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.

TO SEAL THAT TOOTH OR NOT TO SEAL, THAT IS THE QUESTION

What price are you willing to place on your children’s teeth?

Protected tooth
This sealant was placed over 20 years ago and it is still protecting the chewing surface of my tooth.

We invest in our kids. There are the usual things:  clothes, food, and school. We equip them with all kinds of technology which includes cell phones and computers, but investing in their teeth seems to be another story. I was surprised to read an article that highlighted an issue that our children are not receiving preventive care for their teeth. I was flabbergasted at the number of children missing out on care which could prevent bigger problems for them in the future.
Let me throw out some numbers for you to process, by way of a study from the Centers for Disease Control and Prevention or CDC:

Approximately 23% of children aged 2-11 years have at least one primary tooth with untreated decay and 20% of adolescents aged 12-19 year have at least one permanent tooth with untreated decay.*

Untreated decay=cavity. When we use the word cavity, people seem to feel that it is not a big deal. “Oh it’s JUST a cavity. It’s not hurting.” But cavities left untreated will continue to get bigger and bigger until the decayed portion eats away at tooth structure, can cause pain, broken teeth, and worse, infection.

A systematic review of randomized controlled trials found that dental sealants reduce decay in permanent molars by 81% approximately 2 years after placement and continue to be effective up to 4.5 years after placement. *

81% reduction in decay/cavities by placing a sealant on the chewing surface of the tooth! Prevention is what we believe, teach, and preach here at the office. It is so important to protect tooth structure. Yet for some reason parents are not taking advantage of this simple procedure. How can parents leave without scheduling an appointment to place sealants on their kiddo’s teeth?  The main reason I hear repeatedly is THE COST. A study by the CDC addressed several issues which could help explain the lack of preventative care for children. Let’s see if you agree that these could be obstacles to healthcare:

  1. Lack of dental insurance,
  2. If dental insurance is available, the out-of-pocket costs compared to medical expenses were more expensive.

And this is what the study found,

In 2009, the total dental expenses for U.S. children aged 5-7 years were approximately $20 billion (5), accounting for 17.7% of all health-care expenses among this age group (6). Approximately 40% of dental costs were paid out of pocket (5), compared with 17% for medical care (6). Approximately one fourth of U.S. children do not have dental insurance (private or public) (7). The types of services covered by dental insurance vary widely by plan, but typically have higher copayments and lower annual limits than services covered by medical insurance (8). *

In relation to cost, preventive care is usually less costly than restorative treatment.  Or another way to put that is, fluoride varnish and sealants placed on teeth will be less expensive than a filling, root canal, or crown. An added bonus to not having to pay for the more expensive restorative procedures is that tooth structure was saved! Plus, another child did not have to have to have an injection or feel anxious about having “work” done on them. There is also less time spent away from school and school activities. Those are all good things to keep in mind when “preventive care” is presented at the recall appointment.

I have used a number of statistics from the CDC study, and I encourage you to visit the site for EVEN MORE information about the health of our children.  Go to *http://www.cdc.gov/childpreventiveservices/ and click on the * FULL REPORT http://www.cdc.gov/mmwr/pdf/other/su6302.pdf. The information is very informative about medical and dental issues concerning our kids.

If you have children and have questions about preventive care such as sealants, fluoride varnish, or rinses, call our office or your dental provider and get as much information as possible about those important services.

We welcome comments about our blog.

KEEP BRUSHING AND KNOWLEDGE IS POWER!

www.edmonddds.com

Friday Greetings!!

I wish I could keep my excitement at bay, but it’s difficult to not put on my super duper big smile : )) and sing, “Oh, it’s Friday!  Oh, yes it’s Fri…day!!”

We have had a productive week taking care of our patients. Decay has been destroyed, fractures removed, plaque and stain polished away, and no signs of oral cancer this week. Our goal is that our patients will  notice less pain, enjoy better tasting food, and for some….nicer breath.

Over the weekend remember that your time in our office, no matter how comfortable, can be determined by your home care. Spend some time on the teeth you want to keep. Be friendly and brush the plaque off them, they should not be wearing sweaters. Floss between your teeth to keep the touchy parts healthy and flossing will also help keep those gums from bleeding. If you haven’t tried it yet and you are  feeling adventurous, try a tongue scraper. You breath will thank you.

Have a great weekend and remember to KEEP BRUSHING!

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

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

Welcome to our little corner of dentistry!

Dental office to the those seeking a caring, non-hurried environment for dental treatment.
Dental office to the those seeking a caring, non-hurried environment for dental treatment.

What a wonderful way to reach out and be involved with our patients and others! We are able to address concerns and questions that we encounter on a daily basis. The goal is to bring forth answers to questions that people often forget to ask until after they have left the office. Our hope is to educate, and maybe even entertain, while we are navigating to the answers you search.

A dental office visit can be a VERY scary adventure for some people, uncomfortable in the very least. BUT….our aim is to help you help yourself. Our team of trained dental professionals are here to help you in your quest for a happy, healthy mouth and smile. We have armed ourselves with some of the latest technologies to provide you with a road map to wellness. Our tools of the trade we have available in our office are used together with our education and experience to help provide you with the information you need to make educated choices about your dental health.

For some people the scariest part of visiting their friendly dental team is the financial part of the visit. But the dollar amounts associated with dentistry are only part of the full picture. Insurance companies and the policies they negotiate with their customers are often below standards to pay for the optimum, long-term treatment for their customers. Often the insurance language needs translation so our patients understand the benefits they have paid for with these companies. We hope to adequately address questions and concerns about insurance in the future.

I have said that we view ourselves as part of a team to help you help yourself to a happy, health mouth. I want to be clear that this does not mean that we will be expected to show up at your house or workplace to brush and floss your teeth for you. Nor does it mean that we will be able to sugar-coat some dental truths so that they are not painful or uncomfortable to hear or read. With knowledge you have power and that is an awesome first step, wouldn’t you agree? We look forward to hearing your concerns and questions in the future. This will help us to know what you want to know.
Thank you for your time and I look forward to the adventure!

http://www.edmonddds.com/