To my teen patients

Good oral hygiene is a step toward a healthier life. The older you get, the more decisions you will get to make, and some of these decisions will affect whether your smile is healthy and attractive. Brushing and flossing daily, eating a balanced diet and limiting snacks, and regular visits to your dentist will help you maintain a healthy smile. Many of my patients and their parents have questionsabout diet and its impact on your dental health, oral piercing, and teething whitening procedures. I have provided information below that can be used to assist you in making decisions about your oral health. If you still have additional questions, do not hesitate to contact the office.

Nutrition and dental health
The American Dental Association has long recognized the link between good oral health and proper nutrition. There is a growing concern among dentists that many of their patients are consuming an increasing amount soda, sweetened fruit drinks, and non-nutritious snack foods. Eating patterns and food choices among teens are important factors that can affect their overall dental health.

What can you do
- Maintain a healthy diet;
- Make sure water is readily available and drink water more often; and
- Limit eating and drinking between meals. When you do snack, select nutritious foods.

The U.S. Department of Agriculture’s (USDA’s) Dietary Guidelines encourages people to limit their intake of beverages and foods high in added sugars that may crowd out other health foods from the daily diet. Health and nutrition experts recommend following the USDA Food Guide Pyramid, which includes the following food groups:

- Breads, cereals, other grain products;
- Fruits;
- Vegetables;
- Meat, poultry, fish, dry beans, eggs, nuts; and
- Milk, cheese, yogurt.

Eat a balanced diet and limit between-meal snacks. If you are on a special diet, keep your physician's advice in mind when choosing foods. Limit the number of snacks that you eat, and when you do snack, choose nutritious foods, such as cheese, raw vegetables, plain yogurt, or fruit.

How does the food you eat cause tooth decay?
You are probably aware that your mouth contains many bacteria, but you may not be aware that plaque is caused by bacteria. These same bacteria that cause plaque to form, love the sugar and starch contained in the food you eat. When you don't clean your teeth after eating, plaque causing bacteria convert the sugar and starch to acids that can destroy the hard surface, or enamel, of the tooth. Acid can attack the teeth for 20 minutes or more, eventually resulting in tooth decay. So you can see, eating more often and allowing sugar and starch to remain in your mouth for longer periods of time increase the likelihood of tooth damage. As a result, tooth decay may occur.

Many foods that you might not expect to contain sugar or starch actually contain sugar or starch, including fruits, milk, bread, cereals, and some vegetables. The key to choosing foods wisely is not to avoid these foods, but to think before you eat. Eating foods as part of a meal generally reduces the effects of acid forming bacteria, since more saliva is released during a meal, which helps wash foods from the mouth and helps lessen the effects of acids.

Remember to brush twice a day with a fluoride containing toothpaste, floss or clean between your teeth once a day, and finally, visit your dentist regularly. Together we can help prevent problems from occurring and catch those that do occur while they are easy to treat.

Oral piercing
Oral piercing, which includes piercing of the tongue or lip, has increased in popularity among teens in recent years and is often used to make a fashion statement. But many teens that have their lips or tongues pierced may be looking to their dentists and physicians for help afterwards.

Common symptoms after oral piercing include pain, swelling and infection (since your mouth contains millions of bacteria), an increased flow of saliva, and injuries to the gum tissue. Piercing also can cause uncontrollable bleeding or nerve damage. For example, if the needle used in the piercing process strikes a blood vessel, severe and difficult-to-control bleeding can result. Although rare, your tongue, a popular piercing site in the mouth, could swell large enough to close off your airway. For others, chipped or cracked teeth, blood poisoning or even blood clots have occurred. The jewelry itself also presents some hazards. You can choke on jewelry that comes loose in your mouth.

Before getting your tongue or lip pierced consider all the possible side effects. Consider you dental health and skip the mouth jewelry and let your healthy smile make your fashion statement.

Tooth whitening
Everybody loves a bright white smile. Many people are satisfied with the sparkle they get from brushing with fluoride-containing toothpaste, cleaning between their teeth once a day, and regular visits to the dentist. If you are not satisfied with your smile, there are products and procedures available to help you improve its appearance. If you decide to brighten your smile, investigate all of your options, including:

- In-office bleaching;
- At-home bleaching; and
- Whitening toothpastes

Discuss options with your dentist
You may want to start by speaking with your dentist, since they may be able to tell you whether whitening procedures could be effective for you. Whiteners may not correct all types of discoloration. The effectiveness of whiteners generally varies with the color of the staining of teeth. For example, teeth that have yellowish stains will probably bleach well, brownish colored teeth may bleach less well, and grayish teeth may not bleach well, if at all. Also, bleaching may not enhance your smile if you have bonding or tooth-colored fillings in your front teeth. The whitener will not affect the color of these materials, and they will stand out in your newly whitened smile. In these cases, you may want to investigate other options, like porcelain veneers or dental bonding.

What is in-office bleaching?
If you are a candidate for bleaching, your dentist may suggest a procedure that can be done in the office. This procedure may require more than one office visit, and each visit usually requires 30 minutes to an hour. During this bleaching procedure, the dentist applies a protective gel or rubber shield to your gums to protect them from the bleaching agent. A bleaching agent is then applied to the teeth, and a special light is usually used to enhance the bleaching agent.

What are at-home procedures and products?
There are several types of products available for use at home, which can either be dispensed by your dentist or purchased over-the-counter, including:

Bleaching solutions. These products contain peroxide, which bleaches the tooth enamel and typically rely on carbamide peroxide as the bleaching agent. Carbamide peroxide comes in several different concentrations (10%, 16%, 22%). Peroxide-containing whiteners typically come in a gel and are placed in a mouthguard. Note that directions for use vary. Some products are used twice a day for about 2 weeks, while others are intended for overnight use for 1-2 weeks. If you obtain the bleaching solution from your dentist, he or she can make a custom-fitted mouthguard that will fit your teeth precisely.

You may want to speak with your dentist should you experience any side effects while using bleaching solutions. For example, teeth can become sensitive while you are using the bleaching solution. In many cases, this sensitivity is temporary and should lessen once the bleaching treatment is finished. Other people experience soft tissue irritation from a poorly fitting tray or from bleaching solution that contacts the soft tissue of the mouth. If you have concerns about such side effects, you should discuss them with your dentist.

Toothpastes. All toothpastes help remove surface stains through the action of mild abrasives. Whitening toothpastes have special chemical or polishing agents that provide additional stain removal effectiveness. Unlike bleaches, however, these products do not alter the intrinsic color of teeth.