Friday, November 16, 2012


Stomatitis, a non-specific term for an inflamed and sore mouth, can disrupt a person's ability to eat, talk, and sleep. Stomatitis can occur anywhere within the mouth, including the inside of the cheeks, gums, tongue, lips, and palate.

Types of Stomatitis

Types of stomatitis include:
  • Canker sore: A cancer sore, also known as an aphthous ulcer, isa single pale or yellow ulcer with a red outer ring or a cluster of such ulcers in the mouth, usually on the cheeks, tongue, or inside the lip.
  • Cold sores: Also called fever blisters, cold sores are fluid-filled sores that occur on or around the lips. They rarely form on the gums or the roof of the mouth. Cold sores later crust over with a scab and are usually associated with tingling, tenderness, or burning before the actual sores appear.
  • Mouth irritation. The irritation can be caused by:
    • Biting your cheek, tongue, or lip.
    • Wearing braces or another type of dental apparatus, or having a sharp, broken tooth.
    • Chewing tobacco.
    • Burning one's mouth from hot food or drinks.
    • Having gum disease (gingivitis) or other type of mouth infection.
    • Having hypersensitivities to certain agents, such as foods or medicines.
    • Having certain autoimmune diseases affecting the mucosal lining of the mouth, such as lupus, Crohn's disease, or Behcet's disease.
    • Taking certain drugs such as chemotherapeutic agents, antibiotics, medications used for rheumatoid arthritis, or epilepsy medications.
    • Receiving radiation as part of cancer treatment.

Symptoms of Stomatitis: Canker Sores and Cold Sores

Canker sore symptoms include:
  • sores that can be painful
  • sores usually last 5 to 10 days
  • sores tend to recur
  • sores are generally not associated with fever
Cold sore symptoms include:
  • sores are usually painful
  • sores are usually gone in 7 to 10 days
  • sores are sometimes associated with cold or flu-like symptoms

Causes of Stomatitis: Canker Sores and Cold Sores

Canker Sores
Nobody knows what exactly causes canker sores, but many factors may contribute to their development, such as certain medications, trauma to the mouth, poor nutrition, stress, bacteria or viruses, lack of sleep, sudden weight loss, and certain foods such as potatoes, citrus fruits, coffee, chocolate, cheese, and nuts.
Canker sores may also be related to a temporarily reduced immune system because of a cold or flu, hormonal changes, or low levels of vitamin B12 or folate. Even biting the inside of the cheek or chewing a sharp piece of food can trigger a canker sore.
Canker sores may result from a genetic predisposition and are considered an autoimmune disease; they are not contagious.
About 20% people in the U.S. will have canker sores at some point during their lifetime -- women more often than men.
Cold Sores and Fever Blisters
Cold sores and fever blisters are caused by the herpes simplex virus type 1. Unlike canker sores, cold sores and fever blisters are contagious from the time the blister ruptures to the time it has completely healed. The initial infection often occurs before adulthood and may be confused with a cold or the flu. Once the person is infected with the virus, it stays in the body, becoming dormant and reactivated by such conditions as stress, fever, trauma, hormonal changes (such as menstruation), and exposure to sunlight.
When sores reappear, they tend to form in the same location. In addition to spreading to other people, the virus can also spread to another body part of the affected person, such as eyes or genitalia.

Dental Health and Tooth Discoloration

There are several causes of tooth discoloration, including:
  • Foods/drinks. Coffee, tea, colas, wines, and certain fruits and vegetables (for example, apples and potatoes) can stain your teeth.
  • Tobacco use.Smoking or chewing tobacco can stain teeth.
  • Poor dental hygiene. Inadequate brushing and flossing to remove plaque and stain-producing substances like coffee and tobacco can cause tooth discoloration.
  • Disease. Several diseases that affect enamel (the hard surface of the teeth) and dentin (the underlying material under enamel) can lead to tooth discoloration. Treatments for certain conditions can also affect tooth color. For example, head and neck radiation and chemotherapy can cause teeth discoloration. In addition, certain infections in pregnant mothers can cause tooth discoloration in the infant by affecting enamel development.
  • Medications. The antibiotics tetracycline and doxycycline are known to discolor teeth when given to children whose teeth are still developing (before the age of 8). Mouth rinses and washes containing chlorhexidine and cetylpyridinium chloride can also stain teeth. Antihistamines (like Benadryl), antipsychotic drugs, and drugs for high blood pressure also cause teeth discoloration.
  • Dental materials. Some of the materials used in dentistry, such as amalgam restorations, especially silver sulfide-containing materials, can cast a gray-black color to teeth.
  • Advancing age. As you age, the outer layer of enamel on your teeth gets worn away revealing the natural yellow color of dentin.
  • Genetics. Some people have naturally brighter or thicker enamel than others.
  • Environment. Excessive fluoride either from environmental sources (naturally high fluoride levels in water) or from excessive use (fluoride applications, rinses, toothpaste, and fluoride supplements taken by mouth) can cause teeth discoloration.
  • Trauma. For example, damage from a fall can disturb enamel formation in young children whose teeth are still developing. Trauma can also cause discoloration to adult teeth.

Online and Mail-Order Pharmacies: How to Be Safe

People get deals on shoes, travel, and appliances online. Why not prescription drugs? You can find lower prices and convenience through mail-order or online pharmacies. Just be careful.
"Rogue" pharmacies use the Internet to market counterfeit drugs. You could end up with something that doesn’t treat your condition and could harm your health.
In this article, WebMD helps you find the real deals at mail-order and online pharmacies.

Mail-Order Pharmacies = Convenience and Lower Costs

Many insurers and some retail pharmacies now offer drugs by mail order. These companies ship prescribed drugs to your home so you don’t have to pick them up in person. Often you can get a three-month supply at a reduced cost. The convenience and savings can pay off in surprising ways. Kaiser Permanente in Oakland found that patients who used its mail-order pharmacy were more likely to take the drugs as prescribed.

4 Signs of a Legitimate Pharmacy Web Site

  • U.S. Location and License

    Pharmacies that operate in the U.S. undergo heavy scrutiny in order to be licensed by state boards of pharmacy. "There are a lot of legitimate mail-order pharmacies in this country," says Richard Sagall, MD, president of NeedyMeds, a Massachusetts nonprofit that provides information about financial assistance for drugs.
  • Verified Pharmacy Practice Site
    The National Association of Boards of Pharmacy® (NABP®) inspects Internet pharmacies and awards a "VIPPS" seal (Verified Internet Pharmacy Practice Sites™ Seal) to those that meet its criteria. But watch out, some rogue sites flaunt fake seals. You can look up VIPPS-accredited pharmacies on the NABP web site.
  • Prescription Required
    Any trustworthy pharmacy will insist on a prescription from a health care provider who has seen you in person. That doctor can monitor you for any side effects from the drug. "Some side effects are so subtle you won’t be aware of them," says Sagall, "like an electrolyte imbalance that you can only detect by doing blood work."
  • Real People on the Phone
    You should be able to talk with a human being, including a licensed pharmacist, to answer questions about your prescription.

Online Pharmacies Often Deliver the Wrong Goods

Although mail-order pharmacies usually have a web site, the similarity between mail order and many online pharmacies ends there. In a review of 8,000 online pharmacies, the National Association of Boards of Pharmacy found only 4% that met its safety standards. "There are a lot of counterfeit drugs and [old] drugs that should have been destroyed but ended up back on the market," says Corey Sawaya, RPh, pharmacy manager of Acme Pharmacy in Stow, Ohio.

Can Teeth Whitening Become an Addiction?

Robert Gerlach, DDS, MPH, principal scientist for worldwide clinical investigations at Procter & Gamble, maker of Crest Whitestrips, notes that teeth whitening products have a built-in safety mechanism against people over-treating themselves.
"When you've had the peroxide on too long, you can get a real profound, throbbing pain in your tooth. It goes away, but your teeth hurt," Gerlach tells WebMD.
Further, there's a low percentage of whitening agent in over-the-counter teeth whitening products, says Messina.
After you wear products such as Crest Whitestrips for the recommended half-hour time period, virtually all the peroxide is gone from the strip, says Gerlach.
"You can't add more, you can't doctor it," he says.
Gerlach, who has done more than 100 studies on Whitestrips, points out that there has been no evidence of any large-scale abuse or negative effects from people doing at-home teeth whitening.

Teeth Whitening Tips

If you're considering using a tooth whitening product containing bleaches, the American Dental Association recommends that you see your dentist first.
Experts say it's important to talk with a dentist about the reason for any tooth discoloration, whether you're a good candidate for bleaching (which depends in part on your dental health), and how quickly your teeth will change.
It's also important to have realistic expectations.
"Some people get these glow-in-the-dark teeth because their teeth will go that far. But some people's teeth won't go that far," Haywood says. "You have to expect that you won't necessarily turn out like Julia Roberts, because you don't necessarily have the teeth for it."
And how white is white enough? The general guideline is that your teeth are white when they're the color of the whites of your eyes.
"If they get a lot whiter than that, your teeth stand out like the teeth in a Cheshire cat," says Zase.
Because the peroxide in teeth whiteners adds a "sparkle" to teeth immediately after the treatment, Haywood recommends that people wait two weeks until after they've finished the teeth whitening process to see how effective it really was.

More Teeth Whitening Tips

Dentists also have these tips about teeth whitening:
  • Use desensitizing toothpaste before and after using teeth whitening products.
  • Get your teeth cleaned before starting teeth whitening.
  • Don't use teeth whitening products when pregnant. Since they haven't been tested on pregnant women, Zase says the danger level is uncertain.
  • Don't use tooth bleaching products if you have crowns, veneers, or bridges. These restorations do not lighten, so you could end up with unevenly colored teeth.
  • A few groups, like people who used tetracycline as young children, may need more teeth whitening than normal, such as six months of continuous daily use. (Gerlach notes that studies show even these patients haven't experienced more adverse effects.)
  • Carefully follow the directions and recommendations on any teeth whitening products you use.
  • To help your newly white teeth stay that way longer, avoid stain-causing food and drinks. Also, follow good oral hygiene practices.
  • If you experience tooth sensitivity after whitening treatments, stop, and wait for the sensitivity to disappear. You can then resume the teeth whitening, but for less time or with a lower-strength product.

Can Teeth Whitening Become an Addiction?

But there's such a thing as too much of a good thing. While most would stop short of calling it an addiction, dentists say some people do overdo it in the quest for the perfect smile (or at least one as bright as those of Matthew McConaughey or Julia Roberts).
"Yes, there definitely is a tendency of people to overuse them, although most people don't," says Marty Zase, DMD, president of the American Academy of Cosmetic Dentistry.
It's another example of the keeping up with the Joneses, Zase says: "Now the Joneses have white teeth."
"Some people see that some beauty is good, so obviously a lot must be better," he says. "Certainly there are some people that you just can't teach the subtlety of a good thing."
Says Van Haywood, DMD, a professor in the Department of Oral Rehabilitation at the Medical College of Georgia: "Some people look like they just glow in the dark. To us dentists, it looks like the most fake-y thing we've ever seen. But to them, it's beauty."

Are You Overdoing It with Teeth Whitening?

There are two main types of home teeth-whitening products:
  • Whitening strips, thin strips coating with bleaching gel that are applied to the teeth.
  • Tray-based systems, in which a tray filled with beaching solution is worn over the teeth.
Most are meant to be used over a two- to four-week period.
And how long does the whitening effect last? After completing the initial teeth whitening treatment, whether in a dentist's office or using an at-home product, a once-a-month touch-up is probably sufficient, says Matthew Messina, DDS, consumer advisor with the American Dental Association.
People who smoke and drink dark liquids such as tea and coffee might need an update every two weeks.
Your own pearly whites are the best way to tell whether you're overusing teeth whitening products, experts say. Dentists say the biggest signs of overuse are:
  • Excessive sensitivity of the teeth, especially to cold items.
  • Redness, irritation and bleeding in the gums.
Another sign: Your teeth may start to appear translucent or blotchy.

Americans love a white smile. And, increasingly, we're using teeth whitening treatments to get one. Teeth whitening treatments are now the No. 1 requested cosmetic dental procedure, having increased more than 300% since 1996, according to the American Academy of Cosmetic Dentistry.
At-home teeth whitening treatments have become increasingly popular as well. An array of over-the-counter tooth bleaching kits can be found in most any drugstore, discount store, or even grocery store.

Addictive Pursuit of Pearly Whites?

The most widely used of these over-the counter products are whitening strips and a tray-based technique, in which a plastic tray, containing a bleaching gel, fits over a person's teeth and is worn for part of the day.
Some experts are reluctant to call this mania an addiction. "No, it is not possible to become addicted to teeth-whitening agents," says Robert Gerlach, DDS. Gerlach is principal scientist for worldwide clinical investigations at Procter & Gamble, the maker of Crest Whitestrips.
Others acknowledge that people are often guilty of overusing over-the-counter teeth-whitening products. How does this fixation start and what are the consequences?

What Motivates Overuse

For some, it's a narcissistic compulsion to maintain their youth, analogous to going for repeated plastic surgery, says Richard Frances, MD, an addiction expert and a clinical professor of psychiatry at New York University Medical School. "People are obsessed with the idea of perfecting their bodies and warding off the effects of age," he says.
Matthew Messina, DDS, a dentist in private practice in Cleveland and a spokesman for the American Dental Association, says television makeover programs have had a tremendous influence in making people see how an investment in their smile was also an investment in self-confidence. But this awareness, he says, "can be obsessive if we become hyperfixated."
"People are looking for anything they can get their hands on that can improve every part of the way they look, every advantage possible to one-up the next person" says James H. Doundoulakis, DMD. Doundoulakis has a cosmetic dentistry practice in New York and is the co-author of The Perfect Smile: The Complete Guide to Cosmetic Dentistry.
"Because of New York's competitive nature," Doundoulakis says, "you need all the tools - and one of them is that smile, which not only shows you're confident but that you're healthy and you have energy."

The Warning Signs of Overuse

While Messina underscores that "tooth whitening is a very safe and effective technique when done according to the product manufacturer's instructions and under the recommendations of a dentist," some people are after more than that. The warning sign for Messina is when patients "look for changes in their teeth to correct other issues and problems that have nothing to do with their teeth," such as improving their social lives or getting a better job.
Messina says that even a little bit of overuse of an over-the-counter whitening agent "is not going to do any long-term damage. The reason, he says, is "the safety margins for over-the-counter products is pretty large."

How Can I Prevent Teeth Discoloration?

By making a few simple lifestyle changes, you may be able to prevent teeth discoloration. For example, if you are a coffee drinker and/or smoker, consider cutting back or quitting all together. Also, improve your dental hygiene by brushing and flossing regularly and getting your teeth cleaned by a dental hygienist every 6 months.
If your teeth appear to be an abnormal color without ready explanation and, if other symptoms are also present, make an appointment to see your dentist.

What Treatment Options Are Available to Whiten Teeth?

Treatment options to whiten teeth can vary depending on the cause of the discoloration and may include.
  • Using proper tooth brushing and flossing techniques
  • Avoidance of the foods and beverages that cause stains
  • Bondings
  • Veneers
  • Using over-the-counter whitening agents
  • In-home whitening agents purchased from your dentist
  • In-office whitening procedures

Dental Health and Tooth Discoloration

There are several causes of tooth discoloration, including:
  • Foods/drinks. Coffee, tea, colas, wines, and certain fruits and vegetables (for example, apples and potatoes) can stain your teeth.
  • Tobacco use.Smoking or chewing tobacco can stain teeth.
  • Poor dental hygiene. Inadequate brushing and flossing to remove plaque and stain-producing substances like coffee and tobacco can cause tooth discoloration.
  • Disease. Several diseases that affect enamel (the hard surface of the teeth) and dentin (the underlying material under enamel) can lead to tooth discoloration. Treatments for certain conditions can also affect tooth color. For example, head and neck radiation and chemotherapy can cause teeth discoloration. In addition, certain infections in pregnant mothers can cause tooth discoloration in the infant by affecting enamel development.
  • Medications. The antibiotics tetracycline and doxycycline are known to discolor teeth when given to children whose teeth are still developing (before the age of 8). Mouth rinses and washes containing chlorhexidine and cetylpyridinium chloride can also stain teeth. Antihistamines (like Benadryl), antipsychotic drugs, and drugs for high blood pressure also cause teeth discoloration.
  • Dental materials. Some of the materials used in dentistry, such as amalgam restorations, especially silver sulfide-containing materials, can cast a gray-black color to teeth.
  • Advancing age. As you age, the outer layer of enamel on your teeth gets worn away revealing the natural yellow color of dentin.
  • Genetics. Some people have naturally brighter or thicker enamel than others.
  • Environment. Excessive fluoride either from environmental sources (naturally high fluoride levels in water) or from excessive use (fluoride applications, rinses, toothpaste, and fluoride supplements taken by mouth) can cause teeth discoloration.
  • Trauma. For example, damage from a fall can disturb enamel formation in young children whose teeth are still developing. Trauma can also cause discoloration to adult teeth.

An Overview of Toothaches

Toothache Causes

Toothache occurs from inflammation of the central portion of the tooth called pulp. The pulp contains nerve endings that are very sensitive to pain. Inflammation to the pulp or pulpitis may be caused by dental cavities, trauma, and infection. Referred pain from the jaw may cause you to have symptoms of a toothache.

Toothache Symptoms

Toothache and jaw pain are common complaints. There may be severe pain to pressure, or to hot or cold stimuli. The pain may persist for longer than 15 seconds after the stimulus is removed. As the area of inflammation increases, the pain becomes more severe. It may radiate to the cheek, the ear, or the jaw. Other signs and symptoms that may lead you to seek care include the following:
  • Pain with chewing
  • Hot or cold sensitivity
  • Bleeding or discharge from around a tooth or gums
  • Swelling around a tooth or swelling of your jaw
  • Injury or trauma to the area
These signs and symptoms may sometimes be associated with dental decay or gum disease (periodontal disease). Dental decay or an area of redness around the tooth's gum line may point to the source of pain. If you tap an infected tooth, it may make the pain more intense. This sign may point to the problem tooth even if the tooth appears normal.
A toothache needs to be differentiated from other sources of pain in the face. Sinusitis, ear or throat pain, or an injury to the temporomandibular joint (TMJ) that attaches the jaw to the skull may be confused with toothache. Pain from a deeper structure (called referred pain) may be passed along the nerve and be felt in the jaw or tooth. In order to pinpoint the source of the pain and get relief, call your dentist or doctor.

When to Seek Medical Care for a Toothache

You should call your doctor or dentist about a toothache when:
  • Pain is not relieved by over-the-counter drugs.
  • You experience severe pain after a tooth is pulled. This may occur on the second or third day after tooth extraction. This is a result of the tooth socket being exposed to air. The condition is known as "dry socket syndrome." If you develop this condition, you should see a dentist within 24 hours.
  • Pain is associated with swelling of the gums or face, or you have discharge around a tooth. Fever is an important sign of infection in dental disease. Simple dental decay (caries) does not cause fever. These signs may signify an infection surrounding the tooth, the gum, or the jaw bone (mandible). Fever and swelling may indicate the presence of an abscess. Dental abscesses may require antibiotics and surgical opening (drainage) of the abscess. When this procedure is recommended to be done inside the tooth (endodontic drainage), a "root canal" is performed.
  • Broken or knocked-out teeth occur from an injury. Unless associated with more severe injuries, your dentist should be contacted as soon as possible. Swallowed teeth and permanent tooth loss are considered dental emergencies. Tooth loss due to injury (traumatic loss) is cared for differently in children who have lost their primary teeth than in older children and adults with injury to their secondary -- or permanent --teeth.
  • Pain is present at the angle of your jaw. If every time you open your mouth widely you have pain, it is likely that the temporomandibular (TMJ) joint has been injured or inflamed. This can occur from an injury or just by trying to eat something that is too big. Your dentist may be able to suggest solutions to this problem.
  • Wisdom teeth are causing pain. As wisdom teeth (third molars) are coming out, they cause inflammation of the gum around the erupted crown. The gum overlying the crown may become infected. The tooth most commonly involved is the lower third molar. The pain may extend to the jaw and ear. There may be swelling in the affected area so that the jaw cannot be closed properly. In severe cases, pain in the throat and the floor of the mouth may make it difficult to swallow.

Preventing Tooth Decay

  • Brush your teeth at least twice a day with a fluoride-containing toothpaste. Preferably, brush after each meal and especially before going to bed.
  • Clean between your teeth daily with dental floss or interdental cleaners, such as the Oral-B Interdental Brush, Reach Stim-U-Dent, or Sulcabrush.
  • Eat nutritious and balanced meals and limit snacks. Avoid carbohydrates such as candy, pretzels and chips, which can remain on the tooth surface. If sticky foods are eaten, brush your teeth soon afterwards.
  • Check with your dentist about use of supplemental fluoride, which strengthens your teeth.
  • Ask your dentist about dental sealants (a plastic protective coating) applied to the chewing surfaces of your back teeth (molars) to protect them from decay.
  • Drink fluoridated water. At least a pint of fluoridated water each day is needed to protect children from tooth decay.
  • Visit your dentist regularly for professional cleanings and oral exam.
  • A mouth rinse containing fluoride can help prevent tooth decay, according to the American Dental Association.
    Researchers are developing new means to prevent tooth decay. One study found that a chewing gum that contains the sweetener xylitol temporarily retarded the growth of bacteria that cause tooth decay. In addition, several materials that slowly release fluoride over time, which will help prevent further decay, are being explored. These materials would be placed between teeth or in pits and fissures of teeth. Toothpastes and mouth rinses that can reverse and "heal" early cavities

    Tips to Prevent Tooth and Mouth Injuries

    Injuries to the teeth and mouth are common. Approximately 80% of dental injuries affect one or more of the front teeth and may cause damage to soft tissues – the tongue, lips, and inner cheeks.
    In the very young child, injuries to baby teeth usually result from learning to walk. There may also be damage to the unerupted permanent teeth. Sports injuries are the main source of tooth and mouth injuries in older adolescents and adults. Up to 40% of dental injuries in older adolescents and adults occur while playing sports.

    Tips to Prevent Sports-Related Tooth and Mouth Injuries

    • Mouth Guards: When playing sports, the best way to protect your teeth and mouth is by wearing a mouth guard.
    • Face cages: This equipment protects against trauma to the face, especially when playing certain sports positions, like baseball catcher or hockey goalie.
    • Helmets: It's always wise to wear a helmet made for the activity that you are participating in. Although most helmets won't protect the teeth and mouth, they will protect another important area – your head, to help protect against a brain concussion.

    Can Knocked-Out Teeth Be Repaired?

    Yes, knocked-out teeth can be repaired, and the sooner you can get to your dentist's office, the better. Knocked-out teeth with the highest chances of being saved are those seen by the dentist and returned to their socket within one hour of being knocked out. If a tooth has been knocked out, gently rinse any debris from the root and attempt to place it back into the socket. If that’s not possible, hold it in the mouth on the way to the dentist. If all else fails, keep the tooth in milk until you get to the dentist's office.
    Even if your tooth can't be saved, you haven't necessarily lost your smile. Due to advances in dentistry, a dental implant -- a freestanding artificial tooth – can now be anchored directly onto your jawbone, and with a porcelain crown attached, to aid in biting, chewing, and for esthetic reasons.

    Thursday, November 15, 2012

    Diabetes & Oral Health: How to Protect Your Teeth

    Having diabetes can make you less able to fight off infection, including gum infections that can lead to serious gum disease.
    In early stages, gum disease is known as gingivitis. The gums are swollen, soft, and may bleed, particularly during brushing or flossing.
    If gum disease progresses, however, the gums may begin to detach from the teeth, forming pockets that can trap bacteria and boost the risk of infections. Untreated, the infections can destroy the underlying bones that hold the teeth in place.
    Surgery may be needed. In one technique, called pocket depth reduction, the dentist or periodontist folds back the gum tissue, removes the bacteria, and secures the tissue into place so that it fits more tightly around the teeth, sometimes cutting away some of the unattached gum.
    With diabetes, you may heal more slowly after oral surgery. Your health care provider may prescribe antibiotics to keep infection after surgery at bay. Pay close attention to and control your blood sugar levels before and after oral surgery.
    If you have diabetes, you are also at risk for fungal infections in the mouth, called oral candidiasis or thrush. This is true even if you wear dentures.
    Dry mouth, called xerostomia, is another common problem among people with diabetes. Saliva is important to oral health -- it helps wash away food particles and keep the mouth moist. When you don't have enough saliva, bacteria thrive, tissues can get irritated and inflamed, and your teeth can be more prone to decay.

    Diabetes & Your Teeth: How to Minimize Risk

    Taking care of your oral hygiene at home every day is crucial. Make sure you brush at least twice a day and floss once a day.
    Antibacterial mouth rinses can also help reduce bacteria that can cause plaque build-up on teeth and gums.
    Examine your mouth for inflammation or signs of bleeding gums. If you notice either, let your dentist know as soon as possible.
    Experts recommend having your teeth professionally cleaned every six months, or even every three or four months. Step up the professional cleaning schedule if you know you tend to build up plaque or tartar quickly.
    Be sure to tell your dentist that you have been diagnosed with diabetes. It will also help your dentist to know the names of all prescription and over-the-counter drugs you take.
    You may be referred to a periodontist -- a dentist who specializes in gum disease -- if your gum problems persist or seem to get worse.

    How Stress Affects Your Oral Health

    Excess stress may give you a headache, a stomachache, or just a feeling of being "on edge." But too much stress could also be doing a number on your mouth, teeth, gums, and overall health.
    The potential fallout from stress and anxiety that can affect your oral health includes:
    • Mouth sores, including canker sores and cold sores
    • Clenching of teeth and teeth grinding (bruxism)
    • Poor oral hygiene and unhealthy eating routines
    • Periodontal (gum) disease or worsening of existing periodontal disease
    So how can you prevent these oral health problems?

    Mouth Sores

    Canker sores -- small ulcers with a white or grayish base and bordered in red -- appear inside the mouth, sometimes in pairs or even greater numbers. Although experts aren't sure what causes them -- it could be immune system problems, bacteria, or viruses -- they do think that stress, as well as fatigue and allergies, can increase the risk of getting them. Canker sores are not contagious.
    Most canker sores disappear in a week to 10 days. For relief from the irritation, try over-the-counter topical anesthetics. To reduce irritation, don't eat spicy, hot foods or foods with a high acid content, such as tomatoes or citrus fruits.
    Cold sores, also called fever blisters, are caused by the herpes simplex virus and are contagious. Cold sores are fluid-filled blisters that often appear on or around the lips, but can also crop up under the nose or around the chin area.
    Emotional upset can trigger an outbreak. So can a fever, a sunburn, or skin abrasion.
    Like canker sores, fever blisters often heal on their own in a week or so. Treatment is available, including over-the-counter remedies and prescription antiviral drugs. Ask your doctor or dentist if you could benefit from either. It's important to start treatment as soon as you notice the cold sore forming.

    Teeth Grinding

    Stress may make you clench and grind your teeth -- during the day or at night, and often subconsciously. Teeth grinding is also known as bruxism.
    If you already clench and grind your teeth, stress could make the habit worse. And, grinding your teeth can lead to problems with the temporomandibular joint (TMJ), located in front of the ear where the skull and lower jaw meet.
    See your doctor and ask what can be done for the clenching and grinding. Your dentist may recommend a night guard, worn as you sleep, or another appliance to help you stop or minimize the actions.

    Tooth Enamel: What Helps, What Hurts

    The outer surface of teeth, called enamel, is designed to last a lifetime. "Enamel is the hardest substance in the body," says dentist Leslie Seldin, DDS, a spokesperson for the American Dental Association. Some wear and tear of tooth enamel is inevitable. But Seldin says there's plenty you can do to keep your enamel strong. Start with these eight steps.

    1. Limit Sugary Soft Drinks and Foods

    Sugar leads to the production of acids in the mouth, which soften and eventually wear away at enamel. Chewy candies that stick on your teeth are particularly damaging. So are soft drinks. Along with sugar, soft drinks may contain citric acid and phosphoric acid, making them even more acidic. Artificially sweetened soft drinks are a smarter choice than sugary soft drinks. But sugarless sweeteners are acidic and may erode enamel over time. The best choice when you're thirsty: a glass of water.

    2. Help Yourself to Foods That Protect Enamel

    Calcium in foods neutralizes acids in your mouth. Calcium is also an essential mineral needed to keep bones strong. Milk, cheese, and other dairy products all help protect and strengthen enamel, says Pamela L. Quinones, RDH, president of the American Dental Hygienists’ Association. Choose low-fat or fat-free dairy to help keep fat and calories to a minimum. If you frequently drink orange juice, O.J. with added calcium may be the best choice. Calcium buffers the normal acidity of orange and other citrus juices.

    3. Avoid Over-brushing

    Brushing too vigorously can wear down enamel. "Always use a soft brush and brush gently," says Seldin. Hold the brush at about a 45-degree angle to your gums and move it back and forth in short strokes, about the distance of one tooth. Don't brush immediately after eating sweets or citrus fruits. Acidic foods temporarily soften enamel and may make it more susceptible to damage from brushing. Wait for up to an hour after you eat, giving your enamel time to re-harden. Then brush your teeth.

    4. Treat Heartburn and Eating Disorders

    With severe heartburn, stomach acids may escape up into the esophagus. If those acids reach your mouth, they can erode enamel. The eating disorder bulimia, in which people vomit food after they eat, is another threat to enamel. If you have symptoms of heartburn or bulimia, talk to your doctor about treatment.

    5. Beware of Chlorinated Pools

    When swimming pools aren't chlorinated properly, the water may become too acidic. Tooth enamel exposed to pool water can begin to erode. In a study by the Centers for Disease Control, 15% of frequent swimmers showed signs of enamel erosion, compared to only 3% of people who don't swim. Check with the recreation center or gym where you swim to make sure the pool's pH is checked regularly. While swimming, keep your mouth closed to avoid exposing your teeth to chlorinated water.

    Most bacteria in your mouth reside in plaque

    Most bacteria in your mouth reside in plaque.

    All bacteria are bad for the health of your teeth and gums.

    All bacteria are bad for the health of your teeth and gums.

    Drinking green tea may help keep your teeth and gums healthy.

    Drinking green tea may help keep your teeth and gums healthy.

    Antiseptic mouthwashes can kill the germs that cause bad breath

    Antiseptic mouthwashes can kill the germs that cause bad breath.

    To avoid the buildup of bacteria, the American Dental Association recommends replacing your toothbrush

    To avoid the buildup of bacteria, the American Dental Association recommends replacing your toothbrush every month.

    To protect your toothbrush from harmful germs, you should:

    To protect your toothbrush from harmful germs, you should:

    Which of the following items can transfer potentially dangerous microbes between people?

    Which of the following items can transfer potentially dangerous microbes between people?

    If you find yourself without a toothbrush, it's a good idea to borrow a friend's.

    If you find yourself without a toothbrush, it's a good idea to borrow a friend's.

    Anyone who kisses someone with gum disease will always get it.

    Anyone who kisses someone with gum disease will always get it.

    Germs Quiz: What Lives in Your Mouth?

    If you drop food on the floor, it won't pick up any germs if you pick it up within five seconds.

    Germs Quiz: What Lives in Your Mouth?

    A dog's mouth is cleaner than a human's.

    Germs Quiz: What Lives in Your Mouth?

    A typical human mouth contains billions of bacteria. If you haven't brushed your teeth lately, you might well have more bacteria in your mouth right now than there are people living on planet Earth. Scientists have identified more than 700 different species of mouth-dwelling microbes.

    Quiz: The Germs in Your Mouth

    The number of bacteria in your mouth is closest to the population of which of the following?

    What You Can Do About Bad Breath

    Worried about bad breath? You're not alone. Forty million Americans suffer from bad breath, or halitosis, according to the American Dental Hygienists' Association. Bad breath can get in the way of your social life. It can make you self-conscious and embarrassed. Fortunately, there are simple and effective ways to freshen your breath.

    1. Brush and floss more frequently.

    One of the prime causes of bad breath is plaque, the sticky build-up on teeth that harbors bacteria. Food left between teeth adds to the problem. All of us should brush at least twice a day and floss daily. If you're worried about your breath, brush and floss a little more often. But don't overdo it. Brushing too aggressively can erode enamel, making your teeth more vulnerable to decay.

    2. Scrape your tongue.

    The coating that normally forms on the tongue can harbor foul-smelling bacteria. To eliminate them, gently brush your tongue with your toothbrush. Some people find that toothbrushes are too big to comfortably reach the back of the tongue. In that case, try a tongue scraper. "Tongue scrapers are an essential tool in a proper oral health care routine," says Pamela L. Quinones, RDH, president of the American Dental Hygienists' Association. "They're designed specifically to apply even pressure across the surface of the tongue area, removing bacteria, food debris, and dead cells that brushing alone can’t remove."

    3. Avoid foods that sour your breath.

    Onions and garlic are the prime offenders. "Unfortunately, brushing after you eat onions or garlic doesn't help," says dentist Richard Price, DMD, a spokesperson for the American Dental Association. "The volatile substances they contain make their way into your blood stream and travel to your lungs, where you breathe them out." The only way to avoid the problem is to avoid eating onions and garlic, especially before social or work occasions when you're concerned about your breath.

    4. Kick the habit.

    Bad breath is just one of many reasons not to smoke. Smoking damages gum tissue and stains teeth. It also increases your risk of oral cancer. Over-the-counter nicotine patches can help tame the urge to smoke. If you need a little help, make an appointment to talk to your doctor about prescription medications or smoking cessation programs that can help you give up tobacco for good.

    5. Rinse your mouth out.

    In addition to freshening your breath, anti-bacterial mouthwashes add extra protection by reducing plaque-causing bacteria. After eating, swishing your mouth with plain water also helps freshen your breath by eliminating food particles.

    6. Skip after-dinner mints and chew gum instead.

    Sugary candies promote the growth of bacteria in your mouth and add to bad breath problems. Instead, chew sugarless gum. "Gum stimulates saliva, which is the mouth’s natural defense mechanism against plaque acids which cause tooth decay and bad breath," Quinones tells WebMD.

    7 Secrets to a Healthier Smile

    5. Seeing the dentist may save your life.

    People are slowly realizing that gum disease might be a sign of heart disease. Some studies indicate a connection but more research needs to be done. It's all about inflammation -- be it of the gums or of the arteries of the heart. Some studies show that bacteria in gum disease is also in plaques in heart arteries. Seeing the dentist can benefit not only your smile and the whiteness of your teeth, but also your overall health.

    6. The mouth tells no lies.

    I can tell so much about a person just peering into their mouth. I can see if they have certain habits or issues -- whether they drink a lot of soda or coffee and if they have had a drug problem in the past or present. If they are experiencing a lot of stress, they may grind or clench their teeth, leading to gum recession or telltale wear patterns. Acid erosion patterns can betray a bulimic. Bad breath can even say a lot -- be it acid reflux, a poor diet, or even diabetes. You just can't hide these things once you open your mouth.

    7. Not all whites are right.

    There's no one-size-fits-all shade of white. If you bring in a picture of someone whose bright smile you admire, it's entirely possible it won't suit you. It depends on your coloring and your teeth. It's a bit like hair color in that respect. Everyone has a different potential for whiteness.

    7 Secrets to a Healthier Smile

    When it comes to lighting up some of Hollywood's brightest smiles as well as tending to the pearly whites of the average Joe, New York City dentist Steven Roth, DMD, does it all. With more than 25 years of cosmetic and restorative dentistry experience, he created a technique that allows patients to "test drive" cosmetic dental procedures (such as temporary veneers) before taking the plunge. We chatted with Roth from his Manhattan office, SmilesNY, and asked him to share the seven things he always tells every patient.

    1. You probably aren't seeing the dentist enough.

    The standard twice-a-year visit (covered by most dental plans) is only half enough. Adults should see the dentist every 90 days. I know it sounds like a lot (and believe me, I get some resistance from reluctant patients), but, after just three months, the bacteria we clean out of your mouth during a check-up -- it's all recolonized! I know it can seem expensive, especially if you have to pay for the additional visits out of pocket, but it's well worth it from a health perspective. If you think about what you might spend on regularly cutting or coloring your hair, it's really not far off from that.

    2. If you're scared of the dentist because you think it's going to hurt, you're not seeing the right dentist.

    Today we can manage every single aspect of discomfort with the right medications to handle the annoyance of keeping your mouth open for a long period of time, or anesthesia for more extensive, invasive procedures like root canals. You name the issue, we can address it.

    3. If you wait until you feel pain, it's way too late.

    Know this: Most dental issues don't cause pain at first. Cavities, before they become deep, are painless. Gum disease -- also silent. But once you're wincing in pain, that means there's probably already an infection or the pockets of your gums have become riddled with bacteria. Bottom line: Make frequent check-up appointments to nip invisible-to-you problems in the bud, and put your dentist on speed-dial should you notice any problems.

    4. Nothing can replace good, old-fashioned dental floss.

    Sure, you can buy sharp little instruments at the drugstore for picking at your teeth or follow every meal with a toothpick, but until you get in between the teeth, where the surfaces abut one another, you're not attacking the location where some of the worst bacteria hide. The truth is, brushing only gets about 50% of the nasty stuff off of your teeth. Floss is the only thing that can attack the other half. No matter how fantastically high-tech your brush is or how thoroughly you go over each tooth, you still need to floss.

    Wednesday, November 14, 2012

    Tobacco Use and Your Oral Health

    In addition to affecting your overall health, tobacco use and smoking can cause a number of oral health issues, ranging from oral cancer to discolored teeth.
    “You can get yellow teeth [and] a yellow tongue," says Thomas Kilgore, DMD, professor of oral and maxillofacial surgery and associate dean at the Boston University Henry M. Goldman School of Dental Medicine. "You see a lot of staining on the tongue.”
    Smoking and tobacco use can lead to more serious oral health complications as well, including gum disease and oral cancer.
    Smoking and Oral Cancer
    “The most serious issue is mouth cancer,” Dr. Kilgore says. “It’s hard to say what percentage of people who smoke will get mouth cancer, but the death rate of those who do get it is high — between 40 and 50 percent of all cases, and that hasn’t changed over the last few decades.”
    The American Cancer Society estimates that 90 percent of people with oral cancer (cancer affecting the lips, tongue, throat, and mouth) have used tobacco in some form. Likewise, the risk of oral cancer is six times higher among smokers relative to non-smokers. Your individual risk of oral cancer depends on how long you’ve been using tobacco — the longer you use it, the greater your risk.
    Smoking and Periodontal Disease
    “Smoking cigarettes doesn’t cause dental decay, but it does cause periodontal, or gum, disease,” Kilgore explains. “Bone loss is part of periodontal disease. It starts out as inflammation of the gums. In the natural and unfortunate progression, the bone supporting the roots of your teeth becomes inflamed,” and then the underlying bone can deteriorate, he adds.
    “There are surgical and nonsurgical therapies to reverse or slow the progression of periodontal disease,” Kilgore says, but without proper treatment, gum disease does eventually lead to tooth loss and jawbone damage. One study found that smoking was associated with more than 50 percent of periodontal disease cases.
    For Oral Health, No Tobacco Is Safe
    People often think that different forms of tobacco are "safer" than others. However, says Kilgore, “Tobacco in any form has risks. It’s hard to figure out which is worse” — when tobacco is chewed, smoked, or inhaled.
    The bottom line is that regular exposure to tobacco in any form can compromise your health. Kilgore points out that “pipe smokers may not smoke very often, but they can [still] get cancer of the lips, as they’re always holding the pipe in the same place on the lip.” Additionally, “there’s a myth that chewing tobacco has less risk, but it’s been shown pretty clearly that this isn’t true.”
    And people who use smokeless (chewing) tobacco are at a four to six time greater risk of oral cancer than people who don't use tobacco at all. People who use smokeless tobacco are also at higher risk of tooth decay and cavities because some varieties of chewing tobacco contain sugar for a sweeter taste, and sugar is a primary cause of tooth decay.
    Protecting Your Oral Heath
    The following three principles can help to ensure good oral health throughout the years:
    • Quit smoking. After you’ve quit smoking, your risk of oral health problems decreases significantly. And the longer you remain a non-smoker, the lower your risk becomes. A decade after you’ve quit, your risk for periodontal disease is similar to that of a person who never smoked at all. “A lot of dentists now are taking the initiative to ask patients about their smoking habits, and are talking about the [nicotine] patch” and other ways to help people quit, Kilgore says.
    • Get regular dental checkups. As with most cancers, early detection can improve your outcome. “The good news is that regular checkups by a dentist are a good way to catch oral cancer early,” advises Kilgore. “Any mouth ulcers can be checked out with a biopsy, and you can get a diagnosis.” The sooner you start treatment, the better your odds of survival.
    • Brush properly. “Most people who have periodontal disease develop it from not brushing and flossing properly,” Kilgore notes. The heat and carcinogens found in cigarettes and tobacco are also damaging to your mouth and gums. So people who use tobacco need to be doubly careful about brushing and flossing correctly and doing so as often as recommended. Ask your dentist or dental hygienist to watch you brush and floss to make sure you’re doing a thorough job.
    Having Trouble Quitting? Visit the Dentist Regularly
    If you do use tobacco, cutting back and eventually quitting are some of the most important actions you can take to improve both your oral health and your overall health.
    Tobacco use “is a tremendously addictive habit, so in the meantime, regular dental visits can help with early detection” of gum disease and precancerous mouth sores, Kilgore says. He adds that the people at greatest risk for oral cancer are chronic smokers who don’t visit their dentists regularly. “By the time oral cancer is detected, it’s hard to treat," he says. Plus, the treatments can be more challenging at later stages. Surgery and radiation treatments are often disfiguring and can affect your ability to speak and eat.

    Oral Hygiene and Your Overall Health

    How well you care for your teeth and gums has a powerful effect on your overall health. Neglecting your oral health lead to more than just sore teeth and bad breath — it can open the door to all sorts of health problems, including some pretty nasty diseases like oral cancer. Researchers have found possible connections between gum problems and heart disease, bacterial pneumonia, stroke, and even problem pregnancies.
    “You cannot be healthy with an unhealthy mouth any more than one can be healthy with an infected foot,” says Richard H. Price, DMD, spokesperson for the American Dental Association (ADA) and a former clinical instructor at the Boston University Dental School.
    The Role of Diet and Lifestyle in Oral Health
    A number of dietary habits and lifestyle factors can affect oral health, including:
    Sugar consumption. “Having a sugar-laden diet will contribute to tooth decay and gum problems, as the bacteria in the mouth thrive in this environment,” producing tooth and gum-destroying enzymes and acids, says Dr. Price, who retired after 35 years as a dentist in Newton, Mass.
    • Smoking. Dental care experts have long known that smoking cigarettes and cigars and using tobacco products can cause periodontal disease (gum disease), tooth decay, and oral cancer. Cigars can also cause periodontal disease and throat, or pharyngeal, cancer. “The smoke from tobacco has a toxic effect on gum tissue, and can interfere with blood flow,” Price explains. “Smoking also stains the heck out of teeth, is a direct cause of oral cancer, and can contribute to bad breath.”
    • Drinking alcohol. “Drinking can contribute to oral problems indirectly by resulting in a dehydrated mouth, which can allow bacteria to run rampant,” Price says. In addition, people who have alcohol addiction issues are probably less likely to consistently follow good dental care habits, he says.
    • Changes in weight. For those who wear dentures, changes in body weight tend to affect the way dentures fit, Price says. “Just as weight gain or loss affects the way clothes fit, that gain or loss also affects the gum pads on which dentures rest,” he says. To help maintain a healthy weight and fight tooth decay, the ADA advises people to eat a diet rich in high-fiber fruits and vegetables.
    • Medication. “Some medications, for example, some antibiotics, can cause internal staining of teeth, such as tetracycline staining, depending on the age at which you take them,” says Price. Also, “there are 200 to 400 medications, prescribed or over-the-counter, that have the side effect of drying up saliva. A dry mouth is more prone to gum disease and tooth decay, as well as bad breath.”
    Healthy Mouth, Healthy Body
    To maintain your oral health — and overall good health — Price says you should see your dentist regularly to head off any problems early. You should also practice good oral hygiene at home by carefully brushing and flossing your teeth regularly in order to prevent plaque from accumulating and causing problems. There is nothing a dentist can do that a patient can’t undo by neglecting their dental care, says Price.

    Professional Teeth Whitening Options

    Want a brighter smile? Your dentist can help.
    Of all the cosmetic treatments offered by dentists, teeth whitening is the most popular. That may be because teeth whitening is less expensive than most other cosmetic dental procedures, yet it can make a dramatic difference in a person’s appearance and self confidence.
    Teeth whitening products are available over-the-counter and at the dentist’s office. “But seeing a dentist for teeth whitening is the fastest and most effective way to whiten your teeth because the bleaching materials are stronger than what’s available in the stores,” says Kimberly Harms, DDS, consumer advisor for the American Dental Association (ADA).
    Professional teeth whitening can be performed in the office by your dentist or at home under your dentist’s supervision. Here are the pros and cons of each method:

    Teeth Whitening Done by a Dentist
    How it works: A whitening product is applied directly to the teeth. The product contains hydrogen peroxide (bleach) in concentrations of 15 to 35 percent. Light or heat may be used to accelerate the whitening.
    • Pros. Fast results. “One session lasting about 60 to 90 minutes can give excellent whitening,” says Dr. Harms. Many people only need one visit but, some people may need two or three to achieve the color they want. Because the bleach is applied directly to the teeth, teeth whitening performed in a dentist's office gives the most uniform results.
    • Cons. Since the whitening solution is so concentrated, your gums must be protected with a gel or a rubber shield. Even so, some people experience temporary tooth sensitivity and gum irritation.
    • Cost: $500 to $1,200. This is the most expensive method of teeth whitening. “Typically, the more time you spend in the dentist’s chair, the higher the cost,” says Harms.
    Home Teeth Whitening Supervised by a Dentist
    How it works: Your dentist takes impressions of your mouth and makes a customized mouthpiece for you to wear. You’ll be given a tooth whitening gel containing a lower concentration of hydrogen peroxide than what's used for in-office whitening. At home, you’ll fill the mouthpiece with the whitening gel and wear it for a few hours each day or night. The customized mouthpiece allows maximum contact between your teeth and the whitening gel.
    • Pros: Convenience and price. You can whiten your teeth on your own at home, while saving money over the more expensive in-office whitening. Your dentist will supervise the whitening with checkups to be sure the mouthpiece fits properly.
    • Cons: Slower results. The average patient must wear the mouthpiece for one to two weeks before whitening becomes visible. Some patients choose to wear the mouthpiece for several months, depending on the degree of staining on their teeth and the desired level of whitening. This form of professional whitening may require more visits to the dentist to check that the mouthpiece fits properly. Ill-fitting mouthpieces can allow the solution to leak out, causing irritation and uneven or unsatisfactory whitening.
    • Cost: $300 to $500, including material and consultations with your dentist.
    How White Can You Go With Teeth Whitening?
    Professional teeth whitening (either performed or supervised by a dentist) can make your teeth up to seven shades lighter. Your dentist may show you cards with various shades of lightness to give you an idea of the amount of whiteness to expect.
    However, the degree of whiteness achieved can vary considerably from person to person. “It’s difficult for the dentist to predict exactly how white your teeth will get,” says Harms. “The degree of whiteness can depend on the condition of your teeth, the nature of any stains, and genetics.”
    Teeth Whitening Health Risks and Restrictions
    Teeth whitening is safe and carries no serious oral health side effects but some people may experience mild tooth sensitivity or gum irritation after bleaching. “Your teeth may be a little more sensitive to cold, but this usually goes away,” says Harms. A prescription gel can reduce the sensitivity, but most people don’t need it.
    It’s recommended that pregnant and nursing women avoid teeth whitening because the effects of whitening agents on fetuses and babies are unknown. And people with gum disease or cavities shouldn’t undergo teeth whitening until these conditions are treated because whitening solution can penetrate into tooth decay or diseased gums.
    Keep in mind that teeth whitening isn’t permanent. Maintaining your gleaming white smile means repeating the process regularly. But if you avoid smoking and other staining agents such as coffee, tea, and red wine, the effects of professional teeth whitening can last one to two years before a touchup is needed, and most people are happy with the results.

    Teeth Whitening at Home

    Here’s an overview of teeth-whitening products currently on the market.
    Teeth-Whitening Strips
    • How they work: Teeth-whitening strips are thin, almost invisible pieces of plastic coated with a whitening solution (usually a low concentration of hydrogen peroxide). The strips are applied directly to your teeth for 5 to 30 minutes once or twice daily for 5 to 14 days (depending on the product). Generally, strips that are designed to be worn for shorter periods of time have higher concentrations of the whitening solution.
    • Cost: $25-$60
    Teeth-Whitening Gels
    • How they work: Designed to be painted directly on the teeth using a small brush or pen, teeth-whitening gels are typically peroxide-based. The gel is usually applied before you go to bed and left on overnight. The process is repeated for two weeks or longer.
    • Cost: $12-$18
    Teeth-Whitening Trays
    • How they work: Tray-based whitening systems involve filling a mouthpiece-like tray with a peroxide-based whitening gel. The tray is worn for a certain time period each day or night for one to four weeks or longer.
    • Cost: $15-$45
    Light-Based Kits
    • How they work: After using an acid rinse, you paint a whitening gel on your teeth with an applicator and hold a special light (included in the kit) up to your teeth to accelerate lightening. The process can be repeated multiple times.
    • Cost: $45-$60
    Teeth-Whitening Toothpastes
    • How they work: Toothpastes with whitening agents don’t actually bleach or change the color of teeth. Instead, they help remove surface stains using polishing or chemical agents and mild abrasives. This may make the teeth look slightly whiter over time.
    • Cost: $4-$10
    Do Teeth Whitening Products Work?
    Most over-the-counter teeth whitening products will work to some degree if you use them long enough, says Kimberly Harms, DDS, a spokesperson and consumer advisor for the American Dental Association’s (ADA). Over-the-counter teeth whitening products contain much lower concentrations of whitening agents than professional tooth-whitening products used under the supervision of a dentist. “The biggest problem with these store-bought whiteners is that people give up too soon,” says Dr. Harms. “In most cases, you need to use them for weeks and weeks and weeks before you’ll see any change in the whiteness of your teeth.” In a recent study published in the journal General Dentistry, people who used whitening strips for 30 minutes twice daily showed significant improvements in yellowness and lightness/brightness. But all the patients in the study used the strips for 44 consecutive days.
    Are Teeth-Whitening Products Safe?
    Whitening your teeth using over-the-counter teeth whitening products is considered safe but some people may experience mild tooth sensitivity or gum irritation. If you experience these side effects, stop using the product for a few days, says Harms.
    Teeth-Whitening Tips
    The following recommendations will help you get the most out of over-the-counter tooth-whitening products.
    • Talk to your dentist before getting started. The ADA recommends that you consult with your dentist before using a bleaching product, even an over-the-counter one. The reason: Whitening can be uncomfortable or ineffective for people with worn tooth enamel, gum disease, sensitive teeth, tooth-colored fillings, or crowns.
    • Buy well-known brands. Harms recommends choosing major brands that have been around for awhile when selecting an over-the-counter product.
    • Look for the ADA seal. Whitening toothpastes that display the ADA Seal of Acceptance have met the ADA’s standards for safety and effectiveness. Harms says that no over-the-counter whitening strips, gels, trays, or light-based systems currently carry the ADA seal, although several bleaches dispensed by dentists do.
    • If you use the tray-based system, choose a tray with a flexible mouthpiece. Some mouthpiece trays can be molded to your mouth to some degree. “It’s better than an inflexible mouthpiece that may not fit snugly around your teeth,” says Harms. If the mouthpiece doesn’t uniformly make contact with your teeth, whitening can be uneven. Plus, the solution may leak out, irritating your gums.
    • Avoid staining beverages. Your whitening will last longer if you avoid coffee, tea, and red wine. Also avoid smoking, which can stain the teeth.
    • Wait to whiten if you’re pregnant or nursing. It’s recommended that pregnant and nursing women avoid teeth whitening because the effects of whitening agents on fetuses and babies are unknown.
    Though you shouldn't expect dramatic results from over-the-counter teeth-whitening products, over time, a store-bought teeth whitener can make your teeth several shades lighter. Slightly yellow teeth are the easiest to whiten, and new stains are easier to remove than old ones. Gray or black stains are more difficult, and may require professional whitening or another cosmetic dentistry procedure, such as veneers.

    Teeth Whitening: Do It Yourself or Visit the Dentist?

    Do you hesitate before flashing your big, bright smile — because it’s not as bright as you’d like? You’re not alone: According to the American Academy of Cosmetic Dentistry, 96 percent of respondents surveyed believe an attractive smile makes a person more appealing. But if your discolored teeth are keeping you tight-lipped, you may want to consider teeth-whitening treatments.
    According to Elisa Mello, DDS, a cosmetic dentist at NYC Smile Design in New York City, there are various options, both professional teeth whitening and drugstore solutions, to consider. But is one option better than the other?
    The teeth-whitening option you choose will depend on your budget, the severity of your teeth discoloration, and how dramatic you want your results to be. Keep in mind — teeth that are yellow will probably lighten more than teeth with a brownish or grayish tinge.
    Here’s how to choose the right tooth-whitening treatment for you.

    Teeth-Whitening Option No. 1: Laser Bleaching at the Dentist's Office
    "With laser bleaching, a barrier is put around the gum tissue and a strong bleach is put on your teeth," Dr. Mello says. "A laser light is used to activate the bleach and make it work."
    Because your gums are protected and you are under the supervision of your dentist during this professional teeth-whitening treatment, the bleach is a stronger solution than one you’d use on your own at home.
    Laser teeth whitening can be performed in one office visit, generally with three 20-minute bleaching treatments. Dr. Mello calls it instant gratification — "In an hour, you are going to walk out with your teeth a lot brighter." But this is the most expensive of the teeth-whitening options (see price estimates below).
    Teeth-Whitening Option No. 2: Professional Bleaching Trays
    Another professional teeth-whitening option your dentist may offer is bleaching trays. With this method, your dentist will use an impression of your teeth to design custom bleaching trays that perfectly fit your teeth. At home, you'll use a special bleaching solution in these trays daily for one to two weeks. According to Mello, bleaching trays can be used in addition to dentist office laser bleaching when stains are particularly bad or when you're looking for a dramatic result.
    Teeth-Whitening Option No. 3: Over-The-Counter Teeth-Whitening Kits
    Today, there are many types of over-the-counter teeth-whitening products available. "You can buy kits to make your own trays, gels, swabs, strips, paints — there are many different ways to actually get the bleach on your teeth," says Mello.
    Of the various drugstore teeth-whitening choices, Mello recommends strips to her patients because you're less likely to swallow bleach or damage your gums with these products. While the bleaching solution used in over-the-counter products may be too mild to yield dramatic results or to whiten severely stained teeth, these products may help whiten mildly discolored teeth, especially in younger people since their enamel is stronger and less easily stained.
    Making Your Decision
    When weighing your options and deciding whether to undergo a teeth-whitening treatment, consider the following:
    • Cost. Professional teeth-whitening treatments generally cost $500 to $1,200, depending on the option you choose. At-home teeth whitening kits cost anywhere from $15 to $50.
    • Maintenance. Teeth-whitening treatments don't last forever, and most people need to get touch-ups. "In our office, we have that noticed results for in-office bleaching can last up to a year," says Mello. She says that you can expect the results of at-home professional whitening trays to last 6 to 12 months and over-the-counter whitening to last 3 to 6 months. She notes that people who smoke and regularly consume food and beverages that can discolor teeth, such as coffee, tea, and blueberries, can expect their results to fade more quickly. "If [patients] drink three espressos a day, in six months they will probably want to do a touch-up," says Mello. She says that some people can go one to two years between treatments if they limit their teeth-staining habits and regularly brush their teeth.
    • Risks to dental health. "The biggest risk [of teeth whitening] is sensitivity to hot and cold afterwards," says Mello. "It's usually short-term; however, it can be quite uncomfortable." The bleaches used in teeth whitening can also damage the gums and other soft tissues inside your mouth, causing mouth sores and discomfort, so you must take care not to let the bleaching material come in contact with these tissues.

    Accelerated Orthodontics: A Faster Way to Straighten Your Teeth

    If you’re looking for a speedier way to straighten your teeth with braces, you’re in luck. Accelerated orthodontics is a new concept in orthodontic treatment that can accomplish the same goals as traditional orthodontics in much less time.
    “Accelerated orthodontics is becoming popular with adults because the procedure allows teeth to straighten in months rather than years,” says Robert Bray, DDS, an orthodontist in Atlantic City, NJ, and president of the American Association of Orthodontists (AAO).
    According to the AAO, today one in five orthodontic patients is an adult.

    Advantages of Accelerated Orthodontics
    The main advantage of accelerated orthodontics is speed. “With traditional orthodontics, patients may need to wear braces for two to four years, but accelerated orthodontics shortens that time to under a year,” explains Dr. Bray. Most accelerated orthodontics patients wear braces for just three to eight months.
    With orthodontic therapy, you get more than a pretty smile. There are health advantages as well. Because braces help to correct structural problems that may be causing an overbite or crooked teeth, accelerated orthodontics, just like traditional orthodontics, can improve your overall dental health. Having “straight teeth contributes to the health of teeth and gums, as well as the ability to effectively bite, chew, and speak,” says Bray.
    Disadvantages of Accelerated Orthodontics
    Accelerated orthodontics requires a minor surgical procedure, usually performed by a periodontist (gum specialist) about a week after the braces are applied.
    Done under local anesthesia, the in-office surgical procedure alters the gums and bones that hold the teeth in place, which allows the teeth to move into their proper places more quickly. The surgery typically causes the same amount of discomfort as a dental cleaning. It is common, though, for patients to experience an itching sensation with accelerated orthodontics because the teeth move much faster than with traditional braces.
    The Basics of Braces and Orthodontia
    As with traditional orthodontics, accelerated orthodontics involves the use of braces — devices that place pressure on the teeth, forcing them to shift into the proper position. There are three general types of orthodontic braces — ceramic, lingual, and metal. Bray says that any of these types of braces may be used in accelerated orthodontics:
    • Ceramic braces. Made of composite materials, ceramic braces are very strong and stain-resistant. Ceramic braces blend in with teeth and aren’t as noticeable as metal braces. But the ligatures — bands that hold wires to the ceramic brackets — can stain your teeth if you smoke or drink coffee. However, these bands are replaced every time you get an adjustment — usually once a month.
    • Lingual braces. Placed behind your teeth, lingual braces are hidden from view and are popular with adults who don’t want anyone to know they’re wearing braces. “Although lingual braces can be used with accelerated orthodontics, they can be more challenging to apply and it may be more difficult to get the desired result than with ceramic or metal braces,” explains Bray. They’re also more expensive.
    • Metal braces. Although metal braces are very strong and can withstand even the most aggressive accelerated orthodontics treatment, they are the most visible. Initially, metal braces can be more irritating to the gums than other braces, but they’re also the least expensive.
    As with traditional orthodontics, you’ll need to wear a retainer periodically after the braces are removed to prevent your teeth from moving back to their original incorrect position, says Bray.
    Is Accelerated Orthodontics Right for You?
    Accelerated orthodontics is effective in most cases where traditional orthodontics is the recommended treatment. Because accelerated orthodontics is fairly new, there are no long-term studies on how well it works. “However, the procedure appears safe and very effective,” says Bray.
    The cost is similar to traditional orthodontic treatment, even though the length of treatment is shorter. This is because several doctors, including an orthodontist and a periodontist, are involved in the treatment. Expect to pay $2,000 to $6,000 for accelerated orthodontics treatment, which is not usually covered by insurance. Most orthodontics practices offer payment plans, however.
    Accelerated orthodontics provides the same results as traditional orthodontics, but in much less time. If you’ve always been bothered by crooked teeth or have problems with biting and chewing, but dread the thought of wearing braces for several years, accelerated orthodontics may be a good alternative. Ask your dentist for a referral to an orthodontist with training and experience in accelerated orthodontics or visit the AAO Web site to find an orthodontist near you.