Public Oral Health Information

 

Questions & Answers:

Why was flossing invented?
Because the toothbrush cannot remove plaque from between the teeth. The teeth are as wide through as they are across and the brush can only remove half of those four sides.

When should I take my child to their first dental visit?
At the first dental visit, which is usually at their first birthday, is a typically “happy” visit. The child can see the office, sit in the chair, and maybe have a polish. This is a time to teach them about brushing and talk with the parents.

Where to find a dentist? Call 211.
You can call a dentist who is a specialist, i.e. Periodontist or orthodontist, to get their opinion on who is the best restorative DDS in the area. Interview the dentist or their staff before deciding and be sure you are comfortable with the dentist and their staff. Check the qualifications of the person cleaning your teeth; it should be a licensed dental hygienist (RDH) or a dentist by law. A license should be visible. Call your local health district if you are looking for affordable dentistry in your area or for kids, call a school that has a dental hygiene program.
What to do about severe dental fears?
In severe cases call the UW Dental Fears Clinic 206-543-2034 or tell your general dental staff about your fear. If they are not empathetic, leave and find a practice where there is empathy and TLC.

How long should a cleaning appointment take?

  • 45 minutes to one hour is the usual time allotted for an adult prophylaxis (cleaning).
  • If a patient has been brushing and flossing daily, then a routine cleaning will apply.
  • If a patient is not brushing and flossing daily, it may require a more lengthy process, especially if there is presence of gum disease.

There are variables to this routine time frame:

  • Patients with less than a full compliment of teeth
  • How long it has been since the last cleaning
  • Frequency of recall (3 months, 4 months, 6 months, etc)
  • Presence of gum disease
  • Presence of lots of plaque on the teeth


If the cleaning is a deep cleaning with anesthetic (often referred to as scaling and root planning), the time allotted is 1.5 hour for each side of the mouth, then every three months for cleaning or perio maintenance cleaning thereafter for 1 hour. The hygienist will clean the whole mouth focusing and monitoring the deep pocket areas.


Some patients are very clean and very healthy and won’t take much more tan 30-45 minutes, especially if the dentist does not do the exam in the hygiene room. This type of cleaning can seem very gentle and feel very light, but the dental hygienist will still be assessing as he or she checks each tooth.

How does dental whitening work, and is it safe for my teeth?
Tooth whitening should be discussed with your dentist and done under dental supervision.

In dental whitening, carbamide peroxide or hydrogen peroxide is placed in contact with the teeth to oxidize away the stains that have penetrated into the enamel of the tooth. The carbamide peroxide is able to penetrate between the enamel rods to reduce the food stains there to oxygen and water.

Major differences between whitening systems include percentage of the whitening agent, the carbamide peroxide present in the gel, paste of strip being used, length of time the carbamide peroxide is in contact with the teeth, and how comfortably and precisely the delivery method fits. Many delivery methods allow the carbamide peroxide to come into contact with the gums, which may cause irritation of the gums. Lower percentages of the active ingredient, and lesser contact times, will increase the amount of time needed to achieve noticeable results.

Teeth that have discolored into the yellowish and brownish shades respond best to whitening, while grayish discolorations like those from tetracycline staining respond poorly. In addition, teeth are not meant to be paper white, so whitening product users need to keep their expectations realistic. Certain teeth, the canines or “eye teeth” for example, are naturally more yellowish than their neighbors. Whitening does not change this natural feature of teeth. Teeth are also more yellowish at the gum line than at the chewing or biting edge. Whitening does not change this either.

If the teeth become sensitive during the whitening process, discontinue whitening for a day or two. Fluoride rinses such as ACT or Fluoriguard can quickly clear up the sensitivity as well. These rinses are available in the mouth rinse area of a drugstore and are over the counter. Rinse for 60 seconds as the directions on the bottle direct you to, and swish several times per day while whitening-associated sensitivity is an issue.

How should I care for my dentures?
Dentures should be removed for at least several hours each day. This allows the oral tissues a chance too breathe and slough old skin cells. While the denture is out, it should be thoroughly brushed with a denture brush or toothbrush. Toothpaste is not needed to brush a denture. Dentures are usually left to soak for several hours after brushing in a denture bath. A cleansing agent is usually added to the soak, something like Efferdent or Polident. A very good denture soak is Stain Away, but it is a bit harder to find. A little bleach added to the water would seem like a great idea, since it would make a nice disinfectant, but it tends to bleach the color out of the pink, gum-colored portions of dentures. It is also too corrosive for any metal parts that may be present in the denture.

While the denture is out, the skin of the mouth should be wiped with a damp washcloth to keep it healthy. I would also recommend scraping or brushing the upper surface of the tongue.

Why doesn’t my denture fit as well now as it did when it was made?
There is a saying about “Use it or lose it”. This applies to bone inside the mouth. Because bone is heavy, the body does not maintain that which is not being used. Much of the bone in the lower parts of our faces is, or was, there to support the roots of the teeth. When the teeth are no longer present, the body gradually reabsorbs the bone from those areas, resulting in changes to the mouth and a poorly fitting denture. A well-fitting denture does not require denture adhesives to stay in place. Dentures can often be relined, but do eventually wear out and need to be remade.

What causes dry mouth and why is it a problem?
Dry mouth can be a result of aging, illness or medication use. About one half of all medications list dry mouth as a possible side effect. Medications that can cause dry mouth

Since one of the functions of saliva is the buffering of acids in the mouth, dry mouth can be significant in that it increases the risk of dental decay (cavities). To combat the increased risk of cavities, thorough brushing and flossing of the teeth and extra fluoride to keep the teeth well mineralized are helpful.

What is dental decay (cavities) and how is it treated?
Dental decay is the removal of minerals from the structure of the tooth by acids. The acids can come from foods which contain acidic components like lemonade (ascorbic acid) or soda pop (phosphoric acid), but more likely are produced by the bacteria residing in our mouths. As minerals are removed from the enamel of the tooth, a white-spot lesion often occurs, called demineralization or incipient decay by your dentist. At this early stage of a cavity, the decay process can be stopped by thorough homecare and extra fluoride such as a home fluoride rinse.

As the decay progresses, the area becomes brown, then black. By this time the tooth structure is so weakened that it frequently collapses, resulting in large areas of missing tooth structure. Even if the tooth appears intact on the surface, a dental exam with x-rays will often detect areas of a tooth where, unseen, below the surface, the tooth has been seriously damaged.

To treat decay, the dentist removes the damaged and destroyed portions of the tooth until he or she gets to solid tooth structure. Then the dentist fills in and rebuilds the missing portions with silver amalgam or tooth-colored composite material. In severe cases, build-up material is used to ready the tooth for a crown.

Left untreated, decay-causing bacteria will eventually reach the tooth’s internal nerve and bleed supply (the pulp). Once this has happened, a dental abscess is a frequent occurrence, and root canal therapy is the usual recommendation. In severe cases, the dentist may recommend that the tooth be removed.

Why is fluoride important?
Fluoride is an ion with an affinity for calcium, which is a large component of tooth and bone structure. Fluoride occurs naturally in many water sources, but the concentration is often adjusted to a level that has been shown by research to be optimal for preventing cavities.

Fluoride in the water or as a supplement benefits children the most. It is integrated into their teeth as the teeth are developing, resulting in adult teeth that are harder and more decay resistant, through and through.

For adults, and the teeth that are already in the mouth, fluoride can only benefit the outer surfaces of the teeth. In these instances, a stronger concentration of fluoride is placed in contact with the teeth. The fluoride in absorbed into the outer surface of the tooth, resulting in a more decay-resistant outer shell to the tooth, which we hope will be enough to resist the demineralization caused by acids released by cavity-causing bacteria. I think of this as being like the hard outer shell of an M & M candy. Of course, cavities will still occur sometimes.

What are dental sealants, and why are they important?
Dental sealants are a plastic resin used to seal deep pits and grooves in the teeth. The deeper pits and grooves in teeth are often impossible to keep totally free of bacteria. The undisturbed bacteria then cause cavities to occur on the chewing surfaces of the teeth, especially in children, whose tooth-brushing skills are still being developed. As these teeth erupt into children’s mouths, it is now common to place a liquid plastic resin into these grooves, and cure it to a hard, durable finish with a special light. If placed in optimal conditions, sealants can last for years, but should be checked to make sure that they are still in place at each dental visit. Dental sealants are easy to place, with no anesthesia or numbing necessary. The patient needs to keep his or her mouth open for about 5 minutes to allow the tooth to be cleaned, the resin to be flowed over the surface of the tooth, and the use of the bright light that cures the resin material into a hard, durable shield against cavities.

What is periodontal disease?
Periodontal disease (gum disease, pyorrhea) is the loss of connection between tooth roots and the bone that supports the tooth roots. While frequently called gum disease, periodontal disease is more complex than that, involving bone and the stretchy ligaments that help to connect tooth roots to bone. Sadly, teeth without a single cavity can still be lost when the connection between tooth root and surrounding bone is destroyed.

To diagnose periodontal disease, the dentist or hygienist will measure the depth of the sleeve of gum tissue surrounding each tooth. This helps us to determine whether or not the patient is able to thoroughly clean below the gum line. It also provides evidence of infection of the gums. The x-rays taken at the same time will show the dental team the bone levels surrounding the teeth. These, combined with measurements of gum bleeding, patient reports of oral discomfort, and an analysis of mobility of teeth, provide an accurate assessment of how well anchored into the bone the tooth roots are.

In periodontal disease, genetics (family history), individual susceptibility (patient’s overall health), host response (individual immune response), oral homecare (how well the patient cares for his or her mouth), and lifestyle (smoking contributes enormously to periodontal disease development) all play a role. Bone-destroying bacteria thrive in deeper gum pockets. In an effort to destroy the bacteria, the body’s immune response may destroy the very bone that supports the tooth roots. As this bone is lost, more tooth root is often visible, while the teeth can begin to shift positions and even begin to be movable within their sockets. Signs of the battle the body is fighting can be seen in appearance of the gums. Swollen, red gums that are tender to the touch and bleed easily or even leak a little pus are all signs that the body is fighting a serious battle just out of sight. The patient’s entire body is weakened by this battle, and the sufferer of periodontal disease is often tired and worn-down by this chronic infection. The toxins produced by the bacteria travel throughout the body, damaging and weakening other organs.

How is periodontal disease linked to other health issues?
Periodontal disease has been directly linked to a number of other health problems. Among these is smoking, diabetes, pregnancy problems and heart disease.

Smoking has been shown to make periodontal disease significantly worse. Smoking decreases the blood supply to the oral tissues, and inhibits the body’s bone-building capability. The decreased blood circulation of a smoker can act to mask periodontal disease, since there is often less bleeding of the smoker’s gums. However, the bone loss is frequently much worse, and nearly impossible to stop unless the smoker is willing to stop smoking.

Diabetes has health implications throughout the body, and a growing number of Americans are being diagnosed with diabetes. In diabetics, the higher levels of sugars in the body fluids (including oral fluids) provide the bacteria of the mouth with a constant food source. In addition, the diabetic’s immune system is not as strong as others. The bacteria are able to thrive, producing toxins that travel throughout the bloodstream, and act to worsen the diabetes. This situation requires close monitoring by both dental and medical teams, if the teeth are to be saved.

The toxins produced by bone-destroying oral bacteria are now thought to travel throughout the bloodstream. They can result in pre-term, low birth weight babies. For this reason, pregnant women are strongly encouraged to see their dental care team, and keep their periodontal disease under control while pregnant.

Recently, a possible new player in heart disease was identified. C-reactive protein results from chronic, low-grade infections such as periodontal disease, and is now strongly linked to heart disease. Eliminating the source of chronic infection will place less stress on the immune system, while helping to reduce the risk of additional damage to the circulatory system.

Did you notice the many possible links between these health problems, and how they can act together to make bad situations worse? For the health of an unborn child, periodontal disease needs to be controlled, but so does diabetes, and smoking should be stopped altogether. Periodontal disease plays a role in heart disease, but so does smoking. Smoking and diabetes both worsen periodontal disease, making it even harder to treat.

How is periodontal disease treated?

While periodontal disease is chronic and incurable, it is treatable. Bone that has been lost cannot be regained, even by bone grafts. The patient’s dental care team will focus on maintaining the bone levels that are present. The patient’s daily homecare may need to improve to remove as many bone-destroying bacteria as possible. The patient will need to follow the dentist’s recommendations for frequent professional cleanings to remove bacteria from areas below the gum line (pockets) that are not accessible to the patient. Antimicrobial rinses and other medications are often prescribed. Occasionally, the dentist may recommend a gum surgery to shallow the gum pockets to allow better care at home by the patient.

What exactly is a dental hygienist and what is your training?
For a printable brochure about Dental hygiene pdf click here
Dental hygienists are licensed oral health professionals who focus on preventing and treating oral diseases-both to protect teeth and gums, and also to protect patients' total health. We are graduates of accredited dental hygiene education programs in colleges and universities (2 years of pre-requisites and 2 years of a dental hygiene clinical program), and in Washington state, must take five (5) written and clinical exams before we are allowed to practice. In addition to treating patients directly, dental hygienists also work as educators, researchers, and administrators.

What Do Dental Hygienists Do?

Each state has its own specific regulations and the range of services performed by dental hygienists vary from one state to another. As part of dental hygiene services, in Washington state dental hygienists may:

  • perform oral health care assessments that include reviewing patients' health history, dental charting, oral cancer screening, and taking and recording blood pressure; expose, process, and interpret dental X-rays;
  • remove plaque and calculus (tartar)-soft and hard deposits-from above and below the gumline;
  • apply cavity-preventive agents such as fluorides and sealants to the teeth;
  • teach patients proper oral hygiene techniques to maintain healthy teeth and gums;
  • counsel patients about plaque control and developing individualized at-home oral hygiene programs; and
  • counsel patients on the importance of good nutrition for maintaining optimal oral health.
  • use anesthesia
  • place and carve restorations

Can a dental hygienist work independently (ie without supervision of a dentist)?
Dental hygienists can work as clinicians, educators, researchers, administrators, managers, preventive program developers, consumer advocates, sales and marketing managers, editors, and consultants. In Washington state, clinical dental hygienists mostly work in private dental offices, however, Washington law allows dental hygienists to work independently in public health clinics, state residential facilities, correctional institutions, senior centers, school sealant programs and nursing homes. Under 6020 qualified hygienists are able to work independently to place sealants for children at local schools. In 2009, hygienists began to provide dental hygiene services in Senior Centers and are now allowed to clean children's teeth as part of their services in schools.

What Does the "RDH" Designation Mean?
The "RDH" means Registered Dental Hygienist. The RDH credential identifies a dental hygienist as a licensed oral health professional. State licensure requirements typically indicate that a dental hygienist must graduate from an accredited dental hygiene education program, successfully pass a national written examination, and a state or regional clinical examination.