Biofilm–What Is It and Why you should care

It was the end of a long day and I was deeply immersed in my nightly bedtime ritual of brushing, flossing, and getting ready for some badly needed sleep. My Troop of Chore Police (my doggies) came in and informed me that I had forgotten something very important–I had forgotten to check their water.  As I grabbed the water bowl, my thumb noticed a film on the inside of the bowl.

“Ewww! Gross! And there are floaters in the water too!” I said to the Chore Police.

At that moment, my thought bubble popped out of my head.  thoughtbubble1

What is the slime? It is known as a biofilm.  I will quote the definition given by Colgate at www.colgateprofessional.com/patient-eduction/articles/whati-is-biofilm:

Biofilms form when bacteria adhere to surfaces in some form of watery environment and begin to excrete a slimy, gluelike substance that can stick to all kinds of materials–metals, plastics, soil particles, medical implant materials, biological tissues. Biofilms can be formed by a single bacterial species, but biofilms more often consist of many species of bacteria, as well as fungi, algae, protozoa, debris, and corrosion products. Essentially, a biofilm may form on any surface exposed to bacteria and some amount of water.1

So that is the long definition of biofilm. How does this affect you, the person reading a dental blog? I want you to think in terms of this–biofilm=plaque.  Plaque is our nemesis in the dental office.  We know that plaque (biofilms) do bad things when they are allowed to hang out in your mouth. When you see your dentist or dental hygienist for your evaluations, you probably have been nagged, excuse me-I mean instructed, by your dental professional to use a toothbrush and floss at least once a day to keep your teeth and gums healthy.  Is that verbal instruction from a professional enough to keep you motivated? Probably not, since most people do not floss on a daily basis or even on an every other day basis.

For those of you that require a little more motivation let me introduce to you a video. This video is especially good for those visual learners. There is no distraction from sound or color-just the facts. It is about 2 minutes long and shows the bacterial growth in 24 hours. These bacteria are not actors, they are the same types of bacteria growing and flourishing in your mouth right now. If you want to skip to the last 15 seconds, that’s fine. The end shows how much the bacteria colony has grown in 23-24 hours. Yuck!!

Okay, so I hope I have moved you to want to take action. What can you do?

  • Brush daily. I suggest brushing at least twice a day using an ultrasonic toothbrush. The action of brushing mechanically breaks up the protective slime barrier and helps to obliterate the colony. An ultrasonic toothbrush, such as Sonicare or Oral-B, utilizes ultrasonic vibration and mechanical means to disrupt the bacteria.
  • Floss at least once a day. Flossing is an important tool used to reach areas between the teeth and below the gumline. Brushing alone is inadequate in these areas to break up the bacteria. Flossing is another mechanical means of breaking up the bacterial colony.
  • Brush your removable dental appliance. If you are wearing some sort of removable dental appliance such as a full denture, a partial denture, a mouthguard or nightguard, you will want to use a soft toothbrush on a daily basis to clean the surfaces. These appliances build up the same biofilm and can cause problems if left to multiply.
  • Check your denture or partial dentures for wear and report to your dentist. Cracks, rough areas, and peeling of your dental appliance will give the bacteria a place to hide and multiply.

The decision is yours.

Are you willing to let the biofilm have a place to live and thrive in your mouth by giving them a safe place to stay, allowing them to eat what you eat, and possibly taking over your dental and all-over health by their increasing numbers and by-products? Or do you become your own Chore Police and train yourself to spend a few extra minutes per day to brush and floss so that bacteria isn’t allowed to run rampant in your mouth and become a sticky, slimy biofilm?

Be your own Super Hero!!

Have a great week and remember that KNOWLEDGE IS POWER!

Your comments are appreciated and read by the author. Your idea could be our next blog topic.

Trick or Treat! It’s Halloween Time. Where is your toothbrush, Super Hero?

Trick or treat!

Check my teeth!

Give me something good to eat!

Halloween decoration at our office
Halloween decoration at our office

 

Happy Halloween time everyone! How many of you are having visions of piles of sugary treats of all types right now.  Let me share my thoughts with you. I envision many different types of chocolate treats which include chocolate bars, chocolate with peanut butter hidden inside, chocolate with caramel, chocolate covered fruit, the list is endless, and that makes me happy. (I like chocolate, can you tell?) There are also the hard candies, such as Jawbreakers, Red Hots (cinnamon flavored goodness), Jolly Ranchers, and Lemonheads. I cannot forget the soft taffy-like candies: Skittles, Laffy Taffy, gumdrops, jelly beans, and gummy-anything. There is also the old Halloween favorite, a black or orange wrapped unidentifiable candy (?).  Did any of you envision fruit or veggies when you read, “Give me something good to eat”?  Me neither, but if you did I think you may be in the minority.

We offer a taste of candy or lipbalm for those people that can stay away from chocolate.
We offer a taste of candy or lip balm for those people that can stay away from chocolate.

 

As a dental professional, a parent, and someone who doesn’t want to be a party pooper, I enjoy Halloween.  I enjoy watching the variety of costumes from both young and old trick-or-treaters. My favorites are the little kiddos that come to the door dressed as pirates, monsters, or your pick of princesses.  I will also admit that I enjoy the candy; especially the hard candies (Lemonheads and Red Hots-I have not told my dentist about this.). My disclaimer is this: You should suck on the hard candy, not crunch it. I have a couple of crowns to prove it.

 

I have a childhood Halloween memory which resembles a scene from the Charlie Brown Halloween special. There is a bright moon outside to lighten our way through the neighborhood. My friends and I are running from house to house, costumes flying behind us as we try to get to as many houses as we can before quitting time. “Trick or Treat,” we scream and hold our bags open, politely waiting for the sound of candy to drop to the bottom of our bags.  “Thank you” and then we were off to another house. Our pirating for candy for the evening was almost complete when we stumbled upon the dentist’s house. Once again, “Trick or Treat” and “Thank You, Mister,” then back to the van to check our booty for the evening by the dim interior light of the van.

 

“A toothbrush?!?  What is this?” We were all thinking the same thought at the same time. It was the equivalent to Charlie Brown’s disappointment when he says, “I got a rock.” Yes, it was a toothbrush and yes we were disappointed but that dentist was on to something. I can have candy but I also needed to brush afterwards. Ta-Da! It seems so simple now. Eat candy, and then brush away anything that sticks to my teeth. How easy is that? That man had a secret weapon against cavities and he gave each of us one of our own. He was a super hero against decay!

 

Now, I am far too old to be out on the Trick or Treat trail, but if you have kids, you may be out there. Be safe and remember that you too can be a super hero against tooth decay. Simply give a toothbrush or help your kids brush to help save teeth.

                Happy Halloween from Count Porkula and our office!

                http://www.edmonddds.com

 

Keep brushing!

Happy Smile, Healthy Smile

As you may have noticed, I tend to use my own dental experiences in writing this blog. Write what you know about, right? Well, this morning while enjoying my morning tea, one thought that popped to mind was that it was time to touch up my whitening. I’m sure for most of you that would not be the thought that breaks up that beautiful moment when your first caffeine hit of the day takes place. So why is touching up my whitening such a big deal? Mainly because I want to put my best smile forward from the moment I step into my office. I think of myself as a reflection of what is possible for everyone-a happy, healthy smile.

Have you thought about whitening your teeth?
How can I assist you today?

I will admit that I work really hard and have made a real investment in my keeping my teeth healthy. I do the daily flossing thing, well, except on the weekends. My toothbrush of choice is a Sonicare, because I find that it delivers what I paid for it to do-removes the plaque and stain from my teeth. The tongue scraper I have is used every time I brush my teeth, which is at least twice a day. My daily investment of time pays off when I put my lipstick on and smile in the mirror. Or when I see my dentist for my recall and evaluation.  But what about the financial investment? Just like you, I have invested many $$ over time for my healthy smile and I haven’t regretted one cent of it.

Keep you mouth healthy by investing in your oral health.
Keep you mouth healthy by investing in your oral health.

Since I use myself as a demo on this blog, I have had a chance to REALLY see my investment in pictures. I have a couple of crowns to protect my fractured teeth from the massive chewing forces I put on them when I chew gum and eat Lemonheads (Shhh, don’t tell my dentist). I have several fillings-more than several, really-I have lots of fillings throughout my mouth. I have even paid to wear braces for a few years, which I paid for out-of-pocket, because my dental insurance did not have orthodontic coverage for someone my age. Oh yeah, and let’s not forget the Waterpik I used while in my braces to ensure I didn’t get areas of discolored decalcification after those braces came off.

All that said, I can remember a time when I would not smile because I was embarrassed of  my smile. I would hold my hand over my mouth when I smiled or laughed. Sad, huh? For many years I tried to hide the one thing that universally is a sign of happiness-a smile. This shame was due in part to the dentist that degraded me as a child because of my inadequate brushing habits. He did not take the time to ask how I was brushing then correct my behavior. He didn’t even ask if anyone was helping me to brush. He did let me know, in no uncertain terms, that he was very disappointed in my mouth. I was a little older the first time I went to a dentist, so this little kid at the time was appalled!  His chairside manner was atrocious!   I felt so bad about myself and not just about how dirty my teeth were at the time. This embarrassment carried over to my adulthood.

I’m so glad that we have such a wide variety of dental professionals to choose from today. We don’t have to endure the bad treatment from our dental teams as I did back then (in the old days). I am willing to investment in myself, both time and money, to avoid the pain and humiliation I felt all those years ago. I understand the fears and concerns our patients have when they walk into our office. BELIEVE ME, I understand and want to help others get to a place where they are able to enjoy a happy, healthy smile.

Share you smile with others.
Share you smile with others.

Keep Brushing!

http://www.edmonddds.com

Diag-NO-What?….DIAGNOdent, that’s what!

Let me introduce you to one of the secret weapons we have in our arsenal of cavity-fighting weapons. This little warrior uses a laser beam to detect cavities at the most conservative level.  A laser beam is used to detect changes happening before we can feel or see those changes happening. This little helper is designed to detect slight changes in the tooth structure. This little laser, used in conjunction with digital x-rays, often proves to be superior to the older method of using the “pointy poker” to find soft spots in the teeth. And it can be done without you, the patient, feeling the laser working. No pain, now that is a plus!

Folks, meet DIAGNOdent.

laser caries detector
laser caries detector

We have been using this tool for fighting cavities in our office for many years and the technology has been around since 2005. Along with our digital x-rays, we are better able to help our patients maintain a healthy mouth.  The technology available to help you maintain your healthy smile keeps getting better and better.

What does it mean to you to have a cavity-fighter such as DIAGNOdent in your corner? It could mean less tooth pain and problems because we are able to detect and treat cavities before they become large and bothersome. As you may or may not know, cavities do not go away by themselves. We can’t brush them away. We can’t give them away or even wish them away. The only way to get rid of a cavity, or the decayed part of the tooth, is to remove it. We have to physically remove the area which has decayed and replace the open hole with a filling material. Another plus with earlier detection of decay means that you will spend less time and money at the dental office. It’s a win-win situation and we like win-win, are you with me?

The DIAGNOdent uses a laser to detect differences in healthy and unhealthy tooth by measuring degrees of fluorescence in your tooth structure. These readings are recorded in the chart and monitored.

00-10      Healthy Tooth Structure

11-20      Outer Enamel Changes (The enamel is the hard outer protective covering of your tooth.)

21-30      Inner Enamel Changes

30+         Dentin Changes (Dentin is softer than enamel and decay often moves more quickly when it burrows this deep into the tooth.)

X02584_3
The reading on this tooth was 26, indicating changes through to the inner portion of the enamel. No soft spots were noted in clinical evaluation.
X02584_2
Tooth is intact with no soft spots noted.
X02584_10
This is the area which needed to be removed. Also notice the crack in the enamel wall of the tooth structure.

The goal in our office is to keep your smile healthy and be able to do provide pain-free dentistry. Part of the whole picture is being able to educate our patients so that they are able to help decide how to keep themselves healthy and happy. A smile is a universal sign of happiness and we are so lucky to be able to help people keep their teeth and to be able to smile. Know that when you come in to see Dr. Alspaugh and the rest of the team, we will work to provide you the best dental experience by using up-to-date technology to help fight disease in your mouth.

Keep brushing and smiling!

www.edmonddds.com

Yes, we will work with your dental coverage.

Dental insurance is a tricky subject. When looking at it from a patient’s point of view there is a good reason to pay a company to help with coverage for dental treatment. Dental insurance allows the patient to feel they can afford dental care. The person feels covered, taken care of, and protected. There is also a dark side when considering coverage for dental treatment. It is the business side of the insurance game. In the same way a used car salesman will exaggerate the positive points when you are looking at a car, such as the new tires and the spiffy spare tire in the trunk or the jack which is included, and will downplay the negative, possible past accidents, you should be prepared to ask questions to get the most of what you pay for. The insurance brokers are selling to a customer’s needs, not necessarily to satisfy a patient’s needs. A person’s expectations of what they have paid for can often leave a bad taste in their mouth when they show up at their dental office with their shiny, new dental insurance card and find out what their “benefits” are or are not.

The question, “Do you take my insurance?” can be too vague of a question when calling to search for a dentist. Why? Because most offices can and will accept benefits from any company that is providing coverage for its customers. Most offices will also file the dental claims for the services provided by the dentist. What you want to know is, “I am covered with Company X, is your doctor a preferred provider with that company?” Or, “Is Dr. X. contracted with Company X? I am looking to save money by using a network provider.” If your goal is to save money, don’t be afraid to say so. You are more likely to have your expectations met if you are clear in what you are seeking. Another possibility to consider is that your policy will dictate which dentist you use by withholding payment, unless you use a dentist contracted with that company. If you like the choice to be yours, be sure your policy allows you to choose your dentist.

Currently, the office where I spend my day, the dentist has decided to be contracted with one company. The question often comes up as to why the doctor is not signed up with more insurance companies. I will explain, you may not like what I have to say, but here it goes. He prefers to provide dentistry to his patients in a low-volume, less-rushed environment so that the he can spend quality time with each person. We want our patients to feel comfortable while they are here and that takes time and personal attention. The relaxing atmosphere can be lost when you are pushed to do more for less, which can happen depending on how many companies the dentist is contracted with.  This is due to the discounts and adjustments which are made when a provider becomes contracted with each company. Plus, a dental office patient load will most likely increase because insurance companies will promote their contracted providers. A contract can limit your choices, be sure you get what you pay for.

A great way to find a dentist is to ask around. If your company provides insurance there is a big probability that others in your workplace have found someone they trust, like, and the dental office works well with the insurance company which covers the company’s employees. Your friends and coworkers will often give you the low down on the office too. Such as sharing which is their favorite hygienist or dental assistant and the little things that make their dentist, “THE BEST!” We love inside referrals, because that shows that we are doing something right.

There is more to this story, so stay in touch and keep in mind that Knowledge is Power. The more you know about your individual dental insurance policy, the more empowered you become about your dental health.

Keep brushing!

It’s just a cleaning…..Uh, nope!

I hear this a lot from people when they want to reschedule their preventative recall appointments without the guilt.

“I need to move my appointment. It’s just a cleaning, right?”

It's just a cleaning, right? Nope, we need to check things out and make sure we keep you in tip-top shape.
It’s just a cleaning, right? Nope, we need to check things out and make sure we keep you in tip-top shape.

Is the Taj Mahal just a building? Of course not! Was Monet just a painter? You could look at it that way, but his efforts made him an artist. Is Disney World just a theme park? No, of course not because it’s the happiest place on Earth. These are just a few examples of places and things that have taken effort to become what they are known for today.

Let’s look at what happens during a preventative hygiene recall dental appointment.

 The steps may be different from here, but here we go.

One of the trained professionals, whether that be a dental assistant, hygienist, or dentist will review your medical history to be sure that any medical changes are noted. It is very important to keep your dental team informed as to what has been going on medically with you for the last 6 months. There may have been changes in your medication. Some people don’t understand how that could affect their dental health. Well, the changes in medication could cause changes in your mouth, such as dry mouth, which could  leave you more prone to decay and gum disease.  If you want the how and why a dry mouth is bad, add a comment. And what about surgeries? If you believe they don’t affect your mouth and your mouth can have an affect on those surgical areas, think again. If you have any type of joint replacement surgery, it is often recommended that you take an antibiotic before having dental treatment. This is to protect your heart from possible infection. You are an enclosed, all-inclusive, dynamic, one-of-a-kind machine and all parts affect the others.

Next you get to relax, lay back, and get ready to have someone taking care of you for the next hour or so. Bring headphones if you like to listen to music and if you are anxiety-prone be sure to ask for the nitrous oxide.

A thorough check of your mouth will begin. Each tooth is checked for decay (or cavities) and cracks, the pockets around your teeth are measured (have you been flossing or not?) and are there signs of cancer. CANCER-that is a big deal and it is a real reason to see the dentist regularly. If you participate in activities that put you at a higher risk for oral cancer, you really should see the dentist every 6 months.

We have all heard the risks-alcohol and tobacco use which includes smoking and smokeless tobacco. But there is a growing concern about the HPV or human papillomavirus. This is a virus that can cause warts and certain types of cancer. I am not an expert on this, but for more information and pictures visit www.oralcancerfoundation.com or search “HPV and oral cancer.” Again, I stress that if you have risk factors for oral cancer, stick to the 6 month recall visits to check for cancer during those visits. We as dental professionals are not here to judge your personal habits, but to do what we can to help you stay healthy.

The “cleaning” or dental prophylaxis time of the visit happens when the hygienist will begin to physically remove any debris, buildup, and stain from the teeth. If flossing is not one of your routine habits, this is the time when it will show. “She made my gums bleed.” Uh, no that is not true. The bacteria living and thriving in the pockets around your teeth are helping to make your gums bleed. BLEEDING=INFECTION The bacteria and their community are being disrupted and cleared away. A point to remember: The more time you spend at home on your maintaining your teeth and gums, the less time you will need to see your dentist’s chair.  If you want to blame something for the bleeding, blame the bacteria. If you want to blame someone for the bleeding, name your bacteria. There are tons of other ways we could go with the cleaning portion, like discussing all the difficult-to-impossible to remove stains the hard-working hygienist has to break a wrist in trying to remove without the use of a chisel and also the debris left behind due to years of not having a cleaning, but I will keep those stories for another time. Cleaning is cleaning and when someone else is doing the cleaning, we have a tendency to diminish the efforts involved. If you want to limit the time our professionals are in your mouth, spend more time in your mouth at home.

Okay, next is to check the health of the teeth. “My teeth are fine, nothing hurts.” That may be true, but it is the underlying problems that we are trying to catch before they become BIG, PAINFUL problems. I would think this concept would be appreciated, but the cost of treatment often trumps our efforts to take care of small issues when they are small. Here is a simple formula for dental treatment: A filling will cost less than a crown. A crown will cost less than a root canal and crown. And they all tend to cost less than pulling a tooth and replacing with an implant and restoring the implant with a crown.

What other issues are addressed during the preventative recall and evaluation appointment? Well, the issue of bad breath does come up occasionally. What causes bad breath? It may indicate a deeper problem like a sinus infection or GERD, but bacteria is usually is the culprit. The bacteria can be in the bleeding pockets or they could be living and thriving in the cavity you have decided not take care of “until it bothers you.” While you are waiting for the tooth to hurt enough to cause you pain and suffering, the bacteria could be causing your breath to become, well kinda rank. The bacteria are working on breaking down the tooth structure causing the tooth to decay and breakdown. If you have ever gotten to savor the smell of a compost pile on a day when the temp is 98.6 degrees, then you may have an idea of what smells could be produced from that cavity in your mouth. I would never tell someone that their breath is baaaddddd, but I sure am thinking it as I put my head down and turn away. Would you like a mint?

Another home for bacteria is the tongue. How many people really scrape their tongues daily? I do, but I’ve seen too much stuff not to do that daily. I offer you a challenge. Take your fingernail (Gross, I know but hang with me.) and scrape it across your tongue…….What did you find? Would you like to share. I did not think so, but for those that want to share, please do so for the rest of us. That stuff, my friends, is a blanket of bacteria. Enough said.

Remember to brush or scrape your tongue
This is a person’s tongue that has the coating which would benefit from a tongue scraping. Notice the thick coating on top of the tongue. Bacteria…bacteria….bacteria.

Okay, so now your preventative recall and evaluation appointment is winding down. The fun is coming to an end. We have discussed your recent medical history, checked for oral cancer and gum disease, scraped the debris off the teeth, polished them to a bright & shiny state, and discussed the finding of any necessary dental treatment you need to schedule for next. Topical fluoride is an option, which I suggest taking when you can after having the teeth polished. Any questions you have thought about while lying there with your mouth open can and should be discussed before you leave they room. We definitely do not want you to leave unless you fully understand what has happened during your appointment and you have a chance to ask questions. Remember: Knowledge is power.

So I ask, is it “just a cleaning”? It doesn’t sound that way to me.

www.edmonddds.com