That blindingly white smile may obscure serious problems.
Michael Tillotson, a 23-year-old environmental technician from Windermere, visited the dentist every other year or so. In between visits he relied on over-the-counter tooth-whitening strips, but, he says, “they hurt.” The pain he experienced was “like biting something cold.” For Tillotson, the solution was simple: Ditch the strips. But according to Wallingford dentist D. Andrew Lewis, tooth sensitivity from whitening should never be brushed aside. “Patients who don’t have a regular dentist are using over-the-counter products in an unsupervised way,” Lewis explains, “so there may be underlying issues that cause the sensitivity.”
Tooth sensitivity arises because the delicate root is disrupted by the whitening process. Products that use dissolving strips work by stimulating the fluids deep inside your teeth and breaking down the organic materials that cause stains. If you have weak enamel, fractured teeth, or, as Tillotson did, cavities (all of which are otherwise pretty painless), the whitening process can agitate your exposed nerve endings and cause a jolt of extreme pain.
It’s not that whitening is bad for you. The problem, Lewis says, is that people are more concerned with having white teeth than achieving overall oral health. “Whitening products really have become very safe, but it’s always better to get a professional opinion instead of just going to Safeway.” To encourage patient visits, Lewis—along with many other dentists on our list—offers free whitening to new patients. “It’s a value-added service,” he says. “You come in for a complete exam, and then the whitening is supervised.”
And whether you decide to whiten at the dentist’s office or at home, your hygienist can work with you to minimize discomfort. “Sensitivity issues can be taken care of in a lot of ways,” Lewis explains. When appropriate, dentists may recommend a desensitizing toothpaste or enamel-strengthening fluoride. “If you have sensitivity, get it looked at right away,” says Lewis. “It might be more serious than you think.”
Flossing isn't everything when it comes to healthy gums.
Dr. Thomas Kang is a periodontist: a dentist who specializes in gums. Like most dentists, he advises his patients to floss. But for Kang, the issues go beyond flossing. In fact, a patient who comes to his Federal Way office with chronically inflamed gums is more likely to be sent to a primary care doctor than to be sent home with an extra box of floss.
That’s because red, puffy, or bleeding gums may actually be a sign of more serious health conditions like diabetes, or heart or kidney disease. “Periodontal disease triggers the body’s inflammatory response,” explains Kang, “and, while inflammation initially intends to heal the body, over time chronic inflammation can lead to dysfunction of the infected tissues and therefore more severe health complications.”
Kang remembers one active, healthy patient in her mid-40s whose dental implant wouldn’t heal properly. When the implant ultimately failed to integrate, he sent the patient to a physician, who diagnosed her with Type 2 diabetes. “Uncontrolled Type 2 diabetes can lead to poor wound healing,” he explains, “but once her physician was able to treat her condition, we could perform the implant successfully.”
The take-home message is simple: “It’s not ‘floss or die,’” says Kang, “but having your dentist monitor your periodontal health regularly is very important.”
Get Felt Up
Are you being properly screened?
At her private practice in West Seattle, Dr. Christine Kirchner checks every patient for signs of oral cancer. So when she found an unusual spot on one of her regular patients, a fortysomething merchant marine who had been a smoker, she sent him straight to the oral surgeon with a specific description of the spot and its location. Sure enough, the patient had carcinoma in situ (a very early stage of cancer that has not yet spread) on the base of his tongue. The surgeon removed the spot, and the patient has been cancer-free ever since.
Thanks to his routine dental checkup, Kirchner’s patient avoided a disease that afflicts 36,000 Americans each year. Recent research shows that patients who smoke, drink alcohol heavily, or have been exposed to the HPV virus are most likely to contract oral cancer, but scientists insist that everyone should be screened for the disease every six months.
Dentists provide the first line of defense with thorough screenings, and Seattle’s Fred Hutchinson Cancer Research Center is leading the nationwide effort to better predict the progression of the disease and the survival of patients. Dr. Chu Chen, a public health scientist at the Hutch, enlisted volunteer patients from the University of Washington and Harborview medical centers for the study, the first of its kind. “Worldwide, oral cancer is the sixth most prominent type of cancer,” she says, “and it’s pretty deadly.” Currently about 21 percent of diagnoses come too late, and Chen’s study could bring that number down.
Every visit to Kirchner’s office includes a meticulous screening. You should expect your dentist to look at and feel all the surfaces of your tongue, neck, jaw, gums, and cheeks. Kirchner also swears by an LED tool called a Velscope, which lights up the cells on the inside of your mouth and detects any abnormalities. Brian Hill, founder of the Newport Beach, California–based Oral Cancer Foundation, insists that “visual and tactile screenings are the backbone of early detection,” and a thorough exam only takes about five minutes.
Chew on This
Grinding your teeth can be hazardous to your smile—and your wallet.
Dr. Jeffrey Schur, an orthodontist in Bellevue, had a patient with a slight overbite who was grinding his teeth in the middle of the night. But with no pain or clenching during the day, the patient was able to easily ignore it. By the time he wore his teeth down to half their original size, his unchecked night grinding problem had cost him thousands in dental bills.
“Grinding, particularly in your sleep, is very damaging to the teeth,” says Schur. When you’re sleeping, you’re likely to use a lot more force than you would when awake, which causes permanent damage to your pearly whites. “It forms cracks,” he says, “and like cracks in a windshield, they propagate, until fragments of the teeth eventually break off.”
Night grinding can be solved very simply with a night guard, which a dentist fits specifically to your bite. But when a patient doesn’t address the problem, he or she is likely to end up with cracked teeth, broken crowns, and bite correction orthodontics. Schur could have noticed the warning signs: worn teeth, a clicking jaw, and an uneven bite. “A lot of people go to the dentist because of pain,” he says, “but most of the dental problems we deal with as adults progress silently and painlessly, and the dentist is really the only one who is going to catch those problems.”