I don’t receive birthday cards from many of my friends, but I do get one from my dentist. A smiling tooth wishes me a happy birthday, along with a reminder to make an appointment. Yet, I’ve postponed my last three visits.

This is a mistake, said Dr Tricia Quartey-Sagaille, a spokesperson for the American Dental Association (ADA) and a practicing dentist in New York City’s Brooklyn in the US. “A lot of people see the absence of pain as an indicator that nothing is going wrong and say, ‘My teeth are fine, I don’t need to go’,” she said

Often, Dr Quartey-Sagaille pointed out, there is “no pain at all” with periodontal diseases, which are usually caused by an infection of the gums and the bones supporting the teeth and affect nearly half of adults 30 and older, potentially leading to tooth and bone loss. And the last thing you want is to have to make an emergency appointment when you’re in pain. For one thing, she said, when that happens, it is inevitably “on a weekend, or when you’re on a holiday internationally.”

Here are five other things that our dentists would like us to know.

Gums should not bleed

As every dentist you’ve ever seen has probably said, you should floss daily. It’s true that if you slack for a while, you may see a little blood when you restart the habit, said Tien Jiang, an instructor in oral health policy and epidemiology at the Harvard School of Dental Medicine, US. But stick with it. “It’s like starting to exercise when you haven’t in a while, and your muscles ache,” she said.

“I encourage patients to push through that initial period because they need that debris to come out to get back to health.”

If your gums have been bleeding for a prolonged period of time, see your dentist, said Dr Pernima Kumar, chair of the department of periodontology and oral medicine at the University of Michigan School of Dentistry in the US. “Would you be worried if any part of your body bled?” she asked.

Dr Kumar also suggested that people who have gaps between their teeth use an interdental brush, a small, skinny, “absolutely fabulous” brush designed to reach the hidden places where bacteria grow.

Avoid charcoal toothpastes

Toothpastes containing powdered activated charcoal, marketed as a natural teeth whitener, have grown in popularity in the past few years.

But a 2017 study published in the Journal of the American Dental Association concluded that while charcoal toothpastes might be “fashionable”, they did not have a whitening effect. Instead, researchers found that the abrasiveness of charcoal toothpaste could cause tooth hypersensitivity; that particles of charcoal might lodge in gum pockets, causing damage and discolouration; and that few contained fluoride. Jiang said, whitening toothpastes that receive the seal are good to use every day.

Electric toothbrush isn’t needed

Brush your teeth. Do it twice a day, against the gumline at a 45-degree angle, for two minutes. Both electric and manual toothbrushes work.

That said, if you’re an enthusiastic brusher, an electric toothbrush with a pressure sensor to tell you to take it down a notch can be helpful, as brushing too forcefully is a leading cause of receding gums.

Mouth health is tied to total health

The mouth and the rest of the body are intimately connected, but in healthcare, they are often treated separately, said Nezar Al-Hebshi, co-director of the Oral Microbiome Research Laboratory at Kornberg School of Dentistry, US.

And a growing body of research shows how dental health can affect other parts of the body. Al-Hebshi listed five diseases for which there was “moderate to strong evidence” that periodontal disease might be a contributing factor, including diabetes, certain cancers and cardiovascular disease.

In a 2022 survey of dentists across the US, conducted by the ADA, half reported that they had treated patients who were under the influence of marijuana or another drug.

“I am seeing this in my office,” Dr Quartey-Sagaille said. One reason patients may self-medicate, she noted, is that they are nervous. But, she explained, “You can’t consent to a treatment if you’re high. If patients have anxiety, it could make things worse, and I’m not able to numb people as effectively.” A 2019 study of cannabis users undergoing minimally invasive procedures found that one-fourth of them had needed twice the anaesthesia as patients who didn’t partake.

Inquire about options for pain control, if that’s what worries you, Jiang said. For teeth that are particularly sensitive, she added, start brushing a few weeks before your appointment with a desensitising toothpaste that contains potassium nitrate, such as Sensodyne.

And if you did take a weed gummy before you arrived, tell your dentist. “You know, we’re not here to judge, just to provide you with the best care,” Dr Quartey-Sagaille said.

NYTNS