Clean teeth and healthy gums during teeth straightening- The role of diet, soft drinks, dentists and unhealthy gums. Part 2
Dr Andrew Chang interviews Dr Teck Tang, of the Specialist Dental Centre, Sydney to talk about clean teeth and healthy gums during teeth straightening- The role of diet, soft drinks, dentists and unhealthy gums. He is a well regarded specialist gum dentist, an expert in the field of maintaining healthy teeth and gums. In this Part 2, what’s covered are:
Please click here to access the audio version of the podcast. For those who prefer reading, the transcript is below:
Dr. Chang: We also have some patients who lead very busy lifestyles or they have braces which are attached behind their teeth or sometimes with teenagers, it’s quite a battle. I mean it can be quite hard as parents trying to encourage them to brush their teeth. So I know there are like gadgets that would save time like Waterpiks. Can this be perhaps an alternative to these cleaning in between their teeth with perhaps they are struggling with using Piksters or flossing?
Dr. Tang: For Waterpik or AirFloss, they are great. They are probably to get food debris out. But plaque can be very, very sticky. So I’m worried that the water pressure from those gadgets may not be strong enough to remove the plaque. So I will still recommend them to do mechanical brushing properly and using these as additional gadgets. It helps but I don’t think it can replace the use of interdental brushes or dental floss.
Dr. Chang: So mechanical brushing as in you mean physically getting you to brush or the brush as in the Piksters and just getting there and just cleaning the plaque out.
Dr. Tang: That’s right, rather than relying on the water pressure from AirFloss or WaterPik. It’s fantastic but it’s not ideal.
Dr. Chang: And of course, diet has – I mean what we eat has got a big factor to play. I mean I suppose if we’re eating something really sticky then it’s more likely to be hard to clean it off as well compared with fibrous fruits.
Dr. Tang: Yeah. For patients with a diet rich in carbohydrate, that could be a problem. They could have very sticky plaque. Or patients who have snacks all the time, so limit snacking. It could be need beneficial. And also, I always recommend the patient to brush thoroughly two or three times a day and especially after eating.
Dr. Chang: Speaking about that, we also have teenagers who are maybe listening, one of the things that they sometimes consume is softdrinks or fizzy drinks or carbonated drinks. I may see sometimes maybe their brother or sister, they’re bringing a bottle of softdrinks. Is there a right way to consume? Of course, we have to consume these in moderation and that goes to fruit juice as well. But is there a right way to drinking this or should we just cut it off entirely?
Dr. Tang: Ideally, I’ll prefer my patients to cut it off completely. But obviously, this is not possible. With the fizzy drinks, it’s not only the sugar that I’m worried about. It’s actually the acid as well. So in an acidic environment, you can get more bacteria that’s causing tooth cavities. So if you really want to consume it, try to limit the frequency if you can.
Dr. Chang: As in drinking it all in one go, right? Rather than sipping it every now and then. But if you’re doing these sort of sports when your mouth gets dry, drink it all in one go. And would that be …
Dr. Tang: Yeah, that’s exactly right.
Dr. Chang: And rinsing out with some water afterwards just to rinse out all the sugar. Would that be OK?
Dr. Tang: Yeah. I’ll probably wait for the saliva to neutralize the acid. I’ll probably wait for 20 30 minutes before I brush my teeth.
Dr. Chang: Right, yeah. And then definitely that as well. Right. Thank you. So, if we can now just go to the – OK. Let’s say I’ve had some – I mean sometimes when I haven’t been cleaning my teeth well, how – what are some signs or – I mean as a parent, I want to know that my son or my daughter is cleaning their teeth well, my teenage son or teenage daughter or a younger child, how can I check? How do I know?
Dr. Tang: Well, the first sign you’ll probably get with gum disease is probably bleeding gums and sometimes you might get swollen gums. So the gums appear puffy especially underneath the braces. And these could be the first warning signs. So if you are in doubt, always get your local dentist or your orthodontist to have a look and really check it out properly.
Dr. Chang: And this one common, very common question I get is, “My gums bleed when brushing. Should I stop brushing in that area? I mean what should I do? I mean I’m worried my gums – I mean I’m worried about bleeding.”
Dr. Tang: Andrew, I assume we’re talking about gum disease. So that’s basically a plaque related issue. So if you control the plaque well, most of the time, the bleeding gum will stop.
Dr. Chang: And that actually means spending an extra time brushing where you have this sort of situation where you haven’t cleaned well. You’ve got this food debris on your teeth let’s say for a day or two and it has been causing your gums to bleed. Don’t stay away from that area even though it may bleed a bit.
Dr. Tang: Exactly. In fact, you should do it more. And you find that if you brush really well for a few days, the bleeding gums actually stop. Now, if it still doesn’t stop, there might be some other underlying problems which you should really get your local dentist or orthodontist to have a look.
Dr. Chang: And as an orthodontist, can I say that one of the very, very common areas I see with patients and this goes with children, with teenagers, with adults, with braces, one of the areas that they don’t spend or the gums usually going to be puffy are the lower front teeth where the braces are closest together. So this is one area where actually I would suggest to all patients to actually spend more time cleaning that area.
So – which leads us to the next question. Let’s say if we have gum disease, and this is – how can it be treated? Let’s say, I’ve seen my orthodontist. I’ve seen my dentist and he says, “This is something which is a bit more than the usual gingivitis or the swelling gums that goes away after a couple of days of good brushing.” What should I do?
Dr. Tang: OK. Generally, there are two types of gum disease. One is gingivitis, which is reversible in nature. Another one is really – is we call periodontitis, which is irreversible in nature. So essentially for periodontitis, we’re dealing with two problems. First problem is infection in the gum and second problem is the bone loss that occurs as a result of the infection.
Dr. Chang: And that – I mean how would I know? Let’s say, if I got this thing called periodontitis, how would I know that I’ve got this condition? You did mention bone loss. I mean I presumed, are you talking about – would I have one of my teeth be loss? I mean what actually happens? If you can take a stage that you see in your practice, I mean there are stages, the gradual progression of this.
Dr. Tang: OK. The first thing you can do is get your local dentist or orthodontist to have a look and to check for the presence of infection. There are several parameters that we look at in the clinical setting.
Dr. Chang: You mean there are several things that you look for like when you see the patient?
Dr. Tang: That’s right. We check for inflammation. We check for swellings. We check for gum pockets. And in terms of bone loss, we definitely send the patient for x-rays. That will really tell us how much bone the patient had lost over the years as a result of periodontitis.
Dr. Chang: I see. OK.
Dr. Chang: So, can this gum disease be treated? And can a patient who has gum disease after gum treatment have gum disease again?
Dr. Tang: So like I said, a gum disease is simply and infection in the gum that leads to bone loss around the teeth. There is definitely a treatment for gum disease. So that involves a very good oral hygiene. So basic brushing and also professional cleaning which involves removing the bacteria under the gum.
Dr. Chang: As in like seeing one who has got expertise in this, as in a professional?
Dr. Tang: Yeah, a dentist, a hygienist, or a gum specialist. They are very well-trained in removing bacteria deposits under the gum. And that is crucial. And even if the gum infection is under control, the bacteria will always come back. And that’s why you still need to make sure you see your hygienist, dentist, or gum specialist regularly to make sure that the disease doesn’t come back.
Just like what you normally do, you continue to exercise on the daily basis in order to keep fit and healthy.
Dr. Chang: Yup. How often then should one who has got some gum disease be seeing their dentist or hygienist or periodontist?
Dr. Tang: In terms of the amount of time in between your visits with your dentist, hygienist, or gum specialist all depends on patient’s personal needs. But generally, once a patient’s gum condition is under control, we like to see them every six months for a regular reco and maintenance.
Dr. Chang: So now coming to people who are actually having their teeth straightened when we’re creating these straight and beautiful smiles on their teeth, I do know that for one, having really puffy gums can make any spaces, any gaps will be causing more difficulty. It can slow down the treatment. What about from the gum health point of view like it kind of move teeth when the gums are unhealthy or let’s say they were healthy before and then there are signs and now you know the bleeding gums and not cleaning well and they become unhealthy, how can it then affect in terms of their gum health?
Dr. Tang: So if this recurrence of gum infections during orthodontic treatment, there is an increased risk of further bone loss especially if you got forces being applied to move your teeth around. Really this is not something that you want. And so, gum infection has to be completely stable before, during, and after orthodontic treatment.
Dr. Chang: So in other words, it’s important to see your hygienist or your dentist or your gum dentist for these regular gum cleanings. Is that correct?
Dr. Tang: Clearly, yeah.
Dr. Chang: So lastly, can all dentists manage gum disease? I mean I know it sounds like a simple question. I often have patients who are saying, “Can I just go to my dentist and have my gums treated?”
Dr. Tang: Some general dentist and hygienist, they are capable in managing mild to moderate gum diseases. But as a gum specialist, we generally specialize in managing patients with gum disease of varying severity. And I’ve seen really bad ones. I’ve seen the really mild diseases. But whoever is able to stabilize their infections, that should be fine.
Dr. Chang: And to see a periodontist, do patients need a referral to see a periodontist?
Dr. Tang: Generally, patients are referred to us by their general dentist. But I’m happy to see patients without referral. But in saying that, they could easily get a referral from their general dentist or orthodontist. So at least, they would have gone through the screening process. Yeah.
Dr. Chang: So, thank you so much, Dr. Tang. I mean it has been lovely for your time today to share your insights into teeth and gum health and your many years of experience. How can a patient find out more about you?
Dr. Tang: Our clinic has a website. It’s called Specialist Dental Suite. We have a branch in Parramatta, Randwick. And we also have a location in Gladesville. So please feel free to send us emails or course if there are any queries. Thank you.
Dr. Chang: Thank you again, Dr. Teck. Lovely to have you.