I am a dentist ask me anything

Hnngmmphhff mpphhggnn knngghffnnttgghh?

Yes I like to golf, I have a tee time this weekend at the country club with the partners and my father in law. And no, you cant spit yet, please wait until im done jabbing you with this prison shank.

how many surveys have you been in when 9 out of 10 dentists recommend a product, and you've been that 1 dentist that was like, "nah".

haha I love being that guy

id say about 9 out of 10 surveys i take.

Does anybody refuse X-rays for cancer/radiation concern?

Yes, many do.

FYI: unless necessary for immediate treatment, i tend to avoid xrays in pregnant women especially during 1st trimester. There is really no evidence to say xrays do damage to the fetus, however may as well wait a few months, just to be safe.

Always wanted to ask!: I have that weird habit, it's like biting nails, but instead I'm always nibbling away small pieces of skin from the inner part of my mouth/cheek/lips. Is that.. uhm, apart from looking like a complete fool when doing that,... dangerous?

DID NOT KNOW ANOTHER SOUL DID THIS... STAND STRONG BROTHER

There are literally, dozens of you... (I hope someone watches arrested development here). No honestly I have many many patients who do this, dont be ashamed.

I hope someone watches arrested development here

You have no idea

/r/arresteddevelopment

/r/everyredditorever

FTFY

heeeeey brother

Are you saying you bite your cheeks? If so thats not necessarily dangerous, you will likely form something called linea alba on the inside of your cheeks, this is basically a white line that is caused by frictional hyperkeratosis. There is some research that says any hyperkeratotic region has a higher rate of cancerous development, but this is still highly debated.

tl;dr - chew away, if it bleeds stop.

Thank you for doing this. It's fascinating.

What's the deal with one day dental implants (aka All On 4)? How are they different than regular implants? How do they compare, generally, pain wise, price wise, overall?

Great question. Please upvote I want this to be seen.

In rehabilitation of partially or totally edentulous patients with implants, the desire for immediate implant placement has become very popular because of the increasing demands of a shortened treatment time.

You show up to my office and you either have a missing tooth, or a tooth that is about to be missing. Im going to carefully examine the quality and quantity of your bone as well as your bite pattens and bite force. If you have a tooth that needs to be extracted I'll determine if I can extract it and place an implant on the same day, I will determine this based on the size of the tooth, the quality of the bone, and the amount of bone remaining. If you just have a missing tooth I will place an implant that day. The next question is restoration of the implant I.E. place a crown on the screw (implant).

When you place implants, the patient shows up sits down gets numb and we literally place a screw into their bone, this screw is generally about 8-12mm long and requires at least 2-3mm of additional bone height for success. The screw is called an implant and is made of a biocompatible titanium etched surface that actually becomes integrated with your jaw bone.

The question is how long does it take for the bone to be integrated onto the implant adequately for it to be stable enough for you can chew and transmit forces onto the implant so it wont fail "lose its stability". We often drill pilot holes that are just smaller than the implant platform so that when the implant is inserted it cuts into healthy bone to establish primary stability. This primary stability is the most important indicator of implant success and the most important qualifier for immediate loading of implant. Your mandible and maxilla have different types of bone and vasculature. Implants seem to show better immediate stability in the mandible and more often qualify for immediate restoration with a crown. When I say, or when you hear the term immediate loading, it means the implant screw is receiving forces within the first day of placement, from chewing forces. Implant success rates have reached into the 95% realm for patients with adequate bone and systemic conditions. Smoking, diabetes, and the need for boen grafting all lower this success rate. Success rates in the maxilla is about 5-10% lower than in the mandible.

Some studies show that immediate loading of implants can increase failure rates by 2-3 times. This is because the implants are experiences forces before they are integrated into the bone. Other studies show that if implants have very good primary stability then they can be immediately loaded.

All on 4 is a procedure where four implants are placed at specific angles in a jaw that has no teeth and a denture is screwed onto those implants. You cannot remove the denture on your own, I can. This denture does not rock around when you move your jaw and patients love it.

Price? The all on 4 procedure is expensive roughly 10-15k but it is complete rehabilitation with vey high patient satisfaction.

Pain? When implants fail it can be painful. Placing implants isn't all that painful, your jaw will be a little sore but ibuprofen for a day or two usually manages the pain.

I could go on and on and on. I hope this helps.

What kind of toothpaste do you use?

crest pro health

That toothpaste peels the inside of my lips for some reason. About fifteen minutes after each time I used it this would happen

I have a friend with that problem. It's an allergy for her, I'm not sure what the specific ingredient is, but whenever she uses something with it, her lips will peel like crazy. It happens with lip balm too.

There are many people that have a bad reaction to Sodium Lauryl Sulfate, or other additive or flavoring in toothpaste.

Are you being paid to tell us this?

Unfortunately no...

How would you react if someone started licking your fingers while you were messing around in their mouth?

haha, I have had some weird things happen like this.

Once an older man was licking my finger during a filling. I said, "Sir are you aware that you are licking my finger?" He said yes, and that it felt good to him, I finished the filling and told him it would be best to seek dental care somewhere else in the future.

ah, that seems a bit harsh, don't you think?

you had to be there...

My dentist likes to talk to me the whole time he's working on me. How does he expect me to respond? Sign language? I don't know it.

THIS. Is something all dentists struggle with. Our options are awkward silence, or awkward one sided conversation. I choose one based on the patient in the chair, and sometimes i choose wrong. I try to tell stories and tell jokes to pass the time, but sometimes accidentally ask a question, then my patient bites the mirror.

My advice: if its a yes or no question just grunt, in affirmative or negation. If its not a yes no question just dont say anything, your dentist should realize he put you in a stupid situation and phrase it as yes/no.

But I feel like a jerk if I don't answer!

My dentists office put TVs in the...I don't know what to call them..."operating rooms"(places for regular cleanings etc). "Tilt your head back more" "But then I can't see the tv!!"

I can't win in that place.

google glass...

My new dentist has tv's on the ceiling 😄

NICE! I will do this after my loans are paid off!

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Perhaps go get a second opinion. Take your xrays to another dentist and see if that dentist recommends fillings in the same places. Your current dentist might not like this, but who cares.

I obviously cant tell you why you need fillings without seeing your mouth and seeing your hygiene practices, however I would guess youre doing something wrong. Talk to your dentist about it and make them show you proper flossing, etc.

I think an implicit secondary part of that question was: is over prescribing treatment not uncommon in dentistry, for the sake of the money? If so, any statistics or studies done on this?

There is a definite spectrum between conservative and aggressive dentists. Amongst my more aggressive colleagues I dont know any who do it for the money. I'm not aware of any studies on this, although i would be very interested in seeing one.

Both sides of the spectrum have their arguments and both are fair. I would say I'm more middle of the road. I like to catch things before they get worse, but I also like to allow certain things to reverse on their own when feasible.

I've found dentists as a whole are less money grubbing then some other professions. The ADA has a very strong stance on this and has little tolerance for treatment guided by anything other than evidence.

there was one done in Au a few years ago by a not for profit group who does independent product reviews.

That study speaks more to the fact that there is more than one way to skin a cat, it doesnt mean that we're skinning the cat for money.

Why did this get downvoted? Its true this study doesnt say anything about dentists choosing different treatment plans because they could make more money. It only speaks to the fact that different procedures work better or worse depending on whose hands are doing the procedures. Furthermore, different dentists have different philosophies and will often suggest slightly different treatment plans. Just like if you went to a plastic surgeon to get your nose done. Not every surgeon would make the exact same nose. This doesnt mean the surgeons are quacks.

What's so special about orange juice that attempting to drink it after brushing your teeth is like trying to imbibe radioactive sewage?

Sodium lauryl sulfate an ingredient in tooth paste and most commercial soaps is an effective foamer and acts as a taste modifier, temporarily suppressing the sweet receptors of the tongue. Since sweetness blocks bitter and sour flavors, its absence enhances the bitterness and sourness found in the citric acid of orange juice.

I'm from England what's a dentist?

Im dentist, whats england?

Maybe we should meet?

Why do dentists cost so much money? Is it really worth that much?

I graduated dental school with 250k in loans so i need to pay that off. My dental materials cost a lot of money, the machines that are in my lab that you dont see cost money, my lease on my building costs money, my employees, assistant, hygienists all need to make a living. I need to make a living.

Is it worth it? Yes obviously it is. Besides esthetic and functional (gotta eat), before modern dentistry, something called Ludwig's angina was a leading cause of death, this is an infection of the airway that spreads, overtime, from a dental infection.

so if dental school was paid for by your parents you would charge less?

haha fair point, honestly no i wouldnt charge less, if my parents paid for my education I would just reach my peak salary a lot more quickly. Education is just one of many factors that go into the cost of dentistry.

How many 9 year olds do you think you could beat up?

It obviously depends on their strength and whether they are on the influence of nitrous oxide. 9 year olds can be quite strong and they can generate a bite force of up to 500lbs/sq inch.

I would say somewhere between 8-20 9 yr olds depending on how much fluoride i had that day.

What are the most promising areas of research in dentistry that have the best chance to revolutionize dentists visits? IE Growing new teeth, etc

Oh man, so many areas are promising right now.

Stem cell driven tooth generation is a highly funded area of research that may one day (not anytime soon) replaced dental implants. Remember that we cant just grow any new tooth, it has to be the right size, shape, color and consistency.

I'm convinced that dental implants have been one of the most revolutionary innovations in recent modern dentistry. It allows for any number of teeth to be restored. This is also a huge area of research as we are still trying to maximize longevity and minimize complications.

Prevention: Dentistry is unique in that almost all dental related problems are preventable. Fluoride has been one of the most successful public health movements in the 20th century.

As far as innovations that will change regular dental visits. I would have to say materials research has the most impact on dental visits. Materials are faster, more user friendly and more esthetic than ever before.

OH! actually my answer is CAD/CAM dentistry this stands for computer assisted design and computer assisted milling. This means that in the right circumstance the dentist can prepare a tooth for a crown, core, onlay, inlay, take a series of digital pictures that will be send to a milling machine in office, this machine will mill the restoration and color it while you wait and you will then leave with a restoration cemented in over the span of a couple hours, instead of weeks. I encourage you to question your dentist about this and perhaps consider shopping around for dentists in your area that have this and have experience using it.

What are your thoughts on enamel strengthening toothpaste? I heard years ago they were having breakthroughs in this area.

Enamel strengthening toothpaste have been on the market forever, really its just advertising coming up with new slogans. Heres a secret - its just fluoride, and pretty much all toothpaste has it.

Does the same go for NovaMin? Because if so I've been completely duped...

I have to admit I dont know much about NovaMin, but I have read one study with a modest sample size that showed promising results

https://www.ncbi.nlm.nih.gov/pubmed/21207920

Its an ingredient of Sensodyne toothpaste and can help with certain types of sensitivity

Is it really necessary to get full sedation if I'm having my wisdom teeth pulled? According to my dentist, I need an oral surgeon, and my insurance covers nearly none of it, including the sedation. It's well over 1k for just the bottom teeth with sedation. My bottom wisdom teeth are impacted and in sideways

onewing_z makes a good point, there are many types of payment plans through 3rd party like FSA or through the dentist/oral surgeon.

It is not always necessary to be under general sedation (IV in your arm) for wisdom teeth, I take out many many wisdom teeth under local anesthesia (just lidocaine injection). Depending on the difficulty of the extraction, general anesthesia might be much more comfortable for you, and easier for the dentist because your not annoying him while hes trying to work.

Many dentists dont like taking wisdom teeth out because there are complications involved and they dont want to deal with the added liability. However there are many dentists who do it for much cheaper than oral surgeons and could do just as good of a job.

When i was in dental school, as a 4th year student I would take out 4 impacted wisdom teeth for around 500-600$ without general sedation. I never had any complications that i didnt know how to handle, but it did take me longer than it would have taken an oral surgeon.

Is there a dental school in your area? Perhaps you should look into getting it done there.

1. could you tell if a patient of yours has been smoking weed based off looking at their teeth? (besides the color)
2. also does marijuana have any negative consequences on your teeth? thanks

1. No i couldn't tell
2. As long as you drink lots of water, and after the munchies brush your teeth well, there are no known negative consequences.

How can I get my teeth whiter without spending too much money?

White strips are the cheapest most reliable way to go, I like crest products. They take longer than in office whitening but can have as good of a final result. I would avoid the people in the mall that want to whiten your teeth, they're not dentists and have had no training in anything.

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Professional tooth whitening is the same ingredient as the white strips but a much higher concentration, however the professional treatment does a much better job at targeting just the teeth, the white strips often get on the gingiva and can cause irritation to some people. If youre sure that it was your teeth that were sensitive, I would bet that they would be sensitive to professional treatments as well, however the white strip applications are meant to be applied for up to a month and professional treatment are only a few days, so if you can take it just for a few days it may be manageable.

I work in construction. Depending on the crew/job I will usually find myself without access to water, sinks/basin etc. On many occasions during long drives we eat many meals in transport. I try during these times to at the very least chew gum for like 10-15 minutes to get the food particles out. Is this method effective? What other options are there?

Great question. First of all a gallon of water is 1-2$ at most gas stations, if youre driving, throw it in the back and sip it throughout the day. You need to have access to water, if you work in the US, and your job doesnt provide access to water, or is giving you a hard time when you try to lug around water with you, bring it up with your union rep or boss, its a labor law violation.

Gum does help remove food particles as long as it is sugar free. Gum also, importantly, stimulates salivary flow which is very good for you're teeth.

There are disposable toothbrushes, toothpicks, proxabrushes, floss holders etc, that you could throw in your bag and use while you transport

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why are you? If so we should hang out.

When 9 out of 10 dentists recommend a toothpaste, what do they mean? Do they say it's the best toothpaste or do they just recommend using toothpaste in general?

Its advertising BS. Dont really bother listening to it. Any dental product that has an ADA seal of approval means its great and will suit your needs.

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There are some instruments that are plastic, has your hygienist tried a cavitron on you for cleanings? Some people respond better to that than the metal cleaning instruments.

Many people have an aversion to metal clanging on your teeth, some dentists are more careful than others.

Am I suppose to use mouthwash before brushing or after brushing?

I prefer brush, floss, rinse

Studies show order doesnt matter

What are your thoughts on the fluoride controversy? Here's the link to a wiki article in case they don't teach this in school:

http://en.wikipedia.org/wiki/Water_fluoridation_controversy

I have had easily over 100 hours of lecture on fluoride and the fluoride controversy. I have had 100s of patients ask me about this, I have done extensive research on topic. Yes they teach this in school, yes every dentist knows about the controversy and has done research on the subject. Not to brag but i could write a book on this. I am going to try to be succinct in my answer.

I am a doctor, please dont link to wikipedia. If you want to bring something to my attention it better be a peer reviewed journal article.

Facts:

-Fluoride prevents cavities, it strengthens teeth and prevents bacteria from causing decay

-At the current water levels of 0.7-1.2 ppm fluoride has zero negative effects on systemic health

-The form that fluoride is in the water and dental products is not neurotoxic, it is not the same as nerve gas ( i hate when people say this) Its like saying, oh well since carbon is in atom bombs and rat poison then we better not eat carbon containing foods (IE all foods).

-Fluoride is found in the natural environment. In fact the way we found out about fluoride having a positive effect on oral health was when a dentist found a community that high little to no cavities, they also had mottled enamel, which is the white pitting on teeth that you see if you get TOO much fluoride during development. The dentist looked all over the place to see why these people had no cavities then eventually found that the wells in the area had extremely high levels of fluoride. Since then researchers have found a concentration that still prevents cavities but doesn't cause negative effects like fluorosis and mottled enamel.

I'm sorry for linking Wikipedia. I understand how everyone hates that due to the inability to control the information being conveyed. But at the same time It gave you a quick and easy way to determine what information was being conveyed to the general public on this matter. Therefore I found it to be a viable resource.

How do you feel about the ethical concerns of those countries who have discontinued their fluoridation programs? Do you think it's noteworthy to speak of involuntary medicating?

Balthanos I like you. Really great questions, and the reason i did this AMA! No worries about wiki. You're making me think... :)

Fluoride discontinuation: It is my belief that given the current research on the widespread benefits of having a fluoridated water supply, it would be unethical to keep it from the general public. This is a hard topic because there isn't much precedent for it, I cant think of any public health initiative that has had such strong and time tested research behind it. Perhaps Iodide supplementation in salt? You raise an excellent point about involuntarily medicating the public. I am having some conflicting thoughts on this subject, and it raises a number of questions pertaining to democratic intervention ethics that I havent studied. Few question whether government has a right to chlorinate and clean the water we drink or pasteurize and homogenize the dairy, or regulate the sanitation and nutrition of the food we buy. However widespread additives to the public water supply seems to set itself apart from the aforementioned examples of intervention. I think that there are many examples of times where government needs to make a decision for the public good because the public may not be educated or trained in the subject (pardon me i really dont want to sound like a socialist...). We are supposed to elect/delegate officials to power because they are experts and we can trust them to vote and on our behalf on issues that we may not be experts in, and we hope that they have only our best interests in mind when they do so. Sadly, this doesnt really happen most of the time, our officials walk a fine line between voting so that they may stay in power, voting to appease lobbyists, and voting to ensure re-election from their electorate. We, as the electorate only really have influence on one of those and thats voting them into power and the only tool that we have at our sides is being a well educated electorate, which sadly is increasingly rare. In america, the average person is misguided at best and an idiot at worst, we believe in evolution, we believe in the coming rapture, we are illiterate, we cast our votes based on faith instead of fact. History proves that time and time again the common belief of the public is mocked by future generations as being naive and incorrect. So then why do we deserve to elect people into power? Maybe because though democracy is a horrible form of government, it is better than all the alternatives? So as an uneducated populace we may not have the right to tell the experts to stop medicating the public, or maybe we do, or, maybe the answer is small government?, the strong will survive and seek out fluoride on their own and the weak and uneducated will get cavities. I am not in a position to decide. I have no affiliations and gain nothing by public fluoridation, in fact I would make a lot more money if we didn't put fluoride in the water, but money isn't the reason i became a dentist, I became a dentist to raise, even if only by a little the oral health of my community, and one of the tools in my box is fluoride, so please dont take that tool away from me.

That was a well thought out answer. Thanks.

I personally agree with you that fluoride is a valuable tool in dentistry. While I was a kid I received fluoride mouthwash once a month from the school I attended as well as the recommended gel treatments from my dentist on a regular basis. If it poisons or brainwashes I'd have been a drooling fool by now. I've yet to have a cavity and I'm in my late 30's.

I'll have to admit that I was slightly misleading but I assumed that If I agreed with you from the start you may have not given so thorough of an answer.

My other choice was mercury amalgam. Call me devil's advocate if you will. >:)

You are right, we are quicker to defend than to agree. I appreciate the questions. The mercury amalgam debate is another beast in and of itself, and I have had more difficulty defending my beliefs on that front, than I have for fluoride.

Hey, I just wanted to say thanks for being open-minded and civil about this topic. I've seen so many people go apeshit over fluoridation on Reddit, and it's really refreshing to see someone who just wants to assess some informed answers.

Thanks for noticing.

We, as a community, lose out when we just want to force information down each other's throats without "assessing informed answers". When someone comes in here who has real world experience with issues the less informed aren't aware of we should allow them the respect they have already given us by coming here.

That's really what the internet is all about. I'm glad that folks love their cats and such but I'm here for intellectual stimulation and knowledge. Sometimes I have the opportunity to share some of my own thoughts or ideas. Other times I am given the opportunity to be educated.

Too many times I've realized that I was so obsessed with being right that I was oblivious to the other person's message. You also become a lot more embarrassed after the fact when you realise you are completely wrong.

Wise words

Any thoughts of fluoride during the growing years (i.e., incorporated into teeth/bones during growth) versus its utility once teeth have finished forming? Does the application of fluoride in various preparations actually help maintain or rebuild enamel?

In children under ~6 years of age, fluoride becomes incorporated into the development of permanent teeth, making it difficult for acids to demineralize the teeth.

Fluoride helps speed remineralization as well as disrupts acid production in already erupted teeth of both children and adults.

You can only develop dental fluorosis during tooth mineralization with occurs in utero - 6yrs.

Is it safe?

No, stay inside and brush your teeth.

Great AMA so far, and thanks for doing this! A few questions I've always had a few questions for a dentist.

1. i don't have dental insurance (in the US) and am interested in getting my teeth straightened out - my teeth. Would i need braces or would Invisalign work for the crowding issue?

2. Do we 'start off' with a lifetime supply of enamel or does it regenerate at all?

3. And finally, when you see super perfect teeth on celebs - absolutely perfect shade of white, perfect shape, size, alignment, etc..how did they get that? Does a dentist do that or is that through a plastic surgeon who removes their teeth and puts in false ones?

Thank you again!

1. I would need to see xrays, however my initial impression is yours would be a good case for invisalign

2. Yes we cannot (as of now barring any new scientific breakthroughs) generate new enamel. Ameloblasts are the cells which form enamel during development, when they are finished they die and you cant get them back. Odontoblasts form dentin and pulp however and those are still alive.

3. Perfect teeth are most often a combination of orthodontic and esthetic dental procedures. Plastic surgeons do not remove teeth or place false ones, dentists ( and more specifically prosthodontists) do this.

I see, thank you for the reply.

Anytime

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Thanks. Dentists are humans too. When im not working I watch AD and reddit.

What do you think about mouthwash (Listerine, etc..)? Is it good, bad, or neither?

Listerine is the only ADA approved mouthwash for fighting plaque and gingivitis. It also prevents bad breath (halitosis) which is really caused by plaque (bacteria). However many mouthwashes have benefits, and just havent gone through the process of being ADA approved.

I know of no common side effects of using mouthwash and I have seen improvements in many of my patients gingival health after using mouthwash regularly. I dont really buy into the mouthwashes that advertise tooth whitening.

ACT mouthwash which contains fluoride is another story. Yes this is very good if you are at risk for developing caries. If you have a history of several cavities in your mouth, if you have had many filling, crowns, root canals, it is a good idea to rinse with ACT mouthwash once a day.

What about this claim that Listerine and other alcohol-containing, strong antibacterial mouthwashes actually kill the good mouth bacteria as well?

There have been no high quality studies to prove this claim. Im not saying its not true, so keep your ears out for news on the subject.

My advice: Dont over do it with the mouthwash.

Really dumb question here. If toothpaste typically contains 1,000 to 1,450 ppm of fluoride, or 0.22% to 0.312% fluoride, but ACT contains 0.02% fluoride (click on "ingredients," as ACT's website doesn't seem to work) as 0.05% sodium fluoride, what makes ACT so much better? It looks like it has a similar composition to toothpastes, but even less fluoride.

Great question! Your conversions are accurate. Its not that ACT is so much better than toothpaste, if you could only do one, I would recommend toothpaste, its that ACT is an effective adjunct to toothpaste and is a better and more thorough delivery mechanism for fluoride i.e it gets in every nook and cranny of your teeth.

What is, in your opinion, the ideal dental routine?

1. get a good night sleep
2. wake up eat breakfast thats not too sugary, I have had eggs, toast with almond butter and coffee every morning for the last many years.
3. drink some water that has fluoride it in
4. brush your teeth for two minutes
5. floss (optional) either do it now or after lunch or after dinner
6. go to work or go to school and kick ass, be a champion, and make the world a better place. Learn something, and progress in some way shape or form.
7. eat lunch
8. brush (optional) but at least drink some water
9. go home, and play with your kids or SO
10. have some awesome dinner, with lots of protein
11. before you go to bed and after your last snack/meal brush your teeth and floss (not optional) this is by far the most important step and if you only do one thing on this list do this one.

• feel free to use mouthwash as an adjunct
• keep floss in your car, by your tv and by your bed
• avoid having carbs or sugar on your teeth for a long period of time
• talk with your hygienist/dentist to make sure you're brushing flossing properly, have them actually show you while you hold a mirror -if youre less then 6 years old or you cant tie your own shoes, have someone else brush your teeth or at least check to make sure you did a good job. -just dont drink soda, now and then is fine, but its pointless, so man up and stop it.
• exercise, this helps many things including salivary flow which helps prevent decay
• watch your medications, many cause dry mouth, talk to your doctor/dentist if you experience dry mouth.
• if you have a history of cavities, maybe rinse with ACT mouthwash or ask your dentist for an rx of prevident toothpaste.
  

You have coffee every morning? I drink coffee and tea all throughout the day (no added sugar or milk, just plain). Do coffee and tea do any tooth damage that I need to be worrying about and trying to prevent? Like, I am afraid the acidity of the drinks is eating away at my teeth or something!

I'd worry more about stains- just brush after and you should be cool.

I have coffee every morning before work. I love it. I take it black, but many of my colleagues add sugar. Coffee and tea are slightly acidic, but not as much as soda (by a factor of 10-20). As long as you dont swish them through your teeth and drink water throughout the day its fine and shouldn't cause acidic related decay.

They do cause staining, but as long as you brush often and get regular cleanings itll be under control and you can maintain nice white teeth.

What is the biggest thing we do in our everyday life that damages our teeth the most?

tl;dr = Eat sugar/carbs and let them remain on our teeth.

Parents, this includes juice, please please please dont let your children drink more than 8oz of sugary juice/day, and under no circumstances let your babies go to sleep with a bottle of juice or pop. Drink water, just do it, stop complaining that you dont like water and drink it. Our bodies are machines that run on water and not soda, juice etc.

Historically/anthropologically, the western diet has damaged our teeth the most. Teeth get decay (cavities) because bacteria eat sugar and poop acid (sorry for the simplicity I can elaborate if you wish but will be a longer post) There are bacteria and bacterial fragments on our teeth at all times, if they are left for long enough they will form a biofilm which is difficult to remove with simple manual brushing/floss. These bacteria metabolize complex carbohydrates and lower the ph in the microenvironment on our teeth. This drop in ph solubilizes the outer layer of enamel causing hypocalcification and eventually a cavity (hole) in the tooth.

... and under no circumstances let your babies go to sleep with a bottle of juice or pop...

I'm a graduate student in a child psychology program, and one child we had reviewed a case study on discussed the fact she needed something in like 18,000 in dental work for this reason. The parents just let her teeth go until her whole lower jaw was swollen and red through the skin and neck. Unbelievable.

so sad

Why do you try to talk to me while your metal instruments of death are in my mouth?

Silence is terrifying.

I am not sure whether lips fall under your area of expertise but I think asking's worth a try. Around a month ago I experienced something that frightened me a lot and after that incident I ended up with 5 herpes at once and they lasted for 2 weeks. Since I've been having on again off again herpes reoccurences and never in my life do I remember this many happening all at once. I do not have a boyfriend so I cannot say that I get infected from someone else and I haven't been using my lipsticks since they first came out. Is there any way to get rid of them? I tried using zovirax and vectavir but they haven't been useful so far.

Thank you in advance.

Thank you for your question. It is my belief that dentists are experts of the entire head/neck, if you're a dentist and you're not an expert of this area, you really shouldn't be practicing dentistry and calling yourself a doctor.

I have a few questions to ask you. - how do you know these are herpes, have you showed them to a doctor/dentist? - do you have a history of cold sores - have you ever been with someone who has herpes 1 or herpes 2 (HSV1 vs HSV2) - do you experience prodrome symptoms before the onset of the herpes blisters?

It is next to impossible to dx over the internet, however my guess is that you have HSV1, which is a viral herpes infection of (most commonly) the trigeminal ganglion in the head and at this point in time there is no cure. The outbreaks are most common right after inoculation and should subside as time goes on, the antivirals you mentioned wont cure the herpes, but they can lessen the pain, frequency, duration and severity of the outbreaks.

Take a picture of the outbreak, go see a doctor, make sure you tell them what you told me and be prepared to answer the questions i asked.

best of luck

Is it your actual intention to murder my gums?

Yes, dentists are actually an ancient secret order that mascarades as health practitioners in order to murder gums.

gingacide?

ohhh dental humor

I am in dental school....how hard is it to open your own practice? and where did u go to dental school?

Opening a practice is very hard, but very rewarding. There are a million ways to do it, and many seminars, books and dvds that give information on where to get started. You need to have a desire to be a businessman and advertiser as well as a dentist. If you dont like that side of things, consider partnering, associated, or buying a well established practice.

You will need a team of lawyers, financial planners and accountants. Find ones that specialize in medical/dental.

I went to michigan

What is the worst mouth you have ever had to work on? (Or seen in training or something like that)

23 year old, with 23 remaining teeth (we have 32) each remaining tooth had either broken off at the gumline or had a large cavity in it. He had facial swelling, and pain so bad he could hardly speak. Over the course of 2 hours I extracted all his remaining teeth.

This was last week and is not uncommon

Had he not had dental care in his entire life, or was he making really poor life choices (or a combination) to end up like this?

yes

Wow, sucks. In this sort of case, what happens? Do you give him dentures and send him on his way?

His bone will heal and reform over the next 3 months, at that point I will fabricate an implant supported denture for his upper and lower jaws.

What are the dangers of brushing teeth too much? (10+ times/days)

Severe gingival recession and tooth abrasion. Google image both if you want examples.

Dont brush your teeth too much, dont do it too hard, and dont use hard bristles. All you need to do when you brush your teeth is removed food particles and superficial plaque.

My dentist smokes, and you can really tell when he leans over me. Would you ever go to a dentist that chose to do something that's not good for your teeth that?

I wouldnt go because, I couldnt stand the smell when he was working over me.

However, Its ok to take advice from people who know what they are talking about, even if they dont practice it.

flouride? what is YOUR opinion? Replacing old fillings with new porclain, good or bad? Dentists are very UNDER APPRECIATED!! Peoples mouth's are as nasty as some feet!!

Dude, they are WAY nastier than anyone's feet I've ever seen.

I addressed fluoride above. Briefly, my opinion is that it can really help as long as it is used in the right concentration and monitored during the child's development.

Replace old fillings only if they are failing. How do you know if they're failing? Tell your dentist to take x-rays, he'll know.

Thank you, we are under-appreciated but not because teeth are gross.

I want to be an orthodontist when I am older (I am 16). I know you have to go to dental school and then more schooling to become an orthodontist and was just wondering if all the schooling is worth is? I love science and kids so I figured it would combine those things. Also if you have any advice, it would be greatly appreciated!

When I was 16 I wanted to be an orthodontist too! I fell in love with general dentistry and realized ortho wasnt for me. However as an ortho you make a shit load of money. dont work very much and get great esthetic results. Of course the schooling is worth it, dental school was hard but very fun, and its a great investment in your future. Keep your mind open throughout college and dental school, you may find something else that you love. You have to be the absolute top of your dental class to get into an ortho program.

Many people your age, including myself at that age desire a certain profession without knowing enough about it. My advice would be to get your hands wet, find an orthodontist and work for him. Youll start out doing shitty work, but youll be able to see what its like, and eventually youll work your way to more and more interesting jobs at the ortho office. Kick ass in high school, ace your ACT, get into a good college and get a good GPA in college, ace the DAT, do some research in college that is somehow related to dental school. Get into a good dental school and do some research in dental school that is somehow related to ortho, kick ass in dental school and youll get into ortho.

EASY?!

I've had a little bubbly abscess under the same rotten tooth for two years. It never hurts or anything. How long until I die?

12 years and 6 months exactly.

You likely have something called a draining fistula, or parulis. The tooth will probably need to be extracted or have a root canal depending on the restorability of the tooth. I have seen these go on for years without many negative systemic effects, however I have also seen these go for a few week, then the infection spreads and causes widespread facial swelling.

Why do you make me hurt so!

Because youre bad to your teeth and you should feel bad.

We are the sworn protectors of the teeth, hurt them and you hurt us, we are merely enacting revenge on you, on their behalf.

is it true that the toothpaste isn't really necessary to clean teeth?

Its not necessary, but it really helps. I have been to villages in rural south africa, kenya and australia where they use twigs and no toothpaste to clean their teeth, they eat well and have fewer average cavities than americans.

What's your favorite filling for a sandwich?

This is the hardest question yet. I really like tuna. Also avocado, but i need something crunchy so maybe lettuce or red pepper

Do whitening strips such as Crest do long term damage to my teeth?

White strips have no long lasting side effects. Some people experience temporary reversible sensitivity for up to two weeks.

When you tell me that you are proud of me for taking good care of my teeth in between appointments do you really feel proud or are you just patronizing me?

Also is diet soda bad for your teeth?

EDIT : Thanks so much for the AMA, I've read all of the responses and it was much more interesting than I thought it would be.

Well proud may be the wrong word, but yes we really are happy that you take care of teeth. Dentists more than anyone see the negative effects of oral hygiene and we really wouldnt wish that upon our worst enemy, and we like you, and for some reason you keep comig back and giving us money and sending us xmas cards, so keep up the good work.

Diet soda IS bad for your teeth, I hear this ALL the time and it drives me nuts. All soda, even diet is acidic, sure it doesnt have sugar so its a little better then regular, but its still acidic.

Im proud of you Im glad it was interesting.

I have a weird brushing routine where i break the clock up into thirds with one minute to my top teeth and another to the bottom. I like to think I'm evenly cleaning my teeth; am I just crazy? And thanks for answering!

It goes like this:

0:00-0:40 brush all front teeth

0:40-1:00 brush biting surface of bottom teeth

1:00-1:20 brush backs of bottom teeth

1:20-1:40 brush biting surface of top teeth

1:40-2:00 brush backs of top teeth

Umm yea thats awesome. Keep up the good work, tell your friends.

What's the most efficient, yet economic way for someone to have their remaining teeth removed and get dentures? A close friend of mine has had her molars removed from the top and bottom row already, but has pretty bad damage to the remaining teeth. In fact, it's enough damage that they need to be removed and replaced for her health, confidence, and overall well-being as soon as possible. Which procedure would you recommend? She has dental insurance, but it seems it will still be pretty expensive. Are there any public health programs or something she can take advantage of?

I'd really like to be able to give her advice from an actual dentist. Thanks.

Hi, Im sorry to hear about your friend, this is something I deal with very often, almost daily.

My advice, would be to check the prices at the nearest dental school. They often due extractions at around 70-80$/ tooth and dentures at ~600$/ arch.

If your friend needs to have the remaining teeth taken out, there are really two options for her. The first one is a little more expensive but it is what i recommend, go to a dentist and say you want a temporary complete denture made for both her mandible (bottom jaw) and maxilla (top job) the dentist will take a couple weeks to make then, then he will take out the remaining teeth, and deliver the temporary denture immediately. Your friends bone will then heal and remodel over the next 3-4 months to point where the original denture will be loose but will still be wearable. At this point the dentist will fabricate a final denture that will fit much better. Insurance should pay for a part of this. The other option is to not have the immediate denture made, and go 3 months on a liquid diet until the final denture can be made. Depending on finance, talk to your dentist/ dental school about doing an implant retained mandibular overdenture, they are much nice than mandibular complete dentures.

I have white shit on my tongue that's been there for years and I have to scrub it for like ten minutes every day to make it go away. Ever seen anything like that?

I would have to see it however, something called hairy coated tongue would be high on my differential diagnosis, if it comes off when you brush its likely non-dysplastic (cancerous) and is likely caused by bacteria build up, oral candidosis, or a reaction to medication. If you also have bad breath it would help confirm the diagnosis.

Yes I have seen that many times.

Talk to your dentist. Tell him what I said.

If its bacteria, you need to eat less sugar, and use mouth wash more often, if its candida, youll want a prescription for an antifungal like nystatin, its possible to dispense these in troche (like a cough drop) I think those work the best.

I have two questions! First, how necessary is it to go to a dentist twice a year? Will once a year suffice? Once every five years?

Secondly, my husband uses snus and used to dip. I've convinced him to scale back to only using the camel snus, which he still does, everyday. I know genetics play a big part, but realistically, how long before I should expect his teeth to fall out/cancer? (He's been using, ever day, since his teens. He's now 30) Also: he's convinced it's a cancer easily recovered from. TBH, I don't want to do the research because I'm afraid of the answers, and because there's loads of internet lore out there, but not a lot on the new snus packets which, ostensibly, should be less dangerous?

1.) Unless you are doing a 100% perfect job cleaning your teeth and you never miss more than a coulpe days of perfect oral hygiene than you really should go every 6 months. In fact for people with periodontal disease I would recommend every 3 months. The reason being centers around the bacteria that cause decay. Imagine tooth bacteria like a scaffold. Your tooth is the base for the scaffold. Imagine you got the best dental cleaning ever and your teeth were perfectly clean. As soon as you leave the office something called a pellicle will form on your teeth, this is full of glycoprotein, mucus and bacterial fragments, this isn't bad and causes no damage. The first rung on the scaffold are bacteria in your mouth that can stick to this pellicle, if these bacteria are allowed to grow and they have a food source the can provide for attachment of more dangerous bacteria, which can then go on and cause attachement of even more bacteria and so on. It gets to the point where you can no longer remove these bacteria with commercially available hygiene products and need to go to the dental office to get them professionally removed. Studies show that it can take between 3-6 months for the bacterial scaffold to build. Socransky published the pivotal study in this area in 1998.

2.) Chewing tobacco is less dangerous than smoking, in fact in some smokers which I have had a very hard time getting to quit I have them first switch to chew and eventually have them wean of off that. However chewing tobacco CAN still cause types of oral cancer that are very dangerous and even fatal if they arent caught. Make sure your husbands dentist does a thorough cancer screening at every dental visit. As soon as any dysplastic signs are shown in his oral mucosa be sure to follow up with oral cancer specialists. I cant tell you how long until his teeth fall out or get cancer, but i can encourage you to encourage your husband to quit, oral cancer is not pretty, just google image oral cancer reconstruction.

How painful is a root canal. Be honest?

If your dentist is proficient and properly anesthetizes the nerves to the teeth as well as any accessory nerves, root canals can be completely painless, uncomfortable, but painless. Some people have difficult anatomy, and certain teeth in certain people can be extremely difficult to numb completely, in these cases there can be some pain associated with the procedure, however it shouldnt be too much worse then a sensitive tooth.

might be too late but i got two questions...

i am a smoker, and beccause of that i brush 2-3 times every day religiously. am i still doing irreparable damage to my teeth?

dentists have a very high suicide rate among occupations. do you have any idea why?

Well you're doing irreparable damage to your oro-pharyngeal mucosa and your body by smoking, but you're not really doing that much damage to your teeth as long as you keep them clean and remove stains.

I question the suicide stat. The research that went into that is shaky at best. I have no idea why, but I love dentistry and dont want to kill myself at all.

However maybe it would help if you guys didn't tell us you hated us all the time. We dont like hurting you. People take shitty care of their teeth then blame us for a few minutes of pain while were fixing it.

I've forgotten where I can get this, and I may have the name wrong, but isn't there a toothpaste called 'STOP' that can be used to prevent tooth decay/reverse tooth decay?

Im sorry I havent heard of this.

What I do know is that some degrees of decay called incipient decay that hasnt cavitated can be reversed.

Do people REALLY need to go to the dentist? How effective can removing plaque buildup once every 6 months be versus good dental hygiene at home.

I dont know if youll believe me when i say this, but yes absolutely its important to get your teeth professionally cleaned. The dentist office has tools that can reach places and depths that OTC hygiene instruments cannot.

In regards to the recall period. The 6 month recall was established as an average of what the majority of patients need to maintain oral health as well as screen for advancing cavities and oral related diseases. Ideally a recall visit would be tailored to each individual based on there own oral health.

There is nothing as important as proper oral hygiene at home.

I'm going to school to be a dental assistant, will I make decent money? Do you make decent money? Can I have some money?!

You will make a decent living as a dental assistant. Anywhere from 40-70k.

I make very good money :)

Sorry you cant have any money, I am still paying off loans.

Thanks for doing this! I actually had a couple of questions that I wanted to ask my dentist when I see him in a few days but your input would definitely help put my mind at ease.

A few weeks ago I was told I had somewhere between mild and moderate periodontitis (I have a huge phobia of teeth and, although I tried, I didn't look after them as well as I should have) and since then I've really stepped up the game on my brushing and my dentist has assured me that it's improving. As long as I keep at it and treat my mouth better, can I expect to keep all my teeth? Also, will the small pockets behind a couple of my teeth go away, or are they just something to get used to?

Yes mild-moderate periodontitis can have a very good prognosis if you keep up the good work and continue your recall visits with your dentist.

The small pockets behind your teeth? Not sure exactly what you mean by this. Have you had scaling and root planing done? If not I would recommend this. Also talk to your dentist about crown lengthening to get rid of 'pockets'

I haven't brushed my teeth in a good bit (a few weeks) I just started again and plan to do this every day ( flossing, brushing at morning and night), because I didn't brush for so long, how Badly will this affect my teeth?

Go see a dentist now, a thorough cleaning and exam is in order. You have accumulated a biofilm on your teeth that you wont be able to remove with OTC instruments, a professional cleaning is what you need.

Why do dentists stop using those fluoride mouthguard things(if wrong terminology, the things where after they are used you can't drink/eat for 30 minutes) when you turn 18?

I still use these. We call them fluoride trays and they come in several awesome flavors including strawberry mint and minty strawberry.

How nice are your teeth?

I was lucky and had an amazing orthodontist and dentist in the family, as such, I do have beautifully sexy straight teeth with no cavities.

Free advice request: 2 dead black upper wisdom teeth, both impacted & growing outward at odd angle, can't afford time or money for oral surgery, how long do I have before complications spread to other teeth?

Thanks for your time.

I really cant say how long, but it will happen. The complications wont necessarily spread to other teeth though, in fact, its scarier than that, the infection will spread into the bone and throughout your face.

My advice is go to a dental school and have the wisdom teeth taken out, it will only take a couple hours and will not cost more than 200$.

Its going to need to happen eventually, so why not do it now before the pain comes.

What toothbrush is best to use? Do you pay for what you get?

Use soft bristles - many people brush too hard and can cause damage to teeth and gums.

you dont really get what you pay for, all those fancy bristles with the colors and different sizes and shape dont do anything. Buy a toothbrush you like to use and that you can use properly, the rest doesnt matter.

Do you know anything about oil pulling and would you say the benefits (cleaner teeth, healthier gums, etc) are as a direct result of the oil?

I have heard about this, I have read no research on it so i cant really give my professional opinion. People approach me all the time with alternative dental techniques, oil pulling being one of them. I know its common in eastern cultures, and have seen no negative effects. As long as you're using it as an adjunct and not in lieu of regular dental hygiene I would say go ahead and continue. Some benefits I have heard are reduce plaque and better breath.

I spent almost a decade in rural Alaska. I got some excellent dental work from two dentists, and some incredibly awful dental work from a dentist who used to work as a prison dentist before coming to rural AK (he misrepresented himself as being able to do the crown work I needed on a front tooth). We also have a major shortage of dentists, so to fill the need there are certified dental therapists. the ADA freaked out. Do you have a position on this issue about dental therapists in majorly underserved areas?

All licensed dentists are qualified to do crowns on any tooth. However many shouldnt be.

The ethics and repercussions of dental therapists, AKA mid level (tier) providers, is still a hotly debated topic. In medicine there are nurse practitioners and physicians assistants that are able to do certain procedures without direct oversight by a physician, so why cant there be in dentistry? In my dental school interviews I was asked what I thought was the biggest problem facing dentistry today. I answered access to care in underserved areas. I was given a big smile and pat on the back. Later in the day I was asked my opinion on mid tier providers, I said I support it as long as it is very tightly regulated. My interviewer sat on the dental board of that state and was very unhappy with my answer. I was confused. As time went on my belief that mid tier providers would be helpful has only strengthened, however my understanding of how difficult it would be has expanded. It would change dentistry. However is it doable? Yes of course it is. So put pressure on your local dental board. Get the word out. Just dont quote me ;)

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I will have no problem paying off my loans, I have a good financial planner, I live a modest but very comfortable lifestyle and only buy what I can afford.

I went into dentistry for many reasons. My grandfather was a dentist and loved it, he led an amazing life and raised an amazing family which he was able to spend lots of time with. I wanted to work in healthcare but still be my own boss. Its fun, there are lots of cool toys and tools that i get to tinker with as a dentist. I love the relationships i get to establish with my patients. The list goes on.

Schooling was very hard. Modern dental school teaches you full body anatomy, physiology and pharmacology as well as the an extreme focus on all aspects of the head and neck. On top of all that you learn a trade, and learn how to work with your hands and work with complex materials and machines.