We all encounter biofilm in daily life. If you have been wondering what biofilm is, or what dental plaque is made of, this article will provide clarification.

Biofilm contains bacteria and other microbes

Biofilm is a sticky substance that forms in moist environments, such as ponds, pet water bowls, and the human mouth. Dental biofilm, commonly known as plaque, adheres to the teeth and other oral tissues such as the tongue. Plaque is sticky and contains food particles. Dental biofilm also contains bacteria and other germs, such as viruses and fungi ^[2][4]. In fact, the COVID-19 virus is present in the biofilm of people with active, symptomatic cases of COVID ^[2]. Both good bacteria and bad bacteria comprise the oral environment. Bad bacteria in the oral microbiome are usually anaerobic (meaning they do not need air to survive) ^[1][5]. Good bacteria have a protective role in your oral health.

It forms quickly

Dental biofilm begins to form within minutes of brushing and flossing your teeth. Most people develop biofilm above the gumline at about the same rate ^[7]. However, people who have gum disease develop bad bacteria below the gum line at a faster rate than those with healthy gums ^[7].

It causes bad breath

Bacteria produce acid and other byproducts as it digests the foods and beverages you eat and drink. The bacteria and its waste products emit an unpleasant odor, which is a key factor in bad breath. Your oral pH can contribute to the formation of biofilm (bad bacteria love acidic environments), so your diet and other oral factors influencing pH may be making your bad breath worse ^[6].

It damages your teeth

Acid is a key factor in cavity formation, and the production of acid in the mouth is a vicious cycle. The more bad bacteria you have in your mouth, the more acidic your oral pH. The more acidic your oral pH, the more the bad bacteria grow and reproduce ^[6]. Teeth are made of minerals, and all this acid eats away at the calcium and phosphate in your enamel and tooth root surfaces ^[6]. With weakened tooth structure, cavities form.

It damages your gums and bone

The bad bacteria in your oral microbiome also damages your gums and the bone underneath. It hides underneath the gums in areas that your toothbrush may not be able to reach and actually makes its way through the gum tissue. The bacteria can even end up on the bone that surrounds the teeth. All of this bacterial invasion causes the immune system to respond, which ultimately causes permanent damage to the bone. The bone slowly begins to recede, leaving less and less supporting structure for the teeth ^[3].

It needs to be removed

As you now know, dental biofilm needs to be removed to prevent dental disease like cavities and gum disease. Twice daily removal of dental biofilm is recommended with brushing and flossing along with plaque disclosing tablets or other techniques your dental care professional recommends for you. Look for our other articles on how to protect your teeth and gums with effective oral home care!

Rachel Stroble

Rachel Stroble is a researcher, professor of dental hygiene at Rose State College in Oklahoma, and registered dental hygienist with 10 years of experience in dentistry. She supports education in the classroom with her own students, in the professional community through the development and presentation of continuing education courses, and you may have seen her articles in RDH Magazine, Today’s RDH, and the Oklahoma Dental Association Journal.

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References

1. AGGREGATIBACTER ACTINOMYCETEMCOMITANS – AAP Connect. (n.d.). Higher Logic, LLC. Retrieved September 17, 2022, from https://members.perio.org/libraries/glossary/entry?GlossaryKey=7601a9b2-e9ce-42dc-b36d-83059e33ac32&ssopc=1
2. Gomes, S. C., Fachin, S., Fonseca, J. G., Angst, P. D. M., Lamers, M. L., Silva, I. S. B., & Nunes, L. N. (2021). Dental biofilm of symptomatic COVID‐19 patients harbours SARS‐CoV‐2. Journal of Clinical Periodontology, 48(7), https://doi.org/10.1111/jcpe.13471
3. Lasserre, J. F., Brecx, M. C., & Toma, S. (2018). Oral Microbes, Biofilms and Their Role in Periodontal and Peri-Implant Diseases. Materials, 11(10), https://doi.org/10.3390/ma11101802
4. Matsumoto-Nakano, M., (2018). Role of Streptococcus mutans surface proteins for biofilm formation. Japanese Dental Science Review 54(1), http://dx.doi.org/10.1016/j.jdsr.2017.08.002
5. PORPHYROMONAS GINGIVALIS – AAP Connect. (n.d.). Higher Logic, LLC. Retrieved September 17, 2022, from https://members.perio.org/libraries/glossary/entry?GlossaryKey=965ec455-2938-4d54-9947-196ea454164b&tab=groupdetails&ssopc=1
6. Tarcísio Jorge Leitão, Jaime, A. C., & Livia Maria Andaló Tenuta. (2018). Kinetics of calcium binding to dental biofilm bacteria. PLoS One, 13(1) https://doi-org.argo.library.okstate.edu/10.1371/journal.pone.0191284
7. Uzel, N. G., Teles, F. R., Teles, R. P., Song, X. Q., Torresyap, G., Socransky, S. S., & Haffajee, A. D. (2011). Microbial shifts during dental biofilm re-development in the absence of oral hygiene in periodontal health and disease. Journal of Clinical Periodontology, 38(7), https://doi.org/10.1111/j.1600-051X.2011.01730.x

The post What is biofilm? appeared first on Smile Brilliant.

The effect of sugar on your mouth

Sugary foods and drinks can wreak havoc on your oral health. The bad bacteria that live in your mouth love sugar! They metabolize it and create acid as a by-product^[4]. Even among sugary foods, not all are created equal. Sticky foods such as gummy candies stay in the mouth longer because they adhere to your teeth. Also, many sugary foods and beverages are also acidic. For instance, sodas and energy drinks are very acidic. This is the perfect storm—the bad bacteria that love sugar also love acid! In this environment, these bacteria grow and multiply quickly. Acid leaches minerals out of your teeth and encourages cavity formation as sugar promotes bacterial growth.^[3]. Furthermore, even though diet drinks may be sugar-free, they are often still quite acidic. It’s a good idea to treat them as if they contain sugar, in terms of how you consume them, to reduce your risk of cavities.

How acid damages your teeth

Acid is the enemy of teeth. Our teeth are made of minerals, primarily calcium and phosphate, and acid actually dissolves these minerals out of the tooth enamel, leaving the teeth weak and demineralized ^[5]. After an area of your enamel is demineralized, the bacteria are able to move deeper into the tooth, where they secrete more acid. This is how cavities form. The bacteria are basically burrowing into the teeth, destroying tooth structure as they go. To make matters worse, the more acidic your mouth is, the more bad bacteria you probably have. The more bad bacteria you have, the more acidic your mouth becomes!

Frequency and duration of consumption matter

Yes, what you eat and drink does matter! However, did you know how you consume it makes a difference too? If you are sipping on a sugary drink over a long period of time, you are essentially bathing your teeth in acid. Even if you aren’t drinking a large amount of the beverage, frequent exposure means that your teeth suffer a more prolonged acid attack ^[2]. Let’s all be honest. Most people are not going to be swearing off candy and soda altogether. Enjoy your snacks, but enjoy them in moderation, and in one sitting (20 minutes or less). It’s also a good idea to drink water when you are finished to help rinse away residual food debris and sugar.

Good oral hygiene helps

One of the best things you can do to prevent dental disease, including cavities, is to keep your mouth clean! Brushing and cleaning in between your teeth by using floss, a water flosser, or interdental brush, dramatically decreases how much bacteria is in your mouth because you are removing biofilm (plaque). Ideally, everyone should brush twice per day and clean between their teeth once per day. The lower the level of bad bacteria you have, the lower your risk of cavities and gum disease ^[4]. Additionally, chewing sugar-free gum after consuming sugary foods or drinks helps to stimulate saliva flow. Saliva helps to neutralize the pH of the mouth and rinse away some of the residual sugars and food particles ^[1]. You don’t have to give up sugar for the sake of your teeth, but you can be smarter about how you consume it!

Rachel Stroble

Rachel Stroble is a researcher, professor of dental hygiene at Rose State College in Oklahoma, and registered dental hygienist with 10 years of experience in dentistry. She supports education in the classroom with her own students, in the professional community through the development and presentation of continuing education courses, and you may have seen her articles in RDH Magazine, Today’s RDH, and the Oklahoma Dental Association Journal.

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1. Dodds, M., Roland, S., Edgar, M. et al. Saliva A review of its role in maintaining oral health and preventing dental disease. BDJ Team 2, 15123 (2015). https://doi.org/10.1038/bdjteam.2015.123
2. Ireland, R., & Yeung, C. A., (2020) Stephan’s curve. In A Dictionary of Dentistry (2nd ed.). Oxford University Press.
3. Kulshrestha, S., Khan, S., Hasan, S., Khan, M. E., Misba, L., & Khan, A. U. (2015). Calcium fluoride nanoparticles induced suppression of Streptococcus mutans biofilm: An in vitro and in vivo approach. Applied Microbiology and Biotechnology, 100(4), 1901–1914. https://doi.org/10.1007/s00253-015-7154-4
4. Scannapieco, F. A., & Dongari‐Bagtzoglou, A. (2021). Dysbiosis revisited: Understanding the role of the oral microbiome in the pathogenesis of gingivitis and periodontitis: A critical assessment. Journal of Periodontology (1970), 92(8), 1071–1078. https://doi.org/10.1002/JPER.21-0120
5. Tarcísio Jorge Leitão, Jaime, A. C., & Livia Maria Andaló Tenuta. (2018). Kinetics of calcium binding to dental biofilm bacteria. PLoS One, 13(1)
   https://doi-org.argo.library.okstate.edu/10.1371/journal.pone.0191284

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If you have been fighting bad breath, you may have noticed that your mouth often feels dry. This is not a coincidence! Keep reading to find out how dry mouth may be contributing to your oral woes, as well as what you can do about it.

Do you have dry mouth?

Have you ever stopped to consider whether or not you have xerostomia (dry mouth)? While dry mouth is quite uncomfortable for some people, others may not realize they have it. Some common symptoms are feeling like your tongue or cheeks are sticking to your teeth (especially when speaking), a burning sensation, a change in your ability to taste foods, and a bad taste in your mouth. If you are unsure, have a discussion with your dentist or dental hygienist! They can assess your salivary flow and can help you determine if your mouth is unusually dry.

What causes dry mouth?

There are many causes of dry mouth. Do you find yourself breathing through your mouth? Mouth breathing dries out your oral environment. If you breathe through your mouth because your nose is often congested, you may talk with your doctor about treatment options. However, even if it is caused by a different problem, there may be ways your doctor can help. Additionally, consuming alcoholic beverages and using alcohol-containing products such as certain mouth rinses can dry out your mouth, further complicating the issue.
Certain serious health conditions can also cause dry mouth. In fact, it is one of the hallmark symptoms of diabetes ^[1]. If you frequently experience dry mouth, excessive thirst, and excessive urination, you should talk with your doctor about getting tested for diabetes ^[3]. Furthermore, some autoimmune diseases, such as Sjögren’s syndrome, can cause dry mouth. Lastly, dry mouth is one of the most common effects of prescription and over-the-counter prescriptions. However, you should take your medications as prescribed by your doctor to protect your health. Keep reading for tips on how to manage your dry mouth, whatever the cause!

How does dry mouth affect your oral tissues?

Saliva is part of your mouth’s natural cleansing mechanism. When it is in short supply, food debris and bacteria collect at higher rates. Bacteria can overgrow, causing an acidic shift in oral pH ^[2]. The more acidic your mouth is, the more the bad bacteria grow, increasing the risk of cavities and gum disease ^[4]. Also, severe dry mouth causes a painful burning sensation in the oral tissues. Burning mouth can impact quality of life.

Is your dry mouth causing bad breath?

Bad breath can be caused by sinus infections or drainage, poor oral home care, oral disease, dry mouth, or an overgrowth of bad bacteria (4). If you suffer from dry mouth, you may also experience bad breath. An unpleasant taste in your mouth is a clue that you have bad breath, or someone may have mentioned your breath odor to you.

What can you do about it?

Depending on the cause of your dry mouth, increasing your water intake can help combat dry mouth. If you are dehydrated, your saliva flow may also decrease. People with dry mouth should avoid too many alcoholic beverages as well as dental products containing alcohol, such as certain mouth rinses. Sugar-free mints and gum can help to stimulate saliva flow. Additionally, lozenges containing xylitol help to fight dry mouth as well as the bacterial overgrowth that may accompany it. If you feel that you are experiencing dry mouth, speak with your dental professional for further guidance on how to protect your oral health!

Rachel Stroble

Rachel Stroble is a researcher, professor of dental hygiene at Rose State College in Oklahoma, and registered dental hygienist with 10 years of experience in dentistry. She supports education in the classroom with her own students, in the professional community through the development and presentation of continuing education courses, and you may have seen her articles in RDH Magazine, Today’s RDH, and the Oklahoma Dental Association Journal.

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1. Carramolino‐Cuéllar, E., Lauritano, D., Silvestre, F., Carinci, F., Lucchese, A., & Silvestre‐Rangil, J. (2018). Salivary flow and xerostomia in patients with type 2 diabetes. Journal of Oral Pathology & Medicine, 47(5), 526–530
   https://doi.org/10.1111/jop.12712
2. Kulshrestha, S., Khan, S., Hasan, S., Khan, M. E., Misba, L., & Khan, A. U. (2015). Calcium fluoride nanoparticles induced suppression of Streptococcus mutans biofilm: An in vitro and in vivo approach. Applied Microbiology and Biotechnology, 100(4), 1901–1914.
   https://doi.org/10.1007/s00253-015-7154-4
3. Little, J. W., Miller, C. S., Rhodus, N. L., & Little, J. W. (2018). Little and Falace’s dental management of the medically compromised patient (Ninth edition.). Elsevier.
4. Mizutani, S., Ekuni, D., Tomofuji, T., Azuma, T., Kataoka, K., Yamane, M., Iwasaki, Y., & Morita, M. (2015). Relationship between xerostomia and gingival condition in young adults. Journal of Periodontal Research, 50(1), 74–79. https://doi.org/10.1111/jre.12183

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Tooth enamel, the outside layer of your tooth, is the hardest, most mineralized substance in your body ^[1]. It’s even harder than bone! However, it is still susceptible to wear as the teeth take an incredible amount of force each day with chewing, clenching, and for many patients, grinding. Enamel is constantly undergoing a process of remineralization and demineralization. Let’s discuss what this means for oral health.

What is enamel and what is it made of?

Enamel is comprised of 95% minerals, 4% water, and 1% proteins ^[1]. It makes up the top layer of the teeth and functions to protect the underlying dentin and pulp (nerve) of the tooth. While enamel is incredibly durable, it still needs to be replenished with minerals like calcium and phosphate to keep it strong ^[2]. It can also break down through the process of erosion in which one eats acidic foods, drinks acidic drinks, or has GI issues that cause acid reflux. These acids eat away at the enamel, breaking it down and exposing underlying tooth structures. While not visible, the enamel is constantly undergoing a process of remineralization and demineralization.

What is enamel remineralization?

Enamel needs its minerals replenished as they are constantly depleted through eating and drinking (especially acidic foods). This process of mineral depletion is known as enamel demineralization ^[2], and when this happens, the enamel is weakened and susceptible to decay. The oral cavity’s defense mechanism is enamel remineralization, in which the body takes calcium and phosphate from the saliva and puts these minerals back into the enamel ^[3]. This is an ongoing process as the enamel loses and replenishes minerals throughout the day with eating and drinking.

What products are good for enamel remineralization?

For the saliva to be able to put calcium and phosphate back into the enamel, it’s going to need somewhere to get it! The first source is saliva, which is why it’s important to eat a diet rich in vitamins and minerals. However, if someone has xerostomia (dry mouth) or is especially susceptible to tooth decay, there are some other ways to remineralize enamel. The first is a fluoride varnish treatment which is done in the dental office and promotes enamel remineralization as well as protects the tooth against hot and cold sensitivity. An oral probiotic is the second as a balanced oral microbiome will reduce the acidity of the pH, reducing enamel demineralization. Finally, good home care will promote remineralization as decreasing plaque biofilm will reduce places for bacteria to populate. Once enamel starts to demineralize, oral pathogens sweep in to take advantage ^[3]. If there is no plaque biofilm or acids for it to cling onto, there’s less of a chance they will cause decay.

Teeth are incredibly resilient but still need nourishment to fight decay and withstand daily forces. Nutrition, proper home care, and maintaining a healthy oral microbiome go a long way in maintaining strong enamel.

Esmy Ornelas

Esmy Ornelas is a registered Dental Hygienist, writer, educator, and consultant with 10 years of experience in dentistry. She is passionate about education, empowering hygienists to advance their careers in and out of the operatory, and about community. She has written for RDH Magazine, the RDH Graduate, and is a full-time professor of Dental Hygiene and Assisting at Rose State College in Oklahoma.

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1. Abou Neel, E. A., Aljabo, A., Strange, A., Ibrahim, S., Coathup, M., Young, A. M., Bozec, L., & Mudera, V. (2016). Demineralization-remineralization dynamics in teeth and bone. International journal of nanomedicine, 11, 4743–4763. https://doi.org/10.2147/IJN.S107624
2. Arifa, M. K., Ephraim, R., & Rajamani, T. (2019). Recent Advances in Dental Hard Tissue Remineralization: A Review of Literature. International journal of clinical pediatric dentistry, 12(2), 139–144. https://doi.org/10.5005/jp-journals-10005-1603
3. Lacruz, R. S., Habelitz, S., Wright, J. T., & Paine, M. L. (2017). Dental Enamel Formation and Implications for Oral Health and Disease. Physiological reviews, 97(3), 939–993. https://doi.org/10.1152/physrev.00030.2016

The post About tooth remineralization: can tooth enamel grow back? appeared first on Smile Brilliant.

What are cavities?

Cavities are also called dental decay or dental caries. They are caused by bad bacteria and an acidic oral environment ^[3]. Additionally, frequent exposure to sugary foods and drinks increases the risk of cavities. In the early stages of a cavity, it may appear white and chalky if it is in an easily visible area. Next, cavities may appear brown, and then black. Over time, cavities appear as a hole in the tooth. However, even if you do not see a hole in your tooth, you could have a substantial cavity! Sometimes, they start small and burrow under the enamel, causing large amounts of damage.

Do cavities always hurt?

Teeth are made of three main layers. The enamel, or the outer surface of the tooth, is the hardest substance in your body. The next layer is dentin, a slightly softer layer. The third layer is the pulp, or the nerve and blood supply of the tooth. When cavities are just beginning in the enamel, you probably won’t feel pain ^[1]. Once they progress into the dentin, you may start to have tooth sensitivity to cold or sweets. By the time most people have pain, the cavity has progressed all the way into the pulp of the tooth! If your cavity is this advanced, you will probably need more complex dental treatment. It’s also important to know that there are other dental conditions that can cause pain, so be sure to see a dentist if your mouth is hurting.

How do I know if I need a filling?

Regular preventive dental visits are important to protect your dental and whole-body health ^[4][5]! During the earliest stages of dental decay, your dental healthcare professional is your best asset in identifying cavities. X-rays and special magnification eyewear are two of the ways your dental team can detect cavities when they are still very small. During this stage, simpler treatment may be possible to repair the damage. If you have noticed that you have a hole in your tooth, you need dental care! A filling or other treatment may be recommended. The earlier you catch dental decay, the more conservative your dentist will be able to be. Depending on how advanced your cavity is, you may need something more in-depth, such as a crown or root canal.

What can I do to prevent cavities in the future?

In addition to seeing your dental team two to four times annually, depending on your oral condition, one of the best things you can do at home to prevent cavities is to brush your teeth twice per day for two minutes each time and to clean in between the teeth with floss or other methods at least once per day. Also, toothpaste and mouthwash with fluoride help prevent cavities by strengthening the teeth ^[2]. Be sure to read the instructions on your dental products to be sure you are getting the maximum benefit from them!

Rachel Stroble

Rachel Stroble is a researcher, professor of dental hygiene at Rose State College in Oklahoma, and registered dental hygienist with 10 years of experience in dentistry. She supports education in the classroom with her own students, in the professional community through the development and presentation of continuing education courses, and you may have seen her articles in RDH Magazine, Today’s RDH, and the Oklahoma Dental Association Journal.

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1. Boyd, L. D., Mallonee, L. F., Wyche, C. J., Halaris, J. F., (2021). Wilkins’ Clinical practice of the dental hygienist. Jones and Bartlett Learning
   
2. Horst, J. A., Tanzer, J. M., & Milgrom, P. M. (2018). Fluorides and Other Preventive Strategies for Tooth Decay. Dental clinics of North America, 62(2), 207–234. https://doi.org/10.1016/j.cden.2017.11.003
3. Institute for Quality and Efficiency in Health Care (2020, February 27). Tooth decay: Overview. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK279514/
4. Little, J. W., Miller, C. S., Rhodus, N. L., & Little, J. W. (2018). Little and Falace’s dental management of the medically compromised patient (Ninth edition.). Elsevier.
5. Maurer, K., Rahming, S., & Prvulovic, D. (2018). Dental health in advanced age and Alzheimer’s disease: A possible link with bacterial toxins entering the brain? Psychiatry Research.

The post Answers to the 4 most commonly asked questions about cavities appeared first on Smile Brilliant.

Teeth whitening is a popular cosmetic procedure that can improve the appearance of your smile. There are many reasons why you might want to whiten your teeth. Maybe you’ve just noticed that your teeth have lost their luster over time. Or perhaps you’re getting ready for a big event like a wedding or job interview. Whatever the reason, there are several ways to achieve whiter teeth.

However, it is important to remember that it can also influence your oral pH level. The whitening process uses chemical agents like hydrogen peroxide and carbamide peroxide to oxidize the molecules in the enamel that cause discoloration. These agents are effective in whitening teeth but can also slightly decrease the mouth’s pH level.

Oral pH is Important

The mouth can become an acidic environment, which can lead to tooth decay and other problems. The pH scale ranges from 0 to 14, with 7 being neutral, and the pH balance in the mouth should be slightly alkaline. A balanced pH helps maintain healthy teeth and gums by preventing cavities and reducing gum disease risk. When the pH falls below 5.2, enamel demineralization and root resorption have been reported.^[1][2]

According to a study that measured the pH of 26 whitening products, the pH of these products ranged from 3.67 (highly acidic) to 11.13 (highly basic). ^[1][2] To keep your mouth’s pH level balanced, it is essential to practice good oral hygiene habits, such as brushing and cleaning in between the teeth twice a day and using an alcohol-free mouthwash.

Teeth whitening alters oral pH

Whitening teeth can help improve the look of your smile and boost your confidence, but it’s important to speak to your dentist before using any whitening products. The bleaching agents’ pH is a factor that can directly influence the whitening process. Teeth whitening products can lower the pH, leading to enamel erosion and increased tooth sensitivity.

The pH of some whitening products is acidic primarily to increase the shelf life, and manufacturers have paid attention to the acidity of bleaching gels because low oral pH can produce various harmful effects on the structure and properties of the tooth.^[3] The effectiveness of dental bleaching is influenced by several factors, such as the bleaching system used, bleaching agent concentration, application time, and light application.^[4]

Safely use teeth whitening products

When teeth whitening products are used incorrectly, they can strip away the natural protective layers on your teeth, making them more vulnerable to acids and bacteria. This increase in the mouth’s acidity can cause cavities, enamel erosion, and tooth sensitivity. To help minimize this risk, following the directions on the whitening product you are using is important, in addition to discussing with your dentist any potential risks before starting any whitening treatment.

If you experience sensitivity, your dentist may suggest using a potassium nitrate product. Potassium nitrate helps those with sensitive teeth by blocking the pain signal resulting in less pain and sensitivity, and can be found in over-the-counter and prescription dental products.

If you have active periodontal disease or gingivitis, it is highly recommended to treat the infection first before proceeding with any whitening procedure, as it can irritate your gums further. Maintaining oral pH balance, healthy gums, and choosing a tooth whitening product for your needs under the direction of a dentist are some of the key components of a healthy, beautiful-looking smile.

Lacy Walker

LACY WALKER, RDH, BS, CDA, FAAOSH - dental hygienist, speaker, owner of Shared Hygiene, LLC, & writer w/ 25 years of experience in the dental field working in a psychiatric hospital, cosmetic, restorative, DSO, and periodontal practices. Lacy is the CE Director for A Tale of Two Hygienists podcast & Public Relations Chair for the AADH. She has a passion for the oral-systemic connection & is published in DACE, RDH Magazine, & DrBicuspid. Lacy is an approved provider of CE credits through AADH.

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1. Price, R.B. (2000) Download pdf | the ph of tooth whitening products – researchgate. https://www.researchgate.net/publication/12282985_The_PH_of_tooth_whitening_products
2. Price, R., Sedarous, M. and Hiltz, G.S. (2000) The pH of Tooth-Whitening Products, The pH of tooth-whitening products. Available at: https://www.cda-adc.ca/jcda/vol-66/issue-8/421.html
3. WIJETUNGA, C.L. et al. (2021) Effect of ph of bleaching agent on tooth bleaching action in vitro, Dental Materials Journal. The Japanese Society for Dental Materials and Devices. https://www.jstage.jst.go.jp/article/dmj/40/3/40_2020-191/_pdf
4. Soares, A. F., Soares Bombonatti, J. F., Alencar, M. S., Consolmagno, E. C., Honório, H. M., & Lia Mondelli, R. F. (2016). Influence of pH, bleaching agents, and acid etching on surface wear of bovine enamel. Journal of Applied Oral Science, 24(1), 24-30. https://doi.org/10.1590/1678-775720150281

The post The little-known secret to teeth whitening – low pH appeared first on Smile Brilliant.

You already know that brushing is important to your dental health, but were you aware that when you brush matters?

When should I brush?

To keep your mouth healthy, you should brush twice per day. The most important time to brush is before you go to bed, after your last meal or snack of the day. Pre-bedtime brushing is incredibly important because it removes plaque, which contains bad bacteria that multiplies overnight and can cause cavities and gum disease. Furthermore, any lingering sugars or carbohydrates feed the bacteria, compounding the issue.

What you eat matters

Even though brushing is critical, you should consider the timing of your brushing. If you have eaten or drank something acidic, such as soda, fruit, or coffee, brushing immediately afterward means you are scrubbing the acid into your tooth enamel. Acid is extremely detrimental to enamel and increases the likelihood of cavities. Also, even if you ate something that isn’t obviously acidic, such as crackers, the bacteria in your mouth metabolizes the carbohydrates to produce acid. Because if this, it is best to wait at least 30-60 minutes after eating to brush your teeth ^[1].

Consider these options instead

If you want a fresh mouth after eating, consider chewing sugar-free gum. Chewing gum helps to stimulate saliva flow, which in turn neutralizes pH and rinses away food debris^[3]. Additionally, gum helps to remove tiny food particles from the grooves in your teeth, helping to lower your risk of cavities^[3]. Selecting gum that contains xylitol offers a bonus! Xylitol is a naturally derived sugar alcohol that actually helps to kill the bad bacteria that causes cavities^[3]. Ingredients in food products are listed in order of concentration. In other words, the earlier in the ingredient list xylitol is listed, the more the product contains. Look for gum that has more xylitol in it for greater benefit. Keep all xylitol containing products away from dogs! It is poisonous to them ^[2]!

Another option is using mouthwash. Mouthwash can help to remove food debris and freshen your breath, without the risk of damaging the teeth. Look for a rinse that is alcohol-free and has a neutral or basic pH. Selecting a rinse that also contains fluoride will help to lower your risk of cavities as well.

If you must brush now

If you have a need to brush immediately after eating (maybe you will be giving a big presentation or walking down the aisle), ideally you should swish with baking soda water, as it neutralizes acid in the mouth. If you don’t have any baking soda on hand, plain water will rinse away some of the acidity. Try to keep brushing right after eating to a minimum, perhaps only for special events.

When you do brush…

No matter what time you are brushing, there are certain qualities to look for in a toothbrush. Always select a soft or extra soft brush, and replace it at least every 3 months, or sooner if you have been sick or the brush is worn out. If you use an electric toothbrush, you may consider using an at-home ultrasonic/UV cleaner to disinfect your toothbrush head after you’ve been sick. However, remember electric toothbrush heads need to be replaced just as often as manual brushes.

Rachel Stroble

Rachel Stroble is a researcher, professor of dental hygiene at Rose State College in Oklahoma, and registered dental hygienist with 10 years of experience in dentistry. She supports education in the classroom with her own students, in the professional community through the development and presentation of continuing education courses, and you may have seen her articles in RDH Magazine, Today’s RDH, and the Oklahoma Dental Association Journal.

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References

1. BDJ Team. (2015). The oral health benefits of sugarfree gum. BDJ Team 2, 15151. https://doi.org/10.1038/bdjteam.2015.151
2. Food and Drug Administration (n.d.) Paws Off Xylitol; It’s Dangerous for Dogs. https://www.fda.gov/consumers/consumer-updates/paws-xylitol-its-dangerous-dogs
3. Newton, J. T., Awojobi, O., Nasseripour, M., Warburton, F., Di Giorgio, S., Gallagher, J. E., & Banerjee, A. (2020). A systematic review and meta-analysis of the role of sugar-free chewing gum in dental caries. JDR Clinical & Translational Research, 5(3), 214-223. https://doi.org/10.1177/2380084419887178

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You may have heard that enamel is the hardest substance in the body, but how much do you actually know about it? This article will help you to understand this oral superstructure!

What is enamel?

Enamel is the outermost covering of the part of your teeth that you usually see inside your mouth. It is made primarily of minerals including calcium and phosphate ions that are formed into prism-shaped rods^[6]. This mineralized material is referred to as hydroxyapatite. Enamel formation, also known as amelogenesis, is a very complex process that occurs in a special capsule inside the jaw bone. The process starts long before the teeth come in. Interruption of amelogenesis by high fever or other conditions can lead to defects in the enamel^[3].

Enamel Is essential for tooth health

Enamel is the protective layer that protects the more delicate inner layers of your teeth: the dentin and the pulp. Enamel provides the hearty structure necessary to crunch on almonds and crispy cookies without damaging your oral structures. It also protects against cavities because it is more resistant to acid and damage caused by plaque than other tooth structures^[6].

Acid and sugar damages enamel

Even though healthy enamel is very strong, it is still susceptible to damage from acid. The bad bacteria that live in your mouth secrete acid as a byproduct that dissolves the minerals in your enamel^[5]. This damage is known as demineralization. Bad bacteria thrive in an environment containing sugar and other simple carbohydrates. The more sugar present for the bacteria to feed on, the more acid is produced. Furthermore, higher acid production causes greater damage to enamel! All of this is the perfect storm for cavities to develop.

How to protect your enamel

Healthy eating habits and good oral hygiene are essential to keep your enamel healthy. Sugary foods and drinks should be consumed at mealtime, paired with other non-cavity forming foods such as meats and vegetables. If you want a sugary drink in between mealtimes, it’s best to limit the amount of time it takes to drink it—aim for 20 minutes or less.

Sipping on sugary drinks, or even sugar-free acidic drinks like diet soda, for a long period of time causes substantially more damage than drinking the beverage more quickly. This is because the oral pH is acidic for a prolonged period of time^[4].

Can damaged enamel be repaired?

Once enamel has been damaged by acid attack, there is hope for repair. However, this is only true if it is caught in early stages of damage. Demineralized enamel can be strengthened by exposure to fluoride. Fluoride actually binds to the enamel and strengthens it. Surprisingly, enamel that has been remineralized by fluoride exposure is stronger than enamel that was never demineralized in the first place^[2]! That is because the chemical makeup of the enamel has changed from hydroxyapatite to fluorapatite. Fluorapatite is very similar to the calcium and phosphate composition discussed above, except that it also contains fluoride ions, providing additional strength^[2]. Brushing your teeth twice daily with a fluoride toothpaste helps to strengthen the teeth, and the use of fluoride trays or other specialized treatments may be needed if you are at high risk for cavities^[1].

Rachel Stroble

Rachel Stroble is a researcher, professor of dental hygiene at Rose State College in Oklahoma, and registered dental hygienist with 10 years of experience in dentistry. She supports education in the classroom with her own students, in the professional community through the development and presentation of continuing education courses, and you may have seen her articles in RDH Magazine, Today’s RDH, and the Oklahoma Dental Association Journal.

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References

1. American Dental Association. (2021, July 15). Fluoride: Topical and systemic supplements. ADA. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/fluoride-topical-and-systemic-supplements
2. Arifa, M. K., Ephraim, R., & Rajamani, T. (2019). Recent advances in dental hard tissue remineralization: A review of literature. International Journal of Clinical Pediatric Dentistry, 12(2), 139–144. https://doi.org/10.5005/jp-journals-10005-1603
3. Fatturi, A. L., Wambier, L. M., Chibinski, A. C., Assunção, L. R. da S., Brancher, J. A., Reis, A., & Souza, J. F. (2019). A systematic review and meta‐analysis of systemic exposure associated with molar incisor hypomineralization. Community Dentistry and Oral Epidemiology, 47(5), 407–415. https://doi.org/10.1111/cdoe.12467
4. Ireland, R., & Yeung, C. A., (2020) Stephan’s curve. In A Dictionary of Dentistry (2nd ed.). Oxford University Press.
5. Kulshrestha, S., Khan, S., Hasan, S., Khan, M. E., Misba, L., & Khan, A. U. (2015). Calcium fluoride nanoparticles induced suppression of Streptococcus mutans biofilm: An in vitro and in vivo approach. Applied Microbiology and Biotechnology, 100(4), 1901–1914.
6. Lacruz, R. S., Habelitz, S., Wright, J. T., & Paine, M. L. (2017). Dental enamel formation and implications for oral health and disease. Physiological Reviews, 97(3), 939–993. https://doi.org/10.1152/physrev.00030.2016

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“I’m sorry to tell you this but you have a cavity.” These are words that no one ever wants to hear when they visit the dentist but are especially frustrating to someone who’s been meticulous about their dental hygiene. They’ve been brushing, they’ve been flossing, they’ve been using mouthwash… and still get a cavity! What gives?!

Unfortunately, while proper dental hygiene is a critical component of preventing tooth decay, it is only one piece of a much larger puzzle. Let’s discuss a few reasons you can still get cavities even when you’re brushing and flossing.

Bacteria

Bacteria is a bad thing right? Well, not necessarily. The truth is, your oral microbiome is a combination of the two, both good and bad bacteria. Decay happens when 1.) you have too much bad bacteria and 2.) you have an acidic pH. The pH of the oral cavity ranges from 6.2 to 7.6^[1]. When this drops to about 5.5 or lower, bad bacteria takes over and the good and bad bacteria are no longer balanced. You can combat this by steering clear of acidic foods. Examples would be carbonated beverages, sugary and simple carb heavy foods like sugary breads and candy, and lemons and grapefruits. If you can’t give these up, drink lots of water or consider taking an oral probiotic . An oral probiotic will help replenish your microbiome so that you can fight decay.

Diet

We’ve discussed foods you should avoid, so now let’s discuss something a little more fun… the foods you should eat! When you think of healthy teeth, do you think of healthy bones? Probably not, but the truth is, bone is what supports your teeth and tissues. To have healthy teeth, you need strong bones. To do this, incorporate lots of calcium and vitamin D in your diet. The two are paired because vitamin D helps your body absorb calcium^[2]. When you think of calcium you probably think of dairy products like cheese and milk. While these foods are rich in calcium, so are vegetables like kale and beans. Be mindful of the sugar content of these foods. Many yogurts have added fruits or flavors that give them a high sugar content. As for vitamin D, get out in the sun! Your body creates vitamin D from direct sunlight on the skin when you’re outdoors^[3]. However, this isn’t true in the winter months so when it’s too cold or dark to get outside, eat lots of fish, egg yolks, or take a supplement to get your vitamin D.

Salivary flow

Saliva is one of the oral cavity’s biggest defense mechanisms against decay and unfortunately, one that individuals don’t have any control over. It cleanses bacteria from the teeth and buffers the pH in the oral cavity to create an environment that promotes good bacteria and fights bad bacteria. Dry mouth, or xerostomia, can promptly exacerbate tooth decay. If there is no salivary flow, food and plaque stay stuck in between the teeth or on the chewing surfaces and, if one is eating sugary or acidic foods, create an environment conducive to decay by dropping the pH of the oral cavity. While there is not a cure for xerostomia, there are mouth rinses that can soothe dry tissues, oral probiotics to keep the oral pH balanced, and sugar free mints with xylitol to increase salivary flow.

It’s never fun to hear you have a cavity, especially when you’ve been brushing and actually flossing! However, keep in mind that decay and the oral cavity are intrinsically linked with nutrition, overall health and wellness, and genetics. Brushing and flossing are integral to oral health but even if you’re meticulous, decay can still happen. Don’t beat yourself up over this! Your dental professionals are on your side and know that you’re doing your absolute best.

Esmy Ornelas

Esmy Ornelas is a registered Dental Hygienist, writer, educator, and consultant with 10 years of experience in dentistry. She is passionate about education, empowering hygienists to advance their careers in and out of the operatory, and about community. She has written for RDH Magazine, the RDH Graduate, and is a full-time professor of Dental Hygiene and Assisting at Rose State College in Oklahoma.

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References

1. Baliga, S., Muglikar, S., & Kale, R. (2013). Salivary pH: A diagnostic biomarker. Journal of Indian Society of Periodontology, 17(4), 461–465. https://doi.org/10.4103/0972-124X.118317
2. NHS. (n.d.). NHS choices. https://www.nhs.uk/conditions/vitamins-and-minerals/
3. Willershausen, B., Ross, A., Försch, M., Willershausen, I., Mohaupt, P., & Callaway, A. (2011). The influence of micronutrients on oral and general health. European journal of medical research, 16(11), 514–518. https://doi.org/10.1186/2047-783x-16-11-514

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Why you should remove certain mouthwashes from your oral care routine

Using mouthwash is a familiar part of our oral care routine. Many rely on mouthwashes to help them to battle bad breath, however some can contribute to adverse effects to our oral health. While the use of mouthwashes does not replace brushing and flossing, the usage of certain mouthwashes might prove beneficial for some people.^[1]

Do you need alcohol in your mouthwash to enjoy the cleaning benefits?

Many mouthwashes contain alcohol that produces a familiar burning sensation that many perceive to be what is cleaning their mouth. The alcohol that is in some mouthwashes actually strips away good bacteria along with bad bacteria from our oral microbiome. This reduces saliva production and can contribute to dry mouth, and in-turn increase your risk to cavities. Having sufficient saliva in your mouth is important to lubricate your oral environment.^[2]

Types of Mouthwashes

There are two main types of mouthwashes that are frequently used: cosmetic and therapeutic.^[1] Cosmetic mouthwashes may temporarily control bad breath and leave behind a pleasant refreshing taste. They do not however treat or prevent plaque buildup, prevent decay, kill bacteria that causes bad breath, or provide any other lasting benefit.^[1]

Therapeutic mouthwashes can help to reduce plaque, gingivitis, dissolve oils that contribute to bad breath, and help to prevent tooth decay. They may contain active ingredients that are beneficial for building up good bacteria in the mouth such as fluoride, xylitol, essential oils, and zinc.^[1] Some prescription and over the counter mouthwashes can help provide relief and manage mouth sores or irritation that may occur when undergoing chemotherapy or radiation treatments.^[3] The ultimate goal in our oral care routine is to limit decay and gum disease. Using a therapeutic mouthwash can help us to achieve this goal along with thorough brushing and flossing.

What You Can Do

Your diet is a contributory factor in the health of your oral microbiome. A modern diet often contains high levels of sugar, acidic, and processed foods that contribute to a lowered pH level in the mouth. A lowered pH level coupled with an overgrowth of bad bacteria in our mouths contributes to an increased presence of cavities, stains, and the prevalence of bad breath. Certain health conditions such as diabetes or chronic acid reflux can contribute to bad breath.^[3] Consuming a diet that is rich in calcium, vitamin D, magnesium, phosphorus, and using a pH balancing mouthwashes can be beneficial to maintaining an optimal healthy oral microbiome.

Often bad bacteria is present on our tongue. Using a tongue scraper can help to remove this harmful bacteria that contributes to bad breath, cavities, and improves digestive health.^[2] The key to a healthy microbiome is keeping the oral bacteria balanced, practicing good oral hygiene habits, and regularly going to your dentist. A dentist can help you to determine the root cause of your dental issues and help treat the cause rather that you just treating the symptoms.^[3]

Kari Carter-Cherelus

Kari Carter-Cherelus RDH, DA is a registered Dental Hygienist, writer, consultant, coach, international keynote speaker, with 23 years of experience in dentistry. She is passionate about helping others recover from burnout, improving organization’s work culture, and helping her clients to improve their mindset. She authored the book The Ultimate Guide For Dental Hygienist Burnout, and has written for RDH Graduate, RDH Magazine, and Inside Dental Hygiene.

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References

1. ADA. (2021, December 1). Mouthrinse (Mouthwash). https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/mouthrinse-mouthwash
2. Burhenne, Mark. (2018, July 10). Is Mouthwash Bad for You? Best Mouthwash + Risks and Alternatives. https://askthedentist.com/mouthwash-risks-and-alternatives/
3. The Ohio State University. Mariotti, Angelo. (2022, March 8). https://health.osu.edu/health/dental-health/does-mouthwash-kill-the-mouths-healthy-bacteria

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