Maintenance Recommendations

Routine Care

Being a specialist, I do not perform routine maintenance and cleaning of average patients. We have many practices in the surrounding area with robust hygiene programs that provide a much more streamlined experience than a single doctor without a hygienist can accomplish. With that being said, there are certain types of patients where I recommend either committing to a maintenance program here, or splitting care with a trusted general dentist/hygienist in the area, usually close to where you live. 

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Home Care for Natural Teeth and/or Implant Crowns

If you have natural teeth, a few crowns, or a few implants, I recommend to brush at least twice a day, and floss once a day. I personally am not a fan of string floss, even though officially that's the best type of floss. I use floss picks that have an angle on them; those are the easiest for me to use. I put floss picks in easy to find places to remind myself. I recommend also to use a fluoride, zero alcohol mouth rinse that's diluted at a 1:1 ratio with peroxide. The peroxide at full strength is too concentrated, but diluted has great antimicrobial properties and is good for gum health. 

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For implants, home care is even more important, as implants are more susceptible to gum disease, as the natural 'sheath' of gum around the implant crowns isn't as strong as what's found in natural teeth. Adding in a water flosser is a strong recommendation, with instructions to use it on the highest setting that doesn't hurt your gums. I usually recommend to just use water in the reservoir as to not gunk up the reservoir over time.

 

Removable Prosthetics

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I have unique recommendations for cleaning and maintaining removable prosthetics. First, disregard the movies- don't store your teeth in a cup of water. The water will eventually infiltrate into the pink gum acrylic and over time will weaken the acrylic. I recommend taking anything removable out after meals as needed to rinse your mouth,  and definitely at night to let the gums breathe. If you sleep with your teeth in, you run the risk of a yeast infection called candidiasis, which is treatable but hard to get rid of even with medication. 

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Brush the prosthetics firmly and vigorously with soap, not toothpaste! Any soap will do, I recommend a dish detergent without perfumes or dyes, but no toothpaste. 99% of toothpastes have abrasives that quickly return the high polish shine to a dull satin or matte finish- perfect for letting bacteria adhere to the surface. For the mouth, I recommend swishing with a 50:50 mix of peroxide and the mouth rinse of your choice for a minute or so, then spitting most of the rinse out. Then, brush your hard palate, ridges, tongue and any implants/bars with a soft bristle tooth brush. 

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If you have snap in dentures, be sure to clean the tops of the abutments (the little metal pieces that stick out of your gums) because if they have much debris on them, sometimes the gaskets in the denture will wear out much faster or the denture won't fit at all. I've even seen where particulates actually bend the gaskets and then they won't snap in at all, which is a worrisome but preventable problem.

 

A professional cleaning should be done at least once or twice a year if you have implants, and even if you have no teeth and no implants, you should come in once a year to have the dentures professionally cleaned in a solution and a quick oral cancer screening to make sure there aren't any problems lurking about.

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All-On-X Maintenance and Home Care

 

If you've spent the time, energy, and resources on all-on-x bridges, you need to protect your investment with even more rigorous home care than people with natural teeth. My recommendation is first and foremost to have the bridge removed after year one, with me, to check and make sure hygiene is adequate and that nothing in the implant apparatus is loose. After year one, I custom tailor your removal and cleaning appointment to fit your specific needs. This is critical to avoid biologic issues such as an infection around an implant that could have been caught and treated early. I also recommend seeing a general dentist/hygienist team every six months to perform a 'spritz cleaning' where they use an ultrasonic instrument to remove as much as possible underneath the bridge without taking it off. Removing these bridges should ideally be done by the provider who fabricated and is familiar with it. 

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How you take care of these bridges at home is what truly dictates your long term outcome. A water flosser is your best friend. I recommend using the strongest setting that doesn't hurt, and using a hooked tip to get underneath the bridge to purge debris. I keep the same recommendation as removable prosthetics for cleaning the prosthetics- use a soft bristle tooth brush after rinsing with a 50:50 mix of peroxide and a zero alcohol mouth wash. I don't like the use of toothpaste once again because the abrasives over time can abrade off the glaze layer on the ceramic, which can lead to a rough surface and more plaque sticking to the bridge where the damage is. If you only have one arch with an all-on-x, by all means use tooth paste to clean your natural teeth. Just make sure to clean, period, for optimal long term health of yourself and your implants. 

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