Dr. David Kennedy’s Fluoridegate

A new documentary well worth your time and attention, from one of America’s leading experts on fluoride and fluoridation:

Persistent Pathogens : Dedicated Defense

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

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

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

• 3 Ways to Get More Vitamin D
• Dr. Mercola’s vitamin D resource page (Lots of great articles & links!)

Image by Electron, via Wikimedia Commons

Fluoridation Politics

If you keep up with developments on the fluoridation front, you’re likely aware that Portland, Oregon’s City Council opted for it, despite vocal opposition. Anticipating such an outcome, citizen activists had already mobilized to put fluoridation on the ballot, and it’s likely they succeeded.

According to the Salem Statesman Journal, Clean Water Portland submitted more than double the signatures needed – more than 43,000 total – and a day before deadline, too!

If the petitions are certified, the City Council could choose to put the issue before voters next year. Otherwise, the election would be in May 2014.

It’s hard to imagine the council would put it to ballot any sooner than necessary, especially in light of recent news that its members met with pro-fluoride lobbyists yet failed to disclose those meetings as required.

Promoted by then-Commissioner [now Mayor] Sam Adams beginning in 2005, the lobbying and reporting rules are supposed to preserve integrity in city decision-making. The requirements affect both lobbyists and city officials and are meant to reveal who attempts to influence city leaders – and on what topic.

Upstream Public Health is behind the push to add fluoride to Portland drinking water. But its plan has since been challenged through a referendum effort that may block the City Council’s Sept. 12 unanimous approval.

According to a recently filed disclosure, lobbyists reported meeting with Commissioners Randy Leonard on July 26, Dan Saltzman and Nick Fish on Aug. 2, Amanda Fritz on Aug. 6 and Mayor Adams on Aug. 27 to push for fluoride in public drinking water.

But those same city officials –who are required to publicly post their calendars on a quarterly basis – either didn’t disclose the meetings about fluoride or left a vague subject heading. Adams and Leonard say they weren’t actually present at the meetings.

Regardless of fluoride’s potential role dental health, giving it to everyone via a necessity such as drinking water whether they need it or not is, as we noted previously , ethically dubious at best. As Dr. Paul Connett has asked, “What other drug have we ever delivered through the public water supply?”

None. And for obvious reasons: 1) You cannot control the dose, 2) You cannot control who gets it, and 3) It violates the individual’s right to informed consent to medicine.

Fortunately, more people become informed every day and choose to take a stand for their right to choose. And education is what Clean Water Portland is focused on now.

One teaching tool is the powerful documentary An Inconvenient Tooth, which was released at Portland City Hall just about a week before the council vote – and which you can watch in its entirety below.

Learn more about Clean Water Portland.

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

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

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

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

Oral Health, Physical Health

 

See the rest of the interview…

Exercise: Good for Muscles, Heart, Lungs & Yes, Teeth & Gums, Too!

If you’re unfamiliar with holistic approaches to health, you might be surprised by the fact that what’s good for general health is also good for your teeth and gums. Conventional wisdom says dentistry and medicine are two separate fields, not specializations within a single, broad field. So you see a dentist for your teeth and a physician for the rest of your body, as though one had nothing to do with the other.

Funny – how easily we can forget that the mouth is connected with the rest of the body!

Even physical exercise – or the lack of it – affects more that just our muscles, lungs and heart. Those are just the three areas where we feel it most. While we might get a “runner’s high,” we don’t really feel exercise in our brains, even as exercise has been shown to keep the brain fit and improve thinking. Likewise, we don’t feel exercise in our teeth and gums, but there are, in fact, established links between physical fitness and oral health.

For instance, check out the 2005 Journal of Dentistry study, which found that regular exercise lowers the risk of periodontitis (gum disease):

• Never-smokers who exercised regularly “were about 54% less likely to have periodontitis” than those who didn’t exercise.
• Former smokers who exercised regularly had a 74% lower risk.

Unsurprisingly, exercise did nothing to lower the risk of gum disease for smokers.

We see similar results when obesity is factored into the equation. For instance, one paper published last year in the Journal of Periodontology found that those with the lowest body mass index (BMI) and highest measure of physical fitness – gauged by percent body fat and maximum oxygen consumption – were less at risk for periodontal disease than other study subjects. “This study suggests,” wrote the research team, “that obesity and physical fitness may have some interactive effect on periodontal health status.”

In fact, there are three positive factors – “health-enhancing behaviors” – that have been shown repeatedly to reduce the risk of gum disease. They’re spelled out in the abstract of one last study I’d like to draw your attention to, also from the Journal of Periodontology:

After controlling for age, gender, race\ethnicity, cigarette smoking, other tobacco products, education, diabetes, poverty index, census region, acculturation, vitamin use, time since the last dental visit, dental calculus, and gingival bleeding, a 1-unit increase in the number of the three health-enhancing behaviors was associated with a 16% reduction in the prevalence of periodontitis (odds ratio [OR] = 0.84; 95% confidence interval [CI]: 0.77 to 0.93). Individuals who maintained normal weight, engaged in the recommended level of exercise, and had a high-quality diet were 40% less likely to have periodontitis compared to individuals who maintained none of these health-enhancing behaviors. [emphasis added]

So what are you waiting for? Get out there and get moving!

Images by Mait Jüriado and BBluesman, via Flickr