Why Should I Care About Geriatric Dental Care?

The World Health Organization defines the population between 65 and 75 as “elderly”. The term “old” is used for people between 76 and 90 and “very old” for those people over the age of 90. In general, older adults severely underutilize dental services. Less than 1/3 of the elderly population sees a dentist regularly, and almost 50% haven’t visited a dentist in over 5 years. Practicing in the Palm Beach area, many of my patients maintain their active and healthy lifestyles, so consequently they are living longer today. So what does that mean when it comes to the oral health of this segment of the population? And why should you care about this topic if you’re younger than 65? Let me tell you why!


Years ago, and still today, many people believe the myth that tooth loss is caused by old age. In fact, the most common reason for tooth loss is active, untreated periodontal disease. This happens across all ages. Infection in the gums is the major reason why people experience tooth loss. Gum disease is easily treatable and preventable with regular visits to the dentist and proper oral hygiene care at home. That is why it is vital that people over the age of 65 continue to keep regular dental maintenance visits every 3 months.


With increased age there is an increased risk of staining, chipping and cracking and this age group is more at risk for fractures. This means that there is an increased need for continued maintenance and replacement. This means that if we keep on eating all foods with different textures – i.e. hard, crunchy veggies or nuts – then naturally we will see more wear and tear on our dentition – whether it is our natural dentition or a denture. This means that replacement of old, existing restorations, dentures and crowns are to be expected. Just like you take your car in for regular maintenance, it’ll be up to you to visit the dentist regularly to make sure everything is in proper working order and make any replacements necessary before the teeth become hopeless and require removal. If you do this from a young age, then you’ll be sure to have the least amount of dental treatment necessary to keep your mouth healthy for a lifetime.


Recurrent decay – (under existing crowns and fillings) – and root surface decay – (where the root is exposed due to gum recession from gum disease and/or malaligned bite) account for the most common type of cavities in the older population.

Older adults typically don’t feel pain when it comes to cavities because the pulp (nerve) shrinks as we age. When you’re young, a small cavity is much closer to your nerve, so you feel the discomfort sooner and are more apt to visit the dentist for treatment. However, the older population usually will complain about food getting caught in the cavity, and sometimes by the time they decide to seek dental care, the cavity is deep below the gum line, that the tooth is now hopeless and requires extraction. This is why it’s so important that older patients seek routine maintenance dental care to avoid preventable tooth loss.


Older patients are generally on multiple medications due to various systemic diseases. Many medications cause dry mouth as a side effect. Also, head and neck radiation treatment for patients with cancer in that region of the body, almost always have loss of function of their salivary glands, leading to dry mouth. Patients with xerostomia, or dry mouth, are at an increased risk for decay and must be specially monitored to prevent tooth loss. Possible dental treatments to help prevent decay include fluoride treatments, both daily and in-office, as well as artificial saliva products and medications.


As people age, physical and cognitive problems arise. Arthritis typically sets in and causes a significant decrease in manual dexterity. However, there are people of all ages with physical disabilities that may affect their oral hygiene. There are many options to practice good oral hygiene for someone with physical issues, including electric toothbrushes, tennis balls (YES! I said tennis balls! Don’t worry, I’ll probably write a blog on this topic alone.) and other unique tools. If cognitive issues, such as Alzheimer’s or dementia exists, then the task of oral hygiene falls to the caregiver. If there is no caregiver, there’s even a higher chance of it leading to poor oral hygiene practice at home, therefore increasing the on-set of decay and gum disease in the aging population. For this segment of the population, it is especially important to see the dentist even more often, perhaps even as often as every 1-2 months.

These are a few of the issues that afflict our brilliantly aging population. So if you know someone who has a lot of life experience, but hasn’t been to the dentist lately, then give them a call and tell them to visit the dentist TODAY!


Dr. Meli

Which Mouthwash is Right for Me?

Let’s talk mouthwash! I know it’s always so confusing when you’re standing in the oral health care aisle at a store and you look at the myriad of bottles of colorful mouthwash, wondering which one is right for you. Let me break it down so you can get a better understanding of what is available OTC.

Manufacturers divide OTC mouthwashes into three main categories:

1.) Fluoride

2.) Antiseptic

3.) Whitening

Fluoride Mouthwashes:

Fluoride mouthwashes, which are usually purple in color, are also known as “anti-cavity” because they usually contain 0.02% sodium fluoride. Yes, fluoride is good for your teeth and prevent cavities if you are cavity prone. However, in order to get this super low concentration of sodium fluoride into your teeth, the mouthwashes are super acidic, meaning they have a low pH. Over the long term, this can damage your enamel on your teeth. In fact, one of the ingredients they use is phosphoric acid, which is what we use to etch the teeth when we do bonding on teeth. So you can imagine how strong of an acid that is!

However,the fluoride treatment that you get at a dental office usually has 10 times higher concentration of fluoride, and it usually has a neutral pH. This way right after your dental hygiene maintenance, when there is no plaque or tartar present, the fluoride has it’s best chance of permeating your enamel and strengthening your teeth, and even your gums. If I had to recommend an OTC fluoride mouthwash, it’d be the ACT mouthwash. Why? Because it has a neutral pH and has 0.05% sodium fluoride in it, almost three times that of the rest of them. Also, it has a unidose measuring system at the top of the bottle, so you can never use too much and get an overdose of the mouthwash or fluoride in it. So if you like Berry Blue, Bubblegum or Fruit Punch flavor, then go for it!

Antiseptic Mouthwashes:

The next category is antiseptic mouthwashes. These are the most commonly used, and typically you’ll feel a burning sensation when rinsing with these due to the high level of alcohol. The alcohol is in fact antiseptic, but it indiscriminately kills all bacteria in our mouth, leaving it unbalanced and therefore more susceptible to a yeast or fungal infection. Also studies have definitively shown that alcohol is a huge risk factor for oral cancer. So these mouthwashes usually have 25-27% alcohol content. This is 2-3 times what we find in a glass of wine or beer. And when you drink a glass of wine or beer, you’re simply sipping it and swallowing it. Whereas with an antiseptic mouthwash, your swishing it for 30 seconds straight, twice a day, pushing it into your oral mucosa of your cheeks and gums. Over time it’s going to cause cell mutations and then lead to oral cancer. Alcohol also has a drying effect, and a dry mouth is more prone to cavities, so be aware!

Also, another popular ingredient in antiseptic mouthwashes is Cetylpyridinium Chloride, aka CPC. This has antiseptic properties, but will stain your teeth brown. And the Eucolyptol and Thymol commonly found in antiseptic mouthwash will stain your teeth yellow. Now, these stains can be removed with a professional dental cleaning, but do you really want to be walking around with severely stained teeth from a mouthwash?

Which OTC antiseptic mouthwash would I recommend? Only one that is alcohol free for sure, but overall I don’t recommend them to my patients. If they want some fresh breath and that’s about it, then I tell them to dilute it with water, this way they get the freshening effect without the harmful side effect of the alcohol contained within. In fact this is what we do in the office to give a better flavor to the water our patients rinse with while in the dental chair.

Whitening Mouthwashes:

The final category of OTC mouthwashes is whitening. These generally have hydrogen peroxide as a whitening agent. Usually you’ll see the bottles are opaque, not translucent, so that that hydrogen peroxide doesn’t disintegrate. The level of hydrogen peroxide is minimal, but it can still be damaging to your gums. Over the years, I’ve seen so many patients who’s cheeks were peeling away on the inside of their mouths due to using a whitening mouthwash. As soon as they discontinued use of the whitening mouthwash, the pain and discomfort and peeling stopped. I do not recommend anyone use a whitening mouthwash, even if it says “Pre-brushing whitening rinse” on the bottle. These only cause sensitivity and are not as effective as you might think, especially if you have plaque and/or tartar buildup on your teeth. And for patients for have any recession, the sensitivity can be especially high. If you really want whiter teeth, then be sure to floss and brush them!

So I hoped this helped open your eyes to what’s available when it comes to OTC mouthwash. I’ve also got a Mouthwash Review video on my YouTube channel, so be sure to check it out.

Next time, I’ll discuss Natural Mouthwashes and what I recommend when it comes to that category.


Dr. Meli

8 Common Mistakes you make when Brushing your Teeth


TOOTHBRUSH: You tend to brush in all sorts of ways, and our gum tissue is fragile. Be sure to pick up a toothbrush with SOFT or EXTRA SOFT BRISTLES only – this way you won’t damage your gums. If you’re having trouble keeping your mouth open while brushing, then look for a toothbrush with a smaller head on it. If your arm hurts after brushing, or you have manual dexterity issues or you’re just lazy, then get an electric or ultrasonic brush that’ll do most of the work for you.

METHOD: You want squeaky clean teeth, so you think brushing harder is better. WRONG! You should hold the toothbrush at a 45 degree angle, so you feel the bristles going in between the teeth and up underneath the gums. Then, brush in a compact circular motion and sweep away from the gum. Do this with gentle pressure on both the inner and outer surfaces of each individual tooth. Then you can brush the biting surfaces at the end. This method applies to both manual and electric toothbrushes.

TOOTHPASTE: So you think using a whitening toothpaste is going to make them sparkly white, right? WRONG! Whitening toothpastes have tons of abravises and are way too harsh for your gums, and can wear away enamel over the long term, so avoid using them. Instead, use a regular toothpaste with fluoride, or an herbal dentifrice, without any sodium lauryl sulfate, which is what causes the foaming action.

TIMING: You need to brush for at least TWO FULL MINUTES for the fluoride to be activated in your toothpaste. Plus it takes at least two minutes to really cover all of the surfaces of your teeth while brushing. First set your timer on your cell phone for 2:00 minutes. Then, divide your mouth into four quadrants – upper right, upper left, lower left and lower right – and work your way from quadrant to quadrant as you watch the timer. Spend at least 30 seconds brushing the teeth in each quadrant.

LONGEVITY: You think it’s ok to keep using your toothbrush forever and ever and ever. WRONG! Bristles get broken and splayed and they are totally ineffective. Be sure to get rid of your toothbrush every 3 months, and get a new one that’s strong enough to stand up to the task!

FREQUENCY: You think brushing more often is better. WRONG! Brushing more than 3 times a day can be damaging not only to your gums, but your enamel as well. Keep your brushing frequency to no more than 3 times a day to avoid undue damage to your smile while maintaining its health!

AREAS: You think it’s ok to just brush your teeth. WRONG! Don’t forget to brush your tongue as well every time you brush your teeth. Tons of bacteria lurk amongst your tastebuds so you can use a special tongue brush, or gently use your toothbrush to brush the top of your tongue as the final step before you rinse out.

FLOSS: You brush before you floss. WRONG! You must floss first, then brush your teeth. Why? Imagine if you vacuumed the floor, then dusted and all the dust fell on the floor and you’d have to vacuum the floor again. That is exactly what you are doing when it comes to your mouth if you brush before flossing. The toothpaste is not effective if you haven’t flossed first to remove the funk that’s sitting in between your teeth and just underneath your gums on the surface of your roots. So FLOSS and then BRUSH your teeth!

Hope this has helped you with your daily oral hygiene routine. And remember, a healthy smile is always in style!


Dr. Meli

Top 5 Foods to Combat Bad Breath

Top 5 Foods to Combat Bad Breath

We’ve all had tasty meals where we absolutely looooooooved the garlicky pasta we ate, but then regretted it afterwards because of the bad breath it gave us. So, before you deny yourself that delicious pasta dish, think about what you can order for dessert afterwards to help get rid of that bad breath!

We all have bacteria in our mouths, and when we eat a meal, the food particles left behind act as an energy source for those bacteria. The bacteria then release a toxin that either attacks the soft tissue causing gum disease, or the hard tissue – your teeth – causing decay. Either way the release of the toxin leads to infection and bad breath. The foods listed below all help by combating mealtime for the bacteria and microbes that naturally exist in our mouths, thereby reducing and/or eliminating bad breath!

APPLES: Granny Smith apples were shown to have the highest phenol content, but any apple after dinner will do! Phenols are known to be anti-bacterial and anti-fungal. Raw apples are great because not only do their phenols inhibit bacterial growth leading to bad breath, but when you chew on these crunchy foods, they physically cleanse the teeth and help prevent the buildup of biofilm that forms plaque. Maybe they should change it to “An apple a day keeps bad breath, gum disease and cavities away!”?

BERRIES: All berries are not only full of healthy anti-oxidants, but they also contain the abovementioned phenols which are anti-bacterial and anti-fungal. Studies have shown that fruit like blueberries, raspberries and blackberries inhibit the growth of C. albicans which is the fungus that leads to oral thrush – better known as a yeast infection. Also, strawberries and raspberries have been shown to be strong inhibitors of Salmonella.

CITRUS: Oranges, lemons, grapefruits, mandarins and tangerines are all citrus fruit. However the antimicrobial powers of these fruits come from the essential oils in the peels, not the juicy flesh inside. So after eating your Kung Pao chicken at lunch, be sure to eat the orange wedge they offer you, first on the inside, and then squeeze the rind to release those oils and rub it on your teeth and tongue to eliminate bad breath. Remember not to suck on lemons or limes as the acid will erode the enamel of your pearly whites!

PARSLEY: Parsley is tasty, cheap and has anti-microbial properties. Parsley comes in two varieties: curly or flat leaf. Either one works. Be sure to chew on that parsley garnish on your plate to avoid bad breath.

CELERY: Celery, or Apium graveolens, has been shown to have both anti-bacterial and anti-fungal properties. It is also chock full of flavonoids. Consumption of natural foods rich in flavonoids helps the body to prevent lung and oral cancer. And again, when eaten raw, this crunchy vegetable will physically cleanse your teeth as you chew.

I hope this was informative and helpful, so next time when you’re out on a date with your significant other, you can still order the pasta all’olio e aglio and kiss afterwards. Remember, a healthy smile is always in style!


Diva Dentist PB