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

Less Soda, More Water, Fewer Cavities, Better Health

Among Native Americans, tooth decay wasn’t too common before the arrival of the Europeans. Young people seldom suffered from it: it was usually associated with aging. But this all changed once the Europeans introduced white sugar and other non-indigenous foods. In general, as Weston Price showed, when communities switch from native to Western style diets, dental problems follow.

Recently, I read news of a study that looked at ways of reducing tooth decay (as well as obesity) among young Native Americans by discouraging soda consumption and increasing water intake. Of course, soda – which we might just as well call “sugar water” or “liquid candy” – is one of the prime accelerators of tooth decay in many communities. Not only do soft drinks bathe the teeth and gums in sugar – a favorite food of the oral microbes whose acidic waste products cause tooth decay. The acids they contain also weaken tooth enamel, making the teeth even more vulnerable to cavities.

For the Ethnicity & Disease study, the research team designed an intervention to encourage more healthful behaviors among members of a few Native American communities.

To implement TOTS (“The Toddler Overweight and Tooth Decay Prevention Study”) the researchers worked closely with tribal councils. In three of the four communities, good tasting water was made readily available in water fountains and inexpensive, refillable gallon jugs. Sugared soda was removed from tribal stores, and substitution of water for soda was actively encouraged through community outreach programs. Families received food counseling and breastfeeding support through tribal community health workers.

“After the successful switch to water, we compared the rate of tooth decay in children born in these three communities over the next 30 months with those born in a fourth community, where the young children had not benefited from the community interventions. We found a decrease of between 30 and 63 percent in early stage, potentially reversible tooth decay. For more advanced tooth decay the impact was smaller but nevertheless substantial. Children in intervention communities had 34 to 44 percent fewer cavities than those in the comparison community,” said Gerardo Maupomé, B.D.S., M.Sc., Ph.D., professor of preventive and community dentistry at the Indiana University School of Dentistry and a Regenstrief Institute affiliated scientist. He is the first author of the study.

One of the things that caught my attention here was just how clearly this study shows how healthier environments can encourage healthier behaviors. This is, of course, the thinking behind initiatives to get sodas, sports drinks and other sugary beverages out of schools. Yet these may have only a minor effect. After all, the larger environment remains unchanged. A student who can’t buy soda at school can still buy it away from school and lives in a culture in which drinking soda is the norm.

Yet we can still take steps to create and maintain positive, healthful personal environments for ourselves. And maybe our choices can serve to inspire and motivate others to value and pursue true health – something so much more profound than just the mere avoidance of sickness.

 

Image by Nicholas Taylor, via Flickr

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.

 

Nutrition & Your Amazing, Self-Healing Teeth

When people ask how I became a holistic dentist, I like to tell them that I was born into it. My mother was committed to natural health and holistic living, so that was the environment I grew up in. Eating a nutrient-rich, whole foods diet, getting plenty of physical activity, balancing work and play – these were the norm. It was only natural, then, that holism would inform my work as a dentist.

So I practice what I preach (and what was preached to me), so to speak, and encourage my staff to do the same. After taking a recent nutrition seminar, for instance, all of us in the office adopted the detox diet we’d learned about. No, detox isn’t just for those who show symptoms of illness. After all, we live in a toxic world. Even if you make all the best, most healthful choices, you’re still exposed each day to countless pollutants through each breath you take. We can all benefit from detoxing now and again, coming away, as my staff and I did, with renewed energy and a heightened sense of physical well-being.

Once upon a time, many used to think that nutrition was beyond the scope of dentistry. Only holistic and biological dentists commonly offered nutritional counseling as we helped chronically ill patients heal from the effects of mercury fillings or other toxic dental materials, focal infections or cavitations. But as many conventional dentists are finally starting to see, nutritional counseling and support can and do play a part in general dental health, as well. And it’s not just about avoiding sugar so you don’t get cavities. It’s also about how key nutrients such as minerals, antioxidants and Vitamin D support strong teeth and healthy gums and bone.

What’s more, not only does a good diet help prevent tooth decay. It can even reverse it once it’s begun.

It’s important to remember that your teeth aren’t just solid, static structures in your mouth. They’re living organs – just as your liver, lungs and heart are living organs. Under the hard enamel covering each tooth is the dentin. It consists of miles – yes, miles! – of microscopic tubules containing fluid and cellular structures. Below that is the pulp, which is made up of living connective tissue and odontoblasts – cells that create dentin. Both dentin and pulp are also rich in nerves, which is why your tooth will start to hurt when there’s deep decay or other damage.

Early in the 20th century, the great dental researcher Dr. Weston Price did some impressive research on the effects of diet on dental health. In studying various native populations around the world, he found that shifts from traditional diets to non-traditional Western diets rich in refined flour and sugar commonly led to oral changes such as smaller, narrower arches that led to the crowding of teeth. It also increased cavities. But it also worked the other way around. That is, he found that a diet rich in minerals and fat-soluble vitamins (A, D, E and K) and low in phytic acid promoted remineralization of the dentin, thereby reversing the course of tooth decay. (Phytic acid is main storage form of phosphorous. Its found in many plants, but humans can’t absorb it since we lack the enzyme needed to break it down.) As Dr. Price wrote in Nutrition and Physical Degeneration,

The chemical analysis of the saliva revealed a marked improvement which progressively increased. At the beginning of the test the average for the group showed a very low factor of safety, so low that we should expect tooth decay to be active. In six weeks, the average changed to a condition which we should expect would be accompanied by a cessation of tooth decay. The saliva factor of safety continued to improve for five months at which time the program was discontinued for the summer.

Several incidents of special interest occurred. Two different teachers came to me to inquire what had been done to make a particular child change from one of the poorest in the class in capacity to learn to one of the best. Dental caries is only one of the many expressions of our modern deficient nutritions.

Similar findings were published by Drs. Edward and May Mellanby. Stephan Guyenet at Whole Food Source offers a good discussion of their research:

When enamel is poorly formed and the diet isn’t adequate, enamel dissolves and decay sets in. Tooth decay is an opportunistic infection that takes advantage of poorly built or maintained teeth. If the diet remains inadequate, the tooth has to be filled or removed, or the person risks more serious complications.

Fortunately, a decaying or broken tooth has the ability to heal itself. Pulp contains cells called odontoblasts, which form new dentin if the diet is good. Here’s what Dr. Edward Mellanby had to say about his wife’s research on the subject. This is taken from Nutrition and Disease:

Since the days of John Hunter it has been known that when the enamel and dentine are injured by attrition or caries, teeth do not remain passive but respond to the injury by producing a reaction of the odontoblasts in the dental pulp in an area generally corresponding to the damaged tissue and resulting in a laying down of what is known as secondary dentine. In 1922 M. Mellanby proceeded to investigate this phenomenon under varying nutritional conditions and found that she could control the secondary dentine laid down in the teeth of animals as a reaction to attrition both in quality and quantity, independently of the original structure of the tooth. Thus, when a diet of high calci­fying qualities, ie., one rich in vitamin D, calcium and phosphorus was given to the dogs during the period of attrition, the new secondary dentine laid down was abundant and well formed whether the original structure of the teeth was good or bad. On the other hand, a diet rich in cereals and poor in vitamin D resulted in the production of secondary dentine either small in amount or poorly calcified, and this happened even if the primary dentine was well formed.

Thus, in dogs, the factors that affect tooth healing are the same factors that affect tooth development:

1. The mineral content of the diet, particularly calcium and phosphorus
2. The fat-soluble vitamin content of the diet, chiefly vitamin D
3. The availability of minerals for absorption, determined largely by the diet’s phytic acid content (prevents mineral absorption)

They later replicated these findings in human subjects. As they wrote in their 1932 British Medical Journal study, also cited by Dr. Guyenet,

The hardening of carious areas that takes place in the teeth of children fed on diets of high calcifying value indicates the arrest of the active process and may result in “healing” of the infected area. As might be surmised, this phenomenon is accompanied by a laying down of a thick barrier of well-formed secondary denture… Summing up these results it will be clear that the clinical deductions made on the basis of the animal experiments have been justified, and that it is now known how to diminish the spread of caries and even to stop the active carious process in many affected teeth.

To learn more about the role of nutrition in dental health, see my previous article “Eating Well for Good Oral Health” and video “Feeding Your Teeth.”

 

 

Tooth diagram by Ruth Lawson, Otago Polytechnic

How Cavities Happen

 

Does Fluoride Really Prevent Cavities?

Conventional wisdom has it that fluoride prevents caries (cavities), and, as with many things, a lot of people tend to think that more is better. So dentists give fluoride treatments and supplements. Cities fluoridate public water supplies. This is sensible insurance, we’re told; good, preventive medicine.

 

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No doubt the intentions of fluoride proponents are good, but you know what they say about good intentions. And the adage bears even more truth when those good intentions ignore hard facts, starting with the reality that evidence in support of fluoride supplementation is a little sketchy.

In 2008, JADA – the official journal of the fluoride-advocating American Dental Association – published “Fluoride, Supplements, Dental Caries and Fluorosis,” a broad review of the scientific research on whether fluoride supplements actually help prevent cavities. While the authors did find some evidence of their doing so in older children, they concluded that the evidence was “weak and inconsistent” for their preventing caries in children under six years old. They also found that “mild-to-moderate dental fluorosis is a significant side effect.”

Fluorosis is what happens when a person gets too much fluoride. In its mildest form, we see the teeth marked by white streaks or flecks. In more severe forms, we see brown and black staining of the teeth, along with pitting and cracking of the teeth.

Meanwhile, water fluoridation doesn’t appear to prevent caries at all. This is borne out in report after report on outcomes in communities with fluoridated water. A recent one out of New Zealand found that children in non-fluoridated communities actually had 1% fewer cavities than children in communities with fluoridated water. And yet the Ministry of Health continues to recommend fluoridation!

The truth is, fluoride is just not necessary to prevent caries. What does help? Regular flossing and brushing – with any kind of toothpaste or even none at all. Eating a low-sugar, nutritionally-dense diet based on whole foods. Regular dental visits. Habits like these make a much more positive impact.

For the other important thing to remember about fluoride is this: not only is it ineffective and unnecessary; it’s also a poison that can damage many different organs and structures in the human body.

 

 

When you weigh the risk against its negligible benefits, fluoride hardly seems a good solution to the problem of tooth decay.

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Dental Care Great, Dental Health Worse?

An article in the Vancouver Sun this week suggested that Baby Boomers have “unique” dental problems. Although, as a group, Canadian Boomers “are keeping their teeth clean and healthy, they are also experiencing an increase in such problems as exposed gums, dry mouth, acute sensitivity and tooth root cavities.” We see similar trends in the US.

Dr. Steven Weiner, an Ontario dentist featured in the article, generally attributes the phenomenon to better care early in life, more saved teeth and longer lifespans.

“In previous eras, if you had a toothache, you pulled the tooth. Then you had to deal with other issues that involved. People now are retaining their teeth longer – for a lifetime – and that wasn’t the goal back then.

“We see so many perfect teeth now, through orthodontics, great home and dental care, but what we have as a result of the aging population is great teeth and poor gums.”

 

 

How is it that a person can have “great home and dental care” yet have “poor gums” and other dental problems? And is this really unique to Baby Boomers? Or is it more that theirs is just the first generation to have these problems in large numbers?

My hunch is that there’s more truth in the latter.

The article mentions – almost in passing – some trends that I would argue are now having a big impact on people’s dental health. One of them is the increased use of pharmaceutical drugs, many of which cause dry mouth as a so-called “side effect” – drugs as varied as antidepressants, anti-anxiety medications, antihistamines and muscle relaxants. Dry mouth may not sound like anything too serious, but it’s got some significant dental implications, raising the risk of caries (cavities), tooth erosion and periodontal disease. This is because one of the functions of saliva is to wash away the microbes that make up dental biofilm (plaque) and food particles that feed them. Saliva is also a source of the calcium and phosophate particles that help keep tooth enamel strong. The less saliva, the more conditions favor decay and other tooth damage.

There are a number of safe and helpful products available to help increase saliva flow and alleviate dry mouth – products such as GC Dry Mouth Gel and the Dental Herb Company’s Tooth and Gums Tonic. Drinking more water can help, as can eating more foods that require chewing, especially foods like crunchy vegetables.

This brings us to another major trend I see affecting people’s dental health: diet. Since the Boomers came of age, highly processed convenience foods and sugary soft drinks have become much more common – more available and consumed in larger amounts. High fructose corn syrup has become ubiquitous in processed foods, increasing our overall consumption of added sugars. Our intake of refined carbohydrates has skyrocketed, and few of us eat nearly enough whole grains, fresh vegetables and fruit. The result is a diet that is highly acidic, promoting tooth decay and inflammation. (Gum disease, like heart disease, is a chronic, inflammatory condition.) Moreover, the acids and sugars in sodas, energy drinks and similar beverages further contribute to tooth erosion, as a great many studies have shown.

If we, as a society, continue in these directions, we can expect the “unique dental problems” mentioned by Dr. Weiner to be the new norm. But it’s not too late to turn things around. By making positive, healthy life choices, we increase the likelihood of our having both healthy teeth and gums into our senior years.

 

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Secondhand Smoke Hurts Kids’ Teeth & Gums

When we think about the health effects of smoking, the first things that come to mind are usually diseases such as cancer and emphysema. But smoking does a number on a person’s dental health, too – and far beyond simple bad breath and stained teeth. For instance, smokers are four times more likely than non-smokers to develop periodontal disease, even if their home hygiene is exemplary. Gum health deteriorates, often leading to bone and tooth loss. Some periodontists – dentists who specialize in treating the gums – refuse reparative treatments to smokers if they continue to use, such is the ongoing damage.

More than half of all cases of periodontal disease can be attributed to smoking.

 

Furyk/Flickr

 

If you smoke, you might think, “Fine, but it’s my body. I can do what I want to it,” and that’s certainly your choice – though I would argue it’s far from the best you can make. But you’re not the only one exposed to the toxins in cigarette smoke. Just as secondhand smoke can cause cancer, emphysema and other diseases in non-smokers, so can it cause dental problems for a very vulnerable population: young children.

Two studies published over the past couple years have demonstrated that “passive smoking” (exposure to secondhand smoke) considerably raises young people’s risk of dental problems. The first, published in 2008 in the Archives of Oral Biology showed quite plainly that children exposed to cigarette smoke had more caries (cavities). They also showed higher counts of pathogenic oral bacteria, more acidic saliva and a lower rate of salivary flow – all factors contributing to the formation of caries.

The second study, published earlier this year in the Journal of Clinical Periodontology, found that children exposed to cigarette smoke also show deterioration of their gum tissues. Here, the researchers measured levels of continine – a primary metabolite of nicotine – in the children’s saliva, urine and gingival crevicular fluid (found in the small space between each tooth and the surrounding gum tissue), as well as conducted periodontal exams. Those children with higher continine levels showed lower clinical attachment levels (the attachment of gum tissues to the alveolar bone and tooth structure) – a marker of gum disease. Though it’s not clear why, this effect was more pronounced in children whose fathers smoked compared to those whose mothers smoked.

The moral of the story? If you choose to continue to smoke, avoid doing so around others, especially children. But best of all – for kids’ health as well as your own – is to quit tobacco use altogether. For those of you ready to take that step, here are some resources from the CDC and info on a few natural remedies to help you get started stopping.

 

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