Why do regular brushing, flossing and dentist visits fall by the way side all too often? Dr. Katera Hopkins, dentist, and Chelsea Brooks, registered dental hygienist, share tips for good dental habits and how to maintain them.

Listen to the interview at the link below or read the transcript that follows.

Learn more about Dental and Oral Health at the University of Vermont Medical Center. 

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What are mistakes that people make the most often when it comes to dental care?

Dr. Hopkins: There are a lot of people out there who are very fearful around dentistry. Either they’re embarrassed or they just are afraid of what we do, whatever it is. There’s a lot of resistance to even coming in and starting with a dentist. So, we try to spin it in a way that it’s not about mistakes so much as what can we do to help serve you.

We care a lot about prevention and education and establishing a dental home and just getting people in the door to get them comfortable to kind of establish a baseline routine with hygiene, home care, nutrition counseling, maybe smoking cessation counseling if that’s appropriate and going from there. Chelsea?

Chelsea Brooks: I would say if there was any mistake it would just be trying to sweep things under the rug and not coming in, letting that fear stop you from coming in. It’s like Dr. Hopkins said, just spinning it so that, you know, we’re not focusing on anything negative or really trying to change so much but just the education piece and trying to give them these new tools and new tricks to make it something that is not a scary experience but a positive one.

How often should we visit the dentist?

Dr. Hopkins: It really depends on the patient. Ideally everyone should be seeing the dentist and almost even more importantly in some senses, the dental hygienist, at least twice a year. Somebody who doesn’t have any teeth should be seeing a dentist at least once a year to have a soft tissue then or a cancer screening. Make sure if they have an appliance that that’s fitting well and not causing any issues or irritations. Somebody who has teeth, if they’re healthy and being maintained well with their regular hygiene program, taking good care of things at home, can usually get away with every six months.

There are other factors. The two primary disease states that we’re working with are caries, just dental decay causing cavities in the tooth structure and then periodontal disease which is destruction of the gums and the bones. Both of these are bacterial processes and these are the things that we’re trying to help improve or fight against when we’re having folks come in to have exams and to have cleanings.

Chelsea Brooks: People in those situations if they are kind of afflicted with those diseases just need a little extra attention so then sometimes we recommend that we see them for regular dental visits and care even up to like every three months or every four months. It, like she said, kind of just depends on their need and where they’re at with those diseases.

Dr. Hopkins: Especially we know, and there’s more and more literature coming out supporting the connection between the oral cavity and the environment in our mouths and how that can affect us systemically. A really good example of this is, type 2 diabetes and periodontal disease are very much interconnected with improvement of one, the other can improve. With exacerbation of one, the other can exacerbate. If we have a patient who is diabetic, we know that they are at greater risk for periodontal disease, they need more frequent hygiene visits and examination.

Why is that? How are they connected?

Dr. Hopkins: It basically comes down to an inflammatory process. Your body is essentially reacting to the inflammatory process and creating breakdown and destruction of the gums and the bone that supports the teeth. Uncontrolled sugar levels can also play a role in that inflammatory reaction.

Chelsea Brooks: To put it in like lay terms, it’s like people that have diabetes it’s harder for them to kind of fight and resist infection. If you think of this infection in their body, we all have that bacteria in our mouth so somebody with diabetes that can’t fight it as well is just going to be more susceptible to more destruction from that infection and more bone loss and things of that nature. We see them more frequently so we can kind of get rid of that infection, that bacterial level before it does more damage.

Make dental health a priority for your family.

How can adults and children incorporate good dental behaviors into our daily routines so we don’t have to come in as often?

Dr. Hopkins: Definitely, like we talked about, establishing a dental home, seeing somebody routinely and hopefully all you need is a cleaning and exam. Then from there, most of it is what you do on a daily basis at home through brushing and flossing. Twice a day for brushing, once a day for flossing, using a fluoridated toothpaste. A lot of people ask about is it really necessary to floss and, you know, can I only brush once a day, that sort of a thing. It is really important to actually mechanically remove the plaque and the buildup because it really starts to adhere to the teeth well after those 12 hours so that’s why that recommendation exists.

Beyond that, nutrition is a huge factor especially as far as sugar and acid consumption. Sugars and acids both can either help promote the bacteria that cause tooth decay and/or cause enamel erosion and breakdown of the outer structure of the tooth. There’s a lot of foods that we think of that are healthy and they are healthy, they’re nutritious. However, they can be sticky, like dried fruit for example, can be really sticky and adhere to the tooth structure and cause that breakdown process. We spend time counseling parents especially around that.

Same with juices or smoothies. We see the packets a lot that kids consume which is great because they’re getting their fruits and vegetables. However, just making sure for kiddos that their parent is taking a wet washcloth or making sure to brush with a fluoridated toothpaste. It’s really important.

What are some of the more acidic food that you run into?

Chelsea Brooks: I mean, a huge one are you know, sports drinks and sodas. Especially sports drinks where people think that oh, you’re replenishing that electrolyte balance. My kid just was at soccer practice and they need this power aid or whatever but those are really really acidic. Then just, again, every step you’re bathing your teeth with those things. I think that the main culprits that we see are people with sodas or orange juice, lemonade. A lot of those things that again, maybe there is some nutritional benefit in orange juice and some of these teas 00:07:14] but the more that you’re just exposing your mouth to them the more that you’re bathing your teeth really essentially in those acids which are pretty bad.

I think that most people like when they come in there, “Oh, my kid doesn’t have candy that much or we don’t have lozenges” like a cough drop lozenge. You know you would think is but that’s essentially kind of a hard candy that you’re just pressing up against your teeth and in your mouth while it takes time to dissolve. That’s another huge time frame for your mouth to kind of be in that acidic environment as it melts.

Dr. Hopkins: The longer your teeth have that exposure, the more possible the damage is.

So should we all just stop drinking Gatorade?

Dr. Hopkins: Yeah, we’d like to say, yes. We understand that that’s not necessarily always going to be a possibility but certainly focusing on moderation and really trying to hydrate with water for the most part. Then if and when you really do need those electrolytes after a one-hour run or a really intense workout, try to have low-sugar, low-acid types. There are some out there. Limit it to less than once a day and over a short period of time so that you’re not drinking it throughout the day, exposing your teeth to those. Yes, it helps to rinse your mouth out immediately having what we call an acid exposure. So when you expose your mouth to either the acids or the sugars, rinsing your mouth out with water is a great idea.

However, your teeth are, let’s say a little bit softer right after they’ve been exposed to acid, so they are more prone to breakdown if you … to the abrasion from the toothpaste and the toothbrush. We actually recommend that after an acid challenge that somebody waits for half an hour to kind of neutralize the saliva before brushing. But that reminds me of another topic that’s a good thing to do at home. It’s just hydration in general. There are a lot of things, whether it’s medications or alcohol or mouth breathing, that can contribute to dry mouth which is, we call it xerostomia, that has huge implications for oral health. Especially for cavities but it can also just be really uncomfortable for folks. Most medications contribute at least a little bit to dry mouth. Some contribute significantly.

You’ve done work with the population that takes medication for opioid use. Could you tell us a little more about how that might impact oral health?

Dr. Hopkins: Definitely. Medication assisted treatment generally in this area is done through Suboxone which we definitely want to recognize the importance of it for patients who are in recovery but it certainly has pretty significant oral health implications that we’re trying to raise awareness around. So, we want patients and prescribers to know that all of these things that we discussed as far as just taking care of your teeth, establishing a dental home, trying to hydrate with water and avoid sugary, acidic beverages in particular, trying to avoid smoking or cut back on smoking, are all factors that can help improve your chances of a healthy mouth.

Suboxone is taken in sublingual form so it’s a film that dissolves under the tongue so the oral environment has prolonged exposure to the Suboxone which is very acidic and like we talked about, the acid can really cause breakdown of the teeth. A lot of times patients have a lot of other things going on and so their oral health isn’t necessarily their first priority especially as they’re first initiating that recovery process. We do see a lot of just general neglect, lack of brushing, pretty heavy plaque accumulation.

Tooth decay: Can you talk a little bit about some dental diseases you see often and how to prevent those?

Dr. Hopkins: The primary two things are cavities and periodontal disease or gingivitis. Really truly a lot of the things we discussed as far as taking care of things at home, having a good diet, getting plenty of rest. All the things that we know in general keep us healthy are the things that also keep our mouths health. With a healthy mouth we’re a lot better off. Brushing and flossing I cannot emphasize enough, using a fluoridated toothpaste to help protect that enamel.

Other concerns that we see especially related to stress, not always to stress but sometimes it’s perhaps to maybe a sleep apnea, breathing issue. We can see wear on the biting surfaces of the teeth. That is either we’re grinding our teeth or we’re trying to thrust our jaw forward at night. If somebody is snoring or having apneic episodes, it’s definitely, definitely really important, not just for your overall health which is a critical reason, but also for your teeth, to have an evaluation and possibly a sleep study. That would be something that a primary care physician would discuss.

I tell almost anybody who is in graduate school that they should have a night guard because stress can really manifest itself in our mouths. Many of us clench at night or grind our teeth at night, sometimes during the day as well, and that can certainly be exacerbated by stress.

Could people do that and not know it?

Dr. Hopkins: A lot of people don’t realize that they’re doing it but we see signs of wear or breakdown or fractured teeth, that sort of a thing. Another thing that I think is important to talk about is trauma. We see a lot with children either sports activities. Definitely wearing a mouth guard is really important for any kind of impact sports. Helmets are important to prevent or reduce the effects from falls from bikes, skiing accidents, all this.

One thing I didn’t mention is the correlation that we know exists between pregnant women, periodontal disease, and the possibility of pre-term and/or low birth weight. We know that it’s important for pregnant women to get seen early for an evaluation if they need cleanings to make sure that they’re having that work done. It’s very safe for them to also have dental work done especially in the second trimester, whether it’s fillings or cleanings, that kind of thing.

Is there anything we’ve missed?

Dr. Hopkins: I don’t think I talked too much about smoking. Smoking can really do damage on your teeth, especially on the periodontium, the gum and the bone that supports the teeth. I know that smoking is a really challenging thing to try to quit or cut back on. We try to just make sure that patients are aware of the effects. We also ensure that they are supported if they are interested in quitting or at trying to cut back. Even if you’re cutting back, you’re making steps in the right direction.

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