The NobleDentist Blog

This is an article published recently in the Toledo Blade (American Article).

Some Americans were skeptical when reports first suggested a link between gum disease and other ailments. But more and more dentists are asking patients questions about their overall health.

And although more research is undoubtedly needed, there is one very telling sign that the dentists are on the right track: Increasingly, insurance companies are paying close attention to these findings and urging their clients to take advantage of dental benefits.

It’s no secret that when money is tight, many families put off regular visits to the dentist. But there is growing evidence that this is a false economy. Scientists have already linked gum disease to other aspects of poor health. Their discoveries are enough to make even those most faithful about brushing and flossing want to do more.

Researchers believe there’s a connection between periodontal disease and heart disease, diabetes, and respiratory illness. They are also looking at possible links between gum disease and oral, colon, cervical, lung, and stomach cancers. Several pregnancy-related problems are also believed directly affected by gum disease, from infertility to pre-eclampsia, and premature and low-birth birth-weight infants.

That’s why dental assistants these days are apt to check a patients’ blood pressure and want to know about the patient’s personal and family illnesses. Good oral hygiene, it seems clear, helps improve overall health. It’s especially significant when an insurance giant like Aetna, together with Columbia University College of Dental Medicine, announces that the overall medical costs of patients with heart or vascular disease or diabetes dropped when they got early and regular dental care.

Clearly, good dental hygiene has far more benefits than a mouth full of pearly whites. That’s why those twice-yearly trips to the dentist should stay high on families’ priority lists.

This is an article by Dr Karl Kruszelnicki that was published recently on the ABC -Great Moments in Science.

You might not think about this very often, but there’s a very clear demarcation line between doctors and dentists. Doctors “own” all of your body – except for the 32 little white things in your mouth, which “belong” to the dentists, and about which doctors know hardly anything. And that’s why, when I went to see my dental surgeon to find out about the pain in my gums, I was very surprised to find that the health of your gums can affect your overall health.

The outside of your teeth are covered with the hardest material in the body – enamel. Enamel is dead. But immediately underneath the enamel is “dentine”, a living material similar to bone. And in the very centre of the tooth is the “pulp”, which has cells, a nerve and various cells – the pulp nourishes the dentine, and keeps it alive. Now while the tops of the teeth are fairly flat, at their bases they each have roots, which reach down below the gumline. And finally, bundles of fibres join the gum to the roots of the tooth. So that’s your Tooth Anatomy 101.

Periodontitis is a disease of the gums where pockets form between the tooth and the gum, and bacteria living in these pockets, leading to collections of pus. Pus is a mixture of living and dead bacterial cells, and your own dead immune system cells. So now there’s a gap, a pocket, between the tooth and the gum, filled with pus. Sometimes these pockets are very shallow, but sometimes they penetrate deeply to the very roots of the tooth. The bacteria can eat away the bone of the gum, threatening the life of the tooth.

If the pocket is 1-2 mm deep, and there is no bleeding, that’s not a real worry. If the pockets are 3-4 mm deep, they may need regular dental cleaning. But if they are 5 mm deep, then the tooth is in danger, and dental surgery is needed. And if the patient has diabetes, or is pregnant, more care is needed.

But periodontitis is not just a local disease – it can affect parts of your body way beyond the mouth.

My dental surgeon previously held a position at a hospital that did all kinds of transplants – kidney, lung, liver and heart. He told me that each of these transplant operations had its own specific failure rate. He said that when he treated periodontitis in patients who were scheduled for heart transplant surgery, the failure rate halved. The transplant surgeons and my dental surgeon weren’t 100% sure why, but they guessed it was related to the patients having a collection of pus near the roots of the teeth. Presumably the pus was periodically releasing a shower of bacteria in the blood stream, which the patient’s immune system would then have to go and mop up as best it could. In the short term in transplants patients, the bacteria could infect the transplanted organ, making it fail. Removing the pus improved the success rate of the transplant operations. This fitted in with a saying that I learnt in surgery was, “If there is pus about, let it out” – in other words, remove it.

But look at the long term, say months or years, in an otherwise-healthy population. If showers of bacteria from the periodontitis spray into the blood stream every few hours, this would weaken their general health, and some of the bacteria would sneak past the immune system and set up house somewhere in their body.

So infected gums can negatively affect the linings of the arteries throughout the bodies, thereby setting the patient up for later cardiovascular disease. Periodontitis is also associated with preeclampsia, a life-threatening disease of pregnant women in which the blood pressure rises catastrophically. It’s also associated with premature delivery, diabetes, osteoporosis, some cancers, stroke, female fertility, bad outcomes in pregnant diabetic women, and so on. So treating gum disease should reduce other medical conditions, and costs, later in life.

Which makes me ask why, if the mouth is part of the body, and if gum disease can affect your general health, is dental care not covered by Medicare?

This is an article by Amanda Strindberg recently published by The Press-Enterprise.

At 4 years old, Kylie Metcalf needed a dentist big time.

A trip to the tooth doctor revealed a cavity count of 11.

“I was shocked,” said mom Kristi Metcalf, while sitting with her daughter, now 5, in the waiting room of Corona pediatric dentist R. James Richardson II before a routine checkup. “We brushed and flossed since she was little.”

For Haley Moscowitz, 3, a recent visit to Richardson also found tooth decay. Two cavities meant two fillings for the pint-size Corona patient.

“She’s only 3. It seems so young,” said mom Christine Moscowitz, while holding her daughter’s hand as Richardson discreetly gave Haley an injection of “sleepy juice.”

Kylie and Haley represent a worrying trend. Cavities in the preschool-age crowd are on the rise.

While cavities decreased in permanent teeth, a new study shows 28 percent of 2-to-5-year-old children surveyed from 1999 to 2004 had cavities compared with 24 percent of children surveyed from 1988 to 1994.

For the past four decades, tooth decay in baby teeth has been decreasing. But the latest federal report from the Centers for Disease Control and Prevention provides the first statistical evidence that this trend is reversing, dental experts say.

Reasons for the upswing were not studied, but experts say the troubling pattern shows the preschool-age crowd might be getting too much sugar and not enough fluoride and not brushing properly.

Toddling Dental Patients

The Inland area is not free from the influx.

“I see so much decay,” said pediatric dentist Roy Beam, of Kids World Children’s Dentistry in Riverside. “Baby teeth are just like adult teeth. They will decay.”

Richardson’s days are also busy filling the cavities of small children, many younger than 5, he said.

The grape-flavored relaxing laughing gas, the aquarium with bright-colored clown fish and the token-taking machines stuffed with prizes make filling the cavities easier, but tooth decay in young children is never pleasant, he said.

“A deep cavity in a baby tooth hurts,” Richardson said.

The key is early prevention, experts say. The American Dental Association recommends a child visit the dentist by age 1.

“The biggest mistake parents make is thinking their child is too young to go to the dentist,” Richardson said.

Some children’s teeth are simply prone to more cavities, Richardson said. The quicker the decay is treated, the less likely other cavities will form.

Colleen Leonard, 39, of Corona, isn’t taking any chances with 18-month Lorelei. The little one had her first checkup last week where Richardson showed Leonard how to brush and floss her toddler’s teeth.

“With the last one, we started way too late,” Leonard said.

Sister Hailey Leonard had her first appointment at age 5, revealing four cavities, an abyss and a needed baby root canal.

“We are getting this one in early to avoid emergency appointments later,” Leonard said.

Preventing Decay at Home

Monitoring a child’s diet can also help ward off decay, experts say.

“Kids are eating more prepackaged meals, less fruits and veggies, and more items that are presweetened,” said the study’s lead author, Dr. Bruce Dye, of the National Center for Health Statistics.

Dr. James Crall, chair of UCLA’s pediatric dentistry program, agrees.

“All the food contributing to the obesity epidemic is detrimental to teeth,” he said.

Multiple snacks with simple carbohydrates, such as crackers, fruit snacks, pasta and cereal, are also likely contributing to the increase, said Dr. Mary Hayes, a Chicago pediatric dentist and spokeswoman for the American Dental Association.

“It’s this idea of grazing,” she said. “With the wrong foods, you are simply allowing the bacteria to thrive and causing an acid attack on the tooth more often.”

It’s the same story with a child sipping juice all day or going to bed with a bottle.

“You’re allowing the bacteria to be happy,” Hayes said.

Hayes advises no more than 4 ounces of juice a day. After that, she considers it candy water.

Experts say another issue contributing to the climb in youngsters’ cavities is the growing number of bottled water drinkers.

Bottled water typically doesn’t contain enough fluoride to prevent decay, according to the American Dental Association.

Richardson suggests buying bottled water with added fluoride. About 20 bottled water manufacturers add fluoride to some of their water brands, according to the International Bottled Water Association.

Some tap water has natural levels of fluoride, and beginning in October, the Metropolitan Water District, which serves much of the Inland area, will begin to fluoridate its water, a measure to help reduce tooth decay.

Since levels vary, check with your dentist to see if the fluoride content in your water is adequate to help prevent decay.

“If you chose not to use fluoridated water, you are removing that chance for prevention and success,” Hayes said.

Fluoride supplements are also available, but talk to a dentist since too much fluoride can cause white spots to appear on the teeth’s surface.

Parents should also help their children brush. Unless children can tie their own shoes, they do not have the motor skills to brush properly, Hayes said.

Dentists suggest brushing twice a day. Begin using a pea-size amount of fluoridated toothpaste once the child turns 2 years old.

A princess toothbrush has made brushing more fun for Haley, mom Christine Moscowitz said.

“It’s kid-friendly and she can relate to it,” Moscowitz said.

For Brooke Dieterle, 5, of Riverside, it’s the watermelon toothpaste that gets her brushing.

“I don’t know what we’d do without it,” mom Kelli Dieterle, 42, said.

Why brush? “Because if you don’t, your teeth might get stinky,” Brooke said.

This is an article by Claudia Atticot that was recently published in Time for Kids.

The tooth fairy might be working overtime this year. According to the largest government dental study in 25 years, tooth decay in baby teeth has risen from 24 percent to 28 percent in children ages 2 to 5 since 1999. Before that, tooth decay had been on the decline for 40 years.

Food for thought

Experts believe that this new trend might have something to do with kids’ eating habits. “Parents are giving their children more processed snack foods than in the past and more bottled water or other drinks instead of fluoridated tap water,” said Dr. Bruce Dye, of the National Center for Health Statistics, who lead the study.

Bottled water often does not have the right amount of fluoride. Fluoride is a substance that is found in tap water. Research has shown that at certain levels, it strengthens tooth enamel and helps prevent tooth decay. Many communities add fluoride to their water supplies to tap into this cavity-fighting power.

Processed snack foods tend to be loaded with sugar. Sweet, starchy foods stick to the teeth, forming a film. If that film is not brushed away, it can lead to tooth decay.

Children have 20 baby teeth. Most kids start losing their baby teeth when they are about 6 years old, but some fall out earlier. Dentists are calling for parents to take kids as young as 1 year old to the dentist to help prevent cavities.

A reason to smile

Thankfully, not all the news is bad. The study found that kids age 6 to 11 have fewer cavities. Experts think this might be due to the fact that more dentists are using dental sealants, or plastic coatings that are applied to teeth to prevent decay.

Adults can also share in the good news. A serious form of gum disease called periodontitis has decreased by 50 percent in adults 20 to 64 years old. “Overall, we can say that most Americans are noticing an improvement in their oral health,” Dye said.

There’s limited evidence that so-called behavior management techniques help dentists convince patients to brush and floss their teeth properly.

That’s the conclusion of British researchers who reviewed four previous studies that included a total of 344 people with periodontal (gum) disease.

In one study, patients attended five 90-minute groups sessions about proper care of their teeth and gums, while two other studies required patients to meet with psychologists to discuss periodontal care. In the fourth study, patients called or visited a periodontist twice a week.

The review authors noted there were flaws in how these studies were conducted, which made it difficult to draw any firm conclusions.

“We need better-quality trials assessing the effects of psychological interventions to improve people’s oral health. I also think we need broader research on the benefits of the application of psychological theory to dentistry, as I believe it has a great deal to offer,” said review co-author Dr. Peter Robinson, professor of dental public health at the University of Sheffield in England, said in a prepared statement.

“Dentistry has worked really hard at trying to educate patients to get them to change behaviors, but we have been a bit old-fashioned. We have tended to think that if we give people information, their attitudes and behaviors should change.

“In fact, people can change a little, but those new behaviors are difficult to sustain. We have a lot to learn from psychologists and other experts in the field if we really want to help people,” Robinson said.

This is an article by Rossella Lorenzi of Discovery News that appeared in ABC Science Online.

Viking warriors filed deep grooves in their teeth, and they probably had to smile broadly to show them off, according to new finds in four major Viking Age cemeteries in Sweden.

Caroline Arcini of Sweden’s National Heritage Board and colleagues analysed 557 skeletons of men, women and children from 800 to 1050 AD.

She discovered that 22 of the men bore deep, horizontal grooves across the upper front teeth.

“The marks are traces of deliberate dental modifications … they are so well-made that most likely they were filed by a person of great skill,” Arcini writes in the American Journal of Physical Anthropology, a journal of the American Association of Physical Anthropologists.

Traces of teeth mutilation have been found in all parts of the world except Europe, with the practice reaching its peak from 700 to 1400 AD, during the height of the Viking Age.

The Vikings were the first Europeans to have displayed this custom, perhaps because they picked it up during their travels.

“This discovery is important as it shows that signs of cultural contact may happen between people over vast distances,” Arcini says.

However, the reason for and the importance of the furrows remain mysteries.

“The only things that the people have in common are that they were men and that majority had died when they were quite young. The filed furrows were made in more or less the same area of the teeth in all individuals,” Arcini says.

The marks were cut deep into the enamel and occurred often in pairs or triplets.

“To show their furrows, the individuals would have had to smile quite broadly,” Arcini says.

The researcher speculates that the marks could have been some sort of decoration or a badge to indicate class or military rank.

“Maybe they were warriors, although no skeletal injuries have been detected,” Arcini says.

A status symbol?

Pia Bennike, at the University of Copenhagen’s biological anthropology laboratory, agrees:

“They did it on purpose, to mark that they belonged to a special group. Or maybe they were slaves. This is a very unique and interesting find.”

One hypothesis is that they could show an individual’s ability to resist pain. They could have also represented some kind of achievement.

“Maybe this is the explanation for multiple furrows or deeper ones,” Arcini says.

The tools that the Vikings used for handicrafts were made both of iron and stone. An experiment on a medieval tooth showed that with a lot of force and a file of steel, it takes about 20 minutes to cut a mark like the those of the Vikings in the enamel.

“How long it took on a living person is really difficult to know. Even if the filing did not hurt, it most certainly must have been unpleasant,” Arcini says.

This is an article by Mike Stobbe published by Associated Press.

ATLANTA – Tooth decay in young children’s baby teeth is on the rise, a worrying trend that signals the preschool crowd is eating too much sugar, according to the largest government study of the nation’s dental health in more than 25 years.

The study also noted a drop in the proportion of non-elderly adults who have visited a dentist in the past year – a possible indicator of declining dental insurance.

But there was some good news: Older children have fewer cavities and adults have less periodontal disease than in the past, and more of the elderly are retaining their teeth.

“Overall, we can say that most Americans are noticing an improvement in their oral health,” said the study’s lead author, Dr. Bruce Dye of the National Center for Health Statistics.

Experts are concerned about the prevalence of cavities in baby teeth of children ages 2 to 5. It increased to 28 percent in 1999 to 2004, from 24 percent in 1988 to 1994, according to the report.

Tooth decay in young children had been decreasing for 40 years. Some studies have suggested the trend might have ended, but the new report contains the first statistically significant proof the trend has reversed, dental experts said.

One reason is that parents are giving their children more processed snack foods than in the past, and more bottled water or other drinks instead of fluoridated tap water, Dye said.

“They’re relying more on fruit snacks, juice boxes, candy and soda” for the sustenance of preschoolers, he said.

Others experts agree diet is at least part of the explanation for the rising cavity rates.

“The same things contributing to the obesity epidemic can also contribute to tooth decay,” said Dr. Gary Rozier, a dentist who teaches public health policy at the University of North Carolina.

Inadequate dental care may also play a role. Cavities in young children can form quickly, and parents should begin bringing their children to the dentist at age 1, said Dr. Joel Berg, chairman of the University of Washington’s Department of Pediatric Dentistry.

Parents also must help their young children brush properly. “Preschoolers don’t have the dexterity to really clean their teeth,” Berg said.

Baby teeth naturally fall out as children age, but dentists say untreated decay can spread and is too dangerous to go untreated.

Rotten baby teeth are treated with fillings or – if the decay is extensive – extraction. But baby teeth fill certain spaces in the mouth, so their early removal may lead to crowding when adult teeth come in.

The study is based on an annual federal survey of about 5,000 people. It includes detailed in-person health interviews, and medical and dental examinations by health care professionals.

The study averaged the findings from surveys done in 1988 to 1994 and compared them with the average results from surveys done in 1999 to 2004.

The results were reported last week at a meeting of the American Association for Public Health Dentistry in Denver.

Experts were heartened that the study found that cavities in permanent teeth decreased to 21 percent of children in 1999 to 2004, from 25 percent in 1988 to 1994.

That may be at least partly because of the growing prevalence of dental sealants, a plastic coating applied to teeth that protects against decay. About 38 percent of children and teens ages 12 to 19 had dental sealants in the most recent set of surveys.

Some of the other findings:

•Among senior citizens ages 65 and older, the percentage with complete tooth loss dropped to 27 percent, from 34 percent.

•Moderate and severe gum disease in adults ages 20 to 64 dropped to 5 percent, from 10 percent. Gum disease dropped to 17 percent, from 27 percent, in seniors.

•Tooth decay in the permanent teeth of children ages 6 to 11 dropped to 21 percent, from 25 percent. Tooth decay in youths ages 12 to 19 dropped to 59 percent, from 68 percent.

•The percentage of adults who said they’d been to a dentist in the previous year dropped to 60 percent, from 66 percent.

This is an article that appeared recently in Child Health News (American Publication).

The American Academy of Pediatric Dentistry (AAPD), the recognized leader in children’s oral health, continues to emphasize that the way to decrease children’s tooth decay is by visiting a dentist early on.

The AAPD recommends that each child should have a dental home by his/her first birthday.

The results from the recent Centers for Disease Control and Prevention (CDC) report show that young children do not receive the proper oral care they need to promote optimal oral health. Tooth decay declined in every other age group, except for children aged 2 to 5 years which increased from 24 percent to 28 percent between 1988-1994 and 1999-2004. Tooth decay is the single-most common chronic childhood disease, yet 90 percent of all tooth decay is preventable.

The AAPD recommends that parents adopt the following practices to help prevent tooth decay in young children:

Year-one dental visit – Dental visits should begin around six months but no later than one year, or with the appearance of a child’s first tooth. The earlier the dental visit, the better the chance of preventing dental problems. Children with healthy teeth chew food easily, learn to speak clearly and smile with confidence.

Fluoride use – Young children require fluoride to help developing teeth grow strong, and it helps prevent tooth decay in older children when used on a regular basis. Children who primarily drink bottled water may not be getting the fluoride they need. If your child routinely drinks bottled water, make sure to choose a product that contains fluoride. Talk to your pediatric dentists about your child’s fluoride needs.

Healthy eating habits – Parents should ensure their children are eating a balanced diet, and limit frequency of snacking which can increase a child’s risk of developing cavities. In order to prevent cavities, parents should limit the child’s number of snacks and the amount of time each child snacks throughout the day.

“Proper preventive care, fluoridation use and a balanced diet are key to the oral and overall health of every child,” said Dr. Phil H. Hunke, D.D.S., M.S.D, president of the AAPD. “When kids are exposed to sugar for extended periods, they are at a higher risk of tooth decay. If left untreated, this puts these young children at increased risk for pain and infection, which can lead to missed school, lost sleep and loss of appetite.”