Some months have passed since the topic of a link between dental X-rays and brain tumors made waves in national and international media. The flurry of news stories and blogs, press releases and tweets died down after just a few days, and the details of the x-ray/tumor link were mostly buried under hurried summaries that focused on the most sensational angle.

Now that the air has cleared a bit, we thought we’d take a look at the issue again and try to clarify the key points for today’s consumers.

What the study actually said

In April, 2012, the study, “Dental X-rays and Risk of Meningioma,” appeared in a peer-reviewed journal, Cancer, which is published by the American Cancer Society. The research was led by researchers from Yale University School of Medicine. They concluded the following:

Dentist and assistant analyzing an x-ray.

What’s the link between dental X-rays and tumors?

“Exposure to some dental X-rays performed in the past, when radiation exposure was greater than in the current era, appears to be associated with an increased risk of intracranial meningioma. As with all sources of artificial ionizing radiation, considered use of this modifiable risk factor may be of benefit to patients.”[i]

Not quite the same as what made it into the headlines. The caveat, “X-rays performed in the past, when radiation exposure was greater than in the current era,” sort of got lost in the shuffle.

Instead, “increased risk of intracranial meningioma” stole the show. Not so hard to do with descriptions reported in the media that included details about typical tumor sizes (“can reach sizes larger than a baseball”) their effects (“often benign, but can be debilitating”) and the populations affected (“commonly found in people 40 – 70 years old and mostly women”).

In the end, the authors’ reasoned recommendation of “considered use” simply got railroaded by fear-inducing headlines.

Responses to the study

Almost immediately, perhaps to help calm the media frenzy, some dental experts issued a statement that questioned the study’s findings. They were concerned, they said, because the association of X-rays with brain tumors in the study had been based on anecdotal evidence.[ii]

In Yale’s population-based, case-control study, people with intracranial meningiomas were asked to recall how often they had received dental X-rays at various stages of their lives, including whether the type of X-ray used was a bitewing, full-mouth, or panoramic variety.

In part, the dentists’ response read as follows:

“Taken together, the methodological weaknesses of this study put the validity of any relationship between dental radiographs and meningioma into serious question. Oral and maxillofacial radiography is an important diagnostic tool in the armamentarium of the dentist, and the American Academy of Oral and Maxillofacial Radiology continues to endorse its careful and judicious use in dentistry.”[iii]

Oral and maxillofacial radiography is an important diagnostic tool…

The study reported in the journal Cancer may not sound like the type of strictly controlled objective observation most people would commonly associate with scientific investigations. However, in this case the approach was deemed to be pragmatic, in that it allowed the scientists to explore variables that, unfortunately, simply weren’t foreseen 50 years ago.

While what they reported has some practical relevance for people who were having X-rays in the 1960s, the typical dose of radiation a patient received from a single exposure was significantly higher at that time than it is today.

What’s best for consumers?

Ultimately, at a higher level, the conversation was about weighing the risks and benefits to patients of using radiography. And here – theoretically at least, there is clear agreement. When it comes to dental radiography, the study’s recommendation aligns, after all, with those of the ADA.

Everyone agrees: X-rays should only be used in specific, carefully considered situations.

The American Dental Association publishes strict guidelines for using X-rays[iv] to help ensure this is always the case. Consumers should therefore never allow a sensationalized fear of brain tumors the size of baseballs to prevent them from getting appropriate dental care when needed.

…never allow fear to prevent getting appropriate dental care when needed.

So if your dentist suggests that you have X-rays, it’s fine to ask whether there are any reasonable alternatives. And if X-rays are, in fact, deemed necessary, you can also expect to hear some very carefully reasoned justifications.

Do you worry about dental X-rays and brain tumors? Did this blog help you understand the risk? Share your thoughts in the comment section below.

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Citations:

[i] Claus, E. B., Calvocoressi, L., Bondy, M. L., Schildkraut, J. M., Wiemels, J. L. and Wrensch, M. (2012), Dental x-rays and risk of meningioma. Cancer, 118: 4530–4537. doi: 10.1002/cncr.26625,

[ii] “Experts question X-ray study: Association with brain tumors based on patient recall of radiographs,” By Jean Williams, ADA News staff,

[iii] AAOMR Response to Recent Study on Dental X-ray Risks,

perio chart

Preventive oral hygiene includes regular checkups and cleanings to remove plaque and tartar that build up on teeth even with dedicated daily care.

Rotten teeth, tooth decay, and gum diseases like gingivitis or periodontitis are usually the result of poor oral care. These health conditions cost far more to repair than to prevent.

You may not be able to kill two birds with one stone, but when it comes to oral health there is one very simple and affordable thing you can do to avoid these serious – and potentially expensive – problems. That is: take preventive oral hygiene seriously.

Tooth decay and gum diseases get their start with a substance called plaque. Preventive oral hygiene includes daily efforts to eliminate plaque and prevent its build up. It also includes regular checkups and professional cleanings to remove plaque and tartar that can build up on teeth despite dedicated daily care.

What is plaque?

Plaque is the name for a sticky and translucent substance that is constantly being produced by our mouths. The bacteria in plaque consume sugars that are contained in various types of food. This creates acids that attack the surface of the teeth and toxins that may attack the bone beneath the gums.

The acids assault tooth enamel for 20 or more minutes after you have sugary food or beverages. Eventually, the acids may begin to destroy the enamel, which is how tooth decay gets a foothold, so to speak.

Plaque can also penetrate below the gum line, where the toxins can threaten the underlying bone.

Plaque can also penetrate below the gum line, where the toxins can threaten the underlying bone. The result is gingivitis or periodontitis. Obviously, neither situation – a rotten tooth or poor gum health – is high on anyone’s wish list.

Treatments and costs

Not least among the reasons for avoiding tooth decay or gum disease is the expense involved in treatment. In either case, treatment options depend on the severity of the problem, and as the severity mounts, so do the costs for professional care.

…as the severity mounts, so do the costs for professional care.

Milder cases of tooth decay may be treated by simply using a fluoride-based treatment. If cavities have developed, however, a filling will be required. More severe cases may require that a dentist fit the tooth with a crown, perform a root canal operation, or even pull the tooth altogether.

Gum disease is likewise increasingly more expensive to deal with the longer it is ignored or left undiagnosed and allowed to progress. If a milder case of gum disease is caught in time, patients may be able to simply brush and floss their way back to optimal health. More serious cases will require professional cleaning by a dental hygienist to get rid of built up plaque. A severe case of gum disease may require antibiotics or even surgery.

Preventing tooth decay and gum disease

Repair or prevent? Well, we think it’s a “no brainer” – but then, consider the source

If you really need any more convincing, try plugging the phrases “Oral Conditions and Diseases” or “Tooth Conditions and Disorders” into your browsers’ search bar and see what images come up. YUCKA!!!

But, if you’re already convinced about the power of prevention – and could use a brush up on oral care basics – check out this overview of basic dental care in our blog archives.

While you’re at it, why not call to schedule your next dental checkup?

Happy flossing!

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Teeth whitening before and after

Having teeth professionally whitened by a dentist is the safest way to keep them their brightest.

Everyone wants white, healthy-looking teeth, but professional teeth whitening can be expensive. No wonder home teeth whitening is such a hot search topic. We’re all looking to save money without (hopefully) sacrificing our pearly-whites!

Even in tough times, though, people are apparently willing to spend a little extra to ensure a winning smile. Industry analysts at IBISWorld report that, in the face of a difficult economy during 2012, the Teeth Whitening Product Manufacturing industry was still able to grow. The analysts estimated the industry’s revenues for 2012 at nearly $383 million, a 3.7% increase over 2011.

Having your teeth professionally whitened by a dentist is always the safest way to keep your teeth their brightest. But for those who are looking for a more affordable alternative, home teeth whitening products and a few homemade alternatives may be able to help. Here’s a rundown.

The basic ingredient in most whiteners: peroxide

Hydrogen peroxide and carbamide peroxide are the key bleaching ingredients used in most tooth whitening products. Whichever type is used, the peroxide safely bubbles away on the surface of tooth enamel and helps to scrub away stains. Teeth get whiter when the concentration of peroxide is higher and when the peroxide is left in contact with teeth longer.

…gums can become irritated if the peroxide solution they contain is trapped against the gums.

There are some possible side effects of using teeth whitening products that contain peroxide, though. For example, some people temporarily experience increased tooth sensitivity after using products that contain peroxide. In addition, when using trays and strips with peroxide (see below), gums can become irritated if the peroxide solution they contain is trapped against the gums.

And here’s the kicker: after bleaching teeth with a peroxide-based product, the enamel is more receptive to new stains for 48 hours.

Home teeth whitening products for routine care

With more and more home teeth whitening products available, whitening teeth can be part of anyone’s daily oral care routine. Today, there is a variety of toothpastes and oral rinses that can help make teeth whitening at home easy and practically automatic.

Typically, toothpastes that help to whiten teeth are made with slightly abrasive particles. The abrasives help to scour away stains. However, because the abrasives used in home whitening products are not as strong as those used by dental hygienists, it may take a few days before you see noticeably whiter teeth when using whitening toothpastes alone.

…a variety of toothpastes and oral rinses can help make teeth whitening at home easy and practically automatic.

Whitening mouthwashes and rinses are also available for daily use. These generally contain a small amount of peroxide that washes away minor surface stains before they have a chance to become more permanent. Whitening rinses stay in contact with teeth for a very short time, though, which means their effectiveness is typically lower compared to whitening toothpastes. Still, using the two types of products together may help you maintain a healthy smile.

Breaking away from the routine: trays, strips, and paint-on teeth whiteners

In addition to using whitening toothpastes, mouthwashes, and rinses as part of the daily tooth care routine, a variety of additional home teeth whitening products are available. These include trays, strips, and paint-on teeth whiteners.

Dentists generally agree that using teeth whitening trays or strips delivers the most dazzling results at home. Unlike toothpastes and rinses, trays and strips keep the tooth whitening solution in contact with teeth longer, so the results are more dramatic. Achieving results that are more striking also requires a greater time commitment. To achieve the desired shade of whiteness, most manufacturers recommend using trays or strips for a specified period each day for several days.

…paint-on teeth whiteners offer yet another option.

For those who find trays and strips uncomfortable (due to sensitive teeth, for example), paint-on teeth whiteners offer yet another option. The whitener is painted directly onto the surface of teeth, so no trays or strips are needed. The paint-on whitening solution is less likely to get on the gums, where it can cause irritation.

Natural teeth whitening home remedies

Can you whiten your teeth using walnut tree bark or with banana peels? It turns out there are a few natural teeth whitening recipes you can experiment with at home.

One of the most widely recommended home tooth whiteners is baking soda. Baking soda is a safe, mildly abrasive powder that can help scour away surface stains on teeth. Similar to the solution in teeth whitening trays, baking soda can be rubbed on teeth after being mixed with a few drops of hydrogen peroxide. Let it remain on the tooth surface for a few minutes, and then rinse it away.

Be careful to keep the baking soda solution on your teeth only…

You can also whiten teeth by brushing with a solution of three parts baking soda and 1 part water. Be careful to keep the baking soda solution on your teeth only, though. In combination with a toothbrush, baking soda can be hard on your gums and may cause irritation.

If you’re feeling really adventurous, you can find numerous articles online about whitening teeth using exotic ingredients, such as fresh sage leaves, hardwood ash, and walnut bark. A word of caution, though: check with your dentist or dental hygienist before you go too far out on a limb, so to speak.

Easy does it!

While you can use simple ingredients at home to get teeth whiter, getting them their whitest (especially if there is any moderate to severe staining to begin with) will probably mean making a trip to the dentist. If you do try whitening your teeth at home using natural ingredients, be sure to go slowly and allow your teeth and gums to rest and recover between treatments.

…never repeat a natural teeth whitening treatment more than once a week until you reach the shade of whiteness desired.

A good rule of thumb is to never repeat a natural teeth whitening treatment more than once a week until you reach the shade of whiteness desired. After that, reduce treatments to once a month at most, or better still, every other month. Otherwise, you run the risk of wearing down tooth enamel, increasing the risk of cavities, and developing tooth sensitivities.

Do you have a favorite home teeth whitening solution? Let us know what has worked for you in our comment section below. We’d love to hear from you!

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bottles with mouthwash

The three basic types of mouthwash include antiseptic, fluoride, and cosmetic varieties.

To rinse or not to rinse? Depending on personal circumstances and whom you ask, the question whether to use a daily mouthwash or oral rinse has different answers.

There are many types of mouthwashes, and everyone’s health is unique, so it’s important to understand the pros and cons of using mouthwash.

But first, an overview…

There are three basic categories of mouthwash: antiseptic mouthwashes, rinses that contain fluoride, and those that claim cosmetic benefits.

  • Antiseptic mouthwashes are designed to fight tooth decay by attacking plaque, the thin film of bacteria that forms on the surface of teeth
  • Mouthwashes that contain fluoride help fight tooth decay by making enamel tooth surfaces more resistant to plaque
  • Cosmetic mouthwashes simply help to reduce or mask bad breath and provide a refreshing feeling and taste for users

Pros and cons of using mouthwash on a daily basis 

Generally speaking, there are as many potential benefits as there are possible downsides to daily mouthwash use. Let’s start our comparison with a focus on the upside.

…while oral rinses can temporarily improve bad breath, most are not a permanent solution.

As we all know, mouthwash kills bad breath. What you may not have learned is that while oral rinses can temporarily improve bad breath, most are not a permanent solution. For that, you may need a special therapeutic rinse.

Nevertheless, using a mouthwash on a regular basis can help improve your mouth’s overall cleanliness. Gargling and swishing with an oral rinse can help to remove any remaining debris after flossing or brushing. Antibacterial and fluoride mouthwashes can help protect your gums and tooth enamel against inflammation, infections, and decay.

When not to use mouthwash

There are a number of dentists who say using a daily mouthwash is not crucial to oral health. They believe that brushing and flossing without mouthwash is an adequate daily oral health routine.

In some cases, skipping mouthwash altogether is definitely recommended. For example, children under the age of six and anyone who has difficulty rinsing and spitting should not use mouthwashes or rinses.

Alcohol-based mouthwash in particular presents a number of concerns. The high alcohol content in many brands of mouthwash can lead to dry mouth, cause tooth sensitivity, and aggravate canker sores. In addition, since the 1970s, studies have suggested there may be a link between mouthwashes that contain alcohol and oral cancer because the alcohol dissolves the mucous layer, leaving the mouth vulnerable to cancer-causing agents.

What does your dental health professional recommend?

Dental professionals generally agree: it is more important to brush your teeth twice a day and use dental floss than it is to use a mouthwash every day.

There are certain situations when using a daily mouthwash is recommended. For example, based on any special oral health needs — such as a recent periodontal surgery, difficulty flossing or brushing, or to treat infection, reduce inflammation, or reduce pain — your dentist may recommend rinsing daily or more often for a period of time. Similarly, to help relieve canker sores, your dentist may recommend a simple salt and water rinse or other mouthwash as a temporary treatment.

…you should talk to your dentist or oral hygienist about whether regular rinsing is right for you.

In general, though, because there are so many variables when it comes to mouthwash use, you should talk to your dentist or oral hygienist about whether regular rinsing is right for you. Together, you can determine the type of mouthwash ingredients and rinsing frequency that will suit your personal needs.

If you do decide to rinse, always remember: washing, gargling, or rinsing are very different from drinking. While you may accidentally swallow a small amount of most mouthwashes without any trouble, no mouthwash should be deliberately ingested. Some ingredients in mouthwashes can actually be poisonous if consumed in large-enough quantities.

Finally, it’s important to understand that just gargling with mouthwash or only using a dental rinse is not an acceptable substitute for brushing and flossing. After all, you wouldn’t skip the shower and just make do with a splash of perfume or a dash of cologne, would you?

For definitions of dental terminology, visit our Online Resources. Be sure to consult with your dentist or dental hygienist if you need additional guidance.

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Berries on wooden background

Many of the foods that promote tooth stains are also among the best choices for the vitamins and minerals essential to strong teeth and bones.

If you ask your favorite search engine, you’ll discover there are about 27 million reasons why having white teeth is important. However, we think one reason stands out: looking and feeling your best.

The trouble is: many of the foods that promote tooth stains are also among the best choices for the vitamins and minerals essential to strong teeth and bones. Intensely colored foods such as dark red beets and many kinds of berries can leave behind substances that weaken or cling to tooth surfaces and lead to stains.

Let’s take a look at some foods and habits that can contribute to yellow or brown teeth. We’ll also look at ways you can minimize the potential for staining without cutting vital nutrients out of your daily diet.

The compounds that stain and discolor teeth

There are three primary components that contribute to tooth staining. These are: intense color, acidity, and the presence of tannins.

  • Intensely colored foods and beverages: As a general rule of thumb, foods that are more intense in color have greater potential for staining your teeth. The reason? Dye-like molecules called chromogens that love to cling to enamel tooth surfaces.
  • Acidic foods and beverages: Acid erodes and softens dental enamel, which makes it that much easier for chromogens to latch on and stain teeth. The foods and beverages that contain relatively high levels of acid may not be intensely colored at all – think white wine – but the acid-based erosion contributes to staining all the same.
  • Tannins: The third member of the unholy trinity of stain-promoting agents is tannins. Tannins are found in a wide variety of foods and beverages (red wine is the poster child here). They work together with chromogens and boost their ability to adhere to enamel and stain teeth.
October is National Dental Hygiene month! Learn more at ADHA.org

Foods and beverages that stain teeth

Intensely colored, acidic, and tannin-rich substances come into contact with your teeth through a broad assortment of foods and beverages. Here’s a roundup of the types of food that are most likely to stain and discolor teeth:

  • Colas and sports drinks: The combination of acidity and chromogens in many colas and sports drinks give these items considerable staining ability. The beverages may be light or dark in color and still contribute to staining simply due to the enamel softening effects of the acids they contain.
  • Dressings and sauces: Like other deeply colored foods, some dressings and sauces can contribute to brown or yellow teeth. For example, soy sauce, balsamic vinegar, ketchup, mustard, tomato sauce, curry sauce, and other deeply colored sauces can leave behind stains due in many cases to the dental double whammy: both acidity and chromogens.
  • Intensely colored produce: Vegetables and fruits – and the juices, pies, and other foods and beverages made from these items – are rich in chromogens and can therefore contribute to tooth staining. Included in this category are beets, blackberries, blueberries, cherries, cranberries, grapes, pomegranates, and raspberries, to name only a few.
  • Tea and coffee: Most people know that frequent coffee consumption can stain teeth. They may not know the reason: coffee is rich in chromogens. Black tea, though, gets even worse marks from many dentists, not because of chromogens, but because it is so loaded with tannins.
  • Wine: Red, white, rosé – whatever the shade of your favorite wine, there’s a good chance it may help dim the appearance of your teeth. That’s because even if they do not contain tannins (as red wines notoriously do), wines are acidic and can therefore weaken tooth enamel, making it easier for chromogens from other sources to do their dirty work.

5 tips for minimizing tooth stains

There are certain things that you can and should do to help prevent tooth staining and discoloration. If you don’t smoke or have quit smoking, congratulations! You’ve already taken one giant step towards keeping your smile as bright as possible.

Avoiding sweets and other foods and beverages with high amounts of intense coloring (such as coffee and tea, red wine, candies, popsicles, jams, jellies, and pies) makes sense for any number of reasons, not least of which is the effect these items can have on tooth color and whiteness.

But what can you do to minimize the staining potential of all those other things that are so good and, often, so good for you?

Here are our top 5 tips for minimizing tooth stains:

  1. Eat your greens first: According to some sources, certain foods like broccoli and lettuce help to protect teeth against staining when consumed first.
  2. Use a straw: Sipping darkly colored, acidic, or tannin-rich beverages through a straw can decrease the amount of time the liquids are in contact with your teeth.
  3. Swallow without too much delay: To minimize your exposure to stain producing compounds, avoid holding stain producing foods in your mouth longer than necessary for proper chewing and swallowing.
  4. Brush, but not right away: Immediately after consuming acidic or tannin rich foods or beverages, tooth enamel is softer and more vulnerable than at other times. To avoid damage to the enamel and wash away much of the potentially harmful residue, swish with water and wait about 30 minutes before brushing.
  5. Chew sugarless gum: A good way to fight stains after eating or drinking, chewing sugarless gum mimics the mechanical action of a toothbrush or floss to help remove stain-causing substances from tooth surfaces.

It can be easy to minimize the potential for tooth stains, but just be sure you aren’t also eliminating vital nutrients in the process.

How do you keep your teeth looking their whitest? Let us know in the comment section below!

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For more information about dental health, including a glossary of dental insurance terms and articles about oral health and dentistry, visit our dental resources pages.