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.

Tooth Whitening - It takes all types

Charcoal, anyone?
(photo: Y. Mikalopas)

Often a bright white smile can be obtained simply by brushing and flossing regularly, but even people with good hygiene habits can still be unhappy with the color of their teeth. Factors such as age, heredity, medications, coffee, tea or wine drinking, and habits like smoking can cause teeth to be dull or yellow looking. External stains can usually be removed during regular dental cleanings while internal stains cannot. It is important to look at the reasons why the teeth are stained or discolored, any dental conditions that may be present, cost factors, and the level of whiteness one wants to achieve. There are also several “natural” or “home” remedies that range from the practical, to the strange, to the doubtful. At the end of this post I discuss one I recently tried for myself.

Professional whitening in the dental office is perhaps the best way to get that bright “Hollywood” smile. But there are several things to consider. Staining caused by inherited conditions or some medications, will not respond even to professional treatment. In that case bonding or veneers may be needed to whiten the teeth. Existing bonding and caps or crowns will also not usually respond to whitening treatment. People with recessed gums or sensitivity may have increased tooth sensitivity after whitening treatment. 
Treatments may also take repeated visits and can be expensive.

If time and money is an issue (when isn’t it?) your dentist may suggest whitening trays. These trays, along with professional grade whitening gels can be used at home as needed and instructed. Often these products will come with a desensitizing gel to be used along with the whitening agent to decrease or eliminate sensitivity. 

Professional grade whitening strips can also be ordered through most dental offices. These strips contain a higher amount of the whitening agent than usually found in over the counter products.

For patients who are already sensitive due to gum recession or other reasons, whitening may not be appropriate at all. Let’s face it – it is better to have teeth that are not sparkling white than teeth that hurt. For others, a good place to start is with the over the counter strips while using a desensitizing toothpaste (like Sensodyne.) Strips are available that can be worn from 10 to 30 minutes for a period of days, usually about two weeks.

Another way to brighten the smile is with the use of everyday products you may already have around the house. Swishing a couple of times a week with diluted hydrogen peroxide (half water, half hydrogen peroxide) can help whiten the smile. The active ingredient in whitening agents is a form of hydrogen peroxide and at about $1.00 a bottle, this is a very cheap alternative. (The whitening effect was first noticed in patients with periodontal conditions who were asked to rinse with hydrogen peroxide as part of their therapy.) Always check with your dentist or dental hygienist first, however, to review any dental or medical conditions you may have.

Baking soda (sodium bicarbonate) is a mild abrasive which may help to remove external surface stains and can also be used a couple of times a week. Just dip your toothbrush in a little of the powder, with or without toothpaste, and gently brush the teeth. This is not recommended for people with medical conditions like high blood pressure as baking soda contains sodium.

There are a host of other whitening remedies I have read about and been asked about. Some are harmless – like applying a thin layer of Vaseline on the teeth to make them look shiny (an old technique from the modeling world.) Others are more questionable, like pastes made with fruits such as strawberries or lemons. Because fruits also contain sugar, it is not recommended that they be applied to the teeth for whitening, especially if there are any other existing dental conditions like recessed gums, bridgework, or active cavities. Sugar causes the germs that live in the mouth to grow and make acid on the teeth, which can cause cavities.

Oil pulling with coconut or other oils has also been touted as a whitening remedy and while not necessarily harmful, has its downsides. “Proper” oil pulling needs to be done for a minimum of five minutes at a time and claims that it is a substitute for brushing or flossing have not been supported by hard research. (See my post on oil pulling here: http://mydentalhygienist.blogspot.com/2014/08/oil-pulling-fab-or-fad.html )

Charcoal tablets, anyone? 

(photo: Y. Mikalopas)

Charcoal tablets which are sold in stores as an antacid are also rumored to be useful in reducing stains on teeth. I  purchased a box  for about $4 and after reading up on a couple of different methods, I opened several tablets and, using a toothbrush, applied it to my teeth. A "volunteer" I enlisted used another method and simply chewed on the tablets. While using charcoal is not harmful, it was a complete mess. The charcoal, once on the teeth, was difficult to get off the teeth as well as the gums. The stain removal benefits may be in the amount of brushing it takes to remove it!

Do you have questions about whitening techniques? What techniques have you used or heard about? I welcome your comments and questions.

Please see your medical or dental professional regarding any conditions you may have. This blog is not intended to treat or diagnose any condition.

National Dental Hygiene Month, October 2015

Floss, Brush, Brush (photo: Y. Mikalopas)

October has many, many, specially designated days and weeks but is probably most notably known as Breast Cancer Awareness Month - if you haven't noticed all the pink ribbons and products around, open your eyes. October is also National Dental Hygiene Month and for six years, the American Dental Hygienist Association and Wrigley, the gum company, have together promoted good oral health habits during this month. While Wrigley's does have gum brands that are sugar-free they also have plenty of products that contain sugar, are very sticky, and not anything that someone should eat if they want to have healthy teeth. I kind of feel about this the way I feel about wine companies promoting breast health by putting pink ribbons onto their bottles and the way I feel about tobacco companies making donations to smoking cessation programs. Having said that, the American Dental Hygiene Association is a wonderful group of very dedicated professional hygienists who are very passionate about people taking care of their teeth to have healthy mouths and live healthy lives. I am proud to be a member. So this
month take a few minutes every day to "Do the Daily 4"- Brush, Floss, Rinse, Chew. I'll be happy if you do the "Terrific Two" - brush two times a day for two minutes and floss once daily. And remember, the more you do at home, the less your hygienist has to do when you are in the chair!

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.