Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

August 3, 2016

So does flossing really help?


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So the Drudge Report yesterday linked an article from the British newspaper The Guardian about flossing. The link said, “Smile! Now experts decide flossing makes no difference.” The article in The Guardian is titled “Everyone recommends flossing – but there’s hardly any proof it works.” I’m not going to give the article any respect by linking to it–if you want to read it you’ll have to Google it.

But I can sum up the article in one word–ridiculous.

There is strong evidence through multiple scientific studies that flossing helps prevent both gum disease and interproximal tooth decay. In my dental practice, I could tell whether or not a patient was flossing simply by examining their gums. In fact, the science is so carefully calibrated that dentists can predict how long it would take a patient with inflamed gums to bring the inflammation under control with daily flossing. Two weeks of regular, daily flossing would do the job. In my practice that timing worked every time.

And rarely do regular flossers get interproximal tooth decay.

But if you go back and re-read the article, it’s fairly easy to detect the slant in the writing. Notice that the article doesn’t say there is no proof. It is titled there is “hardly any proof.” Think that through. That means there is proof.

Further along in the article it says: “A major review last year concluded: ‘The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal.'” Notice again the wording, which admits that there are studies that demonstrate the benefits of plaque removal, but it’s not a majority of studies, or rather, it’s not a majority of the studies that were available to the person that made this comment.

Let me play this same word game with the benefits of showering. I could say something like this: “The vast majority of studies published in American medical journals fail to demonstrate that showering prevents body odor.”

Well, you may respond, the vast majority of studies in American medical journals don’t even deal with the subject of showering.

Oh, you’re so smart.

And this article in The Guardian is so stupid.

Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

February 11, 2016

She can’t floss after getting porcelain veneers

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Dr. Hall,
I have just had 9 eMax veneers fitted one week ago. I use Oral B Pro Expert toothpaste which dentists in the UK highly recommend for tooth hygiene. Is this toothpaste okay for my veneer care? Also the way my dentist has placed the veneers on I can’t floss in between so I have used Phillips Airfloss to clean gums.
– Michelle from Derby, UK

Michelle,
Before I address the toothpaste, which is a minor matter, the thing you need to be most concerned about is that you can’t floss between your teeth. This is a serious problem. In my opinion this is a serious deviation from the standard of care. At least you are using the Phillips Airfloss to try to clean between the teeth, but this isn’t as good as flossing. You should not only be able to floss between each of your front teeth after getting porcelain veneers, but that floss should glide smoothly along the surface of each tooth, with no snags or rough spots, clear into the sulcus of the tooth.

Without this, your gums will be puffy and not healthy. This is one of the critical things I look for when I examine photographs of the work of cosmetic dentists that I recommend on this website.

Were your veneers made by the laboratory this way? Or did your dentist simply skip the step where the excess cement is cleaned off?

There are situations, such as with advanced gum disease or creating support to hold in a bridge where some front teeth may need to be bonded together in order to strengthen them. But to create that situation for an aesthetic procedure is something I would consider completely inappropriate.

Correct Porcelain Veneer Bonding Technique

Here’s an explanation of a typical method of bonding on porcelain veneers, which I used, and which I believe is pretty much accepted technique among cosmetic dentists, or something very similar to this. After priming the surface of the tooth with the proper etching and bonding agents, I would place the bonding composite in each veneer individually and then press each veneer onto its corresponding tooth, which would cause excess composite to squirt out the sides. I would then remove much of the excess composite with a cotton roll and then begin to cure the bonding composite. This composite is light cured, and dentists use a special high-intensity curing light that emits a particular wavelength chosen so that it activates the hardening agent in the composite. porcelain veneer bonding technique small tip curing lightBut rather than cure the entire tooth, I would use an ultra-small light tip (a 2-mm tip is shown here) so that I would cure only the composite in the center of the tooth. This would tack the veneer in place so that I could floss around it without dislodging the veneer. After thus tacking all the veneers into place, I would carefully floss around the teeth, making sure that all the excess composite was removed and we were left with smooth surfaces between all the teeth.

porcelain veneer curing light large tipOnce that was done, I would go back with a larger curing tip, similar to the 13-mm tip shown here, and cure all of the remaining composite, so that the veneer was solidly attached to the tooth. Then I would finish the case by going between the teeth with fine polishing strips, leaving everything with an ultra-smooth polished finish.

Dentists who don’t do a lot of porcelain veneers may not stock this ultra-small curing tip. Not using a tool like this means a lot of extra work, because cleaning off the excess composite once it is hard is time-consuming and laborious. Of course, if they just skip that step, it’s quick and easy.

The first step I list on my page about how to take care of porcelain veneers after they are placed is “brush and floss faithfully.” If you don’t do that, you risk getting decay around the edges of the porcelain, and you risk losing the teeth to gum disease. Not good.

So I would go back to this dentist, share what I have given you here, and see if he or she can fix this so you can floss. Meanwhile, continue using your Phillips Airfloss–it’s better than nothing. But be sure you don’t put a mouthwash in it that contains alcohol. Alcohol softens the bonding composite around your veneers.

About your toothpaste, I would disagree with your dentists in the UK, that Oral B Pro Expert toothpaste is anything special for general dental hygiene. I don’t believe there is any toothpaste that is anything special for general use. I look at the ingredients in the Oral B toothpastes and I see stannous fluoride, which other toothpastes have. It’s a fluoride compound. I actually think that sodium monofluorophosphate is a better ingredient for delivering fluoride, but stannous fluoride is okay. Some of the Oral B formulas have tartar control agents, which other toothpastes also have. Some formulas have whitening agents, but other toothpastes have those and they don’t really work anyway. Some have antibacterial agents, which, again, are present in other toothpastes. Nothing unique or special here.

There are two toothpastes that are specifically designed for maintaining cosmetic dental work. One is Rembrandt toothpaste, which uses aluminum oxide as an abrasive, which is especially gentle. The other is Supersmile toothpaste, which cleans the teeth with an enzymatic action that actually dissolves the protein pellicle to which the stains attach. Because it is so gentle and thorough, that is my recommendation for maintaining cosmetic dental work, and when I placed a set of porcelain veneers, I started each patient off with a complimentary tube of Supersmile.

If you learn anything more about why your dentist made it so you can’t floss between your teeth, I’d love to hear from you.
Thanks,
Dr. Hall

Do you have a comment? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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