Babies typically start to experience tooth eruption some point between 4 months to 7 months, with some babies getting tooth earlier or later than average. By the time all 20 baby teeth have erupted, the child is typically between 2 to 3 years of age. Signs of baby teething: more fussy than usual difficulty falling asleep refusing to eat drooling more than usual more biting than usual less common: fever, rashes, cough, and diarrhea Keep in mind that these signs may start a few months before the tooth erupts. What can I do to make my teething baby more comfortable? Most of the signs and issues with teething stem from tender gums. The best way to soothe the gums is by gentle rubbing with a cool instrument. A cool spoon, cold chew toy, or a clean, moistened then frozen rag may relieve your child's discomfort. Are teething gels safe for babies? The FDA warns against using teething gels, many of which contain benzocaine to numb the gums, without direct supervision of a health professional as methemoglobinemia is possible. Signs of this rare but sometimes fatal condition include: pale, gray, or blue-colored skin, lips, nail beds shortness of breath fatigue confusion headache lightheadedness rapid heart beat What about oral viscous lidocaine for teething babies? Oral viscous lidocaine is also discouraged by the FDA due to risk of seizures, severe brain injuries, and heart problems if given in too high of a dose. The best thing to do when your child gets his or her first tooth is to schedule a visit with your dentist. She or he will be able to review techniques for discomfort, how to properly clean your baby's teeth, discuss habits and conditions that can affect tooth or jaw growth, and many other topics. Your child's first dental visit should be within 6 months of their first tooth or by their first birthday. They may not let you do much at first, but the sooner they come in, the more comfortable they'll become! Dr. Stephanie Stephan DDS, Dentist in Auburn Hills, Pontiac, and Waterford Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

Tooth erosion, or tooth wear, is the loss of the surrounding tooth structure. This loss occurs when the enamel (the hard part of your teeth) is worn away by acid. Over time, this erosion can leave your teeth sensitive, cracked, and discolored. What causes tooth erosion? Acid is the main cause of tooth erosion. Plain and simple. Drinks that contain carbonic acid (aka "carbonated drinks") such as energy drinks, sports drinks, and pure fruit juice, can cause tooth erosion, especially when consumed in large amounts. In addition, certain medical conditions, including acid reflux and bulimia, also can cause tooth erosion by increasing the levels of stomach acids in the mouth. What are the signs and symptoms of tooth erosion? Sensitivity – Since protective enamel is wearing away, you may feel a sharp pain when you consume hot, cold, or sweet foods and drinks. The more enamel that is worn, the more sensitive your teeth can become. Discoloration – As the enamel wears away and the dentin layer (inner layer) of your tooth becomes exposed, teeth appear more yellow in color. Rounded teeth – Your teeth may have a rounded or “sand-blasted” look. Transparency – Your front teeth may appear slightly transparent, especially near the biting edges. Cracks – Small cracks and rough areas may appear at the edges of your teeth. Cupping – Small dents may appear on the chewing surfaces of your teeth, and fillings might appear to be rising up out of the teeth. What can I do to prevent tooth erosion? Most importantly: watch what you're eating and drinking. Cut down on your consumption of carbonated beverages, sports and energy drinks, and pure fruit juice. Drink acidic drinks quickly and with a straw. This helps prevent acid from coming in contact with your teeth. Also, don’t swish these liquids around or hold them in your mouth for long periods of time. After consuming acidic drinks, rinse your mouth with water to neutralize the acids and wait at least one hour before brushing your teeth. Often people will have breakfast drinks such as coffee or orange juice and brush immediately after. DON'T DO THIS! Doing so will wear away your weakened enamel. Give it time for the pH in your mouth to neutralize before brushing your teeth. Chew sugar-free gum, which helps your mouth produce more saliva to re-mineralize your teeth. Brush with a soft toothbrush and be sure your toothpaste contains a high amount of fluoride. Don’t let your child consume highly acidic drinks or fruit juices in his or her sippy cup or bottle. How can I deal with the sensitivity caused by tooth erosion? You can reduce sensitivity by receiving fluoride treatments at your dental office and using specially formulated toothpaste or over-the-counter enamel-building products. Tooth erosion impacts everyone in different ways. Make sure you speak with your dentist about your oral hygiene and find out what else you can do to protect yourself from tooth erosion. Dr. Stephanie Stephan DDS, Dentist in Auburn Hills, Pontiac, and Waterford Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

There are many causes of sensitive teeth. If you have sensitive teeth, it's important to figure out why so that you can know what to do about it. While tooth sensitivity usually indicates that something is wrong, sensitive teeth can be treated. What causes tooth sensitivity? Tooth decay (cavities) Fractured or cracked teeth Worn or deep fillings Pressure on teeth - from clenching or grinding Gum disease or poor oral hygiene - from poor homecare or irregular dental visits Worn tooth enamel - from diet or aggressive brushing Exposed tooth root - from gum disease, grinding/clenching, or aggressive brushing In healthy teeth, a layer of enamel protects the crowns of your teeth (the part above the gum line). Under the gum line, a layer called cementum protects the tooth root. Underneath both the enamel and the cementum is dentin. Dentin is less dense than enamel and cementum and contains microscopic tubules (small hollow tubes or canals). When dentin loses its protective covering of enamel or cementum these tubules allow heat and cold or acidic or sticky foods to reach the nerves and cells inside the tooth. Dentin may also be exposed when gums recede. The result can be hypersensitivity. How are sensitive teeth treated? The type of treatment depends on what is causing the sensitivity. Tooth decay (cavities): Your dentist will remove the decay and place a filling. A liner or root canal therapy may be needed if the cavity is approaching or into the tooth's nerve. Fractured or cracked teeth: A crown, inlay, or bonding may be needed along with the possibility of root canal therapy. In some cases, the crack may go so far down the root that saving the tooth may not be possible. Worn or deep fillings: For worn fillings, replacement will usually improve or eliminate the issue. For deep fillings, replacement with or without the use of root canal therapy may be needed. Pressure on teeth: A custom-fitting night guard will help you to overcome this habit and/or protect your teeth when you are clenching or grinding. Gum disease or poor oral hygiene: Regular dental care, prophylaxes, and deep cleanings can help your gum tissue to bounce back a bit and help with root exposure. Unfortunately, bone does not grow back once lost so desensitizing toothpastes and fluoride treatments are often recommended. Worn tooth enamel: Unfortunately enamel can't grow back once lost so desensitizing toothpastes and fluoride treatments are often recommended. Crowns or veneers may also be an option if the wear is severe enough. Exposed tooth root: Surgical gum grafts, fillings along the gumline, and fluoride treatments are often the recommended treatments. If gum tissue has been lost from the root, gum grafts or fillings will protect the root and reduce sensitivity. How do sensitivity toothpastes and fluorides work? Desensitizing toothpaste: This contains compounds that help block transmission of sensation from the tooth surface to the nerve, and usually requires several applications before the sensitivity is reduced. The brand you use doesn't matter much. Whichever one you will use is the best one for you! Fluoride gel: This is an in-office technique which strengthens tooth enamel and reduces the transmission of sensations. Proper oral hygiene is the key to preventing sensitive-tooth pain. Ask your dentist if you have any questions about your daily oral hygiene routine or concerns about tooth sensitivity! Dr. Stephanie Stephan DDS, Dentist in Auburn Hills, Pontiac, and Waterford Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

We know we should floss at least once a day, but not everyone knows the right way to do it. Use this step-by-step guide to find out how to properly floss your teeth: 1. Break off about 18 inches of floss and wind most of it around one of your middle fingers. Wind the remaining floss around the same finger of the opposite hand. This finger will take up the floss as it becomes dirty. 2. Hold the floss tightly between your thumbs and forefingers. 3. Guide the floss between your teeth using a gentle rubbing motion. Never snap the floss into the gums. 4. When the floss reaches the gum line, curve it into a C shape (as viewed from the chewing surface of your tooth) against one tooth. Gently slide it into the space between the gum and the tooth. 5. Hold the floss tightly against the tooth. Gently rub the side of the tooth, moving the floss away from the gum with up and down motions. Repeat this method on the rest of your teeth. Don’t forget the back side of your last tooth. Once you’re finished, throw the floss away. A used piece of floss won’t be as effective and could leave bacteria behind in your mouth. And if you can't fit your fingers all the way back there, consider other methods of interproximal plaque removal such as floss-picks and angled flossers (floss on a plastic handle). Dr. Stephanie Stephan DDS, Dentist in Auburn Hills, Pontiac, and Waterford Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

This is never a great position to find yourself. You or your child had a bad fall/was playing a sport/had one too many... and you find yourself with a tooth (or part of one) in your hand. Is this a dental emergency? Who do you call? What should you do? Baby (Primary) Tooth: Under the age of ~12 (or if you have a retained baby tooth), there's a good chance that the tooth that has been injured is a baby tooth. Sometimes it's easy for you to tell, sometimes it's not. It's important to make that distinction because what you do when trauma occurs can be different for a baby tooth. This chart may help you make that distinction: Now, if it is a baby tooth read on. If not, skip to the next section. Is it an IMMEDIATE emergency? Typically, with a baby tooth, most trauma cases are not emergencies in the sense that you need to get in to see your dentist RIGHT AWAY. Treatment will be the same if the dentist sees them at midnight or in two days, and children are generally upset or in pain and won't let the dentist perform any treatment or even take a look in some cases. Who do I call? Your general dentist, or if your child is seeing a pediatric specialist, will be your best bet. Give your dentist a call and set up an appointment to see them soon. You definitely want someone to take a look at the area, likely take a radiograph (x-ray), and possibly recommend or perform treatment. If there are any teeth knocked out, or pieces broken, bring those with you to the appointment whenever possible. What do I do? That depends on what happened. Find your case below... If the tooth was hit and is Not Moving and often not missing any pieces: We call this concussion if the tooth was hit but is not moving, not out of position, and there's no bleeding. You should see your dentist who will likely take a radiograph for a baseline image and monitor the tooth. Future issues such as nerve damage or nerve death are possible and your dentist will know how to deal with these. We call this lateral luxation if the tooth was hit but is not mobile though it is out of position. You should see your dentist who will likely take a radiograph for a baseline image, closely monitor the tooth, and possibly recommend trying to move it back in position likely with anesthesia, allowing the tooth to naturally reposition, adjusting the bite, or extracting the baby tooth early...it all depends. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these. If the tooth was hit and Is Moving and often not missing any pieces: We call this subluxation if the tooth was hit and is moving, possibly with bleeding. You should see your dentist who will likely take a radiograph for a baseline image and monitor the tooth. Future issues such as nerve damage or death are possible and your dentist will know how to deal with these. We call this root fracture if the tooth was hit and it looks like the tooth is moving. This time, though, it's moving because the root is fractured. You should see your dentist who will likely take a radiograph and likely recommend repositioning and splinting for a few weeks followed by close monitoring. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these. We call this alveolar fracture if the tooth was hit and it looks like the tooth and the bone around it are moving. This time, though, it's moving because the jaw bone is fractured. You should see your dentist who will likely take a radiograph and likely recommend repositioning and splinting for a few weeks followed by close monitoring. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these. If the tooth was hit and is Knocked In or Out of the Gum: We call this extrusion if the tooth was hit and is moving out of position and it looks like the tooth is going to fall out. You should see your dentist who will likely take a radiograph for a baseline image, closely monitor the tooth, and possibly recommend trying to move it back in position, allowing the tooth to naturally reposition, or extracting the baby tooth early. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these. We call this intrusion if the tooth was hit and it looks like the tooth has moved into the bone. You should see your dentist who will likely take a radiograph for a baseline image and either recommend allowing the tooth to naturally reposition and closely monitoring or extracting the baby tooth early so as not to cause further damage to the adult tooth. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these. If the tooth was Knocked OUT: We call this avulsion if the tooth was hit and is knocked out of the mouth. You should see your dentist who may take a radiograph for a baseline image or to make sure the tooth isn't lodged in the bone (especially if you can't find the tooth) and likely recommend palliative care if needed and monitoring especially for any problems with the adult tooth. Future issues such as problems with the adult tooth are possible and your dentist will know how to deal with these. IT IS IMPORTANT TO NOTE THAT, UNLIKE IN AN ADULT TOOTH, YOU SHOULD NOT TRY TO REIMPLANT THE TOOTH IN THE MOUTH. A baby tooth that is knocked out should stay out. If the tooth is chipped or part of it is broken: We call this fracture if part of the tooth is missing. Whether it's a small chip or a big chip where the nerve is exposed, or the crown of the tooth is gone and the root is left, you should see your dentist. The larger the chip or fracture, the more urgent it is to see them right away. Your dentist may take a radiograph and then recommend treatment that can range from something as small as smoothing and monitoring the tooth to a filling or to something as major as a partial baby root canal and build-up to an extraction. It really depends on how big the chip is, what parts are broken, and if the nerve is involved. You'll want your dentist to check this out. IMPORTANT TO NOTE: Teeth that are chipped or broken can also have further root or bone issues, one issue noted above does not mean there aren't other issues as well. You should also keep an eye out for discoloration of the tooth which could mean nerve damage or death, as well as for an abscess (a "pimple" on the gums) by the traumatized tooth and let your doctor know right away if you notice these changes or your child complains of sensitivity or pain. You should also note that baby tooth trauma can sometimes affect the developing adult tooth underneath it, so other issues may be noticed when the adult tooth erupts. Adult (Permanent) Tooth: If you, or your child, are/is over the age of 5 or 6, there's a chance that the tooth that has been hit, broken, or fallen out is an adult tooth. Is it an emergency? Typically, with an adult tooth, minor trauma cases are not emergencies in the sense that you need to get in to see your dentist RIGHT AWAY. However, typically, timing is more important so you should schedule to see your dentist as soon as possible, even if that is in a day or two. Emergencies requiring treatment as soon as the trauma occurs include: a tooth that has been knocked out or a chipped tooth where the nerve is exposed - timing here is critical! Who do I call? Your general dentist will be your best bet. You definitely want someone to take a look at the area, likely take a radiograph (x-ray), and possibly recommend or perform treatment. If it is an emergency and you can't get a hold of your dentist quickly enough, call an office that is open or has an emergency line and go see them for your trauma care. Follow up with your dentist after. What do I do? That depends on what happened. Find your case below... IMPORTANT TO NOTE: In an adult, radiographs are generally always taken because, unlike some kids, you can sit still enough for them. They are important in making decisions long-term and determining if there have been any changes during follow-up appointments. If the tooth was hit and is Not Moving and often not missing any pieces: Concussion - similar to above. See your dentist within a few days to closely monitor. Lateral luxation - similar to above. See your dentist soon! See your dentist who will take a radiograph and likely recommend trying to move it back in position likely with anesthesia and stabilize with a flexible splint for a few weeks. If the tooth was hit and Is Moving and often not missing any pieces: Subluxation - similar to above. See your dentist who will take a radiograph and possibly recommend a flexible splint for a few weeks. Root fracture - similar to above. See your dentist soon! Repositioning and splinting for a few weeks to a few months is common. The options and prognoses of this fracture depend on where the fracture is on the root. Long-term this may mean root canal therapy or even extraction. Alveolar fracture - similar to above. See your dentist soon! Repositioning and splinting for a few weeks followed by close monitoring. Long-term this may mean root canal therapy or even extraction. If the tooth was hit and is Knocked In or Out of the Gum: Extrusion - same as above. You should see your dentist soon who will likely take a radiograph for a baseline image, reposition the tooth, and stabilize it with a flexible splint for a few weeks. Root canal treatment is often needed as is regular follow-up. Intrusion - same as above. Depending on the age of the patient's tooth, either passive eruption or orthodontic/surgical repositioning stabilized with a flexible splint are recommended. You should see your dentist soon. Root canal treatment is often needed as is regular follow-up.  If the tooth was Knocked OUT: Avulsion - same as above. THIS IS THE TRUEST DENTAL EMERGENCY. You should try to see your dentist - or any dentist available - WITHIN 60 MINUTES for the best long-term prognosis. If you really can't get to your dentist or an emergency dentist within an hour or two, if it's just not possible, be aware that your treatment plan may be different. Your treatment depends on when you are able to see the dentist and what your situation looks like. WHAT YOU CAN DO TO HELP YOUR TOOTH SURVIVE BEING KNOCKED OUT: IMPORTANT TO NOTE: avoid storing your tooth in water! If you can't find milk, saline, or Hank's Balanced Salt Solution, use your spit or store the tooth in your cheek until you can see your dentist. If the tooth is chipped or part of it is broken: Fracture - same as above. Whether it's a small chip or a big chip where the nerve is exposed, or the crown of the tooth is gone and the root is left, you should see your dentist. The larger the chip or fracture, the more urgent it is to see them right away. Your dentist will take a radiograph (maybe not if the chip is really small) and then recommend treatment that can range from something as small as smoothing and monitoring the tooth to a filling or to something as major as a root canal and build-up with a gingivectomy to surgical or orthodontic extrusion to an extraction. It really depends on how big the chip is, what parts are broken, and if the nerve is involved. You'll want your dentist to check this out. If your chip is relatively large in size, bring it to your dental appointment. Sometimes that piece can be reattached and often is the nicest looking option in terms of replacement. If you have any further questions, ask your family dentist, they are always happy to help - especially in cases of trauma! Stay safe out there! Dr. Stephanie Stephan DDS, Dentist in Auburn Hills and Rochester Hills, Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

With such a complex topic, it's hard to dive in with just one blog posting, so I'll touch on same basic questions I've been getting and get into the nitty gritty in multiple future posts! At some point in your life, you may need a root canal, which is then often capped with a crown. It's important to keep in mind that every case is different, and there are often multiple "right ways" to treat someone's tooth, so the best person to answer your questions is your own dentist who knows your history, your past dental treatments, and can see your radiographs (x-rays) and come up with an individualized plan that's right for you. Q: Why do I need a root canal? A: Root canal treatment may be necessary for different reasons. But whatever the reason, it is best to consider root canal treatment as a means to try and save the tooth. The nerves and blood vessels within the roots of our teeth can become infected through disease such as tooth decay, trauma from athletic injuries, or as a result of long-standing large fillings. Unfortunately, unlike in the body this infection will not heal by antibiotics alone. The infected material must be removed from the roots (or the roots themselves need to be taken out through tooth extraction), and the space must be filled with a non-toxic biocompatible material. Q: How long will the procedure take? A: To perform this procedure well and to ensure the canals have been cleaned adequately significant time is required. Sometimes multiple appointments are necessary, depending on the number and condition of the roots. Every situation is different, as the extent of existing infection can influence both the procedure and the recovery. The need for sedation or the patient's desire to return to work is more dependent on the patient’s comfort with the appointment, as opposed to the technical aspects of the procedure itself. Q: Will there be pain or discomfort? A: It is best to anticipate a certain degree of discomfort when chewing on the tooth for a few days following root canal treatment. So, plan for a diet that is comfortable to chew. (In many cases, it is more than likely that discomfort was experienced when chewing before the root canal was performed due to the infection present). Q: Why do I need a crown? A: Not all teeth that have had a root canal require a crown afterward. But because the nerve is attached to the blood supply, the tooth becomes very dry and fragile once the root canal is completed. More often than not, we see patients who spent good money to save the tooth with the root canal who do not continue on to get the protection from the crown return to us a year or two later with a fractured tooth that now requires an extraction. If the structural integrity of the tooth has been significantly compromised, a crown is often the best option to help save the tooth. Every situation is unique - ask your dentist for her or his opinion. Q: Why are a root canal and a crown performed at separate appointments? A: Most often, the crown procedure is accomplished at an appointment separate to the root canal. Part of this reason is for your own comfort. A root canal appointment is often a lengthy and sometimes unpredictable appointment. In addition, certain crowns require two appointments, depending on the process and materials required, for optimal results. Good things take time! Keep an eye out for more detailed Root Canal posts in the future! Dr. Stephanie Stephan DDS, Dentist in Auburn Hills, Pontiac, and Waterford Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

Brushing your teeth is not enough to maintain healthy gums. You need to remove plaque in order to have healthy gums and teeth. This includes removing plaque from between your teeth where your toothbrush can't reach. Gum disease is the most common dental problem and can become serious to the point of tooth loss if not arrested. Prevention is the key to fighting gum disease and saving your teeth. This is why using interdental cleaners, such as floss and interdental brushes, is an essential part of a good oral health routine for both adults and kids. Parents and caregivers should start flossing their child’s teeth as soon as at least two teeth are touching each other. The anatomy of the space between teeth sets up the perfect environment for plaque to accumulate and for bacteria to thrive, thereby creating disease of the gum and tooth tissue. Not sure which interdental cleaners are best for your teenage son who has braces? Want an alternative to flossing? Wondering if irrigation devices are useful? When it comes to figuring out what will work best for each person, ask your dentist! Your dentist will consider your manual dexterity, any physical disabilities, your age, the health of your gum tissue, and your overall health, as well as the existence of dental appliances and any dental work. There are A LOT OF OPTIONS, so if you get lost in all of this, ask your dentist who knows you and your mouth best! Dental floss: There are many types of this interdental product used to clean between the teeth and below the gum line, commonly made from 35 strands of nylon that have been twisted together. With waxed floss, the standard nylon floss is covered with a light wax coating. This waxed form is less likely to break, but the wax coating may make it harder to use in tight spaces, and some complain that a waxy residue is left behind on their teeth. Unwaxed floss is ideal for flossing in tight areas, but it can be prone to shredding and breakage. Dental tape is a broader and flatter form of standard floss and can be waxed or unwaxed. It is ideal for those with teeth that are more spaced. Super floss is made from yarn-like material with a stiffer end, making it easier to clean under bridges and around braces/wires. Floss threaders are useful for cleaning around bridges, implants and orthodontic braces and retaining wires. The floss threader is a nylon device that looks like a needle, and the floss is the thread that is inserted into the “eye” of the floss threader. The floss threader carries the floss between the teeth and around bridges, implants and orthodontic appliances. Some floss products are made from the same material used to make Gore-Tex fabric products. This allows for easier flossing in extremely tight areas between the teeth, and the likelihood of shredding is reduced. Overall, flossing is simple, portable, inexpensive, and very effective for the majority of people. A certain degree of manual dexterity and two clean hands are needed to achieve the maximum benefit of plaque removal below the gum line. And, since it is rather technique-sensitive so any compromise reduces its effectiveness, it's important to make sure your dentist or dental hygienist reviews the proper technique with you! Wooden stimulators/ wedges and toothpicks: These are often used after meals to remove food caught between the teeth and to stimulate the gums. Be careful, however, as using standard toothpicks can damage the gum tissue and carry bacteria, reintroducing it from one area in the mouth to the next. And even though they are simple and easy to use, they’re of limited use in removing plaque and can splinter if used too aggressively. These interdental tools can be used with one hand, and if used properly they are a good addition to flossing, but are not a replacement. They are really only helpful for people who have areas where food easily catches between their teeth. Rubber-tipped stimulators: Consisting of a rubber tip attached to the end of a metal or plastic handle, these devices remove plaque in between the teeth, and stimulate and massage gums. They’re easy to use with one hand, and while they’re less effective at removing material from between the teeth, they are excellent tools to improve the health of the gums in chronically irritated areas, especially from orthodontic appliances, compromised fillings, and dentures. In addition, they’re often used following gum surgery, as they have the ability to reshape the gum in between the teeth. Floss picks: These convenient plastic devices have a small piece of floss between two posts at one end and often an interdental pick at the other end. Floss picks can be used with one hand, so not as much manual dexterity is required as with conventional floss. However, they may be more difficult to use in areas where spacing is tight. And due to their inflexible design, the floss can’t be wrapped around the whole tooth surface in between the teeth and therefore some plaque/food may be left behind. Nonetheless,they’re excellent for people with dexterity problems or a very small mouth an a great beginner device to build kids’ skills with flossing. Interdental brushes: These cone-shaped soft-wire disposable brushes, often with a reusable handle, are designed to remove debris and plaque from between teeth and hard-to-reach areas. Easy to use with one hand, these brushes are good for those with limited dexterity, orthodontic appliances, bridges, implants, and large spaces between their teeth. Things to keep in mind, however: they’re less effective than floss in areas below the gum line, they’re more expensive than conventional floss, and the wire brush may damage gums. Irrigation devices: Good for removing food and debris from large spaces and difficult-to-reach areas, these electric interdental devices are gentle on gums and are especially good for people with sensitive gums. They are also ideal for those with orthodontic appliances, as they can help flush out food from around the braces and wires and for those with gum disease as they can flush out the bacteria from deep pockets around the teeth that can’t be reached with conventional flossing. And although a gentle stream of water usually acts as the irrigant, antimicrobial agents or other treatments can also be used, as directed by a dental professional. The main disadvantage of these devices? They aren’t effective at removing plaque, as they primarily have a rinsing action only. Plaque removal requires a mechanical contact action that is not achieved through the use of an irrigation device. Other disadvantages? Cost — the tips must be changed every three to six months, and can be messy to learn how to use, requiring a sink, which makes them much less convenient than other interdental cleaners. The key to success? The main goal is to remove plaque from the spaces between your teeth and do so by choosing an interdental cleaner that works for you on a daily basis. Make it a habit, then inconvenience and a lack of time are no longer factors; it simply becomes one of those things you always do! Dr. Stephanie Stephan DDS, Dentist in Auburn Hills, Pontiac, and Waterford Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

If you ever get nervous just thinking about going to the dentist, you’re not alone. Perhaps you’re scared the visit might hurt or you haven’t been in a while and you're not sure what the dentist will find. Whatever your reason, the right dental team will make sure your dental and your emotional health are taken care of. The more you delay – or just don’t go – to the dentist, the higher your risk of developing dental problems that will make gearing up for future dental visits more difficult. In fact, seeing your dentist regularly can actually make the entire process – from making an appointment to sailing through it – much easier on many levels. Use these strategies at your next appointment to help ease your anxiety and strengthen your smile. 1. Speak up Anyone with anxiety knows sharing your feelings makes a world of difference. If you're tense or anxious, do yourself a favor and get your concerns off your chest. Your dentist and dental team are better able to treat you if they know your needs. Tell your dentist about your anxiety. When you book your appointment, tell the receptionist you’re nervous about dental visits. And try to book your appointment at a time of day that is the least stressful for you. Often, that's at the beginning of the day. Remind the dentist and dental staff about your anxiety when you arrive. Share any bad experiences you may have had in the past and ask for suggestions on coping strategies. Keep in mind that there are techniques (including prescription medications and laughing gas) that your dentist can implement to make you more comfortable. Knowing that you may need these techniques means that your team is able to offer these comfort items or options to you. Don’t be afraid to ask questions. Sometimes knowing what is going to happen alleviates any fears of the unknown. Agree on a signal. Let your dentist know by raising your hand if you need to take a break during an exam. If you experience pain even with a local anesthetic, tell your dentist. Some patients get embarrassed about their pain tolerance or don’t want to interrupt a dentist during a procedure. Talk with your dentist about pain before it starts so your dentist knows how to communicate with you and make it more comfortable. 2. Distract yourself Taking your mind off the exam may seem impossible when you’re nervous, but there are some things that that can help distract your thoughts. Wear headphones. If the sound of the drill bothers you, bring headphones so you can listen to your favorite music or audiobook. Some dental offices even have televisions or show DVDs. Occupy your hands by squeezing a stress ball or playing with a small handheld object, like a fidget spinner. Imagine your happy place and visualize yourself at a relaxing beach or garden. Try NOT to move your legs or fidget your body as a method to relax. Moving one body part causes the rest of the body (and consequently your head) to move thereby making your treatment more difficult and your appointment time more lengthy. 3. Use mindfulness techniques Relaxation starts in the mind. Try deep breathing exercises to help relax tension in your muscles. Count your breaths. Inhale slowly and then exhale for the same number of counts. Do this five times while you’re waiting for your appointment, or during breaks while you’re sitting in the dental chair. Do a body scan. Concentrate on relaxing your muscles, one body part at a time. Start with your head and work your way down to your toes. For example, you can focus on releasing tension starting in your forehead, then your cheeks, your neck and down the rest of your body. Finally, try to remember that you're here to avoid tooth pain. Not going will lead to infections and extractions or root canals. And going will lead to healthier teeth and easy cleaning appointments. Bite the bullet. With time, and the right team, everybody becomes comfortable in the dental chair. Best of luck on your journey! Dr. Stephanie Stephan DDS, Dentist in Auburn Hills, Pontiac, and Waterford Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

Bad breath happens. If you’ve ever gotten that not-so-fresh feeling on a date, at a job interview, or just talking with friends, you’re not alone. Studies show that 50 percent of adults have had bad breath, or halitosis, at some point in their lives. What Causes Bad Breath? There are a number of reasons you might have dragon breath. While many causes are harmless, bad breath can sometimes be a sign of something more serious. 1. Bacteria Bad breath can happen anytime thanks to the hundreds of types of bad breath-causing bacteria that naturally lives in your mouth. Your mouth also acts like a natural hothouse that allows these bacteria to grow. When you eat, bacteria feed on the food left in your mouth and leaves a foul-smelling waste product behind. 2. Dry Mouth Feeling parched? Your mouth might not be making enough saliva. Saliva is important because it works around the clock to wash out your mouth. If you don’t have enough, your mouth isn’t being cleaned as much as it should be. Dry mouth can be caused by certain medications, salivary gland problems or by simply breathing through your mouth. 3. Gum Disease Bad breath that just won’t go away or a constant bad taste in your mouth can be a warning sign of advanced gum disease, which is caused by a sticky, cavity-causing bacteria called plaque. 4. Food Garlic, onions, coffee… The list of breath-offending foods is long, and what you eat affects the air you exhale. 5. Smoking and Tobacco Smoking stains your teeth, gives you bad breath and puts you at risk for a host of health problems. Tobacco reduces your ability to taste foods and irritates gum tissues. Tobacco users are more likely to suffer from gum disease. Since smoking also affects your sense of smell, smokers may not be aware of how their breath smells. 6. Medical Conditions Mouth infections can cause bad breath. However, if your dentist has ruled out other causes and you brush and floss every day, your bad breath could be the result of another problem, such as a sinus condition, gastric reflux, diabetes, liver or kidney disease. In this case, see your healthcare provider. How Can I Keep Bad Breath Away? 1. Brush and FlossBrush twice a day and clean between your teeth daily with floss to get rid of all that bacteria that’s causing your bad breath. 2. Take Care of Your Tongue Don’t forget about your tongue when you’re taking care of your teeth. If you stick out your tongue and look way back, you’ll see a white or brown coating. That’s where most of bad breath bacteria can be found. Use a toothbrush or a tongue scraper to clear them out. 3. Mouthwash Over-the-counter mouthwashes can help kill bacteria or neutralize and temporarily mask bad breath. It’s only a temporary solution, however. The longer you wait to brush and floss away food in your mouth, the more likely your breath will offend. 4. Clean Your Dentures If you wear removable dentures, take them out at night, and clean them thoroughly before using them again the next morning. 5. Keep That Saliva Flowing To get more saliva moving in your mouth, try eating healthy foods that require a lot of chewing, like carrots or apples. You can also try chewing sugar-free gum or sucking on sugar-free candies. Your dentist may also recommend artificial saliva. 6. Quit Smoking Giving up this dangerous habit is good for your body in many ways. Not only will you have better breath, you’ll have a better quality of life. 7. Visit Your Dentist Regularly  If you’re concerned about what’s causing your bad breath, make an appointment to see your dentist. Regular checkups allow your dentist to detect any problems such as gum disease or dry mouth and stop them before they become more serious. If your dentist determines your mouth is healthy, you may be referred to your primary care doctor. Need a dentist? Dr. Stephanie Stephan DDS, Dentist in Auburn Hills, Pontiac, and Waterford Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

Let's start with the basics... What is fluoride? Fluoride is a naturally-occurring mineral compound found in water and soil. It is also present in the foods you eat and the beverages you drink at varying concentrations. Why does is matter when it comes to my teeth? When used in the appropriate amount, fluoride helps prevent cavities by making teeth more resistant to decay. Decades of research shows that fluoride helps prevent cavities in both children and adults. It makes the entire tooth surface more resistant to acid attacks from the bacteria that live in the plaque on your teeth. It also promotes remineralization (i.e. adding minerals such as calcium back in to your teeth). Remineralization helps to repair early decay before a cavity, or hole, forms in the tooth (once the hole forms, the decay must be removed and a filling placed where the hole was). How can I get the right amount of fluoride? Most importantly: talk to your dental professional. Like any vitamin, you want to ensure you're not getting too little or too much. Someone who knows the water in your area and can review your fluoride sources can help you to determine the right amount for you. That being said, there are two ways to receive fluoride protection: Topical applications Systemic applications What is topical fluoride? Topical fluoride is applied directly to and absorbed by the surface of the teeth. It is found in personal oral hygiene products such as toothpastes and mouth rinses, which contain a safe and effective concentration of fluoride to fight tooth decay. These products are rinsed from the mouth without swallowing. Professionally administered topical fluorides such as foams, gels, or varnishes are applied by a dentist and left on for a few minutes, usually during a cleaning treatment. For patients with a high risk of cavities, the dentist may prescribe a special gel or toothpaste for daily home use. (To find out if your oral hygiene products contain fluoride: Check the label on your toothpaste to see if fluoride is an ingredient. You should also check for the ADA (American Dental Association) Seal of Approval to ensure that your toothpaste contains the proper amount of fluoride). What is systemic fluoride? Systemic fluoride is taken into the body through consuming fluoridated water, fluoride supplements, or foods and beverages. Once systemic fluoride is absorbed via the gastrointestinal tract, the blood distributes it throughout the entire body. Fluoride is then deposited into unerupted, developing teeth. It also then appears in saliva where it continually bathes the teeth and protects them from decay. Tell me more about fluoridated water Studies prove that water fluoridation continues to be effective in reducing dental decay by at least 25 percent in children and adults. In fact, the Centers for Disease Control and Prevention proclaimed community water fluoridation as one of 10 great public health achievements of the 20th century. Fluoride is naturally present in all water sources, but the level varies widely. Water fluoridation is simply the adjustment of the natural fluoride level up to the level recommended to prevent tooth decay. The exact amount is only 0.7-1.2 parts per million...that's pretty small, but enough to make a big difference to your teeth. To give you some perspective: 1 ppm is the equivalent of 1 minute in 2 years. Four drops in a 55 gallon (208 liter) barrel. Or in other words: I won't go on. Simply by drinking tap water in communities with a fluoridated water supply, people can benefit from fluoride's protection from decay. Research for the past 60 years has shown community water fluoridation to be safe and the single most effective public health measure to prevent tooth decay in adults and children. Water fluoridation is endorsed by nearly every major national and international health organization including the American Dental Association, American Medical Association, World Health Organization and the U.S. Centers for Disease Control (CDC). How do I find out if the water in my community is fluoridated? The easiest and most accurate way to find out is to contact your local water company and ask. The CDC web site also has a page "My Water's Fluoride" (http://apps.nccd.cdc.gov/MWF/Index.asp) that allows consumers to learn the fluoridation status of their water system. What if I drink mostly bottled water? If most of your water comes in the form of bottled water, you are missing out on the valuable fluoride found in tap water, which helps to protect teeth from cavities. In most cases, the fluoride concentrations in bottled water (even in some that are fluoridated) fall below the U.S. government's recommended range of 0.7-1.2 parts per million (ppm) of fluoride, the ideal range to prevent cavities. If you drink mostly bottled water, you should talk to your dentist about fluoride supplements (tablets or drops), fluoride mouth rinses, and topical fluoride gels. Are children more sensitive to fluoride? Fluoride is absorbed easily into tooth enamel, especially in children's developing teeth. In young children, excess fluoride intake can cause dental fluorosis (a typically harmless cosmetic discoloring or mottling of the enamel. It can look like chalky white specks and lines or pitted and brown stained enamel on teeth). This is why it is important to talk to your dentist about your fluoride intake to ensure that you are not taking supplements when unnecessary. Parents should monitor the use of toothpaste, mouth rinses, and fluoride supplements in young children to ensure they are not ingesting too much. Check with your dentist on the proper amount of toothpaste to use or the proper dosage of a fluoride supplement based on your child's age and needs. If you are concerned about the fluoride levels in your drinking water, call the local public water department or your water supplier. If the source is a private well, request a fluoride content analysis from your local or county health department to ensure that the fluoride levels are within the proper range. So how will I make sure I don't give my child too much fluoride? For children younger than 3 years old, you only need to be using a smear of fluoridated toothpaste. If they swallow some of it, the amount of fluoride they are ingesting is minute. For children aged 3-6, you only need to dispense a pea-size amount of toothpaste. So...why are there people against fluoride? Likely because they fail to realize that "the dose makes the poison." In other words, anything (including air and water) is toxic if too much is ingested. The toxicity of a specific substance depends on a variety of factors, including how much of the substance a person is exposed to, how they are exposed, and for how long. The paper that some may be mis-quoting dates from 2012 and led by Anna Choi. Many of the studies her team reviewed included too small sample sizes, but the conclusion they reached was that “the results support the possibility of an adverse effect of high fluoride exposure on children’s neurodevelopment.” BUT the key to the paper’s conclusion is the term “high fluoride exposure.” Choi’s team looked at previous studies that investigated if large amounts of fluoride were dangerous. This wasn’t really a surprise to anyone. Lots of substances that are good for you in small doses are really dangerous when you have too much. The studies looked at by Choi and her team concerned parts of the world – Iran and China, mostly – where natural fluoride levels in the water were extremely high, sometimes up to 10 or 11.4 milligrams per litre (that's 10 ppm...i.e. 10 times more than that of fluoridated levels in the US!). To put it in perspective, if doctors say that 8 glasses of water a day is good for you and you drink 10x that amount (80 glasses) and 24 glasses of water in a day is enough to kill a 165 pound person, then you've died 3 and 1/3 times over. The dose makes the poison. Fluoride levels in ordinary drinking water are about 1 milligram per litre in Australia, and between 0.7 to 2 milligrams per litre in the US. These levels are way below the US Environmental Protection Authority’s maximum safe limit of 4 milligrams per litre. Indeed, study after study has found that 1 to 2 milligrams per litre fluoride in the water is not only safe but good for you – assuming you’d like to avoid fillings and extractions as much as possible. Now that you know the numbers and facts, decide what's right for you. Don't be scared by people touting the dangers of too much fluoride. That's 100% true. Any dental or medical professional can agree on that and can review the issues that come with too much fluoride. But unless you're ingesting fluoride supplements without the direction and supervision of your health professional or you are eating toothpaste for breakfast - you're definitely safe drinking fluoridated water that is monitored by your city to maintain a safe, low dose. And you're definitely safe - and better off - with your pea-size amount of toothpaste twice a day. If you have any further questions, just ask your dental team! That's what we're here for :) Dr. Stephanie Stephan DDS, Dentist in Auburn Hills, Pontiac, and Waterford Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com