Stain Prevention

Many dental patients want to keep their teeth white.  To prevent stain, especially for 48 hours after teeth whitening1, don’t let the following food and drinks touch your teeth: Tea2, coffee, red wine, tomato sauces, and strongly-colored fruit3.  When drinking staining liquids, periodically swish some plain water around your mouth to rinse your teeth off.  Some people drink coffee through a straw.  The company Hot Straw™ makes a straw that is safe to use with hot liquids5.  If you smoke, avoid smoking for 48 hours after whitening4.

Try to brush after every meal, to remove food debris that may become stained.  Many people mistakenly brush their teeth too hard, thinking it is more effective.  Harder toothbrushing may cause abrasion (tooth wear), especially if you eat or drink acidic products6.  It may also cause the gums to recede, exposing dentin, the more fragile tooth layer underneath.  These fragile teeth surfaces are more susceptible to being stained8, as well as getting cavities and being sensitive.  It is more effective to brush with lighter pressure and to tilt your toothbrush at a 45 degree angle, so that the toothbrush bristles go slightly underneath your gumline.

Almost all toothpastes have ingredients that remove stain7.  However, the ingredient hydrated silica may microscopically wear down your tooth enamel.   The following ingredients remove stain, but are less abrasive:  Dicalcium phosphate, sodium bicarbonate and calcium carbonate9.  In addition, the following ingredients remineralize your teeth, which may prevent stain10:  Fluoride, CPP-ACP, and nano carbonate apatite11.

If you are unable to brush after every meal, at least periodically swish some water around your mouth to rinse your teeth off.  Chewing sugarless gum after meals stimulates saliva9, whose remineralizing effects can prevent stain13,14.

With these tips, your bright smile will be preserved for a long time.



1,3,4Al Quran, F., Al Wahadni, A., Al-Hyari, S., Mair, L., & Mansour, Y (2011). Efficacy and persistence of tooth bleaching using a diode laser with three different treatment regimens.  The European Journal of Esthetic Dentistry, 6(4), 1-10.


2,10, 13Chand, P., Ram, S., Shetty, O., Singh, R. Yadav, R. (2010).  Efficacy of casein phosphopeptide-amorphous calcium phosphate to prevent stain absorption on freshly bleached enamel: An in vitro study.  Journal of Conservative Dentistry, 13(2), 76-79.

5Hot Straw™ corporate Internet website.  Retrieved on February 3, 2014 from

6Attin, T., Egert, S., & Wiegand, A. (2008).  Toothbrushing before or after an acidic challenge to minimize tooth wear? An in situ/ex vivo study.  American Journal of Dentistry, 21(1), 13-16.

7Joiner, A. (2010).  Whitening toothpastes: a review of the literature.  Journal of Color and Appearance in Dentistry, 38(2), e17-e24.

8Addy, M. & Watts, A. (2001).  Tooth discolouration and staining: a review of the literature.  British Dental Journal, 190, 309-316.

9Moore, M, Putt, M., & Schemehorn, B. (2011).  Abrasion, polishing, and stain removal characteristics of various commercial dentrifices in vitro.  The Journal of Clinical Dentistry, 22(1), 11-18.

11Kim, B., Kim, Y., & Kwon, H. (2011).  Effect of nano-carbonate apatite to prevent re-stain after dental bleaching in vitro.  Journal of Dentistry, 39(9), 636-642.

12Ly, K., Milgrom, P. & Rothen, M. (2008). The Potential of Dental-Protective Chewing Gum in Oral Health Interventions.  Journal of the American Dental Association, 139, 553-563.

14Grandini, S., Perra, C. & Porciani, P. (2010).  Effect on dental stain occurrence by chewing gum containing sodium tripolyphosphate–a double-blind six-week trial.  The Journal of Clinical Dentistry, 21(1), 4-7.

Whitening and Damage

enamel rods

Microscopic view of enamel

Occasionally, a patient will ask me if whitening can damage their teeth.  Damage may be prevented with certain precautions.  Before whitening, have your dentist repair any cavities or fractures you may have, or whitening might make them worse.  The main ingredient in whiteners is either hydrogen peroxide or carbamide peroxide (another form of hydrogen peroxide). They come in varying percentages. The higher the percentage, the quicker the whitening process, but the higher the incidence of teeth sensitivity. [Read more...]

Think Twice About Oral Piercings

Piercings of the tongue, lip, or cheek are very popular in all age groups, but piercings can be linked to health risks. Hygienists have to educate patients before, during and after oral piercings. Though as hygienists we can discuss and discourage a patient for proceeding with any oral piercings, but in the end it is the patients’ decision. As hygienists we have to educate our patients how to care for the piercings once he or she has acquired one or several. Following piercing of the tongue swelling occurs that can be severe that may block the airway and make breathing problematic.

During the first stages of piercings and throughout the lifetime of the piercing “vast amount of bacteria in the mouth, and the introduction of additional bacteria from handling the jewelry all work to increase the risk of infections” (p. 1, WebMd, 2013). Many diseases can be acquired through piercings such as Hepatitis B and C. With the piercings changes of bacteria entering the bloodstream could lead to endocarditis which can cause harm to the heart in the future.

A higher risk of gum disease because of the increased bacterial count around the jewelry placed on the tongue and lip. Over time the gingival disease (periodontal disease) “causes recession of the gum tissue, which can lead to loose teeth and tooth loss” (p. 1, WebMd, 2013). The types of materials such as metal vs plastic may vary in the damage to the oral cavity, but “”No matter what material [the stud] is made of, it’s going to hit the back of the front teeth,” said Dr. Ruchi Nijjar Sahota, a dentist in Fremont, Calif. “Most of the patients I’ve seen have developed either a gum infection or had some sort of trauma to their teeth because of the tongue ring” (Higgins, 2011).

Teeth can be damaged through contact with the piercings such as chipping and cracking of tooth structure. “A study published in the March 2002 issue of the Journal of Periodontology, for example, reported on 52 young adults who had had their tongues pierced. Among those who had had a tongue stud for four or more years, 35 percent had recessed gums, and in those who wore long-stemmed barbells for two or more years, 50 percent had gum recession” (2010, Mitchell).

In addition chipped teeth occurred in “47 percent of the subjects who had had a barbell for four or more years. According to the American Academy of Periodontology 2001-02, “anyone with a pierced mouth should receive a thorough oral examination of their gums and teeth to identify problem areas. Taking precautions now will increase your chance of keeping your teeth for a lifetime” (2010, Mitchell).

Piercings can cause problems in every day function including speech, difficult chewing, and increased saliva production (drooling). Aspiration of the jewelry is another concern that will cause injury if lodged in the lungs or injury to the digestive tract. Lastly an allergy to the metals in the jewelry can cause a hypersensitive reaction called dermatitis.

If oral piercings are ultimately something a patient wants to do than precautions should be taken prior and after the piercings. Make sure the piercing studio has up-dated health certificates, autoclaves, sterilized needles, jewelry and sterilization packaging is in the studio and staff members are vaccinated against Hepatitis B. If there are any hesitations in the staff answers or they cannot answer questions one needs to consider another establishment.

Warning signs to notice after oral piercing are as follows:

Discharges that are yellow or green coming from the piercing site is not normal. Clear or white discharge is normal. Thickness of tissue building up around the oral piercing that turns color. Keratinization or white scarring is normal. Redness, abscess, and tenderness with pain or increased tenderness contact and visit your local dentist.

Caring for the piercing includes avoiding spicy foods, alcohol, smoking and any tobacco products. Rinse with Salt water rinses until piercing wound heals and brush after meals. After healing continue brushing after every meal and using non-alcohol mouth rinses such as Listerine Zero or Crest Pro-health rinse and keep regular appointments with your hygienist.


Higgins, C., (January 19, 2011). U.S. News, Health. “Metal Tongue Piercings Linked to Raised

Infection” Retrieved July 11, 2013 from:

Mitchell, Deborah, (2010, August 3). Tongue Piercings Can Cause Tooth Gaps and Chips (para 6 and 7).

Retrieved July 11, 2013 from:

WebMd (2013), Dental Health and Oral Piercing (p. 1). Retrieved July 11, 2013 from


Author: Nancy M. Costa-Larson RDH, BS, MHA

Author biography:

Nancy Costa-Larson, RDH, BS, MHA has worked in the dental field for 20+ years as well as the medical community for 3 years. She works as an active clinician and Practice Manager in Birmingham Alabama working with students and training from local colleges toward careers in the dental community. Nancy was a delegate in the Massachusetts Hygiene Association Board. She received an Associate in Science in Hygiene at the Springfield Community College, Bachelor of Science in Business at University of Phoenix, Tampa, and a Master’s in Healthcare Science Administration from Argosy University in Florida. Nancy has written for the Dental Hygiene Tribune (International) and profiles in ACCESS Magazine. Contact info: Whitesmiles4you@gmail or LinkedIn

Five Innovative Dental Techniques and Tools – And What This Means for Your Next Visit

Did you know that being a dental professional requires ongoing education and training? Dentists are constantly searching for new procedures, technologies and tools that reduce the duration of common procedures, expedite a patient’s healing and increase overall patient satisfaction and comfort. To learn which innovative techniques and tools are currently changing the dentistry field for the better, check out our list below!

Regenerating Lost Adult Teeth

If an adult patient loses a tooth, the only possible treatments at this time are dentures or dental implants. But imagine if we had the ability to naturally re-grow lost adult teeth! Thanks to researchers at the Tissue Engineering and Regenerative Medicine Laboratory at Columbia University Medical Center, we may be close to achieving that kind of natural tooth regeneration. The new procedure, which is currently tested on animals, involves implanting tooth scaffolding into the mouth and then redirecting the patient’s stem cells to regenerate the new tooth in the same position as the previous one. If it succeeds in human trials, this revolutionary procedure would drastically reduce the amount of artificial materials used in dentistry around the world.

Increasing Patient Comfort with Isolation Devices

During complex dental procedures, dentists and their assistants need to isolate the tooth in need of repair from the tongue and cheek, while simultaneously using a suction device to prevent an excess of moisture from building in the patient’s mouth. Now there is a new device that does all of this at once, while also allowing the patient’s mouth to relax and feel more comfortable for the entire procedure. Isolite Systems has created this useful tool, which provides increased patient safety and also cuts down on treatment time by as much as 30%. This technology not only allows the dentist to work more efficiently, but also helps the patient return home sooner.

Constructing Crowns in an Hour

Traditionally, if a dentist says you need a crown, it indicates that you will be back for at least two more visits. During those separate appointments, the dentist will drill the tooth, make an impression of it and send the impression to a lab where it takes as much as two to three weeks for the crown to be constructed. Only after this process has been completed can the dentist remove your temporary filling and secure the new crown into place. However, with a new dentistry technology named CAD/CAM (Computer-Aided Design and Computer-Aided Manufacturing), the dentist can outfit you with a new ceramic crown in just one visit. Instead of making an impression of the tooth, the dentist uses a small camera to acquire a three-dimensional image of the tooth, which is then transmitted to a machine in-house that creates the crown out of a chunk of porcelain. You’ll most likely be in and out of the dentist chair within an hour!

Eliminating Drilling with Air-Abrasion Technology

Many patients who fear visiting the dentist will blame one tool in particular for their trepidation – the dreaded drill. But thanks to advances in technology, the drill is being used less frequently than before. A new technology called “air-abrasion” employs the Kinetic Cavity Preparation (or KCP) system, which emits a stream of microscopically-fine powder and gently sprays away decay on tooth surfaces. Because this method greatly reduces heat and vibrations in comparison to the traditional drill, there’s very little discomfort to the patient and therefore very little need of anesthesia. In addition, this form of “drill-less dentistry” enables dentists to treat decay at an earlier stage and preserve more of the tooth’s healthy original structure.

Detecting Oral Cancer Using Blue-Spectrum Light

Nearly 42,000 Americans will be diagnosed with oral cancer this year alone, and quick detection of the disease is vital to ensuring proper treatment and survival. Dentists are discovering new, more advanced ways to detect oral cancer at its earliest stages, using blue-spectrum light technology. The VELscope Vx system is becoming increasingly popular in dental practices, as it quickly, painlessly and successfully examines deep within the oral tissues. The tool, which causes molecules inside the mouth to emit light in differing shades of color, is helping dental professionals more accurately visualize any abnormalities that may indicate cancer.

With such technological advances in the field, dentists are continually striving to ensure your comfort as well as your oral health. Whether you’re receiving an in-depth procedure or simply a routine check-up, your dentist wants to provide you with the safest and most state-of-the-art treatment available, so relax – you’re in great hands!

About the Author

Dr. Frank Nia, one of the skilled and highly-trained general dentists at Stonewalk Family Dentistry in Alpharetta, GA, is a dual graduate of the University of Pennsylvania, where he received both his DMD degree from the School of Dental Medicine as well as his MSEd in Higher Education from the Graduate School of Education. An active member in the dental community, Dr. Nia is a firm believer in the notion that preventative dental care should focus on improving patients’ overall health, rather than only the health of their teeth. To further his training and expand his knowledge of the field, Dr. Nia also participates in multiple dental organizations that aim to better develop widespread clinical and care standards. When he’s not busy working to improve the lives of his patients, Dr. Nia enjoys playing tennis, football and golf, as well as spending quality time with his wife and family. To learn more about the experienced and compassionate team of dental experts at Stonewalk Family Dentistry, please visit

Copyright © 2013

How Stress Can Impact Oral Health

When we are having toothaches the pain is actually the least of our concerns. In fact, pain is good because it tells us that some part of the body is not functioning well and there is a need to intervene to maintain health. Oral health is still the best way to fight off tooth decay that can cause unhealthy conditions. It has been said that every cell in our bodies are interconnected. Even our teeth have a vital role to play in overall wellness. It has been largely documented that poor oral health habits could impact heart health. It will no longer be surprising how tooth infections can severely impact even mental health. [Read more...]

Understanding Dental Anxiety

An individual who has dental anxiety would avoid seeing dentists. It is also because of dental anxiety that a person would refuse undergoing any dental procedure or dental treatment. Dental anxiety knows no age and gender. However, according to research dental anxiety affects more women than men. Not many people are aware of the fact that dental anxiety is more common than we think.

[Read more...]

Root Canal…Don’t Be Scared…It’s Just a Word

At some point or another, all of us will visit the dentist for one reason or another: some for basic oral hygiene; some as a result of injury and others for necessary dental procedures to ensure good oral health well into the future.

However, just the mention of certain dental procedures can cause anxiety in some of us. This is normal. Over 24 years of experience has taught me a few things about managing patient anxiety. For instance, I always advise people who are going to have procedures like wisdom teeth removal, or dental implants not to tell anyone. If you do, in most cases, the person you tell will likely fill your head with scary thoughts that are usually not true….”I had a friend who had an implant and it was so painful,” or “I know someone who had their wisdom teeth taken out and they ended up in the hospital.” The same goes for root canals. My advice is not to tell anyone when you are having a dental procedure.

[Read more...]