You eat well. You hit the gym five days a week. But when it comes to your choppers, they’re probably last on your list of healthy habits. You’re not alone. Population studies estimate that almost half of the U.S. population has dental anxiety — if you avoid going to the dentist each year, you’re one of them — while nine to 15 percent suffer from dental phobia and completely avoid a dental visit altogether.
Although lying back in the dentist’s chair may make your heart race, it can’t compare to the risk of heart disease associated with poor oral health. And if that correlation doesn’t surprise you, we’ve found nine others that will. Test your knowledge and see if you can guess fact from fiction.

1. Consistent bleeding gums are usually due to flossing. MYTH

While aggressively fishing a popcorn kernel out of your teeth might result in some blood-tinged saliva, flossing generally shouldn’t cause your gums to bleed. If it does, consider it an early warning sign of periodontal disease.

According to the National Institutes of Health, an estimated 80 million Americans have some form of the disease and most are treatable. Regular teeth cleaning hinders bacteria, in the form of sticky plaque, from accumulating.

“Flossing is important. A toothbrush can only clean the visible surfaces of the teeth, but harmful bacteria (left behind) stay hidden in between the teeth,” adds Dr. Neal Shah, DDS of Austin Dental Arts.
The longer plaque sits on the tooth, the more likely it will cause irritation and inflammation — known as gingivitis. Untreated gingivitis allows bacteria to seep deeper into your gums, promoting bleeding and an immune response.

This potent combination of aggressive bacteria and your body’s own defensive enzymes will actually start to break down the bone and surrounding tissue that hold teeth in place. Expect to don a toothless grin in your next family photo if you continue to cancel your dental appointments after this point.
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2. Flossing increases life expectancy. TRUE

In case you weren’t sure, the purpose of flossing is two-fold: to clean between teeth and to remove debris from under the gum line. It may seem obvious but if you’re like most people, you neglect this necessary tooth task and leave behind more than 300 types of destructive bacteria that make up plaque and tartar.
You probably realize by now that excessive plaque will cause gum disease known as gingivitis. And this inflammation isn’t limited to the mouth. High levels of bacteria seep into the irritated pockets between teeth and gums producing toxins that continue to promote the disease, externally and internally.

This chronic infection facilitates bacteria’s journey to your arteries, where it hangs out causing further inflammation and a different kind of plaque accumulation — a dangerous combination that often results in atherosclerosis. There is debate among dentists on how many years of life flossing can give you.

“The classic number that gets thrown around is 6.4 years,” explains Dr. Shah. “There isn’t one study out there that can truly measure this, but those that floss tend to do many other things which are beneficial to their health like exercise.”

As you’ll continue to read throughout this article, massive amounts of oral bacteria may lead to serious heart disease and an untimely death.
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3. Chronic bad breath is cured by mouthwash. MYTH

A swish of Listerine might cover up odor in the short-term but that fresh mint smell will quickly fade. Although most of us have suffered from a transient bout of garlic breath, chronic halitosis affects about 25 percent of the population and is often indicative of a more serious condition.

There are more than 600 types of bacteria found in the mouth, so it makes sense that 85 to 90 percent of bad breath cases originate there. Obviously brushing and flossing are vital to removing rotting and smelly food, but those methods are also known to mask odors temporarily. Decaying debris on the tongue is an often overlooked culprit so brushing or scraping the far back of the tongue can drastically reduce putrid breath, permanently.

Another smelly offender is persistent dry mouth, also called xerostomia, which occurs when the flow of saliva decreases; usually due to medications, breathing through the mouth or salivary gland problems. The enzymes in saliva help to clean the mouth and break down food particles that are known to cause odor. To get saliva flowing again, try sucking on sugarless candy or increasing your fluid intake.

The other 10 percent of halitosis incidents can be due to internal problems such as local respiratory or sinus infections, postnasal drip, diabetes or gastrointestinal upset. Tobacco and other smoking products are known to cause rancid breath — giving you another reason to kick the habit.
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4. Electronic toothbrushes are significantly better than manual ones. MYTH

According to the Academy of General Dentistry, the best toothbrush that you can buy is the one you will actually use. If electronic toothbrushes help you reach the recommended two to three minutes of brushing twice a day, than any dentist would suggest you spend the extra money. But when you directly compare the cleaning power of both toothbrushes, there isn’t much difference.

In 2003, Cochrane Oral Health Group conducted a study that found powered toothbrushes — specifically those with rotational-oscillation action — reduced plaque and gingivitis by only 7 and 17 percent respectively when compared to manual toothbrushes. But both are equally effective when following the two minute brushing rule.

If you’re not sure which toothbrush to pick up, consider your manual dexterity (spend the cash on an electric toothbrush if you have arthritis) and financial status (powered toothbrushes can cost up to $120). Whichever you prefer, dentists recommend using a soft bristle as many of us are overly aggressive brushers, meaning we put our teeth at risk for premature enamel erosion.
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5. You get enough fluoride from your toothpaste. MYTH

This is a bit of a trick question that depends on a number of factors such as age and even fluoride exposure. Unbeknownst to many of us, some toothpaste brands have more fluoride then others, indicating that we may not be getting maximum enamel protection.

There is disparity even among brands: Crest Pro-Health has almost double the amount of fluoride at .454 percent compared to Crest Nature’s Expression with .243 percent of the mineral. This disparity doesn’t necessarily affect all of our choppers equally. According to Dr. Patel, children and young adults — except those under six years of age — may need additional sources of fluoride compared to most full-grown adults.

For those who do need extra protection (including adults born with thin enamel), it’s a good idea to get extra amounts of this mineral topically. Clinical studies have demonstrated that using a fluoride mouth rinse with toothpaste can provide extra protection against tooth decay over that provided by fluoride toothpaste alone.

Fluoride prevents cavities by both strengthening the protective layer of enamel on your teeth and reversing low levels of tooth decay by remineralizing soft spots on your teeth. According to the American Dental Association (ADA), the best way to reduce tooth decay is to get fluoride both topically and systemically. So don’t be afraid to sip on tap water, systemic fluoride can reduce tooth decay by 20 to 40 percent.
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6. Most toothpaste can be damaging to your teeth. MYTH

Serious enamel abrasion is not usually your toothpaste’s fault. Along with fluoride, most toothpaste contains sweeteners, detergents and abrasives. And although they each have their own oral health issues, none are the primary culprits of tooth tarnish.

Sweeteners: You might not be able to stand the taste of keeping your teeth clean if it weren’t for this addition. Saccharin is the most common sweetener and helps to make mint actually taste like mint. Fortunately, it does little to contribute to cavity formation.

Detergents: These create the foaming action, which prevents the toothpaste from dribbling out as we brush. Sodium lauryl sulfate, the same ingredient found in your shampoo, is most commonly used but has been known to promote canker sores in susceptible individuals — about 20 percent of the U.S. population.

Abrasives: In conjunction with fluoride, abrasives give toothpaste their cleaning power. All ADA-accepted toothpastes contain them, often in the form of silica, calcium phosphate or alumina. All these minerals remove stains and plaque, while polishing teeth.

Unfortunately, some types of toothpaste can be more abrasive then others: Relative Dentin Abrasivity (RDA) was tested in a number of popular toothpaste brands. Close-up toothpaste scored the highest at 218 and the winner for least abrasive paste was Enamel Saver at 44. The brands you most likely use, Colgate and Crest, scored at mid-range with 106. And if you’re worried about abrasion, you might want to skip whitening toothpastes altogether.

*Be careful with the whitening toothpastes, they may contain some abrasive particles in them that, when used aggressively, can scratch teeth and make them sensitive,” explains Dr. Shah.

Since most of us will spend a total of 38.5 days brushing our teeth over the course of our lifetime, most dentists would say the biggest perpetrator behind enamel erosion would be overly vigorous brushing with a hard bristled-brush coupled with over-consumption of sugar.
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7. Gum disease can cause heart disease. TRUE

You probably guessed right, but the statistics on this correlation will still shock you. If you’re one of the 75 percent of the U.S. population that has had some form of periodontal disease, than you are almost twice as likely to be diagnosed with coronary artery disease.

A study conducted at the University of Buffalo found that of all the hundreds of bacteria found in your mouth, two specific strains were significantly associated with increasing heart attack risk. Tannerella forsynthesis and Preventella intermedia, the two culprits, enter the bloodstream through irritated and vulnerable gums.

Although research is still preliminary, experts have found oral bacteria clumped in artery plaques — contributing to blocked arteries and further promoting atherosclerosis. Unfortunately, that’s not the only hazard to your heart associated with gum disease.
Alternatively, inflammatory oral bacteria such as Streptococcus viridans also find their way into the circulatory system. And while they might not contribute to narrowing of the arteries, these bacteria can settle and grow on the valves of your heart causing endocarditis, an inflammation of the inner layer of the heart.

A serious bacterial infection isn’t rare. In fact, in 1997 the American Heart Association started recommending pre-treatment antibiotics for people who already have heart conditions such as hypertrophic cardiomyopathy or mitral valve prolapse.
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8. Teeth whitening is safe for your enamel. TRUE

The short answer is yes, but as you know by now, the answer is never short. Every time you eat or drink, the leftover residue accumulates to form a pellicle film. This scummy film sits on your tooth and despite your best brushing attempts, over time it can seep into the porous enamel and reach spots you simply can’t scrape away with a toothbrush.

This is when an estimated 10 million Americans depend on whiteners to rescue them from yellow-stained choppers. Whiteners work by using bleaching agents such as carbamide peroxide or hydrogen peroxide, which are able to get deep into the enamel and oxidize (or break apart) the staining compounds. The result: A bright, white smile.

All over-the-counter whitening gels containing 10 percent peroxide bear the ADA seal and clinical studies have continued to indict that this active ingredient ratio does not cause any damage to the enamel. In fact, the only major side effects of home whitening are tooth sensitivity and the occasional gum irritation.

But, on the other hand, professionally applied bleach whiteners can be harsh against tooth enamel. These products contain higher concentrations of peroxide — sometimes up to 35 percent — and are often used in conjunction with ultraviolet lights to enhance the whitening process. This aggressive combination may weaken enamel and is therefore not eligible for the ADA seal. But, even so, dentists add high levels of fluoride to this process to prevent any potential negative effects on enamel.
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9. Tooth loss is mainly a cosmetic problem. MYTH

You’re probably a teeth expert by now and have correctly recognized this statement as false. Besides a rough hockey game, tooth loss is caused by either gum disease or extensive tooth decay (cavities). There’s more bad news if you’re a smoker: You’re three times more likely to lose all of your teeth than those who stay cigarette free.

A study published in the July 2003 online issue of Stroke demonstrated a significant relationship between number of teeth lost and an increased risk for clogged carotid arteries — the blood vessels that supply oxygen to the brain.

Even as a non-smoker, if you don’t take care of your teeth, you’ll likely be dealing with serious health consequences. In 2005, the American Journal of Preventative Medicine published a similar study that links heart disease to tooth loss in non-smoking adults, thus signifying poor oral health as its own cardiac disease risk factor. According to the research, the percentages of participants likely to have heart disease associated with tooth loss are as follows: 1 to 5 missing teeth: 6.8 percent; 6 to 31 missing teeth: 10.2 percent; complete tooth loss: 11.5 percent.
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10. Sugar is the only culprit behind cavities. MYTH

According to the CDC (2002), 78 percent of Americans have had at least one cavity by the age of 17. But this decay isn’t solely the fault of our unrelentless sweet tooth that we all have at a young age. As adults, we can easily recognize the obvious cavity culprits such as candy and soda, but might not realize that post-workout Gatorade gulps could damage enamel.

“Many sports drinks contain highly acidic compounds that can chemically erode teeth,” says Dr. Shah. “We have many athletes as patients who train year round with high incidences of tooth decay.”

If you watch what you eat and drink but continue to get cavities, highly-corrosive stomach acid could be silently making its way to your mouth each night. More than 60 million people experience some form of gastric acid reflux. When left untreated, it not only eats away at tooth enamel but can promote esophageal cancer.
Another overlooked cause of erosion is frictional wear. Bruxism, also known as teeth grinding, can destroy enamel very quickly. Surprisingly, most of the population suffers from some form of this abrasion.

“There are studies out there that show somewhere around 80 percent of people grind their teeth at night,” explains Dr. Shah.

According to him, the main causes are stress or neurological disturbances requiring a simple and non-invasive remedy — a dental night guard. Still, it’s important to be mindful of your sweet cravings. Many studies have found that people who drink three or more sugary sodas each day have 62 percent more dental decay, fillings and even tooth loss.