The NobleDentist Blog

This is an article published recently on the ABC News Online.

Almost half the population hasn’t been to the dentist for more than two years. So it’s not such a surprise that there are between 30 and 50 thousand preventable hospitalisations for dental infection per year.

Dental groups have been lobbying solidly for reforms to cut waiting lists for public dentistry and to address the affordability of dental care and the shortage of dentists in regional areas. Not to mention a severe shortage of dental academics to train new dentists.

Both the government and opposition have made policy promises on dental care but the Association for the Promotion of Oral Health says they range from ‘stupid to disappointing.’

This is an article by Dennis Thompson that was published recently in the US News & World Report.

The dental health of Americans is improving as people take better care of their teeth. But that encouraging trend doesn’t extend to some of the country’s most vulnerable individuals—children.

Studies have found that baby tooth decay is on the rise. One federal report found that decay in baby teeth among 2- to 5-year-olds increased from 24 percent to 28 percent from 1988 to 2004.

This decay can have unwanted lasting effects on a child’s overall heath, ranging from impairment of permanent teeth to systemic illness caused by infection from bacteria in the mouth.

Jean Connor, a dental hygienist in Cambridge, Mass., and president of the American Dental Hygienists Association, said parents need to teach their children that a clean mouth is just as desirable as clean ears or hands or feet.

“It’s just another part of the body that must be kept clean,” Connor said. “If you have a dirty mouth, you’re carrying bacteria and infections around.”

Baby teeth are often thought of as disposable or temporary. But if left to decay, those teeth can fill the mouth with bacteria that could harm the permanent teeth as they come in. And if baby teeth are pulled early due to decay, the permanent teeth behind them can come in crooked.

Oral cleanliness can come from a variety of techniques. Parents should teach their kids how to brush and floss and also how to keep their mouth clean by watching what they eat.

This care can start even before a child is born, said Diann Bomkamp, a dental hygienist in St. Louis, and president-elect of the American Dental Hygienists Association (ADHA).

Expecting mothers can give their unborn children an advantage by taking special care of their dental health during pregnancy, Bomkamp said.

“If the pregnant woman does not have good dental care, she could have more of the decay-producing bacteria in her mouth, and it’s very likely she could pass these bugs on to her child,” Bomkamp said.

Once the child is born, parents should start keeping the mouth clean even before the first baby tooth has erupted.

The ADHA recommends thoroughly cleaning an infant’s gums after each feeding with a water-soaked infant washcloth or gauze pad to stimulate the gum tissue and remove food.

“Even before they have teeth, you can clean out their mouths and get the kids used to the idea of it,” Connor said.

When the baby’s teeth begin to erupt, parents should brush them gently with a small, soft-bristled toothbrush using a pea-sized amount of fluoridated toothpaste.

At age 2 or 3, a parent can begin to teach their child proper brushing techniques. However, the child will need help with brushing and flossing up through age 7 or 8. By then, they will have developed the dexterity to do it alone.

Parents also should be cautious about inadvertently sharing their own mouth’s bacteria with their child, through even the most seemingly innocuous behavior.

“Decay bugs can be transmitted through sharing food and drink, through sharing a toothbrush or sharing utensils,” Bomkamp said. “Even blowing on food, your saliva can be transmitted to the child.”

Watching what children eat also can help protect them from developing cavities or large amounts of decay bacteria in their mouths. This includes making sure that kids are fed regular meals throughout the day, especially breakfast, to keep them from feeling the need to snack on unhealthy foods.

One recent study found that the odds of decay in baby teeth were greater in the children with poor eating habits. Children who don’t eat breakfast every day had higher levels of tooth decay, the study found, as did those who don’t eat five servings of fruits and vegetables a day.

“If they’re eating several snacks a day, they probably aren’t eating foods that are good for them,” Bomkamp said.

Also, don’t let a young child go to bed with a bottle, Bomkamp said, and avoid allowing them to run around with sippy cups filled with sugary juices.

Another potential problem is the increased use of bottled water, she said. Tap water in almost all U.S. cities contains fluoride, which helps prevent tooth decay. “Most bottled water doesn’t have the fluoride levels we’d like to see,” Bomkamp said.

Dental hygienists also urge parents to get their kids in to see a dentist as early as possible, within six months of the eruption of their first baby tooth or by their first birthday.

“Parents often don’t think to take their child to the dentist until it’s too late to prevent problems,” Connor said.

This is an article by a staff writer that was published recently in www.ArabianBusiness.com.

Diet plays a crucial role in optimising oral health. A dynamic relationship exists between nutrition and overall oral health, and it is recognised that one of the primary measures for reducing caries risk is adherence to healthy dietary practices. While the frequent intake of acidic foods and beverages is well established as having a detrimental effect on teeth, many dentists are unsure of how to advise parents on dietary guidelines for their children. This article aims to give an overview of current dietary advice, from a dental perspective.

Fermentable CARBS

The cariogenic potential of sugar and other fermentable carbohydrates is evident. That the incidence of caries still ranks worldwide as one of the most common diseases in society demonstrates that established oral hygiene practices, and fluoride use, do not completely protect teeth from dietary risk factors.

Sugar consumption is reported to be higher in Middle Eastern countries than in many other developing areas. A study conducted by Sayegh et al. (2002) in Jordan shows that sugary snacks are consumed by a majority of children. Confectionary was reported to be regularly consumed by 76% of the 4 to 5 year-old children surveyed, and biscuits and cakes by 71%. More than 50% were reported to drink canned fruit juice and carbonated drinks regularly between meals. Consequently, the prevalence and severity of caries in 4 to 5 year-old children was high; 67% of the children had some caries experience and 33% had DMFT greater than 4.

Dental caries is caused by the dissolution of the teeth by acid, produced by the metabolism of dietary carbohydrates by oral bacteria. The process can be explained as a loss of mineral, as the neutral pH value of saliva is affected. From an average value of 7, once the pH of saliva drops below 5.7, the dental enamel begins to lose calcium and other minerals, leading to dissolution. Many common food products containing fermentable carbohydrates can, after consumption, drop a plaque pH below 4.

The development of caries requires the presence of sugars and other fermentable carbohydrates, which are metabolised to acids by plaque bacteria. Sucrose is one of the most, but not the only, cariogenic substance in the diet. Glucose, fructose, lactose and starch are examples of other fermentable carbohydrates.

The relation between frequent sugar consumption and caries is notable in early childhood caries (ECC). This condition is characterised by significant decay of a child’s teeth, particularly the upper and lower incisors. Poor feeding practices without appropriate preventive measures can lead to a distinctive pattern of caries in infants and toddlers, known as baby bottle tooth decay (BBTD). Frequent bottle feeding at night, nocturnal breast-feeding on demand, and extended and repetitive use of a no-spill training cup are associated with ECC. Caries is often triggered by prolonged exposure to liquids or snacks containing sugar, or by the tradition of dipping pacifiers in honey, sugar or syrup.

The correlation between sugar consumption and caries is also a sociocultural phenomenon. In newly industrialised countries, such as certain Middle Eastern countries, the incidence of caries has increased as residents switch from a dependence on traditional, staple foods, to a dependence on refined carbohydrates, without an accompanying change to regular oral hygiene habits.

Food acids and erosion

Tooth erosion is the progressive loss of dental hard tissue by acids, in a process that does not include plaque bacteria. Tooth erosion is not an infectious disease, but the resulting defects can impair the integrity of the tooth. Dental erosion is less common than caries primarily because saliva flow protects the teeth by neutralising acids. When dental erosion does occur, it is usually the result of either a diminished saliva flow rate or frequent consumption of soft drinks, fruit juices, sports drinks and flavoured waters.

The majority of soft drinks contain one or more acids, most commonly phosphoric and citric acids. Consumers often mistakenly believe that sugar-free soft drinks are safe for teeth. Although diet sodas may not have sugar, their pH value may be lower than 3.5, and therefore can also break down enamel. Besides water and unsweetened tea, only milk is recommended due to its relatively low cariogenicity and high calcium content.

Limiting sugar intake

The frequency of sugar consumption is a significant contributor to the cariogenicity of the diet. Each time fermentable carbohydrates are nibbled or sipped, demineralisation commences. This continues for about 30 minutes, or longer if teeth are coated in existing plaque. Repeated acid attacks do not give teeth the time to recover, thus small amounts of snacks with fermentable carbohydrates eaten frequently during the day increase caries risk.

The amount of sugar consumed is less important than how quickly it is cleared from the oral cavity. The longer carbohydrate-containing foods are retained, the greater the potential the starch has to break down into sugars and contribute to the caries process. For example, liquids consumed with a straw do not expose teeth to the degree that a sipped beverage does. Retentive foods – as opposed to sticky foods, such as jellybeans or caramels – are slower to clear from the mouth. Cookies or potato chips, for example, have high retentive properties, while the soluble sugars found in ‘sticky’ confectionary are washed away more quickly by saliva flow. Besides sweets, certain medicinal products such as cough drops, vitamin chews, cough syrups and lozenges may be detrimental to teeth when consumed frequently or during the night.

Diets that favour remineralisation are typically high in calcium, phosphate and protein, to take advantage of the anticariogenic properties of cheese and milk. Lactose is the least cariogenic sugar and, although milk supports bacterial growth, it has a high buffering capacity and requires substantially more time than sucrose to produce caries. Milk may be encouraged as a snack drink in preference to more acidic drinks such as orange juice, soft drink, or flavoured mineral waters.

Cheese, specifically mature cheddar-type cheese, has been shown to protect against coronal and root caries. In vivo studies have found that when eaten immediately after sugar, cheese naturalises saliva pH levels. Its high calcium and phosphorus content appears to be a factor in its cariostatic mechanisms; decreasing demineralisation and enhancing remineralisation.

To motivate patients to reduce the number of snacks, it is vital to stress the importance of main meals to their child’s oral and physical health. Once main meals are properly made up, the desire of eating between meals is reduced. The goal is not to exclude sugar from the diet but rather to consume sugar in a more sensible way, meaning in reasonable amounts and predominately at meal-times.

Sugar substitutes

In certain product groups, sugar can be fully substituted by non-cariogenic sweeteners. Sugar-free confectionery, soft drinks, medicine, mouth wash and toothpaste are examples of products where sweetness is provided without fermentable carbohydrates. Toothfriendly sugar substitutes can be divided into two distinct groups: polyols and intense sweeteners. Polyols are sugar alcohols which can be found naturally in various fruits and vegetables. Sorbitol, mannitol, maltitol, isomalt, lactitol, xylitol and erythritol are members of the polyol family. Polyols deliver the taste and texture of sugar with approximately half the calories of sucrose. Intense sweeteners include sucralose, acesulfame K, aspartame, cyclamates, saccharin, thaumatin and neohesperidine DC. These products have played an important role in weight control, diabetes and dental health for over four decades. The intense sweeteners used in food production today have been deemed safe for daily consumption by national food safety authorities.

While the Middle East food industry has been slow to target healthier options, when compared to other industrialised countries, there has been some progress with tooth-friendly confectionery. Tooth-friendly chewing gum and sugar-free sweets are an alternative to high-sugar snacks between meals. Products that carry the ‘Happy Tooth’ symbol, attesting to their approval by Toothfriendly International, do not contain fermentable ingredients or high amounts of harmful erosive substances.

The role of fluoride

It has been demonstrated that water fluoridation and topical fluoride supplements decrease the incidence of dental caries. Fluoride helps prevent decay of a tooth by binding to the hydroxyapatite crystals in enamel. According to caries data, children living in the poorest, non-fluoridated communities suffer highest levels of tooth decay.

WHO recommends community water fluoridation as a safe and cost-effective means in preventing dental caries in every age group, benefiting all residents served by the community water regardless of their social or economic status. Domestic salt fluoridation is another method of automatic fluoridation. Switzerland was the first country to introduce fluoridated salt in 1983. Since then, positive experience has been made in other European and Latin American countries. In 2006, fluoridated salt was consumed by 180 million people.

Conclusion

Sugars and oral health are integrally related. Dental professionals must recognise the relationship between diet and caries risk, and manage patients accordingly. Routine appointments should include a degree of dietary advice to provide a framework for parents and their children for the prevention and management of dental caries, and the management of sugar intake.

This is an article that was provided by North American Precis Syndicate Inc.

Much like a house or car, the body requires maintenance, including the teeth and gums. However, many people may not be aware of the best ways to take care of their teeth and gums and which foods can contribute to good oral health.

According to Dr. David Russell, associate professor and associate dean of clinical affairs at Tufts University School of Dental Medicine in Boston, good oral health, good eating habits and good general health are all linked.

“Your teeth are meant to last as long as you do, and there are easy steps you can take to maintain oral health,” said Russell.

Most cases of tooth decay and gum disease are caused by a buildup of plaque, a combination of food, saliva and bacteria that settles on teeth. If it is not removed each day with brushing and flossing, plaque will harden into tartar, which is difficult to remove with home care.

Problems caused by plaque and tartar include:

•Cavities: soft areas in teeth that can promote tooth decay.

•Gingivitis: swollen gums that can cause more serious disease if left untreated.

•Periodontal disease: disease of the gums and jawbone that can lead to tooth loss.

•Abscess: infection that can arise from an untreated cavity or tooth infection.

•Toothaches, bad breath or inability to use teeth.

Plaque and tartar can also contribute to a range of health problems outside the mouth, including higher risk of heart disease, stroke and certain types of cancer.

Besides visiting a dental hygienist/dentist at least twice each year for professional cleanings and oral exams, Russell suggests these easy tips for keeping teeth and mouth healthy.

•Brush teeth at least twice a day and, if possible, after meals and before bedtime. Use a softbristled brush and angle it into the gumline and between teeth, where most plaque gets trapped. Be gentle when brushing; scrubbing isn’t needed to remove plaque. Replace toothbrushes every three to four months and more frequently for children.

•Use a toothpaste that contains fluoride. Fluoride, a mineral that helps harden tooth enamel, can protect teeth from cavities and tooth decay.

•Use dental floss each day to clean around and between teeth and under the gumline. Ask a dental hygienist to demonstrate how to floss.

•Avoid tobacco and limit alcohol. Smokers and other tobacco users are more likely to develop gum disease than those who don’t use tobacco. Excessive tobacco and alcohol use increases the risk of oral and throat cancers, especially when used in combination.

•Eat healthful foods to help the body defend against oral infections. Avoid high-sugar or highstarch snacks that can promote tooth decay. Aim for at least two servings of calcium a day to keep teeth strong. Calcium-rich foods include milk products, green leafy vegetables and canned fish with soft bones, such as salmon and sardines.

•Drink plenty of water or other healthful liquids, which will help prevent bacteria from settling on teeth. For those who take medications that cause dry mouth, increase fluid intake or try chewing sugarless gum.

Even with careful brushing and flossing, some plaque will develop. At regular cleanings, dental hygienists can remove this plaque. A dentist will also make sure there are no signs of oral cancer, check for tooth decay and inspect for receding gums, which can signal gum disease.

A RUDD Government would provide vouchers of up to $150 a year to cover 1 million dental visits by teenagers as part of a long-term plan to extend federal control of dental health.

Labor said the plan, to begin next July, would cover children aged 12 to 17 of lower- and middle-income families who are eligible for Family Tax Benefit A.

Kevin Rudd said yesterday the refunds would be made via Medicare and that all dentists would be given a Medicare provider number. The plan would cost $510 million over three years – though dental groups said it fell far short of covering general dental care under Medicare.

“Long term once we have our dentists as part of the Medicare system, it will provide us with a platform into the future to provide much more extensive care through the Medicare system,” Mr Rudd said.

“If you try to clinically separate out dental health from the rest of health, you are not getting the real clinical picture … If you do this well, you are taking away some of the burden of the health care system later on.”

The dental health of Australians is among the poorest in the developed world, figures released by the Organisation for Economic Co-operation and Development show. Research by the Australian Health Policy Institute has found almost half of teenagers have signs of gum diseases and a quarter of adults have untreated decay.

Mr Rudd said the plan was designed to prevent the onset of dental decay and associated oral diseases. Campaigning in Perth, he said the vouchers would cover about half the average dental check-up cost of $290.

This year the Howard Government announced a $384.6 million plan to provide Medicare rebates of up to $2125 a year for people with chronic diseases that could be exacerbated by poor oral health. After taking office in 1996, Mr Howard scrapped a Labor scheme to provide $100 million a year for public dental care. Labor said in September it would end the Coalition’s scheme and instead spend $290 million on clearing public dental waiting lists.

The president of the Australian Dental Association, John Matthews, said funding promises by both Labor and the Coalition fell far short of transferring the bulk of dental services to Medicare.

“Dentistry has been getting a lot of attention but it would cost about $4 billion to $5 billion a year to put dentistry under Medicare,” he said.

Dr Matthews said most dentists already had Medicare provider numbers under existing health schemes. “These are schemes such as the cleft palate scheme and the enhanced primary care scheme, which just came in this year,” he said.

The federal Minister for Health, Tony Abbott, said Mr Rudd was “making up for the mistakes of the state Labor governments” but his policy only half-funded consultations and people with significant dental problems needed treatment.

This is an article that was published recently in the PakTribune.

Tobacco use can cause serious oral health problems, including gum disease and oral cancer, says the Academy of General Dentistry.

“Not only is tobacco use the leading preventable cause of death and disease in the United States, it also causes serious oral health problems. Our profession wants to inform all patients that tobacco use will cause damage to their oral health,” academy spokesman Larry Williams said in a prepared statement.

Tobacco use is linked to oral cancer. Signs of this form of cancer include red, white or discolored areas in the mouth, patches or lumps in or around the mouth, difficulty swallowing, and repeated bleeding from the mouth or throat.

The five-year survival rate for oral cancer is 54 percent because the disease often goes undiagnosed in the early stages. People who notice any symptoms should see a dentist.

Tobacco use also causes tooth loss and gum disease, a chronic infection and inflammation of the gums and surrounding tissue. As the disease progresses, it destroys the bone holding teeth in place. Symptoms include red, swollen or tender gums, bleeding while brushing or flossing, gums that pull away from the teeth, persistent bad breath and loose or separating teeth.

Tobacco use also stains and discolors teeth. It can also cause persistent bad breath and trigger a problem called black hairy tongue. This occurs when heavy tobacco use irritates the tongue, causing blackish or dark brown stains to cover most of the tongue surface.

This is an article by Holy Selby that was recently published in The Baltimore Sun.

An increasing number of studies indicate that periodontal health – that of the gums and the bones and ligaments that support the teeth – is related to the body’s overall well- being, including cardiovascular health. Some studies also have shown a relationship between a pregnant woman’s periodontal health and premature birth.

Although no one is claiming that there is a causal relationship between poor periodontal health and other systemic diseases, there is a great deal of research aimed at further defining these associations, says Harlan Shiau, assistant professor of periodontics at the University of Maryland Dental School. What is periodontal disease?

Periodontal disease is an infection of the supporting structures of the teeth. It includes the bones, the ligaments that hold the tooth to the bone and the gingiva – or the gums.

Specific oral bacteria cause chronic periodontitis, which affects about 30 percent of the population. ... Chronic periodontitis develops when our own immune system reacts. In some sense, as our bodies try to contain the infection, our immune system inadvertently causes damage to the supporting structures of the teeth. What are signs of periodontal disease?

Well, gingivitis is inflammation of the gums, and with this we often associate bleeding, tenderness and a lot of redness of the gingiva.

With chronic periodontitis, there may be similar symptoms. The main difference between the two [conditions] is that gingivitis doesn’t affect the bone or ligaments that support the teeth and technically, it is reversible. So once you remove from the root surface the plaque and the bacteria causing gingivitis, the patient can actually “recover.” With periodontitis, you have actual loss of the supporting structures of the teeth. There’s an old saying that a dog’s mouth is cleaner than a human’s. Just how bacteria-laden are our mouths?

I don’t know if I can substantiate that claim [about a dog’s mouth], but in terms of bacteria, there are about 400 to 500 species of bacteria in a typical mouth.

Fortunately, a majority of the bacteria in our mouths are benign and do us no noticeable harm. Proper home care -that is, brushing and flossing on a regular basis – can keep the bacterial burden in check. What is the role of saliva in terms of periodontal health?

Saliva has a protective function on a number of different levels. The first and most obvious one is saliva physically is able to cleanse the teeth and the areas between the teeth. But also within the saliva are things like antibodies and other proteins that act as antimicrobials.

In cancer patients who have been treated with radiation, one of the unfortunate side effects is xerostomia – basically the condition of decreased salivary flow – so the patient has a high level of cavities because of lack of saliva. What does research indicate about the relationship between a healthy mouth and the body’s overall health?

Over the past 20 years, there has been a lot of interest in the link between dental and systemic health. ... Research has established that diabetes is a risk factor for chronic periodontitis. In addition, it is now recognized that one of the most common oral symptoms of diabetes is periodontitis.

Recent research also has suggested among other things that there was a possible association between periodontal disease and cardiovascular disease. There now is quite a bit of ongoing research on just how the two interact. One of the things that the two diseases share is inflammation.

In periodontal disease, though it is caused by bacteria, it isn’t actually the bacteria that cause the destruction. It is our own biological response to the bacteria: inflammation. ... And the idea is that perhaps the relationship between periodontal and cardiovascular disease is that inflammation in one place may have an effect in another place in the body. Some studies have linked low birth weight to the oral health of pregnant women. What has this research shown?

There have been studies published in the last few years about preterm, low-weight babies and mothers who have periodontal disease. The studies showed an association, but not a causal relationship (in other words, one has not yet been proven to cause the other).

Other studies have shown that there is an association between osteoporosis and periodontal health, but at this point that is all we can say. Although more investigation is needed, how should people interpret the research thus far?

Clearly our mouths are not disconnected from our bodies. I believe that as more research plays out, the connection between the health of our gums and of our bodies will be even more apparent. For now, however, we can’t go wrong by giving attention to our oral health. What are risk factors for periodontal disease?

The main cause of the disease is bacterial plaque, the sticky, colorless film that forms on your teeth, but factors like smoking, diabetes, poor nutrition, stress, certain medications and genetics can affect the health of your gums. Besides not smoking, what steps can people take to prevent periodontal disease?

Eat a good diet; this obviously doesn’t apply solely to periodontal disease. Eat a well-balanced diet, brush daily and go to a general dentist regularly. How is periodontal disease treated?

The most basic treatment for periodontal disease includes the procedures called scaling and root planing – some people call it a deep cleaning. The procedure basically seeks to remove tartar, calcium deposits, plaque and bacteria from the teeth. Fortunately, most mild cases of chronic periodontitis can be managed with reasonable success.