Warn patients of the hazards of toothpicks

12/22/2000  By Chris Smith Managing Editor, E-dental.com After polishing off those holiday meals in the next few days, many patients head for the box of toothpick box as a way to clean their teeth. However, dentists and members of the dental team should remind patients that toothpicks be used sparingly and should never be considered a substitute for brushing and flossing. "Toothpicks should be used only when a toothbrush or floss is not available, for example, when you are in a restaurant and have food trapped between teeth," explains April Grandinetti, DDS, Chicago. "Toothpicks that are used overzealously can damage tooth enamel, lacerate gums, and even cause a tooth to break in severe cases. People who have bonding or veneers can chip or break them if they aren't careful. Overly aggressive use of toothpicks can severely wear the roots of teeth, especially in cases where gums have pulled away from the teeth and leave teeth with root surfaces exposed, notably in the elderly." The toothpick, or its equivalent, is used in many countries as the main tool in the battle against tooth decay -- notably Middle Eastern and Asian countries. For example, in Saudi Arabia, many people used the twigs of trees to clean between their teeth. "Toothpicks have a long history as civilization's primary tooth-cleaning instrument," says Dr. Grandinetti. "The West began to abandon them in the 1700s as the newly created toothbrush gradually became the standard of care for cleaning teeth." Toothpicks date back to 3,500 BC when the earliest known oral hygiene kit featuring a toothbrush was found at the Ningal Temple in Ur. In China, a curved pendant, made of cast bronze was worn around the neck and used as a toothpick. In 536 BC, the Chinese mandated a law that required the use of the toothpick because their armies suffered from bad breath. In the Old Testament, it is written that "one may take a splinter from the wood lying near him to clean his teeth." Toothpicks probably had their heyday in the Middle Ages when keeping a toothpick in the mouth all day long was a common habit. In the 17th century, toothpicks were commonly used by the educated classes throughout Europe. In France, for example, toothpicks were served with desserts, usually poked into fruit to be handy following a meal. After they were used, they could be placed behind the ear for future use. Toothpicks have been made of numerous materials through history, including wood, porcupine quill, chicken bone, ivory, gold, silver and steel. Many woods used were aromatic, some containing tannic acid which was thought to help prevent cavities and gum disease. Today, most toothpicks in the United States come from "toothpick trees" in Maine. The tree is a white birch which has its trunk cut into thin sheets that are cut again to the thickness and length of toothpicks. "I can tell when I have a habitual toothpick user in my dental chair," says Dr. Grandinetti. "There are the tell-tale signs of toothpick marks. So use them if you have too, but don't make it a habit. Brush and floss instead."

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