BIONIQ: Hydroxyapatite and Biomimetic Enamel

Our teeth mainly consist of the mineral hydroxyapatite, which is one of the hardest substances in the human body.

This substance makes the dental enamel hard and resistant, protecting the teeth from acids and bacteria.

Hydroxyapatite is therefore essential for strong, healthy teeth.

However, this mineral wears away over time and cannot be restored by the human body.

To maintain healthy teeth, biomimetic hydroxyapatite – better known as biomimetic enamel – adheres the teeth with the daily use of Bioniq® Repair products.


What is hydroxyapatite?

Hydroxyapatite is a mineral from the calcium phosphate family and is characterised by an extremely high degree of hardness. It is a substance found in our bones and teeth. Whilst bones are formed from around 40% hydroxyapatite, the concentration in our teeth is far higher. In the tooth structure, around 70% of the inner dentine consists of this mineral. The outer enamel actually consists of as much as 97% hydroxyapatite, which makes it the hardest substance in the human body.

All in all, this is quite a powerful substance. However, the hydroxyapatite in enamel in particular wears away naturally over time and cannot be reproduced by the human body.


What damages hydroxyapatite?

Although the mineral hydroxyapatite is highly resistant, it is not impervious to wear: Over a lifetime, enamel wears away as a result of daily chewing. In an acid environment with a pH below 5.5, hydroxyapatite is also slowly dissolved from the enamel. The bacteria which are naturally present in our oral microbiome break down sugar, producing acids.

In addition, acidic foods can intensify this effect. The fruit acids in fruit juices or additives in sparkling drinks, or phosphoric acid, also damage the crystalline compounds in enamel.

Mechanical irritants can lead to signs of wear: the enamel on the masticatory surfaces (of opposing teeth) in particular is worn away little by little as a result of tooth grinding. Aggressive brushing or the use of toothbrushes with hard bristles can also damage the enamel and virtually brush it away.


Why is hydroxyapatite important?

The outermost layer of the teeth, the enamel, has an extremely high concentration of 97% hydroxyapatite. Enamel protects the underlying layers from the penetration of bacteria, which can cause oral diseases such as cavities and can lead to the death of the tooth.

It also occludes off the small nerve channels (dentinal tubules), protecting them from external influences. Sensitive teeth that react with pain to cold, heat or the consumption of sweet or sour foods can be an indication of exposed dentine and the loss of hydroxyapatite.

Furthermore, this substance also has a cosmetic effect. Hydroxyapatite is white. Thanks to the high concentration in dental enamel, our teeth appear whiter. Of course the underlying dentine also comprises around 70% hydroxyapatite, but it appears much more yellow in comparison. Hence, intact enamel and hydroxyapatite are the key to naturally white teeth.

Is it possible to halt the natural wearing away of the enamel? Sadly, the body is unable to make this substance itself. However, science has found a way to recreate hydroxyapatite in the laboratory and to incorporate it in oral care products. Say goodbye to enamel wear with just one brush!


Hydroxyapatite from bionics

Fortunately, nowadays it is possible to reproduce enamel thanks to innovation and progress in dental technology. So-called biomimetic enamel (hydroxyapatite) is based on the principle of bionics. The term "bionics" combines "biology" and "techniques". It refers to the application of a natural phenomenon to a technical system. This concept has already been used successfully in everyday objects:

  • The camera lens was modelled on the human eye
  • Mop heads are inspired by octopus tentacles
  • Hook-and-pile fasteners are based on the way the hooks on burrs attach themselves to things
  • The water- and dirt-repellent lotus effect
  • Helicopters are inspired by dragonflies
  • Thanks to fine lateral grooves, the skin of the common sandfish is incredibly smooth – making it the ideal model for the surface of solar energy plants
  • The tiny holes in the seed pods of the poppy plant were the inspiration for salt shakers
  • The woodpecker's special ability influenced the invention of the pneumatic hammer
  • The shape of the trout provided the template for airships
  • Shark skin was copied when making diving suits, to minimise the friction between the water and the body's surface

These are just a few examples from the field of bionics. Nature is a popular model as we know that it works. These systems have often been tried and tested for thousands of years and have come out on top in the process of evolution. Now we're learning from them!


Biomimetic Enamel (hydroxyapatite) in Bioniq® Repair products

Most accomplishments in the field of bionics bring forth technical innovations. With the production of biomimetic enamel (hydroxyapatite), it has not only been possible to remodel a mineral substance, but also to combine it with a toothpaste. This is why Bioniq® Repair products also echo the blend “biology” and “technique” in their name.

All Bioniq® Repair-Toothpastes contain the innovative active substance biomimetic enamel (hydroxyapatite), also known as biomimetic enamel. With this ingredient, we can give teeth what they need to remain healthy for longer.

During brushing, the microcrystalline structure of hydroxyapatite builds up directly on the enamel surface, enabling it to repair small cracks and porous areas in the enamel. With the daily use of Bioniq® Repair-Toothpaste, teeth not only feel smoother, but also stay cleaner for longer periods, as the bacteria which are present in all healthy oral microbiomes are unable to adhere as effectively to the surface of the teeth. Sensitivity to pain is also reduced.

Numerous studies also demonstrate that biomimetic enamel (hydroxyapatite) has a positive effect on oral health. See for yourself!


Tooth structure, healthy teeth and dentures

Although they fulfill different functions, all 32 of our teeth are constructed in the same way. The milk teeth, molars or incisors – every single one of our teeth has three areas: the crown, neck and root. These consist of different layers and materials – from enamel, the hardest substance in the human body, to the bone-like dentine, all the way down to the sensitive pulp in the centre of the tooth.

In this article you will discover the structure of a human tooth, find out which areas need special protection during your daily oral hygiene routine and what medical approaches are available to restore your teeth.


Tooth structure: crown, neck and root

Looking at a tooth from top to bottom, it can be roughly divided into three areas: the crown, the neck and the root:

Crown (Corona dentis)

The visible part of the tooth is the crown. Its main function is to chew our food. The tapered crown of the incisor teeth is perfect for biting. In contrast, the masticatory surfaces of the molars grind up the food so that it can be swallowed easily.

Neck (Cervix dentis)

The neck of the tooth lies between the crown and the root. A healthy tooth neck is covered by the gums and is therefore well protected from external influences. However, when tooth necks are exposed due to receding gums, they often cause pain and react with sensitivity to cold and heat and to sweet or sour foods.

Root (Radix dentis)

The root is completely covered by the gums. As it is firmly anchored in the jawbone, it holds the teeth firmly in place. Whereas the incisors generally have one root only, the larger molars have up to four. The roots supply the tooth with nutrients, blood and lymphatic fluid to keep it healthy and alive.


Tooth structure: the visible part of the tooth

Gums

The gums cover the neck of the tooth and protect the underlying parts of the tooth and jaw from the ingress of bacteria. Healthy gums are pale pink and firm to the touch. Signs of gum inflammation (gingivitis) can be redness, swelling and bleeding of the gums.

Enamel

Enamel forms the outermost layer of the tooth structure and encases the crown. Enamel is the hardest substance in the human body and is almost entirely composed of the mineral hydroxyapatite. Daily chewing and various other factors can form microscopically small defects in the enamel over time, which means the underlying layers are no longer optimally protected.

Tooth fissures

The small grooves and depressions on the molars are called defects. Although these help when chewing up foods, they are also highly prone to cavities. As defects can be up to 1 mm deep and difficult to reach, plaque can easily form and remain in these areas. As a consequence, so-called fissure cavities frequently occur.


Inner structure of the tooth

Dentine

The dentine lies below the enamel. It is the second hardest substance in the human body and around two thirds of it are hydroxyapatite. Unlike enamel, which cannot be reproduced by the body, it is made continuously throughout our lives. Fine nerve fibres run through the dentine, so-called dentinal tubules or dentinal channels. If the enamel is damaged and the dentinal tubules exposed, external irritants are transmitted via this route into the tooth interior, which often manifests as sensitive teeth.

Tooth pulp

The tooth pulp is surrounded by the hard substance of the tooth and a space known as the pulp cavity or chamber. It is a soft, gelatinous connective tissue, consisting of blood vessels, lymph fluid and nerve fibres, which is why it is often incorrectly referred to as the tooth nerve. The enamel extends as far as the root canals, where nerves and blood vessels enter and exit. Irritation on this sensitive area (pulpitis) is usually caused by untreated cavities. The symptoms are extremely bad toothache and sensitivity to temperature and pressure.

Root cementum

The root cementum is part of the periodontium (the tooth's supporting structure) and surrounds the root and the neck of the tooth. As well as fibres, tissue and water, it comprises up to 65% hydroxyapatite, making the root cementum similar to bone. One of its functions is to anchor what are known as Sharpey's fibres. These stretchy fibres ensure that the periodontium (the tissues supporting a tooth) is flexible rather than immobile. The pressure generated by chewing is cushioned by these fibres.

Jawbone

The upper jaw (Maxilla) is connected to the lower jaw (Mandibula) by a joint that enables the mouth to open and close and thus permits the chewing and grinding of food. The teeth are firmly anchored within a socket (alveolus) in the jawbone. A common reason for loose teeth is irritation on the tooth socket (periodontitis). This is bacterial inflammation where the body's own immune defence system produces bone-destroying cells (osteoclasts). In the worst case, periodontitis can therefore also lead to loss of the teeth.


Oral care and restoration

Brushing is one of the most effective methods of maintaining oral health and supporting the long life of the teeth. Daily brushing is focused primarily on the visible areas of the teeth: the enamel, fissures, the interdental spaces and gums, in particular the gum line.

The objective is to remove food remains and bacterial deposits known as plaque. This protects the teeth and gums from attacks by microorganisms and prevents the formation of cavities or gingivitis.

Bacteria collect easily on the surface of the teeth and along the gingival margin (edge of the gum), feeding on the remains of food and sugar and producing acids as a result. Acids demineralise the teeth and dissolve the crystalline components in the enamel. A diet which is rich in sugary and acidic foods also promotes demineralisation.

As a consequence, microscopic defects appear in the enamel, to which bacteria can adhere more easily, favouring the development of cavities. Furthermore, other irritants can also be transmitted to the sensitive inner layers of the teeth via the tiny defects in the enamel. Very often, these defects are experienced as sensitive teeth when hot, cold, sour or sweet foods and drinks are consumed.

With daily use, toothpastes containing biomimetic hydroxyapatite, repairs the microscopic cracks, thus repairing the enamel surface. The teeth then feel smoother, and it becomes harder for bacteria to adhere to the surface. As a result:

  • The formation of plaque and tartar is reduced
  • Cavities and gum problems are prevented
  • Tooth sensitivity is reduced

Enamel: the protective shield around our teeth

Tooth enamel is the hardest substance in the human body. It protects the teeth from external irritants. Over time, however, our enamel wears away. If it is damaged, this often has painful consequences: it can result in teeth which are sensitive to heat and cold, or cavities.


What is enamel?

Enamel is the outermost layer of the visible part of the tooth, the natural crown. It is also referred to as enamelum. In adults, healthy enamel is 1.5 to 3 millimeters thick and shields the underlying dentine.

This protective layer is made of up to 97% hydroxyapatite. The main components of this mineral are anorganic substances such as calcium, phosphorus and sodium. The crystalline form of the mineral gives the enamel its resistance and protects the teeth from bacteria and acids.

As enamel does not contain any nerve fibres and blood does not flow through it, it is not sensitive to pain. However, this also means that enamel does not consist of living cells and can thus also not be replaced by the body.

Furthermore, enamel also plays a role in the colouration of the teeth. The high concentration of hydroxyapatite in enamel makes the teeth appear whiter. The crystalline form also gives them a slight glow.


Why is enamel important?

Enamel has to withstand quite a lot: eating, drinking, chewing or other triggers such as tooth grinding are daily stressors. The high strength and resilience of enamel protects the underlying layers of the tooth from wear. However, enamel itself is worn away little by little due to the continuous stress.

If the enamel is damaged, the risk of cavities and other oral diseases increases, which, in the worst case scenario, can lead to tooth loss. Enamel also protects the teeth from demineralisation due to acids which are produced when sugar is broken down.

As enamel does not contain any nerve fibres and blood does not flow through it, it is not sensitive to temperature fluctuations – for example when we consume hot or cold food or drinks or breathe in cold air through our mouths. If teeth react with sensitivity or with a brief, sharp pain, this may well be an early sign of enamel wear. This is caused by exposed dentine channels which transmit the irritation directly to the nerve.


Symptoms of enamel wear

Do you sometimes experience pain when you eat or drink something hot or cold? Do your teeth look more yellow lately, or "transparent" around the edges? These can both be symptoms of damaged enamel:

  • The reason for sensitive teeth (in technical terminology, dentine hypersensitivity) is that the dentinal tubules, which are normally sealed by the enamel, are exposed. Unlike enamel, the dentine contains nerves which transmit thermal or mechanical irritants directly, causing unpleasant and sudden pain.
  • Discolouration can also be associated with thinning enamel. As a result, the underlying dentine shows through and the tooth appears less white. Under the light, the teeth can even appear slightly transparent. This is particularly noticeable at the corners and edges of the teeth.
  • The dentist can also detect cavities in the enamel. This type of cavities, also known as initial cavities, is only superficial and has not yet penetrated the deeper layers of the tooth. It is obviously not yet visible as the more familiar hole in the tooth, but it may turn into one if it is not treated.

What causes enamel wear?

On the one hand, enamel is subject to natural wear: daily chewing and grinding of food causes the enamel to wear down little by little. However, this is an extremely long and drawn-out process. On the other hand, there are also additional factors that promote enamel wear and can lead to premature wear:

  • Diet: The most common cause of enamel wear is diet. In industrialised countries, our eating and drinking habits have changed a great deal over the past few decades. Acidic foods and drinks are consumed much more frequently. These can attack the enamel.
  • Incorrect brushing technique: If too much pressure is exerted during brushing, this can lead to damage to the enamel in the long term. A toothbrush with hard bristles can also contribute to enamel wear. Toothpastes containing abrasive particles (sandpaper effect) can also damage the enamel.
  • Plaque: Plaque is the substance that coats the teeth. It consists of saliva, bacteria and the remains of meals and is part of the normal oral microbiome. If it is not thoroughly removed on a regular basis, the microorganisms contained within it metabolise sugar. This produces acids which attack and demineralise the enamel.
  • Tooth grinding: Grinding the teeth during the night can also cause enamel wear. The enamel is exposed to enormous pressure due to the pressing together of the masticatory surfaces. The additional friction caused by tooth grinding leads to the wear of the tooth substance. In the worst case scenario, the enamel can be worn to the extent that the underlying dentine is visible. A so-called bite guard can help, and can reduce the pressure.
  • Gastric acid: In acid reflux disease, for example heartburn, gastric acid rises into the oesophagus and can even reach the oral cavity. So-called silent reflux, where acidic gases rise up from the stomach, is particularly pernicious. These gases can easily enter the mouth, where they can affect the enamel.

Strengthen the enamel through diet

As hard as nature's enamel may be, acids can nevertheless weaken it when they come into regular contact with the teeth, making it thinner and porous. It is then easier for bacteria to adhere to the surface of the teeth and the risk of dental cavities rises.

Foods with a low pH from 2.5 to 3.5 can foster the demineralisation of the teeth. This includes foods such as apples, strawberries, oranges, grapes, tomatoes or salad dressings containing vinegar. However, the complete avoidance of foods with a low pH is not necessary – especially since unprocessed foods also contain other valuable substances that contribute to a balanced diet.

However, it is easy to help your teeth by eating something that contains calcium after consuming acidic foods. This has a neutralising effect and protects the teeth from wear. This is easily achieved with a little yoghurt or quark, or by drinking milk.

You should also drink water with your meals. This has a neutral pH of 7 to 8.5 and helps to reduce the acid load in the oral cavity. On the other hand, sparkling drinks, energy drinks and other sugary beverages also promote demineralisation, so should be avoided as much as possible.


Strengthen enamel with toothpaste

Unlike hair and nails, which grow back throughout our lifetime, enamel cannot regenerate itself. Studies have proven that the remaining enamel can be effectively strengthened by oral care products containing bionic hydroxyapatite. This is manufactured in the laboratory and has similar properties to the basic building blocks of natural enamel.

During brushing, the biomimetic enamel (hydroxyapatite) in Bioniq® Repair-Toothpaste binds to the surface of the teeth and repairs microscopic defects. Even cavities in their initial stages can be filled. A layer is formed that provides protection from wear.

With regular use of Bioniq® Repair products:

  • The formation of plaque and tartar is reduced and cavities and gum problems prevented
  • Teeth are less sensitive to hot, cold, sweet or sour food and drink
  • Teeth feel smoother as fewer bacteria are able to adhere to the surface

Protect enamel with the correct brushing technique

The choice of toothbrush and brushing technique can also help to protect the enamel: To avoid "sanding down" the enamel, choose a toothbrush which is not too hard and make sure to brush gently. If you are unsure about which hardness is right for you, you can also ask your dentist. Some of the latest electric toothbrushes already tell you if you are brushing too hard.

Wait at least one hour after eating before brushing your teeth. The acids in the food will soften and weaken the enamel. After 30 to 60 minutes, the saliva will neutralise the acids and remineralise the teeth.


Sensitive teeth – help and causes

People suffering from sensitive teeth know the sudden, flash-like pain caused by a mouthful of hot tea, when licking cold ice-cream or caused by biting into a sour apple. It can be estimated that approximately every second person is affected by the so-called dentin hypersensitivity. According to some studies, figures are assumed to be even much higher for those affected

The reasons for sensitivity to pain are exposed dental necks. Sometimes they are visible; frequently, however, they are only visible to the experienced eyes of a dentist. Either the tooth's enamel is defective or the gums have receded. In any event, the dentin is exposed and stimuli are directly and immediately transmitted to the nerves.

This article will tell you about the most frequent causes for exposed necks of teeth and the causes for sensitive teeth; it will also tell you what to do in the way of prevention and what can help when you have teeth sensitive to pain.


Why do teeth suddenly react so sensitively?

There are different causes for painful teeth. For most people, caries will certainly come to mind. However, teeth are painful much more frequently if the bony substance of the tooth that is underneath the outer layer (enamel) or the so-called dentin is exposed.

With healthy teeth, the bony dental substance is protected by the overlying enamel and sheathed by the gums. That substance is permeated by many small channels – in dental language, they are called dentin tubules. These small, liquid-filled channels transmit stimuli to the inside of the tooth, the pulp. The pulp consists of numerous fine nerve pathways and blood streams.

If the enamel is damaged, especially in the peripheral area at the transition to the gums, or if the gums have receded, the dentin will be exposed. When savouring hot or cold drinks or foods, thermal stimuli will be directly transmitted to the pulp via the small dentin tubules. The nerves in the pulp immediately signal to our brain the flash-like, sharp pain.

But such pain is not only triggered by heat and cold but also by foods. These are mostly sour or sweet dishes. This is also called chemical stimuli. Exactly as with thermal stimuli, these chemical stimuli are transmitted to the pulp through the liquid-filled dentin tubules.


Six causes for sensitive teeth

The development of sensitive teeth is possible due to a large number of triggers. They can be classified in four categories:

  1. Erosions:Here concerned are enamel damages caused by chemical processes, thus caused by an acid-induced dental enamel erosion. The acids are here e.g. from foods and can dissolve the tooth over time. If this happens permanently, the enamel will become ever thinner, and the neck of the tooth is exposed.
  2. Abrasions: Enamel is here also affected. However, the damage is due rather to mechanical effects. Enamel is eroded due to pressure or friction; thus, abraded so to speak – e.g. by brushing teeth too intensively or by using the wrong (to abrasive) toothpaste. Here again, the areas on the neck of teeth are frequently concerned so that dentin is exposed.
  3. Recessions: The term describes the (non-inflammatory) withdrawal of the gums. Once the gingiva recedes, the neck of the tooth is exposed and thus the dentin as well.
  4. Gingival diseases: Especially the inflammatory diseases of the gums (gingivitis, periodontitis) cause the gingiva to recede. Here as well, the consequences are exposed necks of teeth.

Acidic foods and drinks
People enjoying lemonades, fruit juices and energy drinks will not like the following news item. In case of permanent consumption, acidic drinks will demineralise the dental enamel, rendering it porous and increasingly thinner. Microscopic fissures will be formed so that the enamel has a hard time to protect the dentin and dental nerves from thermal or chemical influences.

Unlike with caries, these erosions occur not by acids produced by bacteria but rather through acid attacks of a non-bacterial origin. Aside from acidic foods and drinks, gastric acid can also result in hydroxyapatite crystals being slowly dissolved from the dental enamel. Accordingly, causes for sensitive teeth can also be reflux, frequent vomiting during pregnancy or bulimia nervosa.

Lack of oral hygiene
The oral cavity has a variety of bacteria which are indispensable for a healthy oral flora. In case of a faulty or non-balanced nutrition, however, harmful bacteria will dominate the so-called biofilm, also named dental plaque. These bacteria produce certain substances which bring about an inflammation of the gingiva. The biofilm deposits especially well in interdental spaces and on the gingival margin. If this biofilm is not removed by brushing teeth daily, gingivitis will frequently develop here. A result of the inflammation will often be a recession of the gums.

Many patients suffering from sensitive teeth or gum problems tend to reduce brushing their teeth or no longer brush them at all. That will be most unfortunate, however, insofar as plaque will lastingly accumulate; it will harden and build up tartar which can only be removed by the dentist. Moreover, the gum inflammation or gingivitis may aggravate and develop to periodontitis. Such periodontitis will affect the entire periodontium – thus the bone as well; and it will not be reversible but require lifelong therapy. Patients with periodontitis frequently suffer from sensitive dental necks.

Wrong tooth brushing technique
However, enamel and gingiva may also be damaged by excessive care. Some people just mean too well in their dental care: They want to be thorough and too forcefully press the toothbrush on their teeth. But the damage will usually be greater than the benefit if the brush also happens to have hard bristles or if teeth are brushed too quickly after eating acidic dishes.

Due to a wrong tooth brushing technique, the dental enamel is downright abraded and the gingiva is injured. Subsequently, the dental necks are exposed resulting in sensitive teeth. If daily oral care results in bleeding gums, this will be a first sign for an inflammation of the gums or even a wrong brushing technique. Either way, consultation of a dentist, dental hygienist or any other expert for prevention is the way to go.

Teeth grinding
Mechanical pressure may also be a cause of teeth sensitive to pain: For example, if teeth permanently grind against each other while grinding teeth. The consequence of the permanent burden is usually dental damage manifesting itself in various ways. However, here again, dentin is often exposed which will react with pain upon stimuli.

Particularly delicate: Many of the people affected will press their upper jaw on the lower jaw, mostly unwittingly or at night. Their surprise is great when the dentist’s diagnosis is a so-called bruxism . The pressure resulting with so-called teeth grinding is many times higher than that used for chewing foods and it will also last significantly longer. Dental enamel is unable to permanently withstand such burdens.

Treatments at dentists
Especially after treatment at the dental practice, many patients complain about sensitive teeth. However, this is a normal reaction as a rule which will soon disappear again. Increased sensitivity to pain will be particularly frequent after:

  • Professional dental cleaning
  • Measures taken for prosthetic devices, such as a dental crown or bridge
  • Periodontitis treatment
  • Dental bleaching

Professional dental cleaning at the dentist’s office will remove tartar and bacterial coatings on the gingival margin. The gingiva may thus be slightly irritated. This is to be expected – regardless of how good and well-trained the dental specialist is. However, the treatment basically contributes to gingival health which is why professional dental cleaning should not be done without. Moreover, discomforts will decrease considerably after a short period of time already.

Bleaching and tooth whitening
Meanwhile, not only dentists are using methods to whiten teeth. Various applications also exist for tooth whitening at home. In bleaching, teeth are usually whitened with hydrogen peroxide. This substance is used to temporarily “dry” the dental enamel, and gums can also be irritated. As a result, patients frequently react with pain when they consume hot, sour or cold foods and drinks.

It is absolutely necessary that patients discuss any tooth whitening measures with their dentist if they are suffering anyway already from teeth sensitive to pain. Otherwise, the patients’ sensitivity to pain can get even worse.


What helps in case of sensitive teeth?

For most affected persons, it is no long-term option to avoid the irritation and ingest only lukewarm foods and drinks. Affected persons can do a few things to counteract sensitive teeth and get more delight from the pleasurable consumption of all foods.

Whether at home or at the dental practice - the best means of minimising any sensitivity to pain is to preserve tooth substance and gums.

The following 11 tips will provide help with teeth sensitive to pain:

Less pressure when brushing teeth
The correct tooth brushing technique can make a considerable difference for teeth sensitive to pain. Because actually, too much pressure in brushing teeth is frequently applied, or the toothbrush is forcefully moved back and forth while scrubbing. It is better to brush with less pressure from red to white – thus from the gums to the tooth. Also take care of how you hold the toothbrush. If you make a fist, you will soon apply too much pressure. It is better to hold the manual toothbrush just with your finger tips to prevent any damage due to brushing.

Select a suitable toothbrush
A gentle brushing technique will be easier to apply with a toothbrush which is suitable for sensitive teeth. But the selection is rather difficult and should be done in coordination with the experts at the dental practice. After all, even soft bristles might result in abrasions. Moreover, some electrical toothbrushes are provided with sensors to warn you if too much pressure is applied. But here again, the enamel may be damaged if you remain too long on one tooth.

Pay attention to whitening toothpastes
Toothpastes for white teeth are generally characterised by a high percentage of so-called cleaning particles. Many toothpastes also have very hard cleaning particles which actually do remove stubborn deposits but also damage the tooth substance and thus render the sensitivity to pain even worse. Accordingly, rather opt for a toothpaste for sensitive teeth.

Protection by dental enamel
A toothpaste with “biomimetic enamel” helps reduce hypersensitivity as it mimics our natural enamel. If used regularly, microscopic defects responsible for stimuli transmission, will be closed and the enamel surface is repaired with each and every tooth brushing.

Routinely use an oral rinse
Oral rinses not only provide for a fresh breath but also remove bacteria from hard-to-reach areas which encourage receding gums. Contrary to a mouthwash, oral rinses are provided already in the specified dose and need not be specially diluted. Solutions not only containing antibacterial ingredients but also hydroxyapatite will additionally strengthen the dental surface.

Entrust yourself to dentists
Keep the regular prophylaxis appointments with your dentist. Here, tooth damage, gum irritations and exposed necks of teeth can be detected early and corresponding measures for treatment can be implemented. If you already noticed any hypersensitivity with your teeth, talk to your dentist about it. They can determine the exact cause – e.g. abrasion, erosion or recession.

Use a bruxism brace to improve teeth grinding
A bruxism brace or a “grinder brace” will help in case of damages due to unwitting or nocturnal teeth grinding. Such a brace will be individually adjusted by your dentist to your set of teeth and is accordingly comfortable to wear. The brace here acts as a buffer between the chewing surfaces, thereby reducing friction and protecting the surface of the teeth.

Sealing of exposed dental necks
Dental necks are not sheathed by hard enamel. Accordingly, once they are exposed, they will react especially sensitively. In order to keep away any external irritations from the dentin, dentists may seal them with a special enamel varnish or gel. With so-called wedge-shaped defects, dental neck filling of plastic may also be used.

Refrain from smoking
Cigarette smoking has negative effects not only on health, heart and the cardiovascular system but also on teeth. Gums have a poorer blood supply and are prone to inflammations. As a result, gums will recede and encourage dentin hypersensitivity.

Avoid acidic foods
Since acids render the dental enamel porous, patients with sensitive teeth should better avoid acidic foods. This includes, inter alia, some carbonated beverages, coffee, yoghurt, citrus fruits, various berries, such as raspberries, blackberries or currants. Also, foods containing high amounts of sugar should feature less on the menu since sugar is also converted into acids by the bacteria of the oral flora.

Tips to weaken acids
Ingestion of acids via foods cannot be entirely prevented. Moreover, there are also other important nutrients especially in acidic fruits, such as cherries, kiwi et al. You can at least weaken the acid attack somewhat. For example, by eating whole-grain products, you can stimulate salivation which will balance the acid. Or you can drink a glass of milk or eat a natural yoghurt with your fruit. The calcium contained in dairy products will additionally weaken the acids.


Special case: An individual tooth is sensitive to pain or pressure-sensitive

In some cases, pain upon the ingestion of foods has nothing to do with any dentin hypersensitivity in the classical sense. If only one single tooth reacts sensitively, irrespective of the food ingested, or if teeth are painful especially upon pressure due to chewing, triggers for the hypersensitivity may also be caries or pulpitis:

  • Caries develops if bacteria metabolise to acids any food residues – especially sugar. Thus, if a lot of sugar is consumed, bacteria will also have a lot of food and accordingly produce many harmful acids. Moreover, if food residues are not thoroughly removed through daily dental care, plaque will develop. For bacteria, plaque is the ideal habitat. They can here proliferate practically without any hindrances. Finally, the tooth is damaged so much that there will be a hole which can only be treated with a filling applied by the dentist. The more caries advances, the sooner pain is felt.
  • Pulpitis is an inflammation of the dental pulp and is also colloquially called dental root inflammation. If caries is not treated, bacteria may advance all the way to the pulp and cause the inflammation. Moreover, pulpitis may also occur after a tooth accident or after setting in a dental crown. In case of pulpitis, the dentist generally performs a root canal treatment.

Inflammation of the gums – detecting and treating gingivitis

If you notice blood when brushing your teeth every day, this could be a sign of gum inflammation. You are not alone: almost every adult occasionally suffers from so-called gingivitis – which often goes unnoticed, as the inflammation is not always associated with pain. The reason for swollen gums and bleeding is bacteria, which build up on the gingival margin (gum edge). If these bacteria are not removed by brushing, they can cause inflammation.

In the case of ongoing inflammation of the gums, bacteria can travel to the periodontium (the tissues supporting a tooth) and cause long-term damage. This would be a case of periodontitis (also commonly known as gum disease). Left untreated, teeth can become loose and fall out prematurely. Consequently, thorough and regular oral hygiene is also the best prevention and treatment for gingivitis!

Causes of gingivitis

Bacteria are the most common cause of acute or chronic gingivitis. It is perfectly natural for bacteria to be present in the mouth: there are actually several thousand varieties in the oral cavity. These are part of the oral microbiome and are beneficial, inter alia, for digestion or in defending the body against pathogens.

However, together with the components of saliva and the remains of food, bacteria can form a viscous substance on the surface of the teeth and the gingival margin – known as biofilm. This biofilm provides excellent protection of the bacteria from external influences. If it is not thoroughly and regularly removed, plaque is formed.

Poor oral hygiene means that not only is this plaque not removed, the remains of food are also left in the mouth. This helps bacteria to proliferate rapidly, as the optimal conditions are present. The food remains are a source of nutrition for the bacteria. During metabolisation, acids are produced which attack the enamel and the gums.

A large number of bacteria accumulate at the point where the tooth meets the gums in particular. This area is referred to by experts as a sulcus and is a furrow measuring a few millimetres only. It offers the ideal place for bacteria, acids and food to collect and to enter the gums. The immune system reacts with an inflammatory response: gingivitis.


Symptoms of gingivitis

But how exactly would you know if you had gingivitis? Here, experts differentiate between acute and chronic inflammation of the gums

Acute gingivitis often goes unnoticed as it is not usually painful. According to estimates, around 80% of all adults have gingivitis without realising it. However, if gingivitis does not heal after a longer period (more than seven days), it becomes chronic and can then also cause pain. Subsequently, gum recession can also occur, exposing the necks of the teeth and making the teeth appear longer.

To stop gingivitis becoming chronic in the first place, you can look out for specific signs and quickly determine whether you have inflammation of the gums:  

  • The colour of the gums: healthy gums are light pink and smooth. Inflammation, on the other hand, is characterised by redness and swelling.
  • Do your gums bleed when you brush your teeth or bite into an apple? This can also be a sign of inflammation.
  • Chronic gingivitis is characterised by pain.
  • Bad breath is another sign of chronic gum inflammation.
  • In particularly severe cases, pus can also form and other physical reactions such as fever can occur.

Gingivitis or periodontosis – what is the difference between these gum diseases?

But how is gingivitis different from periodontitis? Bleeding from the gums is usually dismissed as harmless and ignored, especially as it is only rarely associated with pain. However, harmless gingivitis can quickly progress to periodontitis.

Inflammation of the gums (gingivitis) is caused by inadequate oral hygiene: bacteria in the mouth are not removed correctly and cause an inflammatory reaction at the gum line. The problem is usually quickly resolved by thorough and regular oral hygiene.

With periodontitis, it gets much more complicated: unlike inflammation of the gums, periodontitis is irreversible and often occurs due to untreated gingivitis. Regular oral hygiene is also vital here to halt the progress of the disease. However, treatment will be unsuccessful without a dentist, as the bacteria has penetrated deep into the tooth socket and can no longer be removed using a toothbrush or oral floss.

Whilst gingivitis rarely has serious consequences and bacterial colonisation is mainly limited to the gums, in periodontitis, the entire peridontium is infected with bacteria. This can also cause teeth to become loose or even to fall out.


Treating inflammation of the gums – when should you see a dentist?

In many cases, gingivitis clears itself within a few weeks with thorough and careful oral hygiene. General oral care, consisting of twice-daily brushing (morning and evening) and daily cleaning of the interdental spaces using oral floss or an interdental brush, is indispensable.

There are also other measures that can support the healing process and which are easy to perform:

  • Use a toothbrush with soft bristles to avoid further damage or injury to the gums.
  • Special ointments which are applied to the gums are also formulated to contain the bacterial load.
  • A household remedy for gum inflammation is chamomile tea. Other herbs and substances that contain essential oils and have an anti-inflammatory action such as sage, myrrh or thyme can help to relieve inflammation.
  • Use a mouthwash to minimise bacteria in the oral cavity and to clean hard-to-reach areas.

However, if there is still no improvement in the gingivitis, you should see a dentist. A dentist will use the so-called Parodontal Screening Index – PSI for short – to check whether there is already an increased risk of periodontitis as a result of the gingivitis. The expert will also remove plaque and tartar from the teeth and gums and gently polish the teeth to make it harder for bacteria to adhere to the surface.


Risk factors for gingivitis

Even if the biggest risk factor is poor oral hygiene, there are other factors that increase the risk of getting gingivitis:

  • The likelihood of getting gingivitis is twice as high for smokers as it is for non-smokers.
  • The risk also rises with age, as natural saliva production is lower. This also means that less food residue and bacteria are naturally washed away.
  • The same is true for breathing through the mouth. This also dries out the mouth and increases the risk of gingivitis.
  • A vitamin C deficiency also increase the likelihood of gum inflammation, as do a number of pre-existing diseases such as Diabetes mellitus, leukaemia or HIV.
  • Major hormonal changes such as those that take place during pregnancy or puberty, can often lead to problems with inflamed gums.

Periodontitis – from inflammation of the gums to inflammation of the tooth socket

In layman's terms, periodontitis is also commonly known as gum disease. It is a bacterial disease of the gums and the periodontium and refers to inflammation of the tooth socket. The tooth socket is made up of the gums and cementum, and connects the tooth to the jaw. In periodontitis, the inflammation damages the periodontal apparatus (the tissues supporting a tooth) and can, at worst, lead to the loss of individual teeth.

Periodontitis is often preceded by gingivitis. This inflammation initially only affects the gums. It is an extremely insidious disease, as in the early stages, patients notice only a few or even no symptoms. This means that gingivitis often goes unnoticed: bacteria can proliferate in hard-to-reach areas; inflammation becomes advanced and turns into periodontitis.


Periodontitis as a result of gingivitis

Inflammation of the gums – known as gingivitis – is not rare and affects almost all adults at least once in their lives. It occurs when oral hygiene is inadequate. Bacteria build up on the gum line, where they can trigger an inflammatory reaction. The first signs can be bleeding of the gums and bad breath.

Gingivitis is usually harmless and resolves itself quickly with improved oral care. However, if it persists, periodontitis can develop insidiously as a result.

In periodontitis, the bacteria are transmitted from the gums to the tooth socket, where periodontal pockets are formed. The tooth then loosens from the gums and a gap arises. These grooves are ideal spots for bacteria, as they can proliferate here almost undisturbed. A toothbrush and dental floss cannot reach the periodontal pockets.

The remains of food which bacteria feed on also remain in the pockets, providing them with optimal living conditions. The bacteria then penetrate even further into the periodontium. Finally, the bacteria are able to reach, attack and damage the jawbone and the cementum.

Furthermore, the body also responds to the infection by sending osteoclasts (bone-destroying cells) to defend against the bacteria. The consequences: the function of the periodontium is then impaired and tooth loss may occur.


Causes of and risk factors for periodontitis

The most common cause of periodontitis is inadequate oral hygiene, resulting in a bacterial load in the mouth. Generally, periodontitis precedes gingivitis. Therefore, you should avoid the following risk factors:

  • Correct oral hygiene: Clean your teeth thoroughly at least twice a day to remove plaque and food residue – this is how you can prevent cavities.
  • Avoid infection: It is possible to catch periodontitis. Therefore, you should not share your toothbrush or use the same cutlery as your partner or child.
  • Tartar: If necessary, ask your dentist to remove the tartar from your teeth. Tartar occurs when plaque "calcifies". As a result, grooves are formed which present the perfect environment for the adhesion of bacteria.
  • Smoking: 70% of people with periodontitis are regular smokers. The reason: nicotine impairs circulation, and as a result, the body is less able to fight gum infections.

There are also other risk factors which are harder to control:

  • Predisposition: Periodontitis often occurs repeatedly within a family.
  • Hormonal fluctuations: During pregnancy and puberty, the risk of bacterial infections in the oral cavity increases.
  • Preexisting conditions: Many predispositions can also increase the risk of periodontitis. Diabetes mellitus impacts the circulation, which has a negative effect on immunity. In HIV, the immune system is weakened and is less able to respond effectively to infections.

Periodontitis – treatment by a dentist

Before treatment comes the diagnosis. First, your dentist can use the periodontal screening index (PSI) to determine the progression (stage) of the periodontitis. Jaw X-rays are also taken to detect any possible bone loss. Then the appropriate treatment steps are decided on the basis of these results.

The treatment of infection of a dental socket comprises various escalation stages according to the degree of progression, and the dentist will decide which is appropriate. A basic treatment is usually performed at the start of therapy. If this is not sufficient, further steps can be taken, such as minor surgery.

The primary objectives of the treatment of periodontitis are to limit the proliferation of bacteria, therefore also halting gingivitis and inflammation of the periodontium, at the same time preserving the tissues.

Basic treatment of periodontitis
First the teeth need to be cleaned and plaque/tartar removed. To do so, the dentist will initially perform a basic treatment. Local anaesthesia is necessary for the procedure known as closed curettage . Then the dentist will remove the tartar around the necks of the teeth and the gums, either manually or using medical instruments (e.g. ultrasonic devices). In some circumstances, a laser can also be utilised to remove the affected tissue, which also has an antibacterial effect. Antibiotics may also be necessary. This basic treatment is often enough to halt the progress of the infection and to reduce the symptoms.

Surgical treatment of periodontitis

If periodontitis is extremely aggressive or advanced, or it has not been possible to completely halt the inflammation using the closed periodontitis treatment, open treatment in the form of surgery will be necessary. First, the dentist opens any particularly deep gingival pockets slightly, to combat the bacteria directly and to detect and remove any diseased tissue. The gums can then replaced to fit against the tooth, to limit the adhesion of bacteria in the future.

If the periodontium is already affected and the attachment of the teeth is threatened, a tissue transplant may be needed. For this purpose, one option is to excise the required tissue from the patient's palate for transplantation. So-called transposition flaps can also be used. For this purpose, healthy gum tissue is excised and transposed onto the infected area. The two methods are often combined to achieve a cosmetically flawless finish.

If the bone is also affected, it can be replaced using the patient's own bone tissue or a bone substitute.


Preventing periodontitis

So that treatment of periodontitis or surgery is never needed in the first place, we recommend preventive measures. The following tips will help you to prevent inflammation of the tooth socket:

  • Practise regular and thorough oral care by brushing your teeth in the morning and evening. Also use dental floss or interdental brushes to clean the spaces between your teeth. The use of mouthwash to minimise the bacterial load in the oral cavity is also recommended.
  • Try to eat a healthy diet and avoid the excessive consumption of sugary drinks throughout the day. Ideally, sweet things should be eaten immediately after a main meal so that the bacteria do not have a continuous new food supply.
  • Attend the six-monthly check-up appointment at your dentist, so that periodontitis can be detected at an early stage.
  • Regularly have your teeth professionally cleaned (scale and polish) at your dental surgery. During treatment, the teeth are not only cleaned: potential risk factors are also detected.
  • Try to limit nicotine consumption or ideally, give up smoking. The risk of periodontitis is significantly elevated in smokers.

Secondary diseases in periodontitis

Left untreated, periodontitis can also have other dangerous consequences alongside possible tooth loss: studies have shown a correlation between periodontitis and cardiovascular diseases, as the bacteria can penetrate the coronary vessels through the bloodstream. The respiratory system can also be affected by pathogens, which can sometimes cause pneumonia.


Dr. Wolff's Product Recommendation:
Bioniq® Repair-Toothpaste Products

Bioniq® Repair-Toothpaste

Bioniq® Repair-Toothpaste PLUS

 

All-around protection for teeth and enamel

▪ Contains 20% Hydroxyapatite

▪ Remineralises and repairs enamel surface

▪ Forms a protective layer against acids and bacteria

▪ Reduces risk of gum problems and sensitive teeth

▪ Smoothes the teeth

 

All-around protection for teeth, enamel and healthy gums

▪ Contains 20% Hydroxyapatite

▪ Reduces gum bleeding

▪ Reduces sensitivity of teeth

▪ Combats harmful bacteria which can cause gum irritations

▪ Protects gums from drying out


Frequently Asked Questions

Is Bioniq Repair-Toothpaste suitable for daily use?

Bioniq® Repair-Toothpaste has all the cleaning and protective properties of a conventional fluoride toothpaste.

It also contains hydroxyapatite to repair microscopically small defects in the surface enamel. Problems with the teeth and gums are prevented. This makes Bioniq® Repair-Toothpaste ideal for daily use, in the morning and evening.

How is Bioniq Repair-Toothpaste different from Bioniq Repair-Toothpaste PLUS?

The active ingredient in both Bioniq Repair-Toothpaste and Bioniq Repair-Toothpaste PLUS is hydroxyapatite, 20% artificial / biomimetic enamel.

The use of hydroxyapatite in Bioniq Repair-Toothpaste has a positive effect on the health of the teeth and gums. These effects include the formation of a biomimetic protective film around the teeth and the prevention of tooth sensitivity.

In addition to the active ingredient hydroxyapatite, Bioniq Repair-Toothpaste PLUS also contains two further active substances that help to protect the gums: the natural antimicrobial active substance lactoferrin and the tried-and-tested biologically active substance hyaluronic acid.

This makes Bioniq® Repair-Toothpaste PLUS ideal for persons who are prone to gum problems.

Is Bioniq Repair-Toothpaste suitable for children/infants?

We recommend use for children aged 6 and over, as some of our toothpastes have a minty flavour which is often unsuitable for children.

Can Bioniq® Repair-Toothpaste Plus also be used on fixed or removable dentures?

All Bioniq® Repair-Toothpastes have an extremely gentle formulation. This means they can also be used if a patient has implants and in the case of fixed or removable dentures. As well as hydroxyapatite (BioHAP), the main active ingredient, Bioniq® Repair-Toothpastes also contain cleansing substances and mild surfactants. Gentle abrasive particles are also used to avoid damaging implants, crowns or fillings.

Is Bioniq® Repair-Toothpaste vegan?

The Bioniq® Repair-Toothpaste formulations and the tube and bottle materials do not contain any raw materials of animal origin. The product is therefore also suitable for use by vegetarians and vegans.

Animal testing has not been used in the development of our products. A general ban on the use of animal testing for cosmetics has been enacted by law (Cosmetics Ordinance and EU Cosmetics Directive) for a number of years now.

How does the advertising slogan of the Bioniq Repair-Toothpaste function: ”Brush back enamel“?

The Bioniq Repair-Toothpaste contains biomimetic hydroxyapatite (BioHAP), better known as biomimetic enamel. It accumulates on the surface of the teeth and protects them. But even more, it is not just a matter of accumulation and the development of a protective layer. The (demineralised) acid-weakened teeth are remineralised by daily brushing with the Bioniq Repair-Toothpaste. That means, in daily use, the Bioniq Repair-Toothpaste with biomimetic enamel repairs microscopically small defects in the enamel surface. Accordingly, teeth will feel more smoothly and for bacteria, it is more difficult to adhere to the teeth. The active principle has been proven by scientific studies.

How high is the degree of abrasion/RDA value?

All Bioniq® Repair toothpastes are suitable for everyday use even for sensitive teeth.

Does Bioniq® Repair-Toothpaste contain microplastics?

As all Bioniq® Repair products are based on the principle of biomimetics, we never use harmful or questionable ingredients. Consequently, Bioniq® Repair-Toothpaste contains zero microplastics or nanoplastics. Our toothpastes do not contain tiny plastic beads made of polyethylene, otherwise known as microbeads, as abrasive particles. We only use mineral-based abrasives (silica and hydrated silica).

Does Bioniq® Repair-Toothpaste contain titanium dioxide?

No Bioniq® Repair product contains titanium dioxide.