A guest post by Eva Twardokens (the famous “Eva T.”): two-time Olympian, coach, and Registered Dental Hygienist
As promised in Part 1, I am going to elaborate on the basic advice I gave you there, and share with you the most important information I have learned in the last ten years of my dental hygiene career. This is information and advice I would give to my best friends and family.
Today, I will talk about periodontal disease, a prevalent and silent inflammatory inducer, as well as homecare tools and medicaments to make your life easier. I hope this information will help you through your dental journey with a little more empowerment.
Periodontal disease is the breakdown of the three supporting structures that hold your teeth in your jaw—the cementum, periodontal ligament, and jawbone. The cementum is mineralized connective tissue that covers the roots of the teeth and serves as an anchor for the periodontal ligament, which in turn suspends and holds the tooth in its bony socket and acts as a shock absorber to cushion the impact of chewing. The jawbone is of course, the foundation of your teeth.
A precursor to periodontal disease is gingivitis. This condition is characterized by inflammation of the soft tissue surrounding the tooth. However, while gingivitis is an infection, periodontitis is an auto-immune disease.
Destruction of the periodontium is caused by an overactive immune system calling in white blood cells to the infected area. The white blood cells act on the culprit, but cause damage to healthy tissue as well. On a chronic basis this breaks down all of the periodontal structures, leaving gaps for more bacteria to accumulate. The deeper the gaps, or pockets, the more apt the bacteria are to become anaerobic (oxygen fearing), so they run for cover by going deeper and causing further damage.*
*How does one avoid this scenario? As mentioned in part 1, the first step is periodontal charting and getting your teeth cleaned at least three times a year.
Treatment of Periodontal Disease
If you have periodontal probe readings less than 6 millimeters, the dentist might prescribe a treatment called “root planning.” The hygienist will inject a local anesthetic and then clean either half or one quarter of your mouth at a time. She will then do a deep cleaning with the goal of removing deep bacteria, plaque and tartar, and any dead or halfway healed tissue (granulation tissue). This will give your periodontium the optimum chance to heal, and your pockets a chance to shrink. This process will take two to four appointments.
If you have periodontal probe readings greater than 6 millimeters, the ability of the hygienist to reach areas greater than 6 millimeters deep is unlikely. Failure to reach the base of the pocket can stir bacteria up causing the shallow tissue to heal and tighten up and the missed area to become inflamed resulting in a periodontal abscess. At this point, you will probably need a referral to a specialist called a Periodontist.
The bottom line is to have healthy supporting structures to keep your teeth in your head! Create a milieu for healing and health through maintenance, consisting of regular visits to your hygienist and adherence to a daily homecare protocol.
Don’t think you are fooling the hygienist by flossing like a madman two days before your cleaning. She will know what you’re up to by observing the condition of your tissue, the amount of bleeding you have, and the amount and location of tartar and plaque buildup.
Statements like “my gums always bleed” and “my bad teeth are genetic” are just like saying “I have diarrhea every day” and “I am fat because my grandfather was.” Take some responsibility and realize that if your gums are bleeding there is an underlying problem; 99% of the time it will be residual plaque.*
*The difference between plaque and tarter are that plaque is removable and soft, whereas tartar is a calcified version of plaque, and occurs when plaque is left untouched for around 24 hours or so.
That is why the term “daily” is used—so you rid yourself of the debris on your teeth before it becomes a carpal tunnel situation for your hygienist!
Five Jewels of Prevention
Mouthwash. First, do not use mouthwash in place of flossing. Most importantly, stay away from alcohol-based products, as the incidence of oral cancer is higher in folks who use alcohol based mouthwash than those who don’t. Alcohol-based mouthwash is also an irritant and also causes dry mouth. Stick to non-alcohol mouthwash if you decide to incorporate this into your daily regimen.
Tongue cleaners. Yes, a clean tongue is important, and tongue cleaners are good. However, you can save money by just dragging your floss down your tongue and cleaning it that way.
Fluoride. Many people fear fluoride. They say it causes their bones to get brittle, and won’t allow their children to have it. What I see in kids not getting fluoride is a lot of decay and lifelong visits to the dentist full of injections, fear, drilling, and pain. In the end, the trade-off is significantly poorer oral health for what amounts to a minute amount of fluoride.
What about adults and fluoride? Well, I see a lot of crown replacements in the folks that insist on “natural” toothpastes, and that involves the same kind of consequences. It is a cost/benefit situation similar to x-rays. A little of the perceived “bad” goes a long way for good!
For kids with undeveloped teeth, they must have some systemic fluoride (they must ingest it, so talk to your dentist for a prescription). For adults, topical fluoride is all that will work. I really like “ACT” rinse for everyone. Follow the directions on the bottle, please.
Toothbrush. Use a soft one, always. All other brushes are only good for scrubbing tile grouting and will scratch your teeth! Electric toothbrushes are great, but not the cheesy spin brushes. Sonic types are best, but don’t push too hard. You need to let them vibrate to work, so don’t squish the brush against your teeth. A “flute-like” grip is best.
Floss. The diamond of the jewels. The thicker and more yarn-like the floss, the better. The objective of a good floss is not that is slides between your teeth, but that it removes plaque efficiently once you get it there. I know Costco has cases of “Glide” for a great deal, but use it to sew up the holes in your socks, because this stuff is, for the most part, downright ineffective. I am not even going to debate this. So there.
Stay Tuned for Part 3
In Part 3 of this series, I’ll be talking about the materials that a dentist uses, root canals, and my thoughts on dental insurance—when and when not to take advantage of it.
Eva Twardokens (also known as “Eva T.”) is a two-time Olympian and six-time National Champion in Alpine Skiing. In 2012, she was inducted into the U.S. Ski and Snowboard Hall of Fame. She graduated from Cabrillo College Dental Hygiene School in 2001 and has been practicing in a general dentistry setting for 12 years. She teaches her patients how to aquire oral health, and how good oral hygiene practices contributes to overall health and quality of life.
She is also the founder of Eva T. Strength and Conditioning, a consulting site encouraging strength, health, and happiness through the integration of lifestyle choices, exercise, and functional medicine.