Dietary Influences on Teeth

In previous articles I have discussed the worn dentition. What are the dietary influences on tooth longevity?

Teeth age along with the rest of the body, but I have seen teeth prematurely wear out for many reasons. Some teeth are diseased or traumatically damaged while others simply erode away. Let’s look at tooth erosion.

Tooth enamel is the hardest substance in the body. The next hardest is bone. It changes during a lifetime. Tooth enamel formation is completed by the time it comes into the mouth. The enamel shell will become hardened and polished due to wear. It will chip and crack, wear and erode, and possibly decay. Unlike bone the tooth enamel will not grow back on its own once it has eroded.

Signs of erosion include hypersensitivity, dimples in the chewing surface of back teeth, cupping of the leading edges of your front teeth, shortening of the length, wear on non-functional areas of teeth, increased translucency of front teeth, loss of surface texture and a smooth glazed appearance to the tooth surface.

Chemical erosion can occur from gastro-esophageal reflux disease (GERD) or eating disorders (Bulimia or Anorexia). More commonly chemical erosion occurs from the foods we eat. Cola drinks, carbonated sodas, grapefruit juice, apple juice, orange juice, lemonades, raisins, dried apricots, and pickles have all been shown to have moderate to severe erosive potential.

I enjoy consuming all of the items listed above and do not suggest to eliminate or change your diet dramatically. However, if the adult male drinks an average of 8.6 cans of soda a week then it is wise to not sip the sodas and constantly bathe the teeth for long periods of time. It is best to wash out the soda with a glass of water afterwards. If children are attached to sippy cups don’t fill them with fruit juice. Milk is a better choice and has a low erosive effect on their teeth. Remember that it is the frequency of exposure that matters.

Home remedies include use of toothpastes with fluoride additives. Some toothpastes (Sensodyne ProNamel) are formulated to recharge the tooth surface with fluoride to make it less affected by chemical erosion. These are available over the counter. Other toothpastes actually restore the calcium content and harden soft spots or early cavities. Presently, these dentifrices (Recaldent and MI paste) can only be purchased through your dental office and are more expensive than your regular toothpastes. However, I do believe that in the long run the cost savings will be tremendous.

For those of us who have “weak” teeth it is especially prudent to consider what we can do to make them stronger and what we can do to prevent weak or susceptible teeth from erosion. Likewise, for people who have had appreciable dental work performed it is imperative to prevent our dental work from failing due to breakdown and leakage-just another form of erosion.

Being conscious of how we consume foods will prolong our good dental health.

Electric Toothbrushes-Are they better?

Your dentist may have suggested that you start using an electric toothbrush after years of using hand brushing. Why? Are they better and more effective? What’s wrong with my normal brushing? They are how much?

These are typical responses I have witnessed in my dental practice. I think electric toothbrushes are great and that everybody should invest in one of the good products you find on the store shelves. Sonicare, Oral-B electric, and Roto-Dent are three that provide the finest in electric toothbrushes.

Now let’s investigate whether they are better than hand brushing. For many people with normal sized mouths and straight teeth manual brushing will maintain a good clean environment for optimal health. When mouth sizes are small and teeth are crowded and tight electric brushes will easily attack difficult to reach areas.

Your dentist may have noticed that you brush too hard and are wearing away the teeth and causing gum recession. Using electric toothbrushes with less force will be less erosive on your teeth and still clean very effectively. The very back molars are sometimes forgotten or impossible to clean with hand brushing. The electric brushes will clean even if you just “hold” it against the tooth.

Most dentists will advise to spend at least two minutes when brushing. This is also very true with electric brushes. Electric brushes are no shortcut for hand brushing and are not meant to be “faster”. However, they will provide more brush strokes per tooth per second of use and ultimately get your teeth cleaner.Which electric brush is better? I like all of them. In fact I have three different brushes I use daily. Sonicare by Phillips and Oral-B Professional by Braun are the big over-the-counter brushes. They have robust motors and a long battery life.

Sonicare has an ultrasonic wave action and pulses the toothpaste between the teeth. Oral-B has an oscillating round brush that scrubs the tooth surface. Roto-Dent is sold through dental offices and has the finest brush fibers available and is preferred for people with tooth erosion and fragile gums. It is a simple rotary round brush.

My advice for brushing is to be gentle but thorough. Giving yourself at least two minutes in the morning and before bedtime for brushing is best. Don’t try to rush through and press harder on the brush. Pressing harder will not achieve better results and could lead to early tooth wear.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Think Bacteria!

Why do some people have dental disease and others do not? Bacteria cause dental decay and gum disease. How each individual’s immune system responds to bacteria and the day-to-day care each of us gives to limit the effects of bacteria will determine who will be at risk for developing dental diseases.

First, we all have bacteria in our mouths and it is impossible to sterilize your mouth. Second, there is no drug or antibiotic that will cure dental decay or gum disease. Maybe some day there will be, but not at the present. Let us see why this is so.

Research into both types of major dental disease has isolated over 32 types of bacteria that can cause dental decay and even more bacteria that break down the gum and bone structures that hold the teeth soundly in place. To compound the problem the list of bacteria keeps growing every few years as scientists continue their research. This means that dentists and dental hygienists look to prevention rather than a cure to limit the damaging effects of the millions of organized bacteria that burrow into the teeth and gums.

I haven’t seen any literature that states that bacteria do this on purpose or that they even have a brain. However, all living matter seems to have a will to exist and propagate. The damage occurs when too many unchecked bacteria overwhelm the hardened tooth structure and the immune system that protects us. The dental decay causing bacteria thrive in an acidic environment and the acids produced by them will eat away at the tooth enamel. The bacteria associated with the gums will generate a battleground of bacteria vs. immune cells. Bleeding, puffy gums, and bone loss are signs of this battleground.

If you desire to maintain the health of your teeth and gums you must help your immune system overcome this invasion. First, limit the food source. This means removing any easily digested foods-like sugar-from the teeth. Remember that bacteria can divide into two bacteria in twenty minutes. They need something they can eat and digest really fast.

Second, brush each tooth for five seconds (about 2 minutes for the whole mouth). Floss or use special brushes between the teeth. This is most important. In my experience most dental disease occurs in these areas. Your hygienist or dentist may prescribe special toothpastes and oral rinses to help.

Third, try to maintain a healthy diet. Bacteria love junk food and sugar-our bodies do not. Limit the consumption of fruit juices and sodas. These beverages will make the mouth acidic and help to grow the harmful bacteria.

Fourth, see your hygienist on a routine schedule. This may vary from every three months to just annual visits. Your dentist will recommend a personal schedule depending upon your needs. Dental disease is chronic and mostly slow in nature. It will take a lifetime of good oral care to minimize the amount of dental work.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Canker Sores

Many of us have experienced canker sores. Where do they come from, what are they, and what do you do about them?

In a nutshell we do not know exactly what brings on a canker sore. They appear in young adults more often and frequently arise during periods of emotional or physical stress.
The sores typically occur on the cheek lining, under the tongue, around the uvula, bottom of the mouth and in front of the tonsils. It is not uncommon to have several sores appear near each other. They are very painful and can reoccur without any warning.

They appear first as tiny “bubbles” or red spots. The middle of the lesion becomes necrotic and a grayish-white covering or scab covers the wound. The nerve endings are exposed and the underlying tissue is very raw. Pain is the primary feature and will last for 5-7 days. These sores will typically run their course in 14 days. They can reappear with extreme and exasperating frequency.

Under the microscope scientists have noticed an intense infiltration of inflammatory cells leading to the theory that these sores are an immunologic defect in the cellular immune mechanism. In other words a small patch of cells cease performing the functions that maintain their life.

What can you do about them? Since we do not exactly know what will create a canker sore you really cannot prevent them from occurring. If one does pop up the pain can be relieved with Aphthasol or Kenalog ointments. These are prescription medications that your dentist can prescribe. They are anti-inflammatory and are locally applied to the wound. More severe sores can be treated with high potency steroids such as Decadron.

Otherwise, you can wait until they subside. In the meanwhile keep them clean with hydrogen peroxide and covered with Zilactin (an over the counter oral wound dressing). I like Zilactin with Benzocaine since it numbs the sore and seals it off from spicy and irritating foods. Keeping the wound free of secondary infection is important so your dentist may prescribe an oral antimicrobial rinse such as chlorhexidine.
Canker sores can be confused with herpes and traumatic ulcers. Although herpes is reoccurring it typically does not appear inside the mouth. Likewise, traumatic ulcers usually have a memorable start date and do not reoccur (unless you repeatedly bite the same area).

I advise people with troublesome canker sores to seek pain relief from their dentist.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Care for our aging teeth

Methuselah reportedly lived to the ripe old age of 969 (is that doggie years?). Conveniently he missed the great flood by a week and probably didn’t brush and floss every day because he lost his teeth 800 years earlier. I am sure that if he had cared for his teeth and seen his dentist he could have held on to them much longer.

As we all know aging takes its toll on our physical attributes. The mouth and our dentition are not immune to the march of time. Let me briefly review some of the most common changes that can occur.

Saliva output usually diminishes as we get older. It makes sense considering other glands in our bodies start slowing down as well as the salivary glands. Eventually a “dry mouth” condition develops and teeth lose their lubricating and protective film. Oral bacteria flourish and destructive decay and gum disease that had been in remission for our “mid-life” years returns. There are several over the counter products that can promote salivary output to ease the feeling of dry mouth. Prescription formulations are available for more severe types of dry mouth.

As teeth wear against each other there is microscopic loss of the hard tooth enamel. Through the years this enamel wears thin or entirely disappears until the softer dentin core of the tooth is exposed. At this point the wear rate becomes rapid and the teeth will become noticeably shorter. The smile becomes old and worn and the teeth may look jagged and twisted due to the uneven wearing of the edges. The youthful healthy appearances of the face changes and the teeth no longer show up in a smile. Your dentist can restore lost tooth structure or make removable mouth guards to slow down this wear rate.

If Methuselah drank coffee, tea, and soda drinks for 969 years, his teeth darkened from food stains leaking into the enamel. This probably started when he was 40 years old. He probably didn’t notice because there were not a lot of mirrors and models on magazine covers to remind him of what he looked like. Fortunately for us there are products which can be applied that will help restore the teeth to a more attractive and brighter shade.

Your dentist can monitor and advise you of how your dentition is “accepting” the aging process. Early warning signs can be detected and monitored by regular visits to your dental team.

Oral Cancer

Let me review the facts about oral cancer. The American Dental Association has estimated that there are about 36,000 new cases of oral cancer diagnosed every year in the United States. About 25% will die from this disease. Disturbingly, about one half of these new cases occur in people under 50 years old and most are non smokers. There is a five-fold increase in the incidence of oral cancer in people under 40.

Why are the demographic changes occurring? Some attribute the increase to the sexual revolution and the accompanying increase in oral sex. The culprit is the HPV virus that is a known risk factor for oral, head, and neck cancers.

As with most cancers early detection can reduce the morbidity and certainly the treatment required to rid the individual of the tumor. What doctor actually spends all of their time looking into your mouth to fix cavities, heal infected gums, improve smiles, clean teeth, and remove bad teeth? Your dentist of course!

Dentists and hygienists spend a few moments at every examination studying the soft tissues of the mouth to detect any changes, growths, and discolorations. Although visual examination can be effective dentists have a variety of screening tests that can be performed to detect changes under the soft tissues of the mouth.

These include a mouth rinse and examination with a fluorescent light, an oral scraping, and special optical lights. These tests can assure the dentist and the patient that everything is probably okay. In a few cases a referral to the oral surgeon for a confirming biopsy is necessary. In a minority of these biopsies further treatment is required.

The seriousness or incidence of fatality of oral cancer should require a thorough examination and aggressive treatment. Annual examinations are recommended and follow-up necessary. In general any mouth sore should not last more than two weeks.

I remember when my uncle was informed that he had a squamous carcinoma on his tongue. Thinking it would heal and go away he did nothing about it for three months until the pain was overwhelming. The cancer had spread into the jawbone so the surgeon was forced to remove half of his jaw and tongue. My uncle had to retrain himself how to eat food again in front of a mirror. Speech was greatly hampered and the facial deformity was obvious.

Please see your dentist at regular intervals.


For answers to your dental questions, contact

Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Optimistic Advertising

As a kid I remember the big news in dentistry was the debut of the air driven high speed dental drill. Before the invention of the air turbine dental hand piece it would take a dentist quite some time to remove decay and prepare the tooth for a filling. It would take a very long time for larger inlays and crowns. The ordeal to have one tooth worked on was time consuming, somewhat frustrating, and smelly. The high speed dental drill was going to decrease this time involvement and be almost painless. The public (including me) was very excited about the painless part.

After fifty years of service this technology has certainly made it easier to perform dentistry, however, most dentistry still requires local anesthesia. The euphoric painless part of the news was optimistic and not proven. Recently, lasers have been advertised as pain free dental tools requiring little or no anesthetic for dental cavities. Micro sand blasting cavities and chemical solutions for dissolving have largely come and gone. Although these technologies are promising they haven’t delivered what the manufacturer’s were promising-a replacement for the dental drill. Depending on the depth of the decay and each individual’s threshold of pain these technologies may allow some “needleless” dental work. In my experience there has been no 100% assurance that dental work without anesthetic is possible-yet.

The point is that when a person reads or hears about a miraculous dental advancement offering pain free “needleless” dentistry stop and think about it. Talking to your dentist is the best way to wade through this overly optimistic advertising. Believe me your dentist would love nothing better than to perform dentistry without local injections. No stress with happy outcomes really “makes my day”.

On a more positive note the advanced technologies have added another tool to the dental office to provide more conservative tooth preserving dentistry. High speed drills allow the dentist to prepare a tooth in minutes with cooling water spray to wash away the debris. Lasers can be used for surgical procedures with rapid healing response. Micro sandblasting is very conservative and improves the bond strength of your dental fillings in tiny crevices.

Recently, ads on the radio and newsprint have claimed to overhaul your mouth in one visit while you sleep, place implants at a very low cost, etc. For most of us these are just “hooks” to get us interested. These treatments will cost the same as with your own dentist. Sleep dentistry is common and your dentist can usually accommodate your needs with oral medications or an onsite anesthesiologist. Also, your dentist will use implants and materials that are proven and manufactured by reliable companies.

As an afterthought dentistry is more about relationships than a per tooth service. You and your dentist have invested a long time in nurturing this relationship together. When a crisis occurs or a tooth ache develops you should be comfortable in hitting the speed dial on your phone and getting a hold of your dental office and know who is on the other end of the line.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com