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The Job Behind the Mask – Part Two

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The Job Behind the Mask – Part Two

The Job Behind the Mask – Part Two

November 14, 2005
Part One | Part Two

By: Jean Johnson for Dental1

Portland dental hygienist, Nina Lieblick, R.D.H., continues her patient education with the topics including: Home care, sugar, tobacco and bulimia. We hope that her comments enable you and your family to walk out of that next dental appointment with high marks.

Home Care – Brushing and Flossing

“First of all, I’m a big fan of electric tooth brushes. Sonicare is what I have at home, and I think it works great. But no matter the brand, every time a patient switches to an electric brush, I see improvement in their mouths.”
Take Action
Steps for a healthy mouth:

Keep the mouth as clean as possible by at least rinsing after eating or drinking anything.

Try to brush and floss within 20 minutes after eating any type of sugar.

Think of your teeth as a one-of-a-kind custom-made set of fine jewelry.

If you currently have a bad habit that’s affecting your teeth (smoking, sugary snacks) take steps to cut back or quit.

Lieblick says she realizes people are busy, so she tries to keep the brushing times moderate. “Since we see teeth all the time and know how important it is, we tend to take extra care with our own teeth. I brush two minutes on top and two on the bottom morning and night. Still, if patients are able to at least spend two minutes on their entire mouth that’s a good start.”

She does not suggest whitening or tartar control pastes because she has seen patients that get a reaction complete with rashes. “Also the particles can be abrasive.” Instead Lieblick uses Colgate Total with its dual hit of fluoride and trilosane. “Trilosane is an antibacterial and helps cut down on the bacteria in the mouth just like Listerine does.”

Lieblick recommends flossing at nighttime, although if a person has teeth between which food tends to get trapped, she says they need to floss that area after each meal. As with brushing, however, she notes that the technique is critical. Cupping the floss around the curve of the teeth helps get to all the surfaces a brush can’t reach. And the standard eight to 10 swipes per surface is her maxim. “It’s really all about debriding the bacteria on the sides of the teeth.”

“Also, it’s great to look in the mirror to see you’re getting the right spots,” she said. “But if patients are more comfortable watching TV and flossing, then more power to them. The main thing is try to get not only in between the teeth, but also behind them the best you can.”

Home Care – Water Picks and Rinsing

On water picks, according to Lieblick they can be helpful but aren’t necessary. “Water picks are useful for those who have a hard time flossing and for getting under bridges. The stream lavages under the tissue and flushes things out. The idea is to remove the debris that’s under the gums, and you can also put Listerine into the water for some antibacterial help.”

“But if you do a good job with brushing and flossing, you don’t really need to use a water pick,” she said. “Then again, some people have deep pockets from gum disease that they can’t reach any other way. Also, for those with crown and bridge work, water picking can help keep the margins free from plague buildup.”

For the final touch in her own home care, Lieblick rinses with Listerine at night because she likes its antibacterial action. “It does have 20 percent alcohol that is too harsh and drying for some, but I think it makes everything so nice and clean in there.” That said, for those who want to rinse but can’t tolerate Listerine, she suggests alcohol-free, antibacterial mouth washes like Biotene or BreathRx that are soothing and don’t burn.


Lieblick sums up dentistry’s take on sugar in two words: “It’s bad.” More, she says that the reason “kids have bad teeth is Kool-Aid, Kool-Aid, soda.”

“Sugars mix with bacteria in the mouth and form an acid that eats your enamel away. Much of the adverse effects, though, depend on how long the teeth are exposed. If you drink one soda a day all at once, it’s not nearly as bad as drinking that same soda slowly in little sips all day,” she said. “Also especially bad are the candies that are sticky or those that take a little while to dissolve in your mouth. There was a reason that the most productive year for dentists ever was the year Tic Tac mints came out.”

She points out that eating a cookie is not as hard on the teeth as a food item concentrated with sugar that sits on the teeth. Lollipops, for example, are a not a friend to those who want to keep their teeth intact throughout their lives. “Also a lot of moms will lay a baby down to sleep with bottle milk or juice. When they do that a little bit of the liquid baths their teeth in sugar the whole time they are sleeping. We call these types of cavities ‘baby bottle,’ and it’s really sad to see a three year old with tons of cavities in her or his front teeth.”

The bottom line, then? “Put young ones down with bottles filled with water only.” More, what’s good for the kiddies is good for the oldsters as well. As Lieblick concludes, not surprisingly, “cutting down on the sugars is the answer.”


“Usually what I talk with patients about is the fact that cigarettes have certain chemicals in them that actually close down blood vessels. You have little tiny vessels that supply gum tissue with nutrients to keep it healthy. Those clamp down when a person uses nicotine.”

Lieblick explains that the lack of blood delivery to the gum tissue can cause gum disease, although the tissue might not bleed as it does in non-smokers’s mouths. “Smokers can have a lot of tartar that would normally cause the tissue to bleed, but because they don’t have normal circulation to the area, that symptom doesn’t appear.”

“I even often can tell the place where a person places their cigarette. They have deeper pockets right there,” she said. “A lot of times I’ll go around and probe, and everything will be totally normal until I get to that spot in the front of the mouth where there will often be the deeper gum pocketing and also some bone loss.”

The other problem with smoking is, of course, oral cancer. “We do oral cancer screening on all our patients, but if there is a little lesion that looks suspicious in smoker, we are more inclined to send them to an oral surgeon for a biopsy.”


Lieblich hasn’t seen too many patients with signs of bulimia, but if she does spot the problem she says she will ask if at any point in time they were really sick and throwing up a lot and explain that they have some enamel erosion.

“The big thing with bulimia is that if you’re constantly throwing up stomach acid can erode teeth away. It’s always in the same place – on the back side of top front teeth,” said Lieblick. “Once the enamel’s gone, there’s nothing to do to get it back.”

The hygienist’s suggestion for those suffering from bulimia is to clean their teeth with fluoride paste after a bout to help strengthen the enamel. She adds, though, that unless the situation is resolved, the enamel will continue to wear away. “The loss of enamel can leave teeth sensitive to cleanings especially, but many people live with enamel erosion without too many other problems.”

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