I don’t floss. If I’m too drunk, too tired, too sad, or some combination thereof, I don’t brush my teeth before I go to sleep. On the nights that I do brush, I’ll often get torturously hungry at, like, 11:30 p.m. and pound an entire sack of Goldfish in bed. I am powerless to resist a box of Buncha Crunch or a sleeve of Twizzlers when I set eyes on them in a bodega. I smoke about 1,000 cigarettes a day, and I drink at least 24 ounces of black coffee each morning.
I am, in short, a dentist’s worst nightmare.
I’ve long deluded myself that I can abuse my mouth in such a manner and get away with it, as long as I visit the dentist twice a year. But now the jig is up: In November, I lost my job, and with it, my dental insurance. Shortly thereafter, I canceled my standing appointment at East Village Smiles and quietly began to panic. Now that I’ve joined the ranks of the estimated 86.7 million American adults who don’t have coverage for their chompers—whether that’s because they’re unemployed, can’t afford their premiums, or live in a state that doesn’t offer dental insurance under Medicaid or Medicare—I figure I need to start taking better care of my teeth. So, last week, I called up two dentists for some advice.
As you’ll learn from the experts SELF spoke to, there’s a lot more to protecting your teeth than just brushing and flossing. But don’t freak out: It’s pretty easy to keep your teeth in good shape, once you’re awakened to all the different ways you’re absentmindedly screwing them up. Here’s what I learned about not having to pay exorbitant costs for mouth-based maintenance.
If you’re eating something sugary, eat it all at once.
Here’s why sugar is bad for your teeth: There’s a bunch of bacteria sitting on those bad boys literally all the time, and that bacteria loves sugar, Leila Jahangiri, BDS, DMD, the chair of the department of prosthodontics at NYU’s College of Dentistry, tells SELF. When you consume sugar, the bacteria on your teeth go to town on it. The byproduct of that sugar feast is an “acid attack,” Dr. Jahangiri says, which eats away at your teeth’s enamel, resulting in tooth decay. Decay typically leads to cavities, which can lead to root canals, which can lead to crowns, which can lead to the removal of a tooth entirely. Pain aside, dealing with all of that can be prohibitively expensive, especially if you’re uninsured.
Unfortunately, sugar rips. We’re not going to tell you to stop eating it altogether, and neither is Dr. Jahangiri. But if you’re going to have something sugary, have it all at once—within the span of 5 to 10 minutes, she says. When it comes to your teeth, the amount of sugar you consume in one sitting doesn’t really matter; what matters is how many times you consume sugar each day. “It has everything to do with frequency,” Dr. Jahangiri says. “Let’s say somebody wakes up in the morning, has a can of Coke, and walks around with it half the day. Every time they sip—one damage, two damage, three damage, four damage.”
Snacking on a single candy bar throughout the day can do significantly more damage to your teeth than eating it all at once, according to Dr. Jahangiri. The same rule applies to all sugary foods, whether they’re processed or not. “A lot of people think that if anything is ‘natural,’ it’s good,” Dr. Jahangiri says. “The reality is, honey will do as much damage. Dates would do as much damage as chocolates. Bacteria don’t care whether it’s natural or not. The bacteria go by the sugary substance.”
A final note on sugar: It’s best to have it with a meal, Dr. Jahangiri says. When you’re eating, you produce more saliva, which serves as a buffer that protects your teeth from sugar and acid. If you drink a soda or eat a candy bar within 15 minutes of a meal, it does “very little damage” to your teeth, Dr. Jahangiri says.
Have a strategy around acidic foods and drinks.
Sugar is bad for your teeth because it creates acid in your mouth. By the same token, drinking anything acidic is bad for your teeth too, David Hershkowitz, DDS, the division chair of restorative dentistry at Penn Dental Medicine, tells SELF. “What people don’t think about is fruit juices,” Dr. Hershkowitz says. “Everyone thinks orange juice, or a little squirt of lemon in your tea or over your seafood, is good. But it makes for an acidic environment, and the mouth needs an acidic environment to cause [tooth] decay.”
Again, Dr. Hershkowitz is not asking you to cut OJ out of your life. But when you drink it—or any other citrusy juice—he recommends using a straw. “Throw it into the back of your mouth so it doesn’t bathe the teeth,” he says. If you can, rinse out your mouth with water when you’re done sipping. And avoid brushing your teeth immediately after drinking fruit juice or any other acidic beverages, like soda, energy drinks, or coffee.
“Brushing right away, if you have orange juice or lemon, only makes it worse,” Dr. Hershkowitz says. “The acid on the teeth kind of weakens [them] a little bit. Now you’re taking a toothbrush, which is abrasive, and you’re brushing the tooth. That makes it even weaker. You should take some time before you do the brushing. Rinse with water first, and then brush afterwards.” It’s wise to wait until at least 30 minutes have passed, he adds.
Get specific about your brushing and flossing habits.
Brushing twice a day—once in the morning, and once at night—is obviously important, as is flossing. But Dr. Jahangiri and Dr. Hershkowitz raised a few not-so-obvious pointers to keep in mind.
- Make sure brushing and flossing are the last things you do before you go to bed. Leaving food in your mouth overnight is (a) gross and (b) a recipe for tooth decay.
- Brush methodically, not chaotically. You want to make sure you don’t miss any spots. Start on the left side of your mouth and brush the outside of each row of teeth, making sure to brush where the teeth meet the gums. Then do the inside of each row the same way. Move to your front teeth and repeat. Finally, move to the right side of your mouth and finish up.
- Follow the “brush for two minutes” rule. Some research shows this can help remove 26% more plaque—which is where the bacteria on your teeth live—than if you rush through it, according to Dr. Hershkowitz.
- Use a standard, name-brand toothpaste. Baking soda, peroxide, or other homespun alternatives might damage your teeth, and they don’t contain fluoride. (Fluoride is the key ingredient in toothpaste that protects your teeth, and it can even reverse some of the damage you may have unwittingly done to them. It’s also in most of our tap water. Drink that stuff!)
- When you’re done brushing, spit out your toothpaste—but don’t rinse out your mouth with water right away. That fluoride needs time to sit on your teeth and do its thing. Dr. Hershkowitz recommends waiting about half an hour before you rinse, if you have the time.
- Flossing sucks; there’s no getting around that. To make it suck less, take Dr. Jahangiri’s advice: “Do it while you’re doing something else.” (For her part, she flosses while she’s watching TV.) Don’t worry about using something fancy like a water flosser. Regular floss works well, Dr. Jahangiri says. If you’re not sure about the right technique to use, follow this handy five-step guide to flossing from the American Dental Association.
- Don’t share a toothbrush with anyone—not even your partner or your kid. You run the risk of swapping microorganisms or bodily fluids with each other, which the ADA recommends avoiding.
Can’t afford your old dentist? Try these options instead.
Even if you’re brushing and flossing regularly, watching your sugar and acid intakes, and otherwise doing your best to take good care of your teeth, you still need to go to the dentist for biannual checkups and cleanings if at all possible. Early tooth decay and early gum disease—the two main things that can go wrong inside your mouth—may have no symptoms, according to Dr. Jahangiri. Often, only a professional can spot them. The sooner they’re spotted, the easier and cheaper they are to treat—meaning, putting off a visit until you’re in extreme pain might cost you more in the end, Dr. Jahangiri says.
There are options out there for uninsured folks who want to see a dentist without breaking the bank. Various nonprofits, including Mission of Mercy, offer free dental clinics in some states across the US. To find one near you, Dr. Hershkowitz recommends calling up your local dental association (e.g., the New York State Dental Association) and asking for guidance. If they can’t direct you to a free clinic, they might be able to put you in touch with a private practitioner willing to help you out pro bono. “That’s done all the time in the profession,” Dr. Hershkowitz says. “When I was in private practice, I can’t tell you the amount of pro bono work I did. No person who showed up at my office who was in pain was ever denied.”
Another great resource: dental schools, dental schools, dental schools! You can make an appointment at one and receive the same level of care that you would at a private office for as little as a third of the price, according to Dr. Hershkowitz. “Dental schools deliver wonderful care,” he says. “It’s a dental student who’s treating a patient under the supervision of a licensed dentist. Everything is checked in a stepwise fashion—you can’t proceed from Step A to Step B until Step A is checked—at extremely reduced fees.” So don’t think you’d receive subpar care just because you’re seeing someone early in their career—in fact, it’s quite the opposite.
Dental schools are occasionally able to offer patients care on a sliding scale based on their income, Dr. Hershkowitz says. In some cases, you can even receive treatment for free. “Dental schools will work out a payment plan that’s a lot more liberal than maybe a private practice would,” he explains. “At the University of Pennsylvania, we give millions of dollars away in pro bono care for our patients. Our patients have that need to be treated, and our students have that need to be educated.”
Talk to your dentist about saving yourself money.
If you plan on continuing to see a dentist at a private practice, have a candid conversation with them about the fact that you don’t have insurance and you don’t want to spend a fortune. Depending on your oral health history and your cleaning habits, you may be able to get by on one trip to the dentist per year instead of two; cut back on extensive cleanings; and space out your X-rays, which are often the priciest line item on your bill. “If you’ve lost your job, tell them,” Dr. Jahangiri says. “Say, ‘Listen, I’ve been really good with my brushing, I’ve been really good with my diet. So I just want to limit it to an exam, and anything that’s absolutely necessary at the current time.’ I think most dentists will respect that.”
If your dentist wants to X-ray your teeth, Dr. Hershkowitz recommends asking them why. If you can safely avoid X-rays, you can avoid shelling out hundreds of dollars. “The school of thought years ago was, every new patient should get a full-mouth series of X-rays to see every tooth to have a baseline. We’ve evolved over the years,” Dr. Hershkowitz says. “You should ask, ‘Do I need all these X-rays? If so, why? What is my risk factor? Why are we doing this?’ Be your own advocate.”
It’s worth noting that you can request dental records, including X-rays, from a dentist you’ve seen in the past. Under HIPAA regulations, they’re required to provide them to you, though they may charge you a small fee.
Watch out for warning signs that something is majorly wrong and needs care from a dentist.
As Dr. Jahangiri notes, early tooth decay and gum disease are often painless, and they don’t usually cause noticeable symptoms. But, as these issues progress, that might change. Dr. Jahangiri and Dr. Hershkowitz warn that if you experience any of the following, it’s a good idea to get to a dentist as soon as you can:
- Consistently bleeding gums
- Newfound sensitivity to hot or cold food or beverages
- Pain that lingers after you chew
- Sharp pain when you consume sugar
- Discoloration around your teeth and gums, including black, gray, or white spots
This is scary-sounding stuff, but if you follow Dr. Jahangiri and Dr. Hershkowitz’s advice, there’s a strong chance you won’t have to worry about any of it. “If [you] do everything else meticulously,” Dr. Jahangiri says, “the dental visits are just going to be quick checkups of nothing.” And if I can do it? I know you can too.
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