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.
So the super geeky, jet propulsion lab, MIT wanna be, engineering side of my personality (isn’t there an engineer in all of us?) was fascinated by this video produced by google engineer Ben Krasnow, which in illuminating, exhaustive detail shows the effects of brushing on the bristles of a toothbrush. Google is famous for it’s search engine, but a little known fact is that Google engineers are encouraged to spend 20% of their time to work on things that personally interest them (and which may have an application for Google). Apparently, engineer Krasnow has a fascination with microscopes and toothbrushes. And so do the 280,000 who have viewed the video.
It is common knowledge that one should change a toothbrush every 3 months. Ben’s project showed that after 3 months when viewed through a scanning electronic microscope, the bristles on the end of your toothbrush are worn smooth. In order for brushing to be effective, the tips of the bristles need to be ‘microscopically’ rough which not only aids in abrading away plaque but increases the surface area of the bristle contacting the tooth.
Ben also scans toothpaste, specifically looking at the coarse grains of di-calcium phosphate di-hydrate which is in toothpaste, and which acts as an abrasion agent to aid in the cleaning of teeth. Think baking soda or sand. These grains are 20 microns in diameter, similar to 600 grit sandpaper which is actually surprisingly coarse. He does reveal that in a pinch, one can use toothpaste to clean dirty car headlamps.
The video which is over 8 minutes in length is a nerdy scientist’s dream and is appropriate for anybody who enjoys watching detailed explanations of how things work. It is full of words like zoom ratio, vacuum desiccation, aspect ratios and silver vaporization. I give it a strong 2 thumbs up.
If you need a good excuse to change your toothbrush after 3 months, I highly recommend this video!
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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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 automatically 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.