What if you, as a parent who has a very young child with a cavity, is told that instead of a 30 minute long appointment consisting of the dreaded shot, drilling, and no small amount of drama, that we could very simply, in less than a minute paint a magic substance on your child’s cavity, and voila, cavity is taken care?
Well, what if we told you that such a substance has been used in Japan for the past 80 years, can apparently basically ‘freeze’ cavities in place eliminating the need for placing a filling, and that the cost of such treatment is fairly low. Sounds good doesn’t it?
That magic substance is Silver Diamine Fluoride (SDF). It is a colorless liquid consisting of 24-28% silver and 5% fluoride. The FDA recently approved this for use as a cavity varnish placed on enamel to reduce tooth sensitivity. Though it hasn’t been technically approved for use in the treatment of cavities, some dentists have started using SDF ‘off-label’ (which is allowed) for management of the aforementioned cavities.
As we alluded to in the introduction, the dentist simply dries the tooth with the cavity, swabs a small amount of the SDF liquid on the tooth, allows it to dry (1-2 minutes), and you’re done – the cavity is arrested (which means it kills the bacteria causing the cavity, hardens dentin, and promotes re-mineralization or hardening of the surrounding enamel).
Of course, as with any treatment option, there are some downsides to this treatment. The most significant is that any tooth treated with SDF will turn black in color. To be completely fair, only the cavity turns black, but when we say black, we mean BLACK. Not a slight discoloration, or graying. Black.
It also requires multiple applications for complete success, cannot be used in individuals who have silver allergies, can cause irritation to gum tissue, and has a slight metallic taste when first applied.
While SDF has been used for decades in not only Japan, but also Brazil, Peru, Australia, Thailand and a slew of other Asian countries, studies looking at its efficacy, and safety in the U.S. are limited. To date, there have only been 14 reputable studies on SDF; 7 of which have been completed, 5 that are recruiting, and 2 that have not yet begun recruiting.
Despite it’s drawbacks, there is probably a place for SDF in dentistry. Patients who are unable to tolerate extensive or any dental treatment such as the very young, very old, and/or medically compromised seem like candidates who would benefit from this very non invasive treatment. However, it needs to be understood, that this is not a cure for cavities – it is simply managing a disease process until such time that more definitive treatment (ie. filling, crown) can be completed. Furthermore, more research need to be done around issues of effectiveness, long term safety and treatment protocols.
(Click here for a recent New York Times article on this issue)
We’re always on the lookout for the latest in dentistry, and this newish entry to the world of burgeoning oral health products caught our eye. Developed by an orthodontist, it is a patented disclosing toothpaste (Plaque HD) which is designed to help patients with braces to brush better.
One of the greatest challenges when it comes to braces (especially the traditional metal ones) is brushing. Food and plaque tends to build up very easily, causing significant gingivitis to the point where the gums can grow over the braces and cover one’s teeth completely. This can also lead to extremely significant cavities, the cost of repair approaching the cost of the braces themselves. We’re talking thousands of dollars. Gulp!
But how does one know that you are doing an adequate job? For our younger patients who don’t brush well, we give out disclosing tablets (there are also mouth rinses). These tablets, which are chewed after an initial round of brushing, get incorporated into plaque that hasn’t been brushed off, turning these areas pink. Hence, one can actually see the areas that are being missed, and can go back and brush the pink off. Aside from a great educational tool, it is great fun for the kids to see their teeth turn pink.
Plaque HD incorporates this disclosing agent in their fluoride cavity preventing toothpaste. Instead of pink, it turns teeth green in areas that haven’t been brushed well (ie. plaque is accumulating) and serves as a visual cue for patients to go back and brush in those areas. The benefit of this toothpaste is that it’s a one step process – simply brush, look for green areas and then brush again until removed.
This is a fabulous idea that is a long time coming. It’s applications are not limited only to patients with braces but can be used by anybody who brushes poorly. It is a vast improvement from the traditional disclosing tablet route which is more labor intensive, messy and takes more time. The toothpaste retails for $21 (direct to consumer) which may seem like a lot, but keep in mind that even one small white composite filling costs significantly more. Think of the toothpaste as an investment for not only a beautiful smile, but a healthy one. We think this is a win-win for all.
Oops….Sorry about our earlier email blast which sent out a post of ours that we’re working on but which is still decidedly under construction. To make up for that, hopefully, these pictures of us celebrating Back To The Future Day (October 21st, 2015) will allow us to go back in time, and take back our email (or at the very least show you that pediatric dentists know how to have fun).
If Gwyneth Paltrow does it should you?
One of the hottest trending items found out there in the twitterverse and social blogging world, is the practice of ‘Oil pulling’ (swishing oil in the mouth) which is purported to have numerous systemic and oral health benefits. If you google ‘Oil pulling and teeth’ you will find more than 2 million search results discussing the oral health benefits of swishing sesame, olive, sunflower or coconut oil. Oil pulling claims to prevent tooth decay, halitosis, gingivitis, throat dryness, and cracked lips. Some practitioners of the practice also think it helps whiten teeth and aids in the strengthening of teeth, gums and the jaw.
The practice of oil pulling has its roots in traditional Indian medicine. It is mentioned in the Charaka Samhita, one of the key texts in the practice of Indian medicine known as Ayurveda. Ayurveda is a holistic system of natural healing which evolved in India some 3000-5000 years ago, a system of traditional medicine native to the Indian subcontinent, now practiced in other parts of the world as a form of complementary medicine. It is a complex and individualistic form of medicine which carefully prescribes different forms of therapy depending on the individual. “Oil pulling” is but one part of this traditional medicine, and besides from it’s oral benefits, it is claimed to cure about 30 systemic diseases ranging from migranes to diabetes and asthma, weight loss, clear skin and improved kidney function.
“Oil pulling” involves placing a tablespoon of your edible oil of choice in your mouth, then sipping, sucking and pulling between the teeth for up to 20 minutes or longer. The exact mechanism of the action of oil pulling therapy in the oral cavity has not been clarified. It is thought to prevent plaque from binding to teeth by inhibiting bacterial adhesion and plaque co-aggregation. It may also have a ‘soap-like’ action (or saponification) which can prevent inflammation and bacterial infection.
It is not clear why this traditional method of dental care has suddenly become such a darling of the social media world. Aside from celebrities and alternative/traditional medicine espousing it’s benefits, there has been relatively little in the way of critical, scientific peer reviewed studies done to either support or refute these claims. The few studies (mostly published in Indian Journals) that are regularly quoted by believers in ‘oil pulling’ have clear limitations. The American Dental Association found the following – “Existing studies are unreliable for a number of reasons, including the misinterpretation of results due to small sample size, confounders, absence of negative controls, lack of demographic information , and lack of blinding. To date, scientific studies have not provided the necessary clinical evidence to demonstrate that oil pulling reduces the incidence of dental caries, whitens teeth or improves oral health and well being.”
Evidence based medicine differs from Google based medicine, in that recommendations and guidelines are typically drawn from a large body of peer reviewed studies and committees which methodically, and some would argue very slowly, sort through the data before coming to a consensus opinion. While we all hope for a magic pill to cure cancer, or even a simple ‘natural’ way of preventing cavities, one needs to be patient when analyzing new alternative/holistic therapies. Our recommendations to all of our patients is based on sound scientific principles and demonstrated clinical safety and effectiveness – “Oil pulling” has yet to meet these critical standards, and hence, we would be hard pressed to recommend this practice for our own patients. As they say in the scientific world, more research is needed.
I guess it comes down to who you believe – movie stars make great movies, but I’m not sure I’d go to them for dental advice.
The American Dental Association recently revised their guidelines over the use of fluoridated toothpaste for infants under the age of 3. Now all children, regardless of age (yes, even little teething infants) should use fluoridated toothpaste. It all comes down to the important question of how much.
We are all familiar with the dozens of non- fluoridated training toothpastes available at your local CVS. Many parents, based on labels that they might have read on fluoridated toothpaste tubes, might have assumed that children under the age of 2 shouldn’t be using fluoridated toothpaste at all. Hence, the profusion of training toothpastes.
A study in this month’s Journal of the American Dental Association concludes that an ‘appropriate amount’ of fluoridated toothpaste should be used by all children, regardless of age. The ‘appropriate amount’ of toothpaste for a child under 3 is no more than the size of a grain or rice (a ‘smear’); for children 3 – 6 years of age, a pea sized amount is appropriate (picture below shows a ‘smear’ on the left, pea sized on the right).
The American Academy of Pediatric Dentistry has recommended for years now that all children under the age of 3, who are at risk of developing cavities, use a smear of fluoridated toothpaste twice a day. The American Dental Association has finally agreed with this stance. There has been an abundance of caution over ensuring that children are not taking in too much fluoride (thereby putting teeth at risk of fluorosis), but the latest systemic review of studies have shown that from a risk/benefit standpoint, use of a fluoridated toothpaste is warranted as soon as the first tooth erupts.
Turns out, the problem is not the fluoridated toothpaste, but the amount that is used. Parents should be dispensing the toothpaste for their children and monitoring use. They should be telling their children to spit out any toothpaste, but in the case of young infants, one should not worry if they are swallowing any or all of the toothpaste dispensed.
It will be interesting to seen what impact this will have on the many brands of training toothpastes that one can find. My sense is that this new recommendation will take time to flow through to the general public. Old habits die hard.
The moral of the story is that as soon as a tooth grows in, use a fluoridated toothpaste but only a smear!
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