As a cosmetic dentist, patients approach me with their zeal to change their smile. Sure, doing a multi-unit veneer case or an in office whitening session will deliver dramatic results. But those pearly whites need a healthy stage to shine on. The stage in relation to your smile, is the foundation that supports your teeth, the gums and its relating bone structure. Attaining and maintaining optimum healthy gums (gingival and periodontal tissue) involves a multi-faceted approach to dental care. You can have a nice smile, but if the foundation of the teeth is compromised, you are working with borrowed time. Think of a nice house with a slippery slab.
As a practitioner in a broad dental spectrum, I always like to learn from experts in specificity. We work with our dental hygienist, Negah, for example to obtain feedback on a patient's periodontal progress and to further their oral hygiene education. Today's conversation centers on the ten most popular dental hygiene related questions in our practice, with an avant-garde and pioneering dental hygienist , Lori Herbert. Mrs. Herbert, a Massachusetts based practioner is founder of helpmehygienist.com. Her passion for dental hygiene is demonstrated by her genuine care for her patient's dental health. Her knowledge is expansive, as demonstrated by her website, as well as my conversation with her. She treats each patient uniquely and centers on their oral health, with personalized attention to detail. This is clearly demonstrated with her response to the question pertaining to the best mouth-rinse. Lori's answers are vast but the education is priceless. Her thoroughness shows she truly cares. Bravo, Lori!
IS #1) Tell us about what made you want to be a hygienist?
LH: I didn't know what I wanted to be when I grew up in high school so I picked something interesting to me, psychology. I found the research and science fascinating. I was even a teachers assistant for experimental psychology because I loved the experiments. When I graduated I started working with adolescents with behavioral and psychological problems. I loved it, but I couldn't leave work and my empathy the kids was taking a toll on me. I still felt a strong need to help people so I didn't go into research. Being a science nerd I looked into the medical profession. I narrowed down my choices to nursing and dental hygiene. I chose dental hygiene for a couple of reasons. I wanted a profession that I could form long term relationships with patients, and make a difference in their health, physically. I also wanted to continue helping people psychologically. Dental fear is so prevalent that I knew I would still be able to help patients feel comfortable and safe; allowing them to make good decisions for themselves. A hygienist only gets to work on their patients a few times a year, but the feeling they leave behind for their patient's makes a huge difference in what they will do at home. If they feel cared for and ( see that their oral health) is important to me, it will make them feel that it is more important to them. People need to feel like you believe in them.
IS: #2) What are your own brushing and flossing habits?
LH: I am a huge fan of electric toothbrushes. I have done my research and choose to use the Rotadent myself. I have some crowding of my lower anterior teeth. I was a kid once, also, and wasn't so great at wearing my retainer. I love the short pointed tip of the Rotadent because it gets into these tough areas that other brushes miss. I always keep a few manual brushes around too, just in case I forgot to charge the electric toothbrush. There is nothing worse than getting half way through and not having a back up. I feel like it takes me twice as long to get my teeth clean when I use the manual brush.
I brush twice a day, unless I feel like I need to brush because I ate something stinky or I feel like there is food trapped somewhere.
IS: #3) What is your favorite toothpaste?
LH: My favorite toothpaste, and what I recommend to patients is Colgate Total. As a hygienist I get a lot of samples at conferences. I have tried a lot of toothpaste and I can feel the difference between Colgate Total and other toothpastes. The triclosan kills bacteria even after you are done brushing. I notice when I use other toothpastes that my teeth feel dirty faster. I hate the feeling of “sweaters” on my teeth. I tell my patients that after they brush their teeth the teeth should feel like they are licking the inside of a coffee cup. If they don't they haven't gotten all the plaque off.
IS: #4 What is your favorite floss?
LH: My favorite floss is the Reach Total Care floss. It has micro grooves which get more plaque off than Glide, but it still easily slides into tight spots and it doesn't break easily. This is the biggest complaint about floss that I get from patients. I use this type of floss, but I also sometimes use Gum Soft Picks. These are great. There is only one spot in my mouth where these don't fit. They are small, disposable and very easy to use. I don't use both at the same time. Sometimes I just feel like using one over the other. I love them both. I am usually a once a day flosser, but I sometimes floss more frequently depending on if I eat something that gets trapped and needs flossing out.
IS #5) At what age do you recommend children to start flossing?
LH: Parents should be supervising their child's brushing and flossing when they are young. The best way to do this is for them to brush and floss with their kids. A child who sees their parents flossing is going to be curious and want to do it to. I tell parents to go ahead and floss their kids as soon as they will let them. Earlier is better. I have pictures of my 4 year old trying to floss herself when she was one years old. Even though there is space between the teeth at this age, it is still a good learning opportunity. I find that floss holders are much easier with young children, since it is the parents that do most of the work. The Easter Bunny brought floss for my 4 year old this year. She flosses every night before bedtime. At the latest I want my child patients to start flossing when the adult teeth start coming in. I tell the kids that they are going to have these teeth until they are grandmas or grandpas so they need to take care of them now. They make flavored floss which is much more fun for kids.
IS: #6) What is best type of children's toothbrush you recommend?
LH: I am a fan of electric toothbrushes for kids as well as adults. It makes the brushing experience more fun. When my oldest child was getting her teeth, I would give her a manual soft brush to hold, and I would hold the electric toothbrush, simultaneously. I would put a small amount of fluoride free toothpaste on the electric brush then rub the manual brush on it just to get the flavor. We would take turns brushing. It worked much better than just having me brush, because even as a baby she was Miss Independent. I do the same thing with my one year old now. Both of them enjoy tooth brushing time.
IS: #7) What is the best type of children's toothpaste?
LH: I always recommend fluoride free toothpaste until the child can spit well on their own. Once they are around two years old, fluoride toothpaste can usually be used in small amounts. I find that a lot of kids hate the taste of mint. My daughter says it is too spicy. I really like Tom's of Maine Silly Strawberry. They are very reputable and my daughter loves the flavor. It is easy to find in stores and at such a young age, taste is very important. You want kids to enjoy brushing and if they think that the toothpaste is yucky they won't like brushing.
IS: #8) Which electric toothbrush do you recommend more: Sonicare or Rotadent?
LH: I usually recommend the Rotadent over the Sonicare brush unless the patient has poor dexterity. The Rotadent is more technique sensitive, while the Sonicare is not. I usually see very good results from the Rotadent, but if the patient is doing poorly with this brush I usually recommend they switch to the Sonicare. I usually use the Sonicare as the last option because it is rougher than the Rotadent and many of my patients have periodontal disease. I want something gentle on the gums and root surfaces, and the bristles on the Rotadent are extremely soft. I am also a huge fan of the pointed head which gets between the teeth better than other brushes, and if used properly, can reach slightly below the gum line. It is also great for patients with braces, crowns, bridges and implants. If a patient spends (ample) time on cosmetic, restorative work; then they want to take the time and effort to take the best care of their (expensive smile).
IS: #8) What kind of mouth rinse do you recommend?
LH: Every patient has a different need when it comes to mouth rinses. When deciding what would be best for a patient, several factors must be considered. There are three things I look at when deciding what rinse would be best. First, I assess if the patient has issues with dry mouth. Secondly, I look at their periodontal condition and lastly, cavity risk.
For patients with dry mouth and no signs of bleeding on measuring their gum pockets, I recommend Biotiene to sooth dry mouth, while alternating with a fluoride rinse that is alcohol free like Act. If bleeding is present patients may use a prescription strength stannous fluoride rinse to get bleeding under control, then switch to Closys which is an over the counter alcohol free rinse to use as a maintenance. I recommend Closys a lot because it is great at killing bacteria, non staining and alcohol free. I don't usually recommend Crest Pro Health because I have had a lot of complaints by patients about staining, even though the company says this is not possible. I know that I will be the one cleaning that stain off at the next visit so why make my job harder?
For patients without dry mouth and signs of bleeding, I recommend short term use of chlorhexidine gluconate (usually about two weeks) to get the bleeding under control and after that, switch to Listerine. Listerine is available just about everywhere and generics are available for pretty cheap. Most patients like at least one of the flavors available.
For patients with healthy gums, but a higher risk for caries, I recommend fluoride. For younger patients I usually recommend Act. For many of my older patients I recommend a prescriptions strength fluoride gel like Fluoridex. It is not common for me to see an adult with a high caries rate and healthy gums. Usually periodontal disease is an issue as well. For these patients, I usually use antimicrobial rinses in addition to 1.1% fluoride to get the best of both worlds. I don't frequently use stannous fluoride because I have found that patients have a low compliance rate with this product. I would rather have them actually use chlorhexidine for a few weeks then pretend to be using the stannous rinse. At least they are achieving some antimicrobial action.
IS #9) When do you recommend Waterpik vs floss?
LH: I never advise a patient that I know is actively flossing to switch to a Waterpik. If I have patients who come in already using the Waterpik I do not discourage them. I find a Waterpik useful for those who are unwilling or unable to floss. I also like that chemotherapeutic agents can be added to the Waterpik so patients can irrigate at home. For all my patients, no matter what type of inter-proximal cleaning they do, I advise regular flossing to assess gum health at home. Flossing is the easiest way for a patient so see if there is bleeding at home, and find areas that they may not be spending enough time cleaning. I am also highly intrigued by the new Sonicare Air Floss. The research on it is good and it appears compact enough to take along if you are traveling, while the Waterpik is larger, it may not be a good option for those who travel. I have not personally used the Air Floss, but I do have experience with the Waterpik. I used it when I was a kid with braces and did not floss. Unfortunately, I had many inter-proximal cavities when I got my braces off so my personal experience was not great. I have also seen patients that switch from regular floss to the waterpik go backward in their periodontal condition. I am still not convinced that it is a better option than regular floss in patients who are capable and willing to floss. I would rather have patients do something though, so if this is all they can or will do I say go for it.
IS: #10) Any other useful hygienist tips?
LH: For patients the most important thing is finding a place where you feel comfortable. No one office is best for every patient. On the other hand, it is important to really give the office a try. A first visit can be scary and overwhelming, especially if you have not been to the dentist in a long time. Take this opportunity to learn what is going on in your mouth. Ask questions and you may even want to take notes so when you go home you won't be confused. Understanding what is happening and why you need it is important for you to feel comfortable and safe in any office. Also understand that your health is the most important thing. A good dental office will make sure that disease is taken care of first. If you go in looking just to whiten your teeth and there are infections present, the dentist should recommend this gets taken care of first. It may be frustrating that you don't get the whitening right away like you may have liked, but a good dentist will help you make the right decisions for your treatment. You should feel well informed when you leave.
It is not uncommon to be afraid at the dentist, and we understand that fear. You are not the first person to come into an office afraid and will certainly not be the last. We will not laugh at you or be grossed out by your mouth. We are here to help you and help you reach your goals, whether that be getting out of pain or doing cosmetic changes to approve your appearance.
Finally it is important for patients to understand that oral health is not under the control of the dentist or dental hygienist. We do our best to find, treat and prevent problems when you are in the chair. There is so much more time when you are on your own. Hygienists, dentists and patients work together to get the mouth healthy and keep it that way. If a patient comes to the office and gets all work completed and leaves with clean teeth and no cavities, but doesn't maintain proper oral hygiene care at home, they will return with new problems.
This is one reason why I started my website. I wanted patients to have a way to access information that they might be afraid to ask about or that they didn't think to ask when they were at the dentist. I wanted patients to feel informed so the experience was a little less scary. Most of all I wanted them to feel empowered when it comes to their own oral health. Knowledge is power, but sometimes it can be difficult to sift through all that information and find something useful. I also wanted them to have access to a person if they had unanswered questions. I have spoken to many people though my website and helped them understand their needs and clarified concerns for them. Often times I end up directing them to a dentist since not all concerns are easily addressed over the internet.
Extra Tips on Proper Home Care
LH: I can't define proper home care for every person. In general, a patient needs to clean tooth surfaces and between the teeth. There are many ways to do that. I wish all my patients would use an electric toothbrush because they work so well. Manual brushes can work well if patients use them properly, but I don't find this to be the case frequently. For cleaning between the teeth there are many methods to choose from, you just have to pick one and do it. Good intentions don't work so if you really want to floss but don't do it, floss may not be the choice for you. Try a proxy brush, a Waterpik, heck, even the Rotadent gets in between the teeth better than “trying to remember to floss”. As far as mouthwashes or other products, think of them like medications. Use a product that will treat your condition. You wouldn't take Benadryl for a headache right? The key to finding what is best for you is to ask. Find out what your dental problem is. Dry mouth is not the same as gingivitis, which is not the same as tooth decay. Proper choice of product will help keep you healthy.
Neither, Mrs. Lori Herbert, nor Dr Iman Sadri, have any financial interests or compensation with any of the dental products mentioned.