Your 2011 Dental Questions...

10 Oral Health Questions—Answered partner
by Woman's Day, on Tue Jan 11, 2011 3:13pm PST 315 Keep
your pearly whites in peak condition for better overall wellness
By Sarah-Reistad-Long

Your teeth can reveal a lot about your overall wellness—research has linked poor oral health to conditions like diabetes, cancer, heart disease, stroke and autoimmune disorders. The issue is twofold. If you already have one of these conditions, some signs may show up in your mouth: People with uncontrolled diabetes, for example, are more likely to have gum disease, cavities and oral infections. On the flip side, gum disease can increase your risk of developing health issues in the first place. That’s because the bad bacteria in your mouth (a cause of inflammation) can actually make their way into the rest of the body, causing other areas to become inflamed.

“The cardiovascular connection is known to be especially strong,” says New York City–based periodontist James Jacobs, DMD. For example, one British study showed that people who brush infrequently were 70 percent more likely to suffer from heart disease than those who brush twice a day.

Maybe you’re thinking, I brush. I floss—at least sometimes. Isn’t that enough? Probably not, considering that a whopping 85 percent of American adults suffer from gum disease, according to the U.S. Surgeon General. But it’s not too late to reform your ways. Here, we address your top concerns so you can keep your pearly whites in peak condition. Your good health depends on it.

Is there a right way to brush?

Yes! Grip your toothbrush at a 45-degree angle to the gumline, so it’s slightly pointing up, and apply gentle pressure as you use a combo of back-and-forth and up-and-down strokes, says Santa Monica–based dentist Nushin Shir, DDS. Make sure you brush each tooth all over, as well as the gumline. And don’t rush! A thorough brushing lasts about 2 minutes, so aim to spend about 30 seconds on each quarter of your mouth.

Are electric toothbrushes better than manual ones?

Most dentists think so, even though studies are mixed. If you use them the right way, they prevent you from brushing too hard (which can wear away the enamel, the outer protective layer of the tooth, and make gums bleed) or, more important, not long enough (most have a built-in timer that beeps when 2 minutes are up). They’re also thorough. “Some electric toothbrushes go as fast as 40,000 strokes per second. You just can’t do that manually,” says Jeffrey Golub-Evans, DDS, founder of the New York Center for Cosmetic Dentistry and a past president of the American Academy of Cosmetic Dentistry. The downside: Some can cost more than $100, though it’s possible to find them for as low as $30.

For a less expensive option, consider a batteryoperated brush. They may lack some bells and whistles, but whether you choose a brush that uses replaceable batteries or you opt for the disposable variety, they should still work well. Catrise Austin, DDS, author of 5 Steps to the Hollywood A-List Smile, likes the disposable Oral-B Pulsar 3D White Advanced Vivid Toothbrush, which is only $3.49. If you prefer to stick with a manual, that’s fine—just make sure that it’s labeled soft, since harder brushes can wear down the enamel and cause tooth sensitivity. Remember to replace your brush (or change the head) every three months.

What’s the best type of floss?

Whatever kind you’ll actually use (waxed or unwaxed)—studies show they work equally well. The key is to floss every day. In fact, dentists wish you’d do it twice a day—it’s the only way to remove all the food and plaque (a film that harbors bacteria) that gets stuck between your teeth, says Dr. Austin. Plaque ups the risk of tooth decay and gum disease, which makes you more likely to have bleeding gums and even lose some teeth as you get older. But if you’re only going to floss once a day, do it at night (so you don’t sleep with food particles in your mouth).

How can I get rid of bad breath?

Two words: tongue scraper. Researchers from the University of Sao Paulo in Brazil found that using one improved bad breath as much as 75 percent by removing the bacteria and residue that builds up on your tongue.

Other possible halitosis culprits include heartburn or acid reflux (chewing sugar-free gum after a meal can help) and gum disease, which can cause your gums to recede and bacteria to get stuck. If you have persistent bad breath that doesn’t get better when you use a tongue scraper or chew gum, see your dentist or a periodontist. If the problem turns out to be gum disease, you may need a series of deep cleanings (generally done with local anesthesia) to remove bacteria and diseased tissue.

As I’m getting older, it seems as if more food is getting stuck between my teeth. Am I imagining this?

Not at all. The enamel wears down with age, so your teeth get a little smaller and the spaces between them get slightly wider, which means food gets trapped more easily. Eroding enamel can also make your teeth more sensitive. If you have extensive damage to your enamel (you may notice darker, more yellow spots on your teeth), bonding can help, says Emanuel Layliev, DDS, president of the New York Academy of Cosmetic Dentistry. It entails having your dentist apply a toothcolored plastic filling to the front and back of teeth. The cost can add up (about $150 to $300 per tooth), though insurance often covers at least a portion of it when bonding is done to repair damage (as opposed to for purely cosmetic reasons).

Can I tell if I have a cavity?

Sometimes. The tipoffs: pain or sensitivity in just one area, or a brownish stain on the top of the tooth, says Dr. Shir. Bad breath can also be a sign; a decaying tooth can be a breeding ground for bacteria. But of course, the only way to know for sure is to see your dentist.

Do I really need to go to the dentist twice a year?

Absolutely! Waiting too long between visits means more scraping, because plaque that sits on your teeth for a while hardens and turns into tartar (also called calculus). Going twice a year also gives your dentist a chance to catch a cavity early, when it’s just forming. In that case, you might not even need any filling or drilling; you may simply be sent home with a fluoride treatment to redeposit some of the minerals that have worn away, says Dr. Jacobs. Wait too long, however, and the cavity will progress and can infect a nearby nerve, which means you could end up needing a costly root canal. Frequent visits also mean more opportunity for your dentist to spot signs of an illness that’s affecting your whole body.

What is the best drugstore teeth-whitening option?

Whitening strips, such as Crest Whitestrips, says Dr. Golub-Evans. “They deliver a premeasured, evenly distributed amount of hydrogen peroxide to your teeth. Results build over prolonged use, so I’d recommend the 2- to 3-week ones over the stronger 4- to 7-day option.” Spreading it out also results in less sensitivity. You won’t get as powerful a result as you would from a professional whitening treatment, but they can definitely give you a subtle lift that lasts for 6 months.

Whitening kits that use trays (a tray with a gel mixture goes on your upper teeth and another goes on the lower ones) are also effective, but they tend to be messier, harder to use and can irritate your gums (unless you get custom-fit ones from your dentist). If you go this route, make sure to get one that doesn’t require you to measure and distribute the bleach yourself, because it’s too difficult to do it evenly.

I’ve seen laser whitening treatments being offered in spas and malls. Are they safe?

Maybe—but only if a dental professional (such as a dentist or dental hygienist) is administering them. “I once met a banker who was performing these whitenings for extra income!” says Dr. Austin. The problem: An untrained person could end up damaging your teeth, and many people are selling products that haven’t been proven safe or effective. In fact, states including Tennessee and Alabama have recently banned teeth-whitening kiosks that aren’t operated by dentists.

If you do opt for laser whitening (ideally at a dentist’s office), here’s how it works: A highly concentrated hydrogen peroxide formula will be spread over your teeth. You’ll then sit in front of a laser or other activating light designed to help the formula penetrate, and walk out of the office about an hour later with a whiter smile. Dentist-approved treatments including Zoom! and BriteSmile are safe, but some people experience pain and sensitivity during or after the process. Recently, some dentists have started offering a laser-free option called Opalescence. It involves using a higher concentration of hydrogen peroxide, but it also has fluoride to help reduce sensitivity. Expect a professional whitening treatment to cost between $250 and $600 and for the effects to last for one to five years, depending on your habits. Photo: Shutterstock

Head overseas to save on dental work? Maybe

Dental insurance—if you have it—often isn’t very comprehensive. Paying out of pocket or subsidizing a skimpy policy may be fine when it comes to routine cleanings, but if you need substantial work done, it can end up setting you back thousands of dollars. Because of this, a small but growing number of people are jumping on the medical tourism bandwagon. Statistics are hard to come by, but at the last official count (in 2006), about 200,000 Americans were traveling abroad for dental work alone. The top destinations in recent years: Mexico, India, Costa Rica and Hungary (the latter has a high number of well-trained dental professionals per capita, which has driven down costs). The savings are often considerable.

In the best-case scenario, you’ll see a dentist with good credentials (some have even been trained in the U.S.) and maybe do a little sightseeing, says Neilesh Patel, DDS, CEO/ founder of HealthCare Tourism International, a nonprofit medical tourism website that connects patients with safe, accredited international providers. On the other hand, you’re dealing with different standards of care and sanitary practices, and you’re doing it far from home (even if things go well, follow-ups or unforeseen emergencies can pose a tricky problem). From sorting through language barriers to determining which foreign seals of approval are actually credible, it can take a whole lot of work to make sure your practitioner is up to par. “Of the dental work I’ve seen from Mexico, I would say that the majority of cases would not meet the U.S. standard of care,” says Dr. Patel. “It’s important to do your homework.”

If you’re still up to the challenge, start by looking for professionals that are endorsed on a reputable site. Some are: Dr. Patel’s HealthCare Tourism International ( HealthCareTrip.org); the International Association for Medical Assistance to Travellers ( IAMAT.org), a site recommended by the American Dental Association; or Medical Tourism International ( MediTourInternational.com), a for-profit organization made up of international hospitals, doctors, and other healthcare providers that are screened and inspected to ensure that they adhere to a strict set of standards. Once you’ve narrowed down your options, the ADA suggests reviewing the educational information at The Organization for Safety, Asepsis and Prevention’s website ( OSAP.org; click on “resources” and then “travel”).

Lastly, if you’re very concerned about having all your i’s dotted and t’s crossed, you may want to consider booking through a medical tourism travel agency. Planet Hospital ( PlanetHospital.com), a California-based company, is generally considered to be the most reputable.

Original article appeared on WomansDay.com.

Tooth Erosion due to Acidic Foods

According to research done by GlaxoSmithKline, 50% of U.S. dental professionals report seeing an increase in acid erosion compared to 5 years ago. Signs of acid erosion include changing of shape and loss of contour of the tooth, surfaces that lack shine and look dull, loss of surface ridges or texture, transparency, and a dull yellow appearance. In more advanced stages of acid erosion a total loss of the biting edges of the teeth can occur due to the brittleness and lack of enamel. People that suffer from acid erosion are susceptible to cavities, cracks, and loss of teeth.

Foods that are acidic can lead to tooth erosion. Please refer to the chart below for a list of the acidity levels of some foods and drinks. For reference a pH of about 7 is neutral and a pH of 1 is very acidic. (click on chart to enlarge)



Dr. Jason McCargar, a dentist in Scottsdale, Arizona says that "the pH of the food or liquid is not the sole indicator of how damaging it can be to your teeth. For example, soda is acidic and can cause acid erosion to the teeth. But, drinking the soda through a straw and limiting how frequently you drink soda can drastically decrease your chances of having tooth erosion and tooth decay."

Your Guide to Fluoride

Fluoride is used to prevent cavities. It was originally thought that fluoride worked to decrease cavities solely by making the enamel stronger. However, new studies have determined that fluoride also helps in re-mineralization (a process of rebuilding the tooth after damage) and fighting bacteria. The use of fluoride has substantially declined the rate of cavities.

When children receive an adequate level of fluoride the enamel of the teeth is found to have a formation of fluorapatite crystals that are smaller and stronger and more resistant to breakdown. Fluoride can also act in a process called bacterial inhibition to stop the production of cavities by interfering with cavity-forming bacteria found in plaque.

Fluoride can be found in many sources. Fluoride is intentionally added to toothpaste, some mouth rinses, fluoridated water, and fluoride supplements. It is found naturally in some well water, in some brewed tea, in some bottled water, and some fish. (Products made from or that come from naturally fluoridated water.)

Fluoride was first introduced into the water supply intentionally to help prevent cavities in the 1940s. Communities in Arizona that have chosen to adjust the fluoride level in their drinking water include but are not limited to: Bisbee, Chandler, Gilbert, Phoenix, Tempe, Glendale, El Mirage, Mesa, and Yuma.



Fluoride levels can fluctuate, but are strictly controlled by the local water treatment plant. “The best source of information on fluoride levels in your water system is your local water utility. All water utilities must provide their consumers with a Consumer Confidence Report that provides information on a system’s water quality, including its fluoridation level. The state drinking water administrator or state oral health program also should be able to help you identify the fluoride level of your drinking water. Optimal fluoride levels recommended by the U.S. Public Health Service and CDC for drinking water range from 0.7 parts per million (ppm) for warmer climates to 1.2 ppm for cooler climates to account for the tendency for people to drink more water in warmer climates.”(2)

For example, The City of Chandler strives to maintain fluoride levels at the Sewage Waste Treatment Plant between 0.7 & 1.0 PPM, which is the level recommended by the National Public Service, EPA and the American Dental Association. Ground water does not receive additional fluoride, however, the natural occurring fluoride averages 0.9 PPM. (2) Furthermore, the city of Scottsdale does not add fluoride to the drinking water. However, Scottsdale water sources contain low levels of naturally-occurring fluoride ranging from 0.3 to 1.0pp.(3)

Data obtained from 1992 to 2004 shows the naturally occurring level of fluoride in Maricopa county. It is broken down in this chart based on the water system. As you can see the levels naturally occurring are higher than the recommended levels by the ADA and the EPA. In cases such as this, as a public health measure, the excess fluoride would be removed during processing.


(4)http://www.fluoridealert.org/pesticides/levels/arizona.html

The Environmental Protection Agency has set a maximum level of 4 mg/L fluoride for human consumption. Levels above this can cause fluorosis. The symptoms of mild fluorosis include white mottled areas of enamel due to hypomineralization which can cause a cosmetic concern. More severe fluorosis can result in pitted and malformed areas of enamel and brittle enamel. Fluorosis does not occur in adults because it must occur during pre-eruptive enamel maturation (development of the adult tooth before it erupts from the gum tissue); ingestion of excess fluoride after this developmental phase cannot result in fluorosis. Generally most children have developed all their adult teeth by the age of 8 and therefore, it is very unlikely to see fluorosis in someone older than this age.


In contrast, Reverse osmosis typically removes at least 80% of most constituents, including fluoride. However, you may want to contact the manufacturer of the reverse osmosis device to determine the removal rate for your system. It is possible that if you have fluoridated water and use a reverse osmosis system in your home, then you are not getting adequate levels of fluoride.

If the water supply does not provide adequate fluoride, then supplementation can help to decrease the risk of developing cavities. For children under 16 years of age, chewing or sucking fluoride tablets and lozenges prior to swallowing will maximize the effect of these supplements by providing an additional topical effect before being absorbed systemically. Current recommendations from the American Academy of Pediatric Dentistry, ADA, and American Academy of Pediatrics are to start fluoride supplements, if required, at 6 months of age because prior to that most infants do not have teeth.
The selection, use, and frequency of various types of fluoride treatments for an individual patient are based on his or her risk level, ADA recommendations, patient age, product efficacy, clinical support, safety, ease of use, and patient preference. Your dentist can provide an in-office fluoride treatment in the form of a varnish, gel, foam or rinse. The concentration of in-office fluoride treatments is significantly higher than at-home treatments. The use of at-home fluoride treatments include toothpastes/ gels, and rinses. At home dentifrice (for example: a toothpaste such as colgate or crest) twice daily provides a regular supply of fluoride that results in the presence of low levels of fluoride intra-orally on the teeth and soft tissues. (5) Dr. McCargar, a dentist in Scottsdale, Arizona states that at-home fluoride treatments are most effective if the patient does not swish with water after using. "Many people after brushing rinse their mouth with water, this washes away the fluoride treatment. An extensive number of clinical trials have demonstrated a significant reduction in cavities if people use the fluoride treatments as directed."


(1) http://apps.nccd.cdc.gov/MWF/Index.asp
(2) http://www.chandleraz.gov/default.aspx?pageid=458
(3)http://www.scottsdaleaz.gov/Water/quality/Drinking/FAQ.asp
(4)http://www.fluoridealert.org/pesticides/levels/arizona.html
(5) Twetman S. Caries prevention with fluoride toothpaste in children: an update. Eur Arch Paediatr Dent. 2009 Sep; 10(3):162-67