Xecs Dental Advice

Discussion in 'Random Thoughts' started by Xecuter, Mar 7, 2017.

  1. Xecuter

    Xecuter Brush and floss your amp twice a day

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    Hi Guys,

    There was a little interest in a thread on how to avoid dental problems.
    I'm happy to give general advice on dental stuff, however I am not a general dental and if you are in pain or have not seen a dentist in a few years, go and see one.

    The purpose of this thread it to try help people avoid problems as well discuss some basic advice.
    My main professional focus is preventative dental, treatment of peri-implantitis and severe periodontal disease.

    Firstly: If you wait until you are in pain you are going to have a bad time. A hole in a tooth is basically a hard ball of bacteria and pus which is going to eventually reach the nerve and cause you some grief and at least a Yggdrasil in root canal/crown/implant. Routine x-rays and checks (annual or bi-annual depending on your risk) are a must if you want to have excellent dental health for life. However this is not always affordable.

    End Disclaimer.
     
    Last edited by a moderator: Mar 8, 2017
  2. Xecuter

    Xecuter Brush and floss your amp twice a day

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    Xecs' tips
    1. Floss every evening, if you can't floss use flosettes, can't do that, use interdental brushes. Also, almost no one actually flosses correctly.
    This is the correct depth for flossing. Gently work the floss beneath the gum line. Light bleeding is normal if you haven't flossed in a while. If it is pissing out blood, go see a Dentist. Preferably do this after you brush. Your goal is to have no bleeding. Bleeding means inflammation so persist and seek professional help.
    If you are struggling to grip the floss switch to dento-tape and check out some of the youtube tutorials.
    If using the interdentals, use a size that barely fits, gently file from a few different angles working towards the gum. Not as effective as flossing, also this doesn't break the contacts between the teeth.

    2. Brush twice a day. An electric tooth brush is an excellent investment. I recommend the Oral B 3000 to all my patients. Again very few people are effective. Manual - Electric. Note the angle is pretty much 45 degrees rather than perpendicular to the tooth, and the edge line of bristles finish where the gum and tooth meet. Do not use much pressure (stick with soft brushes) with the manual brush, gently make small circles with the brush and work your way around the inside and outside keeping the angle at 45 degrees. With the electric brush work gently back and fourth keeping the 45 degree angle and do the same circuit. Always spend a bit more time hitting the backs of the last teeth and the inside of the molars.

    3. Minimize snacking. Snacking just creates a constant acid challenge for your teeth. The more sugary the worse it is.
    If you do have a snack, rinse with water directly after.
    Sipping on energy/soft drinks all day is about the worst thing you could possibly do to your teeth.
     
    Last edited: Mar 7, 2017
  3. Xecuter

    Xecuter Brush and floss your amp twice a day

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    Random tips
    • Rinse with water after every beverage and meal.
    • Do not rinse after you brush your teeth - toothpaste residue is good for the teeth (yeah it's grosse)
    • Do not brush directly after meals or beverages.
    • Don't bother with sonic brushes, waterpiks, oil-pulling or mouth rinse (no good evidence)
    • Don't use whitening tooth paste - it's just liquid sand paper
    • Never use medium/hard tooth brush heads
    • Colgate total is the only independently researched paste worth your money
    • Don't drink REALLY hot stuff all the time
    • Change your brush/head at least every 3-4 months
    • Don't brush after vomiting, rinse with water and brush 20 minutes later
    • Chew gum
    • Be gentle when brushing teeth, it is more of a polish. You are disturbing bacteria not scrubbing a dirty pan

    A good dentist is invaluable, because the main issues people will have:
    Decay: undetectable without x-rays. Preventable with good oral hygiene and healthy diet. Results in fillings, root canals and a heavily restored tooth is often lost later in life. Worlds most prevalent health condition.

    Periodontal disease (starts as gingivitis): undetectable without x-rays and dental checks: The disease is preventable with good oral hygiene and professional care. Results in irreversible bone loss and gum recession. About 50% of people over 40 will experience some level of periodontal disease.

    Erosion: caused by frequent consumption of acidic/sugary food/beverages. Use of calcium, phosphate and fluoride tooth creme can reduce chance of decay in high risk patients.

    Abrasion: caused by over brushing or brushing with a medium or hard tooth brush for many years. Using a coarse tooth paste will accelerate the wear.

    Fractures: mainly caused by using your teeth as tools, chewing nails, chewing ice, chewing nuts etc, clenching/grinding and of course trauma. Try to avoid this stuff. Get a splint made if you know you are a bad nocturnal grinder.

    The starving student edition.
    Most of the dental problems in young adults these days are from binge drinking, terrible diets and neglecting basic oral hygiene for months/years.

    1. If you are in pain around your wisdom teeth area it's probably pericoronitis. Antibiotics will settle it down for a few months but it will come back - you need to probably have them out.
    2. Make sure to get vitamin C and vitamin D: I've seen a few cases of scurvy in uni students
    3. If you want a free dental exam. Call up a few local practices and say you want a second opinion and quote because you saw some dentist you're not happy with. Most practices will offer to do it for free to get you in the door.
    4. Follow the brush and floss guide carefully. If you do this efficiently and effectively you won't have a massive bill when you do manage to get around to it.
    5. if you are hitting the pingers every weekend or using valium to get to sleep, get an occlusal splint made. You are less likely to crack teeth/cause abfraction.


    Hope this is helpful to someone!

    Al
     
    Last edited: Mar 7, 2017
  4. Xecuter

    Xecuter Brush and floss your amp twice a day

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    Reserved.

    May discuss dealing with dental sensitivity here?
     
  5. jowls

    jowls Never shitposts (please) - Friend

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    Thanks for the thread!

    I recommend generally just getting a second opinion for anything dental/medical. I didn't see a dentist between the ages of 16 and 21-22 (for one reason or another). The first dentist I saw said $3k of dental work was 'imperative'. I went to get a second opinion and the next dentist said my teeth were in surprisingly good health and I only required a (very thorough) clean.

    Needless to say, I still see the second dentist, every 12 months now though. As do my wife and kids.
     
  6. gixxerwimp

    gixxerwimp Professional tricycle rider

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    I always floss before, using the logic that flossing will scrape the plaque off and then brushing will clear it out. I just googled and found this from Colgate: The sequence makes no difference as long as you do a thorough job.

    What's your reasoning behind flossing after?

    BTW, thanks for this great thread! I'm pretty prone to cavities and around half of my bicuspids and molars have been canalled and crowned.
    I just googled this and other than being more fragile, most answers say they should last a long time, or even a lifetime.
     
  7. Hrodulf

    Hrodulf Prohibited from acting as an MOT until year 2050

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    Best dental advice - invest in a wire stripper.
     
  8. Grahad2

    Grahad2 Red eyes from too much anime

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  9. gixxerwimp

    gixxerwimp Professional tricycle rider

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    Regardless of whether or not it prevents gum disease and cavities, I pretty much have to floss after each meal to get the food out from between my teeth (meat & fibers). So I'm glad it exists.
     
  10. Xecuter

    Xecuter Brush and floss your amp twice a day

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  11. Armaegis

    Armaegis Friend

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    I *think* I brush and floss correctly, but my teeth are getting worse as I get older. I had terrible dental hygiene as a kid and I have a slightly receded gumline. Nowadays, I get that hard buildup between my teeth super fast and I can't seem to stop it. My dentist says that it's simply due to the acidity in my mouth changing as I get older and that's just how it is. Is there anything else that I can do?
     
  12. Changeling

    Changeling Tube Slut

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    Here's the cochrane systematic review for those who'd like to dive deeper into the evidence of flossing https://www.ncbi.nlm.nih.gov/pubmed/22161438
    Not sure if you all can access the full article, but if you can it's an interesting read. Not sure if it changes behavior, evidence seldom does. Anyway the evidence to support a reduction in gingivitis and caries by flossing seems to be quite weak. The recommendation from dental care professionals shouldn't change nevertheless. There's no health risk connected to flossing i.e. not making anything worse - and also the fresh feeling I get from flossing makes me continue.

    EDIT: I need @Big D Design to come back with walls of text. I'm commenting on dental threads... :eek:
     
  13. Thad E Ginathom

    Thad E Ginathom Friend

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    I remember being told that the expression long in the tooth, for advancing age actually has a real meaning: receding gum line!

    I am a daytime grinder with a musical edge: if I have a tune in my head, I mark the rhythm with my teeth. I can do this for a long time before I even realise it. My dentist told me not to do it. My music teacher told me not to do it. It is harder to give up than smoking! o_O

    I started not rinsing when I came to India, where a mouthful of tap water can be injurious to one's health. I use an electric brush, and a half-pea of paste is more than enough (how many people use ten times too much paste every day). Rinsing is just not necessary.

    Newbie visitors to India, aware that there is problem with clean water, often ask about showering and toothbrushing. I have often given this no-rinse advice for teeth and never had it positively received!
     
    Last edited: Mar 8, 2017
  14. gixxerwimp

    gixxerwimp Professional tricycle rider

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    I probably couldn't deal with no rinsing, but maybe I'll just do a light rinse/spit from now on.

    Do NOT encourage him! Nothing wrong with replying to an interesting and useful thread on dental hygiene!
     
  15. Thad E Ginathom

    Thad E Ginathom Friend

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    Do different brands of floss sound different?

    ===========================


    Forty-five years ago, a friend who was a [tripped-out hippy] dental student told me that it is better not to use tooth paste at all. He said it doesn't do much, and some brands even added sugar to make it taste good.
     
  16. Xecuter

    Xecuter Brush and floss your amp twice a day

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    It's a controversial one. For me cleaning teeth isn't about clearing debris or plaque, its about disturbing bacteria. There is an argument that doing it after brushing will push toothpaste into areas where teeth are contacting and beneath the gums. Although you are right, there is no evidence to completely support either argument, it's more important to just do it diligently.

    With regard to root treated/restored/crowned teeth
    GIC restorations last about 5-10 years
    Composite resins last about 10-15 years
    Amalgam restorations - 15+
    Gold crowns/restorations - 15+
    Ceramic crowns last about - 15-30 years
    Cerec crowns: User skill limited 5-10 years

    The problem isn't so much the root canal, although these do fail a lot more frequently than Dentists will admit to. This study shows about 20% extraction despite root treatment over 10 years.
    A tooth with a crown is still structurally compromised and susceptible to decay, heavy loading for years will cause eventual failure of the tooth.
    My comment was more referring to the domino effect we see with teeth.
    neglect>decay>filling>replacement due to leakage/decay/shrinkage of restoration>larger restoration>shearing and cracking of tooth>crown>root fracture/root resorption/decay under crown>loss of tooth>implant/bridge/denture
    Even a small decay starts this process. So best to avoid it if possible!

    As I mentioned, the associated press wanted a study which just wasn't viable. They wanted standardized flossing, they wanted a massive group, and they wanted careful tracking for a long period of time.
    Such as study is just not possible.

    The Cochrane review @Changeling linked is also not very indicative because a group being monitored for their brushing ability are going to brush far better than average people. Also these are people interested in a dental study, they are already a biased group. Also how do they know the group's flossing is effective? This is why the AP wanted the flossing undertaken by a dental professional to be considered 'good evidence'.

    So this is where it gets tricky. Biofilms are only dangerous to SOME people at CERTAIN POINTS of their lives. It's all to do with susceptibility.
    Some people don't need to brush or floss. They simply are not susceptible to decay or gingivitis. Other people are not so fortunate and a little bit of biofilm will cause a lot of damage.

    There are a few studies that demonstrate the links between biofilms and gingivitis/periodontal disease but they do not meet the AP standards. Also any person in Dental will give you plenty of anecdotal evidence!

    A note on susceptibility.
    All of my patients are the susceptible kind, as in their genetics don't want them to have teeth.
    Onset is about 35 years old, patients Risk factors include, but are not limited to: a family history of gum disease, smokers, low SES (controversial), have diabetes, poor nutrition or are obese, have stress full jobs/lives, have osteoporosis, have sleep apnoea (minimal evidence) or are alcoholics.
    A susceptible patient can live for years without issue even with a number of risk factors, until one day their bodies begin to destroy their own connective tissue in the presence of established biofilm. Even though seemingly nothing remarkable has changed in the person or the biofilm.

    This is why it is important to always imagine yourself as the susceptible patient, try to minimize the risk factors and you'll be much less likely to experience disease. If you do experience disease it should be much easier to control. This is the gist of most chronic inflammatory disorder treatment.



    It could be a lot of things that are causing the build up. Things I would trial would be:
    • Rinsing after meals and beverages - particularly cheese/yogurt/tea/coffee (some theories on higher calcium bio-availability, possible osteoporosis links?)
    • If you are snoring/using a sleep apnoea device, try using biotene gel to help with dry mouth
    • Increase the amount of scaling and cleaning you get each year. If you are seen once a year maybe move to 2 or 3 times a year.
    • Use the interdental brushes after meals/snacks (try to not snack) and again rinse! Also chew gum after meals
    • Do not chew any vitamins or pills.
    • make sure to gently pull your floss around on the inside so you are cleaning the entire surface area of the tooth

    Remember, calculus/tartar is basically harmless. The bacteria which can use it as a scaffold to mature UN-disturbed can be dangerous.
    Some people just get this build up. It seems to be genetic and accelerated with dentine exposure. However these tactics can definitely reduce it to a much more manageable level.
     
  17. Riotvan

    Riotvan Snoofer in the Woofer

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  18. Xecuter

    Xecuter Brush and floss your amp twice a day

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    Unfortunately waterpiks/airpicks/sonic brushes can't demonstrate good biofilm disruption in independent research. Flossing and brushing are still the gold standard. Sorry!
     
    Last edited: Mar 8, 2017
  19. Changeling

    Changeling Tube Slut

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    Love it, great reply! Meta analysis and Cochrane reviews certainly has their strengths but also their weaknesses if the inclusion criteria is such that it's far from reality or that the outcomes are already given. I will certainly not dismiss anecdotal evidence or go into a scientific debate with an expert like yourself. But I do find it very interesting to challenge what has always been seen as 'best practice'. I would love to read up on some supporting evidence for floss - is there any good and well conducted trials available?

    Now, dental problems are very much prevalent and all risk factors for dental problems you mention happens to be risk factors for other health issues as well.
    In any case, very interesting thread! :)
     
  20. Riotvan

    Riotvan Snoofer in the Woofer

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    Hmm that sucks, thanks for the advice.
     

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