Creating Healthy Smiles, One Smile At A Time

Monthly Archives: January 2014


One of the hottest new techie devices out on the market  these days is an ‘intuitive’ high tech self-programmable thermostat called “The Nest”.  This thermostat through a motion sensor learns one’s habits – when you leave your home, when you return, when you go to bed, when you wake up etc…. and adjusts the temperature in your house accordingly. You don’t have to think or manually adjust the thermostat yourself.  Fabulous for those of us who don’t practice Yankee thriftiness or have children and siblings who don’t share your passion for saving a few bucks.

What does this have to do with dentistry?

Well, there is a new toothpaste dispenser recently introduced from the folks at “Elevate Oral Care” who have re-engineered the old-fashioned toothpaste tube (a little like the old fashioned adjust it yourself thermostat) and designed a new one (like the new “Nest”) which JR BB_500automatically ensures that you dispense the correct amount of toothpaste for your 2-6 year old. Their promotional material reads “With a single push of the Just Right pump, your 2-6 year old child will get the AAPD recommended pea-sized dose”.  The perfect amount without having to think. A little like the right amount of heat without having to think.

FYI – while fluoride in toothpaste is fantastic at preventing cavities, too much of a good thing is not good.  Excessive (and we mean excessive!) use or swallowing of toothpaste can lead to a variety of dental problems including fluorosis.  Fluorosis manifests itself as staining on permanent teeth which can vary from barely visible white blemishes, to large unesthetic brown staining.

In making recommendations to parents, we follow the guidelines of the American Academy of Pediatric Dentistry which suggest the following:

– For toddlers who are teething, under 2 years of age, and have healthy teeth, use a non-fluoridated “training toothpaste”.  All that is needed is a ‘smear’ of the toothpaste (see picture below; smear is on left, pea size on right). Any more is excessive, and though it is safe to swallow since there isn’t any fluoride, it’s probably not a good idea to swallow a lot of whatever else is in this ‘training toothpaste’.


– For toddlers under 2 years of age who have cavities (and yes this happens), a ‘smear’ of fluoridated toothpaste is recommended.  In this case, even if they swallow some of the toothpaste, it shouldn’t be a worry.

– For children between 2 years and 5 years, we recommend a pea sized amount of fluoridated toothpaste.

– Once children are able to rinse and spit on their own, then you can increase the amount of toothpaste used to perhaps the size of 2 peas.  Any more is really not necessary.

The “Just Right” pea sized dosing sounds like a good idea, especially since it has been shown that despite dentist’s verbal instructions, most individuals don’t dispense the proper amounts. The manufacturer claims that one tube (Retail price $6.95) will last a full 6 months.  And the flavors of Berry Blast and  Freaky Fruit sound child friendly though we have yet to sample any on our own.

All in all, a great idea for parents who don’t want to worry about their child using too much toothpaste.  Like “The Nest” heating system, you don’t have to monitor toothpaste usage.  Unlike “The Nest”, you’ll probably have to remind them to brush.




As dentists, we are constantly asked about the best diet to prevent cavities.  As a rule of thumb, any food type (especially sucrose/simple sugars) which sticks to your teeth, and gets broken down by saliva into fructose is bad.  Fructose is broken down by streptococcus mutans (see our last post about this pesky bacteria) which ultimately leads to cavities.  A lot of the processed foods that line our supermarket aisles are high in sucrose and there is some thought that it is our current day diet which is responsible for the high caries rate in children.

The latest diet du jour is the paleo diet which attempts to mimic the diet that our neanderthal  ancestors ate – ie. wooly mammoth, plants and other now extinct animals.  The thought is imagesthat the ills of modern society such as hypertension, obesity, high cholesterol, heart disease and even cavities can be cured if we all ate as our ancestors did and avoided refined sugars. (See our earlier post “Why a Paleolithic diet may be good for your teeth and overall health” – yes, we do have a thing for cavemen)

Well, along came a 12-15,000 year old skull which has caused some scientists to rethink this. Because apparently, even cavemen and cave women on a paleo diet got cavities.

It doesn’t take a dental degree to recognize the presence of cavities and missing teeth in this picture featured below.  If you need help, the cavities are the big and not so big holes in the teeth.


Below is an exerpt from a piece on NPR which reported this news.  Fascinating stuff.

Looks Like The Paleo Diet Wasn’t Always So Hot For Ancient Teeth

January 06, 2014 3:22 PM

One of the hinge points in human history was the invention of agriculture. It led to large communities, monumental architecture and complex societies. It also led to tooth decay.

When hunter-gatherers started adding grains and starches to their diet, it brought about the “age of cavities.” At least that’s what a lot of people thought. But it turns out that even before agriculture, what hunter-gatherers ate could rot their teeth.

The evidence comes from a cave in Morocco — the Cave of the Pigeons, it’s called — where ancient people lived and died between 12,000 and 15,000 years ago. These were hunters and gatherers; they didn’t grow stuff. And what was astonishing to scientists who’ve studied the cave people was the condition of their teeth.

“Basically, nearly everybody in the population had caries,” or tooth decay, says Louise Humphrey, a paleo-anthropologist with the Natural History Museum in London.

Humphrey says 94 percent of the more than 50 people from the cave she studied had serious tooth decay. “I was quite surprised by that,” says Humphrey. “I haven’t seen that extent of caries in other ancient populations.”

Certainly, life was brutal and short for Stone Age folks, what with saber tooth cats, parasites, and not an aspirin to be found anywhere. But at least the paleo diet — meat, tubers, berries, maybe some primitive vegetables and very few carbs— was supposed to be good for the teeth. Carbohydrates can turn sugary in your mouth, then bacteria turn that into enamel-eating acid.

But apparently, these ancient people had a thing for acorns.

“Acorns,” says Humphrey, “are high in carbohydrates. They also have quite a sticky texture. So they would have adhered easily to the teeth.”

Yes, these people did eat meat. And snails, apparently, whose shells littered the cave. But they also ate a lot acorns, judging by the debris they left behind.

Without toothbrushes … without dental floss … that diet rotted their teeth.

Eventually, the tooth crowns wore away, says Humphrey: “They were eating on the polished roots of their teeth. I think they would have been in pain.”

Humphrey says this is the earliest case of widespread dental caries ever seen, by thousands of years. It contradicts the idea that agriculture ushered in tooth decay, and that the so-called “paleo diet” is inherently healthy, she says.

When it came to cuisine, she says, paleolithic people were simply opportunistic. Some elements of the ancient diet were good; others were not.

“There’s not one kind of paleo diet,” Humphrey says. “I think wherever people lived, they had to make best of the wild food resources available to them.”

In this case, Humphrey believes, ground acorn patties. She hasn’t tried them herself, but she plans to.

“I would like to,” she says. “I imagine that they would be something like sweet chestnuts.”

Kind of like the Twinkies of the paleolithic.


Once upon a time,  I participated in a research study looking at the effect of long term antibiotic usage on the level of streptococcus mutans in the mouth.  In fact, my research was published in Pediatric Dentistry, the official research journal of the American Academy of Pediatric Dentistry.  Guess that makes me a published author.

My full paper (shameless plug) in Pediatric Dentistry is here:

 Streptococcus-mutansS.mutans is the primary bacteria found in all of our mouths and has been scientifically correlated with the development of cavities.  If you have high levels of s.mutans, you have a high likelihood of developing cavities. In fact, you can even blame your parents for this pesky bacteria.  DNA studies have shown that s.mutans is passed from parent to child through the inadvertent exchange of saliva, such as through the sharing of utensils or drinking from the same cup.

For those of you short on time,  let me summarize the paper. Our study was able to conclude that long term use of penicillin leads to a decrease in amounts of s.mutans, and a concomitant  decrease in the number of cavities developed.

I bring this up because just the other day, I saw an interesting article  on the use of a probiotic mint (like probiotic yogurt) to help prevent cavities.  German researchers laced some mints with some ‘good’ bacteria (Lactobacillus paracasei)  which essentially prevented free floating ‘bad’  s.mutans in saliva to bind to teeth surfaces.  They found that sucking on a lactobacillus mint for 10 minutes leads to a significant decrease in the amount of s.mutans.

Before one gets too excited, other researchers point out that in order to cut down on cavities, you have to eliminate s.mutans at its source, and that would be on the actual tooth surface, something that the probiotic mint does not appear to do.



The microbiome which inhabits our bodies is the latest hot area in basic science research.  It is both fascinating and a little disturbing to think that our bodies are simply vessels for billions of microscopic bacteria, fungi and viruses. That being said, research in this area is introducing new ways of thinking about disease.  Research never moves in a straight line, but rather, swerves from a shot in the dark ideas, to good ideas that never quite pan out, to ideas that can take years to become therapeutically practical.

Meanwhile, more research is needed to see if adjusting our mouth’s microbiome can lead to the elimination of dental caries, or is simply an exercise in futility.  We must tread carefully.  After all, bacteria are pretty adaptive, have an uncanny ability to mutate, and there are always unintended consequences that we may not have even thought of.

Then again, there’s really no downside to sucking on a mint (probiotic or not).  After all, sucking on a mint produces saliva,  which in of itself, helps prevent cavities.  There’s a reason restaurants offer mints after a meal. Maybe in the future, they will be teeming with ‘good’ bacteria.


Link to NPR article is below: