Ask The Dentist

Ask The Dentist

Oral hygiene FAQ


A properly implemented home oral hygiene program will do more to promote and maintain your oral health than anything else. Here are some questions people have asked about how to maintain a clean and healthy mouth:

Q: How many times a day should I brush my teeth?

A: The American Dental Association advocates brushing twice each day. You should discuss this with your dental hygienist who understands your individual oral health needs and will be able to make a recommendation appropriate for you.

Q: Which is better: a manual toothbrush or an electric one?

A: Comparisons have been made between power-assisted (electric) toothbrushes and manual toothbrushes to look at the ability of each to remove plaque and prevent or reduce tartar buildup, thus reducing gingivitis. These research studies have shown both powered and manual toothbrushes to be equally effective when used correctly. So probably, in practical terms, which brush you use is not the critical factor, but how you use it. 

Q: What kind of toothpaste should I use?

A: There are a lot of products to choose from, and much of the decision depends on individual preference. A fluoride toothpaste is essential for optimal oral health. Beyond that, your dental hygienist and dentist can alert you to any other features that make one product more suitable than another for you as an individual.

Q: What would you say is the best toothpaste that doesn't injure the teeth or gums and whitens?

A: Most dentists agree that toothpaste does little more than improve "mouth feel" and provide flavor while brushing the teeth. Far more important is the way the teeth are brushed, and the type and condition of the toothbrush. Some toothpastes make claims of brightening the teeth, but they do so only to the extent that they help remove adherent stain. Oxygen-based bleaching agents are not chemically stable enough to be included in toothpastes in sufficient concentration to bleach to any degree. Some toothpastes are specifically made to remove heavy stain, and are frequently referred to as "smoker's toothpaste" or "tooth polish". This is a red flag that the toothpaste may be excessively abrasive, and may cause progressive wearing away of the tooth and supporting tissues. These toothpastes are to be avoided. Some toothpastes have therapeutic agents added, such as fluoride (sodium fluoride, stannous fluoride, sodium monofluorophosphate), or desensitizing agents (potassium nitrate, strontium chloride), and may be of additional use for those prone to either decay or dental hypersensitivity. Different toothpastes may only be commercially available in certain locations. You may want to consult your dentist for recommendations. In most cases, though, it's more effort than the issue merits; toothpaste, for the most part, is simply toothpaste.

Q: Is it better to floss before you brush your teeth or after you brush your teeth? My dental hygienist says either way is OK. Is she correct or is one way better than the other?

A: I think most of my colleagues would agree that we're happy when our patients floss and brush; we can't afford to be too fussy about the sequence. There is a rationale for recommending that flossing be done first if you are using a fluoride toothpaste applied to a toothbrush. Fluoride can only provide a benefit to tooth enamel if it comes into direct contact with enamel. While you brush with the fluoride toothpaste, the bristles remove the plaque covering the surfaces accessible to the toothbrush, which can then benefit from the fluoride. The same can't be said for the surfaces between the teeth, which are covered by a thin film of dental plaque that serves as a barrier to the fluoride. However, if you have flossed before application of fluoride toothpaste, these surfaces between the teeth can benefit from the fluoride as well.

Q: Are there any concerns I should have about the use of triclosan in toothpaste?

A: The use of triclosan in toothpaste (and other common household products) is a somewhat controversial issue. Studies have demonstrated that bacteria can develop resistance to the antimicrobial effects of triclosan, as they do in the case of antibiotics. This not only limits the long-term effectiveness of triclosan, but has implications for the development of pathogen resistance to similar chemical antimicrobials in treatment of more serious conditions.

Q: I’ve noticed that tartar builds up very quickly at the bottom of my lower front teeth on the tongue side. What are my options?

A: Patients under the care of a periodontist (gum specialist) are now typically given a recall interval of every 3 months. Refer to dental hygienist to get the best option for recall intervals. Patients who form a lot of tartar will form it regardless of the effort they claim to employ in its prevention. That said, there is almost always room for improvement in a patient's oral hygiene technique.

Q: Why do I gag when I scrape my tongue???

A: Gagging is a normal protective reflex. It serves the purpose of ingesting a foreign object that threatens to fall into the respiratory tract, which would be a grave occurrence. People vary in the irritability of their gag reflex. This is a problem that dentists must deal with on a daily basis when taking x-rays, taking impressions, etc. It is impractical to abolish the gag reflex. Regardless of just how active a person's gagging may be, they usually can only brush a small portion of their tongue before inducing gagging. The tongue extends quite a bit behind the part that is readily visible, and nearly all will gag if its posterior regions are stimulated. Brushing the tongue will reduce the total bacterial count in the mouth. The consensus among dentists is, however, that the bulk of your hygienic efforts should be reserved for the teeth themselves. This will reduce your susceptibility to both decay and periodontal disease. Brush your tongue if you wish, but don't worry if you can't brush the whole length of it. None of us can!

Q: What Causes Tooth Loss?

A: The most common causes of tooth loss are dental caries, also known as tooth decay or cavities, and periodontal disease, which affects the gums and bone structure that supports the teeth. Dental caries is the major cause of tooth loss in children, and periodontal disease is the major cause of tooth loss in adults; however, it too can afflict children and young adults.

Children’s dentistry FAQ


Children's dentistry is so more than just "dentistry for children." It is in early childhood where lifelong habits are learned, such as the recognition of the need for proper oral healthcare. A dentist helps to form the child's first impressions of dental care, and consequently forging the attitudes toward dental treatment that will last a lifetime.

Q: When should I take my child to the dentist for the first check-up?

A: Around age 3— it may be helpful to bring the child and let them sit in a parent’s lap to get comfortable with the dental environment before their first appointment.

Q: What should I use to clean my baby's teeth?

A: A toothbrush will remove plaque bacteria that can lead to decay. Any soft-bristled toothbrush with a small head, preferably one designed specifically for infants, should be used at least once a day at bedtime.

Q: What should I do if my child has a toothache?

A: First, rinse the irritated area with warm salt water and place a cold compress on the face if it is swollen. Give the child acetaminophen for any pain, rather than placing aspirin on the teeth or gums. Finally, see a dentist as soon as possible.

Q: Are thumbsucking and pacifier habits harmful for a child's teeth?

A: Thumb and pacifier sucking habits will generally only become a problem if they go on for a very long period of time. Most children stop these habits on their own, but if they are still sucking their thumbs or fingers past the age of three, a mouth appliance may be recommended by your dentist.

Q: How can I prevent decay caused by nursing?

A: Avoid nursing children to sleep or putting anything other than water in their bed-time bottle. Also, learn the proper way to brush and floss your child's teeth. Take your child to a dentist regularly to have his/her teeth and gums checked. The first dental visit should be scheduled by around age 3.

Q: How often does my child need to see the dentist?

A: A check-up every six months is recommended in order prevent cavities and other dental problems. However, your dentist can tell you when and how often your child should visit based on their personal oral health.

Q: Toothpaste: when should we begin using it and how much should we use?

A: The sooner the better! Starting at birth, clean your child’s gums with a soft infant toothbrush or cloth and water. As soon as the teeth begin to appear, start brushing twice daily using fluoridated toothpaste and a soft, age-appropriate sized toothbrush. Use a "smear" of toothpaste to brush the teeth of a child less than 2 years of age. For the 2-5 year old, dispense a "pea-size" amount of toothpaste and perform or assist your child’s toothbrushing. Remember that young children do not have the ability to brush their teeth effectively. Children should spit out and not swallow excess toothpaste after brushing.

Q: How do I make my child's diet safe for his teeth?

A: Make sure your child has a balanced diet, including one serving each of: fruits and vegetables, breads and cereals, milk and dairy products, and meat fish and eggs. Limiting the servings of sugars and starches will also aid in protecting your child's teeth from decay. You can also ask your pediatric dentist to help you select foods that protect your children's teeth.

Q: How do I know if my child is getting enough fluoride?

A: Have your dentist evaluate the fluoride level of your child's primary source of drinking water. If your child is not getting enough fluoride internally through water (especially if the fluoride level is deficient or if your child drinks bottled water without fluoride), then your dentist may prescribe fluoride supplements.

Q: What can I do to protect my child's teeth during sporting events?

A: Soft plastic mouthguards can be used to protect a child's teeth, lips, cheeks and gums from sport related injuries. A custom-fitted mouthguard developed by a dentist will protect your child from injuries to the teeth, face and even provide protection from severe injuries to the head.

Q: What should I do if my child falls and knocks out a permanent tooth?

A: The most important thing to do is to remain calm. Then find the tooth. Hold it by the crown rather than the root and try to reinsert it in the socket and see a dentist immediately. If that is not possible, put the tooth in a glass of milk and take your child and the glass immediately to the dentist.

Q: How can parents help prevent tooth decay?

A: Parents should take their children to the dentist regularly, beginning around age 3. Then, the dentist can recommend a specific program of brushing, flossing, and other treatments for parents to supervise and teach to their children. These home treatments, when added to regular dental visits and a balanced diet, will help give your child a lifetime of healthy habits.

Cosmetic Dentistry FAQ


Curious about cosmetic dentistry? Here are the answers to some common questions:

Q: What are the effects of whitening your teeth? Can it damage the teeth?

A: If by whitening you mean a dentist-administered bleaching treatment, it is currently thought to present little risk except for some short-term soreness of the gums and a temporary increase in tooth sensitivity to heat, cold, contact, and sweets. It is a relatively new technology, and the long term cumulative effects, if any, are not known. The same degree of safety cannot be assumed for unregulated over the counter bleaching agents, due to the unknown nature of their content.

Q: I’m thinking about having five new caps made on my upper row of teeth. They will be made to match the color of the two natural teeth that I have on that row. I’m considering having those two teeth bleached first, and then have the new caps made to match the color of my newly bleached teeth. My concern is that the bleached teeth may change color over time and then the new caps will not match them any more. I do not know much about bleaching and I certainly do not know anyone who has had it done to ask them. What do you think?

A: It is true that once bleached, teeth will eventually tend to relapse and darken. There's no reason why they can't be repeatedly re-bleached, but this is something you may prefer not to do. In any case, the bleaching causes only a modest amount of whitening, and the disparity between your new caps and the bleached natural teeth is not likely to be great even if the bleached teeth darken. If you like the color of your natural teeth, skip the bleaching, and just have your caps to match the natural color.

Q: Why do some people's teeth discolor a yellow to brownish color upon aging? There are no injuries to the teeth. I have been told that it is just a part of aging?

A: Often it is just a part of aging. The surface enamel becomes worn and thin during a lifetime of chewing, allowing the underlying dentin (which is a darker color) to shine through or become exposed to the surface. The central pulp tissue becomes increasingly calcified and the surrounding dentinal tissue becomes sclerotic, darkening and opacifying the teeth. Recession of the gum exposes the root surfaces, which are often darker than the crowns of the teeth. Of course, some people become less motivated to clean their teeth, or may become physically incapacitated. This can cause their oral hygiene to suffer, allowing the accumulation of extrinsic staining. All of this can contribute to darkening of teeth with age.

Fear of Dentistry FAQ

Most people manifest some degree of fear and anxiety when confronted with a dental experience, yet some people feel that they are alone in this respect. Knowing that this is both a common and manageable problem will assist those who are so affected.

Q: Help! Please give me some reassurances if you can: I need to go to the dentist, I know that. I have visible cavities in several of my teeth that I know need serious help. I have not been to the dentist in at least three years because I hate needles, I hate people leaning over me, I hate the fact that my mouth is so small that my jaws hurt after every dentist visit from stretching too wide, I hate people treating me like I'm stupid, I hate the fact that I am so sensitive to pain that I need three or four shots every time, and I hate the fact that I have bad reactions every time to the pain medications! Help! I don't want to end up with false teeth, but I get upset even thinking about enduring another trip to a dentist!

A: You are not the only one who has these thoughts and feelings. What distinguishes you and those like you is that through accumulated past experience and/or your personal temperament, you have developed an aversion sufficiently strong to deter you from treatment you know is necessary. We will not sugarcoat dentistry for you, but it is fair to say that objectively, you will perceive it to be far worse than it is due to your fears. A caring, compassionate dentist, such as Dr. Hixson, will arrange for sufficient time for your appointments, allowing adequate time for sufficient anesthesia, mouth rinsing, resting, and whatever you need within reason to get the job done.

Gum disease FAQ


Biomedical advances in the fight against tooth decay have revealed that healthy gums lead to longer life expectancy. No longer is fixing cavities the predominant role of dentistry. The prevention and treatment of gum disease and the promotion of periodontal health has moved to the forefront of modern dental practice and research.

Q: What Causes Cavities (also known as dental decay or caries)?

A: Plaque, a thin, colorless, sticky film containing bacteria, which constantly forms on the teeth. These bacteria use carbohydrates—sugars and starches—to produce an acid that attacks the enamel covering the teeth. After repeated acid attacks, the enamel can be broken down and a cavity begins. Continued acid attacks eventually dissolve the enamel and penetrate the softer, inner layer of the tooth, where decay can spread rapidly throughout the tooth’s structure. Acid attacks begin immediately after every meal or snack and last about 20 to 30 minutes.

Q: Can Cavities Be Prevented?

A: Teeth can be protected from acid attacks by removing plaque, reducing the number of times and the amount of sugar and starches eaten, using fluorides, having plastic sealants applied to teeth, and by regular professional cleaning of teeth by a dental hygienist.

Q: How Does Plaque Attack the Gums?

A: Plaque can also produce harmful byproducts that irritate the gums, causing gingivitis, the early stage of periodontal diseases. If plaque isn’t removed daily, it will build up into a hard deposit called calculus. If plaque continues to form on top of the calculus, it can irritate the gums, and a pocket may develop between the teeth and gums. Plaque build up can eventually destroy the gums and bone structure that support the teeth.

Q: My gums have been really sore for a long time. They bleed a lot and I have space in between my teeth. Is there any one who can let me know what it is and how I can treat it?

A: Periodontal disease ranges from mild gingivitis to severe periodontitis with bone loss. Most people are not equipped to make a precise diagnosis by themselves. See a dentist as soon as possible!

Q: I am 26 and I am having problems with gum recession. How can I stop it?

A: Gingival (gum) recession is due to a variety of factors. In order to determine an appropriate approach to management and prevention, a proper diagnosis must first be made. If there is periodontal (gum) disease, it must be treated professionally. There are some pre-disposing factors to gingival recession which are not under either a patient's or dentist's control, such as the shape and position of the supporting bone relative to the root of a tooth. There may also be instances of gum recession resulting from poor tooth position, which may be effectively managed with orthodontic tooth movement (braces). If other causative factors have been eliminated, attention should be turned to oral hygiene technique. If a hard-bristle toothbrush is used, it should be changed to a soft nylon bristle variety. If an abrasive toothpaste is used (e.g., smoker's toothpaste), it should be dropped in favor of a milder type, such as any of the ADA-approved dentifrices. Finally, if you hold your toothbrush in a white-knuckled death grip and scrub until you're spitting out gum tissue, you should refine your technique to a light grasp, using a gentle, short-amplitude stroke. Once recession has occurred, it is prudent to attempt to limit any further progress. There are periodontal procedures intended to re-claim lost root coverage that have varying degrees of success; they are useful if the gum recession has produced a cosmetic deficit. Otherwise, you may need to deal with root surface hypersensitivity; this is usually manageable with a toothpaste designed for sensitive teeth.

Bad Breath FAQ


The demand for products to deodorize and mask oral odors has never been greater. No one wants to have bad breath, but the truth is that some odor is normal, while some may be a sign of something more significant. Here are some frequently asked questions on this topic.

Q: How do I get rid of bad breath?

A: That depends on what is causing it. Often, bad breath results from less-than-optimal oral health, and sometimes people are not aware that they are not performing oral hygiene as effectively as they could be. A dental hygienist or dentist will be able to evaluate your oral health procedures and make recommendations for improvement. Also, these professionals will be able to recognize any associated problems that might be contributing to an unpleasant mouth odor. In addition to evaluating and suggesting alterations to your brushing, flossing, and tongue-cleaning regimen, your dental hygienist may recommend products such as mouthwash. If it turns out that the problem isn't in the mouth, a physician appointment is advisable. Sinus problems, stomach problems, certain foods and medications, and other factors can contribute to bad breath.

Q: I often have a bad taste in my mouth and it seems to originate from the tongue. Whenever I brush it thoroughly it is okay for a short while. However, after some time passes, or shortly after eating, my tongue seems to build up something on it. I don't often get a visible white coating, and often if I scrape my tongue, nothing will come off. In the morning I sometimes do have a residue on my tongue and have an unpleasant feeling/taste. I brush teeth and tongue regularly and I floss. I've tried various mouthwashes, but they don't seem to do anything, particularly the ones containing alcohol. What might be the problem?

A: The source of bad breath can be anywhere in the path of the airway, although the mouth is often the area first to garner suspicion. One thing we have found is that a person is ill equipped to determine the presence or absence of his own bad breath. "Morning mouth" is a common condition caused by the slowing of salivary flow during sleep. This permits the accumulation of bacteria and debris which would otherwise be cleared from the mouth and swallowed. Everyone has this to an extent. Antimicrobial factors in saliva (enzymes and antibodies) are thought to be irrelevant to bad breath; it is more related to the volume of salivary flow. You should discuss this issue with your dentist. He will be able to determine whether there is a dental basis for it.
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