As a dental hygienist, I am constantly asked by my patients which toothpaste is the best. The number of choices available today certainly can be overwhelming, but my answer is always the same. It's not the toothpaste you use, but how you brush that makes all the difference.

Plaque is the cause of everything bad that can happen in your mouth: cavities, gingivitis and gum disease. It has even been linked to serious systemic conditions such as heart disease, stroke and diabetes. Thorough removal of plaque is so important for the health of your mouth and as well as your whole body.

One secret to brushing better is brushing longer. It takes a minimum of 2 minutes to adequately clean all your teeth. Most people brush for 30 seconds. Use a timer if you have to but don't skimp on brushing time. Also, it is very important to clean between your teeth. Over 40% of you tooth's surface is between the teeth. If you are not doing something to clean this area, you are missing nearly half of all your teeth's surfaces. Floss is usually the best choice for this but there are other implements available that can do the job. Just ask your hygienist.

So find toothpaste that you like and enjoy using, brush longer and clean in between. It will not only benefit your oral health but your total body health.

Written by Kathy C

Halloween is fast approaching, and we know the kids love to trick or treat and load up on the goodies. While it is all in good fun, and only once a year, it might be wise to think about what exactly your kids will be loading up on. Candies loaded with processed sugars and corn syrup are non-nutritious, high in calorie content, raise blood sugars, and help destroy your child's teeth. Some suggestions:

Limit your child's stash. Have your child pick out some of his favorite candies and chuck the rest.
Have your child eat his treat after dinner, like a dessert. Then have him brush his teeth before bedtime.
Put a time limit on how long your child can keep the treat. If not eaten by a certain date, throw the candies into the trash (or you can hide them until next year).

At our office, we are offering a candy "buy-back" program. For all children that bring in their Halloween candy, we will give them a $10 gift certificate to a toy store. We also will make a matching donation to St. Jude’s Hospital for the care of children with cancer.

Enjoy the holiday, but remember good health is the best treat of all.

I get a lot of patients who come to my office for 2nd opinions wanting to know if their previous dentist messed up, misdiagnosed, or was just plain incompetent.

A lot of issues between patients and doctors are due to miscommunication. The doctor is not listening to the patient, and the patient does not understand the treatment he is receiving. Another issue is when the patient is not happy with the results and feels the doctor has delivered substandard care. This is usually due to unrealistic expectations by the patient, and the doctor not communicating the limitations of the treatment to be rendered.

Like any other profession, dentistry has all types of practitioners. Most are excellent technicians. Some are superlative. Others seem to have limited skills.

How do you find an excellent dentist? Ask a lot of questions about any treatment you will be receiving. Also, ask the doctor if he has been taking continuing education on a consistent basis. Many superior dentists do indeed continue to learn and grow through continuing education. Dentistry is constantly changing with technology improving yearly. Make sure your dentist is up to date. Does he use digital x-rays? Is he fluent in the new procedures you're interested in?

As far as trusting your dentist, let me say this: I would say the great majority are extremely trustworthy. Dentists do not need to "make up" work. There are too many downside risks. Make sure you communicate with your dentist before starting treatment to eliminate results that may not meet your expectations. If your dentist does not communicate well, find a new dentist.

Teeth whitening or dental bleaching is a way for you to make your teeth whiter by chemically changing the color of your teeth. You are a candidate for this procedure if you have healthy teeth with few fillings and healthy gums. If you have existing crowns, caps or veneers on your teeth, these teeth will not respond to bleaching.

Teeth with more yellowish tones respond better to bleaching. Teeth that are gray or are very dark do not respond as well. If you have tobacco, coffee or red wine staining on your teeth, it's best to have your teeth cleaned professionally before bleaching.
Bleaching, if done correctly, can whiten your teeth between 4 and 9 shades. It can produce a very positive result in your smile.

There are basically two methods to whiten teeth: bleaching gel and laser, or light activated bleaching. Both methods use oxidizing agents such as hydrogen peroxide or carbamide peroxide to lighten the shade of the teeth. The amount of whitening achieved is dependent on the strength of the bleaching agent in the gel.

If you use the bleaching gel option, you will need a tray that fits snugly around your teeth. You then put the gel in the tray, and wear the tray once a day for 15-20 minutes. You repeat this process as often as you would like to acquire a shade that works for you. However, beware of teeth sensitivity, which is sometimes a by product of bleaching gels. If your teeth do indeed become sensitive, you would discontinue the use of the trays until the sensitivity diminishes.

Over the counter bleaching gels are usually weaker in strength than gels dentists are licensed to distribute. Also, the "one size fits all" trays that you get in over the counter products can be ill-fitting, causing the gel to irritate the gums and soft tissues in your mouth. The gel will work better if you get a custom tray made for you from a dentist.
The gel will stay on your teeth longer, and you probably will not get gum irritation.

Laser, or light activated bleaching utilizes light energy to accelerate the process of bleaching in the dental office. The dentist or his staff will cover your gums with a protective coating, and then apply the bleaching material to the teeth and use a light or laser to activate the bleaching material. In office bleaching usually takes about 1 hour.
You will see the results immediately after this procedure. Your teeth can be sensitive after this procedure, but the sensitivity usually lasts less than 24 hours.

In our office, we use the Zoom II system, and we find it works great. But there are other systems out there like BriteSmile that also work well.

Whitening is not permanent. People who expose their teeth to foods and beverages that cause staining (i.e. red wine, coffee) will see the whiteness fade in as little as 1 month.
If this happens, you can re-bleach the teeth to regain the whiter color. In our office, we give all our patients custom take home trays to use with a gel after getting the light activated bleaching (Zoom II). This way, if the whitening fades over time, they can recharge their smile by re-bleaching with the gel at home.

You've probably heard of someone complaining of TMJ pain, or have experienced it yourself. What is it? The TMJ is the joint where the upper and lower jaws meet. Temporomandibular disorders can represent a wide array of head pain problems such as: ringing in the ears, clicking or locking of the jaw, headaches, and pain on the sides or back of the head.

What causes TMJ pain? The New England Journal of Medicine writes: "the cause is considered multifactorial, with biologic, behavioral, environmental, social, emotional and cognitive factors, alone or in combination, contributing to the development of signs and symptoms of temporomandibular disorders."

Whew, sounds like almost anything can cause TMJ pain. In my experience, the most common causes are clenching of teeth, grinding at night when asleep, or oral habits like frequent gum chewing. The majority of people with TMJ symptoms are women. Some studies put the number at 90% of cases reported are from female patients. The most common TMJ problem is known as myofacial pain disorder, a neuromuscular problem of the chewing muscles characterized by a dull, aching pain in around the ear that may radiate to the side or back of the head.

What are the options to treat TMJ? Resting the jaw is paramount. You want to give the joint and surrounding muscles time to recuperate. Your dentist can construct a custom mouth guard for you to wear at night to prevent you from clenching or grinding your teeth in your sleep. Heat applied at the side of the face also helps, as well as nonsteriodal anti-inflammatory medications for up to 2 weeks. In more painful cases, some patients are helped by a low dose antidepressant or antianxiety medication. If you're under a lot of stress, stress management can do wonders to rid yourself of the myofacial pain. Sometimes, physical therapy to retrain the positioning of the head, jaw and tongue can also help. Certain jaw exercises can help diminish the discomfort. Obviously, you will want to cease any oral habits like gum chewing or biting your fingernails.

These treatments mentioned above will help alleviate probably 95% of all TMJ issues.
If further treatment is necessary (and this is very rare), I would recommend visiting a multidisciplinary temporomandibular clinic, found at many leading hospitals and dental schools.

This is another question I get asked frequently. What is an amalgam filling? It's basically a combination of different metals, including about 50% mercury. Studies have shown that that over time, fillings lose their mercury content. The longer the fillings are in your mouth, the higher the amount of mercury will be released from the fillings. Studies also have shown that mercury vapor is released every time you chew and subsequently, concentrations of mercury levels do indeed increase in your bodies' tissues.

The American Dental Association's stance is that amalgams are safe, and that the amount of mercury released into the body is too minute to be harmful. The ADA does not believe dentists should remove amalgam fillings unless there is existing decay around the filling. However, several states, including New Jersey where I practice, now require dentists to separate the amalgam waste out of the water before it reaches the sewer line. So, common sense dictates that amalgam fillings may be harmful and toxic to the human body. Amalgam fillings also fracture and crumble at the edges, and cause teeth to fracture due to the expansion and contraction of the mercury in the filling. On a personal note, when I remove an old amalgam filling, there is a 90% chance there is recurrent decay under the filling. This is due to the microscopic leakage that occurs along the edges of the filling.

So, should you let your dentist put in an amalgam filling? My personal feeling is no. In my practice, we have not placed mercury fillings in the last 15 years. There are many options, like composite bonded restorations that are chemically attached to the teeth, and contain no toxic metals.

Should you replace your existing amalgam fillings? My advice would be to remove old amalgam fillings that your dentist discovers to have cracks, leakage or decay. Also, if you suffer from an autoimmune disease, such as Multiple Sclerosis, studies have shown that mercury and other toxic metals in your bloodstream may exacerbate your disease. So you may want to remove existing amalgams if you suffer from these types of diseases.

There are also some over the counter products that claim to block the absorption of mercury into your body. These are usually mouthwashes that claim to have a chelating agent, or chemical that attaches to the mercury so it can't be absorbed. If you don't want to have the amalgam fillings replaced by a dentist, these mouthwashes may be an option. However, the evidence is inconclusive as to the efficacy of these products.

I get asked that question all the time. Let's go through the options. Let's say your teeth are in good shape. No big fillings, no existing caps or crowns. But they are crooked, or you have spaces between your front teeth. You can usually do one of these four options:

Invisalign- This is a state of the art process that uses clear aligners to move the teeth. It's basically clear braces. You wear the aligners 24 hours per day, and only remove them to eat or drink. They are indeed invisible, and no one will know you have them on. Depending on how much movement your teeth will need, the range of time needed to wear the invisalign aligners varies from 3 months to 2 years.

Advantages: easy to wear, no drilling of your teeth and there is better occlusion (the way the teeth meet when your jaw is closed).

Disadvantages: inconvenient when dining out & retainers have to be worn after finishing treatment.

All in all, invisalign is a great way to move your own teeth into optimal position.

Cost ranges from $2000-$5500 for simple cases.

Porcelain veneers- Veneers are thin pieces of porcelain that are fitted over the front of the teeth and chemically attached, or bonded to the teeth. Think of a fake fingernail, same idea. Veneers can be made to close spaces, or straighten crowded teeth. Also, the color of your teeth can be lightened as white as you would like. The dentist will need to prepare the teeth, which means some drilling. Then the dentist takes an impression so a lab can construct the veneers. It usually takes 1-2 weeks for the veneers to be constructed. In the meantime, your dentist will make you temporary veneers to wear so your smile looks attractive and you can eat and chew. At your second appointment, the dentist removes the temporary veneers and permanently places the lab constructed veneers.

Advantages: usually only 2 visits, beautiful results that look natural, permanency.

Disadvantages: some drilling of the teeth is necessary.

Cost ranges from $1000-$3000 per tooth.

Lumineers- Lumineers are basically very thin porcelain veneers. Because lumineers are so thin, minimal drilling of the teeth is necessary. This option is great for recessed teeth, or for someone who wants to close spaces or whiten their teeth. Because lumineers do add some bulk to the front of your teeth, you'll probably need to treat at least 6 or 8 teeth per arch.

Advantages: same as veneers without the drilling.

Disadvantages: the need to treat multiple teeth.

Cost ranges from $1000-$3000 per tooth.

Bonding- Bonding is the process of using composite material (a putty-like substance) to chemically attach to the teeth to close spaces, fix cracked or chipped teeth, or straighten teeth. The dentist applies the composite directly to the front of the teeth. Bonding can be done to match any tooth shade, or even whiten the teeth. It is usually done in one single visit, and does not require a lot of drilling of the teeth. Your dentist needs to have a "good artistic eye" to make the bonding look and feel natural. Unfortunately, bonding is not as permanent as veneers. The composite material can chip and stain. But, done right, your teeth can look great in one visit.

Advantages: done in a single visit, beautiful results that look natural, reversible in many cases.

Disadvantages: lack of permanency, can stain and chip.

Cost ranges from $200-$600 per tooth.

So, now that you know the options, you can decide which one is best for you. Or at least ask your dentist about these treatments. Your dentist needs to be certified to treat you using Invisalign, or placing Lumineers.

When you get a sore inside your mouth...what is it? Well it could be one of a few things:

Canker sores- Canker sores are small, white areas of swelling or soreness surrounded by redness. They are not contagious. The cause of canker sores is uncertain, but some research suggests that immune system deficiencies, bacteria, or viruses might be the culprits. Canker sores usually heal within one week. While there is no cure, over the counter topical ointments or gels can provide temporary pain relief. You could also ask your dentist if he has "bacteriol" which helps heal canker sores.

Cold sores- People often confuse canker sores with cold sores (also called fever blisters). Cold sores are groups of painful blisters filled with fluid that appear around the lips and under the nose. It is caused by the herpes simplex virus and usually infects a person in childhood. Cold sores are extremely contagious. They last 7 to10 days. Valtrex helps diminish the duration of the sores. You'll need a prescription for Valtrex.

Leukoplakia- Leukoplakia appears on the inner cheeks, gums or tongue and often appears as a thick, white-colored patch. It is usually associated with smoking or smokeless tobacco use. Other causes include poorly fitting dentures, broken teeth, and cheek chewing. It is extremely important to report any signs of Leukoplakia to your dentist, because an estimated 5 percent of cases can lead to cancer. Leukoplakia usually dissipates after the behavior causing it is ceased.

Candidiasis- Candidiasis is a fungal infection also called "oral thrush". Candidiasis appears as yellow-white or red patches in the mouth. It is most common in newborns or in people whose immune systems are not functioning properly. Also, dry mouth syndrome, or people taking extensive antibiotics are susceptible. People who do not remove their dentures to clean, and let the oral tissues breathe can also get candidiasis.
Antifungal medications are usually used to treat candidiasis.

Oral Cancer- Oral cancer often starts as a tiny white or red spot or sore. Sometimes oral cancer presents itself as a sore that bleeds easily or does not heal. It can affect any area of the mouth. If you have pain, tenderness, or numbness anywhere in the mouth or lips that does not go away after a week, contact your dentist. Your dentist can do a brush biopsy or us the "Veloscope" to check if your sore is indeed cancer. Remember, with cancer, early detection is the key.

There has been growing scientific evidence that poor oral hygiene boosts the risks of heart attacks and strokes. New studies link bacteria and bacterial infections as independent risk factors for heart disease.

How does this happen? If you have gum disease (and 90% of the population has some form of it), an open blood vessel from bleeding gums will give bacteria a portal to gain entry to your bloodstream. Once inside the bloodstream, certain bacteria stick onto cells called platelets, causing them to clot and decreasing blood flow to the heart.

So, while smoking, obesity and high cholesterol are the most common causes of heart disease, the importance of oral hygiene as a risk factor for heart disease cannot be overlooked.

We suggest that if you are concerned about your general health, then it is imperative to have superlative oral hygiene. This includes brushing, flossing and using a waterpik. The spray from the waterpik used with an appropriate antibacterial agent will oxidize a lot of the harmful bacteria that reside in the gums. There are up to 700 different bacteria in the human mouth. Poor oral hygiene will cause these germs to flourish.

Also, many people would benefit from more frequent dental cleanings. Many of our patients have their teeth cleaned every 3 to 4 months. As with anything in medicine, prevention is the best defense to avoid disease.

I have always wanted braces. From the time I was little. I'm not sure why, because this was before I had my adult teeth. Actually, I thought braces were a cool thing to have. I can recall watching reruns of "The Partridge Family" back in the late 70's and admiring Laurie Partridge's metal braces. You might think I was a whackadoodle, but I used to take paper clips and bend them so that they would stretch across my teeth. But I digress. That was a long time ago. I had contemplated getting metal braces when I got a full time job out of college but something held me back. My teeth always bothered me, but I think spending several years of my twenties or thirties with ugly metal across my mouth bothered me more.

The first time I met Dr. Katz was last summer during my interview for my current job. After winning him over with my stellar wit and charm he turned to me and said, "I hope I'm not going to offend you with my next question." Oh cripes, I thought, what horrible thing could he possibly have to say to me? "You're not going to tell me I'm ugly, are you?" was my retort (half joking and half not). He reassured me he wasn't and asked me, "Have you ever considered getting braces?" WOW, I have never been asked that in an interview, that was definitely a first. Were my teeth SO BAD that he noticed how crooked they were in the span of an hour? Was everyone else lying to me when they told me they weren't that crooked all these years? But then I thought this guy is a pro, of course he's going to notice crooked teeth. "Well, actually yes, I have thought about getting braces." I didn't mention my past with the paper clips for fear of losing the chance at the job. Then he mentioned Invisalign. Now, I knew all about Invisalign. I had seen commercials and articles in magazines. It looked like the perfect way to straighten your teeth without looking like a geriatric teenager. The braces are invisible, what a brilliant idea! I was totally down with it!

After I nailed the interview and ultimately got the job, I soon found myself in the chair at Emerson Dental Arts, getting the impressions done for my case. It wasn't a big deal. They put a little gummy substance in a plastic tray that you bite down on until it hardens. A couple of photos were taken plus a panoramic x-ray of my whole mouth. I then had to wait six weeks for my fifteen sets of trays to come in. Every two weeks I would switch out the current trays for the new set. I was so excited to get that first pair. I could not wait to start the process. They finally came in. I snapped them in and looked in the mirror. Amazingly, I really couldn't tell I was wearing braces. You can definitely feel them working the first few nights a new set goes in, but within a day or two they're pretty comfortable. I can't tell you how many times I've been out, and I mention to someone something about my braces and they look at me and say "what braces?" They truly have no idea I'm wearing anything. I don't think I even sound like I'm wearing anything when I speak. Another great thing about Invisalign, is that you have to take your braces out to eat. So if you want to drop those ten pounds you've been griping about, you just eat, brush and pop them back in. You can't eat once you have them in. I've lost a couple of pounds since I've been wearing them. It takes care of that pesky midnight snacking problem I've always had. Also, soda or anything sugary is forbidden when you're wearing them, so if you need to kick a soda habit, this is perfect.

One of the truly nice things about Invisalign is that you can take the braces out, it's an option you just don't have with metal braces. So if you were going out to dinner on a date, you could remove them and pop them back in at home. Imagine how embarrassing it would be to have half your meal left in your metal braces after you've finish eating it? As an adult, Invisalign is perfect, because you don't need to show the world you're straightening your teeth. It's also great for teens because it actually works in less overall time than metal braces. Of course, every case is different and if you're interested, you should go for a consultation. I highly recommend you look into it. It really changed the way I feel about my smile.

Click image to view our latest newsletter, "Word of Mouth", for July, 2008 (PDF format).

Usually, it's a good idea to start bringing your child for his first dental visit around 3.5 to 4 years of age. A good indicator is if the child is potty trained. That usually means they have some understanding of control and can modify their behavior. A young child will usually develop 20 primary, or "baby teeth". It's important that you teach your child to brush his/her teeth as soon as possible. If they won't do it, help them with brushing, or use a washcloth to clean the teeth.
Diet is very important in avoiding cavities. Try to keep you child (I know this is very hard) away from "sticky" candies like licorice or lollipops. The sugars from these sticky foods attach to the teeth and cause aggressive decay. If your child likes sweets, fruits are a great substitution. Stay away from soda, as the acidity and the carbonation destroy teeth quickly. If you were to leave a tooth in soda overnight, it would dissolve by morning. Plus, soda has zero nutritional value.

If your child has a thumb sucking habit, or needs a pacifier to sleep, try to wean them off these habits.
The constant pressure causes the teeth to move outward, and can necessitate the need for orthodontic treatment later (braces). It can also affect their speech as well.

We recommend sealants for your child's molars. These are plastic coatings that seal the grooves in the teeth and prevent the formation of cavities that usually start in these grooves.
Once your child has been for his/her first dental visit, every 6 months thereafter is probably a good frequency to visit the dentist. The dentist can track the formation and eruption of the teeth, check for cavities, and make sure your child is developing good oral health.

Welcome to the smile file. We'll try to give you pertinent and interesting info about the dental field from the dentist's perspective. So, let's get going!

How do you find a good dentist? Obviously a referral from a family member or friend is probably the best way. But if that is not an option, here are some other ways:
Check the internet, and check websites. Does the website look like the dental office put some thought into it? Does it have before and after photos of that dentist's work?
Call the local Dental Association-for example, here in New Jersey, it's the New Jersey Dental Association base in New Brunswick.
Check the list from Consumers Research Council of America. They pick the top dentists by amount of years in practice, continuing education, and name recognition in the community.

When you find a dentist you might want to visit here are some things to look for:
How does the person answering the phone treat you? Are you just another caller, or do they listen to your concerns and answer your questions? Do they offer to give you a tour of the facility?
Do they offer you a chance to meet the dentist before any treatment is started? How does the facility look? Is it clean, modern, and up-to-date? If it's dirty with furnishings from the 1970's, chances are the dentistry is out of date. The technology has changed so quickly, you want to find an office that is on the cutting edge.

When you meet the dentist, does he let you talk and actually listen to you? Or does he just go into a monolog of what you need, and what services he wants to perform on you? Does he address your concerns and needs? A good dentist will take the time to get to know you and listen to you.
It's probably a good sign if the dentist dresses professionally, and creates a good first impression.
If he takes pride in his/her appearance, chances are he'll take pride in his work.
Ask the dentist about his education and experience. Does he keep up with continuing education? Just because he has a diploma on the wall, it doesn't mean he is current on all the new procedures available in dentistry today. Some things you can ask about are: lasers, bonding, invisalign, lumineers, implants, whitening products and all porcelain restorations. We'll go into some of these things at a later date.

When a treatment plan is given to you, make sure you understand your financial obligations. Are they presented clearly to you?

Remember, you'll get what you pay for. If you go to a dentist looking to spend as little as possible, chances are you'll get inferior service. Like anything else in life, better quality usually means more expense. So you need to determine how important your oral health is to you. We'll also discuss this in a future episode.

Hope some of these ideas help.