Brosy Family Dentistry

Charcoal Toothpaste

You can't walk down a toothpaste aisle or scroll through your social media feed without seeing ads for charcoal toothpaste. It started off in natural oral care product lines as an alternative to traditional whitening products. It quickly became popular and the more mainstream companies jumped on the wagon. So, how do they work and is it worth all of the hype...and the potential mess?

Charcoal toothpastes contain activated charcoal. Activated charcoal is a form of carbon that has been treated to make it's surface rough and porous. The rough surface scrubs stains away while the porous areas attract and grab onto the particles that have been removed from the tooth's surface. Charcoal toothpastes work well on surface level extrinsic stains, but they do not have the ability to change intrinsic stains. Most product comparisons show that charcoal toothpastes are more effective than other popular whitening toothpastes at removing stains. The high efficacy comes from the abrasiveness of the activated charcoal. It is important to use charcoal toothpastes sparingly and not more than 1-2 times per week. If used too often, the abrasiveness of activated charcoal can cause irreversible tooth damage and sensitivity. Bottom Line: Charcoal toothpaste is safe/effective when used sparingly.

There are two types of tooth stain, extrinsic and intrinsic. Extrinsic stains are those that sit on the surface of the tooth. These stains are typically caused by food and drinks such as coffee, tea, wine, and berries. Extrinsic stains are not incorporated into the tooth structure, therefore they can typically be removed by brushing and/or by your hygienist during your professional dental cleaning. Intrinsic stains are those that have become incorporated into the actual tooth structure. These stains can also be caused by food and drinks, as well as medication and some health conditions. Intrinsic stains cannot be removed by brushing or scaling done by your dental hygienist. Intrinsic stains require bleaching procedures to be lightened and removed.


Diving Deep into Scaling and Root Planing

Routine dental cleanings are done to prevent gum disease and maintain optimal oral health. But, what happens when you fall off of the prevention wagon or when you have a troublesome area of periodontitis (aka gum disease)? If you have areas of moderate to heavy calculus build-up, deep gum pocketing, inflammation, and/or bleeding, your dental hygienist may recommend scaling and root planning.

To understand why scaling and root planing is sometimes necessary, it's important to understand the different levels of gum disease. Gum disease can be split into two main categories: gingivitis and periodontitis. Each category can be broken down into mild, moderate, and severe forms. All forms of gum disease are influenced by a variety of factors. Oral hygiene, diet/nutrition, genetics, drug and alcohol use, frequency of routine dental care, and systemic health conditions all play a role.

Gingivitis is defined as inflammation of the gum tissue without loss of supporting structures such as bone, periodontal ligaments, and marginal gum tissue. According to the American Dental Association, almost 100% of people will experience gingivitis in their lifetime. Poor plaque control is one of the most common causes of gingivitis. Gingivitis is reversible and can typically be treated with routine dental cleanings, improved oral hygiene, and over-the-counter products. If left untreated, gingivitis can progress into periodontitis.

Periodontitis is defined as inflammation of the gum tissue and support structures that has resulted in permeant damage and loss of tissue. Severity is determined by the degree of bone loss, tooth mobility, and tissue destruction. Periodontitis is typically a multifactorial process and must be addressed promptly to achieve the best possible outcome. This is where scaling and root planing comes in!

Scaling and root planning is often referred to as a "deep cleaning" because it is more involved than a routine cleaning. Often times, this means splitting the cleaning into multiple appointments. Your dental hygienist will evaluate and make a treatment plan by quadrant (upper right, lower right, upper left, lower left) to determine appointment length. You can usually plan on at least two 90 minute appointments to complete your treatment, sometimes more. You may need to be numb for the procedure to allow for all of the plaque, calculus, and debris to be removed comfortably. Don't fret! Different types of anesthetic (some topical and needleless) can be used. Once your comfort needs have been met, your dental hygienist will remove the plaque, calculus, and stain using an ultrasonic scaling device and hand scalers. The ultrasonic scaler works quickly to access hard to reach areas, remove caked on build-up, and help irrigate inflamed gum pockets. It also helps kill bacteria as it cleans which improves healing outcomes. Hand scalers leave a smooth, healthy finish to allow for healing. During the cleaning process, as well as when it is complete, it is very important to practice excellent oral home care to allow the gum tissue to heal. You will typically return in 6-12 weeks for a follow up appointment. At this appointment, your dental hygienist will likely do a thorough periodontal maintenance cleaning and evaluate overall healing. He or she will also determine what type of routine cleaning you need moving forward.

Stopping progressive gum disease in it's tracks is the only way to prevent further destruction. Calculus build-up under gum tissue creates a similar situation to a splinter buried deep in a finger. If you let the splinter stay stuck under the skin, an infection develops and it will continue to worsen until the splinter is removed. The calculus must be removed for the gum tissue to heal to the best of it's ability. The sooner you get started, the better the outcome. You'll never regret taking steps towards better health.


Life with an Implant-Supported Denture

Denture life can be rocky (pun definitely intended), but there is an option that may help with the ups and downs!

A regular denture sits on top of the gums and does not attach to any type of support structure. The lack of support can cause rocking or slipping when you eat, cough, or simply take a deep breath! An implant-supported denture snaps onto dental implants that are permanently placed into the jaw. The implants act as anchors to stabilize and secure the denture. It can be snapped in and out for daily oral care.

There are two types of implant-supported dentures:

Bar-retained: A thin, horseshoe shaped metal bar is attached to at least two implants that have been placed into the jawbone. The denture fits over the bar and is clipped into place by metal attachments

Ball-retained: Each implant has it's own attachment to the denture. The attachments are ball or peg shaped and they fit into sockets on the denture.

In both types, the denture will be made of an acrylic base that will look like gum tissue. Porcelain or acrylic teeth are adhered to the base. The base has metal attachments that snap onto the implants.

The Process

Once you and your dentist decide that an implant-supported denture is the way to go, the first step is placing the implants. This step is often done by a dental specialist (periodontist or oral surgeon) and involves placing the implants in the jawbone. An incision is made in the gum and a hole is drilled in the bone. The implant is placed into the hole and the incision is stitched closed. This implant will typically need 3-6 months to fully integrate into the jawbone before the next steps can take place. During this time the incision heals over and oral care continues as usual.

After the initial healing period, your dentist will take an x-ray to determine if the implants have fully integrated into the jawbone. Next, a small incision will be made in the gums to expose the implants and place healing caps on top of the implant screws. These healing caps stay in place for 10-14 days and train the gum tissue to heal around the future abutments (the part that the denture will snap onto). The healing caps are then removed and the abutments are placed.

Now that the implants are all set, your dentist will take an impression of your gums/implants to make the denture. Most labs take around 2 weeks to build the denture. You will need to return to your dentist a few times to try-in and adjust the denture for an optimal fit.

Life with an Implant-Supported Denture

Game changer! You will likeky experience more stability and support now that you have implants supporting your dentures. We hope that this allows you to eat, drink, and be merry!

Implant-supported dentures should be removed daily to clean the denture, abutments, and gum area. Most dentures can be brushed just like natural teeth. Same goes for gum tissue, implant abutments, and your tongue. Just as with regular dentures, you should not sleep with the implant-supported dentures at night. Your gum tissue needs time to "breathe"! Dental implants can fail and become loose if they are not cleaned properly. You should remain on a regular cleaning schedule with your dental hygienist to maintain optimum oral health. Oral cancer screenings should still be done at least once a year.

If you are tired of the ups and downs of life with a traditional denture, talk to your dental care providers about the option of an implant-supported appliance! It may make your life a whole lot less...rocky.

*all photos are for example only - individual results always vary


10 Quick Facts About Oral Cancer

Oral Cancer 2019

April is Oral Cancer Awareness Month. This month, we shine the light on cancers that invade the lips, mouth, and throat. No one wants to think about oral cancer, but knowledge is power and it just may save you or someone you love. #oralcancerawareness2019 #savealife #themoreyouknow

  1. More than 53,000 people in the United States will be diagnosed with oral cancer in 2019. That number is rising 3% each year. Over half a million cases will be diagnosed worldwide this year.
  2. Most oral cancers have around a 60% five year survival rate, depending on the stage at diagnosis. Nearly 10,000 Americans will lose their battle with oral cancer this year as it kills one person every hour in the United States alone.
  3. Oral cancer is more common in men than women and in people over 40, however, the fastest growing group of new oral cancer diagnoses is made up of healthy, non-smoking people under 45.
  4. Tobacco use (including cigarettes, chew/snuff, and vaping), alcohol use, and a diet low in fruits/vegetables all increase your oral cancer risk.
  5. When you combine tobacco with heavy alcohol use, your risk is significantly increased, as the two work synergistically. Those who use tobacco products and drink have a 15 times greater risk of developing oral cancer compared those who don't.
  6. The Human Papilloma Virus (specifically HPV16) is the most common cause of oral cancer in people under 45. HPV16 is transmitted through bodily fluids and is the same viral strain that is associated with cervical cancer.
  7. Like with most other cancers, oral cancer outcomes are best when it is detected and diagnosed in the earliest stages.
  8. Oral cancer lesions can be painless and seem unnoticeable in early stages. The most common sign/symptom is a red or white patch, sometimes similar to a canker sore, that will not heal.
    Other symptoms include; a painless lump or mass which can be felt inside the mouth or neck, pain or difficulty in swallowing, speaking, or chewing, any wart-like masses, hoarseness which lasts for a long time, or numbness in the oral/facial region.
  9. Treatment options depend on location and stage of the cancer but typically involve a multidisciplinary approach between your general dentist, an oral surgeon, as well as medical doctors. Surgery, radiation, and chemotherapy are often needed in conjunction with lifestyle changes.
  10. Information on oral cancer can be scary and overwhelming. The good news is that preforming regular self checks and having routine dental exams at least twice a year greatly increases the chance of finding oral cancer in the earliest stages, which typically leads to the best possible outcome.

For more in depth information on oral cancer, click here:


Which Toothpaste is Best?

In a world of different toothpastes, what do 9 out of 10 dentists recommend? Why is there always one practitioner that never agrees with the group? Which toothpaste do they pick?

First, let’s look at what makes up a tube of toothpaste. Most contain mild abrasives, stannous fluoride, glycerol like substances, flavoring agents, sodium lauryl sulfate, water, phosphate, and other inactive ingredients.[1] The goal of combining these ingredients is to reduce the formation of biofilm. The biofilm that forms over teeth is made up of food particles, bacteria, and substrates in your saliva. Formation of this film allows bacteria to form a home on the surface of your tooth. Without mechanical removal this film will continue to grow and can cause cavities[2].

It is very important to look at which ingredients make up the toothpaste you use. Many patients exhibit allergic reactions to sodium lauryl sulfate and require a toothpaste free of this ingredient. The ingredients added to increase water retention vary between products as well as the ingredients to create a mild abrasive.

I believe that the best toothpaste is based on individual preference, effectiveness, and use. Many patients dislike the taste of certain brands. Others feel their mouth is not as clean with different flavors. To find the “perfect” toothpaste one should look at ingredients, but most importantly one should be using a toothpaste that will encourage brushing for two minutes twice a day.

[1][2] Action of food preservatives on 14-days dental biofilm formation, biofilm vitality and biofilm-derived enamel demineralisation in situ. Arweiler et al. German Society of Dental, Oral and Craniomandibular Sciences. 02 Aug 2013


To Floss or Not to Floss...

...That is the question!

You know how to get people talking about flossing?  Publish a report that tells them that they don't have to floss! Over the past month we have had more people bring up the subject of flossing than we have over the past year!  So let's break it on I don't mean MC Hammer style!

Many, many moons ago in 1819 a New Orleans dentist by the name of Spear Parmly published a book called A Practical Guide to the Management of Teeth. Dr. Parmly recommended interproximal flossing with waxed silk to dislodge food particles and bacteria.  He noticed a difference in patients who regularly removed plaque that was not accessible by tooth brushing alone and wanted to share his fancy findings with the world! Not long after that, Johnson and Johnson patented the first dental floss product. A dozen packs of floss for $1.50! Jiminy Cricket, who can beat that!?!

In 1979 the US Government added flossing into the Surgeon General's Report for Healthy Living, and later, into the Dietary Guidelines for Americans. Recommendations in these reports are required by law to be backed by evidence-based scientific research. Hygienists everywhere jumped for joy and spread floss samples to the masses!  Less gingivitis! Less bad breath! Less bleeding, less cavities, more teeth saved by prevention! Hooray!

Last year, the Associated Press (AP) asked the Health and Human Services and Agriculture for the evidence behind the recommendation, then later submitted written requests under the Freedom of Information Act. The AP looked at the flossing research that spanned the last 25 years and concluded that it was "weak, somewhat unreliable, and had a moderate potential for bias".  The US Government removed the flossing recommendation for the time being until current evidence-based research is available.

So what does this all mean?  I welcome you to listen to the perspective of someone who is elbow deep in plaque, calculus, and gum disease daily...your hygienist!  There is ABSOLUTELY a difference in the oral health of those who floss versus those who do not.  Even the best toothbrushers in the world do not compare to those who floss with proper technique on a daily basis. Hands down, people who floss have less inflammation (which deserves a blog post all it's own!), less cavities, better breath, and better overall oral health. Believe it or not, we can actually tell if you are flossing or just telling us that you are.  Wink, wink...don't fib to your hygienist! If it didn't make a difference, we wouldn't be able to easily pick out flossers from non-flossers. 

Still need your own proof?  Here is the challenge! Don't floss for 10 days.  Yes, you just heard a hygienist tell you not to floss for 10 days!  Brush, use mouthwash, whatever floats your boat, just no floss.  On the eleventh day, floss!  Make sure you get each surface and reach below the gum tissue. Look at the floss after each tooth.  If you really want proof, smell the floss after each tooth.  That, my friends, is the bacteria that has been globbing together and setting up camp between your teeth and under your gums.  Notice that some places may bleed, that is from inflammation that has set in.  If left to work it's magic, the bacteria will produce enough acid to cause a hole in the tooth.  That's right folks, a good 'ol cavity!  The bacteria gets into your bloodstream and stirs up inflammation around the rest of your body. All of this can be prevented with something that is cheap, fast, and easy! 

The answer to the pressing question...YES, floss.  Although, we do love spending time with you.  If you want to hangout with us more often, try the non-flossing route! Until next time, happy flossing!

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