Can Tooth Brushing Go Bad?

Most of my dental patients are relatively healthy and want to stay that way. Did you know that when it comes to brushing your teeth that sometimes too much of "good" thing can be damaging?

 

A big red flag that a patient needs coaching in brushing is sensitivity. Typically this patient schedules an emergency visit or has waited until their regular hygiene appointment to discuss this excruciating sensitivity to hot, cold, and sometimes sweets. Rarely does the pain persist after the stimulant (hot, cold or sweet) is gone. And, often, the sensitivity is worst when brushing their teeth or drinking.

Of course, when we think of sensitivity we think of cavities (decay). But not all sensitive teeth have cavities.

We search for the source of sensitivity in a thorough evaluation. In the absence of decay, 99 times out of 100 the sensitivity is isolated to the area where the crown meets the root. Often there is recession (gum loss) exposing this area to the oral environment. Root surfaces are very soft when compared their tooth crown counterparts. By scrubbing this soft tooth structure with a tooth brush combined with the abrasives found in tooth paste it is possible to actually sweep away some of the crystalline surface of the root leaving a highly porous surface that has a direct line to the nerve. Every time hot, cold or sweets comes into contact with this area it sends a zinger to the nerve and OUCH – tooth pain.

Here are a few things you can do to prevent or reduce this type of sensitivity:

1. Choose a "soft" or "very soft" bristle tooth brush.
   
2. AVOID long HORIZONTAL brushing strokes. Focus on creating vertical or circular brush strokes.
   
3. Quit using tooth paste in that area. Brush with a wet tooth brush in that area (dipped in Listerine is a good start), then apply the tooth paste and brush in the rest of your mouth.
   

On our side, we will look at the following – if the sensitivity persists:

1. We may need to check your BITE.
   
2. We always evaluate your gums for recession. Sometimes treatment will help if the gum tissue is thin or frail.
   
3. If all else fails, we can apply a desensitizer to the area that will temporarily bring relief. But, without addressing the way you brush or any problems with your bite – this will only be a temporary fix.
   

   
    

Can I wait until next year?

This time of year I hear this question just about every single working day. And, this may surprise most of my dental peers – but my answer is always "Sure." In our dental family, our patients are always in control of their treatment. So, to wait until next year is ultimately their decision. This is the season for utilizing insurance benefits if they remain – and making the decision to wait for benefits to renew if this year's benefit has been maximized. There are times; however, I feel this is not the best advice.

1. When treatment needs exceed the allowable for next year, too. Insurance allowable benefits have remained the same for decades. Literally. We are starting to see some annual benefits creep up, but they were so far behind on the cost of actual dental treatments the difference is negligible. If insurance allows $1500 a year for dental treatment and the remaining estimated cost of treatment is $3000 there will be an additional out of pocket expense. In these cases to wait doesn't gain us any financial benefit. It is better for our team to find a way to spread the estimated cost into balanced payments so that our patients can get the treatment they want, need and deserve.
   
2. Postponing treatment jeopardizes outcome. Often patient's have advanced disease that needs immediate attention. Cases such as deep decay, painful gum infections and painful toothaches. Mouth pain most often is related to bacterial infection. Bacteria live and thrive in warm, dark places like under the gums and inside teeth that have been weakened by decay. This pain can be relieved with the use of antibiotics. But, seldom is the source of the infection alleviated and once the antibiotics have run their course, the infection quickly returns and often with much nastier results. We live in a world where we hear about drug resistant strains of bacteria developing. And this is how it starts. We have an infection; we reduce the infection with the antibiotics. But, since we don't remove 100% of the bacteria, some of those are likely to be resistant to the antibiotic. When the medicine kills all the bugs that are susceptible to that particular medicine, only the resistant ones are left to infiltrate the infected area. We get bigger, meaner colonies of bacteria. And these are harder to alleviate later. So, in painful situations directly related to bacterial infection, I will follow my "Sure" answer with a "but….".
   
3. It's been years, Doc. Wow. I honor and appreciate those folks that have worked up the nerve to get to the dentist after years of fear. This is similar to a fear of flying – or falling off a horse. Many times to wait another three months will put this person right back in the holding pattern they just overcame. Finding the right steps to take for this patient are critical in making sure they proceed toward complete treatment. In these instances, let's make a plan to bite of a little at a time and keep taking small steps forward.