Tag Archives: tooth decay

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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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

Image by Electron, via Wikimedia Commons

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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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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

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What’s Ozone Therapy & How Is It Used in Dentistry?

If you’ve read much about “alternative medicine,” you may have run across discussion of something called “ozone therapy.” But what’s that?

The word “ozone” might make you think of pollution. We’ve all heard of the “hole” in the ozone layer caused by CFCs and other toxins. Maybe you’ve read that ozone is found in smog or know a little about its industrial uses, many of which tap into ozone’s disinfecting properties (including use as a pesticide, bacteriacide and fungicide).

Ozone also has a significant history in medical treatment, as well. According to Dr. K.W. Donsback,

Ozone therapy was used medically by Nikola Tesla in 1900. It has been in continual use for over 50 years in Europe and the USA, but due to our legal pressures, ozone is presently only widely used [as an orthodox treatment in Germany, Russia and Cuba]. When the proper protocols are followed, ozone has been proven effective in the treatment and possibly the elimination of over 40 common diseases.

Ozone therapies are among the safest therapies ever used. One European study of over 5.5 million treatments showed a side effect rate of .0007%, probably among the lowest of any therapy known. Side effects (like fever and weakness) are minor and temporary.

Ozone therapy also has a place in dental practice, although its use remains uncommon here in the US, owing to opposition from the dental/medical establishment. Among those dentists who do use it for oral healing and health, there are five main applications :

  1. Ozonated water may be used as a gargle or rinse to treat oral abscesses, gum problems, sore throats and ulcerations. It may also be used for irrigation.
  2. Ozone gas may be used as a preventive measure against tooth decay and periodontal disease.This is done by fitting a custom tray over the patient’s teeth and gums, and letting ozone into the tray for a short while.
  3. Teeth that might otherwise be subject to a root canal or extraction may be treated by washing an exposed nerve first with ozonated water, then with ozone gas.
  4. Ozone may be used as a disinfectant before a root canal or restorative dentistry is done. Ozonated water and gas can get through the walls of the tiny dentinal tubules, killing harmful bacteria that have taken up residence in these hard-to-reach, hard-to-clean places.
  5. Temporomandibular joint pain may be treated with ozone, where gas injected right into the TMJ can kill harmful microbes, as well as reduce inflammation and spur the growth of new cartilage.

Learn more about dental uses of ozone:

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So Many Sweeteners…But One That Fights Cavities?

Humans have a natural like for things that taste sweet, but as anyone who pays attention to their diet knows, not all sweet things are created equal. Naturally occurring food sugars, such as those in milk and fruit, come along with a host of nutrients, while added sugars are empty calories – empty but tasty, which is why we find added sugars in so many processed foods. The manufacturers exploit our love of sweetness, even as some of the sugars they use, such as high fructose corn syrup, may have other “benefits,” as well (such as a preservative effect).

Artificial sugars were made to provide the taste without the calories. But sweeteners such as aspartame (as in NutraSweet or Equal), saccharin (Sweet’N Low) and sucralose (Splenda) have long been suspected of having a negative impact on health. Researchers continue to explore what’s long been reported clinically and anecdotally.

Sugar alcohols, on the other hand – sweeteners such as sorbitol and manitol – have fared much better. The only common side effects reported to date are gas/bloating and diarrhea – though you’d need to ingest an awful lot to cause them. Because they’re sweeter than artificial sugars and have low carb and low calorie profiles, sugar alcohols are also used in many processed foods. One in particular even has a role in dental health.

Yes, really.

Xylitol occurs naturally in various berries, oats and mushrooms, and it can be derived from sources such as corn fiber and wood. It’s a common sweetener for gum, as well as an ingredient in some toothpastes, including the PerioPaste I recommend to patients for tooth and gum health. This isn’t just because of the sweetness or the fact that xylitol – like all sugar alcohols – doesn’t contribute to tooth decay. Rather, xylitol appears to have special properties that may actually help prevent tooth decay.

Early studies from Finland in the 1970s found that a group chewing sucrose gum had 2.92 decayed, missing, or filled (dmf) teeth compared to 1.04 in the group chewing xylitol gums. In another study, researchers had mothers chew xylitol gum when their children were 3 months old until they were 2 years old. The researchers found the children of the mothers in the xylitol group had “a 70% reduction in cavities (dmf)” when they reached 5 years of age. Recent research[ confirms a plaque-reducing effect and suggests the compound, having some chemical properties similar to sucrose, attracts and then “starves” harmful micro-organisms, allowing the mouth to remineralize damaged teeth with less interruption. (Wikipedia)

A recent feature in Sri Lanka’s Sunday Observer outlines three major factors that make xylitol an effective fighter of tooth decay:

  • It keeps S.Mutans – one of the main microbes involved with tooth decay – from clinging to teeth.
  • Since it can’t be fermented by oral microbes, it inhibits demineralization of the teeth. No fermentation, none of the acidic byproducts that cause caries (cavities).
  • It reduces the growth of S.Mutans.

To the last point, the author notes that “in 2006, researchers at the University of Washington showed that after 5 weeks of Xylitol usage the level of mutans streptococci in plaques was ten times lower than at the start.”

To learn more about this remarkable substance, check out the full article.

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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

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