Happy National Chewing Gum Day, September 30, 2015

Have a chew! (photo: Y. Mikalopas)

Chew on this….

It took a little web surfing to verify that this is even actually a “national day” and then I figured, even if it's not, why not write about the benefits, and potential detriments, of chewing gum.

1- Hold the sugar

Benefits gained by chewing gum are with “SUGARFREE” or “SUGARLESS” gum only.  These gums contain sugar substitutes such as sorbitol or xylitol (which is becoming very popular these days and being added to lots of “diet” products.) Sugar contributes to the creation of cavities so it is NOT a good idea to chew gum that contains sugar. Ever. Sorry.

Potential detriment: Sugar substitutes can cause stomach upset, so go easy with the amount of gum you chew. If you are sensitive to these types of products, you might want to skip it.

2– Have a chew after meals

According to the American Dental Association website (ada.org), chewing gum for twenty minutes after a meal stimulates saliva.  The more saliva you have, the better for your mouth. Saliva helps to wash away the sugars that the plaque bacteria in your mouth need to live and grow and helps to return your mouth to normal pH levels. Saliva also contains potassium and calcium, which along with fluoride, helps to re-mineralize your teeth.

Caveat: If you have jaw problems or “TMJ” chewing for twenty minutes might not be for you. If you have braces, loose fillings, bridgework or dentures, also not for you. And if you have loose fillings or bridgework, please get yourself to the dentist.

3- Stop smoking and lose weight!

The Mayo Clinic (mayoclinic.org) suggests that chewing gum can assist with smoking cessation as well as forestall the urge to eat, decreasing your total intake of calories. It’s a win-win and there is research that backs up these assertions.

I don’t see any negatives here. I’d rather see people chewing gum like cows than smoking.

4 – Four-Step Program

Dental hygienists have proposed a four-step process for a healthy mouth: Floss, Brush, Rinse, and…you guessed it – Chew. (Adha.org)

Please note that chewing gum does not allow one to skip the brushing or the flossing. Ever. Sorry.

5- Smarty pants

There have been multiple studies which seem to indicate that chewing gum may increase memory and improve test performance.

Unfortunately, chewing gum in school – kind of frowned upon.  Too many wads wind up stuck under the desk, in carpet, or in hair. But if you’re studying at home, it can’t hurt.

If you’d like to see a list of sugar-free chewing gums that get the stamp of approval from the American Dental Association – yes, the “four out of five dentists” endorsement is a real thing – visit this page on their website:

http://www.ada.org/en/science-research/ada-seal-of-acceptance/ada-seal-products/product-category/?category=Sugar+Free+Chewing+Gum+for+Reducing+Cavities

Finally: Brush, floss, rinse and chew to get those teeth clean and shiny in preparation for World Smile Day, this Friday, October 2, 2015.

The Predictive Power of Spit

Research presented at the 2015 Alzheimer's Association International Conference on Sunday suggests that it may be possible to use saliva as a diagnostic tool in predicting Alzheimer's disease.  Alzheimer's causes changes in the body years before any symptoms occur and early diagnosis is key, as it is in other diseases, for early treatment and better outcomes.

While this particular study is preliminary and needs to be reviewed and replicated, the predictive power of spit has already been harnessed for other diseases and conditions.  Saliva tests for HIV have been used by medical professionals since the early 2000s and in 2012 the FDA approved a home testing kit for consumers.  According to the National Institutes of Health there are also saliva tests available for hormonal problems and to screen for substance and alcohol abuse.

Oh, spit! 

(photo: Y. Mikalopas)

In dentistry, the importance of healthy saliva has long been recognized as critical for oral health.  In addition to keeping the mouth moist and aiding in digestion of food, saliva contains a host of substances including immune factors, proteins, bacteria, and minerals.  Saliva tests that examine the type of bacteria in the mouth can be used to suggest treatment options for patients at risk for cavities and gum disease.  There are also tests that look at salivary flow, which can aid in treatment of dry mouth.

Saliva tests that examine protein markers, like the preliminary one for Alzheimer's, could potentially be predictive of systemic diseases like cancer.  A study of head and neck cancers at John Hopkins used saliva and blood testing which reliably found DNA markers in the saliva of patients with these cancers.  Changes and differences in proteins in the saliva have also been found in other patients with cancer, such as women with breast cancer.

There is no downside to saliva testing as a diagnostic tool.  Saliva tests that currently exist are easy to use, non-invasive, reliable and relatively inexpensive.  Imagine a future without the need for invasive procedures like biopsies or uncomfortable screenings like mammograms - where a yearly saliva test, done quickly in a doctor's office or at home, could reliably predict disease and result in early intervention and treatment.  

Sources: Alzheimer's Association International Conference (2015). Researchers Report New Ways to Predict the Development of Alzheimers Disease (Press Release). Retrieved from https://www.alz.org/aaic/releases_2015/Sun-8amET.asp; National Institutes of Health, Fact Sheet, Salivary Diagnostics; Y. Wang, S. Springer, et al. "DNA Shed from Head and Neck Tumors Detected in Blood and Saliva," Hopkinsmedicine.org, 24 June 2015; A. Nieves, W. Fitzgerel-Blue. "Saliva: Of Emerging Importance in the Medical and Dental Worlds," rdhmag.com.

This information is not intended to diagnose or treat any condition. Please see your dental or medical professional for treatment and advice.

Over 2 Million Kids Now Using E-cigarettes: Up in Vape, Part II

Last July, I posted about vaping and e-cigarettes.  Of special concern to me that day was the activity I had seen around a boardwalk smoke shop and the number of young people using e-cigarette and vaping products.  In part, I wrote the following:

The attraction of teens and young people to smoking is nothing new…however… there is still so much unknown about the effect of e-cigarettes and vaping on health…. Opportunities to “smoke” continue to grow, regardless of our lack of understanding of the long term consequences…despite claims that e-cigs are safer than regular cigarettes and can help people quit there is little research yet to support this….In the past year there has been a 21% increase in high school students who (use e-cigarettes.)

Earlier this week the American Medical Association released new recommendations for the regulation of e-cigarette products as well as a call for nationwide minimum age purchase requirements. This new policy is based on updated data from the Centers for Disease Control that found a more than 200% increase in the use of electronic cigarettes among high school and middle school students.  That number translates into a total of almost 2.5 million teens and children who use e-cigarettes, up from 780,000 in one year. 

The U.S. Food and Drug Administration is currently considering a variety of regulations on e-cigarettes similar to cigarettes and tobacco products as well inviting public commentary on the subject.  The European Union has already voted to strictly regulate e-cigarettes starting in 2016, especially where children are concerned. A stumbling block for health policy, however, is that research is scant and still ongoing. While the dangers of cigarettes and tobacco products are well established, the true long-term health risks of electronic delivery systems remain to be seen.  A 2014 Japanese study found very high levels of toxic substances in e-cigarettes, however, other studies, such as one that measured metal exposure from e-cigarettes, found no significant difference versus regular cigarettes.  Still, these studies demonstrate that there is an as yet unquantifiable risk for those who are non-tobacco users using electronic products, none of which are regulated for how they are made or what they contain.

The call for more research and regulation by national as well as international medical, dental, and government agencies alarmed at the growing number of both children and adults using e-cigarettes is a portend of the future.  Their apprehension, based on collective professional, scientific, and health knowledge, as well as a concern for public safety, should not be ignored.   

To read the new ADA press release visit:

http://www.ama-assn.org/ama/pub/news/news/2015/2015-06-09-ama-policy-protect-youth.page

For information on current FDA activity regarding e-cigarettes visit:

http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm172906.htm

This information is not intended to treat or diagnose any dental or medical condition or illness.  Please visit your medical or dental health professional if you need medical or dental treatment.

Sources: http://www.ama-assn.org/ama/pub/news/news/2015/2015-06-09-ama-policy-protect-youth.page; www.cdc.gov, www,ada,org, www.fda.gov; http://www.nytimes.com/2014/02/27/business/european-union-approves-tough-rules; Int J Environ Res Public Health. 2014 Oct 28;11(11):11192-200. doi: 10.3390/ijerph111111192. Carbonyl compounds generated from electronic cigarettes. Bekki K^, Uchiyama S,  Ohta K^, Inaba Y^, Nakagome H^, Kunugita N.  Farsalinos, K.E.; Voudris, V.; Poulas, K.; Are Metals Emitted from Electronic Cigarettes a Reason for Health Concern? A Risk-Assessment Analysis of Currently Available Literature. Int. J. Environ. Res. Public Health 2015, 12, 5215-5232.

Your Heart in Your Mouth

"My heart was in my mouth" is an expression I have always loved and a friend of mine used to use it all the time.  At 14 years old she already had a job working in a local bodega, (that's the Brooklyn version of a convenience store only smaller and selling more beer and cigarettes than anything else,) and I thought she was super-sophisticated.  She certainly met a lot of colorful characters and nary a shift went by that something nerve-wracking hadn't happened along the bustling avenue where she worked.

The phrase came to mind the other day as I was reading an article on dental treatment of patients with heart disease.  It is so important that patients with cardiovascular disease inform their dentists and dental hygienists of any changes in their heart health or medications.  Certain procedures, such as valve replacement or stent placement, may require premedication or even delay non-emergency treatment.  Medications for heart disease, ranging from high blood pressure meds to blood thinners also have effects on the mouth such as increased bleeding or dry mouth. Patients who have had strokes may find it difficult to brush or floss due to loss or decrease of function on the affected side of the body and need to adjust their dental home care routine accordingly.

Although people with gum disease do have a higher incidence of heart disease even after accounting for other factors like diabetes or risky health habits like smoking and drinking, no definite cause and effect relationship between the two has been proven.  More research is being done to figure out this relationship and determine if treating gum disease can help to improve heart health in cardiovascular patients or even help to avoid heart problems in the first place.  Until that determination is made, however, it just makes sense to recommend that people with heart disease take excellent care of their teeth and gums.  Tooth decay and gum disease are completely preventable with good daily oral hygiene which reduces inflammation in the mouth as well as the rest of the body.

Brushing at least two times a day for two minutes and flossing every day keeps your mouth healthy, may keep your heart healthy, and will probably keep you from feeling like your heart is in your mouth at your next dental hygiene visit.

This information is not intended to treat or diagnose any condition.  If you have a dental or medical problem or concern PLEASE see your dentist or doctor!  

Braces - Not just for kids

Imagine you need to paint a fence but the slats are crooked and leaning against each other.  You'd fix the fence before painting it, wouldn't you?  Of course!  It's easier to paint that way.  That's the concept behind dental braces.  Braces are meant to align the teeth so that they are straight, fit together properly, and can be more easily cleaned.  There are purely cosmetic reasons to straighten the teeth, to be sure.  However, for the patient who is older and has had problems for years cleaning his or her teeth because they are crooked, braces are more than just a way to achieve a beautiful smile.  They can help to correct a lifetime of difficulty in properly cleaning the teeth and resolve issues that lead to dental disease.

When teeth aren't cleaned well plaque is able to grow, multiply, and harden.  This can lead to cavities, gum disease, gum recession, and worse.  Recently, an adult patient (over 50) finally convinced of the benefits of getting braces, consulted with an orthodontist and started treatment.  After only 8 weeks he noticed an improvement in his oral health as well his attitude about his teeth.  Making the commitment to get braces had strengthened his resolve to floss his teeth and he was as amazed that his gums were no longer bleeding!  He was enthusiastic and optimistic about the future of his dental health.

About 20% of orthodontic patients are over the age of 18 and there are many types of braces for adults to choose from.  Products that use a series of plastic trays which are virtually invisible as well as ceramic braces have removed the "brace face" stigma and made wearing braces much more desirable.  Unfortunately, insurance does not cover adult braces and they can cost between $4,000 - $8,000 over the average 2 year treatment time.  However, if you weigh the expense of braces against future expense and time lost in the dental chair, the money may be worth it.

If you are an adult considering getting braces ask yourself the following questions and follow up by speaking with your dentist or dental hygienist:

Have my permanent teeth been crooked since I was a child/teenager?

Do I have a hard time brushing or flossing because my teeth are crooked?

Do I have areas where my gums bleed even though I brush and floss regularly?

Have I had cavities where my teeth are crooked?

Do my teeth feel like they don't "fit together" right?

Have I had tooth decay where I previously had fillings and now have crowns/caps?

Have I lost teeth?

Are my gums receding where my teeth are crooked?

Has my dentist or dental hygienist told me that my dental problems are related to my teeth being crooked?

Has my dentist or dental hygienist recommended that I consult with an orthodontist?

Do I like to smile?

Does my dental history include fillings or caps due to my crooked teeth?  Is there more work to be done in my future?

Does the cost of fillings (starting at $200 each,) caps/crowns (at around $1,000 and up each,) bridgework ($2,500 and up) as well as time lost in the dental chair outweigh the expense of braces?

Am I willing to change my home care habits to properly take care of braces?

Will I continue to properly care for my teeth after the braces come off?

This information is not meant to diagnose or treat any condition.  It you have any health concerns, please consult you medical or dental professional.