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From the time you were small, you’ve been warned about the dangers of plaque. Why? Because:

• It’s an unpleasant film that sticks to your teeth
• It causes cavities
• It causes gum disease
• It can cause extra problems when you wear braces

And really, do we need to know much more than this to motivate us to brush? But if you’re in a curious mood, you might be wondering just how this soft, fuzzy film accomplishes all that damage. Let’s take a closer look at the sticky problem of plaque.

How does plaque form?

We live with hundreds of species of oral bacteria, most of which are harmless, and some of which are actually beneficial. But when our oral ecosystem gets out of balance, problems can occur. For example, without regular and thorough brushing and flossing, we start to build up plaque.

Plaque starts forming within hours of your last brushing. And even though plaque fits the very definition of “seems to appear overnight,” this biofilm is actually a complex microbial community with several different stages of development.

• It starts with saliva.

Saliva is vital to our oral health, because it keeps us hydrated, washes away food particles, neutralizes acids in the mouth, and provides minerals which keep our enamel strong. Saliva also contains proteins, which help form a healthy, protective film on the tooth surface. This film is called a pellicle.

• Bacteria attach to the pellicle.

There are species of oral bacteria that are able to attach themselves to the pellicle film within hours of its formation. As they become more firmly attached, they begin to grow and divide to form colonies, and are known as the early colonizers of the plaque biofilm.

• A complex biofilm forms.

If you’ve skipped brushing for a few days (please don’t!), you’ll notice a fuzzy, sometimes discolored film on your enamel—that’s a thriving plaque community, and it only takes a matter of days to go from invisible to unpleasant.

If you’re not removing plaque regularly, it can harden further and become tartar. And once you have tartar buildup, you’ll need the care of a dental professional to remove it.

• What happens if we ignore plaque and tartar?

We get cavities and gum disease.

How does plaque cause cavities?

• The bacteria in plaque, like all organisms, need nutrients.

Our normal oral environment and the food in our everyday diets provide the nutrients plaque needs. And, as we mentioned above, certain types of oral bacteria convert these nutrients into acids. Foods such as carbohydrates, starches, and sugars are most easily converted into acids, which is why we recommend that you enjoy them in moderation.

• The biofilm promotes acid production.

Within the plaque film, anaerobic bacteria (bacteria which don’t use oxygen) convert sugars and starches into acids. As the plaque film becomes denser, it blocks acid-neutralizing saliva and oxygen from reaching these bacteria close to the tooth’s surface, creating an ideal environment for the bacteria to produce their acid waste products.

• Acids attack enamel.

The sticky nature of plaque keeps these acids in contact with tooth enamel, where, over time, acids dissolve minerals in enamel, weakening the mineral structure of the tooth.

How does plaque cause gum disease?

• Bacteria cause inflammation and gingivitis.

The bacteria in plaque irritate the delicate tissue of the gums, which causes an inflammation response which can leave your gums swollen, red, bleeding, or tender. This early form of gum disease is gingivitis. Fortunately, good dental care and careful brushing and flossing can usually prevent and even eliminate gingivitis.

• Plaque and tartar can lead to periodontitis.

When plaque and tartar build up around and below the gumline, the gums pull away from the teeth, leaving pockets where bacteria collect, leading to infection as well as inflammation. Infections and constant inflammation not only harm gum tissue, they can destroy the bone supporting the teeth. This serious gum condition is periodontitis, and should be treated immediately to avoid further infection and even tooth loss.

How does plaque affect orthodontic patients?

• Plaque collects around your braces.

Braces provide plenty of spots for plaque to hide from your brush. If you aren’t extremely diligent with your brushing and flossing, plaque collects near brackets, wires, and bands—all those spots that a brush and floss find difficult to reach.

• Plaque promotes demineralization

The demineralization process we mentioned above can cause white spots on teeth (decalcification), where minerals have dissolved. Sometimes these spots can be treated, and sometimes they are permanent. They can become quite sensitive, and may lead to cavities.

Careful brushing and flossing around your braces will help eliminate the plaque that can cause demineralization near brackets. Ask Dr. Don Connolly and Dr. Stanley Sokolow about the tools and the brushing and flossing techniques which will give you the best results.

How do we fight plaque?

From the time you were small, you’ve learned how to fight plaque:

• Brush at least twice a day for two minutes, and be sure to brush all of your tooth surfaces and around the gumline.
• Floss to remove plaque from between the teeth and near the gumline.
• See your dentist as recommended for a thorough professional cleaning.

Be proactive. If you have any questions, talk to us at our Santa Cruz, Aptos, or Watsonville, CA office about the best way to keep plaque at bay. We can show you the most effective ways to brush and floss, recommend anti-plaque toothpastes and rinses, even suggest plaque-revealing tablets if you’re missing some trouble spots.

We’ve only brushed up on some plaque basics, because there is a lot more to discover about this complex biofilm. Happily, even with all there is to learn about plaque’s growth and development, it’s reassuring to know that getting rid of it is quite simple—with just a soft-bristled brush, some dental floss, and a few minutes of your time each day, you’re on the way to a healthy, happy, plaque-free smile.

If your child has just gotten braces, chances are it’s a good time to brush up on dental hygiene! Why now? What’s different? And how can you help? Let’s take a few minutes and explore these timely questions.

Brushing and Flossing Are Especially Important with Braces

There’s no getting around it, it’s harder to clean teeth with brackets and wires. But it’s essential to pay attention to dental hygiene. When bacteria and plaque start building up, your child is at risk for gum disease, cavities, and tooth discoloration.

• Gingivitis

This early stage of gum disease is the result of gum irritation caused by plaque. The gums become red, swollen, sore, and can bleed or start to recede. With proper brushing and flossing, gingivitis can be eliminated, along with the risk of developing more serious gum disease.

• Tooth Decay

One of the major reasons for cavities is the erosion of enamel caused by oral bacteria. These bacteria feed on sugars from our diet and produce acids that attack the tooth’s surface. Plaque, formed by a mass of these bacteria, sticks around brackets and the gum line, putting your child at risk for cavities near his orthodontic work—which might require removing wires and brackets to treat.

• Demineralization

When acids attack teeth, they remove the minerals from our enamel. This demineralization eventually leads to cavities, but in its early stages can cause white spots to appear where the mineral structure has been weakened. Braces wearers are at special risk for demineralization, especially around brackets and near the gums, where plaque can be missed while brushing.

Time for New Brushing and Flossing Techniques

Even if your child has always done a wonderful job of brushing and flossing, braces provide a new challenge for getting teeth their cleanest. Unfortunately, plaque buildup around the brackets and the gum line is all too common in orthodontic patients. Dr. Don Connolly and Dr. Stanley Sokolow can recommend some tools that make the cleaning process easier and more effective.

• Toothbrushes

Manual brushes are available with small, soft-bristled heads designed especially for braces wearers. If your child still has problems getting rid of plaque and food debris, an electric toothbrush might be helpful. And remember, encourage your child to be thorough but gentle for the sake of both braces and gums.

• Flossing with Braces

Flossing can be challenging for children at any time, but especially with braces. We’ll show you how floss threaders work, and how special flosses designed just for braces can fit under wires. This might also be a good time to invest in a water flosser. Your help demonstrating how to floss even with brackets and wires blocking the way will be appreciated by your child and your dentist!

• Products Just for Braces

Interproximal brushes are tiny cone-shaped brushes designed to fit around brackets and wires and between teeth. We can also suggest special toothpastes and rinses to help fight plaque and prevent cavities from developing. Ask us about what to shop for to make both of your lives easier.

You Can Help!

• Teamwork—Works!

When your child first gets braces, practice brushing and flossing together. Our Santa Cruz, Aptos, or Watsonville, CA team will be happy to show you both the very best techniques for keeping teeth their cleanest and healthiest. Especially for young children, your help will make sure those techniques are learned and used.

• Make Time for Cleaning

Your child’s before-braces routine might have meant brushing two minutes each morning and two minutes at night. But thorough cleaning around brackets and wires might take a bit longer. (And, with braces, it’s best to brush after every meal rather than the common twice-a-day routine). Be available, at least at first, for a quick check to make sure braces and teeth are their cleanest. And you may have to help with removing and replacing bands until your child gets the hang of it.

• Be Prepared!

Whether it’s a day at school or an overnighter with friends, be sure your child has a kit filled with cleaning supplies ready to take along. A toothbrush, floss, an interproximal brush, toothpaste, a mirror—with these necessities, your child can keep on top of any cleaning emergencies.

For younger children especially, learning how to keep teeth and braces their cleanest can take some time. Be patient, be prepared, and be willing to help, and you and your child will have a new routine mastered—in no time at all!

We’re all friends here, so if you sometimes feel a bit nervous before your orthodontic appointments, no judging! Ask us about any worries you might have. We are happy to explain procedures, equipment, and your orthodontic options so you know exactly what is going on during treatment. And if X-rays are a concern, we can put your mind at ease here as well.

What Exactly Are X-rays?

Sometimes patients feel reluctant about the process of imaging because X-rays are a kind of radiation. But the fact is, radiation is all around us. We are exposed to radiation naturally from our soil and water, sun and air, as well as from modern inventions such as cell phones, Wi-Fi, and air travel.

Why is radiation so common? Because matter throughout the universe constantly gives off energy, and the energy that is emitted is called radiation. This radiation takes two forms—as particles (which we don’t need to consider!) and as traveling rays. This second type is known as electromagnetic radiation, created by photons traveling in regular waves at the speed of light.

We are exposed to electromagnetic radiation every day, because, whether we can see them or not, these different wavelengths and frequencies create various forms of light. Radio waves, microwaves, infrared, visible, and ultraviolet light, X-rays, and gamma rays are all part of the electromagnetic light spectrum.

Different types of radiation on this spectrum have different wavelengths and different frequencies, and produce different amounts of energy. Longer wavelengths mean lower frequencies and less energy. Because X-rays have shorter wavelengths and higher frequencies than, for example, radio waves and visible light, they have more energy.

How Do Dental X-rays Work?

An X-ray machine produces a very narrow beam of X-ray photons. This beam passes through the body and captures images of our teeth and jaws on special film or digital sensors inside the mouth (intraoral X-rays), or on film or sensors located outside the mouth (extraoral X-rays). These X-ray images are also known as radiographs.

Why are X-rays able to take pictures inside our bodies? Remember that higher energy we talked about earlier? This energy enables X-rays to pass through the softer, less dense parts of our bodies, which are seen as gray background in a radiograph. But some substances in our bodies absorb X-rays, such as the calcium found in our bones and teeth. This is why they show up as sharp white images in radiographs. 

There are many different types of dental X-rays used in orthodontics, including:

• Occlusal X-rays, which show the entire arch of teeth in the upper or lower jaw.
• Panoramic X-rays, which use a special machine to rotate around the head to create a complete two-dimensional picture of teeth and jaws.
• Cephalometric X-rays, which show the patient’s entire profile, and the position and development of the teeth and jaws.
• Cone Beam Computed Tomography, an external device which uses digital images to create a three-dimensional picture of the teeth and jaws.

Why Do We Need X-rays?

You might have noticed that these X-rays, unlike, for example, typical bitewing X-rays, don’t take images of individual teeth. That is because orthodontists deal with the teeth in relationship to each other and to the structures around them.

Beautifully aligned teeth and a healthy bite are the visible result of your orthodontic work, but there’s a lot going on above and below the surface that needs to be discovered and taken into account before your treatment even begins. X-rays help us evaluate:

• The size, shape, and position of your teeth, including impacted teeth and wisdom teeth
• The size, position, and health of your roots throughout treatment
• The size and shape of your jaw bones, and how they affect your teeth alignment and bite
• Your progress during different phases of treatment

How Do Orthodontists Make Sure Your X-rays Are As Safe As They Can Be?

First of all, the amount of radiation you are exposed to with a dental X-ray is very small. In fact, a typical panoramic X-ray provides roughly the same amount of radiation we are exposed to through our natural surroundings in just one day. Even so, Dr. Don Connolly and Dr. Stanley Sokolow and our team are committed to making sure patients are exposed to as little radiation as possible.

Radiologists, the physicians who specialize in imaging procedures and diagnoses, recommend that all dentists and doctors follow the safety principal known as ALARA: “As Low As Reasonably Achievable.” This means using the lowest X-ray exposure necessary to achieve precise diagnostic results for all dental and medical patients.

The guidelines recommended for X-rays and other imaging have been designed to make sure all patients have the safest experience possible whenever they visit the dentist or the doctor. We ensure that imaging is safe and effective in a number of ways:

• We take X-rays only when they are necessary.
• We provide protective gear, such as apron shields and thyroid collars, whenever needed.
• We make use of modern X-ray equipment, for both traditional X-rays and digital X-rays, which exposes patients to a lower amount of radiation than ever before.
• When treating children, we set exposure times based on each child’s size and age.

And now that we’ve talked about some things you might like to know,

Please Let Us Know If . . .

• You are changing orthodontists and have had previous orthodontic X-rays taken. Ask to have your older X-rays sent to our office so we have a complete record of your orthodontic history. (With digital X-ray technology, this transfer can be accomplished with e-mail!)
• You’re pregnant, or think you might be pregnant. Even though radiation exposure is very low with dental radiographs, unless there is a dental emergency, dentists and doctors recommend against X-rays for pregnant patients.

X-rays play an important part in helping us make sure your orthodontic treatment provides you with a lifetime of beautiful and healthy smiles. If you have any concerns, contact our Santa Cruz, Aptos, or Watsonville, CA office. When it comes to making sure you’re comfortable with all of our procedures, including any X-rays that might be necessary, we’re happy to give you all the inside information!

Let’s talk science! From the vastness of the cosmos to sub-atomic particles, science helps us understand the world around us and how it works. So, let’s take some familiar scientific fields of study and apply them to your toothbrush.

My toothbrush?

Yes, indeed! When it comes to your oral health, your toothbrush is the first line of defense, so understanding how and why it works so well might help us use this handy tool even more effectively.

Biology—the study of living organisms

Unfortunately for your toothbrush, the living organisms we’re talking about here are the bacteria which cause tooth decay and those which can lead to illness. How do these problems arise, and how do we prevent them?

Fight Plaque

Plaque is the sticky film that builds up on teeth, and millions of oral bacteria help make up this biofilm. These bacteria convert sugars and other carbohydrates in the foods we eat into acids. And these acids erode our tooth enamel, leading to tooth decay. (More on this when we get to Chemistry.) The best ways to get rid of plaque?

• Brush often. The recommended minimum is two minutes of brushing twice a day, but when you’re having orthodontic work done, it’s even more important to banish the plaque that can stick to your braces or inside aligners. Ask us what brushing schedule is best for you.
• Try an electric toothbrush. For some people with braces, cleaning the teeth is easier and more thorough with an electric brush.
• Replace your brush regularly. Brushes become worn and frayed after three or four months, and you won’t be brushing as effectively.

Stop Germs from Spreading

• Don’t share. Sharing toothbrushes can lead to an increased risk of colds and infections.
• Rinse thoroughly after brushing, making sure you remove any toothpaste or debris left after you brush.
• Store the brush upright and let it air-dry. Covering the brush or keeping it in a closed container can promote the growth of bacteria more easily.
• Keep different brushes separate when they’re drying to avoid cross-contamination.
• Replace your brush regularly!

Chemistry—the study of what makes up substances, their properties, and how they interact

When it comes to improving your brushing chemistry, the best thing you can do for your toothbrush is to put a dab of fluoride toothpaste on it! Why fluoride? Let’s look at the chemistry of tooth enamel.

Tooth enamel is the strongest substance in our bodies—even stronger than bone. But it is not indestructible, and acidic substances can dissolve the mineral bonds which give our enamel its strength, whether they come from the bacteria in plaque or are found in our favorite foods and drinks (sodas, coffee, tomatoes, and citrus are among the tasty, but acidic, culprits).

The enamel in our teeth contains calcium and phosphate ions, minerals which help make it the strongest substance in our bodies. But when the level of acidity in our mouths becomes too high, these minerals begin to dissolve. Eventually, teeth become pitted, bacteria can penetrate more deeply, and decay is the result.

So what can we do? While our saliva helps neutralize acidity naturally, and we can cut back on acidic foods in our diets, using fluoride toothpaste actually helps restore the strength of our enamel in a process known as “remineralization.”

Fluoride works on the surface of enamel to both attract and anchor calcium ions, reducing mineral loss and strengthening the weakened enamel. Fluoride also interacts with the calcium and phosphate compound to create a new compound that is even stronger and more acid-resistant.

When you brush with fluoride toothpaste, you help replace and restore the mineral composition of your enamel—and there’s evidence that fluoride might even interfere with oral bacteria’s ability to produce acid. Now that’s good chemistry!

Physics—the study of matter and energy and their interactions

The matter here is your tooth enamel, and the energy is the force you use when brushing. And this is one time the force should not be with you.

• Over-vigorous brushing can not only damage your brackets, but can also irritate delicate gum tissue and wear down enamel. A “sawing” back-and-forth motion is both hard on your enamel and misses plaque and debris between the teeth. We’ll be happy to show you the safest and most effective way to brush with braces. Just remember, “Massage, don’t scrub.”
• A soft toothbrush is almost always your best option when you use a manual brush, but if you’re still a heavy-handed brusher, or have sensitive teeth and gums, consider an electric model. An electric toothbrush should provide a continuous brushing motion without needing any heavy pressure from the brusher. Some models will even let you know when you are brushing too hard.

Brushing harder is not brushing better, and your teeth, gums, and braces will be heathier with careful brushing habits. If you need tips on brushing with braces, contact our Santa Cruz, Aptos, or Watsonville, CA office and ask!

There’s a lot of science in the simple act of brushing, but we don’t need to spend hours studying to get a passing grade in dental health. The things you do normally—brushing at least two minutes twice a day, using fluoride toothpaste, and applying proper brushing technique—will help create a smile which will earn you top marks from Dr. Don Connolly and Dr. Stanley Sokolow for a lifetime!