Take time to smell the floss

Many people who feel they take great care of their teeth still aren’t flossing or aren’t flossing every day. Not flossing between the teeth can result in cavities between the teeth and for those who already have fillings or caps, decay that returns.

Not flossing is like taking a shower and washing your face, but not washing your hair or ears. Just like your body would not feel properly cleaned, your teeth aren’t cleaned thoroughly if they aren’t flossed.

I have recently started asking my patients to up their flossing game. The suggestion I am now making may sound like an odd one, but it comes from the dental health presentations that I have given to tens of thousands of students of all ages:

Floss your teeth, then take the string or the floss pick and smell it. It will stink. There is nothing like that smell. 

If you find that you have smelly breath or a bad taste in your mouth even though you brush faithfully, you will now understand why and this practice will encourage you to continue to floss. 

Smell the floss - ym'18

If you haven’t flossed in a while, your gums will bleed and that can be very disturbing. Keep flossing. The bleeding will subside and eventually stop. The smell of those plaque germs on the floss, however, will be there every time reminding you to get those sticky, stinky germs out of your mouth. So my advice is take time to smell the floss. Your reward is healthy teeth and a beautiful smile.

Are you afraid of the dentist?

Fighting Dental Fear

Fear that affects one’s ability to seek or receive dental treatment has real consequences. Ignoring gingivitis, gum disease characterized by bleeding, puffy gums, can cause it to progress to periodontitis, advanced gum disease characterized by bone loss in the jaw and loose teeth. Cavities left untreated only get bigger. A sore in the mouth that does not heal may be a sign of oral cancer and ignoring it can be deadly. Neglecting the teeth during pregnancy can result in low birth weight.

Avoiding dental treatment also has financial consequences. A small cavity that could have been treated with fluoride or a filling may end up needing more extensive treatment like a root canal, crown, or other expensive restoration. These treatments also require multiple visits leading to more time off from work. A restored tooth is more likely to need future treatment versus a natural tooth.

Dental fear that prevents a person from getting treatment is recognized as a debilitating phobia called odontophobia. Fear of the dentist or of dental treatment may be related to a person’s tolerance for pain and is often an issue for people who have suffered from abuse. Estimates on the number of people affected by true dental phobia varies widely from 9% to over 30%, however, most people can testify to the fact that going to the dentist for treatment is no walk in the park. 

Dental Fear. (image:ym)

There are a variety of things that may cause dental fear. Some patients may be ashamed that they have waited so long to see the dentist. Aside from being afraid that something is seriously wrong, they fear “the lecture” they may get for not taking care of their teeth. 

Pain is a also common fear. While dentistry has come a long way, it still involves the administration of anesthetic with needles or other methods that can be scary for some people. 

Bad childhood experiences with dental treatment are a cause of fear, too.  People with dental fear have also cited feelings of loss of control during treatment and a general discomfort with the sights, sounds and even smells of a dental office. Some people feel uncomfortable with treatment because they have a strong gag reflex or report feeling like they may choke during dental procedures. 

Whatever the reason, dental fear is real and can be troubling for people. Still, dental treatment and regular dental check ups are absolutely necessary for health.

There are a number of ways to try to cope with dental fear:

Ask questions and discuss your fears with the dentist or dental hygienist. It’s not necessary to reveal your innermost secrets but being upfront about your dental fear will help guide them with your treatment. For example, if you fear the sight of needles, the tray can be covered or they can adjust their approach to keep the needle out of the line of your sight.

Find a dentist and dental hygienist you like and whose staff make you feel comfortable and welcome. 

A dental office’s environment is important. An environment suited to your personality can help you deal with the anxiety you feel when visiting the dentist. Perhaps you favor a soothing environment with soft music or prefer an office with lots of stimuli, like televisions mounted on the ceiling for patient viewing.

Set the mood with music.  Listening to music on headphones during treatment can be very helpful for people who are sensitive to noise.

Wearing sunglasses or goggles while receiving treatment can help with harsh lights.

It is important to set your appointment when you are least likely to be stressed. If rushing to an appointment after a day at work stresses you out, consider making early morning or weekend appointments instead. Dental office staff should be willing to work with you and help keep you on track for your appointments.

Resist the urge to cancel. It is important to keep your appointments since delaying treatment or not going for regular dental hygiene visits is only likely to worsen your dental issue.

Stress reducing methods like guided relaxation techniques and biofeedback, or other professional help like counseling or hypnosis, may help reduce anxiety in the dental setting as well. 

Do you have dental fear? Answer TRUE or FALSE to the questions below:

I hate going to the dentist

I had a bad childhood experience at the dental office

I don’t trust what my dental hygienist tells me

I don’t trust what my dentist tells me

I hate having my teeth cleaned

I frequently cancel appointments for no reason

If you answered TRUE to most of these questions you may have dental anxiety. Think about the reasons you don’t like to or want to go to the dentist and ways you can cope with them. If you are avoiding treatment because of your fear talk to your doctor or dentist to get the help you need.

One of the best ways to deal with dental issues is to not have them in the first place! It is worth the small effort it takes to brush and floss every day.

Sources: http://jada.ada.org/article/S0002-8177(16)30966-7/fulltext; Milgrom, P., Weinstein, P., Heaton, L.J. Treating Fearful Dental Patients: A Patient Management Handbook. 3rd ed. Dental Behavioral Resources.Com, Seattle, WA; 2009; http://www.dentalfearcentral.org/; https://www.health.harvard.edu/blog/dental-fear-our-readers-suggest-coping-techniques-20100825327; 1. Moore R, Birn H. [Phenomenon of dental fear] Tandlaegebladet. 1990;94:34–41. [PubMed]

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

It's Children's Dental Health Month - Baby teeth matter!

It’s National Children’s Dental Health Month! Here are some facts about children’s teeth and tips for childhood tooth care:

 Baby teeth are important: Just because children lose their baby teeth, it does not mean “decay is okay.” Children need to have healthy, strong baby teeth to eat, speak, and smile.

Babies are born with their baby teeth already formed under the gums. This means that baby tooth care needs to start in infancy, before the teeth appear in the mouth! A baby’s gums should be gently wiped with a soft, damp cloth after drinking a bottle or eating. This gets baby used to his or her mouth being cleaned. As soon as the first little tooth appears, it can be brushed with a soft toothbrush using a tiny smear of fluoride toothpaste.

Gum pain gels are not necessary and

can cause a rare but life-threatening condition called methemoglobinemia. It is better to let baby chew on a cold cloth or spoon if “teething.” This should relieve baby’s discomfort.

Always use a separate spoon to test baby’s food. Caregivers and parents spread their own mouth’s germs this way. This is especially important if a caregiver has cavities or gum problems.

Never put baby to bed with a bottle with formula, milk or juice. Don’t let a toddler walk around with a sippy cup with formula, milk or juice. These drinks are for meals. The sugar in them can destroy baby teeth pretty quickly. Children should only drink water between meals.

Lift the lip to check baby’s teeth at least once a month. White spots or lines near the gums may be the start of cavities. Baby teeth should be smooth and all one color. White, brown or black spots indicates cavities. If the teeth are being wiped or brushed daily, this should not happen.

Children start to lose their front teeth at about 6-7 years of age, so those front permanent teeth coming in are obvious. Not so obvious are the first permanent molars that erupt in the back of the mouth around the same age. If daily brushing and flossing aren’t already being done, that can hurt those teeth!

Flossing, too? Yes. While baby teeth usually have space between them that the tooth brush can reach, sometimes they don’t.

As soon as “teeth touch” they should be flossed to remove plaque germs that grow in between the teeth.

Baby teeth fall out over time and kids still have some of them until they are 12-13 years old. Baby teeth hold the space for the permanent teeth coming in.

Cavities are the NUMBER ONE chronic disease in children, more common than asthma. A cavity is a bacterial infection in a tooth!

Dental pain affects a child’s ability to learn and thrive. Dental emergencies cost parents and kids thousands of lost school and work hours. (Emergency room visits for dental issues cost Americans over $1.5 billion dollars in 2012!)

The cost of an amalgam (metal) filling can be well over $100 dollars - depending on how much of the tooth surface is affected, it can be much more. Composite (white) fillings cost even more. If a tooth needs to be “capped” it can run into thousands of dollars! Compare that to the cost of a toothbrush, toothpaste and floss.

Dental decay is preventable! Unless there is an underlying medical condition, cavities are caused by not brushing and flossing and eating or drinking sugar too often. A well-balanced diet helps the mouth and the body to stay healthy!

Preventing childhood cavities is so important and easy to do but young children need a hand. Pediatricians and dentists recommend the first dental visit by age one and that children up until age nine should have help and supervision while brushing.

Brush Morning & Night chart - ym 2017

This information is not intended to treat or diagnose any condition. If you think you or a loved one needs medical or dental treatment, please see a doctor or dentist right away!

Sources: ADA.org, APA.org, ncohf.org

The Great American Smokeout, November 17, 2016

During the Great American Smokeout, held on the third Thursday of each November, the American Cancer Society asks smokers to quit even if just for one day. After 20 minutes of not smoking, heart rate and blood pressure decrease; after 12 hours, carbon monoxide levels in the blood drop. The longer a person stays smoke-free the more health benefits are gained.

image from cancer.org

Smoking also affects the mouth and teeth in very serious ways. 

Smoking increases risk for:

• oral cancer (cancer of the mouth)
• esophageal cancer (cancer of the throat)
• periodontal disease (gum disease that leads to bone loss)
• cavities
• tooth loss
• black hairy tongue (Google an image of it)
• dry mouth
• bad breath

Diseases caused by smoking and second hand smoke are preventable. Quitting, if only for one day, is the first step to better health.

For more information about The Great American Smokeout and how to quit smoking, visit:

http://www.cancer.org/healthy/stayawayfromtobacco/greatamericansmokeout/

cdc.gov, ada.org, cancer.org. This blog is not intended to diagnose or treat any condition. If you need medical or dental treatment, seek help from your doctor or dentist. If you smoke, QUIT!

And the survey says....

photo: YM

A recent survey of adults in the U.S. shows a knowledge gap when it comes to dental health. The survey, done for the Children’s Dental Health Project, asked 5 questions.

Among the findings, only 7% of adults correctly identified tooth decay as the most common chronic health condition affecting U.S. children and teens. Over 40% of adults felt they had little to no control over getting a cavity and only 18% stated that it was true that the bacteria that causes tooth decay can be transmitted from parents to their children.

While obesity and asthma are common childhood diseases tooth decay is more common, even though it is virtually completely preventable with regular oral hygiene and healthy diet. 

Additionally, 41% marked true that children’s teeth should be brushed starting at age 3 when in fact, baby teeth need to be cleaned from the time the first tooth emerges.

On a positive note, most of the adults surveyed recognized that the health of the mouth is important to the health of the rest of the body.

To view the survey visit the Children's Dental Health Project at: Survey reveals big gaps in the public's knowledge of dental health

				Survey reveals big gaps in the public's knowledge of den... As children’s and health organizations observe Children’s Dental Health Month, a newly released national survey conducted for the Children’s Dental Health Project (...
				View on www.cdhp.org	Preview by Yahoo

You are what you drink

Walk around with water

I was not surprised to read about a recent research study out of Australia that concluded "diet" beverages are bad for the teeth. Sugar has long taken the blame for contributing to cavities, and deservedly so, but sugar is not solely to blame. Plaque also has to be present because plaque converts that sugar into acid on the teeth.

While beverages like diet soda contain sugar substitutes plaque germs
can't use to make acid, these drinks themselves contain acid (usually citric, carbonic or phosphoric.) Acid, whether it is made by plaque or in the drink itself, will erode enamel.

It doesn't matter to teeth where the acid comes from. Sipping on an acidic diet drink all day, in terms of the affect on the teeth, is just as bad as sipping on a sugary drink. The only benefit of most diet drinks is the elimination of the sugar and there are many who would argue that sugar substitutes are just as bad for overall health.

Diet Soda - Phosphoric and Citric Acids
Photo: Y. Mikalopas

The best rule of thumb is this: Drink any drink that is NOT water with a meal. Otherwise, drink water. You can't go wrong with water because it is the only drink that is both sugar and acid free.

(Did you know that black coffee and tea are acidic - about a pH of 5, but that green and herbal teas are close to water, about a pH of 7.)

This blog is not intended to treat or diagnose any dental or medical condition - see your dentist or doctor if you need help!

Food Rewards

A teacher uses lollipops as incentive for bringing in "box tops." An autistic child is given fruit chews for sitting quietly. A dad gives his toddler M&Ms for using the potty.

Food rewards are a tempting way to get compliance in children but food based reward systems, whether used at home or in school, contradict what children are being taught and negatively impact their health.

Sugar is known to contribute to a host of health problems including obesity, diabetes and tooth decay. When sweet treats are used as rewards it not only undermines overall health it teaches kids that rewarding themselves with unhealthy foods is a good, positive thing to do. This isn't to say never have treats. Treats as part of a holiday or celebration, like a birthday, serve to reinforce that treats should be for special occasions only. Keeping sugar to a minimum in the daily diet just makes good health sense.

The World Health Organization now recommends that adults have no more than 6 additional teaspoons of sugar a day. (This amount refers to sugars in processed foods and not sugars found in fresh fruits and milk.) One teaspoon of sugar equals 4 grams. To calculate the number of teaspoons in a snack take the grams of sugar listed on the package and divide by 4.

Let's calculate the sugar from the above, real life, reward examples.

Lollipop (1) = 10 grams of sugar = 2.5 teaspoons

Fruit chews (.9 oz bag) = 11 grams of sugar = 2.75 teaspoons

M&Ms (1.69 oz) = 30 grams of sugar = 7.5 teaspoons

Good job!
 photo: Y. Mikalopas

These types of snacks are particularly bad for teeth as they stick to the teeth and are eaten over an extended period of time. (For more on how sugar causes cavities, read my posts: "Sugar - just say 'no'"  http://bit.ly/1MHrPlS and "Less is More" http://bit.ly/202djij)

If a reward for good behavior or achievement is necessary there are other good alternatives. Stickers, art supplies, or small toys may be used instead of food treats, as well as activities like reading, music, or activities of the child's choosing.

What do you think about using food rewards for kids? I welcome your comments.

For more ideas on rewarding kids without using food visit: http://healthymeals.nal.usda.gov/hsmrs/Connecticut/Food_As_Reward.pdf

Additional source information: http://www.cnpp.usda.gov/sites/default/files/nutrition_insights_uploads/Insight52.pdf;

http://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/

This blog is not intended to diagnose or treat any medical or dental condition. If you need medical or dental treatment please see your doctor or dentist.

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.