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 Drs. Cartsos and Zavras 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 Chestnut Hill, Massachusetts 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.

Drs. Cartsos and Zavras and our team have the experience and training to evaluate the present state of your teeth and bite, and to design a treatment plan to give you the healthy, attractive smile you picture for your future. And when you choose Invisalign^® for your treatment, you’ll be able to get an advance view of exactly what that future will look like!

How is this possible? Because when you choose Invisalign, you’re getting the benefit of some of the most advanced technology in orthodontics.

The process begins with a computerized scan of your teeth and mouth. Special scanner software creates a 3D image to capture your smile as it is now. But that’s not all. Using our customized treatment plan, Invisalign software can provide not only a model of your smile today, but an evolving model of what your smile can be. Seeing your present smile transform step-by-step into your future smile is a great motivator to follow that treatment plan!

For each step of your treatment, Drs. Cartsos and Zavras will provide a new set of aligners created to move your teeth and bite toward this goal. Why don’t you need a mold made of your teeth every time you get a new aligner? Because, with Invisalign, we design your aligners to fit your future tooth alignment.

Aligners are not fabricated to snugly fit around your teeth as they are, but as they will be after several days of wear. Each set is molded with small improvements to your alignment, and provides gentle, consistent pressure to move your teeth to that next step.

This “future fit” is why you may experience a bit of discomfort with a new set of aligners. Over the days that you wear them, the fit will become more and more comfortable. This won’t be because your aligners have changed. It will happen because your teeth have gradually moved where your aligners direct them.

Once your teeth and bite have reached this new step in your treatment, it will be time for the next set of aligners in the series, and so on. Drs. Cartsos and Zavras will let you know just how long you need to wear each set, and you can even track your progress with every appointment.

So, are we predicting the future? Not really. When you use Invisalign, we are planning and creating your future smile. Drs. Cartsos and Zavras will use the Invisalign system to customize your treatment for your very specific needs, step by step, and aligner by aligner, until you attain the smile you previewed before you even started treatment.

But one thing we can predict: If you follow our recommendations, keep your appointments at our Chestnut Hill, Massachusetts office, and wear your aligners as directed, there’s going to be a beautiful, healthy smile in your future.

Maybe you’ve wanted braces since childhood. Maybe you had them, but your teeth have shifted over time. Maybe you’re tired of living with an uncomfortable bite. Good news! If you’re not happy with your adult smile, that doesn’t mean you’ve missed the opportunity to have the healthy, attractive smile you’ve always dreamed of.

While there are many benefits to having orthodontic work done as a child, there’s a lot to be said for orthodontic treatment as an adult. After all, you know exactly what you want. You’re dedicated to following your treatment plan. You have plenty of discreet orthodontic options available now, from clear aligners to lingual braces, to make your treatment as inconspicuous as possible.

But, on occasion, adult treatment does come with some adult baggage. Worried about your crowns, fillings, or veneers? If these restorations are part of your dental history, we can generally work with them. Dental implants? Those might fall into a slightly different category.

Implants are a great way to restore your smile because they function like your natural teeth. They are designed to look just like natural teeth, and they allow you to speak, chew, and bite with confidence. Implants even stimulate the jawbone when we chew just as natural teeth do, helping to prevent bone loss in the jaw as we age.

But there is one important difference between implants and natural teeth: implants are firmly anchored in the jaw, while your natural teeth can change position.

Why is this a concern? Because tooth movement is one of the basics of orthodontic treatment. Unlike implants, our teeth aren’t firmly anchored in our jaws. They are held in their sockets by a ligament which cushions them and connects the tooth to the bone.

When braces or aligners gently apply consistent pressure to the teeth, the ligaments and eventually the bones holding the teeth reshape themselves in response to this pressure, and then become stable again during the retainer phase of treatment.

Implants, on the other hand, are crowns attached to a metal cylinder or screw that is surgically implanted into the jawbone. After several months, osseointegration takes place—which is a technical way of saying that the metal base fuses with the bone. This means that there won’t be any movement taking place—good when you’re chewing, but not helpful for realignment!

If you haven’t yet replaced a missing tooth with an implant, it’s often best to wait before starting orthodontic work. We can design treatment around a missing tooth, leaving room to accommodate an implant in just the right spot when your orthodontic treatment is finished.

If you have an implant already, the placement of your implant will help determine your treatment:

• If your implant is already perfectly placed for your future alignment, braces or aligners can be designed to work with and around your implant.
• If the placement is almost ideal, you might find a very small degree of misalignment acceptable, and we can plan your treatment around your existing implant.
• If it’s not possible to work with your implant where it’s presently located, it is possible to remove an implant. You would then have the implant procedure redone after your orthodontic work is complete.

Talk to Drs. Cartsos and Zavras about your treatment possibilities. By analyzing your orthodontic goals and working with your dental history, we can let you know exactly what can be done for your teeth and bite—even if you have an implant.

True, there are many benefits to having orthodontic work done in your childhood, but there’s a lot to be said for orthodontic treatment as an adult. And the greatest benefit of all? You’ll finally have the healthy, self-confident smile you’ve always dreamed of. Talk to our Chestnut Hill, Massachusetts team about making that smile a reality.

We’re not talking about tearing up at the end of a sad movie, or that uncomfortable scratchy feeling you get from a coarse wool sweater—no shame in that kind of sensitivity! But it is a shame if you’re feeling unpleasant tooth sensitivity, especially while you’re wearing braces. No fear—we have some helpful ideas to make you more comfortable as you create your healthy, confident smile.

What do we mean by tooth sensitivity? You know it if you’ve felt it. Pain when you have a cold drink. Or a hot one. Or a sweet treat. Wincing when a light breeze hits your smile. Discomfort after an adjustment.

Fortunately, these annoying twinges can be avoided or eased with some proactive practices.

Keep Up with Your Brushing and Flossing

The oral bacteria in plaque break down enamel when they’re left on the teeth for too long. The result is a cavity, which leaves your sensitive dentin, the layer of the tooth between the enamel and the inner pulp chamber, exposed to elements which can trigger pain. These all-too-common elements include heat, cold, air, or sweet foods. If you suspect you have a cavity, a visit to the dentist will make sure your tooth is cleaned and filled to prevent further damage.

Better yet, prevent cavities before they cause tooth sensitivity. It can be harder to keep your teeth their cleanest while you’re in braces, but it’s more important than ever. You don’t want to have brackets and wires removed, even temporarily, to treat a cavity! You can keep decay at bay by:

• Brushing after every meal and snack.
• Flossing whenever necessary, making sure to clean around your brackets and wires.
• Using cleaning tools made for braces for the easiest and most effective dental hygiene.

Avoid Aggressive Brushing

If you’re using anything other than a soft toothbrush, time for a shopping trip! Using a stiff bristled brush is almost always too abrasive for even the strongest enamel. And vigorous brushing is more harmful than helpful. Poor tools and poor technique can wear away enamel, and, when enamel is worn away, the more sensitive dentin is exposed. Your gums can also be injured, exposing the tops of your roots—which are more sensitive than the enameled crowns.

If your teeth are sensitive because of abrasive brushing, talk to Drs. Cartsos and Zavras about possible solutions for keeping your teeth both clean and strong.

• Use a softer-bristled brush.
• Try toothpaste designed for sensitive teeth.
• Practice proper brushing technique. Gently rub, don’t scrub!

Care for Yourself after Adjustments

Your teeth might be sensitive after an adjustment. This discomfort is normal, and should pass in a few days. In the meantime, treat yourself kindly.

• Brush as usual, taking special care to brush gently.
• Fill your menu with soft and soothing foods. Cool treats like classic ice cream and pudding, or healthier choices like frozen yogurt and fruit smoothies. Comfort foods like cream soups and mashed potatoes. Or all-day breakfasts of oatmeal, pillowy pancakes, or scrambled eggs.
• Take over the counter medication as recommended and as necessary.

Be sensitive to your needs while you’re in braces. If you’re feeling any kind of tooth sensitivity, talk to Drs. Cartsos and Zavras at our Chestnut Hill, Massachusetts office. We have solutions which will make sure you’re both comfortable and twinge-free on your journey to a healthy, attractive smile!