Dr. Nammy Patel, founder of Green Dentistry in San Francisco, and author of the bestselling book, Age With Style— A Guide to a Youthful Smile and Healthy Living, discusses how to get the perfect smile.

John Maher: Hi, I’m John Maher and I’m here today with Dr. Nammy Patel, founder of Green Dentistry in San Francisco, California, helping patients recognize the vital connection between the dental, health, and whole body health and author of the best selling book, Age with Style: Your Guide to a Youthful Smile & Healthy Living. Today, our topic is how to get the perfect smile. Welcome Dr. Nammy.

Dr. Nammy: Hi, John. Thank you for having me.

Smile Problems

John: Sure. So Dr. Nammy would like to go through some typical smile problems and talk about what they’re caused by and how you can fix them so that people can achieve the smile that they’re really looking for. So why don’t we start with stained teeth. Teeth whitening, I think is a big thing that you hear a lot about. Talk a little bit about stained teeth and what causes that.

Dr. Nammy: John, the main cause of stained teeth tend to be drinking coffee, having red wine, not using an electric toothbrush. Those tend to be the most common reasons for stained teeth. Also, aging is very common. As we approach forties and fifties, our teeth tend to get more yellow because the changes on the inside of the natural tooth, they tend to get more of a dentin layer, which tends to make the teeth more yellow. The other things that cause stained teeth are medications. A lot of times people taking asthma inhalers tend to get yellow teeth. Sometimes a diet high in turmeric will go ahead and give standing on the teeth, as well as kombucha, also green tea.

All of these things will cause staining of the teeth and the best way to go ahead and remove that, I always say first start with an electric toothbrush, come in for a cleaning. That usually tends to make the teeth go wider about one to two shades. If you need further whitening, there are at home options and also in-office options. So depending on how much you need to whiten. In-office options tend to be the best because it’s more of a controlled environment and we tend to go eight to 10 shades lighter in about an hour, hour and a half. Long term, it’s better for you because you are only bleaching the teeth once, versus at home, you’re exposing the teeth to bleaching agents multiple times and it also takes longer.

Chipped and Cracked Teeth

John: Okay, good advice. The next issue is chipped and cracked teeth. How does that happen?

Dr. Nammy: So chipping and cracking again tends to be something that happens because of wear and tear over time. Especially if the bite is off or if you tend to clench and grind, or if you have sleep apnea, they will cause the teeth to chip and break. Sometimes accidents also happen like falling off a bike will cause a tooth to chip. A lot of times, the most common things that we find are clenching and grinding and also chipping and breaking of the teeth because of an accident. So the first thing we always look at is how do we fix it. We first want to look at the cause of why the chip had happened. So if it is something like if you have a crossbite where the teeth are not touching properly, they’re colliding, it’s going to cause your teeth to chip and break. So we want to focus on fixing the bite.

If it’s caused by an accident, we want to make sure that the nerve is not infected and the nerve is not dying on its own because of the trauma. Once we find that the tooth is okay, we can actually place, if it’s a small chip, a filling, if it’s a larger chip, we have to go towards a veneer or a crown.

John: Okay. Then kind of related to that would be crooked teeth and gaps in your teeth. Is there any cause to those or is it just genetic and what can you do about that?

Dr. Nammy: A number of reasons. One is genetics. The second is functional habits. So if you ended up sucking your thumb when you were younger, you would end up with an open bite because they are developmental. The other things are, if the wisdom teeth come in, they tend to crowd the teeth as well. The other thing is as we age, well,  our facial profile changes, so that tends to crowd the teeth as well. With the gaps, gaps in to be genetic. Usually there is a developmental muscle that is on the front of the teeth and that tends to pull in between, so causing a diastema or a gap between the two central teeth, that’s very, very, very, very common. Sometimes they’re spacing all over the mouth and it just has to do with genetics and how your jaw structure is made.

Gaps in Teeth

John: Okay. What’s the best fix for gaps in your teeth and crooked teeth?

Dr. Nammy: Ideally, the best way to fix that, I tend to prefer natural forms of fixing these things, which would be fixing the bite. If they’re spacing, it’s easy to close it up. If there is crowding again, it’s also easy to close up and straighten out, which is really nice, and it’s also longer-lasting. So I do really like to straighten the teeth first. If that doesn’t work or if that’s not an option, our next steps are to look at veneers and crowns, which are quicker, but also remove natural tooth structure.

Receding Gums

John: Okay. Then our final thing to talk about, our final issue is receding gums. What causes receding gums?

Dr. Nammy: Receding gums are most commonly caused by over brushing the teeth. We’re using a lot of forces on the teeth to brush them. Teeth actually just need one gram of force to clean them, which is just gently touching them, and it’s actually the mechanical actions of how many times you brush your teeth that actually makes a difference, not how hard you brush your teeth. That’s the number one cause of receding gums. The second is actually airway problems so breathing issues. Anytime that somebody is not able to breathe through their nose, the tongue tends to push against the teeth, getting them to flare out. So there’s a lot of gum recession from that. The third reason is if the teeth are crowded and one tooth is sticking out more than the other. So as we’re brushing our teeth, it will cause gum recession.

Brushing Techniques

John: Okay. You mentioned brushing techniques. Do you recommend that people brush more often, but more gently?

Dr. Nammy: Yes, absolutely. I absolutely love the electric toothbrushes, especially Oral B is one of my favorites. The other one is called the Boka Brush because it’s made out of recycled content and it has a charcoal brush on top. I find that with patients, it ends up getting a better clean, which is great, and also brushing the teeth, not the gum, brushes the tooth because that’s where the bacteria are. It’s when people are brushing, using a Sonicare is very common because the directions for a Sonicare says that brush at a 45 degree angle, half on the tooth and half on the gums because that’s where the bacteria live, and people tend to over brush those areas and that ends up causing a problem.

John: Okay. That’s great advice, and thanks again for speaking with me today, Dr. Nammy.

Dr. Nammy: Absolutely.

John: For more information about Green Dentistry, visit the website at sfgreendentist.com or call 415-578-9347.