You can’t go a day without seeing a new article about which diet is the best for losing weight, staying healthy, building muscle, or being environmentally responsible. There always seems to be some new trend that everyone is trying out. It can be hard enough to sort out which one is right for you before you even start asking the question I’m always thinking…
“What will it do to your teeth??”
I know. I know. It’s probably not the first question that comes to most people’s minds. I think it is a really important one though. A healthy set of teeth is important for eating and chewing as well as overall health. Many people are starting to realize that your mouth is a window into the health of the rest of your body. A great diet should be healthy for your teeth as well as for the rest of your body. Figuring out that part… Not so easy, but I’ve got you covered!
I’m going to go through all the major diets out there, and rank them according to how tooth friendly they are (This doesn’t take into account if the diet is effective for anything else… just how “safe” it is for your teeth). These rankings are my subjective ratings on the diets based on how I think the average person would use the diet.
One last piece of advice before we get into the rankings….
Almost any diet can be made “teeth healthy” if you understand and follow the basic rules about how to eat for healthy teeth (sign up for our email list on our home page for a free, detailed PDF on how to do this!). The problem is that people don’t usually understand how the process works, what foods can actually cause cavities, and how to avoid it.
Diets with a Tooth Score of 0-2 will be very challenging to follow as is and not develop cavities long term.
Diets with a Tooth Score of 3 can be made teeth healthy if you watch what and how you’re eating.
Diets with a Tooth Score of 4-5 will typically be quite teeth healthy without much modification.
This diet recommends six meals a day, each meal containing at least two of it’s twelve superfoods (Almonds/Other Nuts, Beans, Spinach/Green Veggies, Dairy, Instant Oatmeal, Eggs, Turkey/Lean Meats, Peanut Butter, Olive Oil, Whole Grain Breads and Cereals, Whey Protein Powder, and Berries. Smoothies are a highly recommended way to get many of these meals in.
Pros: It recommends limiting refined carbohydrates and sugar.
Cons: It keeps you eating all throughout the day. Whole grain breads and cereals can still cause cavities. Sipping on smoothies, especially if they are berry heavy, is a good way to get cavities.
Tooth Score: 2/5. The constant eating is the biggest risk factor with this diet.
This diet is a relatively complicated one to follow! Here are the basic rules… 1) Eat as much fresh food as possible 2) Avoid processed foods and sugars 3)Get 40-50% of your calories from carbs, 30% from fat, and 20-30% from protein 4)Eat whole grains 5) Eat pasta in moderation 6) Avoid high fructose corn syrup 7) Reduce your intake of saturated fats 8)Eat more vegetable based protein than animal based protein other than fish 9)Eat fruits and vegetables from the entire color spectrum and 10) Drink water
Pros: It recommends you limit most refined carbohydrates, sugar, and high fructose corn syrup. These are the biggest contributors to tooth decay.
Cons: It can be complicated to follow and know if you’re doing right.
Tooth Score: 4/5. It cuts out the vast majority of foods that are known to cause cavities.
The Atkins diet is one of the most popular low carb diets out there. It has you cut out almost all starchy and sugary carb foods including candy, cookies, chips, potatoes, pasta, bread, and sugary drinks.
Pros: It cuts out almost all carbs and sugars which are the biggest contributors to tooth decay.
Cons: None for your teeth.
Tooth Score: 5/5. By cutting out almost all carbs (except those you get from vegetables) you reduce your risk for cavities drastically.
Biggest Loser Diet
The Biggest Loser Diet, popularized by the reality television show, focuses on small portions of food eaten in 5-6 meals throughout the day. It emphasizes weight loss which is achieved by eating fewer calories. The recommended foods for this diet include lean proteins such as turkey or chicken, low fat dairy, whole grains, fruits, vegetables, beans and nuts.
Pros: It cuts out refined carbohydrates.
Cons: You are eating more frequently and still have a good number of sugars and carbs in your diet from grains and fruits.
Tooth Score: 2/5. The combination of eating frequently and carbs isn’t usually a good one for your teeth. Limiting how often you eat grains and fruits will help lessen the impact on your teeth.
The DASH diet was originally created as a diet to help keep blood pressure in check. It has since been rated by several publications as one of the best overall diets to follow. It is similar to and often called the Americanized version of the Mediterranean diet. It recommends eating the following servings of food each day (on a 2000 calorie diet): 7-8 servings of whole grains, 4-5 servings of fruit, 4-5 servings of vegetables, 2-3 servings of low fat or non-fat dairy, 2 or less servings of lean meats, fish, or poultry, 4-5 servings per week of nuts, seeds, and legumes, and limited consumption of fats and sweets. It also recommends keeping sodium intake very low
Pros: Great for your overall health
Cons: It has a large proportion of your food coming from grain and grain products as well as fruits. All of these can contribute to cavities if eaten too frequently.
Tooth Score: 3/5. To make this diet more teeth healthy, limit grain products, fruits, and any sugary items to your specific mealtimes and don’t snack on them throughout the day.
Fast Diet (5:2)
The fast diet (the most popular of which is the 5:2 variety) is a diet in which you eat normally 5 days out of the week and the other two days you eat a very small number of calories (usually around 500 calories). The goal of this diet is to lose weight. It says you can pretty much eat what you want on your non-fast days. The major goal is calorie reduction.
Pros: One of the easier ones to follow.
Cons: There aren’t any recommendations about cutting out refined carbs and sugar.
Tooth Score: 1/5 if your 5 regular days are like the typical western diet (high in refined carbs, sugars, and sweet drinks). If you eat more healthy foods on your regular days this could be a reasonable diet for your teeth.
The Fertility Diet as the name suggests was created to help people get pregnant. Many cases of infertility are related to the woman not ovulating which this diet can help with. The rules include avoiding trans fats, using unsaturated vegetable oils, eating vegetable proteins instead of animal proteins, eating slow carbs such as whole grains, vegetables, and fruits, drinking whole milk, eating iron containing plants, and staying hydrated while avoiding sugary drinks.
Pros: It recommends avoiding refined carbohydrates and extra sugars.
Cons: It is recommended that some women gain weight on the diet to get to a more healthy BMI for fertility. It is easy to eat the wrong foods in order to do this (such as ice cream or too many carbs).
Tooth Score: 4/5. Overall a good diet as long as you watch how often you’re consuming carbs and fruits.
Flat Belly Diet
The Flat Belly Diet claims you can lose up to 15 lbs in a month with their system. For the first four days of the diet you can only eat 1200 calories and avoid all salt, processed foods, carbs, and gassy foods such as broccoli, onions, and beans. After the first four days you shoot for 1600 calories a day, eating a small meal/snack every four hours and sticking to a Mediterranean style diet. You also have to drink 2 liters of water a day that has been mixed with ginger root, cucumber, lemon, and mint leaves.
Pros: After the first four days, it sticks to a Mediterranean style diet, which is pretty tooth safe.
Cons: The water concoction isn’t great for your teeth (regular water would be much better) and eating all throughout the day is associated with a higher rate of developing cavities.
Tooth Score: 2/5. If you drink plain water instead of their “sassy water” and avoid most processed carbs and sugars, it’ll be much safer for your teeth.
The Flexitarian diet aims to have you add five new food groups to your diet without putting specific restrictions on what else you can eat: Plant proteins such as tofu, beans, nuts, eggs, or seeds, fruits and vegetables, whole grains, dairy, and sugar and spice. It also aims to reduce the calories you eat each day.
Pros: Relatively easy to follow.
Cons: Easy to justify eating too many carbs and sugar.
Tooth score: 2/5. While much healthier than the standard diet, it still allows a lot of cavity creating foods, which if eaten too frequently will definitely cause tooth decay.
Glycemic Index Diet
The Glycemic Index Diet attempts to get you to only eat foods that have a low glycemic index (eg. that don’t spike your blood sugar quickly such as refined carbohydrates, sugars, crackers, etc).
Pros: Many of the foods that have a high glycemic index are also cavity causing. Cutting them out will help.
Cons: Some of the moderate to low glycemic index foods can still cause cavities (such as fruits, pasta, or ice cream).
Tooth score 3/5. If you watch how often you eat those additional cavity causing foods, you can lessen the impact on your teeth.
Intermittent fasting is a pretty broad term that spans everything from the 5:2 fast diet to one meal a day to a whole variety of other diets. The one thing that binds them all together is the emphasis on extended periods of not eating / minimal eating.
Pros: Extended fast periods are good and safe for your teeth.
Cons: No guidance on what types of foods to eat.
Tooth score: 4/5. One of the biggest factors in developing cavities is the frequency with which you eat sugars and carbohydrates that cavity causing bacteria feed on. Intermittent fasting makes it so that you don’t eat them frequently, even if you do eat them.
Jenny Craig Diet
Many people love the Jenny Craig Diet because they make it easy. They send you pre-packaged meals and provide you with the meal plans so that you can stay on track. Portion size control is the biggest thing that they do for you.
Pros: By having pre-set meals and snacks you are able to avoid constant snacking throughout the day.
Cons: There are still a lot of refined carbohydrates and sugars in their meals, snacks, and desserts.
Tooth Score: 3/5.
Mayo Clinic Diet
The Mayo Clinic Diet focuses on eating according to their Healthy Food Pyramid which emphasizes eating a lot of fruits, vegetables, and in lesser amounts, “smart” carbohydrates such as whole grains. For the initial portion of the diet, they also recommend cutting out artificial sweeteners, alcohol, and all sugary items but are added back after losing the weight you’d like to lose.
Pros: It recommends cutting out refined carbohydrates and eat “smart ” carbohydrates such as you’ll find in whole grains, fruits, and vegetables.
Cons: Carbohydrates (with a picture of pasta) are still high on their list of foods to eat.
Tooth Score: 3/5
The Mediterranean Diet basically has four different categories of foods to eat… Eat regularly, Eat in Moderation, Eat Rarely, and Don’t Eat. Eat regularly includes fruits, vegetables, whole grain breads and pasta, nuts, beans, fish, and healthy oils such as olive oil. Eat in moderation includes eggs, dairy, and poultry. Eat rarely includes red meat. Don’t eat includes refined carbohydrates, processed foods, processed meats, and sugars.
Pros: It cuts out refined carbohydrates.
Cons: It still has a heavy emphasis on carbohydrates and fruits which can both cause cavities if eaten frequently.
Tooth Score: 3/5
MIND stands for Mediterranean-DASH Intervention for Neurodegenerative Delay (quite a mouthful!). The goal of the diet is to reduce your risk for developing Alzheimer’s disease. Studies have shown that it is effective in doing this if followed well. The foods it recommends eating are a combination of the Mediterranean and DASH diets, specifically the ones that are good for brain health. These include green leafy vegetables, other vegetables, berries, nuts, whole grains, fish, and poultry.
Pros: It cuts out refined carbohydrates.
Cons: Like the two diets it is based on, a large proportion of calories still come from carbohydrates and fruits. This can cause cavities if eaten too frequently.
Tooth Score: 3/5.
The Nutrisystem diet is similar to the Jenny Craig Diet in that you select from pre-packaged meals that are shipped to your house. It focuses on portion control and eating many small meals throughout the day. The meals shoot for 50% of your calories from carbohydrates, 25% from protein, and 25% from fat.
Pros: You have some flexibility in what meals you get.
Cons: A lot of meals have sugar or a lot of carbohydrates in them and it also recommends you eat frequently throughout the day.
Tooth Score: 2/5. Too many carbohydrates too often can lead to cavities.
In the Ornish diet foods are broken up into five categories, Group 1 being the most healthy all the way to Group 5 which is the least healthy. Group 1 includes fruits, vegetables, beans, non-fat dairy, and whole grains. Group 2 includes avacados, nuts, seeds, and various oils such as canola or olive. Group 3 includes seafood and reduced fat dairy products. Group 4 includes poultry, whole fat dairy products, cookies, and cakes. Group 5 includes red meat, butter, fried foods, and other highly processed foods. The goal is to eat primarily from groups 1 and 2, occasionally from group 3, and infrequently from groups 4 and 5.
Pros: It cuts out most refined carbohydrates.
Cons: Depending on how you implement the diet you can end up with a lot of carb heavy meals.
Tooth Score 3/5
The goal of the Paleo diet is to eat like early humans used to eat. This can be quite variable so there are a good number of variations on this diet. Most practitioners of the Paleo diet recommend getting the vast majority of your calories from fruits, vegetables, nuts, and meat. Beans, sugars, and most carbohydrates, even whole grain, are a big no-no.
Pro: It cuts out most carbohydrates except for what you get from fruits and vegetables.
Cons: It’s unclear if this diet is actually healthy for the rest of your body (even though it is pretty good for your teeth)
Tooth Score: 5/5
Slim Fast Diet
You eat Slim Fast products as meal replacements. These primarily include shakes, meals bars, and snack bars. You also fix one 500 calorie meal a day. The primary goal of this diet is to lose weight, not to be a long term diet plan.
Pro: It is an easy diet to follow, if not very exciting.
Cons: Most of the products have sugar or carbs in them.
Tooth Score 1/5.
Slow Carb Diet
The Slow Carb Diet was popularized by Tim Ferris in his book, “The Four Hour Body”. Tim Ferris differentiates between “fast carbs” and “slow carbs”. Fast carbs are things like sugar and refined carbohydrates (such as white flour) that break down quickly into sugars. He specifically says to avoid anything white and starchy as well as fruits. Slow carbs are things like whole grains and vegetables that your body breaks down much more slowly. You basically cut out all “fast carbs” from your diet 6 out of the 7 days of the week. The 7th day is a cheat day and you can eat whatever you want. You also shouldn’t drink any calories so no sugary drinks allowed.
Pros: The diet really cuts out the vast majority of foods that cause cavities.
Cons: Most people go crazy on the cheat day, but it shouldn’t be too much of problem if eat the right things on the other days.
Tooth Score: 4/5
Smoothie or Juicing Diet
Several documentaries have extolled the virtues of a smoothie or juicing only diet for some period of time in order to lose weight. The most popular of these is “Fat, Sick, and Nearly Dead”. The basic idea is that you only make fruit and vegetable smoothies or juice for whatever period of time you need in order to lose your required amount of weight.
Pros: None that I can think of.
Cons: Drinks with sugar (such as almost every smoothie or juice) are terrible for your teeth, especially if you consume them frequently.
Tooth Score: 0/5. This is a dangerous one for your teeth.
South Beach Diet
The South Beach Diet is another low carb / right carb diet. It breaks up the diet into three separate phases. Phase 1 is the most restrictive and cuts out all carbohydrates except those with a very low glycemic index such as such as vegetables. This phase is very tooth friendly and intended to help you lose a lot of weight. Phase 2 lets you re-introduce some of those carbs back into your diet. It recommends only whole grains, fruits, whole wheat pasta, and sweet potatoes. This is moderately tooth friendly. Phase 3 is when you are at a stable weight and are just maintaining. It recommends you make good food choices based on your experiences in the first two phases. You can go back to phase 1 and 2 if you need to lose more weight.
Pros: Cuts out refined carbohydrates for the most part.
Cons: Once you’re at a stable weight, it is far less restrictive and you might start choosing foods that are bad for your teeth again.
Tooth Score 3/5. Depending on what phase you’re in, it can be either good or bad for your teeth.
Standard Western Diet
This isn’t so much a “diet” as it is the typical way many people eat today. It started in the United States and has since spread to most other parts of the world. There is a heavy emphasis on refined carbohydrates, meats, and sugary drinks. Fruits and vegetables are usually an afterthought. It is responsible for the skyrocketing rates of obesity, cancer, diabetes, heart disease, and many other diseases. As expected it is terrible for your teeth too.
Tooth Score: 0/5
The TLC diet aims to lower your bad cholesterol levels and be heart healthy. It does this by reducing saturated fats in your diet. On this diet you’ll want to avoid most saturated fats including butter, whole fat dairy, and fatty meats. It also increases the amount of soluble fiber you consume. The recommended foods include fruits, vegetables, fish, skin off lean meats, bread, pasta, and other whole grains.
Pros: It is rated as a good diet for your heart.
Cons: There are a lot of recommended carbs in this diet. If you’re eating fruits, bread, and pasta too frequently you’ll likely develop cavities.
Tooth Score: 2/5
Traditional Asian Diet
This one spans a good variety of different diets prevalent in the area of Asia. Most of them are low fat and include large amounts of rice, vegetables, fruit, and fish. Red meat is very limited.
Pros: It is typically considered a pretty healthy diet.
Cons: Rice, fruit, and noodles can definitely cause cavities, especially if combined with any added sugars.
Tooth Score: 2/5
A vegan diet aims to cut out all animals products. That means no butter, eggs, dairy, cheese, meats, or fish. Most people on a vegan diet eat large amounts of fruits, vegetables, nuts, beans, pasta, and bread.
Pros: A well done vegan diet (heavy on the vegetables, fruits, beans, and nuts can be really healthy).
Cons: It is easy to load up on carbs or sweets while on this diet since you have so many other restrictions.
Tooth Score: 2/5. I recently had a patient who had 15 cavities while eating a vegan diet. She was snacking on potato chips all day which led to the cavities. I’ve seen the same thing with fresh fruit heavy diets. You can make it more teeth healthy by eating more whole grains, limiting the frequency with which you have them (don’t snack on them!), and avoiding added sugars.
The vegetarian diet cuts out all meat products but other animal products such as dairy and eggs are OK for most people. There are a couple of different variations that allow different items. Most people eat a large amount of vegetables, fruits, cheese, nuts, beans, pasta, and bread.
Pros: A well done vegetarian diet can be really healthy.
Cons: As with the vegan diet it is easy to load up on way too many carbs and sugars.
Tooth Score: 2/5. To make this one more teeth healthy avoid eating carbs and extra sugars except at meal times.
The Volumetrics Diet is different than many of the other diets I’ve featured on here. Instead of focusing on food groups or calories, it recommends simply eating high volume, low calorie foods to keep you full without eating excess calories. Examples of these high volume, low calorie foods include fruits, vegetables, low fat dairy, whole grains, and lean meat.
Pros: It recommends cutting out refined carbohydrates.
Cons: You can still develop cavities if you are eating a lot of the fruits and grains too frequently.
Tooth Score: 3/5
Weight Watchers Diet
Weight Watchers works by using a SmartPoints system. You have a set number of points you can use each day. Foods that are healthy cost very few points while calorie heavy, non-nutritious foods cost a lot of points. No food is banned in this diet. The SmartPoints system aims to get you to eat low calorie and fillings foods such as fruits, vegetables, whole grains, and lean vegetables.
Pros: Most of their “good” foods are pretty healthy for your teeth.
Cons: You can eat small amounts of the “bad” foods on this diet and if you are doing it frequently throughout the day they can still cause cavities.
Tooth Score: 2/5
This diet ends up being a relatively low carbohydrate diet. It allows you 3 meals a day a two snacks. Each meal is supposed to be 30% protein, 30% fat, and 40% non-starchy/non-sugary carbohydrates. High sugar fruits and vegetables are discouraged as well as bad fats like red meat and egg yolks. Most meals end up being about 1/4 lean meat, 2/3 good fruits and vegetables, and the rest good fats such as avocados, etc.
Pros: It cuts out most foods that cause cavities.
Cons: Not many from the perspective of your teeth.
Tooth Score: 5/5
Did I miss any major diet plans out there? Let me know in the comments below!
I went to my dentist for a cleaning, which I have every 6 months. I
had a crown put on a tooth that developed an abcess. This was done
approximately 12 years ago. On the visit today, 2/1/17, the dentist
said the filling in the crown needed to be replaced because of age,
but that he wanted to remove the crown and put a new crown on.
I asked if he could just replace the filling, and he in effect said
I maintain that the filling in the crown is just like a filling in a
tooth and that he should replace it. There is no decay issue, and the
filling is about 12 years old and cracked.
Am I wrong in not having the entire crown replaced?
I’d tend to agree with your dentist. If the old crown and filling are wearing out getting a new crown is your best option. A crown that has had a hole drilled through it is much much weaker and will tend to break more and more over time. Also, the fillings that are placed through that hole typically don’t seal the tooth as well as an intact crown. The primary reason why root canals fail is because there isn’t a good seal and bacteria gets down in there and causes it to become infected again. A new crown will seal that tooth much better! I know it can be expensive to get a new crown, but it really sounds like that is the best thing for the long term health of the tooth.
Hope this helps!
I get a good number of questions via email and do my very best to respond to all of them. Occasionally I’ll publish those questions on here along with my answer.
I had a root canal on my upper right premolar on 14 Feb 2017. This is my last appointment (third appointment). The pain has decreased gradually but I still can’t chew hard food. I still can’t brush this tooth with a normal force which means I brush it very softly. How long will the tooth become normal again? When can I use that tooth to chew hard food?
On the 2nd and 3rd appointment, the dentist put a file in and out of my tooth. When the file pushes too deep into the end of my root, it feels extremely painful. Do other patients feel this pain too?
The dentist did not put a crown for my tooth.
The Healthy Mouth Project is officially a year old!
Thank you to everyone who has visited the site, left comments, signed up for the newsletter, or shared our articles.
There has been a lot accomplished in the last year…
- 203 posts with over 147,000 total words (That’s equal to about a 600 page novel)!
- Many late nights up writing (I run my dental office full time and have a wife and four kids. I just write in my “free” time)!
- Way too many design changes (I think I’m finally settled)!
- Quickly growing numbers of people finding the website and using it to improve their oral health!
Going forward I still have a lot of goals I’d like to accomplish with The Healthy Mouth Project…
- Continue to put out new and useful content on a consistent basis.
- Keep you up to date on new developments in dentistry and how they can help you.
- Increase the numbers of people who find the website and use it to improve their oral health.
- Start a fund that will be used to provide free or low cost dental care to children and adults in need.
How Can You Help?
There are two things I ask of you …
- If you’ve found this website useful, please share it with your friends and families on social media or by word of mouth. It’s easy! See those buttons on the left side of your page or below any post? Click on them to share the article. That’s it!
- Secondly, let me know what additional content you’d like to see on the website. Whether it is additional product reviews or a specific topic, I’m interested to hear what you’d like to see! You can comment on any article or send me an email at firstname.lastname@example.org. I read every single one of them.
Thanks for visiting!
Did you know certain osteoporosis medications, particularly if delivered as an IV injection, can affect your dental health?
I had a patient recently who came to my office complaining of an ulcer on the tongue side of his gums. It had been there for about a month and wasn’t going away. Most normal ulcers will go away within 2 weeks. If we find it isn’t healing by then, then there is likely something else going on. It can range from oral cancer to a drug reaction to various autoimmune diseases. We sent him over to see an oral surgeon who evaluated the area.
The oral surgeon called me a week later to tell me that he had localized osteoncrosis (bone death) as a result of a certain class of osteoporosis medications known as bisphosphonates (which are also used to treat breast cancer and certain types of bone cancer). This patient had been taking them to treat multiple myeloma (a type of cancer). The bone in the area had died and was breaking off. It shows up a big, non-healing ulcer.
Not fun right?
So how do you know if you’re at risk for this?
Most people who’ve taken oral bisphosphonates (pill version) have a slightly higher risk of something like this happening. The risk is very low and generally not something to be concerned about. The benefit of the medications is much higher than the risk to your dental health.
If you’ve taken IV bisphosphonates, you are at a much higher risk of this happening. Your physician will only use IV bisphosphonates if absolutely necessary because of the risks of something like this happening.
How to Avoid Bisphosphonate Related Osteonecrosis:
Many cases of osteonecrosis occur after some type of oral surgery, usually when you have a tooth taken out. If you’ve taken IV bisphosphonates in the past you’ll want to do a couple of things to decrease your risk…
- Make sure your dentist knows that you’ve taken IV bisphosphonates
- Take care of your teeth. Cavities or gum disease can cause you to need a tooth extraction. You absolutely want to avoid tooth extractions or other dental surgery if at all possible.
- If you do need a tooth extraction, consider seeing an oral surgeon or a general dentist who is very experienced with extractions. The less traumatically the tooth comes out, the less risk of osteonecrosis afterwards.
What Does Osteonecrosis Look Like?
Most cases of osteonecrosis in the mouth will show up just like I described, an ulcer on your gum tissue that won’t heal. Sometimes it is painful and other times it isn’t. It happens more often in the bottom jaw than the top due to there not being as many blood vessels that supply the bone there. One of the most common areas is on the bottom jaw, on the tongue side of your gums right below where your molar teeth would be.
If you have a history of taking these medications and have an area that just isn’t healing, you should have it evaluated.
How Is It Treated?
You should see an oral surgeon for treatment. They have a lot more experience treating this condition than a typical general dentist. Whatever happens, you want to avoid any further trauma to the area to give it the best chance of healing. Like I mentioned previously, surgical interventions can actually make it worse.
The usual treatment for something like this is to gently remove some of the dead bone, go on antibiotics, and place a wound dressing over top of it. Additional surgery can actually make the condition worse and cause more bone to die.
One controversial treatment for it is to have hyperbaric oxygen therapy. The jury is still out on whether this helps. It can be very expensive and your medical insurance may not cover it.
Guest Post By Philip L. Fava, DMD, MDSc
Estimates show that as many as 15 million dental implants are successfully placed worldwide each year. Patients benefit from one, two or even an entire mouth of replacement teeth that look and function as good as (or in some instances, even better than!) regular teeth. Today’s dental implants are predictable, with long-term success considered the rule rather than the exception. Placed by a properly trained and certified periodontist, your dental implants should offer increased oral health and overall esthetic, with virtually no problems.
However, just like our natural teeth, implants can fail if not taken care of properly. Poor plaque control can lead to bacteria damaging gum tissue and even causing bone structure beneath the implant to deteriorate. And implants aren’t immune from issues that can result from either improper placement or other overall medical issues that affect oral health.
Peri-implant inflammation (inflammation around an implant), and even worse, peri-implantitis (inflammation and bone loss around an implant), are rare and often preventable complications that can affect a dental implant. This infectious bacterial disease affects both soft and hard tissue and can lead to bone loss. Thankfully, if necessary, modern periodontics can tackle peri-implantitis with both surgical and non-surgical treatments.
Patients at Higher Risk
Dental implant patients most at risk of possibly developing this complication include:
- Patients who don’t adhere to good oral hygiene practice or those who grind their teeth
- Smokers—who are more likely to already have gum disease and whose blood vessels constrict when smoking, leading to bone loss
- Patients with medical issues such as autoimmune diseases, diabetes or osteoporosis
- Those patients with implants placed at poor angulations or implants with poorly designed crowns and prosthetics
Peri-implantitis is not always painful, and often times will be asymptomatic. However, early signs of this implant complication can include bleeding at the gum line and/or purple-looking gums. Some patients may experience pus, plaque build-up, or a puffy looking gum tissue.
Today’s Top Treatment
The periodontist’s long-term goal is to stop the bone loss and help patients maintain healthy implants. Sometimes it’s as simple as prescribing antibiotics. For more difficult cases, surgery was once the only other option, in which the periodontist had to cut out the infected tissue. Today, many practitioners employ modern laser technology to help save failing implants, without surgery. LAPIP® (Laser-Assisted Peri-Implantitis Procedure) is a minimally invasive solution that utilizes laser to focus directly on disease-causing bacteria, thereby sparing healthy tissue. No scalpel or stitches are needed. By removing unhealthy tissue around the implant that’s being rejected, the laser gets rid of the infection and stimulates normal bone growth around the “failing” implant.
If you suspect a problem with your dental implants, we have the ability today to make “sick” implants healthy again without invasive dental surgery. Don’t wait for an implant to come loose or you experience more severe symptoms to have your dental implant assessed.
Philip L. Fava, II, DMD, MDSc partners with Dr. Robert A. Levine at the Pennsylvania Center for Dental Implants and Periodontics, located at Einstein Center One, Suite 211-212, 9880 Bustleton Avenue, Philadelphia, PA 19115. The Center offers “All-on-Four™ dental implants, SameDay Smile®, esthetic (or “Smile Zone”) dental Implants and crown and bridge implant restorations in addition to LANAP® and LAPIP® laser treatment of periodontal disease and reconstructive dental surgery.
Many people come to me and ask the question, “Am I a good candidate for Invisalign?”. You may be wondering the same thing about yourself. I’ve found that many adults desperately want to straighten their teeth but aren’t interested in going through traditional braces. If this is you, you’re not alone. You may have even been to several dentists who have told you that you’re not a good candidate for Invisalign.
A couple of years back I attended a continuing education seminar for advanced Invisalign treatment. The presenter was a dentist who has done thousands and thousands of Invisalign cases. He related to all of us that he constantly gets that same question of “Am I a good candidate for Invisalign?”.
His reply back?… “Do you have teeth? Then, YES, you are a good candidate for Invisalign.”
Yes, it’s a little bit of an exaggeration but it gets the point across. Invisalign isn’t the same that it was 15 years ago. In an experienced dentist’s or orthodontist’s hands, Invisalign can treat almost anyone. I have an orthodontist I refer patients to who exclusively treats his patient’s with Invisalign. That includes people who are missing teeth, have major crowding, or have large spaces.
I have a lot of patient’s who have gone through Invisalign or are currently in Invisalign. They range from people with minor crowding issues to people who have major bite and cosmetic problems. They range in age from 16-65 years old. Just about every one of them will complete comprehensive treatment in under a year.
If you’ve been told that you’re not a good candidate for Invisalign, you should get a second or third opinion from someone who has a lot of experience treating a wide variety of cases. What many dentists are actually saying is that they personally wouldn’t feel comfortable treating you with Invisalign. It doesn’t mean that it can’t be done.
Who’s Actually Not A Good Candidate?
In truth there are a couple of things that will disqualify you from Invisalign (but they would disqualify you from regular braces too)…
- A mouth full of cavities. You’ve got to get them fixed first.
- Active gum disease. If you’ve been treated for gum disease and your gums are healthy and the teeth are solid, then you can still have Invisalign. If the disease is active or you have loose teeth from gum disease, Invisalign or regular braces aren’t a good idea.
There are also a couple of things that can make Invisalign more difficult but aren’t an absolute disqualifier.
- Dental implants can’t move with Invisalign (or regular braces). If it is in a bad spot, it may need to be redone.
- Bridges, especially long ones as they won’t move very well.
- Current TMJ problems
It’s also important to remember that you may need additional dental restorative procedures after Invisalign to get that perfect result. The most common reasons to need additional treatment are…
- Misshapen teeth
- Teeth that are too small
- Worn teeth
Dental restorative treatment can involve bonding, veneers, or crowns to change the shape or color of the teeth.
Finding A Dentist or Orthodontist
So we’ve learned that almost everyone is a good candidate for Invisalign. How do you go about finding someone who can treat you effectively if you’ve got a difficult case?
Your best option would be an orthodontist who does a lot of Invisalign. They’ll typically have the best training and experience.
Another good option is to find a general dentist who is an Invisalign Premier or Elite Provider. You can look this up on the Invisalign Doctor Finder. There will be different designations next to each dentist or orthodontists. It can get a little confusing so here is what they all mean…
• Treats 10 cases per year minimum
• Has treated at least 50 cases total
• Treats at least 25 cases every 6 months
PREMIER ELITE PROVIDER:
• Has treated at least 300 cases total
• Treats 50 cases every 6 months
• Is in the top 1% of all providers in numbers of cases treated.
Most orthodontists will fall in the Premier or Premier Elite Categories. Most general dentists will fall in the Preferred Provider category while you’ll occasionally find one who is Premier.
For as long as I can remember I’ve had sensitive teeth. There were always a couple of areas that I knew I couldn’t put ice cream or ice cold water. I’ve been a dentist for a quite a while and over the years I tried every solution out there for decreasing sensitivity without a whole lot of success. These included Sensodyne toothpastes, Gluma desensitizer (professional application only), Fluoride varnishes (professional application only), Crest Sensi-Stop Strips, and using dental bonding agents over the sensitive areas (professional application only). Nothing was really effective.
Then I started using a toothpaste product we sell at our office. I actually started using it to protect my teeth from cavities without thinking it would do much for the sensitivity. About a month after starting to use it I noticed that my sensitive teeth were no longer quite so sensitive. In fact, they were hardly sensitive at all. The wonder product that has reduced my sensitivity to an almost unnoticeable level? Prevident 5000 Sensitive Toothpaste. The only bad news for most people is that it is by prescription only.
It combats sensitivity in a couple of different ways. The first is by its high concentration of fluoride. Most regular over the counter toothpastes contain around 1000-1500 parts per million (ppm) of fluoride. Prevident contains 5000 ppm. High levels of fluoride are known to decrease sensitivity in teeth.
The second major active ingredient is 5% potassium nitrate. Potassium nitrate is used in many other over the counter sensitivity toothpastes such Sensodyne or Colgate Sensitive. Potassium nitrate is the most common ingredient used to combat tooth sensitivity. It helps plug the small tubes in the tooth where cold sensations can penetrate.
It’s important to note here that I’ve had a lot of patients who have had good success with over the counter sensitivity toothpastes. I just wasn’t one of them. Everyone’s level of sensitivity is different and some people require more desensitization than others. I just happened to be one of those people who needed more help than most. If you’re one of these people, Prevident 5000 Sensitive is something you should try.
So how do you get this product?
You’ll need a dentist to write a prescription for this specific product and check the box on the prescription that says not to substitute with a generic. As far as I’ve found, there aren’t any generic products that include a desensitizing agent along with the high fluoride concentration toothpaste. If you find something out there let me know by email or via the comments!
Almost any dentist will be happy to write this prescription for you. The only people who shouldn’t use this product are children under the age of 12 and people with certain types of thyroid issues as fluoride can cause some specific problems for them.
How long does it take to start working?
It takes a couple of weeks of consistent use to start seeing results. The fluoride and potassium nitrate take some time to build up to the levels needed to see an improvement in sensitivity.
Are there any other benefits to using this product?
High fluoride toothpastes like Prevident 5000 decrease your risk for cavities by a significant margin. Fluoride combines with the enamel crystals in your teeth to form an even harder crystal that is more resistant to acid attack. I’ve written before about how I think most people would benefit from a prescription strength fluoride toothpaste.
What if it doesn’t help with sensitivity?
You may have more going on than just sensitive teeth. Failing fillings, cavities, and bite issues can all show up as sensitivity. You’ll need a dentist to let you know for sure.
Article Updated May 17th, 2017
Invisalign is always innovating. New materials, new software algorithms, and support for many different digital impression systems are just a couple of the many changes they’ve made over the last couple of years.
None of those changes were nearly as exciting to me as a dentist (and to many of my patients) as when they announced in late 2016 that their aligners could be changed every week instead of every two weeks.
Yep, you read that right. Your treatment time can be halved. No other changes necessary. Just change the trays every week.
So how did this happen?
Most people who’ve gone through Invisalign are familiar with the standard rules… Wear your trays 20-22 hours a day and change to the next set every two weeks. In late 2016 Invisalign changed up those rules. They announced that after extensive testing they’d found that trays could be changed every week instead of every two. Individual dentists and orthodontists had been experimenting with this for a couple of years with great results but Invisalign didn’t want to put their rubber stamp on it until they were sure that it was safe and effective. After collecting a lot of data, they found that it was in fact just as effective as the two week change period.
This change has been a result of the Invisalign innovation in materials and software that we talked about earlier. The aligners are made of a proprietary material that creates gentle but consistent force on the teeth. The attachments that are used on teeth are constantly being evaluated to make sure they are creating the most effective force on teeth. The software is continually getting better at predicting how teeth will move. This all adds up to extremely predictable tooth movement and in a shorter time than before.
The Most Important Thing To Remember!
Changing once a week only works if you are extremely compliant with wearing your aligners. That means that you wear them for 22 hours a day, only taking them out to eat and brush. If you don’t wear your aligners as often as you should, you’ll have to stay on the two week schedule. Now that is some motivation to wear them consistently!
There are also a couple of products that I highly recommend using (especially if you’re doing 1 week trays changes) that will help make Invisalign treatment easier and more effective for you…
Chewies look like a rolled up piece of gauze or cotton but are actually made of a sponge like plastic material. Many dentists and orthodontists recommend them during Invisalign treatment. When you put your trays in you’ll want to chew on them for 5-10 minutes. Invisalign recommends that you do this several times a day and especially before bed.
What this does is pushes the trays up against your teeth more tightly. The closer the fit on your teeth, the faster and more effectively they will move. This is especially important when you first change trays. You can’t get that same pressure using just your hands to pop them in place.
If you’re going to do 1 week tray changes, I highly recommend using chewies.
You can purchase chewies relatively inexpensively on Amazon. It doesn’t really matter what brand you get, as long as you get as long as they are literally “chewy”. Here is a link to the brand that I usually recommend… Orthoband Chewies.
You’ll want to throw away the chewy once it is all smashed up and not as spongy. There are re-usable until then (although you may want to clean them occasionally so they don’t get super dirty!).
Getting the Trays Off
Changing the trays once a week means that your trays will be tighter on your teeth much more of the time. For some people this isn’t a big problem and they don’t have any issues getting their trays on and off with their fingers. Most people can hook a fingernail around the backside of the tray and pop it off. For other people, especially those who have severely tilted teeth or a lot of “buttons” on their teeth, this can be really challenging! I’ve known some patients who would leave them on for two full days until their teeth moved enough to loosen them.
If you’re one of these people, there are some products out there that can help. None of them is perfect, but it is definitely better than not being able to get your trays off!
What I recommend is a Metal crotchet hook. This is the cheapest and easiest solution for most people. You’ll hook the tip up and around the edge of your tray and pull down to pop it off on one side. Once you get one part off, the rest comes off pretty easy.
There are some other products made specifically for getting the trays off but I’ve found that the metal crotchet hooks work better, are cheaper, and don’t break. The other products are made of plastic and tend to be a bit bulkier and can’t get in between the teeth and tray as well.
So what’s next for Invisalign?
I wouldn’t anticipate them being able to speed up tooth movement too much more with their aligners alone (there are other options being explored for that) but I do see them continuing to make technology changes that allow Invisalign to treat more and more types of cases. As it stands now, the vast majority of cases can be treated successfully with Invisalign. Will Invisalign ever replace traditional braces completely? I really doubt it, mostly because some people need braces that are fixed in place and no compliance with wearing them is required (Here’s looking at you teenagers!). I do see it becoming a viable alternative for just about anyone who wants it treatment with Invisalign. I think your dentist saying “You’re not a good candidate for Invisalign” will become a thing of the past.
So now you know. If your dentist or orthodontist tells you that you can change your trays every week, it is actually recommended that you do so by Invisalign. If your dentist or orthodontist is still having you change your trays every two weeks ask them to look up the updated recommendations from Invisalign. They may not have heard about the change quite yet. You’ll be glad you did and they’ll probably thank you too!