Happy New Year!!! Tips for Caregivers on excellent oral hygiene…

Caregivers are responsible for the oral and overall health of those they care for.  As a caregiver, many questions may come to mind regarding your responsibilities for one’s oral health:


How should I go about caring for someone’s mouth and teeth?  What type of dental hygiene routine is best for my loved-one, friend or patient?  What is the proper way to brush and floss teeth?  How often should my dependant see his/her Professional Dental Team?  What types of oral health products should I use that will allow me to provide the best oral care I can?  How do I clean false teeth?


Our goal is to help answer these questions and to provide information that you can use to improve your overall practices for excellent dental health, whether it be your own or someone else’s.


When the question of how to provide care for someone else’s oral health comes to mind, try to think of how you would care for your own mouth.  Brushing your teeth twice a day (morning/night) and flossing once a day, should come to mind…  When brushing, be sure to use a soft-bristled toothbrush and a toothpaste that contains fluoride.  Fluoride helps strengthen the outer layer of the teeth to prevent cavities.  You shouldn’t use a medium or hard-bristled toothbrush because the rigid bristles can damage the gums and cause them to recede.  When the toothbrush bristles become ‘wilted or frayed’ in appearance, it’s time to change to a new one.  A good rule of thumb is to replace your toothbrush every three months, or whenever you’ve been sick.  Changing your toothbrush after you’ve been sick is extremely important—the bristles can harbor bacteria and prolong your illness.  Always use a light, but firm pressure when brushing.  For instance, imagine that you are brushing a ripe tomato and don’t want to bruise it.  These use and maintenance tips also apply to those who use electric toothbrushes.


It can be more difficult flossing someone else’s then than flossing your own, but the principles are the same.  To properly floss, take a piece of floss approximately           18-inches long and wrap it around your middle fingers.  Use your index fingers and thumbs to guide the floss between the teeth.  Once the floss is in between two adjacent teeth, be sure to adapt the floss to each tooth, forming the floss into a ‘C’ shape.  Gently slide the floss below the gumline, adapt to the adjacent tooth and do the same.  There are several flossers or floss picks on the market that can help assist with this motion.  The concept remains the same…you must adapt the floss to each tooth!



Ideally, everyone should see their dentist every six months and in some cases, more frequently.  Your dentist and dental hygienist work together at these visits to assess the health of your gums and teeth.  The dental team will determine the proper visit interval to ensure that an excellent level of health is maintained in your mouth.  Aside from assessing the health of your mouth and having a professional cleaning, the doctor will also perform an oral cancer screening at your regular visit.  The members of your dental team are the only health care professionals that look into your mouth on a regular basis.  It is imperative for them to establish a baseline of what your mouth looks like and record the presence of any abnormalities.  Regular oral cancer screens ensure your mouth is examined for cancer on a consistent basis and the necessary precautions and/or treatments are performed in the event an abnormality is found.



The following are important points when caring for those with false teeth or dentures:  Make sure the dentures are taken out every night before sleeping.  Your gums need to breathe!  Keeping the dentures in place all day and night can cause the gum tissue to become red and irritated.  Irritated gum tissue can cause discomfort when wearing the dentures.  Constant wearing of dentures can also cause oral infections.  When cleaning dentures, be sure to brush them as you would your own teeth.  Use a denture brush or a soft-bristled toothbrush and denture cleaner—you may also use an antibacterial soap or a mild dishwashing liquid.  When the dentures are out of the mouth, they can be soaked in a denture cleanser or water, to help avoid drying and potentially losing their form.  Before replacing the dentures in the mouth, gently brush the gums and tongue to stimulate circulation and remove any plaque debris that may be present.



Remember that your Professional Dental Team is here to help you.  If you need any assistance or have any questions about caring for your loved ones, don’t hesitate to contact them.  As a caregiver, be sure to remember what is necessary to care for one’s oral health: brushing twice a day with fluoridated toothpaste, daily flossing, eating well-balanced meals, and visiting your Dentist regularly.


Children’s Dental Health

Children’s Dental Health

Matthew Norman, DDS and Michelle Phillips, RDH


February is Children’s Dental Health Month.  It is important for both parents and children to value the care of the child’s teeth from the beginning.  Good oral home care begins very early on, even before the first tooth comes in.


Your child’s first dental visit should occur by the time they have their first birthday.  The primary reason for a visit to the dentist at this young age is to assess the child’s mouth for possible abnormalities and to check for the presence of any erupted baby teeth.  Most importantly, this visit provides the parent with an opportunity to answer any questions they may have regarding caring for their child’s mouth and teeth.


While your child is an infant, you will want to wet a washcloth and rub it along the baby’s gums to keep their mouth clean. Your child’s first dental cleaning is typically around age 3.


Caring for your child’s teeth is no different than your caring for Fluorideyour own.  They should brush their teeth twice a day and floss once a day.  Keep in mind that children do not have the manual dexterity to effectively clean their teeth on their own, and will need your help.  A child should not brush alone until the age of 7 and floss alone until the age of 9.  And when applying toothpaste, simply use a “pea” sized amount to ensure they are getting a healthy amount of fluoride.


After a child begins to get his/her teeth, be sure to use a fluoride-free toothpaste until they can effectively spit the toothpaste out, generally at age 3-4.  Once a child can successfully spit out toothpaste, it is important to provide them with one that does contain fluoride.   Fluoride is very beneficial to your child’s dental health.  There are two types of fluoride: systemic and topical.  The fluoride found in the toothpaste, or fluoride treatments at the dental office are considered topical – this only helps strengthen the teeth that are currently present in the mouth.  Systemic fluoride, such as that found in city water or fluoride tablets/drops, is ingested into the body and helps to strengthen the permanent teeth that are currently developing underneath the gums.  Both types of fluoride are very beneficial and needed for optimum dental health.


Around the age of 6, children begin erupting their permanent teeth.  The first teeth that typically erupt are the permanent first molars in the back of the jaw and the two middle front teeth. The permanent first molar teeth are typically referred to as the 6-Tooth-Sealantsyear molars, because of the age they commonly erupt.  Once these permanent molars fully erupt, we may discuss placing dental sealants.  A dental sealant is a completely non-invasive procedure that helps further protect these molars from developing cavities (see Example above).  Naturally, these permanent molars have deep pits and grooves and are a common place for tooth decay to occur.   The dental sealant liquid is placed into the grooves of the tooth and hardened it with a curing light.  After the sealant is hardened, it is bonded to the tooth and provides a smooth surface across the top of the tooth to help prevent cavities.


Below is a tooth eruption chart with the approximate age that babies with begin to get their primary teeth, as well as the estimated age in which they will lose the baby tooth and begin to erupt the permanent teeth.

eruption chart

If you have a child in need of a dentist, or have any dental-related questions about your child, feel free to call Norman Dental at 336-282-2120.

Good Oral Hygiene with Dexterity Difficulties

Good Oral Hygiene with Dexterity Difficulties

Michelle Phillips, RDH


With one who has dexterity difficulties such as arthritis, there are several oral hygiene aids that can help.  There are things such as electric toothbrushes and flossers out on the market now to aid in good oral hygiene.

Electric toothbrushes come in an array of varieties, with the basic function all the way up to those with all the bells and whistles.  They can cost from less than $10,  and even go up to over $100.  Electric toothbrushes help those with a lesser ability to grasp small things like a manual toothbrush.  Most come with a substantially larger handle compared to the manual brush.  Another good feature of the electric brush is that the head will either oscillate or rotate, so all you have to do is literally hold the brush on your teeth and move it from tooth to tooth.  Other potential features of electric brushes could include a two-minute timer and pressure sensors.  Two minutes is the optimal time to brush.  Some electric toothbrushes will give some sort of pulsation when two minutes have lapsed, so that the optimal brushing time is achieved.  The pressure sensor is good for those that may have sensitivity due to gum recession.  This indicator will usually turn the brush off momentarily to let you know that you’re pressing too hard.


Flossers are aids to help someone floss without having to wrap the floss around your fingers.  There are disposable flossers and those that tend to be larger that you have to insert floss into.  An arthritic patient is a great candidate for these flossers, because you don’t have to hold the floss on your fingers and manipulate it in the mouth, you simply hold the handle instead.


Another option for those unable to grasp small things like the handle of a manual toothbrush is to cut a small hole in a tennis ball and insert the handle of the toothbrush.  With this, it’s much easier to grasp the tennis ball than the toothbrush handle.




One last alternative is to place a rubber band around the handle of the toothbrush, around the back of the hand, then back on the toothbrush handle.  This way, no grasping is required!



These are some useful alternatives to helping those that may have some dexterity difficulties with brushing and flossing.

Dry Mouth and its Effects on the Oral Environment

Dry Mouth and its Effects on the Oral Environment

Matthew Norman, DDS and Michelle Phillips, RDH

Xerostomia is the dental term for dry mouth.  One out of every four adults suffers from some form of dry mouth.  Several factors can contribute to the presence of dry mouth such as: diabetes, anxiety, alcohol consumption, trauma to a salivary gland/duct, radiation/chemotherapy treatment for cancer, and medications.  Medications are the most common cause of dry mouth—both prescription and over-the-counter.  The more medications that a person is taking, the higher the risk that individual is to have diminished salivary flow and a dry mouth.

Saliva performs many functions.  Not only does saliva help to moisten the tissues in your mouth, but it also helps keep your mouth and teeth healthy and clean.  There are certain enzymes present in your saliva that help to digest food and plaque that adhere to your teeth after eating. If the salivary flow in your mouth is diminished, plaque and food sticks to your teeth more resiliently which increases the chance of having tooth decay or cavities.  Dry mouth can also lead to mouth infections, bad breath and periodontal (gum) disease.  Someone suffering from dry mouth may have gum tissue that appears red, a “cracked-looking” or red tongue.  The tongue can even appear shiny from the dryness.  Dry mouth has also been linked to an overall burning sensation in a person’s mouth.

Currently, there is no treatment available to directly increase someone’s salivary flow or the amount of saliva one produces, but salivary substitutes do exist.  One “over-the-counter” option available is a salivary substitute called Biotene.  Biotene comes in several forms—a mouthwash, toothpaste, moisturizing gels and even a chewing gum.  The Biotene products help to lubricate and protect your mouth just as your own saliva would.  Incorporating these salivary substitutes into your daily oral hygiene regime can improve your oral health and comfort while decreasing the risk of tooth decay caused by diminished salivary flow.

Another option for defense from the effects of xerostomia is fluoride.  Fluoride helps strengthen the outer layer of the tooth to prevent tooth decay.  As mentioned earlier, plaque and food can more easily stick to teeth in a dry mouth, attacking the minerals in the enamel to cause cavities.  Fluoride mouthrinses, such as ACT, helps to counteract this process and strengthen the teeth.

Whether you have a dry mouth or not, brushing twice a day with a fluoridated toothpaste, flossing once a day and visiting your Dentist on a regular basis (at least twice a year), is your best defense against tooth decay and gum disease!

Your Dental Health Can Indicate Other Health Issues

Your Dental Health Can Indicate Other Health Issues

By: Matthew Norman, DDS and Michelle Phillips, RDH


Your teeth, gums, tongue, and overall oral health are a reliable indicator of other overall health issues. Heart disease, diabetes, HIV, osteoporosis and eating disorders are examples of health issues which have symptoms visible in the mouth. Teaming with your Dental Office for regular checkups can help identify these conditions.


Cardiovascular disease is very closely linked with the health of your mouth and the presence of infection. Those with periodontal (gum) disease are at higher risk of developing cardiovascular disease. Some studies have suggested that heart disease, clogged arteries and even stroke may be associated with the oral bacteria present with periodontal disease. Your mouth has an abundance of bacteria— both good and bad. Bacteria have the ability to enter your bloodstream, especially in an unhealthy mouth with swollen or bleeding gums. Once in your bloodstream, the dangerous bacteria can pass to your heart and cause infection in the inner lining of the heart. This is a very important reason to maintain optimal oral hygiene. By practicing good brushing and flossing habits, bacteria remain at healthy levels and have a lessened chance of entering the bloodstream.



Your mouth is the gateway to the rest of your body and can reveal a great deal about your overall health.  Diabetes is an example of a systemic disease which has a direct relationship with your oral health.  Diabetes inhibits the body’s ability to fight against infection.  People with diabetes must keep their blood sugar levels under control.  When a diabetic patient has uncontrolled blood sugar levels, the risk of having more-frequent and severe gum infections increases—opposed to those with controlled blood sugar levels.



Other systemic diseases that can be detected based on conditions present in the mouth.  HIV / AIDS patients are prone to having painful sores in the mouth.  They also have an increased risk of developing thrush—a fungal infection in the mouth.  Osteoporosis is a condition in which the bones become weak and fragile. This includes the bones of the jaw that support your teeth, which can eventually lead to tooth loss.  Patients suffering from eating disorders, such as bulimia, can cause chemical erosion to their teeth due to the stomach acid which consistently comes in contact with the teeth.


Not only is saliva your main defense mechanism against the harmful bacteria and viruses in your mouth, but it can be a tool in diagnosing systemic disease.   Dental offices now have the ability to test and analyze your saliva.  The testing can diagnose many diseases such as: diabetes, Parkinson’s disease, cirrhosis of the liver, oral cancer, breast cancer, HIV, hepatitis, periodontal disease and cardiovascular disease.  These conditions have specific markers which show up in your saliva that these tests can identify.  Salivary tests are completely harmless and non-invasive to perform.


Your mouth is a vital information source about the condition of your overall health.  Practicing excellent oral hygiene will help to keep your mouth and teeth healthy, as well as other areas of your body.  It is important to see your dentist on a regular basis to ensure your mouth is in a healthy condition.  Your regular dental appointment is also an opportunity for your dentist to examine your mouth and check for conditions which can indicate the presence of other diseases.


Radiation & Chemotherapy – the Effects on Your Mouth

Written By:

Matthew Norman, DDS and Michelle Phillips, RDH


With the prevalence of cancer becoming more widespread, it is important to be aware of and know how to manage side effects that cancer treatment can cause in your mouth.  Radiation and chemotherapy are two different types of treatments for cancer, but can have similar effects in the oral cavity.  Radiation therapy and chemotherapy can cause cavities, mouth sores, oral infections, dry mouth, bleeding gums, and mouth pain/soreness.  Most symptoms are acute, meaning that they begin shortly after treatment begins and go away shortly after treatment ends.  The symptoms can last indefinitely when there is direct treatment to the head and neck.

Cancer cells are generally the fastest growing cells in the body and these rapidly dividing cells attack the healthy cells.  Chemotherapy works by killing all the rapidly growing cells in your body, while killing healthy cells at the same time.  Radiation therapy is generally more site-specific, targeting the cancerous lesion but healthy cells are affected too.  The cells lining the mouth are fast-growing, making it more likely for these cells to be damaged by the treatment. 

Dry mouth can arise from both radiation therapy and chemotherapy treatments.  Dry mouth is typically the root to the other side effects associated with cancer treatments.  When the gum tissue is dehydrated and very dry to the touch, any trauma (from a toothbrush, floss, or food) can not only cause your gums to bleed, but this trauma can also cause a mouth sores.  Because your immune system is compromised while going through radiation and chemotherapy treatments, these areas heal at a slower rate.  When the tissues in your mouth are really dry, it may even be painful to eat and swallow, which can create nutritional deficiencies.  Your taste perception can also be altered by these treatments, which can compound the problem of malnourishment or dehydration.  Dry mouth is a major instigator of rampant dental caries (or decay), especially on root surfaces of teeth.  Saliva is very important in protecting our teeth from tooth decay—there are certain enzymes present in our saliva to defend against the formation of dental caries.  Saliva helps to wash the teeth clean to remove the plaque or food debris that may be present.

Maintaining a healthy mouth is very important while going through radiation therapy and chemotherapy.  There are several things that can be done to help keep your mouth healthy.  To help keep the mouth moistened, you can suck on ice chips, sip water frequently, chew sugar-free candy and gum, or use saliva substitutes.  You also want to be sure to keep your teeth and mouth as clean as possible.  Using an extra-soft toothbrush and gentle flossing will be kinder to your gums.  Try to keep away from foods with sharp edges, like chips, to avoid any scratching or trauma to the gum tissue.  Additionally, hot and spicy foods may be uncomfortable if you’re suffering from dry mouth, as it may cause a burning sensation.

Fluoride exposure is especially important when undergoing cancer treatments.  Fluoride helps to strengthen the teeth and prevent cavities, especially when a dry mouth is present.  Fluoride-containing toothpaste and mouthrinses are critical throughout your treatment.  Fluoride varnish treatments should be applied at your regular dental hygiene appointments.  If dental decay becomes a problem during your treatment, your Dentist may recommend making custom fluoride trays to allow for frequent fluoride treatments at home.  If mouth sores become a problem, your Dentist can prescribe a rinse to help with the discomfort.  This rinse contains a numbing agent (for pain), and an anti-fungal/anti-bacteria component to speed up healing.

It is extremely important to be examined by your Dentist to ensure your mouth is in a healthy condition before you begin your cancer treatment.  As you undergo your cancer treatments, be aware of your mouth and the condition it is in.  Keep in mind these tips which will help you to manage the possible symptoms that may arise while going through radiation therapy and chemotherapy.  Continue your hygiene appointments with your Dental Office and don’t hesitate to call if you have any problems.