Oral Health - It is Not Just About Cavities

Oral Health.  It is not just about cavities.  Here are two significant briefs from the literature highlighting that oral health has wide reaching implications for your total health.   

Risk for Two Birth Defects Affected by Overall Quality of Pregnant Woman's Diet.  Medical News Today – October 4. The overall quality of a pregnant woman's diet is linked with risk for 2 types of serious birth defects, according to a new study in the Archives of Pediatrics & Adolescent Medicine. In the study, women who ate better before and during pregnancy gave birth to fewer infants with malformations of the brain and spinal cord, or orofacial clefts, such as cleft lip and cleft palate. “Our study showed for the first time that the overall quality of the diet, and not just a single nutrient, matters in terms of reducing the risk of birth defects," say researchers. The study is also the first to connect diet quality with reduced risk for cleft lip or cleft palate.  

Oral Health of Diabetes Patients Closely Linked to Heart Disease and Cancer Risk.  Medical News Today – October 3.  A new report in the British Dental Journal reveals that many individuals who suffer with diabetes are not aware that their oral health is closely connected to their risk of developing complications. According to the authors, inflammation from gums that are swollen can increase the severity of diabetes, increase deaths from oral cancer, and make cardiovascular disease worse. In addition, diabetes that is longstanding and poorly controlled seems to speed up the development of gum disease. However, a survey of 229 adults visiting a diabetes clinic discovered that the majority were unaware of any connection between dental health and their condition. Only 13% of participants were aware that swollen or tender gums could be affected by the disease, and only 12% knew there might be a connection between the disease and loose teeth.

Good oral health habits as well as good eating habits are just the beginning of living healthy productive lives.  What you put in your mouth and how you care for your teeth will have a definite impact on the quality of your life forever.  It is not just about cavities.

ScottThompson, DDS
Meadow Vista, CA 95722

Sugar Blues: It's Not Just About Cavities

A book I read in the 1970s entitled “Sugar Blues” made a clear connection of sugar with disease (high blood pressure, cardiovascular disease and heart attack, and diabetes) as well as demonstrating the addictive quality of sugar.  Since then I have been dismayed by the huge attention given to fat in the diet.  Though excess fat in the diet is not good, it is not nearly the bad culprit it has been made out to be.  Meanwhile, a far bigger player in the chronic disease patterns in our culture has gotten very little attention; namely sugar, and specifically fructose (which is half the sugar molecule in your table sugar).  You have all seen fructose advertised a great deal in recent years, but have you noticed?  There is very little mention of fructose in food advertising lately.

I recently had the distinct pleasure of hearing a seminar discussion conducted by 3 leading pediatricians who are all metabolic specialists in teaching hospitals in the USA.  They discussed metabolic syndrome (high blood pressure, cardiovascular disease, diabetes and dislipidemia), and its cause (fatty liver degeneration and liver failure) which in children is caused primarily by excess fructose intake.  In adults it is also caused by sugar, but is more commonly thought of as caused by alcoholism.  It turns out the liver is the only tissue in the body that can break down (digest) a fructose molecule (there seems to be no system in the body that has a use fructose).  The liver has a limit how much fructose it can metabolize in a day.  When it gets too much fructose, it’s attempts to metabolize the fructose results in half digested “byproducts” which are toxic, which the body needs to deal with and which ultimately get stored as “excess fat,” not healthy fat.

The average American surpassed eating the liver’s daily maximum amount of sugar in about 1977.  The rise in excess weight gain and increase in the presence of metabolic syndrome started about the same time.  As a matter of fact, the average sugar consumption in this country in the 1960s (30 grams) has increased to an average today of 200 grams.  The liver’s capacity maxes out at about 50 grams of fructose.  Today, metabolic syndrome does not affect just elderly adults.  It affects everybody eating excess sugar, including our children. There are documented cases of liver transplants for fatty liver degeneration in obese teenagers.
And about addiction.  The biochemistry research documents that sugar delights the pleasure centers of the brain exactly the same as alcohol, addictive drugs, nicotine and other substances.  I won’t belabor that; just know sugar is just as addictive as those other substances.  Notice how your craving increases during these sugar laden holidays?

Please, Please.  Don’t start your children, toddlers and infants on sweet beverages (liquid candy), sweet pastries, candies and sweet cookie/cracker snacks.  It is not just about the cavities.

Scott Thompson, DDS
Meadow Vista, California

Will a Clean Tooth Decay?

A Clean Tooth Will Not Decay.

The reality that a clean tooth will not decay was demonstrated in multiple experiments in the 1950s and 60s. Since then scientific research has not only re-demonstrated it countless times, we have advanced the science to allowing patients to stop decay after is has started ... and ... if the decay has not progressed too far the patient can reverse the decay (that would be heal the cavity).

And yet! ... People clean their teeth daily, they visit their dentist regularly, and they still get cavities. Why? The answer lies in the reality that most people's attempts to clean their teeth are not effective. The teeth don't get clean. And so they get cavities in those places, ... repeatedly.

When was the last time your dentist and/or hygienist helped you learn how to effectively (the key is effectively) clean your teeth ... AND ... showed you how to evaluate your own effectiveness at home? In other words, be able to check any day, in your own home, whether you actually get your teeth clean. A CLEAN TOOTH WILL NOT DECAY!

And those of you who have cavities already that need filling, how about creating an environment in your mouth that will prevent new decay from destroying that rather expensive investment called "dental restorations."

For more information or just to discuss your child's oral health, feel free to give me a call -

Dr. Scott Thompson - Pediatric Dentistry

How to Prevent Cavities?...Not so difficult

1)    Establish a dental home for your child’s first tooth.  It is a lot easier to prevent cavities if you learn how before the cavities have started.
2)    A clean tooth will not decay!  Do you get your teeth clean?  Most people brush longer than necessary but are not effective cleaning their teeth.  Find a dentist whose primary objective is teaching you how to evaluate your own tooth cleaning and knowing your teeth are truly clean each day.
3)    Floss the teeth you want to keep.  9 out of 10 of the fillings I do are because of cavities between teeth where the tooth brush cannot clean.  100% of the gum disease adults struggle with and lose teeth from started between their teeth.
4)    Monitor your snacking frequency.  Simple carbohydrates (sugars and cooked starches) feed the bacteria that cause cavities.  The more frequently those bacteria are fed through the day, the more frequent your teeth suffer acid attack and the higher your risk grows for cavities.
5)    Drink water.  Sipping sweet beverages is the simplest way to feed those bacteria and provide multiple cavity causing attacks by the bacteria.  It also promotes overgrowth of the cavity causing bacteria so they become the predominant bacteria in your mouth.
6)    Drink more water.  All the sweetened beverages are highly acidic.  These acids will attack the surface of the teeth, softening the entire surface and making it easier for the cavity causing bacteria to do their damage.
Dr. Scott Thompson  - Winning With Smiles Pediatric Dentistry

Fluoride Benefit vs. Fluorosis Risk

Get maximum dental benefit AND minimize fluorosis risk.  Every parent wants to get this right.  We want to prevent dental decay for our children for sure.  We also want to avoid unsightly fluorosis on our children’s permanent teeth.  Please note: only children are at risk for developing fluorosis. As a pediatric dentist, I can help answer your concerns.

First about the fluorosis value at risk.  For the average person eating normal foods and using typical dental care products there is a small risk of very mild to mild fluorosis.  Very mild to mild fluorosis is tiny white specks on the teeth.  They are typically not noticeable at conversational distance.  Some people appreciate them because the teeth appear whiter.  Often, photographs of severe fluorosis are published in fluoride warning publications.  Severe fluorosis is a very disfiguring opaque white with brown blotches discoloration on the surface of the teeth.  It is ugly.  People at high risk for moderate to severe fluorosis live in areas were natural fluoride occurs in well water and public water in levels of three parts per million or higher (up to 10 parts per million in some regions of the country).  Another group at risk is infants and toddlers allowed to brush their teeth with (and eat) a full squeeze of fluoride toothpaste.  Fluoride toothpaste is for children age two and above and should be applied to the brush by an adult in the size of a split pea or grain of rice.  Note: Topical fluoride like toothpaste and mouth rinses and gels present no risk of fluorosis unless they are swallowed.

Second:  About the frustrating development of additional fluoride sources.  The difficulty physicians and dentists have measuring and prescribing fluoride comes largely from our food industry.  Fluoride is naturally found in all water supplies including oceans (two parts per million) and freshwater.  Originally fluoride was primarily available in water supplies, naturally or added by water municipalities.  It was easy to measure and estimate how much a typical person consumed.  Today it is additionally and intentionally available in toothpaste, mouth washes, prescription dental gels and dental floss.  If these are spit out they present no risk of fluorosis and don’t complicate the Dr’s prescription.

Fluoride is also unintentionally present now in many sodas, juices, baby formula, other beverages and other foods processed with or reconstituted with fluoridated water.  The amount of fluoride that is present in these products depends on which bottling or processing plant made them.  The amount is unknown, varies widely in the same products and is not labeled on the product.  Due to the multiple unmeasured sources of fluoride, it is impossible for a physician or dentist to calculate an appropriate supplement of fluoride for a growing child.

Fluorosis comes from ingesting (swallowing) too much fluoride when a child is still developing teeth.  Adults without fluorosis can never create fluorosis with any amount of fluoride.  Topical fluoride applied to the surface of the teeth will not create fluorosis.  The fluoride benefit for teeth is on the surface and can be maximized with topical products that are spit out and not swallowed.  To improve the fluoride benefit to your teeth allow the fluoride to remain on the teeth longer by not rinsing your mouth after use and not eating right away either.

Suggestions to maximize the benefit and minimize the ingestion of fluoride:  Starting with toothpaste, use a small amount on your brush approximately the size of a split pea or grain of rice.  After brushing your teeth thoroughly spit out the foam and do not rinse your mouth afterwards.  Also try to avoid eating or drinking anything for the next 30 minutes.  This allows more time for the minute amounts of fluoride to incorporate in the surface of the tooth.  If you have a history of cavities you may wish to talk to your dentist about using a prescription high fluoride concentration toothpaste (Not for children under 12 year old).  If you have a history of cavities you may also wish to use a fluoride mouth rinse daily.  This would best be done in the evening just before going to bed.  Saliva flow, which would normally flush the fluoride rinse off your teeth, slows to nearly nothing while sleeping.  This allows the rinse to remain on your teeth several hours.  Also, for those with a history of many cavities, your dentist can provide fluoride varnish applications on a regular interval or prescribe fluoride gels which cling to the teeth better than the rinses.

In general, with the growing number of fluoride sources in our daily lives, dentists and physicians are moving away from attempting to calculate appropriate fluoride supplements and are moving toward the use of topical fluorides.  This minimizes the risk of fluorosis and maximizes the benefit of fluoride protection from cavities.

And, still, the best way to administer fluoride for consistent prevention of cavities is with community water fluoridation.  If your community has the opportunity to fluoridate its water, support it.  Water fluoridation levels have been recently reduced to accommodate the “extra” fluoride in many food sources.  Please note that the fluoride in foods is only present in processed foods.   So if you primarily eat whole foods (whole fruit, vegetables, whole grains, meats and dairy) then your children are not at risk from the growing sources of fluoride in processed foods and beverages.

Learn to prepare food and eat real food.  Want help to insure your children have the brightest smile possible - call me for a consultation today!  530-878-2357   Meet the team!

Sports Drinks and Energy Drinks; Not for Kids.

A few weeks ago I wrote a short series of blogs about sports drinks and energy drinks and their inappropriate and contraindicated use by children and adolescents.  Last week the American Academy of Pediatrics, Committee on Nutrition and Council on Sports Medicine and Fitness published their “Clinical Report – Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?”  In today’s blog I am going to merely quote summary statements from that report.  The full text is available free on line and I encourage you to use the reference at the end to access, print and read the full text.  The details and references are stunning.

“Sports drinks and energy drinks are significantly different products, and the terms should not be used interchangeably.”

“Rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents. Furthermore, frequent or excessive intake of caloric sports drinks can substantially increase the risk for overweight or obesity in children and adolescents.”

“With children and adolescents, careful consideration is necessary when selecting a beverage to hydrate before, during, or after exercise and outside of physical activity to prevent excessive sugar and caloric intake that may encourage dental erosion, overweight, and obesity.”

“Children and adolescents should be taught to drink water routinely as an initial beverage of choice as long as daily dietary caloric and other nutrient (e.g., calcium, vitamins) needs are being met. Water is also generally the appropriate first choice for hydration before, during, and after most exercise regimens. Children should have free access to water, particularly during school hours.”

“Sports and energy drinks are not indicated for use during meals or snacks as a replacement for low-fat milk or water.”

“The actual caffeine content for many energy drinks is not easily identified on product packaging or via the Internet. The total amount of caffeine contained in some cans or bottles of energy drinks can exceed 500 mg (equivalent to 14 cans of common caffeinated soft drinks) and is clearly high enough to result in caffeine toxicity. …

Additional concerns regarding the use of caffeine in children include its effects on the developing neurologic and cardiovascular systems and the risk of physical dependence and addiction.  Because of the potentially harmful adverse effects and developmental effects of caffeine, dietary intake should be discouraged for all children.”

“For most children and adolescents, daily electrolyte requirements are met sufficiently by a healthy balanced diet; therefore, sports drinks offer little to no advantage over plain water. During or after participation in short training or competition sessions, athletes generally do not need supplemental electrolyte replacement.”

“Low-fat milk is a good option for use as a post-exercise protein-recovery drink.”

“In general, the use of amino acids in energy drinks in place of traditional dietary sources is not supported by the scientific literature and, therefore, is discouraged for children and adolescents.”

“Given the current epidemic of childhood overweight and obesity, we recommend the elimination of calorie containing beverages from a well-balanced diet, with the exception of low-fat or fat-free milk, because it contains calcium and vitamin D, which are particularly important for young people.”

I encourage you to read the full text of this informative report which is free and downloadable from:

http://pediatrics.aappublications.org/content/early/2011/05/25/peds.2011-0965

Have a great day and enjoy your next glass of clean, clear, cold water!

Mom's Dental Health and Baby's Dental Health

Dental disease, especially cavities, is contagious!  The truth is a vast majority of infants "get" their dental disease from mom.  Sadly, in an attempt to improve dental health for infants and toddlers, recent literature has been admonishing mothers to avoid:

1)      Slobbery face to face nuzzling and kissing of their babies.

2)      Sharing spoons and cups with infants while helping them learn to eat.

3)      Cleaning baby's oral items like pacifiers and teething rings by licking them off yourself.

To me that is a bit like telling moms not to be moms.  Don't do those cuddly face to face things that moms do so well?  Children get their oral bacterial balance from somewhere, so if it is not mom, who will it be?  Spin the roulette wheel and hope?  No.  The focus is to create good oral health for mom.  Then she can pass her healthy balance of bacteria to her child!  Evidence shows that mom’s with a healthy balance of bacteria in their mouths have babies who "get" disease causing bacteria much later as toddlers. Evidence is also clear; toddlers who establish a cavity causing bacteria in their mouths later have fewer cavities for a lifetime.  The next few blogs will explore:

1)  Good oral health helps a healthy pregnancy.

2)  Poor oral health is associated with pre-term delivery and low birth weights.

3)  Dental care during pregnancy is safe.

4)  Improving oral health is in your hands, it is simple, and it is NOT expensive.

5)  Xylitol, toothpaste, mouth rinses and other over-the-counter products can improve your oral health if used correctly.

So until the next week, remember:

Don't floss all your teeth; just the ones you want to keep.

Scott Thompson, DDS
Pediatric Dentistry

Will My Child Suffer Cavities Like I Have?

The standard (and trite) answer is, of course, it depends on how you care for them.  This leads most people to think of how often they brush, what toothpaste they use, do they use a mouth rinse and perhaps whether they are an excessive candy eater.  Few people think more broadly of what they eat or feed their kids, especially beverages.  We speak extensively in our office about beverages, both for adults and especially for children.

Let me cite one piece of literature (among many showing this problem).  Dr. Philip Marsh was interested in what happens to the oral biofilm of bacteria developing for children sipping juice or other sweet beverages.  Children today are commonly weaned from breast milk or formula to "healthy" juices, typically diluted a bit.  This then evolves into juice or other sweet beverages for the toddler in a handy and available sippy/tippy cup.

Using known data on saliva flow and chemistry, food flow, and the various micro environments in and around teeth, he designed a research study to monitor tooth biofilm.  Dr. Marsh then introduced juice periodically to mimic a child sipping some juice from a sippy cup or bottle and introduced plaque bacteria (similar to how children get these bacteria in slobbery kisses and feedings with parents).  With sampling over time he measured the bacterial balance in the biofilm developing on tooth surfaces.

Tooth biofilm in a healthy mouth typically contains about 1-2 % of the cavity causing bacteria.  While mimicking a child's juice sipping pattern Dr Marsh measured the shift in cavity causing bacteria from 1-2 % to over 50%.  At that level, those bacteria control the biofilm, supporting the acid loving bacteria and destroying the "healthy" bacteria in the biofilm.  Most distressing is that once this biofilm balance has established on the child's developing teeth, about age 2 ½ to 3 years old, it is extremely difficult to change.  It will likely be a high cavity inducing biofilm the rest of the child's life.

Ouch! … $ $ $ $ too!

Please don’t introduce juice and other sweet beverages to your child until they are at least 4 years old.  Even then, limit it to meals.

Dr. Scott Thompson - Pediatric Dentistry

Babies Don't Come with Cavities.

We don't inherit “soft teeth” from our parents and babies don’t come with cavities.

Cavities are caused by a bacterial disease called “caries.”  We catch this disease from our close family and friends.  Like any other contagious disease, how we take care of ourselves determines how our body will handle the disease.  How the family takes care of oral health will affect the cavity rate of the infant and toddler.  Correct family oral care will limit the contagion of the disease.  Correct oral care for the infant and toddler will limit the survival of the bacteria that cause cavities.  Diet and beverage patterns for infants and toddlers will either limit or support the cavity causing bacteria.  The disease, “caries,” establishes its lifetime pattern while the baby teeth are emerging from age 6 months to 30 months old.

Establishing a dental home with a dental office that offers well baby exams will give you the information you need to create a lifetime of dental health for your baby.  Other advantages of establishing an early dental home with your family dentist or pediatric dentist are:

1)      Money savings.  Children who visit the dentist before their fast birthday have an average 40 % lower dental cost during their first 5 years.  These savings will continue through life.

2)      Enamel defects, if addressed early, can be remedied with simple techniques to prevent tooth deterioration.

3)      Early dental cavities can be healed rather than filled if detected early enough and addressed at home with proper information and prevention.  Infants don't come with cavities.  Creating a no cavity environment for your baby can lead to a no cavity environment for a lifetime.

The first tooth deserves a dental home.

Next Blog: 1% or 50%?

Infant and Toddler Warning Regarding Benzocaine.

A recent warning from the FDA indicates infants and toddlers under 2 years old are particularly vulnerable to developing Methemoglobinemia if exposed to Benzocaine.

Methemoglobinemia is a rare disorder of the blood that limits the blood’s ability to carry oxygen.  It can occur as an acquired disease and as an inherited disease.  The inherited version of the disease can have mild consequence for some up to severe and life threatening consequences for others, depending on the type.  Families with the inherited version are generally well versed in the prognosis of their type of Methemoglobinemia.

The acquired version of the disease is generally less dramatic and easily managed once the triggering agent is identified and avoided.  It is, however, very frightening and stressful when it develops and warrants an immediate trip to the doctor.  On rare occasion this type has also been life threatening.

Benzocaine is a known trigger for this disease and the FDA has issued a warning regarding use for children under age 2.  They are significantly more susceptible and vulnerable to a more severe reaction.  The soothing agents for teething and other mouth sores like canker sores and viral ulcers typically contain Benzocaine.  This warning is particularly important for parents of toddlers and their dentists.  Some typical agents containing Benzocaine are: Anbesol, Hurricaine, Orajel, Baby Orajel, Orabase, and store brands.  Many of the dentist’s topical anesthetics contain Benzocaine.

Also common sense reminds us, topical anesthetics have not been available until very recent human history.  Infants get through their teething issues with good nurturing, good food, and friendly things to chew on.

Next Blog:  Babies don't come with cavities.

Setting Your Child’s Cavity Risk Early

Few people realize that cavities are the result of a contagious disease. As infants, when we are teething those precious little baby teeth, we are also being exposed to the kinds of bacteria that cause cavities. These bacteria typically come from our closest caretakers, like moms, dads, nannies and siblings. Typically via slobbery kisses, shared spoons, and other close encounters. It is inevitable so don’t panic about it. However, there are numerous ways to insure this contagion will not destroy your child’s teeth.

First, reduce the amount of bad bacteria being transferred to the child. Parents with clean healthy mouths and no recent cavities will have fewer of the cavity causing bacteria in their saliva. Learn how to truly clean your teeth when brushing and flossing. Also, if you are a gum chewer or mint popper, find Xylitol gum and mints on the internet and health food stores. There are numerous studies showing dramatic reduction of the cavity causing bacteria in the mouths of those who put Xylitol (a natural sweetener) in their mouths several times daily.

Secondly, don’t feed those bacteria and promote their growth. These bacteria thrive on sugars and simple carbohydrates (cooked starch). It has been shown that frequent (frequency is the issue here!) exposure to simple carbohydrates promotes the preferred growth of the cavity causing bacteria (mutans streptococcus, sobrinus streptococcus, etc.). If we promote these bacteria early, they establish in high numbers and will continue to be in high numbers in the saliva and on teeth for a lifetime. Juice is an especially common mistake in sippy cups and bottles. Let’s not do that to our children. When your children are ready to give up milk and formula in the bottle, move to water. Do not, I repeat, do not start them on juice or any other sweetened beverage when they move away from milk, unless your pediatrician has specifically written a prescription for your child to have juice because of some metabolic reason. Ask your pediatrician and they will confirm this. The American Academy of Pediatrics does not support the use of juice as a snack or hydration beverage until age 4. Even at age 4 there is a word of caution and recommendation for continued use of water.

Thirdly, clean your child’s teeth effectively each day. It has been shown that the more the plaque (a biofilm of over 600 different bacteria) builds on the teeth, the more it promotes the acid loving bacteria that cause cavities. By simply disrupting this biofilm each day and forcing it to rebuild will prevent it from maturing to the level that it harbors and promotes the growth of the acid loving bacteria that make cavities. As the plaque matures and stagnates, it supports acid loving bacteria which begin to flourish and dominate the plaque. As acid loving bacteria numbers grow, they begin to control the plaque growth and with a higher balance in the saliva, they cause a more rapid maturing of the plaque into a destructive acid loving plaque which dissolves holes in the calcium rich enamel of your teeth. Once established, this balance can be extremely hard to change and may remain for a lifetime. Don’t let it start.

Give your kids a healthy start. Help them become water drinkers as a habit and you will create a lifetime of better health for them. Clean the gum line and between teeth daily to promote a healthier bacterial balance in your mouth’s dental biofilm. If you like gum or mints, discover Xylitol.

Give Your Teeth a Rest

I get a chuckle when children come into the office the week after Halloween or Easter.  They have eaten a bunch of candy in the last week and are worried that it made some cavities.  The reality is cavities take months or more commonly years to form.  When the complex biofilm of bacteria develops in the nooks around your teeth it creates acids as a byproduct of sugar metabolism.  These acids dissolve calcium out of tooth enamel.  As the disease progresses the enamel first develops a white mark as the calcium is dissolved out.  The enamel is softening and beginning to look like white chalk.

Next the microscopic voids where calcium has dissolved begin to collect stain and the mark on the tooth darkens brown or black.  Eventually the softening of enamel reaches the point that pieces of enamel begin to chip out and leave a hole, the cavity.  Depending on your habits, this process can take months or years or never become a cavity at all.

Each time we put simple carbohydrate (sugar or cooked starch) in our mouth the dental biofilm will function at a high metabolic rate for about 40 minutes.  During this time the high acid production is attacking all teeth.  Calcium is being dissolved out of our teeth in large quantities.  Don't despair!  Saliva has the ability to capture and hold that calcium in super saturation.

After the 40 minutes of high acid output, the biofilm bacteria hibernate and wait for their next sugar meal.  Now the saliva can neutralize the remaining acid.  When the mouth is neutral, the calcium balance favors calcium uptake and so the enamel recaptures the calcium that was lost during the acid attack.

If we eat 3 meals and a snack each day our teeth are under attack for about 5 hours each day and they here 19 hours to REST and RECOVER the calcium they lost.  A good balance with good rest time.

Grazers, however, especially children, have acids attacking their teeth all day with little or no recovery time.  If a child eats 3 meals and also has a sippy cup of juice to sip (hourly) between meals, her teeth will be under attack all day.  No recovery period for the teeth to regain lost calcium.  If the child goes to sleep sipping something, it will pool in the mouth and feed the bacteria all night.  The acids are attacking all day and all night!  This is why I have seen teeth with no detectable cavity on exam or x-ray develop a cavity so large and deep it requires a root canal treatment and crown within 6 months.

Give your teeth a rest!  Eat 3 meals and a snack and give your teeth a chance to rest and recuperate between meals.  If you like sweet beverages have them with meals where the sugar and acids get buffered by the other food.  For snacks use protein (nuts, seeds, cheese) and complex raw carbohydrate (carrots, celery, cauliflower, broccoli, jicama), perhaps with a nut or cheese spread.  Calories with robust nutritional support and no simple carbohydrates to threaten teeth.  Between meal beverage?  Water.  Only water.  That is what the human body needs.

Next:  1) Setting your cavity rate early.  2) Changing your cavity rate.

Sports/Energy Drinks - Are We Addicting Our Kids to Them?

We all want more energy and more alertness on the playing field, whether it is sports, debate, cards, or just joking around.  It is not surprising the distinction between sports drinks and energy drinks is blurring.  The concerns for our youth with growing bodies and developing physiologic systems are multiple.  The sugars in these drinks are addicting enough and challenging to the insulin endocrine system.  The energy drinks, however, are fundamentally different due to many additives in them.

The most obvious concern is caffeine.  Energy drinks typically contain 10 mg (to 16 mg) per ounce.  This totals 240mg (to 390 mg) for a 24 oz. drink.  Note: The amount of caffeine necessary to create measurable physiologic changes in a full size adult is about 50mg.  Also note: Cardiac arrest (heart failure) has been anecdotally associated with drinking large energy drinks.  Although the direct causal relationships has not been proven (obviously difficult research to do if someone’s life is at risk), the implications are obvious.  For some young children with sensitive myocardium (heart muscle) the potential threat is clear and catastrophic.

Are we addicting our children's physiologic developing systems to caffeine?  The amount of caffeine for full size adults to develop an addiction is about 100 mg per day.  In a recent study of 228 families with young children, 75% of the children consumed caffeine.  For those children who consumed caffeine, the average daily consumption for 5 to 7 year olds was 52 mg and for 8 to 12 year olds it was 109 mg.  Yikes.  An additional note about caffeine for youth.  Caffeine consumption in youth age 5 to 12 has been correlated with decreased average sleep.  Sleep studies have linked inadequate sleep with ADHD type behavior.

Guarana, an additional ingredient in energy drinks contains both caffeine and guaranine, a stimulant that acts very much like caffeine in our bodies.  The amount of guaranine (nor Guarana) is not listed in these drinks.  Guaranine has documented cardiac side affects like caffeine and the medical literature recommends patients under cardiac care consult their physician before taking any Guarana supplements.  I have not seen a potency comparison between caffeine and guaranine, but the cardiac affect of the 2 is additive.  Should we be allowing our growing athletes to consume these addictive substances?

Taurine, another ingredient, an amino-acid, is more difficult to pinpoint.  The literature contains a broad list (with some warnings) of the possible effects and mechanisms of this stimulant.  Though we know it stimulates changes in physiologic function within cells, the specific results are ambiguous in the research literature.  It is added to these beverages because of its stimulant value.  It is concerning to me when I realize children with developing physiologic systems are consuming supplemental amounts of taurine.  All of these ingredients (Caffeine, Guarana, Taurine) came to us from ancient cultures in which the shaman discovered the mood altering capabilities of these herbal plants. 

Once again I come to some basic tenets of sports (and energy) drinks.

Water - the basic ingredient of these drinks - is usable and vital to our bodies.  Next time try plain water, it is nature’s best.

Sugar (fructose, sucrose) - We don't need more if we eat regular meals.  Most of us are damaged by the excess empty calories.  Children getting extra calories from beverages become picky eaters because they are not really hungry at meal time.  And they become overweight despite their activity level.

Electrolytes - If we eat real food at our meals, we don't need more electrolytes.

Energy stimulants (Caffeine, guaranine, taurine) we don't need.  A college student might appreciate it if studying late and some of us need a “wake up” in the morning.  However, our youth, including the college student and young athlete, don't need artificial stimulants (energy?) for physical activity.

Next blog: Give Your Teeth a Rest.       

Dr. Scott Thompson  - Pediatric Dentistry 

 www.winningwithsmiles.com

Sports Drinks - How to Dissolve Your Teeth

 This is about those wonderful fruity flavors.  In order to create the flavors in today’s beverages, those tangy and/or fruity flavors, the makers use fruit juice as their base or they add organic acids that come from organic juices.  Reading the label you will usually find citric, ascorbic, or malic acid; often several.  Also, there is commonly a fruit juice concentrate which will have high amounts of organic acids.

"Organic "systems are designed to maintain stability.  In other words, if nature establishes a fruit with a certain acid level, there is also a "buffering" system that holds that acid level constant.  This reserve system is huge so that living systems can resist significant insults from the outside world and still survive.  For example:  Comparing a glass of Coca Cola (inorganic) with apple juice (organic), the apple juice will require 8 times as much base (antacid) to upset the balance and neutralize the apple juice compared to the Coke.  It is this lasting power that makes it possible for sports drink acids to do so much damage to teeth.

The other crucial ingredient is how we use these drinks ... sipping.  Sports literature expounds the value of maintaining hydration during physical activity.  This has translated into sipping patterns to maintain hydration during sports.  Large bottles (lots of calories) are at game side for frequent gulps during game breaks.  The athlete is bathing her teeth in acid attack.  This frequently translates into a sipping style of hydration every day for many of us, especially our youth.  Athletes in sports that allow a hydration pack on their back are bathing their teeth continuously with enamel dissolving acids.

The most alarming example I witnessed was a patient of mine.  For 13 years this bright and personable boy had been a cavity free patient in my practice.  He is quiet, studious and has a real creative talent with computers.  He developed a habit of coming home from school, doing his homework and then his computer graphics and programming.  He was bathing (sipping) his teeth in organic acids (sports drinks and other beverages) all afternoon and evening several days a week.  In the short period between 2 regular cheek-ups his teeth deteriorated so severely he needed several crowns. And it was not cavities nearly so much as he just dissolved the enamel off of his teeth.

My simple rules of thumb.

Hydration - nature designed us to use water.

Electrolytes-we get plenty of them if we eat “real food.”

Calories.  We get enough in our meals so be careful about snacking.  Our bodies store plenty of glycogen to get us through long periods of exercise and exertion.

Next week:  Sports Drinks becoming energy drinks with dangerous implications. 

Sports Drinks - Not What You Might Hope They Are.

Have you checked out the ingredients of your "sports drink?"  Basically you will find:  1) water,  2) sugar of some kind,  3) organic acids (or citrus juices) for the tangy taste, and  4) some electrolytes.

The water is obvious and great.  We need to rehydrate during and after sweaty exercise.  No problem.

Sugar of some kind?  The amount of Calories we burn during exercise is not as much as you might think.  A jogger running for an hour only uses about 400 Calories.  (Just 1 scone at your favorite coffee shop will replace that!)  A marathon runner will run for 3 hard hours before he depletes his easily available glucose energy storage in his muscles.  Sports event players don't need sugar of any kind in their water.  To the contrary, adults and kids alike are consuming hundreds of excess (un-necessary) calories, empty calories (containing no nutrients to help adequately metabolize the calories), with these drinks.

The sipping nature that many people employ drinking these sports drinks is also boosting the sugar loving, cavity causing germs in our mouths.  The bacteria that cause cavities will thrive at high metabolic rates for 40 minutes following a simple sugar exposure.  Assuming 3 meals and 2 snacks, the teeth are under acid attack 4 hours.  The other 20 hours each day the teeth are recovering calcium from the saliva.

People who sip sports drinks from backpacks or before, during and after sports events and celebrations have their teeth under attack a majority of the day with inadequate recovery times to maintain healthy enamel.  Screw cap lids make it possible to sip these beverages all day and for those children who do, the teeth have no opportunity to recover the calcium lost during the constant acid attack of the bacteria.  Their cavity rates begin to soar.

The human condition has evolved over several millennia with water to hydrate us.  In the last couple decades sports drinks have not made us healthier or improved our sports performance.  However, they have:

1)  Done huge damage to our teeth and oral health.

2)  Contributed heavily to an overweight and obese population, especially our kids, that pediatricians and other physicians and health care workers are working desperately to change.

3)  Been a significant contributor to the growing problem of Type II diabetes in our children.

A third and highly “hyped” ingredient is electrolytes.  Electrolyte replacement with these sports drinks is not necessary and inefficient besides.  With a mere 25 cent envelope of Emergen-C I can:  1) replace those electrolytes and more,  2) get a healthy dose of vitamins and minerals as well,  3) get only 25 Calories in the bargain, and  4) gulp it down in short order any time during the day so it is not bathing my teeth for hours.  The real bottom line, however, is that our daily diet gives us adequate electrolytes each day so unless you are an extreme athlete doing strenuous exercise several hours each day, you don’t need to be concerned about electrolytes.  If you are truly concerned about chemical balance, the 3^rd article in this series on sports drinks will address a few additives of real “concern” that are in these sports drinks.

The last primary ingredient in sports drinks is organic acids (citric acid, ascorbic acid, malic acid, etc.)  Next week I'll tell you how to dissolve the enamel off your teeth the easy way with sports drinks.