Category Archives: Dental Hygiene

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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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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A Mouth Full of Bacteria, a Tablespoon of Oil

Did you know that there are more bacteria in your body than human cells?

Yes, really. Microbes outnumber them, 10 to 1.

That’s not a bad thing. For not all “bugs” are bad (despite what you see and hear in some ads). Some are essential to human health, doing things like

  • Synthesizing and excreting vitamins
  • Preventing colonization by pathogens (“bad bugs”)
  • Inhibiting or destroying pathogens
  • Stimulating tissue and antibody development

The human mouth alone contains an estimated 10 billion bacteria. Yet most of us grow up thinking that a “clean” mouth is a germ-free mouth. As professor of oral microbiology Dr. Phillip Marsh puts it,

What we’ve been brought up with is “Plaque is bad – get rid of it.” But it’s actually too much plaque and plaque in the wrong places that are bad for us. We want to prevent the buildup of levels of organisms, particularly in hard-to-reach places of the mouth, that could lead to disease. Pushing to have an ultraclean mouth isn’t beneficial to us; we should be trying to maintain our natural microbiota at levels compatible with oral health in order to preserve their beneficial activities.

Dr. Aaron Weinberg, dean of the School of Dentistry at Case Western Reserve, agrees:

You don’t want a sterile mouth; you want a mouth that has primarily good bacteria in it, in order to keep exogenous microorganisms out and prevent them from colonizing the mouth.

Seems common sense, doesn’t it? Keep the good, control the bad. And that’s what dental hygiene is really about: not eliminating but controlling bacteria, especially those that contribute to tooth decay and gum disease. As mentioned before, the mechanical actions of brushing and flossing are crucial in this, breaking up microbial colonies. Mouthwash, on the other hand, is often meant to kill – or at least slow down the proliferation of – pathogens, whether by chemicals or herbal extracts and essential oils. While rinse is seldom necessary, it can be a help, especially when periodontal (gum) disease is an issue.

But there are traditional, natural alternatives for controlling oral flora, as well – practices such as oil pulling.

Oil pulling comes to us from Ayurveda, a system of traditional medicine developed in India thousands of years ago. Often described by Western holistic practitioners as a way to “pull out toxins,” it effectively cleanses the mouth by controlling oral bacteria, especially along the gumline and in the periodontal pockets. Vitamins and minerals in the oil are absorbed, while pathogenic microbes are bound up in the oil and ultimately removed from the mouth. The natural balance of oral flora is restored, which allows tissues to regenerate.

Research (PDF) has demonstrated a marked decline in levels of decay-causing microbes after oil pulling. Other studies have found oil pulling to be at least as effective as chlorhexidine in controlling bad breath.

We’ve seen remarkable results in patients who have turned to oil pulling to take control of their periodontal health – much healthier gums, much smaller pockets.

Although some recommend using coconut or other oils, sesame oil is often preferred. According to a short paper published in the Indian Journal of Dental Research,

The sesame plant (Sesamum indicum) of the Pedaliaceae family has been considered a gift of nature to mankind because of its nutritional qualities and its many desirable health effects. The seeds of the plant are commonly known as ‘gingelly’ or ’til’ seeds. Sesame oil has a high concentration of polyunsaturated fatty acids and is a good source of vitamin E. The antioxidants present in it are mainly sesamol, sesamin, and sesamolin. Sesamin has been found to inhibit the absorption of cholesterol as well as its production in the liver. It reduces lipogenesis and exhibits an antihypertensive action.

Likewise, from the first study cited above,

Sesame lignans have antioxidant and health promoting activities (Kato et al., 1998). High amounts of both sesamin and sesamolin have been identified in sesame (Sirato-Yasumoto et al., 2001). Both sesamin and sesamolin were reported to increase both the hepatic mitochondrial and the peroxisomal fatty acid oxidation rate. Sesame seed consumption appears to increase plasma gamma-tocopherol and enhanced vitamin E activity which is believed to prevent cancer and heart disease (Cooney et al., 2001).

Even so, a good number of naturopaths advocate sunflower oil instead. It also contains vitamin E, as well as a number of nutrients key to good dental and oral health, including vitamin D, calcium, magnesium and trace minerals.

Sesame or sunflower, whichever you use, do be sure to use a good quality oil: organic, cold-pressed and unrefined.

The technique itself is simple:

  1. Anytime between waking and breakfast, brush your teeth or scrape your tongue.
  2. Put 1 tablespoon of oil in your mouth and slowly, gently work it around the oral cavity – like using mouthwash but in slow motion, less vigorously. Do this for 10 to 20 minutes.
  3. Spit out the oil (which will look thin and milky white).
  4. Rinse with warm salt water. (Optional)

The first time you try it, you may find the practice feels slightly uncomfortable. Don’t worry. Most people quickly get used to it. If it becomes too uncomfortable, though, just spit out the oil and try again.

One last note: Oil pulling can have detoxifying effects, so you might want to start off with just a few days a week and gradually work up to daily practice.

Images by wellcome images and FotosVanRobin, via Flickr

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Managing the Halloween Candy Haul

Halloween is fast approaching – time for goblins and ghouls, haunted houses, scary stories, trick-or-treating…and the obligatory news items in which dentists give tips for avoiding decay through the candy glut.

Most are just common sense, seasonal variations on what we advise all year round:

  • Avoid sour candies, as their high acidity can damage enamel.
  • Avoid sticky or gummy sweets, which cling to – and between – teeth, feeding the microbes that cause decay.
  • Don’t graze on candy and sweets through the day, as this also perpetually feeds those microbes.
  • Rinse your mouth with water afterward, or chew a piece of sugarless gum to stimulate saliva flow that will help clean the teeth.

Notice the one I didn’t mention? Right: Toothbrushing – not because it doesn’t matter but because the conventional wisdom about it isn’t entirely accurate.

Consider this example of the standard line:

Mitchell said the key to preventing tooth decay lies in limiting not only the amount of candy children eat, but also how long the sugar remains in the mouth.

Brushing teeth as soon as possible after eating candy may keep harmful bacteria from developing, she said…. [emphasis added]

Unless “as soon as possible” means at least a half hour after eating the last treat, this actually isn’t the best advice in the world.

This is because when we eat carbohydrates – and candy is little but carbs and, often, fat – conditions in the mouth turn acidic. Brushing at this time can damage the enamel. Over time, this leads to enamel erosion and a higher risk of decay.

Oral acidity peaks at about 20 to 30 minutes after eating refined carbs and is usually back to normal within an hour. Consequently, it’s better to wait a while before brushing and flossing.

(The same dentist also recommends sealants as a Halloween “precaution,” but good diet and proper hygiene are usually precaution enough. And sealants themselves may not be all that effective anyway – or so recent evidence suggests. They’re also not as risk-free as proponents insist.)

Perhaps a bigger question for health-conscious parents and guardians is whether and how to moderate kids’ candy consumption. Some, seeing Halloween as a special time to indulge, have no qualms about letting the kids enjoy the gluttony. Others prefer to set limits – x number of pieces per day, for instance, or only after dinner – while others let their child choose a portion to keep and then get rid of the rest, perhaps through a local dentist’s candy buy-back.

Or parents may do buy-backs of their own. One of the most intriguing is from Dina Rose, whose blog is loaded with great tips for teaching children healthy eating behaviors. As she writes, “The “hidden” problem with Halloween is that it teaches kids to eat what they have, not what they want.” Thus, with her own daughter, she does a special kind of buy-back:

Instead of buying my daughter’s candy back with money, toys, or other non-consumables, I offered to buy back my daughter’s candy with…more candy. Not just any candy, though, better candy.

Yup. Instead of trying to de-candify Halloween I upped the ante. I allowed my daughter to swap any candy she didn’t absolutely LOVE for candy she adores.

* * *

You can only be truly satisfied by eating foods you love. Unfortunately, Halloween teaches kids to eat what they get. It’s a kind of scarcity-response, even in the face of abundance.

Eat what you LOVE, not what’s available.

If there were ever a message that kids needed to learn, this is it.

Instead, the real Halloween lesson goes something like this: eat as much candy as you can even if you don’t like it that much.

And if you have a kid who doesn’t get candy that often, the message goes something like this: you better take advantage of this candy because you’re not getting a lot more of it in the near future.

And who says that Halloween treats must be candy – or even food? There are plenty of kid-friendly alternatives – things like wax lips, temporary tattoos, sugarless gum, stickers, low-sugar trail mix or granola bars, blowing bubbles or other small novelties. So many times, I’ve heard people say kids consider their home the coolest precisely because they got something different – not just another candy bar.

Images by sean dreilinger, via Flickr

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Does It Matter What Kind of Toothpaste You Choose?

 

Are today’s toothpaste ads really so different? Each brand still insists that it’s better than the rest – because it has fluoride or baking soda or peroxide or nanosilver or Xylitol or triclosan or whatever.

But truth be told, toothpaste doesn’t do all that much to keep your teeth and gums clean and healthy. In fact, one study, published in the Journal of Periodontology, actually found brushing without paste to be more effective than brushing with it.

Researchers concluded that brushing without toothpaste was more effective in removing plaque from the front surface of teeth. The mechanical action of brushing (moving the brush up and down or sideways) may have been the main factor in determining effectiveness of plaque removal, they said.

This is why cleaning technique matters. Brushing (and flossing) breaks up the biofilm (“plaque”) that forms on your teeth between cleanings – and that’s the key, not necessarily what you break it up with. Our ancient ancestors used things like chew sticks and twigs. Even today, at least one entrepreneur is marketing Miswak twigs as an eco-friendly alternative to regular brushing. In India, twigs of neem – which has antimicrobial properties – are still commonly chewed to clean the teeth.

What toothpaste does offer is grit – silica, calcium carbonate, chalk, alumina or other abrasive to help break up the biofilm. Abrasives can also help remove stains from the teeth, but sometimes at a cost to their enamel, as results of a recent study in the Journal of Clinical Dentistry suggest.

Anything with an RDA, (Relative Dentin Abrasion) score of about 100 is generally considered highly abrasive. Anything above 150 is considered potentially damaging to enamel.

Here’s how some of the popular whitening toothpastes stacked up:

  • Crest White Vivid scored above 200.
  • Rembrandt Intense Stains was only mildly abrasive with an RDA of 90.
  • Ultrabrite Advanced Whitening from Colgate had an RDA of 260, one of the most abrasive.

Of course, toothpastes contain more than abrasives. Most mass market toothpastes contain fluoride, foaming agents, detergents, humectants, thickeners, flavoring and sweeteners. Not all of these are benign. For instance, sodium lauryl sulfate (SLS) – a common foaming agent also used in shampoo, dish soap and other products – has been shown to damage the soft tissues of the mouth.

Some also contain remineralizing agents, although there’s little evidence that they strengthen enamel as the ads say they do. Others tout antimicrobials such as nanosilver and triclosan. We still don’t know much about nanosilver’s biological effects, though early animal studies suggest cause for concern. Triclosan, on the other hand, is a suspected endocrine disruptor and probable carcinogen. The chemical reaction that occurs when it’s combined with chlorinated water (98% of the public water supply) produces chloroform.

Fortunately, it’s easier than ever to find gentle, natural alternatives – pastes made without detrimental ingredients, with essential oils and herbal extracts that support oral and dental health. This article from Natural Solutions contains some good tips on choosing one.

Images by Meanest Indian & Leo Reynolds, via Flickr

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How to Get Rid of Bad Breath Naturally

Urban legend has it that halitosis – bad breath – was “invented” by the makers of Listerine, but what they actually did was just popularize an obscure medical term and brilliantly exploit people’s fear of social rejection through ads like this:

Bad breath, of course, has been an issue for ages. In his 14th century Canterbury Tales, Chaucer described the Summoner as having boozy, garlicky breath, while the “mistress” of Shakespeare’s sonnet 130 has breath that’s said to “reek.” In Don Quixote, the hero rejects the flirtations of Altisadora because of, among other things, “a certain faded breath which will not let you near her for a moment.”

Far from inventing bad breath, Listerine ads and their imitators just made us worry enough about it to spend millions on mouthwashes, strips, sprays, mints, gum and other products to sweeten the breath.

But makes breath smell bad in the first place? Aside from the common culprit of pungent foods such as onions or garlic, there are a number of factors, including

  • Poor or spotty home hygiene.
  • Irregular cleaning of dentures, splints, retainers or other oral appliances.
  • Dental problems, including dry mouth, gum disease, mouth sores and abscessed teeth.
  • Diet – especially high-protein/low-carb, but likewise a diet dependent on processed foods containing sugars, white flour and other fermentable carbohydrates.
  • Smoking or chewing tobacco.
  • Zinc deficiency.
  • Antihistamine or prescription drug use.
  • Medical conditions, including gastrointestinal (stomach/gut] problems, sinus problems and cancer.

Looking at this list, you may already see a few simple things you can do to keep your breath from going bad in the first place:

  1. Practice good oral hygiene (at minimum, brushing and flossing regularly and well).
  2. Regularly clean any oral appliances you use.
  3. See your dentist regularly, both for cleanings and to catch and deal with any small problems before they become big ones.
  4. Eat a varied and balanced diet based on whole foods, low in processed carbs.
  5. Avoid tobacco products.
  6. Supplement with zinc if you’re not getting enough from diet alone.

Be aware that zinc deficiency can be caused by some medical conditions, in which case you should be treated by your physician, who can also oversee your diet and nutritional supplementation. If you’re in otherwise good health and thinking about taking supplements, be sure to consult a qualified health practitioner first to make sure you take the right dose and aren’t at risk for bad interactions with any medications you take (over-the-counter, prescription, homeopathic or otherwise).

If you already have bad breath, taking the steps above – especially those involving hygiene and diet – can help. Here are a few other home remedies:

  1. After eating, rinse your mouth with the juice of half a lemon mixed into a glass of water.
  2. Chew fennel or cardamom seeds after meals.
  3. Use baking soda instead of toothpaste.
  4. Add 1 to 3 drops of tea tree oil to your regular toothpaste.
  5. Take chlorophyll supplements.
  6. Use a mouth rinse that contains hydrogen peroxide (such as Peroxyl) or a solution of equal parts water and 3% hydrogen peroxide. To be safe, use the latter in the short-term only and rinse your mouth with plain water afterward to prevent dry mouth. With either rinse, if you experience any burning, tooth sensitivity or other problems, stop using the rinse and consult your dentist.
  7. Mix 1/2 tablespoon of apple cider vinegar into a glass of water and use as a gargle.

If you have chronic bad breath you suspect may be due to dental problems, make an appointment with your dentist for an exam and cleaning. Likewise, if you suspect a medical issue, consult your physician about it – as you should if you suspect medications may be causing the odor. If they’re prescription meds, do not just quit taking them.

Have your own favorite home remedy for bad breath? Share it in the comments!

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