Brush up on how to care for your teeth

Allyson Chiu

THE WASHINGTON POST – Beyond its psychological toll, the coronavirus pandemic has wreaked havoc on our bodies: Many people have put on pounds, picked at their skin, broken their toes – and, according to dentists, damaged their teeth.

As more Americans return to dental offices, practitioners said they’re seeing a significant rise in tooth-grinding and jaw-clenching likely brought on by pandemic-related stress and anxiety. They’re also seeing an increase in cavities and gum disease that may be due to a combination of lapsed appointments, pandemic eating and drinking habits, and less-than-stellar brushing and flossing.

In a February survey conducted by the American Dental Association, 76 per cent of general practice dentists said the prevalence of teeth-grinding, or bruxism, among their patients had increased compared to pre-pandemic times. About two-thirds reported seeing a rise in associated problems of chipped and cracked teeth as well as headache and jaw pain symptoms, the survey found. Meanwhile, about 30 per cent of respondents said they observed more tooth decay and periodontal disease, an infection of the tissues surrounding teeth, in their patients.

Chief Dental Officer for Delta Dental of Virginia Brad Guyton said the increase in common problems like cavities was not as severe as many dentists had feared, perhaps because many dental practices did not stay closed for long.

“Had we been shut down for six months, that could have been catastrophic, not only to the dentists and their businesses, but more importantly, the patients that needed to get in,” Guyton said.

But although dentists were able to re-open early in the pandemic, concerns about the coronavirus continued to keep many patients away, which made caring for teeth at home “even more important”, said clinical professor at the University of Michigan School of Dentistry Domenica Sweier.

“Most people, I think, tried their best in a very unusual situation,” said spokesperson for the American Dental Association and a consumer adviser with a private dental practice in New York Ada Cooper. “Even at that, there’s no substitute for regular dental visits.”

As the pandemic eases, here’s some advice about brushing up on your oral care habits and dealing with bruxism.

GO BACK TO THE DENTIST

If you’re fully vaccinated and have insurance, there’s no reason not to go back to the dentist. But even if you haven’t gotten the shots or you’re worried about unvaccinated people in your household, dentists say it’s essential to get back on track with appointments and safe to do so.

Before the pandemic, dentist’s offices were already practising “state-of-the-art infection control”, Cooper said. “We’ve always taken extra care to protect patients from viruses and other pathogens.”

Many dentists have since enhanced safety precautions and more than half of the country’s population now is at least partially vaccinated. But resuming regular dental appointments doesn’t mean you can slack off on your personal care regimen, experts said. “We can do the best cleaning in the world, but if you’re not brushing and flossing at home, that gum disease will stay active,” said Detroit dentist Zainab Mackie.

RECONSIDER YOUR DIET

Dentists have long urged people to avoid consuming too many refined carbohydrates and sugars. But that’s been a challenge during the pandemic, said instructor in the Department of Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine Tien Jiang who noted that working from home has led to an increase in snacking. On top of that, more Americans have also engaged in stress eating.

The reason snacking can lead to cavities is that your mouth contains bacteria that feed off food and release acid, Sweier said. This lowers the pH in your mouth and can cause enamel demineralisation, a precursor to cavities.

“The more times during the day you contribute to a decrease in pH,” she said, “the more times you make your teeth susceptible to cavities.”

Beyond cutting down on snacks, Sweier recommended paying attention to your eating and drinking habits. Avoid nibbling on food or sipping on sugary or acidic drinks throughout the day, she said. If you do have a snack, Sweier suggested rinsing your mouth with water after or chewing sugarless gum, which can help stimulate saliva flow.

You should also stay hydrated with water, Jiang said, noting that dry mouth can lead to higher cavity risk.

FIND THE RIGHT TOOLS

Oral care is highly individualised, so choose toothbrushes, toothpastes, floss and rinses that you’ll consistently use, dentists say, as long as you’re using them as recommended. (The American Dental Association endorses products with its Seal of Acceptance.)

Advanced electric toothbrushes have sensors that indicate when you’re applying too much pressure and timers to keep track of how long you’ve been brushing, which can be helpful. But whether you prefer a manual or electric toothbrush, make sure it has a soft bristle head, and replace it when you notice the bristles are splayed or falling out.

The type of toothpaste and mouth rinse you should use largely depends on your oral health needs, experts said. If you’re more prone to cavities, toothpastes and mouth rinses that contain fluoride may be better.

Mouthguards to protect your teeth against grinding or clenching should ideally be custom made by a dental professional, experts said. Over-the-counter mouthguards can vary in softness and might encourage wearers to grind even more, Jiang said. Additionally, people’s teeth have unique points of contact, which generic guards don’t take into account.

“You could actually be stressing some areas of your mouth more than if you had a customised one,” she said.

BRUSH AND FLOSS PROPERLY

Brush your teeth for two minutes at least twice a day, or after you’ve eaten. Focus on each quadrant of the mouth and make sure to brush where your teeth meet your gums. Brush in a circular motion and be careful not to use too much pressure.

“There can be erosion of the tooth surface or of the tissue” if you brush too hard, Guyton said. Aggressive brushing using improper technique can create notches in your teeth, potentially making them more sensitive, or lead to gum recession.

“Some people feel like the harder you scrub, the better off you are. That’s not the right way to do this,” he said. “Be gentle but diligent, and time is more important than the intensity.”

If you use an electric toothbrush, “let the brush do the work”, Sweier said. “Try not to brush with it and actively use it, but guide it like a train on a track.”

And remember to brush your tongue, experts said. Tongues have “little crevices all along them, so it’s so easy for bacteria to just sit there and accumulate”, Mackie said. In addition to bad breath, not cleaning your tongue well might also lead to persistent dental health problems, she said. “Even if you’re brushing your teeth, the bacteria from your tongue can go onto your teeth and then you’ll find yourself still having these issues.”

It’s equally important to floss at least once a day, especially at night before bed, and to use the proper technique. Avoid snapping floss down between your teeth, because that can traumatise your gums, Cooper said. Instead, “shimmy it between the teeth, allow it to float very gently beneath the gum line on both sides of that tooth and the tooth next to it”.

The American Dental Association has videos showing how to correctly brush and floss.

WATCH FOR WARNING SIGNS

If you’re not adequately taking care of your mouth and teeth, you’ll start to see or feel it.

Untreated grinding or clenching can cause headaches, jaw pain and increased tooth sensitivity. You may also wake up with soreness in your temporomandibular joint, which is where your jaw bone connects with your skull, and surrounding muscles.

Bleeding or inflamed, swollen gums, are other signals that there may be problems with your oral health, Guyton said. “When you brush your teeth and it bleeds a little bit, that’s not normal. That could be a sign of gingivitis or something more significant.”

But it can be very difficult to self-diagnose dental conditions or know for sure that your oral care regimen is effective, Cooper said.

“Going to the dentist is really the best way of identifying problems before they become big issues,” she said. “Oftentimes, by the time something begins to bleed, by the time something begins to hurt, the problem requires much more treatment than would have been necessary if the problem had been identified and addressed early by seeing your dentist on a regular basis.”