Prevention,  and Preventive Dentistry
Most people  want to live in a “nice neighborhood,”  where they feel safe.
Now, think of your mouth as a neighborhood;   very prime real-estate, and one of your most important and intimate “neighborhoods.”   Having a full set of teeth, healthy gums, and a well-functioning bite allows you to eat a varied diet and to help ensure what the ancient Greeks called “homeostasis;”  healthy balance.  Your mouth was designed to be a “nice neighborhood.”  Too bad it’s also one of the dirtiest places in your body and the site of constant gang warfare.

The gang members are bacteria.  They reproduce rapidly and their waste products attack your teeth and gums.  You already know how brushing three times a day and flossing once a day can remove these bacterial waste products.  What else can you do to safeguard this prime real estate?

—Diet
While dietary calcium is vital when teeth are developing, it’s not as important once all your teeth have come in.  What is most important is to keep the mineral coating of your teeth safe from bacterial acid attack.
Whenever you eat anything containing sugar, bacteria on your teeth consume this sugar, digest it, and turn it into acids that attack tooth enamel.  Bacteria consume fruit sugar (fructose), dextrose,  or refined white sugar (sucrose), and will subject your teeth to acid attack for the next 20 minutes after their “meal.”  How do you fight that kind of gang warfare?

The longer sugar stays in contact with your teeth, the longer bacteria gorge themselves and produce acid.  The longer and more frequently sweet things stay in contact with your teeth, the longer your teeth are subject to acid attack.  Chugging two liters of soda in five minutes leads to less than a half hour of acid attack.  Drinking soda (or sipping sweetened coffee or tea) a little at a time over a two hour period leads to almost 2 ½ hours of acid attack.  Sipping all day long gives your teeth acid attack all day long.
It’s much less damaging to your teeth if you limit the number of times and the length of time you feed sugar and other carbs to oral bacteria.
Dates and figs are sticky;  their sugars stay in contact with your teeth far longer than the sugars from peaches and berries, for example.  Sticky candies like caramels and Sugar Babies are bad for the same reason.  Sucking candies, mints, and gum can release their sugars over long periods of time—bad stuff.

—Helping your teeth resist acid attack
Diet modification can dramatically reduce your risk of decay.  Equal and Splenda, for example, are not consumed by bacteria.  Products with Xylitol actually help prevent cavities.  Google “xylitol” for gums, candies, and xylitol powder (in packets or in bulk;  you can even buy it by the pound).

There are other ways to make your teeth more resistant to acid attack.  Recaldent® actually replenishes the tooth minerals lost to acid attack.   Trident Extra Care gum contains it.  Or, for maximum benefit, you can buy tubes of MI Paste with Recaldent®  from the office.  You can rub MI Paste onto your teeth after you brush just before you go to sleep (don’t rinse with water afterwards).
Also, I prescribe Colgate’s Prevident 5000+ (and the office sells an inexpensive generic equivalent).  This contains five times more fluoride than regular toothpaste and can dramatically increase your teeth’s resistance to acid attack when used as your regular toothpaste.

Your teeth were designed long before sugar was discovered.  With a combination of smart diet and prevention, you can keep them for a lifetime.

Chemo and Flossing
When I received a heavy dose of chemo and a stem cell transplant at HUP last year I was told by the oncologist not to floss while my immune system was suppressed.  Apparently, these are pretty standard recommendations for those circumstances;  the worry is that bacteria from around your gums will be forced into the bloodstream if you bleed when flossing.
Really, the oncologists and their patients are caught between a rock and a hard place.  The average person doesn’t floss routinely and therefore has some degree of gum and bone disease, from gingivitis to full blown bone loss and infection.
People who have untreated gum disease actually have been shown to “push” mouth bacteria into their bloodstream when they eat steak!  I think many oncologists practice defensive medicine without having a dentist’s full awareness of the risks of not flossing.
Since this is a controversial area, I think that the most sensible recommendation is to follow the oncologist’s advice (I did) but to see to it that your gums are in perfect health and do not bleed when you brush or floss before you start chemo.  Obviously, my wish is that this scenario never happens to you, but remember than knowledge gives protection.

Teeth and a healthy heart

December 19, 2008 (Milan, Italy) – For the first time, researchers have shown that treating mild to moderate gum disease in otherwise healthy volunteers improves the health of blood vessel linings and reduces arterial plaque buildup.

“The novelty of this study is that this is the first physical evidence that you can reverse a lesion that is already growing in the (lining of the blood vessels) by doing something as simple as taking care of your gums,” immunologist and senior author Dr Mario Clerici (University of Milan, Italy) said . “To tell you the truth, we were really surprised by the result, but it turned up in subject after subject.”

Power toothbrushes

Twenty years ago I thought they were toys for guys who like to collect gadgets.  Now, I can’t go on vacation without a power toothbrush, and you couldn’t take away my Braun Oral B and Sonicare brushes without a fight.  If Caroline and Michelle are doing their teaching jobs well, you all know that thorough plaque removal is essential for optimal oral health.  In the early 1960’s, consumers were given a new toothbrushing option with the introduction of electric toothbrushes.  Research on the plaque removal effectiveness of these bulky, expensive, early models was inconclusive, leading most dental professionals to shy away from recommending them to patients.
Fast-forward to 2006, and the picture has changed dramatically.  The electric toothbrush has evolved into the “power” toothbrush, encompass-ing the high-tech rechargeable models as well as the low cost battery-powered toothbrushes.  Brush head and bristle designs are more advanced, based on oscillating/translating, vibrating, or ultrasonic technology.  Power toothbrushes provide anywhere from 10-49% greater plaque  removal than manual toothbrushes.
For those of you who still believe brushing your teeth should be like playing the cello, power toothbrushes require significantly less force  to effectively remove plaque than is required for manual toothbrushes.  Evidence suggests that the forces used with the power toothbrushes should be far less than with manual toothbrushes.  Clearly, power toothbrushes are less likely to cause tooth and gumline abrasion and they deliver better stain removal than manual brushes (up to 82%!).
The bottom line is this:  Power toothbrushes are now affordable.  You can count on high quality performance
and a choice of several excellent products on the market.  If you need help choosing the brush that’s right for you, ask any of my extremely educated, talented, loyal, dedicated, caring, well-fed, reliable, well-groomed, conscientious, attractive staff.
We order power toothbrushes in bulk and try to set our prices  below retail.  This way, you can take your brush home from the office and save a trip to the store.

Silent dental problems: infections
A patient recently came  in with an abscessed tooth that needed a root canal.  His first question:  “Why doesn’t it hurt?”  Good question.
When the pulp (the soft center of the tooth, where the nerve is located) becomes infected, the pus can only escape it one direction—out the tip of the root.  There’s a small hole at that tip where the pulp can “empty out.”
If the bone at the end of the root dissolves away, the abscess can expand without any pain. If the bone doesn’t dissolve away, tremendous pressure can build up at the end of the root.  The ligaments that attach your tooth to your jawbone have a separate and still very much alive nerve supply.   Those ligaments become stretched and can be excruciatingly painful.  I’ve had people with raging abscesses tell me that their teeth were so painful that they couldn’t touch the teeth with their tongues!
So, root canal problems can be silent and painless, or excruciating, or anything in between.
That’s one more reason that we take a complete series of x-rays every five years.  It helps rule out a silent infection such as an abscess.
         
                                                           
The x-ray on the left shows a normal tooth with no infection.  The x-ray on the right shows the same tooth years later infection at the end of the root (that’s the gray area at the upper tip of the tooth).  This patient felt no pain despite the infection.

Cavities can be deep  and painless
My thanks go to my Canadian friend Richard Ehrlich for the excellent photos used in this article.
The following photos illustrate two things:  decay can be very hard to detect, and it can be very deep but not yet painful to you.  The pulp may not signal a problem until it’s too late.

The above photo shows what looks like a pretty normal tooth.  Examination with the standard probe did not reveal any decay, but the Diagnodent laser early decay detection system found a large cavity hidden on the chewing surface.

The second photo shows the cavity that was discovered, with some of the decay removed by air abrasion (drill-free dentistry that I also use in my office).
The third photo, below, shows more of the decay removed and decay-detecting dye applied to the tooth.  The die shows that even more decay remains:

Photo number four, below,  shows all the decay removed.  What a cavern!

The final photo, below, shows the cavity repaired with a tooth-colored bonded filling .    .

This patient had no pain even though the cavity was close to the pulp (nerve) of the tooth.  What these photos illustrate are several things of which most people are unaware:
—The cavity finding probe we use can fail to pick up cavities.  These cavities can be deep and may even lead to the tooth needing a root canal.
—The Diagnodent laser early decay diagnosis system , which Richard and I have both had for about 10 years, is much more accurate than a probe at finding certain kinds of cavities.
—Frequent, on-time checkups with the most modern diagnostic and preventive techniques can save you from ending up being photographed as an example of what can go wrong!
The first line of dental health defense is prevention.  The second line of defense is early and thorough diagnosis.
If you’re late for your checkup, don’t wait until Lisa calls and nags you.  Call us today.

BUFFALO, N.Y. — Patients admitted to a hospital’s intensive care unit (ICU) already are seriously ill, so the last thing they need is a new infection. Unfortunately, statistics show that as many as 25 percent of all patients admitted to the ICU and placed on ventilators develop pneumonia, which can be fatal. Ventilator-associated pneumonia is a major cause of infection in the hospital.   Studies have shown that this infection can add $40,000 to costs and double one’s length of stay  in the hospital.  Ironically, it turns out that the patient’s own dental plaque is a major source of germs causing ventilator-associated pneumonia.                                        Researchers from the University at Buffalo School of Dental Medicine presented findings at the International Association of Dental Research (IADR).  They showed that the same bacteria identified in dental plaque of patients when they were admitted to the ICU and placed on ventilators were found later in the lungs from those who subsequently developed pneumonia.                                     ”Our study shows that a strong relationship exists between oral and respiratory pathogens in patients with ventilator-associated pneumonia,” said Paul Heo, D.D.S., a doctoral student in the UB dental school’s Department of Oral Biology and first author on the study.                                              ”We are saying that if the patients’ mouths and teeth aren’t cleaned while they are in the hospital, they may easily develop lung disease.”          The presentation is part of a three-year double-blind study funded by the National Institute of Dental and Craniofacial Research, headed by Frank A. Scannapieco, D.D.S., Ph.D., professor and chair of the Department of Oral Biology.    The trial aims to determine if swabbing ventilated ICU patients’ mouths with a bactericide protects them from developing pneumonia.    In this component, Heo and colleagues concentrated on three strains of suspected pathogens that are responsible for most hospital-acquired pneumonia: Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. Samples of plaque from teeth and of secretions from the trachea were obtained from ICU patients on the day of admission and every third day thereafter, up to 21 days. Bronchial alveolar lavage samples also were collected from those suspected of having developed pneumonia.
“These results suggest that the teeth likely serve as an important reservoir of infection in these patients,” said Heo. “To prevent opportunistic, hospital-acquired disease, taking care of teeth and gums while hospitalized might be especially important.”   Elaine M. Haase, Ph.D., research associate professor of oral biology, also contributed to the study.
The University at Buffalo is a premier research-intensive public university, the largest and most comprehensive campus in the State University of New York. The School of Dental Medicine is one of five schools that constitute UB’s Academic Health Center.
What does this study mean for you?
Research is uncovering ever-stronger links between the health of your mouth and the health of your body.  Even medical doctors who long considered dentistry to be a separate entity from medicine are now ordering their patients to “clean up their mouths” before a variety of surgical procedures.   Don’t get caught in a dental bind when you need a medical procedure.  Let us help you keep your mouth healthy 24/7 year-round.  As always, prevention is the best solution.