Category Archives: Oral Hygiene

Bad Breath? Good News!

If you decide what to read on the basis of whether or not it has a catchy title, you likely missed “The Efficacy of Different Mouthrinse Formulation in Reducing Oral Malodour: A Randomized Trial” in the Journal of Clinical Periodontology (presuming, of course, you’re the type who reads things like the Journal of Clinical Periodontology).

rinseSo let’s call it “How Well Do Different Mouthwashes Get Rid of Stinky Breath?” instead.

Are you interested now?

The randomized, double-blind trial was small and simple: For one week, 18 participants used one of three rinses. Two products – Halita and Meridol with zinc lactate – contained at least one antimicrobial agent (Halita contains cetylpyridinium chloride and chlorhexidine in addition to the zinc). The other contained fluoride.

Sulfur levels and organoleptic (“sniff test”) scores were taken twice to measure odor – once 15 minutes after their first rinse and again at the end of the week. The first took note of masking effects, while the second noted therapeutic effects.

Those were the rules, but how did it turn out?

All three rinses did fine with respect to immediate freshness, but only those with antimicrobials showed a therapeutic effect. They also had the most powerful masking effect.

Does this mean chemical clean is the way to go?

All have their downsides. Chlorhexidine and cetylpyridinium chloride tend to stain the teeth. The latter may also irritate the soft tissues of the mouth or trigger allergic reactions. Fluoride, of course, has its own problems.

And none have proven much better than more natural products, which raises the issue we’ve noted before:

If the effects of natural substances on oral [pathogens] are at least as good as those of a chemical substance, why opt for the chemical?

One alternative we especially like is Natural Dentist Healthy Gums Mouth Rinse. This natural mouthwash helps control periodontal disease and biofilm (plaque) build-up through its 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.

For other easy ways to improve your breath, see our previous post.

Image by twenty_questions, via Flickr

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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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What You Eat vs. What Eats Your Teeth

Earlier this month on our office Facebook page, I posted a link to a media release debunking several dental myths. Since then, I’ve seen quite a few articles focusing on just one of them: the belief that more sugar means more cavities.

 

Brymo/Flickr

 

Why focus on this? Maybe it’s because it can be spun to suggest that it’s okay to eat all the sugar you want so long as you brush and floss afterwards. (Of course, sugar contributes to a host of other health problems, some of which can contribute to other dental and periodontal problems, but they’re not mentioned.)

After all, in and of itself, sugar does not cause cavities. So why do dentists recommend avoiding it? It’s the preferred food of the oral bacteria that live in your mouth. Their acidic waste products are what cause decay, as explained in this humorous video:

 

 

Importantly, the sugars that microbes love aren’t just “obvious” ones like table sugar and high fructose corn syrup. All carbohydrates can be broken down into sugars. What’s more, many carbs – especially processed carbs – tend to stick to the teeth, giving the oral bacteria plenty of opportunity to feed on them – at least until you brush and floss, which both removes food particles and breaks up the microbial colonies that form the biofilm most people call “plaque.”

A recent article in Caries Research highlights the point. Looking for links exist between snacking behaviors and caries (the clinical name for “cavities”), researchers studied the snacking habits and dental health of more than 1200 American preschoolers. Unsurprisingly, those who ate the most sweet snacks, chips and especially chips with a sugared drink had a higher rate of caries than those who consumed less of such things. The team also found that those who ate chips tended to eat more sweet snacks, including candies and ice cream. All of these foods are ones that tend stick to the teeth or, in the case of sweetened drinks, bathe them in sugars – two factors that tend to increase the length of time the teeth are exposed to sugars, and thus the opportunities for microbes to feed and excrete their cavity-causing acids.

Interestingly, this matter of sugar and cavities was not the crux of the Nutrition Today article touted in the “6 Myths” media release, the title of which expresses its broader focus: “It’s More Than Just Candy: Important Relationships Between Nutrition and Oral Health.” Here’s the abstract:

Oral problems can affect and be affected by both diet and systemic nutrition. Dental caries (tooth decay) remains the most prevalent disease of children: 7 times more common than hay fever and five times more common than childhood asthma. The mouth is an early indicator of general health and nutritional status; clinical signs and symptoms of nutritional and other health problems frequently appear first in the oral cavity. Conversely, oral problems can have profound effects on nutritional status. Emerging research is revealing even more important relationships between nutrition and oral health issues and chronic health conditions such as heart disease, diabetes, and immune-compromising conditions. Health care professionals should help their patients by asking patients about oral health concerns and referring patients for dental consults when indicated. Promoting good oral health as well as good nutrition is essential to optimal overall health status.

To which we can only say, yes, exactly.

 

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Are You Only Partway Cleaning Your Teeth?

Brushing and flossing go together. Most of us know this, but while most of us manage to brush at least twice a day, only about half of us floss even once a day.

In other words, half of us are only partway cleaning our teeth.

A toothbrush can remove biofilm (plaque) from the exposed surfaces of your teeth, but it can’t thoroughly clean between teeth or below the gumline – areas that oral microbes love precisely because they’re dark, moist and harder to get to. Not flossing lets these microbes thrive. The result? Periodontal (gum) disease and, ultimately, tooth loss. What’s more, gum disease has been linked to other inflammatory conditions such as heart disease, diabetes and stroke.

So not only does flossing support good oral health but good systemic health, as well. It may even help your memory.

 

pattyanne:made/Flickr

 

Interestingly, flossing may not be a strictly human activity. Monkeys, for instance, have been seen flossing, both in and outside the lab. A recent “Improbable Research” column in The Guardian describes some of the findings, including observations of the macaque flossing with human hair. (More info about the macaque – and a link to video of the behavior – here.)

It makes you wonder: Is flossing a “natural” behavior of sorts? If so, then why do so many of us humans not just avoid it but come up with all kinds of excuses for it?

The most commonly given reason is a lack of time – even as brushing and flossing together take less than five minutes. But if you’re that pressed for time, why not multitask? Floss while you’re in the shower, say, rinsing your hair, or while you’re relaxing with TV or a book after dinner, or sitting at home in front of the computer .

Once you make flossing habitual, it won’t seem to take much time at all. Besides that, as the health of your gums improves, flossing will no longer cause bleeding or irritation, eliminating a couple more of the common excuses. And if standard, thin floss hurts your fingers, switch to thicker, softer dental tape. Bingo! Another excuse gone.

To learn more about the correct way to floss, see the guides at About.com and Animated-Teeth.com.

 

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A Nanosilver Bullet against Tooth Decay?

We’re often overwhelmed by choice. Just think of your local supermarket and its aisles brimming with so many dozens of kinds of breakfast cereal, soup, crackers, cookies and other products. Most of the time when we do our shopping, we don’t pay attention to the plentitude. When we do become aware of it, it can be truly mind-boggling.

Of course, the matter of too much choice isn’t restricted to groceries but a whole array of consumer goods, from cars to computers, TVs to toothpaste. Anymore, it seems any innovation is glommed onto as quickly as possible to create new products that can stand out amidst the glut of old, familiar ones. And we all know newer is better, right?

Not necessarily. “New” isn’t always “improved.” And sometimes we rush to embrace new things without asking whether they’re really an improvement or what their potential drawbacks might be.

One new technology in dental care products that we may want to ask these questions about is the use of nanosilver in toothpastes.

The first question, though, is why nanosilver – very tiny bits of silver used to coat an item or be suspended in it? The answer is simple: it’s been shown to have antibacterial qualities. So considering that pathogenic microbes – “bad” oral bacteria – play a role in tooth decay and gum disease, it would seem to make good sense to use nanosilver to kill those “bad germs.”

But nanosilver – like other nanomaterials – has other qualities, as well. As noted in an article posted at The Wealthy Dentist,

Nanoparticles behave quite differently from their regular-sized counterparts. Their comparatively large surface area increases their biological activity. Moreover, the particles themselves are much smaller than cells. Nanoparticles can be absorbed through the skin, eyes or nose. They can even cross the blood-brain barrier.

For example, although titanium dioxide is biologically inert, nano-titanium dioxide particles have been shown to damage DNA. Nano-titanium dioxide is estimated to be in over 10,000 consumer products today, including cosmetics, medicines and toothpaste.

Another major nanotech invention, carbon nanotubes have amazing strength. Unfortunately, they can also cause more lung damage than asbestos.

What biological effects might nanosilver have? We don’t really know yet, though some animal studies – such as this one – have shown potential for harm. Much research remains to be done – not just on nanosilver but the full array of nanomaterials.

And what do dentists think about all this? According to a Wealthy Dentist survey, only 6% would recommend it, while 26% would recommend against it and 69% say they don’t know enough about it to say. But caution does seem to be called for. As one Texas dentist put it, “There is not enough scientific evidence that it is more efficacious than other more proven products, and there’s some disturbing evidence that it might do harm.”

Besides, in the world of too much choice, there are already plenty of effective, nontoxic toothpastes available – including ones that contain no fluoride or sodium lauryl sulfate.

What’s more, toothpaste itself plays a minor role in fighting tooth decay, serving mainly as an abrasive to help break up the biofilm (plaque) that forms on your teeth between cleanings. More important is how you brush, as well as whether or not you floss.


Image credits: 1) Toothpastes via Coming Home, 2) Nanosilver via NanotechnologyNow


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