April 29, 2009

To ensure the health of your gums and help you maintain a star-quality smile, we've tracked down answers to five of your most common oral-care questions.

Q I wore braces as a teen, but now I've developed gaps between my top teeth. Why--and is there a no-braces solution?

A It's normal for everyone's teeth to shift throughout life--so yours is a common problem, particularly among women in their 30s who wore braces at one point.

The good news is that you don't need an Ugly Betty-style mouth of metal to correct your smile. A cosmetic dentist can bond thin, long-lasting porcelain veneers on top of teeth to cover gaps and even overlapping. If you're on a budget or don't need your teeth fixed overnight, Invisalign braces are the way to go. You'll wear a series of clear, custom-molded plastic trays that snap over your teeth and guide them into place. Unlike braces and retainers of old, however, no one will be able to tell you've got them on. You switch to a new set of aligners every few weeks as your teeth shift into position. Your smile will look less crooked within the first two weeks, but the procedure can take up to two years to completely straighten your teeth. The cost is comparable to traditional braces: $3,500 to $5,000, depending on the severity of your case.

Q My front teeth are very yellow. What's the best way to brighten them fast?

A Whitening toothpastes are available over the counter--and they're relatively inexpensive, easy to use, and a good first step as they can brighten and lighten the color of teeth by about one shade. If you need more than that, powerful at-home or professional tooth-whitening treatments can help. They remove stains on the tooth surface as well as deeper discoloration (and can brighten teeth three to 12 shades) because they contain high concentrations of bleaching substances like hydrogen peroxide and carbamide peroxide.

An in-office power-bleaching treatment is also an option This technique uses lasers or other sources of bright light and heat to activate a highly concentrated peroxide gel that whitens teeth dramatically in just an hour. The only downside (besides the cost, which runs about $450) is that the process can cause mild to moderate tooth sensitivity for several days--and, in some cases, even a temporary burning sensation of the gums.

If you need a brighter smile in even less time, ask your dentist about the LumaWhite system, which uses an LED light to whiten teeth in eight minutes flat. With this method, not only are you spending less time in the dental chair, you're also reducing your risk for tooth sensitivity because, unlike other professional brightening techniques, this one doesn't use heat to activate the tooth whiteners.

Q Why do my gums bleed when I brush?

A Red, tender, puffy, bleeding gums are the first signs of gingivitis, an inflammation of the gums. The mildest and most common form of gum disease, gingivitis occurs due to an overgrowth of plaque, the sticky, colorless film of bacteria that's always forming on teeth. When plaque isn't removed properly, bacteria can irritate the gums, causing inflammation.

Luckily, Gingivitis can be reversed in nearly all cases simply by removing the plaque and keeping it off with better oral hygiene. Start by scheduling an appointment for an in-office tooth cleaning. Though new research published in the Journal of Periodontology found that brushing and flossing regularly for just two weeks reduces symptoms of gingivitis by nearly 40 percent, it's still necessary to have the hardened plaque (tartar) removed by a professiona. Once the tartar is scraped away, gingivitis should disappear within a week or two.

Q I have bad breath. How can I make it fresher?

A Bad breath (halitosis) is almost always caused by an overabundance of sulfuric gas (like the vapor generated by rotten eggs) that's produced by bacteria on the back of the tongue. To improve your breath, you need to remove the layer of mucus that blankets the back of the tongue; this will expose the bacteria to oxygen, killing and removing many of them instantly.

Use a tongue scraper, not a toothbrush, to dislodge this coating of bacteria. The broad, flat surface of a tongue-cleaning device is 30 percent more effective than a toothbrush at reducing the sulfur-causing compounds, according to research at the University of Sao Paulo, Brazil. Another option: Ask your dentist about mouthwashes containing zinc compounds that neutralize bacteria. If you're brushing, flossing, and scraping religiously, but still need to chain-pop breath mints, see a doctor. In up to 20 percent of cases, bad breath may be linked to a gastrointestinal or sinus problem.

Q Why do I get a shooting pain in my teeth when I eat or drink something hot or cold?

A By far the most common cause of tooth sensitivity is exposed dentin. This hardened tissue, which lies just beneath the tooth's protective coating of enamel, contains thousands of tiny channels that transmit hot and cold sensations to the pulp, the nerve center of the tooth. (Sweet, sour, and highly acidic foods and beverages can also trigger these twinges.)

Over time, brushing too hard or using a hard-bristled toothbrush can wear down enamel--so start easing up on the pressure and switch to a softer toothbrush. Also try desensitizing toothpastes; they're formulated with potassium nitrate, which reduces pain by shielding the nerves under the gum line. In addition to brushing with it, rub a thin layer of the toothpaste on any affected teeth every night. Your pain should lessen within 24 to 48 hours. If pain persists or the jolting sensation lasts more than a minute, see your dentist. You could have a deep cavity, a dying nerve, or a broken tooth. Or you may require an in-office treatment, like a fluoride varnish or a dentin sealer, which can be applied to the exposed root surface to help relieve sensitivity.