Category Archives: Dental Health

Persistent Pathogens : Dedicated Defense

These are our children. We’d do anything for them, right?

kids

Helping them grow up with healthy smiles takes a little wrangling with microbes, though. Consider the results of a study published in last December’s Journal of Oral Microbiology:

The Oregon Health & Science University School of Dentistry have determined that certain genetic strains of bacteria are dominant in children one year after treatment for microbial-caused plaque and tooth decay, and six new previously undetected minor strains were identified.

Some of these, they found, are resistant to xylitol, well-known for its ability to prevent cavities.

But while some kinds of oral flora can cause problems, we rely on others to maintain good health. Think of this: Bacteria make up more than 10 times the number of your body cells. In fact, our bodies are the host to more than 100 trillion microbes, many of which are not just beneficial but necessary.

Think of your body as an enclosed ecosystem. It is only when the ecosystem is out of balance that the populations shift and the pathogens (microbes that can make us sick) overpopulate and gain a foothold, contributing to illness.

Oral health is all about keeping the oral flora in proper balance.

Persistent or not, the mere presence of microbes doesn’t spell doom for your child’s teeth. Cavities are preventable.

Many factors can make the difference at dental check-up time. Frequent snacking and dry mouth are important to avoid. But the best route to a healthy mouth is based on good hygiene and diet.

And what makes hygiene “good”?

  • Waiting 20 to 30 minutes after eating to clean your teeth. (When you eat, oral conditions turn acidic for a while. This delay allows them to neutralize. Brushing right away can actually damage teeth and gums.)
  • Brushing with a soft-bristled brush and toothpaste containing no fluoride or sodium lauryl sulfate.
  • Flossing and using a proxy brush to clean the areas your toothbrush can’t get to.

When it comes to diet, balanced, varied and nutrient-rich is the key, with many more whole foods – including fresh produce and whole grains – than processed. There are a couple kinds of foods, though, to be careful about: sugars and fermentable carbohydrates (carbs that are digested as sugar). These are the preferred foods of decay- and disease-causing microbes, and because they tend to stick to the teeth, they give the pathogens that much more time to feed. These include

  • Soft drinks of all kinds – soda, energy drinks, sports drinks. (And no, diet drinks aren’t the solution, for their acids can still damage tooth enamel, making teeth more decay-prone. More, research now suggests they may raise risk of diabetes, as well!)
  • Fruit juice. (Fresh whole fruit is great!)
  • Candy – especially chewy candies that easily stick to and get wedged between teeth. (If sweets are desired, chocolate is most tooth-friendly.)
  • Dried fruit (the stickiness factor again).
  • French fries and Tater Tots.
  • White bread and pasta.
  • Cake, pie and cookies.

Along similar lines, if your child uses an inhaler for asthma, it can leave an acidic residue. So whenever possible, do let them brush after using their inhalers.

The more dedicated you are to practicing and instilling healthy habits like these, the better your defense against persistent decay.

More tips for helping your little ones develop good oral health habits and healthy smiles

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Another Reason Your Teeth Love Vitamin D

It’s well known that Vitamin D is good for your teeth, which need good, healthy bone for support. The nutrient helps you get that by promoting calcium absorption and the right calcium/phosphate balance for bone to remineralize.

A new literature review now lends more weight to its ability to prevent cavities, as well – an ability some have disputed.

This current survey aimed to shed some light on the matter by analyzing 24 studies conducted over several decades and in several countries. Collectively, they “showed that vitamin D was associated with an approximately 50 percent reduction in the incidence of tooth decay.”

[Review author Dr. Philippe] Hujoel’s findings come as no surprise to researchers familiar with past vitamin D studies. According to Dr. Michael Hollick, professor of medicine at the Boston University Medical Center, “the findings from the University of Washington reaffirm the importance of vitamin D for dental health.” He said that “children who are vitamin D deficient have poor and delayed teeth eruption and are prone to dental caries.”

That said, the current study is not without its limitations, noted by the author himself. For instance, most of the trials that were included “predated modern clinical trial design.” Safeguards like randomization, blinding and controls were used inconsistently. Publication bias was also an issue.

“My main goal,” said Dr. Hujoel in a press release, “was to summarize the clinical trial database so that we could take a fresh look at this vitamin D question.” And it’s an increasingly important question, as tooth decay continues to be epidemic among children and as vitamin D levels have been dropping across many populations.

“Whether this is more than just a coincidence is open to debate,” Hujoel said. “In the meantime, pregnant women or young mothers can do little harm by realizing that vitamin D is essential to their offspring’s health. Vitamin D does lead to teeth and bones that are better mineralized.”

LEARN MORE

Image by Electron, via Wikimedia Commons

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Why Does Poor Oral Health Remain Such a Problem?

Every so often, a new story comes out about the American struggle with oral health. Not long ago, for instance, we heard about how 20% of Americans have untreated decay and most have some history of cavity repair: 40% of children, 52% of teens and 75% of adults. Other studies say that by the age of 65, as many as 90% of adult Americans have experienced decay in their permanent teeth.

Why is it such an ongoing problem?

For one, there’s the standard American diet, which is chock full of sugars even before factoring in the sodas, juices and other sweet beverages we’ve come to drink more of. These, along with refined grains and other processed carbs, feed the pathogenic (disease-causing) microbes involved in oral disease. Sugar has other negative health effects, too, and makes us more susceptible to illnesses of all kinds.

Add to this lifestyle factors such as limited physical activity, high stress, poor and insufficient sleep, high drug use (including prescription drugs, alcohol and tobacco) and the like: all these factors similarly weaken the body’s innate self-regulating abilities. We become prone to illness – or at least suboptimal health.

Then there’s the matter of lack of knowledge about dental health and hygiene – a point made quite vividly by survey findings released by the American Dental Association last week. The headline on their press release?

Americans Score a D
on National Oral Health Quiz

The “quiz” was a series of true/false questions answered by nearly 1500 adults. Here’s what the ADA found – and the correct answers:

  • 90% think you should brush after every meal.
    Twice a day is the usual recommendation. And as mentioned, you should usually wait about a half hour after eating or drinking anything before you brush.
  • 65% think you should replace your toothbrush twice a year.
    Every three months is more like it.
  • 75% don’t know when a child should have his or her first dental visit.
    It should happen as soon as their first tooth erupts or no later than their first birthday.
  • 81% think sugar causes cavities.
    Only part true. As mentioned above, sugars feed pathogenic microbes in the mouth, but it’s the acidic waste they produce that actually damages the teeth.
  • 59% don’t know that those microbes can be passed from person to person.
    Like other infectious agents, oral bacteria can be passed along from one person to another – through things like kissing or sharing utensils.

Taking good care of your health – dental and systemic alike – means understanding how your body works. That’s why you may find your dentist or hygienist always explaining and teaching at your appointments – teaching that, unfortunately, some patients tune out for various reasons. But the teaching does matter, so we keep doing it. It’s central to our work. As I wrote before,

I can’t speak for all dentists, of course, but as a dentist, it’s important to me that you understand what we’re doing and why we’re doing it, as well as what you can do to gain and sustain more optimal oral health in general. After all, dentists are doctors, too – physicians whose specialty involves the teeth and oral cavity. You know how the word “doctor” came about? The English word comes from the Latin word docere, which means “to show, teach or cause to know.”

Teaching is part of our job.

Image by Jacob Barss-Bailey, via Flickr

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Care of the Body = Care of the Mouth = Care of the Body

No doubt, mercury is a threat to human health. Yet more than 2/3 of all dentists still use it on occasion. One thing that can make it easier to justify is a consequence of that that doctor/dentist division I wrote about a couple weeks ago: the tendency to treat teeth as though they were separate from the rest of the body. If that were true, it would seem impossible that mercury fillings could harm other organs, such as the brain.

But of course they can. And do.

The mouth/body split also supports more benign ideas, like the belief that brushing and flossing are enough to ensure healthy, disease-free teeth and gums. They’re important, of course – but so are nutrition, exercise, limited or no drug use (including tobacco and alcohol) and the rest.

For all the things you do to keep your body healthy help keep your teeth and gums healthy, too. And vice versa. And just as keeping your body clean is one part of preventing illness – for instance, washing your hands after using the toilet – keeping your teeth clean is one part of preventing oral disease.

Recently, a pair of Swedish studies made the news for one startling fact they found: 90% of Swedes don’t brush their teeth effectively. I imagine US results would be similar.

Most Swedes regularly brush their teeth with fluoride toothpaste. But only few know the best brushing technique, how the toothpaste should be used and how fluoride prevents tooth decay.

Of course, even scientists aren’t entirely sure how fluoride works. We do know it does little to remove biofilm (the colonies of pathogenic microbes, or “bad bugs,” we call “plaque”). In fact, at least one study has shown that non-fluoride toothpaste is actually more effective at removing biofilm than toothpaste with fluoride. What matters most is the mechanical action of brushing. Toothpaste provides grit to help remove the sticky biofilm.

So how to brush your teeth effectively?

First, despite what you’ve likely been told, you shouldn’t brush your teeth immediately after eating. Instead, wait a half hour or so – especially after acidic foods and beverages, which include those with a lot of sugar or other refined carbs. This gives oral conditions time to return to their usual alkaline state. Otherwise, you’re essentially brushing acids into your teeth, raising the risk of damaging the enamel, which in turn can lead to tooth sensitivity and decay.

Then, when you do brush, follow the technique shown and described here.

And don’t forget to floss. (Even better, clean with a proxy brush, which research suggests may be even more effective than floss. Really.)

Image by rachel a.k., via Flickr

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Raspberries, Piercings & Smoking – Oh, My!

So back to blogging, following up on a few older posts with more recent items I ran across during the hiatus…

Nontoxic Oral Cancer Treatments

We’ve looked at causes and early detection of oral cancer, but then what? Well, if a pair of recent studies holds up, we just might wind up treating precancerous lesions with raspberries.

“Part of the biggest clinical challenge,” says Dr. Susan Mallery in DrBicuspid’s report on her work, “is that we cannot currently identify which lesions will progress to oral cancer. Having nontoxic and effective treatment options available would be a great benefit to both patients and healthcare practitioners.”

In a 2010 study in Pharmaceutical Research, Dr. Mallery’s team found that applying a black raspberry gel directly to the lesions kept precancerous cells from becoming cancerous.

Based on the known mechanisms by which berry compounds function at the cellular levels, researchers speculate that the promising gel trial results reflect activation of two related pathways – apoptosis and terminal differentiation – in the premalignant cells. The ultimate benefit is that damaged cells don’t continue to divide and are therefore not retained.

A new study by the team, published in Molecular Pharmaceutics, showed similar efficacy of patch-delivered fenretinide, a synthetic vitamin A compound. The authors suggest that these “chemopreventives” could be used alone or in rotation, though the raspberry gel was enough for many.

“We’re getting a pretty good handle on what enzymes you need and how you metabolize the compounds, which will give a predictive indicator if you’re going to be a good responder to the raspberry gel alone,” Dr. Mallery said.

How Body Piercing Can Go Wrong

A while back, we looked at a few of the problems oral piercings can cause for your teeth and gums – from infection to pushing teeth out of alignment. But there are others.

Last month, the American Journal of Clinical Dermatology published a comprehensive review of “the medical consequences of body piercing.” First, there are those that can crop up regardless of where the piercing is.

Localized infections are common. Systemic infections such as viral hepatitis and toxic shock syndrome and distant infections such as endocarditis and brain abscesses have been reported. Other general complications include allergic contact dermatitis (e.g. from nickel or latex), bleeding, scarring and keloid formation, nerve damage, and interference with medical procedures such as intubation and blood/organ donation.

Then there are “site-specific” problems. Of concern to dentists:

Oral piercings may lead to difficulty speaking and eating, excessive salivation, and dental problems. Oral and nasal piercings may be aspirated or become embedded, requiring surgical removal.

What the report doesn’t go into, though, are concerns of biological, holistic or integrative practitioners over punching through acupuncture points and housing metal in the body. These can block and disturb energy along the meridians, which can damage health over time. You can learn more about the issue in this helpful overview.

Smokers Avoid the Dentist

Not long after we looked at why smokers need to kick their habit before getting treatment for gum disease – a disease that affects tobacco-users disproportionately – the CDC released some new and sad data on smokers, dental problems and dental care.

The CDC looked at 2008 survey responses from more than 16,000 adults ages 18 through 64.

More than a third of smokers reported having three or more dental problems, ranging from stained teeth to jaw pain, toothaches or infected gums. That was more than twice as much as people who never smoked.

But 20 percent of the smokers said they had not been to a dentist in at least five years. Only 10 percent of non-smokers and former smokers had stayed away that long, the study found.

Smokers seem to be aware their dental health is worse “but they’re not doing anything about it,” said Robin Cohen, a CDC statistician who co-authored the new report.

Why not?

Half said they couldn’t afford it, which makes sense: Smoking rates are higher among lower income groups, it’s an expensive habit and the amount and type of damage it causes can quickly inflate a dental bill. I suspect fear plays a role, too – fear of The Lecture, as noted before, and fear of finding out just how bad the problems are.

Unfortunately, the avoidance tactic usually ends up costing much more. According to a study in the Journal of Periodontology, patients with gum disease who did without periodontal treatment could only replace 4 teeth before they were spending more than they would have for a lifetime of periodontal care.

A lifetime!

“Feasible”?

Last, a headline – from a story about recent UK debates on the use of mercury amalgam in dentistry:

Well, amalgam fillings are sure as heck not feasible in any term!

Images by Lottery Monkey, jpmatth and Savannah Roberts, via Flickr

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4 Things You Might Not Know About Kids’ Oral Health

 

Some interesting facts as we wind down National Children’s Dental Health Month:

  1. Oral health affects how kids do in school.
    According to research published in the American Journal of Public Health, children with poor oral health are three times more likely to miss school because of dental pain and do tend worse academically. Missing class isn’t the issue. Kids who skip school to get routine preventive care show no drop in academic performance.
  2. Bacteria that cause tooth decay can colonize before the teeth come in.
    Earlier this year, scientists using DNA sequencing identified hundreds of bacterial species in the saliva of infants. These included S. mutans, which plays a very big role in the development of early childhood caries (EEC). Such findings underscore the need to begin oral hygiene early and take your child for their first dental visit shortly after their first tooth erupts or around their first birthday.
  3. Teething gels that contain benzocaine can be a problem.
    Benzocaine is a pain-killer commonly found in products such as Orajel, and the FDA recommends against it for teething infants. Why? Such gels raise the risk of methemoglobinemia, or “blue baby syndrome” – a blood disorder that keeps oxygen from getting to the body’s cells. Let your child use teething rings instead, or gently massage their gums with your finger.
  4. Secondhand smoke can damage children’s teeth and gums.
    Studies have found that children regularly exposed to secondhand smoke have more cavities, worse periodontal health and factors that exacerbate both problems: reduced salivary flow, more acidic saliva and higher levels of pathogenic bacteria.

Image by CarbonNYC, via Flickr

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How to Save Money on Dental Care

What keeps people from getting the dental care they need? Fear is a major factor. Another is concern with cost.

According to a new Consumer Reports reader survey on oral health, 43% delayed care due to financial concerns. But the survey also found that those who delayed dental treatment were also less satisfied with the care they got. The why is simple:

Because not going to your dental appointments may lead to more extensive and more costly dental treatment in the long run.

Whether money is tight or you’re a committed saver, the best way to minimize dental costs is the same: Take a proactive, preventive approach. This means

  • Brushing after meals, flossing daily and regularly using a proxy brush, perio-aid or oral irrigator to clean the necks of teeth and at the gumline.
  • Eating a varied, balanced diet based on whole foods, low in sugars and refined carbs.
  • Regularly exercising.
  • Getting enough quality sleep and rest.
  • Managing stress and maintaining a balanced lifestyle.
  • Seeing your dentist every 6 months for a cleaning and exam.

Any money you spend pursuing the above is nothing compared with the cost of dental surgery and restorations!

Funny. You know the entertainment discount books full of coupons? We don’t usually think twice about buying things like those, justifying the cost by thinking of the money we’ll save. Sure, there’s more fun potential there, and a quicker payoff to the investment. It takes years for our lifestyle choices to catch up with us, but when they do…! Of course, writes one dentist,

It is easy to rationalize buying something you want like shoes, a car, diamond ring, etc. On the other hand, it is even easier to rationalize not doing something like dieting or going to the dentist, right? I mean who wants to have someone stick their hand in your mouth, poke around it, mumble a few things and then tell you the bad news?

The catch: It doesn’t have to be bad news.

The challenge: Start backing up our words with action. Most everyone agrees that good dental hygiene is important, yet according to the CR survey, only 1/3 of readers brush and floss as much as they should. Changing that behavior alone would do much to cut down on dental bills.

Here are CR‘s tips for dealing with the cost factor:

  • Shop around and bargain. Look up typical insurance paid rates in your area at FairHealthConsumer.org and HealthCareBlueBook.com, then ask providers to accept that amount, or less, as a cash payment. [Of the two, the first seems better – more specific, targeted and accessible to the layperson.]
  • Consider Free and low-cost clinics and health centers. Some community health centers offer dental care with fees based on the ability to pay. Consumers should call their local health department to find one nearby. But they should expect to encounter waiting lists in some locations.
  • Look into dental and dental-hygienist schools. Consumers who are willing to be treated by supervised students can avail themselves of schools that offer free or discontinued care to the public. A list of schools is available at http://www.ada.org/267.aspx.
  • Investigate dental discount plans. For an annual membership fee of around $50 to $100, one can get access to a network of dentists who have agreed to discounted rates. But Consumer Reports recommends that consumers watch out for pricey add-ons and extra procedures they don’t need.

One caveat: Most low-cost clinics and dental schools are not holistically focused. Things like mercury amalgam fillings, root canals and insufficient cleaning of the socket after tooth extraction can have long term health effects that vastly outweigh the short term bargain of low-cost care. As my colleague Dr. Gary Verigin writes,

In short, “cheaper now” usually means “more expensive later.” In the best case, you wind up replacing work sooner and more often. In the worst case, cutting corners causes more extensive and expensive problems down the road.

The smart consumer looks at the big picture.

Or as a small plaque hanging in our office has it, “Beware of bargains in parachutes, brain surgery and dental care.”

Consider: If you needed surgery on any other living organ – and each of your teeth is a vital organ, just as your heart, lungs, liver, kidneys and such are – would you opt for the cheapest surgeon or the most qualified surgeon whose services fit within your budget?

So also keep in mind that some dental offices will work with you to develop a payment plan for costly procedures. It’s worth asking about when you first call. There are also options such as CareCredit for financing over time.

But again – and as ever – your best bet is to make your oral (and physical) health a priority and minimize the risk of pricey problems arising in the first place.

Image by Danielle Moler, via Flickr

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