Category Archives: Dental Hygiene

Do Natural Mouthwashes Work?

For most people, antimicrobial mouthwashes – “germ-killing” products such as Listerine – aren’t necessary for good oral hygiene, but they can be helpful. By controlling the growth of S.mutans and other microbes that contribute to oral disease, they can help you keep your gums healthy and get rid of bad breath. But so can effective brushing, flossing and rinsing with plain water.

However, when a person is already showing signs of gingivitis or periodontitis – “gum disease” – their dentist may recommend an antiseptic rinse to help reverse the disease and restore the gums to health.

In this case (as well as after oral surgery), dentists often recommend a solution of the chemical chlorhexidine – the active ingredient in products such as PerioGard, PerioRx and Peridex, which the University of Maryland Medicine Center says “reduces plaque by 55% and gingivitis by 30 – 45%.”

But despite claims to the contrary, one thing chlorhexidine may not do is prevent cavities.

According to a 2008 literature review, research outcomes have been mixed, with insufficient data to support the use of chlorhexidine to prevent cavities.

Since dental caries is a disease with a multifactoral etiology, it is currently more appropriate to use other established, evidence-based prevention methods, such as…diet modifications and good oral hygiene practices. Recent findings also indicate that the effect of an antimicrobial agent for reducing the levels of mutans streptococci or plaque reduction may not always correlate with eventual caries reduction.

Now comes a study which shows chlorhexidine to offer no real improvement over natural antimicrobials when it comes to managing oral biofilms.

For this Journal of Dentistry study, researchers tested the effects of herbal extracts and chitosan on oral biofilms in vitro – that is, outside the human body – using chlorhexidine rinse as a control. The natural antimicrobials

showed immediate killing of oral biofilm bacteria, comparable with chlorhexidine. Moreover, exposure of a biofilm to these supernatants or chlorhexidine, yielded ongoing killing of biofilm bacteria after exposure during re-deposition of bacteria to a matured 16 h biofilm, but not to a much thinner initial biofilm formed by 2 h adhesion only. This suggests that thicker, more matured biofilms can absorb and release oral antimicrobials.

Conclusions: Supernatants based on herbal- and chitosan-based toothpastes have comparable immediate and ongoing antibacterial efficacies as chlorhexidine. Natural antimicrobials and chlorhexidine absorb in oral biofilms which contributes to their substantive action.

Which raises the question: If the effects of natural substances on oral biofilms are at least as good as those of a chemical substance, why opt for the chemical?

Of course, this study doesn’t answer the question of whether this biofilm control actually prevent caries. And so we return to the earlier study and the knowledge that other actions – chiefly good hygiene and diet – are enough. (As I mentioned a couple weeks ago, fluoride as a preventative is questionable at best and, any benefits may not be worth the risks.)

In other words: why make things more complicated than they need to be?

Meantime, if you do like to use a mouthwash – and some do just for the extra fresh and clean feeling it gives – there are excellent natural products available. I prefer Natural Dentist Healthy Gums Mouth Rinse, which contains a blend of cleansing and soothing botanicals including echinacea, golden seal, grapefruit seed, aloe vera gel and calendula. It contains no alcohol, artificial sweeteners, dyes or preservatives, and will not stain the teeth (unlike chlorhexidine rinses).

We have this product available in my Glendale office. According to the manufacturer’s website, it is also available at CVS, the Vitamin Shoppe and Drugstore.com.

Top image by Nicole Lee, via Flickr

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Filed under Dental Health, Dental Hygiene, Oral Health, Oral Hygiene

Fluoride Works…How, Exactly?

There’s an interesting double standard in medicine – dental and otherwise. Conventional practitioners can and do promote all sorts of treatments that haven’t been empirically proven or that work in ways we don’t yet understand. At the same time, many insist that “alternative medicine” isn’t valid because many of its treatments aren’t yet proven or understood. Yet when proof is provided, the tendency is to ignore it, discount it or move the goal-posts, holding traditional and natural healing practices to a higher standard than they hold their own. If we say there’s only one kind of medicine – that which works – then shouldn’t all of its premises and practices be held to the same standard?

Science is not a body of knowledge but a process – a way of understanding the world through what can be observed, measured and tested. The tools of science are also always evolving, letting us see more – or more precisely – than before. What can’t be proven in one era may be proved in another as knowledge and technology evolve. What seems like magic to one generation may come to seem common sense to later ones.

For decades now, conventional dentistry has put a large store of faith in fluoride. Fluoride toothpaste, fluoride supplements and fluoridated water have all been touted as important factors in preventing tooth decay. But research has helped our understanding evolve. We know now that ingested fluoride does little to prevent tooth decay yet contributes to a host of physical illnesses. We also see evidence that fluoride supplements may not be effective for children.

But what about fluoride in toothpaste? A new study published in Langmuir, the journal of the American Chemical Society, raises some questions.

In a study that the authors describe as lending credence to the idiom, “by the skin of your teeth,” scientists are reporting that the protective shield fluoride forms on teeth is up to 100 times thinner than previously believed. It raises questions about how this renowned cavity-fighter really works and could lead to better ways of protecting teeth from decay, the scientists suggest….

Scientists long have known that fluoride makes enamel — the hard white substance covering the surface of teeth — more resistant to decay. Some thought that fluoride simply changed the main mineral in enamel, hydroxyapatite, into a more-decay resistant material called fluorapatite.

The new research found that the fluorapatite layer formed in this way is only 6 nanometers thick. It would take almost 10,000 such layers to span the width of a human hair. That’s at least 10 times thinner than previous studies indicated. The scientists question whether a layer so thin, which is quickly worn away by ordinary chewing, really can shield teeth from decay, or whether fluoride has some other unrecognized effect on tooth enamel.

We might also ask, is it really the fluoride at all? For toothpaste really isn’t the biggest factor when it comes to good oral hygiene – which isn’t to say that it has no role. Its main role is to act as a mild abrasive to help break up the biofilm (plaque) that forms on your teeth between cleanings. (Toothpastes that contain elements such as antimicrobials play a dual role in supporting oral health, but their main function is still as an abrasive.) More important are things like brushing regularly and well, flossing and/or using a proxy brush – both of which have a much bigger impact on oral health than brushing alone.

As a dentist, I do not use fluoride, nor do I recommend it to my patients. For hygiene products I do recommend, click here.

Image by alles-schlumpf, via Flickr

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