Contagious Cavities?

Most people recognize that cavity problems seem to run in families. Most people also shrug and say "I have soft teeth, it runs in the family," as if they cannot do anything about it. That is wrong. Research has never demonstrated soft teeth. Research has definitely demonstrated the bacteria that cause cavities are contagious and we usually get ours from our caretakers when we are infants and first growing teeth.

If a family has aggressive cavity causing bacteria, they are typically traded to the infant at those cuddly slobbery spoon sharing times. But, please do not stop being cuddling nurturing parents. There is another way! The contagious disease is dose dependent. Research has shown that cleaning up mom and dad's oral health before baby is born, or at least before infant teeth show up, is an excellent way to reduce bacterial count and improve outcomes for baby. By the way, this includes improving odds for full-term pregnancy.
A good way to start would be a dental checkup. However, by "cleaning up oral health" I don't mean necessarily getting those expensive cavities filled, though that obviously helps too. Immediate and inexpensive, or even free things people can do are:

1. Become a truly effective tooth brusher. 

Use disclosing tools (tablets, solutions, or kitchen food color) to show you the bacteria. Then teach yourself how to thoroughly clean your teeth. Check yourself every couple weeks until you are confident you have figured it out. Most people find they can thoroughly clean their teeth in about half the time they used to.

Dental Health & School Performance Linked

A recent nationwide study published in Pediatrics demonstrated a significant correlation
with reductions in school performance and psychosocial well-being. Children with dental problems were more likely to have problems at school and to miss school, and were less likely to do all required homework. Dental problems were associated with shyness, unhappiness, feeling of worthlessness, and reduced friendliness. The effects of dental problems on unhappiness and feeling of worthlessness were largest for adolescents between 15 and 17 years.

Conclusion

Preventing and treating dental problems and improving dental health may benefit child academic achievement and cognitive and psychosocial development.

A reminder to start early.  The first tooth deserves a dental home.  If you are going to prevent tooth decay, you have to start before the decay starts.

How often should you go to the dentist?

Most dentists are reluctant to stray from recommending a six-month checkup schedule. There is good reason for this, for example: In pediatrics I have witnessed in a child an undetectable cavity progress to a cavity large enough to nearly expose the nerve of the tooth in just six months. Had they elected to return on a one-year checkup schedule the child would have had an abscess and an emergency before the check up was accomplished. Pre-cancerous lesions can show up at a six-month checkup and be treated appropriately. If the check up interval is 12 months, that lesion can be frank cancer with a very different treatment outlook.

The dentist looks at a large number of factors for a patient when determining his approach for care. This includes: history of cavities. Risk level of new cavities. Diet patterns that will affect teeth and other mouth tissues. Existing diseases like diabetes, hypertension and obesity. Current medications which will affect oral conditions. Existing history of typical changes that occur at current check up intervals. Habits and lifestyle patterns like smoking, Drinking, coffee, etc.

Soda and Aggressive Behavior

Soda – not just about bad teeth.

Five-year-olds who drank at least four servings of soda daily had double the risk of aggressive behaviors compared with children who did not drink any soda, according to a study on the website of the Journal of Pediatrics. Researchers noted that regular soda intake also was associated with social withdrawal and attention problems.

Now think about the energy drinks with their high levels of caffeine! In addition to the sugar.

Photo credit: Wikipedia Commons

Dental Health affects School Performance and Self-esteem

A recent nationwide study published in Pediatrics demonstrated a significant correlation
with reductions in school performance and psychosocial well-being. Children with dental problems were more likely to have problems at school and to miss school, and were less likely to do all required homework. Dental problems were associated with shyness, unhappiness, feeling of worthlessness, and reduced friendliness. The effects of dental problems on unhappiness and feeling of worthlessness were largest for adolescents between 15 and 17 years.

Conclusion
Preventing and treating dental problems and improving dental health may benefit child academic achievement and cognitive and psychosocial development.

A reminder to start early.  The first tooth deserves a dental home.  If you are going to prevent tooth decay, you have to start before the decay starts.

Winning With Smiles Children's Dentistry

Fluoride -- Count the Ways

Something new!  The American Chemical Society recently published the results of a study showing that fluoride in the environment, like in your saliva because you drink fluoridated water, reduces the stickiness of streptococcus mutans.  Strep mutans is one of the major cavity causing bacteria in our mouths. It's stickiness allows it to stick to teeth and allow other cavity causing bugs to stick to it.  This conglomeration of bacteria, a bio-film, creates and concentrates the acids that dissolve holes in our teeth, cavities. This stickiness reduction becomes one more way fluoride resists cavity formation.

Other ways include reducing the bacteria's ability to create the acids that dissolve teeth. Also as a salt (sodium-fluoride or calcium-fluoride) in solution in your saliva, the fluoride will exchange with the hydroxide in the tooth enamel crystal (hydroxyapatite to fluorapatite) making it about 100x more difficult to dissolve with acid.

Fluoride is ubiquitous in nature, 2 parts per million in sea water and naturally occurring in fresh water in widely varying levels. At 1 part per million in drinking water it is an excellent preventer of cavities. If you live in a non-fluoridated area, the simplest way to maximize your fluoride benefit, without risking too much fluoride is to simply 'spit your toothpaste after brushing and don't rinse afterward.' The lingering bit on your teeth will have a longer time to interact with the enamel of your teeth as well as the germs themselves.

Photo Credit: wikipedia commons

Ask Your Children's Dentist

When you take your children to the dentist, are you getting what you want? These days the parents are usually thrilled there is sooo much entertainment and distraction for the children to make their dentist visit pleasant. Most parents do not have those pleasant memories. All that is great. I want also to ask you what is your true objective for bringing your child to the dentist? Is that being accomplished too?

In my office for instance: My number one objective is teaching each child how to have a lifetime of cavity free, healthy, beautiful smiles. That starts by teaching the parents how to simply, quickly and effectively prevent cavities before they get started. How to stop them if they have started. How to transition from baby teeth with cavities to adult teeth without cavities (difficult, not impossible). To do this, does your dentist:

1) Start with the parent child team as soon as the child has her/his first tooth? By age 3 the bacterial environment (for high or low risk for cavities) around the teeth has established itself for a lifetime. What parents do those 3 years will influence that environment and the dental health of their children for a lifetime.
2) Teach the parents effective and quick (20 seconds) ways to clean their children's teeth? I find I must include parents with me at chair side for all visits to successfully demonstrate this. What to do and how to coach the team changes as the child grows?
3) Teach how to evaluate your own effectiveness at home so you can verify you are getting the job done well without waiting for that 6 month check-up?
4) Teach how to evaluate how well your child is cleaning her/his mouth so you know when you can allow them to "do the job" and you know how to evaluate periodically to assure they are actually getting the job done?
5) Communicate well with your child so when she/he isn't listening to you, she/he may actually be listening to the dental team?
6) Include educating the parents early and the children later about the outside influences that will damage oral health and how to handle them in the family?

Dentistry for children has certainly become more entertaining than it used to be. That doesn't change the FACT that children's cavity experience is worse than it has ever been and is getting worse by 30% every 10 years for the last 30 years. Start your child on a healthy path early.

Oral Health begins before birth. Oral disease establishes before age 3. For the elderly who have lost their teeth, there is NOTHING in their "I Wish List" that rates higher than having their teeth back. Set the right standard with the first tooth.

Bad Teeth...Bad Grades!

A recent study at USC and published in the Journal of Public Health verifies that children with poor oral health have, on average, lower grades. They also miss more days of school due to tooth aches and dental appointments. It also pointed out that parents of these students miss more days of work due to the need to care for their children's dental appointments.

One of the tragedies here is to know this is so simple to prevent, though without adequate information, parents find it difficult to accomplish. An early start (age 1) with good instruction will demonstrate to parents how simple it is to give children an excellent start to a lifetime of good oral health.  Cavity free, healthy, beautiful smiles.

Chocolate Milk Makes Cavities!

Chocolate milk is candy.  Granted it has milk protein and calcium, but the sugar ratio to other nutrients still makes it candy.  As for its ability to make cavities, it is less of a problem than juice and sports drinks because it is not acidic like them.  I put it on the same scale as chocolate candy, except we do not nibble on chocolate candy multiple times a day every day.  Infants and toddlers who drink chocolate milk do sip on it at multiple opportunities during the day.  Some have it in a sippy cup or bottle and sip on it all day.  As you might expect, these kids develop a high rate of cavities early in life* and they establish an oral bacterial balance around their teeth that will plague them their entire life.**

If your child is already “addicted”*** to the sweet flavor of chocolate milk, there are a couple options for you.

1) Adamantly restrict chocolate milk to one glass at mealtime when it will be mixed with the other foods of the meal.  Note:  If you can do this you are a committed person (and tougher than me).  If children are used to having chocolate milk throughout the day, and they know it is in the house, they will insist on having it as usual and you will have a small war (demands, crying & tantrums) on your hands.  My experience with small wars with children is that they win … every time.  They don’t understand losing and they will persist until they win.

Tips for Optimum Oral Heath During Pregnancy

Pregnant?  Your and your baby’s optimum oral health and general health can begin today!

In a previous blog I emphasized how important oral health is to the health of your pregnancy and your baby.  What can you do now, even before a good dental examination to maximize your oral health?

Gum Chewers and Mint Poppers 
If you chew gum or use mints, be sure to buy ones with xylitol as the first ingredient, and preferably the only sweetener in the ingredients list.  Xylitol is well documented as a cavity-preventing sweetener.  Find xylitol (gum, mints, toothpaste, etc.) at your health food store, Internet, and checkout stand (spry, glee, ice cubes, frost, epic, & more).

Tooth Brush and Spit – DON’T Rinse

Since 1999, when John Featherstone PhD published his new data on the mechanisms of Fluoride in oral fluoride mouth rinse after brushing for the express purpose of leaving fluoride on their teeth.  The same concept can be accomplished by merely leaving the residual toothpaste on your teeth.

health, I and many prevention oriented colleagues have promoted the concept that one should not rinse after brushing one’s teeth.  Just spit the excess foam out and leave the residual toothpaste on your teeth.  After all, don’t we tell you the same after your dental appointment where we give you a fluoride application and tell you not to eat or rinse for 30 minutes?  Many folks will use a

If you like to rinse with a mouthwash for other than a fluoride based reason, then I would recommend waiting at least 30 minutes after brushing if you are going to use a non-fluoride mouth rinse.

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

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