give an appearance of uneven teeth, but it also gives away a mouth that’s experienced years of wear. The chips can be fixed simply and quickly by your dentist. It’s also very important to be conscientious going forward, as in— “don’t open that with your teeth, please.” Aesthetic bonding or porcelain veneers are excellent choices in regaining an homogenous appearance.

3. Excessive wear

The factor of excessive wear is mostly due clenching or grinding. Grinding can be attributed to a number of things like:
  • Medications
  • Unknown origin (maybe even genetic)
Worn down teeth are a major factor in the appearance of aging. The teeth support the lower third of the face and when that dimension is shortened the skin folds / lines around the mouth get deepened. So not only do the teeth contribute to the worn appearance of one’s overall mouth appearance, but loss of support contributes to increased facial wrinkling! We have a couple of options for this:
  • Stop the wear through a nightguard
  • Restore the loss by adding length & size with porcelain

4. Extreme asymmetry

Asymmetry within your mouth causes an appearance of a crooked smile, and a crooked smile unfortunately adds many more years to your mouth than that of a straight smile. Asymmetry can sometimes be caused from grinding your teeth in one direction predominantly, causing wear to that side.

5. Shifting

Shifting within your mouth, whether it be your gums or your teeth, also produces a crooked smile. Teeth are not static our entire lives, they can move depending on changes with your bite. Sometimes they can move when there are periodontal issues. Sometimes even professionally trained dentists have no explanation for the movement. Getting teeth “shifted” back to the correct position is easily accomplished through adult clear orthodontic systems like Invisalign or Clear Correct. Additionally, if you’re missing any teeth, then you’ve probably experienced considerable shifting patterns. If you’re missing a tooth, here’s what happens – the teeth on either side of the hole try to fill it in... as well as the tooth above / below it. That movement causes ALL the other teeth to move in compensation and could throw off your ENTIRE bite. So when we say “it’s ALL connected” (like in our Oral Systemic approach) – this applies to your bite as well!
Now that you have the knowledge and know-how about what it takes to keep your smile fresher and more youthful, all you have to do is follow our suggestions. And hey, when all is said and done, you may find a new best friend in your very own dentist! Join the ranks of people who have stopped saying “I hate going to the dentist!” Yup, patients at Atlanta Dental Spa relate to the mantra, “What if you liked going to the dentist?”

7 Common Problems in Cosmetic Dentistry (Porcelain Veneers)

Practitioners of esthetic dentistry are to smile design as Starbucks baristas are to the perfect latte. Point being, you want the most skilled individuals performing this most important of jobs, and the dynamics behind your smile (in addition to your morning coffee) should be left to the professionals! Imagine flashing your pearly whites while the dental team is giving jumping high fives to each other and the Rocky Theme Song resounds through the office!

While a perfect smile is an excellent way to display a job well done, it is also very beneficial to take note of what happens when violations of smile design principles occur and how dentists can restore any violations back to an ideal form. This will leave you waltzing out of your final appointment with the dental team yelling, “Go book your headshots, Hollywood!” In all seriousness… here are 7 common problems the Docs at Atlanta Dental Spa see in consultations:

1. The Crooked Smile Epidemic

It is crucial that dentists be aware of a patient’s natural head position when examining facial plans. Professional makeup artists and hairstylists also practice at this skill! The dentist’s process involves performing a correct facial esthetic analysis while viewing the face as a whole, instead of focusing solely on the mouth. A vertical line drawn through the middle of the face focuses attention from the tip of the nose to the middle of the chin, allowing for a more exact frame of reference in the smile design, and thus a straighter smile. A win for the dentist, and a long-lasting win for the patient!

2. The Reverse Smile

The flashiest of smiles display a symmetry not only amidst the teeth, but also in the curve of the lips. A reverse smile is when a concave curve is created, resulting in a smile line that comes across as unhappy. To ensure your smile is as happy as a kid in an ice cream shop (disclaimer: brush your teeth after eating ice cream!), your dentist must analyze your tooth lengths and lip shape. They should determine whether there is a need to shorten the canines or lengthen the incisors in order to correct a happy concave smile. This is most effectively done using digital techniques such as photography, video, and digital mock-ups of the teeth. Pucker up and tell your teeth to get ready for their close-up!

3. The Social Six

The violation of the Social Six refers to altering the color and shape of only the six top front teeth. Correcting these teeth without also creating contrast with the back teeth can leave patients with an artificial, narrow-looking smile. Your dental team must take pretreatment photographs and evaluate front and lateral smile views in order to produce a natural looking smile for your paparazzi moments. On the other hand, too much brightening of the back teeth can result in a denture-like appearance; picture the candy mouth during Halloween. Finding a happy balance is key, especially when it comes to perfecting your smile.

4. Ignoring The Golden Proportion

The Golden Proportion was a standard traditionally applied when creating ideal smiles, but today’s “smile artists” lean toward less regimented designs based on an individual’s proportions. Think of Nintendo Gameboy compared to present day’s PlayStation 4; the art of phasing out archaic versions for more modern ones is simply a way of life. With that said, if the less regimented designs are not done correctly, an offset of ratios will create an artificial appearance. And thus, using computer programs to draw lines and proportions on images of a patient’s teeth helps dentists visualize the process for the patient, and also communicate correct proportions with the laboratory during preplanning. If space in the mouth is limited, your dentist can narrow or slightly rotate the lateral teeth to create room for the central teeth. Having the mindset that no one mouth is the same as the next can help ensure better smiles for generations to come. Just think, your future grandchildren’s children’s grandchildren will have the most radiant, and proportional mouths.

5. Over-Contoured Teeth

Teeth can look over-contoured if there isn’t distinction between how light bounces back on different zones on the teeth. Because ceramists work under the confines of preparation designs they are forced to obscure the reflective and deflective zones when building up porcelain, and often times create over-contoured teeth. Depending on how lines and angles are manipulated, teeth can appear short and fat, long and narrow, or more rectangular and curved. Moving angles outward creates wider looking teeth, and moving them inward creates narrower looking teeth. This violation can be reversed if ceramists are given a properly designed mock-up and use the correct thickness when preparing the porcelain veneers. When done correctly, this approach will leave your smile looking full, and human.

6. Ignoring Negative Space

Just like in all areas of life, it’s important to establish boundaries in the space around a tooth. When designing a smile, it is crucial to provide adequate room for angles between teeth. Worn tooth edges in a smile result in reduced or non-existent angles. This unfortunately leads to a flat smile line and aged appearance – no one wants that! Therefore, clinicians must recreate the natural angle progression to restore appropriate tooth lengths and curves. All of this can be done provided there is room to recreate negative space, and properly address the angles in the design stages. Magicians can stick to their smoke and mirrors, because dentists have this covered!

7. Overlooking Gum Margins

The last smile design violation is asymmetrical gum margins. This version of smile design exercises the age old game of symmetry versus harmony. In this case, more emphasis should be placed on harmony versus symmetry. This puts the focus on a general, recurring theme amongst the tooth groups rather than mirror images.

Gum margin positioning is significant in people with medium-to-high smile lines. The smile line is the location of the lip when a person smiles. Pretreatment images are absolutely necessary when it comes to effectively evaluating gum margins. This helps everyone visualize the esthetics to come and further ensure that the results will reflect the expectations. In short, stay harmonious when it comes to smile design, as creating exact symmetry can disrupt the balance and beauty of a smile. Who knew smile design could be so Zen? Namaste, my friends.

Being aware and educated about these 7 most common violations of smile design helps both patients and esthetic dentistry professionals achieve more successful outcomes when it comes to gaining a million dollar smile. Digital photography and modern technology lend a large hand to the success of today’s cases, helping the professionals properly evaluate and restore a smile into ideal form, and helping patients understand the process and giving a realistic image of the final results. Dentistry and technology; working together in harmony.

The Most Affordable Dental Care is at Your Fingertips: a message especially aimed at my 20-40 year old readers

Every week I hear someone mention how dentistry is very expensive, and I don’t disagree, it certainly can be. Moreover, it can be one of the smallest investments in your healthcare budget if you’re doing the right things at home. I also hear the gamut of reasoning behind why a patient thinks their suffering from dental problems: “my parents had gum disease so I do too,” “when I was pregnant I lost all my calcium and my teeth fell apart,” “I have bad genetics,” “my grandparents were in dentures by the time they were 30 so I guess I will be too,” and “my parents never took me to the dentist so now I’m having to deal with all the problems.”

What I rarely hear is, “I know why my mouth is unhealthy; I’ve neglected to take care of it.” Don’t get me wrong, every now and again I meet someone who’s brave enough to own up to their less-than- stellar home care habits, or what I like to call “low-giene.” And if you’re one of the folks that have said or thought one of the statements I previously mentioned, most of those CAN play a FACTOR (the pregnancy one has pretty much been resoundingly refuted though). The reason I emphasize that is because sure, genetics can absolutely play a role, but it’s usually one part of the puzzle and can only really be blamed as the actual cause in extreme cases. Most people don’t realize how much control they have over their own dental fate (or maybe they don’t want to take ownership), but even someone whose whole family has had periodontal disease doesn’t have to suffer the same fate as their ancestors. If they do have similar problems, the reason is much more likely that if their parents never took care of their own teeth, they probably didn’t teach the best habits to their kids…or perhaps they never built value into having a healthy mouth. Regardless, you have the ability to trump genetics, prove your parents wrong, and have a healthy mouth for a lifetime if you commit to it.

I’m not expecting you to become a daily flosser either. Please believe I’d LOVE it if you were, but I know for a fact that most of Americans floss a couple times a month at most, and that’s usually to get the pesky piece of popcorn or steak sandwich out from between some teeth. That, or they’ve got a dental appointment in the next few days and they think flossing in the 48 hours leading up to a cleaning will fool the hygienist. It doesn’t, I promise. However, if you tried flossing about 3 times a week for 2 or 3 weeks I bet you’d fool some of us. That’s because gingivitis (puffy, tender, gums that bleed easily) is a very reversible condition. The inflammation in your gums is your body’s way of trying to fight back from all the plaque and buildup that accumulates daily. If you floss just a few times a week, that allows your body to get that inflammation under control, and you’ll find that pretty quickly it won’t hurt to floss, there won’t be blood in the sink, the floss won’t smell terrible, and it’ll actually start to feel good. Yeah, I said it, flossing can FEEL GOOD. You know how a massage feels nice to a healthy body but would hurt like crazy to a swollen limb or joint…well, the same goes for flossing on some inflamed gums. The nice part here though is that the massage that floss provides removes the offending agent (plaque) and therefore gets rid of the inflammation—you’re actually massaging your gums to health. So keep this in mind: if there is blood in the sink after flossing or brushing THAT IS NOT OK–it means there is some serious inflammation at a minimum. Would you be ok with any other part of you that bled if you just pushed on it a little? Heck no, you’d go see a doctor about it.

But often I find that a major part of the problem is that I’m having this talk with a younger portion of our patients. I don’t mean kids and teenagers, I mean 20 and 30 somethings, and there are a number of reasons for this. For one, some of us cling to a bit of the invincibility-mentality that most of us went through as teenagers. “Bleeding gums aren’t a big deal,” “I’ve never had a cavity,” “nothing hurts,” “yes I have a bite guard, but no I don’t wear it,” etc. I hear this from young people because it’s a SLOW process. Enamel is the hardest substance in our body. It’s incredibly dense, and it takes YEARS for a cavity to dissolve it (bacteria turn sugars you eat into acid and use it to burrow through the teeth). Enamel also doesn’t have feeling; if it did, every hot, cold, or hard thing would hurt our teeth. However, the next layer of tooth is called dentin, and it’s very sensitive and very soft compared to enamel. So you can have a cavity and it will not feel like anything until it’s dissolved its way through the enamel and gotten to dentin–that’s about 25% of the thickness of the tooth! And when it does make it to dentin, things really escalate–it hurts, especially with cold or sweet foods, and the speed at which the cavity grows ramps up because dentin is so soft. So when I hear, “it doesn’t hurt so I’ll wait to do anything about it until it does,” it can be very frustrating. If you fix it before it gets that far, not only is that minimally invasive to your tooth (they’re not that big, you don’t want to have any more removed than necessary) but it’s minimally invasive to your wallet. If you were told you need a filling for a couple hundred bucks, that’s a bummer. If you wait and let the cavity expand, that little $200 filling can rapidly escalate into the thousands as more and bigger procedures are needed to fix the tooth. My younger patients haven’t had to go through these major expenses yet, so they’re skeptical. What they don’t realize is they have the repercussions of decades of low-giene habits accumulating. Think about this: every tooth has the same born-on date, the same manufacturer, are made of the same material, and have been exposed to the same environment. If one tooth is sensitive or having issues, there is an excellent chance you have about 27 other teeth that may be on the brink of the same problem. If you have a $200 filling on all 28 teeth (I see this more than you’d think), that’s $5,600. Let that worsen to the point of $2,000 per tooth (I’ve absolutely seen this too) we’re talking $56,000. I don’t know about you, but as a 20 something I may have felt invincible, but my bank account didn’t (still doesn’t, actually) and $56,000 would have been unfathomable to me. THAT’s how people end up in dentures before their kids hit college age.

The same applies if you’ve been told you’re a clencher or grinder. Most of us are, especially when we have stressful episodes at work, home, whatever. If you’ve been told you need a bite guard, it’s because we can see the wear that you can’t feel yet. After decades of beating on your teeth while you’re asleep (you can bite much harder in your sleep than you can awake because your safety reflexes are turned off) they form little hairline cracks. Just like the little crack in your windshield, it’s tiny and a non-event…until it isn’t. When you hit that pothole (or almond) and that crack all of a sudden runs the length of your windshield, you have to get a new windshield. Guess what, the same is often true for your tooth. Cracks can go vertically or horizontally. Vertically, there’s no saving it and that tooth has to come out and will need to be replaced with an implant or bridge. Horizontally we can sometimes save them with crowns and root canals but the tooth is vulnerable forever. Again, these are expensive repercussions that can easily be prevented with a bite guard. Make sure you use one made by a dentist though–if they aren’t calibrated they can introduce more problems than they prevent, but that’s fodder for another blog. I know this probably sounds like I’m trying to talk myself out of a job, but I have a feeling there will always be people who are lazy about flossing, disregard the advice of their dentists, chomp on almonds, and practice the dark arts of low-giene…but you can’t say I didn’t try to warn you. And if you ever complain to me about the cost of dentistry, be ready to hear my response of, “You know what’s a much more affordable option? Floss.”

-Andrew S. Currie, DMD, MS