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Water picks, sometimes called “oral irrigators,” make an excellent addition to your regular home care regimen of brushing and flossing. Especially helpful to those who suffer from periodontal disease and those patients of ours undergoing orthodontic treatment with full-bracketed braces, water picks use powerful tiny bursts of water to dislodge food scraps, bacteria, and other debris nestled in the crevices of your mouth. Children undergoing orthodontic treatment may find using a water pick is beneficial if their toothbrush bristles tend to get caught on their wires or brackets.

When you use a water pick, you’re not only dislodging any particles or debris and bacteria you might have missed when brushing, you are also gently massaging the gums, which helps promote blood flow in the gums and keeps them healthy. While water picks are an excellent addition to your daily fight against gingivitis and other periodontal diseases, they are incapable of fully removing plaque, which is why Dr. Rothstein and our team at A R Periodontics want to remind you to keep brushing and flossing every day.

If you have sensitive teeth or gums and find it uncomfortable to floss daily, water picks are a good alternative to reduce discomfort while effectively cleaning between teeth. Diabetics sometimes prefer water picks to flossing because they don't cause bleeding of the gums, which can be a problem with floss. If you have a permanent bridge, crowns, or other dental restoration, you may find that a water pick helps you keep the area around the restorations clean.

So how do you choose the right water pick?

Water picks are available for home or portable use. The home versions tend to be larger and use standard electrical outlets, while portable models use batteries. Aside from the size difference, they work in the same manner, both using pulsating water streams. A more crucial difference between water picks is the ability to adjust the pressure. Most home models will let you choose from several pressure settings, depending on how sensitive your teeth and gums are. Most portable models have only one pressure setting. If you want to use mouthwash or a dental rinse in your water pick, check the label first; some models suggest using water only.

Please give us a call at our Livingston office if you have any questions about water picks, or ask Dr. Rothstein during your next visit!

From the time you were small, you’ve been warned about the dangers of plaque. Why? Because:

• It’s an unappealing film that sticks to your teeth
• It causes cavities
• It causes gum disease

And really, do we need to know much more than this to motivate us to brush? But if you’re in a curious mood, you might be wondering just how this soft, fuzzy film accomplishes all that damage. Let’s take a closer look at the sticky problem of plaque.

How does plaque form?

We live with hundreds of species of oral bacteria, most of which are harmless, and some of which are actually beneficial. But when our oral ecosystem gets out of balance, problems can occur. For example, without regular and thorough brushing and flossing, we start to build up plaque.

Plaque starts forming within hours of your last brushing. And even though plaque fits the very definition of “seems to appear overnight,” this biofilm is actually a complex microbial community with several different stages of development.

• It starts with saliva.

Saliva is vital to our oral health, because it keeps us hydrated, washes away food particles, neutralizes acids in the mouth, and provides minerals, which keep our enamel strong. Saliva also contains proteins, which help form a healthy, protective film on the tooth surface. This film is called a pellicle.

• Bacteria attach to the pellicle.

There are species of oral bacteria that are able to attach themselves to the pellicle film within hours of its formation. As they become more firmly attached, they begin to grow and divide to form colonies, and are known as the early colonizers of the plaque biofilm.

• A complex biofilm forms.

If you’ve skipped brushing for a few days (please don’t!), you’ll notice a fuzzy, sometimes discolored film on your enamel—that’s a thriving plaque community, and it only takes a matter of days to go from invisible to unpleasant.

If you’re not removing plaque regularly, it can harden further and become tartar. And once you have tartar buildup, you’ll need the care of a dental professional to remove it.

• What happens if we ignore plaque and tartar?

We get cavities and gum disease.

How does plaque cause cavities?

• The bacteria in plaque, like all organisms, need nutrients.

Our normal oral environment and the food in our everyday diets provide the nutrients plaque needs. Foods such as carbohydrates, starches, and sugars are most easily converted into acids, which is why we recommend that you enjoy them in moderation.

• The biofilm promotes acid production.

Within the plaque film, anaerobic bacteria (bacteria that don’t use oxygen) convert sugars and starches into acids. As the plaque film becomes denser, it blocks acid-neutralizing saliva and oxygen from reaching these bacteria close to the tooth’s surface, creating an ideal environment for the bacteria to produce their acid waste products.

• Acids attack enamel.

The sticky nature of plaque keeps these acids in contact with tooth enamel, where, over time, acids dissolve minerals in enamel, weakening the mineral structure of the tooth.

How does plaque cause gum disease?

• Bacteria cause inflammation and gingivitis.

The bacteria in plaque irritate the delicate tissue of the gums, which causes an inflammation response which can leave your gums swollen, red, bleeding, or tender. This early form of gum disease is gingivitis. Fortunately, good dental care and careful brushing and flossing can usually prevent and even eliminate gingivitis.

• Plaque and tartar can lead to periodontitis.

When plaque and tartar build up around and below the gum line, the gums pull away from the teeth, leaving pockets where bacteria collect, leading to infection as well as inflammation. Infections and constant inflammation not only harm gum tissue, they can destroy the bone supporting the teeth. This serious gum condition is periodontitis, and should be treated immediately to avoid further infection and even tooth loss.

How do we fight plaque?

From the time you were small, you’ve learned how to fight plaque:

• Brush at least twice a day for two minutes, and be sure to brush all of your tooth surfaces and around the gum line.
• Floss to remove plaque from between the teeth and near the gum line.
• See your dentist as recommended for a thorough professional cleaning.

Be proactive. If you have any questions, talk to us about the best way to keep plaque at bay. If you have plaque and tartar that has spread below the gum line, talk to Dr. Rothstein about procedures such as scaling and planing. These non-surgical, deep cleaning treatments available at our Livingston office remove plaque and tartar around the roots and smooth away rough surfaces where bacteria can hide.

We’ve only brushed up on some plaque basics, because there is a lot more to discover about this complex biofilm. Happily, even with all there is to learn about plaque’s growth and development, it’s reassuring to know that getting rid of it is quite simple—with just a soft-bristled brush, some dental floss, and a few minutes of your time each day, you’re on the way to a healthy, happy, plaque-free smile.

Biofilm, the protective housing for bacteria, is a hot topic in the medical and dental fields. Routinely taking an antibiotic for a bacterial infection has become more complicated because of biofilm. Bacterial infections may become resistant to antibiotics in part because the biofilm allows for communication among the bacteria, allowing the infection to be sustained.

You’re probably wondering, Dr. Rothstein , what does this have to do with teeth? Since we’re dental professionals, we can tell you why it’s important and what you should know! There is biofilm in your mouth; healthy biofilm and diseased biofilm. Both are made of the same general compounds, but when combined with certain amino acids and cellular chemicals, the diseased biofilm conquers and destroys.

Periodontal disease, otherwise known as gum disease or pyorrhea, is a biofilm disease. If you are undergoing treatment for gum disease and you do not continue with the treatment plan the disease will progress and/or spread due to the biofilm.

There are several ways to treat diseased biofilm. But remember, antibiotics cannot touch the bacterial infection if the biofilm is established.

When your exam is complete, the Ultrasonic or Piezo Scaler should be used. This method of spraying water disturbs the biofilm and provides an opportunity to treat the infection causing bacteria.

Remember, we all need healthy biofilm. Just as your skin protects your body, biofilm housing good bacteria protects your body. The bacteria in the biofilm replicate every twenty minutes. If your body has healthy bacteria, low levels of hydrogen peroxide are produced by the biofilm, preventing harmful bacteria from residing. Harmful bacteria do not like oxygen.

At your exam, we will take measurements around your teeth checking for “pockets”. The higher the number, the deeper the pocket giving more room for harmful bacteria where there is no oxygen. Ask what your numbers are and be involved in restoring your healthy biofilm.

You brush and floss thoroughly twice a day. You have regular checkups. Everything seems fine on the periodontal radar. Sometimes, however, even healthy gums can become sensitive and irritated. Is it something you did? Maybe! Here are some common causes of gum irritation and sensitivity that you might not be aware of.

• Brushing Bravado

One of the most important tools for gum health is one we use at least twice a day—the simple toothbrush. Two minutes at night and two in the morning reduce the bacteria and plaque that lead to serious gum disease, known as periodontitis. And while preventing tooth decay and gum disease are the primary goals of brushing, let’s also protect delicate gum tissue from injuries and irritation caused by too-forceful brushing.

Try using a brush with soft bristles and brushing with short strokes and gentle pressure, especially if you know you have a tendency to be a bit heavy-handed. Massaging rather than scrubbing will clean teeth and gums just fine.

• Fierce Flossing

Just because we can use dental floss to slice cakes or cookie dough logs doesn’t mean we should apply the same pressure to our gums! While a firm sawing motion seems like the obvious way to clean between teeth and gums, you can actually cause irritation and bleeding that way.

Insert the floss between your teeth carefully, bring it to the gumline, and move the floss with gentle pressure up and down and around the tooth surface. This technique will make sure that you remove food particles and plaque from beneath the gumline without causing your gums any trauma. Ask us about the best flossing techniques—we know them all.

• Appliance Aches

You know how helpful your braces/retainers/mouth guards/dentures are. You just wish that your helpful appliance was a little less irritating to sensitive gum tissue.

This is a problem that often disappears as you get used to your new appliance. But if pain or irritation persists or gets worse, give us a call. We want to make sure your appliance fits properly, and make any necessary adjustments to ensure your comfort.

• Peroxide Problems

Most home whitening kits use peroxide-based gels or treated strips to remove surface stains from the teeth. Those same bleaching agents that make enamel whiter can also cause gum sensitivity and irritation. If you use whitening strips or gel trays, be careful to keep the peroxide solution away from gum tissue. But because these systems are one-size-fits-all, that is often easier said than done.

If you have sensitive gums, one solution is a professional office whitening. We’ll check on your gum (and tooth) health first, and monitor and protect your gums throughout the procedure. If you still want to whiten at home, we can create custom trays for you that will provide more complete exposure to the whitening solution for your teeth, and less exposure for your gums, than over-the-counter products.

• Still Smoking?

Studies have shown a strong link between gum health and smoking and other forms of tobacco use. Smokers are much more likely to suffer from gum disease than non-smokers, and those who have smoked for a long time, or who smoke heavily, have an even higher risk of developing periodontal disease. Some studies suggest that smokers don’t respond as well to treatment as non-smokers.  Unfortunately, it appears that smoking and tobacco use help mask the obvious symptoms of gum disease (redness and bleeding), which could lead smokers to delay getting treatment. If you smoke, talk to us about ways to quit.

We talk a lot about periodontal health because it is so important. Periodontitis can lead to infection, loss of bone around the tooth, and even eventual tooth loss. If you are suffering from any of the signs of gum disease—swelling, redness, bleeding, pain—give our Livingston office a call. Whether it’s as simple as making a few lifestyle changes, or a problem requiring professional dental treatment, being proactive with your dental care is more than good for your gums—it’s good for your health!