School Lunches: Squeeze Out the Juice

Sending the kids back to school means it’s time to start packing those lunch boxes! And when you do, keep in mind that what your children drink can affect their oral health just as much as what they eat.

The scientific evidence is overwhelming that sugar is the most important dietary factor in causing tooth decay, and soft drinks are the largest source of sugar in many kids’ diets. But they’re not the only culprits: Even 100% fruit juices with no added sugar can promote tooth decay because of the sugar they naturally contain.

That’s one of the reasons why the American Academy of Pediatrics recently came out with new recommendations for children’s juice consumption, based on the latest research. Here are the new guidelines by age:

  • Kids ages 7-18 should have no more than 8 ounces (1 cup) of juice per day.
  • Children ages 4-6 should have no more than 6 ounces of juice per day.
  • Toddlers ages 1-3 should be limited to 4 ounces of juice per day.
  • Babies under age 1, and children of any age with abnormal weight gain, should have no juice at all.

Again, these guidelines apply to 100 percent natural juice with no added sugar.

So what drink should you pack in your child’s lunchbox? Water is the most tooth-friendly beverage of all. Low-fat or non-fat milk are also good choices for school-aged kids.

If you have any questions about nutrition and oral health, be sure to ask your dentist. And have a happy, healthy school year.

Stay Cool, but Protect Your Teeth

When the summer sun is beating down, what can you do to stay cool?

If you’re tempted to grab an ice cold soda or a tall glass of lemonade, you might want to think twice. The combination of acid and sugar in these drinks can harm your teeth. Water is an excellent way to stay refreshed and tooth-healthy. Milk is another good choice for keeping teeth strong.

What about a sports drink? Sports drinks are acidic, and many of them have a high sugar content — so they aren’t good for tooth enamel. Again, nothing hydrates like plain water, an option that never damages your teeth.

If you choose a beverage other than water, it’s best to drink it with a meal, and swish your mouth with water afterwards to reduce acidity. This tip applies to all acidic drinks, including fruit juice and diet soda.

One more thing: Acidic food and drink can soften tooth enamel, so wait at least 30 minutes before brushing. This will prevent erosion of tooth enamel over time.

The best advice for cooling down on a sizzling summer day? Grab a cold one — a cold glass of water, that is.

Oral Cancer in Men Caused by Sexually Transmitted Virus Is on the Rise

Not long ago, the prevention and treatment of deadly cancers linked to the sexually transmitted human papillomavirus (HPV) was thought to be mainly a women’s health issue. While HPV-linked cancers were known to affect people of either sex, the number-one cause of mortality from HPV infection was cervical cancer. But a recent study in the journal Annals of Internal Medicineshould serve as a loud wakeup call to sexually active men: The incidence of oral cancers in men caused by HPV is now surpassing that of cervical cancer in women.

According to the study, some 11 million men in the United States have oral HPV infections, as opposed to 3.2 million women. Higher-risk strains of the virus, which can cause cancers of mouth, tongue and throat, were present in 7.3% of men and 1.4% of women. HPV can be passed from person to person by intercourse as well as oral sex. And one particularly troublesome strain, HPV-16, is six times more common in men than in women.

In the past, medical professionals regarded tobacco use and alcohol consumption as the main risk factors for oral cancer. But today, the fastest-growing group of new oral cancer patients is young people of either sex, who are infected by sexually transmitted strains of the HPV virus. And that’s something we all need to learn more about.

At Dear Doctor, we have been following this disturbing trend for some time. In recent issues of Dear DoctorDentistry & Oral Health magazine, we mourned the loss of legendary slugger Tony Gwinn to oral cancer; presented a cancer survivor’s story; and previewed a new salivary test that could help identify people who need a biopsy. We have also emphasized the importance of routine dental exams in diagnosing and treating diseases like oral cancer—and in many cases, even preventing those diseases.

So let’s take this opportunity to review what you can do to fight oral cancer. First, practicing safer sex is important; it can help protect you from HPV and other diseases as well.  Avoid overuse of alcohol and quit using tobacco of any type—including smokeless “dip.” Next, become more informed about oral cancer, including its causes, symptoms, prevention and treatment. (The articles on are a great place to start.) Learn how to perform a self-exam for oral cancer—and make sure to get regular dental checkups, where your dentist can perform a thorough oral cancer screening. Finally, ask your health care provider about the HPV vaccine (Parents: that goes for boys as well as girls).

Oral cancer may be a scary thing to talk about—but it’s a conversation many of us need to have. The good news is that when oral cancer is found and managed early, the odds of successful treatment go way up.

How What You Eat Affects Your Teeth

Every food you eat or beverage you drink comes in contact with your teeth, which means those choices continually impact the health of your teeth and gums. Many foods in a typical American diet — from sugary, processed foods and drinks to those that are highly acidic — can actually eat away at your tooth enamel, causing cavities. So it’s important to focus on eating healthy foods that also help promote oral health.

That means moving away from sugary, sticky, and acidic foods and drinks. Instead you’ll want to focus on eating a well-balanced diet that boosts your intake of tooth-friendly nutrients such as calcium.

With these healthy eating and drinking guidelines, you can reduce your risk of enamel erosion and cavities, and keep your smile looking healthier, longer.

Skip sweets. Cavities have long been linked with a diet rich in sugary, sticky foods as well as poor oral health habits, according to the American Dental Association (ADA). So it’s important to limit sugary foods and drinks. That doesn’t just mean candy, cookies, and cake. Sodas, some sports and energy drinks, and even juices are high in sugar. You might also be surprised to find high amounts of sugar in certain brands of spaghetti sauce, cereal, and canned fruit, so it’s important to check the sugar content in everything you eat or drink.

Eat non-stick foods. Sticky foods like raisins, honey, and molasses, along with starchy foods like bread and potato chips, can cling to the surface of your teeth and increase the risk of cavities, says Ginger Hultin, RD, in practice in Seattle, and a spokesperson for the Academy of Nutrition and Dietetics (AND). Eaten in moderation, with good oral health practices such as brushing and flossing regularly, these foods are acceptable in small amounts.

Watch out for acidic foods. While eating fresh produce like oranges and tomatoes is an important part of a healthy diet, citrus fruits and certain other types of fruit are acidic, which can affect your tooth enamel. Try eating them with a meal — as opposed to on their own — so they’re less likely to harm your teeth.  Keep in mind that acidic fruits in other forms (think lemon juice and cranberry jelly) are still acidic.

Beware of teeth-staining drinks. Certain drinks, like coffee, tea, and red wine, are likely to stain your teeth. That’s because they contain color pigments called chromogens, which attach to and stain tooth enamel. That doesn’t mean you can never enjoy a morning cup of coffee or a glass of wine with dinner — just drink plenty of water with it to help wash away these tooth-staining properties.

Eat a balanced diet. The ADA recommends eating a well-balanced diet that includes vegetables, fruit, whole grains, lean protein such as fish or beans, and dairy to help keep your teeth healthy. Eating a variety of these healthy foods can help you get the nutrients you need to promote oral health.

Aim for anti-inflammatory foods. An anti-inflammatory diet correlates with healthier gums and fewer lost teeth, according to research published in June 2017 in the journal Clinical Nutrition. The AND says certain foods, such as saturated fats and refined foods, contribute to inflammation. “Participants in our study were considered to follow a pro-inflammatory diet if their diet was particularly rich in carbohydrates, trans-fat, or had overall high caloric intake,” says lead author and periodontist Georgios A. Kotsakis, DDS, MS, an assistant professor in the department of periodontics at the University of Washington in Seattle.

Incorporate healthy fats. Healthy fats are an important component of an anti-inflammatory diet that promotes oral health. The AND recommends choosing heart-healthy fats such as olive oil, avocado, and fatty fish like salmon. Dr. Kotsakis emphasizes the importance of including these types of omega-3 fatty acids in your diet. Work with your dentist or a dietitian if you aren’t sure how to incorporate healthy fats into your diet.

Get enough calcium. People who get the recommended daily amount of calcium are less likely to develop gum disease, according to a study published in February 2016 in the journal Public Health Nutrition. Adults should get at least 1,000 to1,300 milligrams of calcium daily, depending on their age, according to the Office of Dietary Supplements. Along with milk and other dairy products, foods that are high in calcium include beans, almonds, and leafy greens, the ADA says.

Drink water. If you’re thirsty, reach for a glass of water. “Plain water is best to protect the teeth and for so many other health-supporting benefits,” says Hultin. “Other beverages that aren’t sweetened are safe for teeth, including unsweetened coffee and tea.” If you do indulge in a sweet beverage, chase it with a drink of water — this is one way to wash some of the sugar off your teeth.

Take breaks. Try not to eat or drink constantly. Your mouth needs breaks to process what you’re putting in it. “Spacing meals and beverages apart by at least two hours reduces risk of tooth decay,” Hultin says. The ADA explains that your mouth produces more saliva during a meal, which can help wash away food particles, than it does in between meals. But ongoing snacking — especially with snack choices that are bad for your teeth, like potato chips or candy — could leave residual particles on your teeth.

Chew sugar-free gum. If you’re having a hard time sticking to a no-snacking policy, try sugar-free chewing gum. “Chewing sugarless gum after a meal or snack reduces the risk of cavities,” Hultin says. This is because chewing gum stimulates saliva and moves the materials that can lead to tooth decay. The ADA says the increased saliva also adds calcium and phosphate to the mouth, which makes tooth enamel stronger. You’ll also get the added benefit of fresh-smelling breath.

8 Surprising Foods Your Dentist Won’t Eat

While it may be obvious that certain foods and drinks are bad for your teeth, like candy and soda, there are other less obvious options that can also be harmful to your oral health. Although some might advise avoiding these problem foods altogether, dentists generally argue in favor of moderation and good oral hygiene.

“I don’t feel bad about having ice cream or chocolate every once in a while because I brush my teeth and I floss every day, so I know I’m removing plaque properly,” says Ana Paula Ferraz-Dougherty, DDS, a dentist in San Antonio, Texas, and a spokesperson for the American Dental Association (ADA).

Whether you want to avoid them entirely or reduce your consumption to help protect your teeth, here are eight surprising foods and drinks dentists try to limit.



While it’s fine to put ice in your drink, make sure you don’t chew on it. “Avoid doing anything that would result in trauma to the tooth, such as chewing ice, as it fractures enamel,” says Van Himel, DDS, an endodontist, head of the department of endodontics, and a professor at the Louisiana State University Health Sciences Center School of Dentistry in New Orleans.


Sports Drinks

When it comes to sports drinks, it’s all about how often you drink them. “If you drink these every day, you’re more likely to develop cavities because they’re acidic — and often high in sugar,” says Dr. Ferraz-Dougherty.

Like sports drinks, energy drinks also contain a lot of sugar that can harm your teeth — so drink them in moderation.

Sour Gummies

“The sour flavor in these candies is created by adding acid to them,” says Clara M.Spatafore, DDS, MS, chair of the department of endodontics at Virginia Commonwealth University in Richmond. Your teeth get a double whammy with sour gummy candies: Not only is the sugary coating damaging your enamel, but the gummy nature of the treat means it sticks around on your teeth longer.

Dried fruit is also in the sticky-and-harmful category, according to the ADA, so it’s best to limit your consumption.

Flavored Coffee Creamer

Unsweetened coffee and tea are healthy options for most people, Ferraz-Dougherty says. But when you add sugar, syrup, or flavored creamers, you’re turning it into an unhealthy drink. “The problem is that if you’re having one, two, or three cups of coffee a day and adding these sweeteners to each cup, it becomes really damaging to your teeth,” she says. If you do drink sweetened coffee or tea, chase it with a cup of water to rinse your teeth.


The occasional glass of wine or beer is no problem, but drinking alcohol frequently and in excess can dry out your mouth, Ferraz-Dougherty says. “When your mouth is dry, over time your saliva flow is reduced, and dry mouth puts you at a higher risk for cavities and gum disease,” she explains. What’s more, excess alcohol consumption is tied to oral cancer over the long run, according to the ADA.


“What’s bad about popcorn are the kernels that don’t pop,” Dr. Spatafore says. “They can break a tooth.” But you don’t have to pass on the popcorn completely, she says. Just be sure to leave the unpopped kernels at the bottom of the bucket. The ADA recommends avoiding chewing on these types of hard objects to reduce your chances of a dental emergency.


Squeezing some fresh lemon into your water or club soda is fine — just avoid sucking on the lemon wedge. “Any type of citrus you suck on is bad for tooth enamel,” Spatafore says. The ADA points out that not only are citrus juices potentially damaging for your teeth, but the acid in the juice can make any sores in your mouth more painful.

Protein Bars

Protein bars have a surprising amount of sugar in them, Spatafore says. She recommends avoiding them altogether, as there are better ways to get protein.

If you do decide to eat a protein bar, try chasing it with some water or chewing some sugar-free gum afterwards to help remove excess sugar from your teeth, the ADA recommends.


The 4 Types of Teeth and How They Function

Your teeth and the structure of your mouth play important roles in your ability to eat, speak, and stay healthy.

Most of us take our teeth for granted — until something goes wrong. Not only do our teeth help us chew and digest food, they also play an important role in speech, and impact our health overall. By brushing up on your dental health knowledge, you’ll be taking the first step toward giving your teeth the attention they deserve.

How much do you know about your pearly whites?

The Development of Teeth

Humans have two sets of teeth: primary (or baby) teeth and permanent (adult) teeth, which develop in stages. Although the timing is different, the development of each of these sets of teeth is similar. Here are some facts about how the teeth develop:

  • According to Shantanu Lal, doctor of dental surgery and associate professor of dental medicine at Columbia University Medical Center in New York City, teeth tend to erupt in a symmetrical manner, meaning that the top molar on your left side should grow in at about the same time as the top molar on the right.
  • “Tooth development begins long before your first tooth becomes visible. For example, a baby’s first tooth appears at around six months, but development of those teeth actually begins during the early second trimester of pregnancy,” says Dr. Lal.
  • The crown of a tooth forms first, while the roots continue to develop even after the tooth has erupted.
  • The 20 primary teeth are in place between ages 2 ½ and 3 and remain until around age 6. Between ages 6 and 12, these primary teeth begin to fall out to make way for the permanent set of teeth.
  • Adult teeth start to grow in between ages 6 and 12. Most adults have 32 permanent teeth.

The Parts of the Tooth

A tooth is divided into two basic parts: the crown, which is the visible, white part of the tooth, and the root, which you can’t see. The root extends below the gum line and helps anchor the tooth into the bone. Your teeth contain four kinds of tissue, and each does a different job. These include:

Enamel This is the visible substance that covers the tooth crown. Harder than bone, enamel protects the vital tissues within the tooth. Enamel is made up of hydroxyapatite, phosphorous, and calcium.

Dentin Underneath the enamel you find dentin, which is calcified and looks similar to bone. Dentin is not quite as hard as enamel, so it’s at greater risk for decay should the enamel wear away.

Cementum This tissue covers the tooth root and helps anchor it into the bone. It’s softer than enamel and dentin; the best way to protect this softer tissue from decay is by taking good care of your gums. Cementum has a light yellow color and is usually covered by the gums and bone. But with inadequate dental care, the gums may become diseased and shrink, exposing the cementum to harmful plaque and bacteria.

Pulp Pulp is found at the center and core of your tooth and contains the blood vessels, nerves, and other soft tissues that deliver nutrients and signals to your teeth.

Types of Teeth and What They Do

Teeth help you chew your food, making it easier to digest. Each type of tooth has a slightly different shape and performs a different job. Types of teeth include:

Incisors Incisors are the eight teeth in the front of your mouth (four on top and four on bottom). These are the teeth that you use to take bites of your food. Incisors are usually the first teeth to erupt — at around 6 months for your baby teeth, and between ages 6 and 8 for your adult set.

Canines Your four canines (fangs) are the next type of teeth to develop. These are your sharpest teeth and are used for ripping and tearing food apart. Primary canines generally appear between 16 and 20 months, with the upper canines coming in just ahead of the lower canines. In permanent teeth, the order is reversed, with lower canines erupting around age 9 and the uppers arriving between ages 11 and 12.

Premolars Premolars, or bicuspids, are used for chewing and grinding food. Adults have four premolars on each side of their mouths — two on the upper and two on the lower jaw. There are no primary premolars; the first premolars appear around age 10, with the second premolars arriving about a year later. These take the places of the first and second primary molars (described below).

Molars Molars are also used for chewing and grinding food. Primary molars, also known as deciduous molars, appear between 12 and 28 months, and are replaced by the first and second premolars (four upper and four lower) described above.

The permanent molars (also four upper and four lower) do not replace any primary teeth, but come in behind all of them, further back in the jaw. The first permanent molars erupt at around age 6 (before the primary molars fall out), while the second molars come in between ages 11 and 13.

Third molars The third molars are commonly known as wisdom teeth. These are the last teeth to develop and don’t typically erupt until age 18 to 20. Some people never develop third molars at all. For those who do, these molars may cause crowding and need to be removed. If they don’t fully erupt they are said to be impacted, and are commonly removed.

Your mouth is important, so don’t take your teeth or oral health for granted. “For good dental health, brush and floss your teeth regularly, don’t smoke, eat a healthy diet, and see your dentist regularly for dental cleanings and checkups,” advises Lal. A healthy mouth makes for a healthy body — and a pretty smile.

Controversial Chemical Can Linger on Your Toothbrush

Triclosan is still allowed in toothpaste in U.S., but not soaps and wipes.

Triclosan — a potentially harmful antibacterial agent used in some toothpastes — accumulates in toothbrush bristles, researchers report.

This means your exposure to the chemical can continue even if you switch to a triclosan-free toothpaste, the investigators warned.

Triclosan is now banned in over-the-counter antiseptic soaps, gels and wipes in the United States. But the germ-busting ingredient is still allowed in toothpaste because it reportedly reduces gum inflammation, plaque and cavities, said researchers led by Baoshan Xing. He is a professor of environmental chemistry at the University of Massachusetts.

Prior studies have shown that triclosan can disrupt hormones in animals and humans. It also contributes to antibiotic resistance and harms marine life, the researchers said in background notes.


In this study, Xing’s team simulated toothbrushing with 22 brushes and a variety of toothpastes.

More than one-third of the toothbrushes tested, including two children’s varieties, accumulated amounts of triclosan equivalent to seven to 12 doses of the amount used per brushing, the study authors reported.

Toothbrushes with “polishing cups” or “cheek/tongue cleaners” — typically made of a class of materials called elastomers — absorbed the largest amounts of triclosan, according to the study.

When the researchers switched to triclosan-free toothpaste but used the same brushes, the chemical was continuously released from the toothbrushes for two weeks.

The study was published online Oct. 25 in the journal Environmental Science & Technology.

Besides the possibility of prolonged triclosan exposure, the study findings suggest that triclosan could find its way into the environment if tainted toothbrushes are discarded, the researchers said in a news release from the American Chemical Society.

The U.S. Food and Drug Administration banned triclosan from antiseptic washes because of possible harmful effects and because there was no proof they killed germs more effectively than soap and water. The chemical is still allowed in clothing and cookware, which don’t fall under the FDA.

What Is Enamel Erosion?

Your daily habits — from what you eat and drink to how you brush — may be harming your teeth.

If your dentist has brought up enamel erosion, it’s worth listening. “Enamel is the hard, calcified tissue that covers the crown of the teeth,” says Ana Ferraz-Dougherty, DMD, a dentist in San Antonio, Texas, and a spokesperson for the American Dental Association. “It’s basically the shield against anything we eat and drink to protect against cavities.”

It’s also the white part of your teeth, so when it wears away, you’ll begin to see more of the underlying dentin, which is more yellow. And that’s something that whitening treatments, which work primarily on removing stains caused by foods and drinks, can’t fix.

How Enamel Is Worn Away

Dental enamel provides an incredibly hard shield for your teeth, but it has one major weakness: its pH. Made of carbonated calcium hydroxyapatite, it has an estimated pH of 5.5. Your saliva works to neutralize acids and maintain that balance, as well as to help replace phosphate and calcium ions that are lost to keep the enamel strong. But when saliva can’t keep up with the acids, enamel erosion can happen.

While enamel is incredibly strong, once it wears away, there’s no going back. Since there are no living cells in the enamel of your teeth, it can’t regenerate or heal itself. And if the protective covering wears away, it can expose the nerves in the center of your teeth, making them sensitive to hot and cold. If left untreated, eventually it can even lead to the loss of your teeth.

However, some enamel erosion is simply a natural part of aging. “We use our teeth for eating, drinking, and chewing. As a result, the enamel wears away over time,” says Dr. Ferraz-Dougherty.

Enamel Erosion and Your Diet

Oftentimes, enamel erosion is due to your diet. “If you’re eating a healthy, balanced diet, it shouldn’t be too damaging. But if you’re drinking sodas all day, every day, that’s going to cause really fast damage to your enamel,” says Ferraz-Dougherty.

Some of the biggest culprits are drinks: sodas, sports drinks, and especially sweet tea, which is more acidic than soda and packs a lot of sugar. “The acids wear down the enamel, and the sugar starts in on developing cavities,” says Ferraz-Dougherty. “It’s a double whammy.” But “sugar-free” doesn’t necessarily mean your drink is in the clear either. Seltzers are very acidic too.

Talking to your dentist about your diet habits can help you determine what types of lifestyle modifications you should make to help prevent enamel erosion.

Medical Problems That Contribute to Enamel Erosion

For some people, erosion of tooth enamel is caused by frequent vomiting or acid reflux, which repeatedly exposes the teeth to stomach acid and can cause pitting in the enamel. The risk is magnified during sleep, when you produce less saliva to protect the teeth.

“A lot of people don’t even know it’s happening,” says Ferraz-Dougherty. But a dentist can tell by looking at the specific patterns of wear in your mouth. For example, with acid reflux that happens at night, a dentist might see it on just the side of the mouth that you predominantly sleep on. Or somebody who is bulimic might have enamel loss on the inside surfaces of the upper teeth.

Grinding your teeth can also physically wear down the enamel, so it’s important to talk to your dentist to figure out the root cause of grinding — from stress to tooth position — and find a solution.

When Brushing Can Harm Enamel

It may seem tempting to grab your toothbrush every time you eat or drink something acidic to help prevent enamel erosion — and banish bad breath. But it’s best to wait about half an hour after eating or drinking to prevent further erosion. Right after you expose your teeth to acid from food or drink, the enamel is more delicate. But the saliva in your mouth quickly goes to work to wash away the acids, remineralize your teeth, and fortify the enamel.

That’s why people who struggle with dry mouth, often as a side effect of medication, can have a tendency to get more cavities, according to Ferraz-Dougherty. They’re missing the protective effect of saliva. Chewing sugar-free gum with xylitol can help to both stimulate saliva production and diminish the acids in your mouth.

And that same gum can also help as a stopgap to prevent bad breath while you wait to brush. When you do brush, consider skipping toothpastes with baking soda, which is naturally very abrasive to your teeth, suggests Ferraz-Dougherty.

Treatment Options for Enamel Erosion

If you experience symptoms of enamel erosion, like discolored teeth or sensitivity to hot or cold foods or drinks, it’s important to see your dentist, who can help you to evaluate your options and choose a course of action. Nothing will replace the enamel, but in addition to making certain lifestyle modifications, there are dental products and procedures that can help.

For starters, your dentist may recommend brushing with a toothpaste that contains fluoride or rinsing with a fluoride-containing mouthwash.

If enamel erosion is causing sensitivity or if you are interested in cosmetic changes, veneers and crowns can give the look of healthy white teeth.

For people who have lost enamel at the gumline, putting fillings in those areas may help, says Ferraz-Dougherty.

10 Dental Myths, Debunked

There are many misconceptions about what it takes to keep your teeth healthy. Separate fact from fiction.

When it comes to taking care of your smile, there are plenty of misconceptions out there. But while good oral health can be achieved in just minutes a day, the wrong practices can cause irreversible damage. Here’s what you need to know.

Myth: The harder you brush, the cleaner you’ll get your teeth.

The real deal: Brushing too hard or with too abrasive of a toothbrush (medium or firm) can actually harm your teeth by eroding some of the hard enamel that protects the inside of the tooth from cavities and decay. “I see it so much where people feel like they’re getting them more clean, but actually it wears away enamel and even the gums,” says Ana Paula Ferraz-Dougherty, DMD, a dentist in San Antonio, Texas, and a spokesperson for the American Dental Association. “I always recommend a soft-bristled brush.”

Myth: Flossing isn’t really necessary anymore.

The real deal: The recommendation to floss regularly was recently removed from the government’s Dietary Guidelines for Americans based on a lack of strong evidence for the practice. However, a lack of strong evidence doesn’t necessarily mean that flossing is not effective. In fact, many dentists — including Dr. Ferraz-Dougherty — haven’t changed their ways or their recommendations. “I totally believe in flossing,” she says. “Intuitively, it makes sense that there is buildup you can only remove by flossing, and I see the difference every day.” It’s important to still follow your dentist’s recommendation on brushing and flossing.

Myth: Chewing sugar-free gum is just as good as brushing.

The real deal: If only this were true, kids everywhere would jump for joy. Chewing sugar-free gum, especially gum with xylitol, can have a protective effect on the teeth. Gum encourages saliva production, which helps to wash away enamel-eroding acids from foods, drinks, and even stomach acid in the case of issues like acid reflux. And xylitol helps to redouble the effects of saliva.

But chewing gum still doesn’t replace brushing and flossing when it comes to removing plaque from all the surfaces of your teeth. You should brush at least twice a day for about two minutes, says Ferraz-Dougherty.

Myth: If your gums bleed when you floss, it’s best to leave them alone.

The real deal: “The reason our gums bleed is due to inflammation,” explains Ferraz-Dougherty. Often it happens when bacteria and plaque get stuck in between our teeth where toothbrush bristles don’t reach properly. Over time the bacteria builds up and causes the gums to become inflamed. Bleeding is part of that process.

If you floss once a month (or just before going to the dentist), it’s likely you’ll notice your gums bleeding. “That’s a sign telling you something is going on there,” says Ferraz-Dougherty. Make flossing a daily habit and the inflammation — and the bleeding — will go away with time.

Myth: You’ve been slacking on brushing and flossing and have a dentist appointment coming up. As long as you brush well before going in, no one will know, right?

The real deal: Sorry to break it to you, but you’re not getting away with anything. “We can tell,” says Ferraz-Dougherty. Without regular brushing and flossing, hard tartar forms around your teeth and at a certain point you can’t get it off with brushing alone. Plus, you can’t undo the inflammation in your gums that occurs when plaque and tartar have accumulated over six months with just a few days of flossing. “Bleeding gums and the amount and location of tartar are the giveaways,” says Ferraz-Dougherty.

Myth: When it comes to cavities, sugar is the main culprit.

The real deal: When you think of cavities, you might think of lollipops and other sweet and sticky treats. But crackers and chips might be even worse for your teeth, says Ferraz-Dougherty. “It has to do with the starchiness,” she explains. “It’s carbohydrates in general — they have the sugars that break down the teeth, but they also really stick to your teeth.”

Myth: If you have sensitive teeth, it means you have worn away too much of the enamel on your teeth.

The real deal: Sensitivity is a key symptom of the loss of enamel, the hard protective layer on the outside of your teeth. But it can be caused by other factors as well, such as gum recession, or even the use of whitening toothpastes. “The hydrogen peroxide [used for whitening] can penetrate to remove stains,” Ferraz-Dougherty says, “And it penetrates through the enamel into the layer beneath, which is the more sensitive part of the tooth.” The good news: If your sensitivity is caused by teeth whitening, switching to a more gentle toothpaste can help improve symptoms.

Myth: Gum disease is only a problem for your mouth.

The real deal: Your dentist might be the first one to notice it, but if you have gum disease you’re more likely to have health issues such as diabetes and hypertension, as well as certain types of cancers that are related to chronic inflammation, says Ferraz-Dougherty.

Myth: The whiter your teeth are, the healthier they are.

The real deal: This can be true but not always. “Our teeth are naturally white,” says Ferraz-Dougherty. And many of the things that cause our teeth to get darker or become yellow are unhealthy, like smoking.

But there are also plenty of things that can darken the color of our teeth that aren’t necessarily unhealthy, such as medication, stains from foods and drinks, or just the natural process of aging.

Myth: If nothing is bothering you, you don’t need a dental checkup.

The real deal: “This is one of the biggest misconceptions,” says Ferraz-Dougherty. “With a lot of dental issues, you don’t necessarily feel pain right away. I have to explain to patients and educate them that with cavities and gum disease you don’t always feel it.” The problem is once the symptoms appear, it’s often a bigger issue. If you wait until a cavity hurts to get it checked out, you could end up needing a root canal or an extraction that could have been prevented with regular checkups.

“The point of going to the dentist is so we can prevent things happening to the teeth to protect them and notice things before they become an issue,” says Ferraz-Dougherty.

Are You Brushing Your Teeth Too Hard?

If you have sensitive teeth, brushing too hard or using the wrong toothbrush altogether can make symptoms worse. Learn the proper technique for brushing your teeth.

When it comes to brushing your teeth, there is such a thing as proper technique. Brushing too hard — or using the wrong toothbrush — can damage your teeth and gums, leading to problems like enamel wear and receding gums, which can in turn lead to tooth sensitivity, says Gene Romo, DDS, a Chicago-based dentist and consumeradvisor for the American Dental Association (ADA). “People tend to brush aggressively, thinking it’s the only way they can get their teeth to feel clean and look whiter,” Dr.Romo says. “That’s counterproductive, because not only does it cause recession of your gums, but you’re also wearing away the white, glossy enamel on your teeth, making them look yellow and darker.” And when that happens, you’re putting yourself at risk for developing sensitive teeth.

Not sure if you’re brushing too hard? Take a look at your toothbrush. If you’ve been using it for three months or less, it should still appear relatively new. “If it looks beat up and flat, that’s a sign you’re brushing way too hard,” Romo says.

The Proper Way to Brush Your Teeth

It requires a lot of mindfulness, but you can change your hard-brushing ways, Romo says. Follow these tips to brush properly to help relieve tooth sensitivity and prevent damage to your teeth and gums:

Use a soft-bristled toothbrush. Choose one with the ADA seal and replace it every three months — or sooner if it frays.

Place your toothbrush at a 45-degree angle to your gums. That way, the bristles can reach and clean underneath your gumline, Romo says.

Gently move the brush back and forth. Use short, tooth-wide strokes to clean the outer, inner, and chewing surfaces of the teeth, the ADA recommends. (If you have a lot of gum recession, your dentist may recommend you try the roll technique instead, Romo says.) If you’re using an electric toothbrush, let it do all the work and just lightly glide it over your teeth instead of pushing it against them. To make sure you’re using a gentle grip, try holding your toothbrush in your nondominant hand.

Slow down. Dentists recommend that you brush for two full minutes — 30 seconds in each quadrant of your mouth — twice a day. Use the timer on your phone or choose an electric toothbrush that alerts you every 30 seconds. “For people who have never tried it, it can feel like an eternity. You don’t really know what two minutes feels like until you actually brush that long,” Romo says. But when you’re not rushing to finish, it will keep you more mindful about brushing too aggressively.

Sticking with these tips can help you keep your teeth clean and your mouth healthy, while eliminating symptoms of tooth sensitivity.