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Dear Patient: Your dental problems might not be your fault

Nov. 29, 2022
No, Amanda Hill isn't advising patients to disregard their role in their oral health—but she does want them to know there are factors beyond what they're doing to care for their teeth and gums.

When I was growing up, my dad used to love to talk about his brother Jeff. He died long before I was born, so took on some kind of superhero status in our minds. Apparently, Jeff never brushed his teeth … to the point where my dad claims Jeff’s teeth had a green film on them. But somehow when all six kids were rounded up and taken to the dentist, Jeff never had a cavity. Meantime my aunt Carole, who was fastidious with her dental hygiene, always had at least one.

Much to Aunt Carole’s dismay, what we know now is that the health of your mouth doesn’t rest solely on your ability to angle a toothbrush properly for a full two minutes and wrestle the floss into a perfect c-shaped curve around each tooth. Please note here, I’m not giving you a free pass to be like my uncle Jeff. But your oral health is far more complex than a toothpaste commercial would have you believe.

The role of biofilm

The biofilm in your mouth is a living entity that is constantly changing based on your habits, your overall health and wellness, and even your stress level. While Carole was great at removing plaque from all the surfaces of her teeth, she was the oldest of the six kids and maybe the stress helping care for them put her gut microbiome out of whack. Or perhaps she was a secret snacker so the pH in her mouth was constantly dropping, or she had a secret boyfriend with untreated decay and he was sharing bacteria. Meantime, maybe Jeff was someone who drank water throughout the day and carefree without a stress in the world. All of this factors in to your body’s ability to fight off disease (and yes, cavities and gingivitis are diseases).

Underlying medical issues

As science evolves we’re learning more and more about different factors outside of your oral hygiene, that affect the report you get at your check-up. And thankfully there are more options for us as clinicians to figure out what’s going on, and more product innovations help us treat your disease.

Many offices are teaming up with medical doctors to do some detective work and get to the root of your disease. Taking a comprehensive medical history and updating it, along with blood pressure readings at every visit, have become standard care. Some practices will even test your blood sugar. Underlying medical issues can truly affect the health of your mouth the same way untreated disease in your mouth can affect your body.

We can now test your saliva to see the pH and buffering capacity. This will help us understand how acidic or basic your mouth is, and how quickly your body can get your mouth back to a neutral pH (if at all) after you eat or drink. This affects how the biofilm matures in your mouth and whether the good stuff or the bad stuff grows.

Offices can send samples of your saliva off to a lab and see what exactly is living in your mouth. Then we know what we’re up against. From there we can recommend treatments, products, or even prescription trays that deliver medicine deep into the pockets around your teeth. Sometimes that pesky biofilm gets so established in those pockets that no amount of home care will ever be enough. Getting medicine into that space daily (or even multiple times a day) might be what you need to stop your gums from bleeding. Remember: healthy gums don’t bleed, even when your hygienist pokes them!

How can you take charge?

So what can you do if you find yourself relating to my aunt Carole? Ask your dental professional to think outside the regular brush and floss lecture. I need to admit that sometimes we get so busy trying to fit all the things into your dental appointment that this conversation might get missed. Bring it up at the beginning of the appointment or even before your appointment. Let the front office team know you need some extra time to get to the root of your dental issues. The only way to get a healthy mouth is to have a healthy oral microbiome, and brushing and flossing might not be enough.