Creating Healthy Smiles, One Smile At A Time

Tag Archives: cavities

 

csax2wgusaecbkf

I happened across a great article  in the New York Times (readers of this blog may have come to the realization that I’m an avid reader of this publication) that sang the praises of the dental sealant.  It still comes as a shock to me to  hear of members of my own profession who still don’t place sealants on a routine basis.  At our practice, most of our patients have sealants placed; the rare instances when we elect not to place them are for patients with extremely shallow grooves,  easily cleaned teeth and a history of no cavities.  Otherwise, we are HUGE believers in the value of sealants.

Consider this – most members of the Silent Generation, and even Boomers have a mouthful of fillings, crowns, implants, partial dentures and even full dentures.  One of the unheralded medical discoveries of the past century, was that of fluoride, and it’s role in the prevention of dental cavities.  In fact the Centers for Disease Control and Prevention public-health-in-oklahoma-13-728(CDC) named the fluoridation of drinking water as one of the Ten Great Public Health Achievements in the 20th Century.  And its impact has been seen in the substantial decline in dental disease in both the USA and around the world.  However, there are still pockets of resistance in certain population groups (ie. low income communities, individuals with poor access to dental care) where dental caries is still prevalent.  Surveys by the CDC show that 21% of children between 6 and 11, and 58% of adolescents have had cavities. So there is still work to be done in decreasing caries especially among the younger members of our population.

fissure_sealant2That’s where sealants come in.  Sealants are a plastic-like tooth colored coating which is easily applied, fills in all the grooves and pits of a tooth where food tends to stick, is cost effective, and has been shown in countless studies to prevent cavities. Where fluoride works well in preventing what’s known as smooth surface (parts of the teeth that are smooth such as in between teeth) caries, it is less effective for preventing caries in the pits and fissures of teeth.  It is these areas that are found to disproportionately develop cavities in the teeth of adolescents. And that’s exactly where sealants do their anti-cavity work.

I won’t bore you with the numbers, but the takeaway from the Cochrane  study (which looked at 34 well designed sealant studies involving 6000 plus children/adolescents) is that in a population of cavity-free children with a 40% chance of getting a cavity in the next two years without sealants, application of sealants would reduce the rate to just 6%. (For those interested in more scholarly evidence, click here.)  Admittedly not zero, which is every dentist’s goal but pretty darn close.

If Evidence-based dentistry is the use of current scientific evidence to guide decision making in dentistry, one should clearly be a believer in the important role sealants play in reducing cavities.

We believe!

 

 

 

 

 

 

 

Advertisements

prosadvantage2

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.

shutterstock_90529192

Child patient with cavities in front teeth treated with SDF

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.

Stay tuned!

(Click here for a recent New York Times article on this issue)

 

 

 

 

 

 

 

 

 


drinks

What do Powerade, Gatorade, Vitamin water, Lemonade, Energy drinks, Snapple and Sprite have in common?

They are all cavity causing if one consumes these popular  drinks in large quantities.

Most people intrinsically realize that soda is bad for their teeth.  The average middle school student (or at least my kid) has done the baby tooth in a cup of soda experiment, so in general most of us recognize that carbonated sugar water is highly acidic and can lead to one’s tooth slowly dissolving away.

A recent article in the Journal of the American Dental Association explores this even further, investigating the pH of hundreds of beverages.  pH as one may recall from chemistry class, is a measure of acidity or alkalinity of a solution.  Low pH (less than 4.0) can lead to the destruction of tooth structure even in the absence of cavity causing bacteria.  In short – acidity in drinks is not healthy for your teeth.

It might come as a surprise to a lot of people that there the vast majority of commercially available drinks such as sports drinks, vitamin waters, and  ‘healthy’ fruit juices have very low pH’s.

The most acidic beverages tested (all with a pH less than 2.4) were lemon juice, RC Cola, Coca-Cola Classic, Coca-Cola Cherry and Pepsi.

And the least ‘acidic’ beverage tested? Municipal water from Birmingham, Alabama which at a pH of 7.2 proves that when it comes to healthy teeth, water is the way to go.

For your viewing pleasure, here are tables taken from the actual article (Reddy, Avanija, Don F. Norris, Stephanie S. Momeni, Belinda Waldo, and John D. Ruby. “The PH of Beverages in the United States.” The Journal of the American Dental Association 147.4 (2016): 255-63. Web) showing the tested pH levels of most drinks from on the shelves of our grocery stores.  Take a look and see where your favorite drink fits in.

 

 

 

Screen Shot 2016-04-18 at 8.45.01 AM

 


plaquehd-tube

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 Heavy-Plaque-on-Patient-with-Bracesones) 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.

Hoffman02-During(small)

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.

 


image

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 pullingCoconut-oil 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.


CHEDDAR_SOFT-FOCUS_525x350

One never ever hears of a mouse developing a cavity.  That may be because they either never do in fact get cavities (ie. their teeth are somewhat resistant to decay) or that the NIDH (National Institute of Dental Health) has determined that federal funding for research is better off spent in other areas.

Or maybe it’s because they like cheese.

Let me explain.  A May/June 2013 article in General Dentistry, the peer reviewed journal of the Academy of General Dentistry (aka a pretty reliable source) found that cheese changes the pH of the oral environment, suggesting that it may imagehelp reduce the risk of tooth erosion.  If you remember High School chemistry, an increase in pH means the environment is less acidic. Studies have shown that a pH of over 5.5 lessens the chance of tooth erosion, and hence also cavities.

The study, which examined 68 subjects between the ages of 12 and 15, divided these subjects into 3 separate groups and tested their pH levels both before and after their consumption of sugar free yogurt, milk or cheddar cheese.   They found that a rapid rise in oral pH levels was found only in individuals who had consumed the cheese.  This could be because that the very act of chewing stimulates saliva production which in of itself causes a rise in pH.  The authors also hypothesize that there are compounds in cheese which adhere to teeth and are anti-cariogenic in effect.  What these ‘compounds’ are is unclear.

Further google sleuthing by us here at Dentistry For Children, did find that mice can indeed develop cavities. None other than the most famous mouse of all has had to seek out dental care, as shown by this 1938 sketch titled, “Mickey’s Toothache”.  We particularly enjoyed the animators portrayal of the dentist as a  bearded, one legged and saw wielding fellow, though we do take issue with the saw.

Mickey_Mouse_Toothache

The takeaway from this sketch is that at least in Walt Disney’s mind, mice can get cavities and that dentists are kinda scary. Fortunately, we now know that if Mickey had stuck to an all Cheese diet maybe he would have had a fighting chance of having a cavity free life.


I was reading the newspaper the other day and saw an interesting article that discussed how as a society, we are reading a lot less.  In fact, most of us just skim the headlines and never read the body of the text (if you’ve gotten this far, well done).  Teens take it one step further – they don’t even bother reading, instead they instagram one another with photos as a means of creative expression.

The most popular posts on social media sites are those that don’t require much reading.  So here’s our somewhat “Wordless Wednesday” post of an interesting poster.

Click here if you are having trouble viewing this poster: http://tiny.cc/c5kxgx

(Credit goes to Erin O’Donnell of the Boston Globe)