Dental Dictionary – Plaque and Calculus by Lauren Marques, BSDH, RDH
Through years of discussions with patients about oral hygiene, I have come to realize that most people use the words plaque and calculus (or tartar) interchangeably. But in fact, they’re totally different! So let’s chat about the stuff that builds up on our teeth, why it’s relevant to oral hygiene, and how to keep it off of our teeth. Plus, who doesn’t love to talk about germs? (Okay, maybe most people don’t… we’re just nerds).
Plaque is the sticky, soft, film that we brush off with a toothbrush. Although it is difficult to see, under our magnifying glass it is usually a white substance with the consistency of cottage cheese. Plaque is what makes our teeth feel like a “sweater” in the morning before we brush our teeth. Plaque is a harmful biofilm that causes inflammation, gum disease, and cavities. The makeup of plaque is around 1000 microorganisms, including streptococcus mutans, a large contributor to tooth decay. Plaque builds up on our teeth naturally with our diet and saliva and is exactly why we brush our teeth at least twice a day.
As plaque absorbs minerals from food and saliva, it begins to harden within as little as 48 hours, turning into a substance called calculus (sometimes referred to as tartar). Calculus is made up primarily of calcium phosphate deposits and is formed in incremental layers. Calculus varies in color- white, green from stain, or even dark/black deposits from iron (bleeding) in inflamed gums. How and why calculus forms has many variables including oral hygiene, the type of bacteria in your mouth, drugs, medications, and tobacco use. Calculus can no longer be removed with a toothbrush and can only be removed by a professional dental cleaning using specific dental scalers and ultrasonic instruments.
Our mouths alone contain over 700 species of microbes (not including what’s under our gums and the bacteria that make up plaque and calculus – another 1200 species). Some of these microbes are good, and some are bad. Your mouth is basically it’s own ecosystem. Oral bacteria and inflammation (bleeding gums) is related to a variety of systemic issues in our body such as heart infections, cardiovascular disease, pregnancy complications, pneumonia, and Alzheimer’s disease. It is important to keep a good balance of the good bacteria in your mouth through low-sugar diet, brushing twice a day, flossing (or using a water flosser), avoiding tobacco use, and of course, visiting your dental hygienist!
Cate, J. (2006) Biofilms, a new approach to the microbiology of dental plaque. Journal of Odontology. 94: 1. doi.org/10.1007/s10266-006-0063-3
Dr. Tungs (2017) [Image] Germs. Retrieved from https://drtungs.com/blog/plaque-health-part-1-plaque/
Dental X-Rays! Why and When? by Lauren Marques, BSDH, RDH
Today I’m giving you the scoop on dental x-rays – why we take them and what exactly we are trying to find. Radiographs are an integral part of diagnostics during your dental examination. In order to provide you with the highest standard of care, we need to see the entire picture… no pun intended.
What are you looking for when you take x-rays?
Dental radiographs are used to look for a variety of issues – even letting us see problems before painful symptoms begin. Here are some of the oral concerns the dentist can identify with diagnostic imaging:
Cavities: When we look at your mouth, we are only able to see the top and side surfaces of your teeth. Cavities often form on the in-between surfaces, and radiographs will allow your dentist to see cavities or the beginnings of cavities forming.
Existing fillings: An x-ray will show re-developing decay or areas breaking down around existing dental work.
Bone structure surrounding the teeth: Looking at the bone levels surrounding the teeth will identify bone loss caused by gum disease. X-rays can also identify jaw problems, cysts, tumors, or abscesses.
Infection: X-rays will show abnormalities at the tip of tooth roots, indicating an abscess or infection. An infection may show up in an x-ray before it shows symptoms that you can see or feel. Sometimes, infections can form years after prior injury.
Fractures: An x-ray can show a fractured tooth or jaw.
Check the location teeth: X-rays help us evaluate teeth that are not forming in the right place or are too crowded to grow in properly, such as impacted wisdom teeth. The doctor can also evaluate crowded or overlapping teeth. In children, x-rays also monitor tooth development and evaluate the need for orthodontics.
But if I have a cavity or other problem, won’t I feel pain?
Typically, you will not feel pain unless a cavity has become larger and approaches the nerve of the tooth. Some people will not feel infections at all! When decay reaches the nerve of the tooth, you are at a higher risk of needing a crown or root canal. It is recommended to treat a cavity while it is small to prevent more extensive dental work.
How safe are x-rays?
What about pregnancy?
At Five Pines, we use digital technology which is up to 70% less
radiation than conventional radiographs! The technology has improved so much
that lead aprons are no longer required for exposure. However, we still
recommend a lead apron for pregnant patients, children, and those who would
still like to use the apron as a precautionary measure.
We still recommend regular check-up x-rays for pregnant patients
to identify problems that may need treatment. According to the
American College of Radiology, no single diagnostic x-ray has a radiation
dose significant enough to cause adverse effects in a developing
embryo or fetus.
This infographic compares a dental x-ray with other sources of
radiation – it is a helpful comparison!
How often do I need x-rays?
We base the frequency of x-rays on a variety of factors that vary from patient to patient. Risk factors such as dental history, medical history, age, medications, diet, and oral hygiene all play a part in the collaborative decision of radiograph frequency. We generally recommend a full set of x-rays every 3-5 years, and limited check-up bitewings every 1 to 2 years.
I saw this sign on the wall of a chiropractic office that was the perfect illustration of radiographs: “To see is to know. Not to see is to guess. And we won’t guess about your health!” It’s important to us that you know exactly what we are looking at when we are evaluating your teeth and want you to be involved with understanding your health.
Every year on our anniversary we try to take a minute amid the chaos of throwing a kegger, er, I mean respectable Happy Hour for adults, to reflect on how far we’ve come since we opened our doors in 2016. This always ends up with us feeling overwhelmingly thankful for our incredible staff and awesome patients and the Portland community in general.
It’s from this thankfulness that the #FivePinesDollarDrive initiative was born. As a fun way for us to give back to the community, every month will feature a different photo prompt and charity. For every photo posted on Instagram, Facebook or Twitter tagging us and #FivePinesDollarDrive, we will donate $1 to that month’s charity.
So now through the end of August, post a photo of a smile (could be your own or someone you love) and we’ll donate $1 to the Dental Foundation of Oregon to help fund dental care for under-served children in Oregon.
We’ll donate for any and all participation (up to $1,000) so you don’t have to be a current patient to participate.
Thanks for helping make Five Pines so special. We can’t wait to see those smiles!
Activated Charcoal – Should I Use It? by Lauren Marques, BSDH, RDH
Activated charcoal is a manufactured product that has benefits such as water filtration, binding with intestinal gas, and is used by doctors to treat poisoning and overdoses. If you’re a science nerd and want to read up on how activated charcoal works, Dr. Anne Marie Helmestine (2019) breaks down the mechanism in which activated charcoal is created and its effectiveness here. Activated charcoal is currently all the rage in skincare products, at the smoothie bar, and now… in toothpaste!
First, let’s talk about how whitening pastes work. Generally, whitening toothpastes remove stain through the action of abrasion – “scratching” stains off of the surface of the tooth (think: sandpaper!). Common mild abrasives you may see in toothpaste are hydrated silica, calcium carbonate, and baking soda. These products are recognized by the Food & Drug Administration (FDA) as being Generally Recognized as Safe (GRaS).
Currently, charcoal pastes are gaining popularity due to its claim that it can brighten your smile though its abrasiveness and “detoxing” mechanisms. But what evidence do we have that it works? Unfortunately, there is not a lot of scientific studies to back up the claim. The Journal of the American Dental Association posted a literature review stating little to no evidence of the safety and effectiveness of charcoal as a whitening agent. In 2017, the Journal of Physics released a study that concluded that brushing with a charcoal paste nearly doubled tooth roughness after three months of use – suggesting that it may be too abrasive to use and suggests reconsidering the use of toothpastes containing charcoal for the long term.
Additionally, the United States Center for Disease Control stated that charcoal powder is as carcinogenic as cigarette smoke, and that mixing a powder into toothpaste form at home can pose a dangerous risk.
However, reputable dental companies are following the trend for charcoal pastes. Crest released a toothpaste with charcoal, claiming to gently remove surface stains and remineralize weakened enamel through fluoride. The brand HELLO released a charcoal paste claiming to be less abrasive than charcoal powder and well within the safety limit for toothpaste abrasiveness as suggested by the International Organization for Standardization (ISO).
So, the short answer: There has been very little evidence that charcoal has any effect on tooth whitening. Charcoal also has minimal studies on the negative effect and abrasiveness on enamel. We recommend that if you do decide to use charcoal toothpaste, purchase from a reputable toothpaste brand as a pre-mixed paste, and do not use it long term.
Keep in mind with any whitening toothpaste – whether or not recognized as “safe” by the FDA or within ISO standards– whitening pastes may cause sensitivity, weaken enamel, or further damage exposed root surfaces (called gum recession). While we do find that most side effects are temporary, please consult your dental professional. We can help you find the products that are best for you!