A Dentist’s Guide to Perfect Oral Health (2025) | Dr. Padhumai | Dr. Hema Sathish | Cureka
Table of Contents:
- Cavity
- Tooth needs a diet
- How to pick the right toothpaste
- Teeth whitening methods and side effects
- Side effects of hydrogen peroxide
- How to reverse Cavity
- Milk teeth cavity
- Cavity can develop more problems
- As a dentist, is it possible to see conditions earlier than other doctors would diagnose?
- Does flossing really helps
- What type of bristles should you choose for healthy teeth?
- Why Gen Z’s get more cavities?
- Tooth sensitivity for Sinusitis people
- Signs of having tooth decay
- Bad breath
- How oil pulling helps in dental health?
Dr. Hema Sathish: Hello Everyone. We have Dr. Padhumai who is a dental surgeon with us today. So Dr. Padhumai, your first question is, when you say dental surgery, how is it different from being a dentist? Because when we talk about a dentist, we talk about only the teeth. But the dental surgeon does a lot more than that. So a little bit of introduction about yourself.
Dr. Padhumai: Okay. So this is a specialization over BDS. It's called as a maxillofacial surgery and MDS in maxillofacial surgery. So it deals with all pathologies and all fractures of the face. It deals with fractures. It deals with TMJ problems, your joint problems. It deals with the fractures, the lesions of the jaw. So this is something in between medical science and dentistry. So it's like a bridge between medical science and dentistry.
Dr. Hema Sathish: Wonderful, wonderful Dr. Padhumai. But today you are here to talk about very general basic teeth issues. So I thought we'll dwell into cavities more because that is one thing which anybody and everybody has got, right? So there's a lot more to cavity. So when you talk about a cavity, it's not the only thing which you see like a dark spot over there or a pain in the tooth which comes in later, right? But beyond that, there's more. So can you just explain a little bit of what a cavity is and then we will go to the rest of it.
Cavity
Dr. Padhumai: Okay. So to begin with, let us see what a tooth is made up of. It is made up of various layers. The first one, the outermost layer is called as an enamel. The second one is called as a dentin and the innermost is the pulp which contains the vital structures. So this enamel and dentin is made up of so many minerals and crystals which are called as hydroxyapatite crystals. So when the acid from the food you eat, like whenever you eat a sugary substance or the acids itself from the food that you eat, it attacks the, like it rests on the enamel and the bacteria act on these sugary substances called producing more acids. And these can cause a layer of mineral to erode away from your enamel. So when this happens, you see white specks. So this is what happens initially. These white spots are the initial caries and these caries in most cases are reversible also.
Dr. Hema Sathish: Oh, okay. That's quite interesting.
Dr. Padhumai: They are reversible. Regularly. Yes, yes, yes. So when you have a visit once in every six months, a dentist maybe will be able to recognize these spots and an early cure is possible. So whenever you address it earlier, you have very little tooth structure which is lost and you can clearly do wonders. You can with a change in your diet or with a change in like you can use some hydroxyapatites like nano hydroxyapatite toothpastes which can remineralize it. A change in your diet can also.
Dr. Hema Sathish: I would like to catch hold of that now because we talk about diets for everything, right? You want to lose weight, you want to stay healthy, you want to be agile, your bone needs diet. Nobody said tooth needs a diet.
Tooth needs a diet
Dr. Padhumai: Cleanliness. I would love that. Oral hygiene and cleanliness does require a diet. So whenever you eat lot of pizzas, chocolates or sugary substances, they stick on to your teeth, your enamel layer of your teeth. So the bacteria act on them, it causes acids and thus remineralization takes place. So whenever you end your meal, make sure you don't have so much sugary, sticky foods on your teeth. Wash well, rinse your mouth well and eating lots of fibers can also help. It can help in mechanical cleaning of the carrots, foods like carrots can help in mechanical cleaning of your teeth and apart from that, the tooth is embedded in sockets, in bone. And hence for a good bone health, you need lots of calcium and vitamin D and vitamin K. So diet does improve your dental decay counts.
Dr. Hema Sathish: That's something very, very interesting.
Dr. Padhumai: Because even the saliva, when the saliva comes out, there are minerals into the saliva also. So your diet helps in your oral health.
Dr. Hema Sathish: And you were talking about some toothpaste. So what would you suggest toothpaste? I mean, of course, there are many types of toothpaste. Like people talk about charcoal intoothpaste, salt in toothpaste. Then they talk about, you know, so many other things for especially for sensitive teeth, there are special toothpaste. So you recommend different toothpaste for different kind of a problem. And like, how would you advise a person to pick the right toothpaste?
How to pick the right toothpaste
Dr. Padhumai: Okay, so generally what a dentist prescribes is a fluoride containing toothpaste. So this is FDA approved and ADA approved. The reason why we prescribe this is we like the fluoride will react with the hydroxyapatite and cause fluorapatite crystals which are more resistant to acid attacks. They are really very resistant to acid attacks and because of that you will have less caries prone. You will be less caries prone. So this is what we generally recommend.
But apart from that, if you have sensitivity, we do recommend a sensitivity toothpaste and they also will have fluoride content in them. But when it comes to a whitening toothpaste, you should always be very careful in selecting them. So when you are buying a whitening toothpaste in the market, you have to be very careful about what it contains because when it contains hydrogen peroxide or carbamide peroxide, which are the most commonly used bleaching agents, the effectiveness may be there but it can also, on a very long run, it can cause sensitivity.
Charcoal toothpaste also, it is said to cause a mild whitening effect. It is less effective when compared to other whitening toothpaste. It is said to have an abrasive action on the teeth and hence a whitening effect. So an increase, whenever there is a high concentration of charcoal, you should also be aware that it is going to cause some amount of abrasion and it can cause sensitivity.
Dr. Hema Sathish: So if you have sensitive teeth, then advisedly don't use an abrading toothpaste. That would include this whitening toothpaste and toothpaste with charcoal.That's quite an interesting revelation. So when you talk about whitening toothpaste, I have heard about so many other methods to whiten your teeth, right? So can you elaborate on some of them and their side effects?
Teeth whitening methods and side effects
Dr. Padhumai: Yeah, so whitening toothpaste are going to be the least effective of all. Okay,
Dr. Hema Sathish: so above them probably that causes a minimum side effects.
Dr. Padhumai: Yes. Okay, so above them you also have:
- Whitening strips.
- Semi-custom trays for tooth whitening.
- Fully custom trays for teeth whitening.
- In-office procedures where the dentist will do the whitening for you.
So to be more effective, the in-office procedure is going to be the fastest, the quickest. So the bleaching agent we use here will be the hydrogen peroxide or the carbamide peroxide and we will protect your gums before we bleach the teeth. It may take 30 minutes to 1 hour procedure and it really has a very huge impact on the teeth. But if you have sensitive teeth, we would advise you not to go for it.
And after that, when you come to the customizable trays or semi-customizable trays, they are those which you can try at home. So they will have some gels of hydrogen peroxide which you can fit into your teeth and you can, it's an at-home procedure actually. And teeth whitening strips are also effective, those having hydrogen peroxide, of course when used on a very long basis will have a sensitivity issue.
And there are also other whitening tooth strips. So when you want to go with whitening tooth strips, you should know what your whitening tooth strips actually contain. So few contain hydrogen peroxide, few contain something called PAP and hydroxyapatite, few contain sodium bicarbonate, few contain coconut oil. So depending upon the ingredient, the effect also varies. The most effective is hydrogen peroxide but it's also going to have side effects and the next others are without side effects.
Dr. Hema Sathish: So when you said hydrogen peroxide has got side effects, what are the side effects we are expecting? And you said some of them do not have side effects, so what I mean how would they be helpful? Could you elaborate on them?
Side effects of hydrogen peroxide
Dr. Padhumai: Yeah, sure. Like hydrogen peroxide, the main side effects would be sensitivity. So whitening strips when they are used for a very long time, it's going to have long.
Dr. Hema Sathish: How often do you think we should use?
Dr. Padhumai: Maybe twice in a year, not more than that when it contains hydrogen peroxide. Twice in a year it's for whitening strips, but whitening procedures depending upon your sensitivity we may limit it to once in a year or if you have sensitivity we also restrict that list.
Dr. Hema Sathish: So, I mean, I keep hearing people of, you know, they are going out on a function or on a party and then they just use the strips. They keep telling me, so you shouldn't use it that often.
Dr. Padhumai: You shouldn't. You shouldn't.
Dr. Hema Sathish: Okay, okay, that's something which everybody should hear.
Dr. Padhumai: But those which do not contain hydrogen peroxide, they are safe to use.
Dr. Hema Sathish: Okay, so how often do you recommend those? You can use them as long as the result like... Okay, so you can use them quite often. So maybe people who say they use it often like before they step out or something like that, then they use it probably, they use the other ones.
Dr. Padhumai: And each whitening strip comes with around 10 for the upper and 10 for the lower. So each time you do it for 10 times.
Dr. Hema Sathish: Oh, alright. So that's quite a number of times. So what ingredients you should absolutely avoid when you're looking at whitening strips?
Dr. Padhumai: There's nothing like, if you're very sensitive, avoid hydrogen peroxide. That's the only thing.
Dr. Hema Sathish: So you said everybody should get their teeth checked every six months. So we have master health checks during that time. I don't think dental health checks are considered. They are. They come in as a package many a times, right? But sometimes they're not added, I was thinking. Some hospitals do do it, I know. But then what I want to know is, there are many a times I see master health check itself, many people say this is just a money making gimmick, you know, you just go and check and then they'll say something to you. And some people even believe that, you know, until and unless diagnosed, we are at peace. So at least we know that we are happy with ourselves. So there are ways and means to take it. It's different for different people. Though I would, as a doctor, suggest that checkups should be regular and should be done dedicatedly so that you know that you're keeping yourself fit. And if something is wrong, then take care of yourself and prevent any further damage.
Okay, keeping that aside, let's start with how you can reverse caries, like cavity.
How to reverse Cavity
Dr. Padhumai: Okay, so to start with, not all cavities are reversible. All right. So those which are in the initial stages, which show themselves as white spots, only those cavities without a break in the enamel are reversible. So that's pretty early in that. That's very pretty early. So these are detected, they should be detected early. So when you come for biannual checkups, we can detect it at this point of time itself. And we'll give you extra, like we may give you a nanohydroxyapatite toothpaste or the phosphate and calcium containing toothpaste and some diet modification, some lifestyle modification, we may suggest to you so that you improve on the cavities.
So once there is an enamel breach, once it's gone very deep into the dentin, or once you have a pain, once it goes into the pulp and you have a pain. So these are the conditions where a cavity reversal cannot be done. So prompt treatment has to be done for them. So for the initial caries, I mean, for those which have a normal filling would do, but those which are very deep, very close to the pulp, giving an alarming sign of dental pain. So you'll have swelling, people will come with a very huge swelling. So when you come with those kind of very severe infections, one, if you have enough tooth structure, then we'll go for a root canal treatment. But if a tooth structure is completely gone, like you don't have the crown part of it, you have only the root, which is inside the bone, or it's very badly damaged, the tooth is very badly damaged, we may ask you to extract the teeth.
Dr. Hema Sathish: Oh, so quite a scary one.
Dr. Padhumai: And nothing is as good as your teeth.
Dr. Hema Sathish: I know. And so it's prevention is better than cure.
Dr. Padhumai: And even for kids, it's always prevention is better than cure.
Dr. Hema Sathish: But you know, in children, like when we see them before, especially when they're having their milk teeth, you know, and if that is having a cavity, I mean, you tend to overlook it. Is it fine to overlook it? Or you should take care?
Milk teeth cavity
Dr. Padhumai: It should be taken care of. It should be taken care of. Like for one basic reason is like you can when it comes to childhood caries, you can actually divide them less than five years, those in a stage where children can tell you that they have pain, in a stage where the children cannot tell that they have pain.
So generally when it comes to very young kids, the most common caries that we note is something called as nursing bottle caries. So what happens here is whenever a child is being bottle fed, and the mother does not clean the teeth well, and overnight the child sleeps with the bottle in the mouth. So you have milk deposits over the teeth, bacteria act on them, produce acids, and there are decays. So what happens is when you see the kid, there will be black stumps, the entire upper will have stumps, and the lower will have stumps, and almost every teeth would have been gone by the time they come to us. So one thing is it can have a psychosocial impact on the kid itself, and pain, the pain also... Dr. Hema Sathish: The psychosocial impact is quite heavy here because kids are very conscious about it. You've got to be very careful.
Dr. Padhumai: And most importantly, when it becomes a huge infection with lots of swelling, it can also cause damage to the underlying permanent. It can also become malformed.
Dr. Hema Sathish: Oh, they'll malform, is it? So that's news. Because I think earlier times when we were seeing kids with caries, we used to tell them, yeah, it's okay now. This teeth will anyway fall off.
Dr. Padhumai: It depends on the time. You expect the teeth to grow off very soon, maybe in another six months, then we may ask them to go for removing the tooth. Or we may ask them to wait. But when it's very early, like you have a caries at some point of time and the next tooth is going to erupt only after five, six years, then it's going to be a huge problem. And also when you remove the tooth, when it's in a salvageable condition, when you remove that teeth, there's a migration of the adjacent teeth. So the underlying tooth cannot erupt and it will cause another set of problems.
Dr. Hema Sathish: So on the whole, you should avoid caries, that is avoid cavities in your teeth. And for whatever action has to be taken, it has to be taken quite early. It's something which we have all to realize.
Dr. Padhumai: And the rare possibility is whenever there's an infection, a tooth infection, it can also spread into your throat and it can cause life-threatening breathing difficulties.
Dr. Hema Sathish: Not only breathing difficulties, there are many other problems, right? Especially when you're having a cavity in your adulthood or later in life also, you can develop a lot of problems, right? That includes heart tissues also. So can you just, I don't want to scare anybody by saying it, but it's something which people should know. So we have to know about it. So Dr. Padhumai, please elaborate on that also.
Cavity can develop more problems
Dr. Padhumai: Okay. So apart from dental caries, you can also have gingival issues. You can have bleeding gums, you can have inflamed gums, you can have tooth mobility. So whatever is the bacteria which causes them. So when there's an inflammation in the gums, there is a lot of bacteria entering the gums through the bloodstreams from the gums. It can travel through the entire body. So for instance, it can go sit in your heart valves or wherever the heart tissue is weak, it can cause infective endocarditis. And also it can cause platelet activation in the blood vessels, which can result in clot, blood clot. So that is an increased risk, two to three times higher risk for getting heart attacks. You can have strokes. Apart from that, whenever you can have pneumonia or you can have, if it's going to be a pregnant women, she can also have low birth infants or a preterm labor.
Dr. Hema Sathish: My God, that's like scary. Chills down your spine actually. Because you know, you don't take teeth so very seriously is what I guess. But then teeth is one very important aspect which has to be. And everybody harps on it, how it has to be kept clean and how you have to have oral hygiene and all those things are told. But you know, nevertheless, you never ever, ever, ever think that it can cause so many internal problems because you think it's just here and you can just gargle and spit it out. So that's a lot of interesting information. You told us about a list of conditions which are like quite alarming to have if you have a dental problem, right? So as a dentist, is it possible to see conditions earlier than other doctors would diagnose? I mean, on the skin you see a lot of conditions, you know. So we will say this is a heralding sign or probably there's something internally and probably that's why this is there. So do dentists also do that?
As a dentist, is it possible to see conditions earlier than other doctors would diagnose?
Dr. Padhumai: Yes, we'll be able to see a lot of conditions, especially like diabetes. So people will come with us with a lot of periodontal issues. They may have mobile teeth shaking. And finally, when we come to a reason, like when we look deeper into it and we just ask them to go for a routine blood checkup, they'll be diagnosed with it. So for diabetic people, even when the plug content or the dirt around your teeth is very little, you'll have a lot of mobility.So that is one thing that can be seen.
Dr. Hema Sathish: It can happen earlier in life also or it's just that it happens later on in life if you develop diabetes or it's a long term diabetes which is causing it?
Dr. Padhumai: It is a long term one.
Dr. Hema Sathish: Okay. So if the sugar is not under control, then you can see something like this. But it is not like when you're younger, you get it and then you'll see this mobility.
Dr. Padhumai: No, not like that. So the next symptom which you can see is bleeding gums. So we say whenever, only whenever we have inflammation around the teeth or whenever there's plug accumulation or whenever there's a gingival problem, there will be bleeding gums. It's just not that, just that. Bleeding gums can be an initial sign of vitamin C deficiency. It can be a sign of platelet deficiency. It can be a sign of leukemia itself also.
Dr. Hema Sathish: That's quite scary. But there has been diagnosis made because of bleeding.
Dr. Padhumai: Yes, there have been. So this is one thing. And where is oral ulcers? Like because of vitamin B12 deficiency or other vitamin deficiencies, there can be oral ulcers, which itself can cause halitosis, burning sensation. People may not be able to eat spicy foods itself. And another issue is gastric ulcers. Whenever people who have gastritis, GERD, they have acid reflux. So what happens is that acid itself can cause erosion of enamel. So whenever you vomit or whenever you have the GERD symptoms, the enamel layer will become thinner. So that is one thing which we can observe. Anemia can be observed or even HIV. Sometimes even the oral manifestations of human deficiency virus will be the first sign which we ever see.
Dr. Hema Sathish: That affects everything. So we have a lot of things in skin to see. Now we have a lot of things in dentistry also to see. So that's yes. So there's a lot, lot more than what we imagine and what we think the teeth is about.
Nowadays flossing is such a fad, right? Everybody who carries a water flosser with them and uses it. So you think if, of course it helps when something is stuck in between your teeth or something like that or hard to get areas and stuff like that. So when you look at flossing, do you think that if you brush lesser or you don't use the proper this thing and you floss it, it's fine? I mean, what's your take on floss, water floss especially?
Does flossing really helps
Dr. Padhumai: Flossing is not an alternative. Okay, okay. So brushing is must. Brushing should always be followed by flossing. So it's always that way.
Dr. Hema Sathish: So clean then ultra clean is it? And a water flosser is a good idea?
Dr. Padhumai: It is, it is. It's a very good idea because it not only helps in flushing out the food that's stuck between the teeth, but it also helps in massaging your gums.
Dr. Hema Sathish: Okay, so how will that help in oral health? Dr. Padhumai: Like there's an inflammation or whatever has happened that will go off. That will go off and then the gums getting massaged, it stays strong and healthy.
Dr. Hema Sathish: Okay, that's quite interesting.
Dr. Padhumai: But it all works only after the underlying disease or condition has been removed. So whenever you have a pre-existing tooth mobility or an inflammation, you should have a scaling done first.
Okay. Followed by proper oral hygiene techniques like brushing twice a day. More than brushing twice a day, it's almost a technique which is always also important. You should always hold your bristles at a 45 degree angulation to your gums and then give up and down motion. And you should also brush all the surfaces of your teeth. And after that you can go with flossing.
Dr. Hema Sathish: Whenever you spoke about brushing, so do you think that electric brush would be better than a normal brush? Because you said 45 degrees and how to hold it and stuff like that. Electric brush does the job more gently, is it?
Dr. Padhumai: It's the pressure always. So even when you're using an electric toothbrush, of course electric toothbrush is better than normal toothbrushes. But when you're going to... The number of strokes per minute.
Dr. Hema Sathish: Oh, okay. So they calculate and they'll do their job. Okay, that's better.
And bristles. When you talk about bristles in a toothbrush, there are so many, right? Nowadays you get disposable ones, biodegradable ones. And then there are something like fine hair ones which I've seen, you know. And I've heard that causes a maximum damage. I was quite shocked to know that. But can you elaborate a little more on the bristles? What type of bristles you should choose for making sure that your teeth are healthy? You don't get sensitivity, you don't get cavities. What do you suggest?
What type of bristles should you choose for healthy teeth?
Dr. Padhumai: It's actually a soft toothbrush. So whenever you buy a toothbrush, it says soft, medium, hard, ultra soft, sensitive. So you should always pick up a soft one. Despite the arrangements, despite the make, you should always choose a soft one. And be gentle. Like you use a moderate amount of pressure. Not too hard pressure. I've seen people brushing horizontally like this. They want to have it super clean. And they finally end up having abrasions. They have on the size of the teeth, they have enamel abrasions seen. So always go with a moderate pressure. Use soft bristles. And always change your toothbrushes once in every three months. Because that itself can harbor lots and lots of bacteria. Which can make you sick later.
Dr. Hema Sathish: I've read articles about how Gen Z's get more cavities. It's not that they don't brush or they don't take care. On the contrary, they're More conscious I believe. But in spite of that, they get more cavities. Why is that so?
Why Gen Z’s get more cavities?
Dr. Padhumai: It's because of their lifestyle changes and dietary changes. So they are like these generation people are more towards fast foods, more towards seeing lots of movies, late time snacking and they forget to actually rinse their mouth. So that happens, lots of sugary substances.
Dr. Hema Sathish: I think the drinks also.
Dr. Padhumai: The energy drinks. They have lots of acid content in that. Even if you go for non-sugary ones, they have lots of acid content which can demineralize the enamel. So that itself can cause. So over a period of time, it will cause an acid attack and also erosions.
Dr. Hema Sathish: So you have to be careful. So dietary links up to a lot of things.
Dr. Padhumai: So eating a lot of fibers also do matter in mechanical cleaning and also deficiency management.
Dr. Hema Sathish: I've seen patients who have sinusitis have severe sensitivity in their teeth and they find it very difficult to chew or do things. I mean, how is it related?
Tooth sensitivity for Sinusitis people
Dr. Padhumai: Sinusitis rather than sensitivity, what I would precisely say is they get tooth pain. So what they initially think is maybe they got a cavity or they've got periodontal problems. But when they come to us, what we see is it's a completely normal tooth. It's a completely healthy teeth. Even the x-rays are normal without any pathological conditions. But because of the sinusitis, especially in the upper molars. It happens especially with the upper molars. So upper molars are very close to the sinus cavities. Sometimes even the membranes, the sinus mucous membranes or the sinuses are on the teeth. So whenever there is a sinus inflammation, inflammation of the mucous membrane inside the sinus, it can mimic as a tooth pain. But it's actually not a tooth pain itself.
Dr. Hema Sathish: So you got to be careful.
Dr. Padhumai: So you see you have no dental issues. Your dental issues are completely fine. Then you go with extra ENT investigations. You can also ask about the history of cold or whether they have history of sinusitis. All these are helpful in diagnosing.
Dr. Hema Sathish: