What is the proper brushing technique?

Proper brushing takes at least 2 minutes. Brush the outer, inner and chewing surfaces of your teeth using short, gentle strokes, making sure to pay extra attention to the gum line, hard-to-reach back teeth and areas around dental work you’ve had done. Start with the toothbrush at a 45°angle against the gum line and sweep your toothbrush away from the gum line. Then brush using short, gentle back-and-forth strokes on the outside, inside and chewing surfaces. Don’t forget to brush your tongue too, to remove bacteria and freshen breath.

What is the best toothbrush to use?

A soft, compact head is best. If you typically spend less than 2 minutes brushing, the best toothbrush for you is an electric one, because it has a timer and will let you know when to stop. With proper technique, electric, battery-operated and manual toothbrushes all work well. Dr.Dr. Picard has a preference for Oral B electric toothbrushes, but all options are good as long as they have soft bristles.

How often should I change my toothbrush?

Every 2 to 3 months, when bristles begin to show wear, or immediately following sickness.

Which toothpaste should I use?

Most toothpaste has fluoride, which helps to fight cavities. The small amount of fluoride in toothpaste is absorbed by the teeth, and is incorporated into the enamel surface of the teeth. We recommend that you use any toothpaste that is ADA approved.

Should I use mouthwash?

Yes, at least once a day, in addition to brushing. Mouthwash enhances oral hygiene and helps keep breath fresh. At the office we use Listerine (Cool Mint) because this is the flavor most people seem to prefer. We dilute it with water so it doesn’t burn.

What is the proper way to floss?

Flossing removes plaque and hard-to-reach food debris in between teeth and under the gum line. The American Dental Association advises flossing once or more daily. Use about 18 inches of floss, wrapped around fingers to leave an inch or 2 of taut floss to work with, using a clean section for each tooth. Curve the floss in a “C” shape around the base of each tooth to go beneath the gum line, and gently floss from the gum line to the tip of the tooth 2 or 3 times between each tooth. Do not allow the floss to snap into the gap. Overly vigorous flossing can cause damage to gum tissue. Flossing before brushing better enables fluoride from the toothpaste to reach in between teeth. Not flossing enough and/or improper flossing can lead to bleeding gums, which results from gingivitis (inflammation of the gums).

What type of floss should I use?

There are different types of floss, and your choice may be based on how tightly spaced your teeth are, personal preference, and price. When used properly, all types are effective at removing plaque and food particles. Nylon (or multifilament) floss comes in waxed and unwaxed, and is made of many strands of nylon, making it more likely to break or shred between tight spaces. PTFE (monofilament) floss slides easily between the teeth and is shred-resistant, and is generally slightly more expensive. Floss picks make it easier to hold the floss, and the extended handles can make it easier to reach back teeth, but they can make it harder to get underneath the gum line. A different pick should be used between each set of teeth.

How often should I have a professional check-up and cleaning?

You should have your teeth checked and cleaned at least twice a year, though your dentist or hygienist may recommend more frequent visits. Regular dental cleaning and exams are essential in preventing dental problems and maintaining the health of your teeth and gums. At these visits, your teeth are cleaned and checked for cavities. Additionally, there are many other things that are checked and monitored to help maintain your dental health and detect and prevent problems.

Information about x-rays and radiation

X-rays are taken to check for small areas of decay between the teeth and underneath fillings, periodontal disease, infections or changes in the bone, and abnormalities. A full-mouth series should be taken every 3 to 5 years, and bite-wings (x-rays of top and bottom teeth biting together) should be taken once or twice a year. We us a lead apron and thyroid guard (a cup attached to the x-ray apron bib) Women who may be pregnant should not have dental x-rays taken.

A typical dental x-ray image exposes you to only about 2 or 3 mrem (millirem, a unit to measure radiation), less than the exposure from flying in an airplane (about 5 mrem for one cross-country flight because of the increased altitude). More about radiation from dental x-rays.

Back to top



Teeth whitening

Bleaching lightens teeth that have been stained or discolored by age, food, beverages, and smoking. Teeth darkened as a result of injury or taking certain medications can also be bleached, but the effectiveness depends on the degree of staining present.

What teeth whitening procedures work best and why?

We take impressions of the teeth to make custom bleaching trays for the patient to take home. The patient wears them for a half an hour to an hour every day for two to three weeks, and can do touch ups once a month or so, to maintain whiteness. These in-home treatments last longer, are less invasive, simpler, and more comfortable than in-office whitening treatments. In-office treatments make the teeth more sensitive and fade much more quickly. While the in-home treatment process is slower, the results are better.

Who is NOT a good candidate for teeth whitening?

A person that has crowns on anterior (front) teeth, someone with a lot of cavities, extremely sensitive teeth and gums, or old composite fillings that are leaking, is not a good candidate for teeth whitening. In these cases, it can actually cause further discoloration of the teeth or heightened sensitivity. If you are considering teeth whitening, please ask us for our opinion, and we will let you know whether we recommend it for you, and what results you can expect.

Composite (white) fillings

Also known as “bonding,” composite fillings are now widely used instead of amalgam (silver) fillings to repair teeth with cavities, and also to replace old defective fillings. Tooth-colored fillings are also used to repair chipped, broken, or discolored teeth. This type of filling is also very useful to fill in gaps and to protect sensitive, exposed root surfaces caused by gum recession.

Porcelain veneers

Veneers are thin, custom-made shells of tooth-colored porcelain that are bonded onto the fronts of teeth, to create a beautiful, natural smile.  They can help restore or camouflage damaged, discolored, poorly shaped, or misaligned teeth.  They are very durable and will not stain, making them a very popular solution for those seeking to restore or enhance the beauty of their smile.  Unlike crowns, veneers require minimal tooth structure to be removed from the surface of the tooth. Veneers may be used to restore or correct the following dental conditions:

  • Severely discolored or stained teeth
  • Unwanted or uneven spaces
  • Worn or chipped teeth
  • Slight tooth crowding
  • Misshapen teeth
  • Teeth that are too small or large

Getting veneers usually requires 2 visits. Veneers are created from an impression (mold) of your teeth that is then sent to a professional dental laboratory where each veneer is custom-made (for shape and color) for your individual smile.

On the second visit, teeth are prepared by lightly buffing and shaping the front surface of the teeth to allow for the small thickness of veneers, with little or no anesthesia required. The veneers are carefully fitted and bonded onto the tooth’s surface with special bonding cements, and occasionally a specialized light may be used to harden and set the bond.

Porcelain crowns (caps)

A crown is a tooth-colored, custom-made covering that encases the entire tooth surface restoring it to its original shape and size. Crowns protect and strengthen teeth that cannot be restored with fillings or other types of restorations. They are ideal for teeth that have large, fractured or broken fillings and also for those that are badly decayed.

Dental Implants

Dental implants are artificial roots that are surgically placed into the jaw to replace one or more missing teeth. Porcelain crowns, bridges, and dentures can be made specifically to fit and attach to implants, giving a patient a strong, stable, and durable solution that works with removable dental appliances.

Invisalign Orthodontic Treatment

Less visible and more effective brackets and wires are making straightening teeth with orthodontics much more appealing to adult patients. Also, in some cases, teeth may be straightened with Invisalign®, a series of custom-made, clear, removable aligners that require no braces.

Back to top




An abscess is an infection of the tooth that can be caused by poor dental health. It can be very painful, and they are typically treated by opening the infection, cleaning the area thoroughly to remove any bacteria, and administering antibiotics.


Attrition is the loss of tooth structure or restoration due to tooth-to-tooth contact while chewing.


Abrasion is the loss of tooth structure caused by foreign substances such as toothpaste, toothbrushes or hard food.


Abfraction is the loss of cervical structure caused by tensile and compressive forces during tooth flexure.


Bruxism is involuntary or habitual grinding of the teeth, typically during sleep.

Dental erosion / tooth wear

Erosive tooth wear is a condition that involves acidic dissolution of tooth structure. Unlike dental caries (cavities caused by bacteria on the surface of the teeth), erosion is caused by extrinsic or intrinsic acid. Extrinsic exposure is frequently due to consumption of sport drinks, apple juice or other acidic beverages. Intrinsic exposure may result from gastric acid, either from gastric esophageal reflux disorder or bulimia. The ensuing destruction of tooth structure is characterized by the softening of the enamel and underlying dentin, subsequently resulting in bulk tooth loss. Since the erosive process is difficult to detect and monitor, the visible progression is often subtle. Erosive damage is amplified when it occurs in concert with abrasion, abfraction, or bruxism.

Dry mouth

Dry mouth occurs when there is a lack of saliva in the mouth or throat area.

Causes:  Saliva serves to lubricate and protect the tongue, teeth, and tender tissues of the mouth.  It also begins the digestive process, and breaks down food caught in the teeth, protecting the teeth from cavities.  Insufficient saliva production can lead to bad breath, increased cavities, difficulty in speaking and eating, and discomfort.  Some medications such as decongestants, pain pills, antidepressants, muscle relaxers, and blood pressure medications can cause dry mouth too.

Symptoms:  Difficulty speaking, sore throat and problems with swallowing.


Gingivitis is inflammation of the gums, and it usually precedes periodontal disease (link to periodontal disease below) (gum disease). However, not all gingivitis progresses to periodontitis. Gums are red and swollen during the early stages of gingivitis, and may easily bleed during tooth brushing or flossing. The teeth are still firmly planted in their sockets. Left untreated, gingivitis can progress to periodontis, with the inner layer of the gum and bone pulling away from the teeth and forming spaces prone to infection. The bacteria produce toxins (poisons) that break down the bone and connective tissue holding teeth in place.

Halitosis (bad breath) causes and treatment

Causes:  There are various reasons one may have bad breath, but in healthy people, the major cause is microbial deposits on the tongue, especially the back of the tongue.  Smoking, alcohol, gum disease, and pungent foods such as spicy foods and garlic, once absorbed into the body, can release odor through the lungs when you breathe.

Treatment:  Some studies have shown that simply brushing the tongue reduces bad breath by as much as 70 percent.  Drink sufficient amounts of water and brush your teeth daily, especially before going to bed.  Exercise and eat fiber rich foods to prevent constipation and foster good overall and oral hygiene, and gargle with salt water to reduce bacteria in the mouth. Replace your toothbrush every 2 to 3 months.  If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth each morning.

Periodontal disease

Most people are unaware of the onset of periodontal disease, because it is usually painless in the early stages.  Unlike tooth decay, which often causes discomfort, it is possible to have periodontal disease without noticeable symptoms.  It begins when plaque, a sticky, colorless, film of bacteria, food debris, and saliva, is left on the teeth and gums.  The bacteria produce toxins (acids) that inflame the gums and slowly destroy the bone.

At first, plaque is soft enough to be removed by a finger nail, but it starts to harden with 48 hours, and in about 10 days becomes dental calculus (tartar).  Brushing and flossing regularly and properly will ensure that plaque is not left behind to do its damage.

Other than poor oral hygiene, there are several other factors that may increase the risk of developing periodontal disease:

  • Many medications – Steroids, cancer therapy drugs, blood pressure medicines, and oral contraceptives
  • Smoking or chewing tobacco
  • Pregnancy, oral contraceptives, and puberty – These can cause changes in hormone levels, causing gum tissue to become more sensitive to bacteria toxins
  • Systemic diseases – Diabetes, blood cell disorders, and HIV / AIDS

Symptoms of periodontal disease include:

  • Red and puffy gums – Gums should never be red or swollen
  • Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss
  • Persistent bad breath – Caused by bacteria in the mouth
  • New spacing between teeth – Caused by bone loss
  • Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone)
  • Pus around the teeth and gums – Sign that there is an infection present
  • Receding gums – Loss of gum around a tooth
  • Tenderness or discomfort – Plaque, calculus, and bacteria irritate the gums and teeth

Snoring and sleep apnea

If you snore loudly and frequently, you may be accustomed to middle of the night elbow thrusts and lots of bad jokes.  But snoring is not laughing matter. That long- sawing noise that keeps everyone awake comes from efforts to force air through an airway that is not fully open.  About 10% of adults snore, and while snoring has no serious medical consequences for most people, for an estimated 1% of those who snore, habitual snoring is the first indication of a potentially life threatening disorder called “obstructed sleep apnea.”

Sleep apnea is the absence of breathing or the want of breath. When there is a cessation of air flow at the mouth and nose for more than10 seconds, an apnea episode has occurred.  If a person experiences 30 or more apnea episodes during a seven-hour sleep period, then they are believed to be suffering from sleep apnea, a condition warranting medical attention.

Temporomandibular Joint Disorder (TMJ Syndrome)

Acute or chronic inflammation can occur as a result of problems with the jaw, jaw joint and adjoining facial muscles that control chewing and moving the jaw.

Signs and symptoms:  Pain in the face, jaw, around the ear, headaches, painful clicking of the jaw, difficulty when opening and closing mouth, anxiety and stress (which can cause tension in the facial and jaw muscles), teeth clenching, excessive gum chewing, nail biting, injury to the jaw or head, orthodontic treatment like braces, bad bite, and muscle spasm.

Tooth decay

The combination of plaque and sugar causes tooth decay. The best way to prevent it is to brush twice a day, floss daily and visit your dentist regularly (at least every 6 months, or as advised by your dentist or hygienist).