Your teeth and people who drill them

[Furiously]

Incompetence.

[ghost]

Most specialists in dentistry are very good.  It's much tougher to specialize in dentistry than in medicine, therefore you're typically getting the very best students that end up as an endodontist, orthodontist, oral surgeon, pediatric dentist, etc.  However, it's not always the case that these people are universally competent.  Some of this is due to philosophical differences, i.e. doctors using information that is outdated or biased on anecdotal evidence, but most times the incompetence in specialists is due to greed leading to compromises in treatment related costs, recommended overtreatment and poor staff hiring.  I find that the doctors that are primarily interested in money are the worst when it comes to treatment quality and patient experience in the office.  General dentists, in my recent experience, are a really mixed bag.  There are a lot that are fairly competent and run horrid offices or run horrid offices and are completely incompetent.  Again, the greedy ones are the people to avoid.  If the office looks like a 3 million dollar house, odds are good it's a money factory and you'll be overcharged or overtreated.  I would estimate that there were about 4-5 people in my class of 45 that graduated dental school that I would let perform dentistry on me.  That number has probably gone up as people got more experience, however all of those 4-5 went on to specialties and about 10 overall specialized.  Contrast this with my medical school graduating class where about 70% specialized and I couldn't come up with a number that I would let treat me as you aren't competent to do anything when you graduate from medical school. 

Is this answer what you were looking for?

[Furiously]

Yes, thank you.

[KallDrexx]

So as a dentist do you brush 3 times a day and floss every day? 

[ghost]

I brush 2 times per day and yes, I do floss every day, 2 times per day.  It's more important than brushing, in my professional opinion.  I also use Listerine twice a day, as it is the dental equivalent of the nectar of the gods. 

[Lantyssa]

You need to invent a liquid floss.  (And subsequently make me rich for suggesting it to you.)

[01101010]

Ahh listerine. If I miss a brushing, I always make it a point to at least hit the listerine before bed. Though that rarely happens now that I have built flossing into my routine before bed. I do wish I had been as diligent about brushing twice and flossing as a kid, but that sihp has sailed.

[ghost]

There is some research out there (albeit probably biased research) that says that using listerine 2 times per day is the equivalent of flossing.  I'm not sure that it is the same, but Listerine is a great product.  If you floss and limit the sugar in your diet you probably don't even need to brush.  And you 're never too late to take care of your teeth unless you're in a denture. 

[Merusk]

I brush 2 times per day and yes, I do floss every day, 2 times per day.  It's more important than brushing, in my professional opinion.  I also use Listerine twice a day, as it is the dental equivalent of the nectar of the gods.  

My Hygienist said the same thing about flossing.   As a guy who's had fillings almost every time he's gone to the dentist since moving to Kentucky, I'm inclined to agree. (They say they fluoridate the water but I swear they don't at this point. Even cutting back on sweets and soda compared to 1/8th of what I did when I lived in Ohio my teeth have gotten worse the longer I lived here.)

I bought that Oral-B flosser w/ the disposable heads.  Thing is a godsend for folks like me with a small mouth and giant teeth and makes it easy to pick-up and use after brushing. Much simpler than the old "tie it off and cram your fingers in your mouth" of the old days.

The purple Listerine is awesome and I've noticed some help since using it for the last year.  I agree with Lant, though. We need a liquid floss of some sort.

Question ghost:   If I run out of heads, how bad is it to reuse one the next day?  The hygienist explained to me that you floss in part to expose bacteria at the gumline to air and get food out of the pockets.  Since it's anerobic bacteria I'm not screwing myself by dropping more of the buggies down in there if I'm forced to reuse, am I?

ed: Oh another tip the Hygienist gave me this last trip. Ask for fluoride if you're having problems.  Evidently a lot of offices don't even offer it to patients since they get all screechy about only doing what the insurance will cover.  The treatment was $32 total, and they said if my insurance won't cover it they'll knock it back to $12.  Pretty damn cheap compared to the $90 filling co-pay.

[ghost]

Ah, they're your bugs and most of them are probably dead from being out in the open air, so I wouldn't worry about it too much.  I wouldn't make a habit out of it though.  The purple Listerine would probably be great for you as it also has fluoride built in.  As for the Kentucky thing, you're probably just getting meth mouth from being in such close contact to all the eastern Kentucky dirtbags.   

[Ingmar]

I use the Crest no-alcohol stuff, Listerine is too unpleasant.

[Furiously]

Or you have a dentist that is bilking you.

[ghost]

I use the Crest no-alcohol stuff, Listerine is too unpleasant.

Listerine is obnoxious, but it's much more well researched and proven than any of the other mouthwashes.  It's the very, very best when it comes to periodontal disease.  It is one of the first ADA accepted mouthrinses (and for a long time was the only one).  I would rather see you use that and cut it down 50/50 with water to get used to it. 

[Ingmar]

You're lucky I use mouthwash at all! Take your small victories!

[ghost]

Just let me soapbox.  You'll survive.   

[Reg]

Hah! I knew all of those tasty new mouthwashes couldn't be as reliable as my good old Listerine!

[Sjofn]

Meanwhile, I brush twice a day and that's it, motherfuckers. And I have fabulous teeth!

YAY FOR RANDOM GOOD TEETH GENES

[Furiously]

We grew bacteria in listerine in high school. I've always considered it pretty ineffective in killing bacteria. I'd imagine swishing vodka in your mouth would be 100 times more rewarding.

[ghost]

We grew bacteria in listerine in high school. I've always considered it pretty ineffective in killing bacteria. I'd imagine swishing vodka in your mouth would be 100 times more rewarding.

Nope.  Sorry.

[Ingmar]

He said rewarding, not effective!

[ghost]

I know several alcoholics that did their worst damage with Scope and Listerine.  

Seriously, one attorney I knew growing up would keep like 7 or 8 bottles of scope in his Ford Explorer all the time.   

[Merusk]

Furiously must be drinking.  Listerine is pretty well-proven to kill bacteria, it's not just a marketing slogan.

[apocrypha]

No-alcohol mouthwash is mostly a waste of time, the only benefit from it is the fluoride and there's something like 1/1000th the concentration of fluoride in mouthwash that there is in toothpaste.

The bacteria on your teeth and under your gums are in something called a biofilm, which is basically lots of bacteria living together in giant colonies surround by polysaccharides and other stuff they secrete. This makes them very, very resistant to things like antibiotics and also protects them from exposure to air, which kills them. One of the very few things that penetrates biofilms is alcohol. The other thing you can do is physically disrupt the biofilm. i.e. with flossing or interdentals.

What I've been told by my dental hygienist & dentist is to rinse with Listerine, use inderdental brushes (TePe's) and then rinse with Listerine again. Wait 30 mins and then brush your teeth with any toothpaste at all as long as it's got fluoride in it and then don't rinse the toothpaste out after brushing. Spit out, but don't rinse, and then don't eat or drink anything for an hour or so. I do all that twice a day and it's a giant pain, but it does seem to be slowly shifting my periodontal disease.

So the interdental brushes disrupt the staph biofilms, the alcohol in the Listerine gets to penetrate them a bit and kills any loose bacteria floating around, and then the high fluoride concentration in the toothpaste gets to sit on the gum/tooth/air interface area for a while doing it's thing.

Does that all sound correct ghost?

[ghost]

No-alcohol mouthwash is mostly a waste of time, the only benefit from it is the fluoride and there's something like 1/1000th the concentration of fluoride in mouthwash that there is in toothpaste.
.....
Does that all sound correct ghost?

Your initial part is wrong.  Listerine is well proven to kill bacteria and is quite effective as a preventative measure.  As for the rest, it may be a good plan for someone with moderate to severe periodontal disease, but all of that rigmarole is quite unnecessary in those that have relatively healthy bones and gums.  I.E., it's preventative, not a treatment.  The problem that you run into with moderate to severe periodontal disease isn't the biofilm, it's the fact that the biofilm is deep in pockets around the teeth that can't be accessed by anything.  That's why your periodontist has to flap open your gums and do the scraping under direct visualization. 

As far as the fluoride being important, yes, it's important, but it has absolutely no effect on periodontal disease causing organisms and is only in toothpastes, etc. to help with the strengthening and remineralization of enamel which is only present on the crown of the tooth.  But even the fluoride in toothpaste is overrated a bit-  the most important fluoride you get is integrated into the tooth as it is being developed through water supply fluoridation and/or diet supplementation. 

The bottom line is this-  Diet is the most important factor in the prevention of cavities.  The singular bug that causes cavities uses primarily glucose to live on.  Cut glucose and cavities go away, more or less.  As far as care, the mechanical action of brushing is the most important part (particularly for those with periodontal disease).  Flossing is the most important thing you can do for your teeth.  It's where people get cavities typically and the interdental area is the petri dish where periodontal disease begins.  Adjunct routines like mouthwashes can be tailored to need and may help out, however they should never be a primary form of prevention.  Brushing and flossing, with or without toothpaste, is where all of the good action is.

[Fordel]

I didn't realize the mouthwash had to be Listerine specifically. I've been using the loser store brand mouthwash 

[ghost]

I didn't realize the mouthwash had to be Listerine specifically. I've been using the loser store brand mouthwash 

Mouthwashes are very different from brand to brand.  Listerine is specifically more active against bugs that cause periodontal disease.  If you have a tendency towards cavities you would want to use something like ACT or the purple Listerine that has fluoride in it. 

[Merusk]

The purple Listerine is no where near as nasty as the Old Gold standard.  I recommend buying one of the "TSA Compliant" travel bottles and trying it out if you're wary.   It's got a minty flavor to it and only burns your mouth if you've managed to scrape up your gums or cheeks somehow.

The hardest part is knowing the right amount and swishing it for the full minute.  Oh, and no eating/ drinking for 30 mins afterward.

[bhodi]

When I got my wisdom teeth removed, I got a prescription for Biotene, which at the time wasn't over the counter. I guess it is now. I thought it was awesome. I'd be using it now if it wasn't $30/bottle.

[ghost]

Biotene is typically more used for dry mouth.  It's odd that they gave that to you.  More typically the oral surgeon will give Peridex (chlorhexidine gluconate), a mouthwash that has been shown to very effective in killing bugs.  I wouldn't prescribe anything but Peridex after wisdom tooth removal (and probably wouldn't even prescribe that.  It's too tough on the exposed tissue. 

As far as Listerine goes, it definitely gets less obnoxious as you use it.  I typically will recommend that people start by diluting it down to 1/4 or 1/2 and work their way up over time.  It's just such a more effective agent than the options when it comes to periodontal disease and gingivitis. 

I think this is the most I've talked to people about Listerine since dental school   

[bhodi]

Whoops, you're right, it was Peridex. Great stuff. I got the two confused, since I once did take biotene for dry mouth. It was weird because it has a sort of fuzzy effect and everything sloughs off rather than the antiseptic Listerine tang.

[ghost]

The big problem with Peridex is that it can turn your teeth a very funky color, tastes like ass and is expensive.  But yeah, it's awesome. 

[apocrypha]

Cheers ghost, yeah I do have moderate to severe peridontal disease, been trying to shift it for a couple of years now. Since starting the rigmarole the bone degradation has stopped completely, most of my medium pockets have closed up and the deep pockets are about 1/2 the depth they were.

I knew that fluoride was for strengthening teeth rather than for any anti-microbial effect. Any idea what it actually is in Listerine that's the effective agent?

My hygienist said, last time I saw her, that after one more round of her scraping under the gums she'd refer me to a dental specialist at a hospital to see if there was anything further they could do to try and get rid of the periodontal disease for good. I'm in the process of moving house now though so I'm going to have to go through the hassle of getting on the register & queue for an NHS dental practice in the area I'm moving too :/

[ghost]

Good on you for getting a good regimen and trying to get it under control!  It's tough to get a complex routine like that down.  Perio disease is much more difficult to deal with as it's much more limited by the effects of diet.  A lot of it is "you just got bad bugs" and there is probably more of a genetic predisposition to perio problems. 

The active ingredients in listerine are menthol, thymol, methyl salicylate, and eucalyptol.  It also contains a high concentration of ethanol, although it isn't particularly active at the concentration used. 

Regarding the specialist, I find that specialists are much more competent at dealing with periodontal disease here in the States.  The general dentists are too focused on elective, cosmetic procedures and implants, typically (the higher paying stuff) and patients hate periodontal treatments.  Specialists also typically have access to more up-to-date remedies through a more modern professional "database", if you will.  I don't know if this will be the same in the UK (that is where you are, right?).  You'll just have to check around and see, but I would personally try to get in with a specialist for at least an examination.  If they think you're okay at the GP, then that's great. 

[apocrypha]

Cheers man. I suspect there is a genetic component - my mother, two of my uncles (on my mothers side) and one of my brothers all developed the exact same problems around 40-50. Being told at the age of 41 that you're in danger of losing *all* your teeth within 10 years tends to focus the mind a little bit and makes sticking to a regime much easier 

Yeah I'm in the UK, which means that I either need to get referred to a specialist by my general dentist or hygienist, or go private, which I really can't afford. The way it works here is that the hygienist can refer me to a specialist after 2 complete deep cleaning passes. We've got 1 more visit for me to be at that stage since she splits the deep cleans up into 2 sessions, so hopefully soon I'll get a referral.

[Sky]

I use the regular old minty listerine. I got the no-alcohol version once by mistake because I didn't realize that was even a thing, I just grabbed the bottle of the correct flavor. I tried to stick with it for a week and tossed it out for the good old alcohol version. The burn is good, but I also use 90% rubbing alcohol for aftershave.

So what's this about the purple kind? Is it better than the regular green or blue or whatever it is I use?

My mother has pretty bad perio, mine was up to 6's in the back but over two years I brought it down to 3's in the worst spots. I'm bummed because we have a new hygienist and she's nowhere near as good with the perio treatments. I'm considering going to the practice she went to, even if it means a 45 min drive each way. What's that compared to your teeth? But I love my dentist, so it's a tough call. Anyway, note that I was a dumbass and didn't go to the dentist for 18 years after high school, and got away with only one crown and a filling for that. In my defense, having no insurance in the 'greatest country in the world' is fucking balls.