Are You Cavity Prone?

Research has recently shown an amazing difference in the biological ecosystems between a healthy, disease-free mouth and one with lots of cavities.  A healthy mouth averages 145 different types of germs versus only 95 when cavities are present.  I frequently tell my patients that a healthy mouth is like a rain forest with lots of living plants and animals, and a cavity-prone mouth is like a desert.  Unfortunately it’s the ”cacti” which cause decay. Apparently, the greater varieties of germs compete with the bad bacteria, thereby reducing their ability to destroy your teeth. Our goal is to figure out the reasons for the difference!

While fluoride has been very helpful in reducing the incidence of tooth decay (caries, or cavities) it certainly has not eliminated it.  It helps by strengthening  the enamel, making it more resistant to the acids produced by the bad (or cavity-causing) bacteria, mostly Strep Mutans,  but it fails to significantly change the type of bacteria in a patient’s mouth.

We obviously continue to emphasize the importance of excellent home care, to reduce the overall volume of bacteria, and dietary control of sugar to reduce the energy source necessary to produce acid.  The new cavity-prevention strategies suggested here are for the 15-20% of our patients where the disease is out of control and all conventional efforts have failed.  Our objective is to actually reduce or eliminate the presence of these bacteria, the IDEAL CAVITY PREVENTION!

1. Brush TWICE DAILY with baking soda. We know that the bad bacteria LOVE acid! They LIVE in it.  We also know that as the pH of a patient’s mouth drops (meaning increased acidity), the percentage of bad bacteria significantly increases.  Baking soda (sodium bicarbonate) is a powerful acid neutralizer and works to deprive the germs from their ideal environment.

We recommend filling a shot glass with the baking soda and dipping your wetted toothbrush (preferably a Sonicare) into it.  Should the taste be an issue, first apply your favorite toothpaste.

2. Chew TWO PIECES OF ICEBREAKERS ICE CUBES GUM Three Times a Day. This has the ideal concentration of xylitol, a natural sugar with only 40% of the calories, which has been shown to significantly reduce the percentage of Strep Mutan colonies on teeth.  These bacteria eat glucose, fructose and sucrose and very efficiently produce high levels of acids over and over. Xylitol, however, can be consumed but not metabolized, leaving them bloated, constipated and unable to eat the other sugars.  Studies have shown as much as an 80% reduction in Strep Mutan colonies.  CHEW ON!

For more information, check out www.dentist.net/xylitol-teeth.asp

*Note: a small percentage of patients can develop digestive problems, and it needs to be kept away from all dogs as this can make them dangerously sick.

3. Try MI PASTE. MI paste is a product that helps in two ways.  First, it helps create a more stable neutral environment in your mouth, thus inhibiting the growth of the bad germs.  Second, while fluoride only helps reduce the demineralization of the enamel, MI paste actually creates a chemical environment that permits the remineralization of both the enamel and dentin with calcium and phosphate. This product has the ability to help the teeth repair themselves. It’s like vitamins for your teeth.

Try applying a “dab” to your finger after brushing at night and swipe it around your top and bottom teeth. If you have any bite splints, retainers or trays, wear them as well.

*Note: Not everyone in the dental community is convinced there is an adequate body of valid clinical trials to make the claim that it is effective at remineralization on all patients.  Some feel that with normal saliva quality and volume there is already enough calcium and phosphate present.  I personally feel that when nothing else has worked on our highly decay-prone patients, there is enough evidence to give this a try.  For more information, check out:  www.gcamerica.com/products/preventive/MIPaste/

4. Every Three months, Suck on ONE GYLIC LOLLIPOP IN MORNING AND AGAIN AT NIGHT For Ten Days. It contains licorice root, which has a natural anti-microbial affect that disables the germs that cause cavities and periodontal disease. Research conducted by Delta Dental of Michigan supports the company’s claims that this reduces decay. Go to www.drjohns.com for more information or to order.  We also stock glycolic lollipops, so please contact the office for more information.

5. Increase the amount of ARGININE IN YOUR DIET by eating more spinach, soy, seafood and nuts. Arginine is an amino acid that reacts with any acids to produce ammonia, which rapidly raises the pH in the mouth for an extended period of time.  Bad news for bad bacteria!

6. Try to Keep Your Mouth on the Moist Side. Patients with dry mouth symptoms have a particularly difficult challenge. Healthy saliva is your teeth’s best friend helping reduce acids naturally and ask as an excellent lubricant while eating.  These symptoms often develop as a side effect to many medications, head and neck radiation therapy and simply aging.  We have some suggestions:

• Nuvora is a company that makes a number of products under the brand name Salese.  These contain sodium bicarbonate and xylitol which increase moisture and pH reducing the bad bacteria. For more information, visit www.nuvorainc.com or contact us.
• Pilocarpine is a drug that, when taken in pill form, significantly increases your body’s secretions, including saliva and sweat.  Needless to say most patients are not too happy when sweating profusely.

To significantly reduce these negative side effects we can order prescription Pilocarpine lollipops which can be sucked on periodically during the day. This creates a topical effect on the salivary glands to increase flow without nearly as many side effects.

7. Control Sources of Additional Acids in the Mouth. Because cavity-causing bacteria are acid-producing machines, they thrive in that environment  Recent studies have shown that even a small drop in pH (increasing acidity) results in significant increases in the percentage of Strep Mutans in plaque. My patients seem to understand when I give them my analogy: “If cacti are the cause of cavities, don’t move to Mexico.”

8. Seek Help for Bulimia and Gastric Esophageal Reflux Disease (GERD). For years, we felt these patients were prone to more cavities because of the acids softening the teeth.  It should be obvious for what we have discussed here; the stomach acids create a perfect environment suitable for the acid-loving bacteria.  While GERD patients can be helped with acid-reducing drugs such as Prilosec or Prevacid, bulimics pose a particularly challenging problem.  The difficulties involved in curing or managing this disease is well known and every possible measure should be implemented to help them.

Try these new cavity-reducing strategies and let me know how they work for you. For more information on this or other dental topics, feel free to contact Northway Family Dentistry at 616.531.7480 (Grandville office) or 616.957.1190 (Cascade office).

In this fifth posting from a 10-part series, we’ll explore Secrets Your Dentist Doesn’t Want You to Know. We’ll take a look at why your dentist might not want you asking these questions—and why it’s critical that you should. When your oral health and beautiful smile are at stake, you owe it to yourself to make sure you have all the facts.

A competent dentist screens for more than tooth decay. He or she should be concerned about sleep apnea, jaw-related pain known as TMJ or temporomandibular joint disorder, periodontal disease, oral cancer, diabetes and hypertension.

Sleep Apnea: Asking simple questions about snoring, weight gain, or medications such as blood pressure or acid reflux drugs can give your dentist clues about sleep apnea. Find a dentist that takes a thorough medical history.

TMJ: Did you know migraines and neck problems can be related to the position of your jaw? Your dentist should feel your joint and ask about any pain or discomfort you may be having.

Periodontal Disease: By carefully checking the condition of your gums for periodontal disease, your dentist can detect early indications of heart disease, stroke and diabetes.

Hypertension: Most Novocain used by dentists contains epinephrine, which can increase blood pressure. If you already have dangerously high blood pressure, the addition of epinephrine could cause a stroke. Your dentist should be aware of your medications and take your blood pressure before giving an injection or doing any dental work.

Oral Cancer: Advancements in oral cancer screening allow your dentist to find it sooner. A Vizilite exam is a detection tool used by dentists to see tissue changes in their earliest form. The dentist has you rinse with a solution and then shines a specially designed light in your mouth which will indicate the presence of oral cancer. A similar system by Velascope is also very effective at early detection.

If your dentist is not doing these health screenings, find one who does. Northway Family Dentistry takes an interest in our patients’ oral and overall health and sees the benefit in providing more than just cleanings and cavity fillings.

On the Today show, Wednesday, March 7, 2012 … they discussed how there is a substantial increase in the prevalence of cavities in preschool children, ages 2-5. We thought you might want to take a look at this story. If you have any concerns about your preschool child – call us for a free consultation.

http://today.msnbc.msn.com/id/18395089/ns/today-today_health/t/cavities-increasing-baby-teeth/

In this fourth posting from a 10-part series, we’ll explore Secrets Your Dentist Doesn’t Want You to Know. We’ll take a look at why your dentist might not want you asking these questions—and why it’s critical that you should. When your oral health and beautiful smile are at stake, you owe it to yourself to make sure you have all the facts.

While I love the statement, I would counter that the lab is “as important” as the dentist, not “more important.” The quality of care dentists deliver is like a chain: it is as strong as the weakest link.

Too many patients are under the assumption that all dentists practice the same and that “a crown is a crown,” much like a Ford is a Ford. However, neither Borgman nor Keller Ford is responsible for the quality of their product; they just sell what is sent to them.  Dentists, however, are responsible for each and EVERY step that goes into delivering oral health care. From the comfort of the patient, to the type of materials we use, the shaping or drilling of the tooth or tissue, the accuracy of any impressions or models needed (often times the most neglected step) and the competency of the labs we delegate our work to, all factors are determined by the dentist.

Northway Family Dentistry is very, very fortunate to have the opportunity to work with two of the best Certified Dental Technicians in Michigan.  All of my non-removable work, such as crowns, bridges and veneers are created by Sandy Mosey at North Kent Dental Arts. My removable appliances are done by John Rethman, who runs Heritage Dental Lab in Saginaw.  At one time, both ran large operations with many employees working with many doctors.  At about the same time, and independent from each other, they both realized that only a small percentage of their doctors consistently provided them with excellent models, impressions and accurate documentation and instructions.  As a result, they encountered very few failures or costly remakes.

While it was painful for her to do (she’s incredibly nice!), Sandy literally dismissed 90 percent of her doctors, choosing to only work for her top 10 percent.  John, on the other hand, prompted by a cancer scare which he has recovered from, sold his large facility to an even larger operation, like the mega labs that ship overseas. However, he excluded from the sale a small group of his best dentists.  It is a source of great pride that two experts in their fields who have first-hand experiences in judging the quality of work produced by different dentists have judged our work to be at the top.

Testimony to how great John is: Last spring, I was walking my very noticeable 170-lbs. Leonberger, Tanner, on Grand Traverse Bay north of Elk Rapids.  A women emerged from her house to meet my dog and we struck up a conversation.  Her husband soon joined us and I discovered that he ran a small dental lab.  I asked if he knew John Rethman.  He said: “You work with John? Then you must be great because he now only works with the best.  I try to get him up here every year to lecture to our local lab society.”

Sandy is equally impressive at her work, which she has done for more than 30 years. Sandy has earned and maintained her National Certification for that length of time, and has studied with world-renowned technicians and dentists. All of her lab restorations are fabricated with precise detail under a stereo microscope, yielding the most beautiful, natural-looking and strong restorations possible.

While a great lab is essential for excellent dentistry, John and Sandy will tell you that they can’t make up for mediocre dentistry.  It is a two-way street.

Most patients wouldn’t think to ask their dentist which lab(s) they use, but consider doing so. If you’re considering a crown, denture or bridge, the quality of the lab creating your device could impact you for years to come.

In this third posting from a 10-part series, we’ll explore Secrets Your Dentist Doesn’t Want You to Know. We’ll take a look at why your dentist might not want you asking these questions—and why it’s critical that you should. When your oral health and beautiful smile are at stake, you owe it to yourself to make sure you have all the facts.

In the original DailyFinance article that prompted this series of responses, I have to agree with everything stated under Secret #3. In fact, my patients could think that I had written it!

However, I will admit that there are circumstances where mercury is warranted. When I see patients who come to us with tons of decay and limited financial resources, amalgam (mercury) fillings are still the fastest and most affordable way to help them.  I routinely explain to these patients that it is not the material of first choice, but it allows me to “put out fires.” Unfortunately, while I am stopping the decay, these fillings will have to be replaced in the future as they degrade over time and cause problems down the road.

I also occasionally find it necessary to use amalgam when we are unable to control the environment around the tooth, meaning blood and saliva. The benefit of composite and porcelain restorations come largely from our ability to bond them to the tooth and thererefore seal off the tooth from bacteria.  This is a very sensitive technique and it requires a clean and dry tooth. A poorly placed bonded restoration won’t last as long as an amalgam under these circumstances.

However, because of the concerns around mercury and pregnancy, in no case would I place amalgams on pregnant women.

What about your dentist? Does your dentist routinely use mercury fillings? They’re less expensive and easier to use, so some dentists ignore the health risks and continue to fall back on this outdated procedure. Ask your dentist how many amalgams he/she places per year. If the number is high, you’d be advised to find another.

In this second posting from a 10-part series, we’ll explore Secrets Your Dentist Doesn’t Want You to Know. We’ll take a look at why your dentist might not want you asking these questions—and why it’s critical that you should. When your oral health and beautiful smile are at stake, you owe it to yourself to make sure you have all the facts.

The technological advancements made recently in dentistry have been awesome. At Northway Family Dentistry, we pride ourselves on keeping up with new technology. In fact, we sometimes have used “new” technology for so long that we are already taking it for granted by the time other dentists in the area start toying around with it. We sometimes assume all offices are using these new advances, and we’re often surprised to realize they don’t.

Some examples: we have been using ultrasonic scalers, digital x-rays and diagnostic laser detectors for years. In 1998 we were the first office in West Michigan to install chair-side computers in all our operatories and as a result, we’ve been completely paperless since 2007.  While I sometimes miss the patient charts for my notes, we committed to the change ultimately because it significantly reduces the transference of germs throughout the office.  It is obviously absurd to expect charts that in some cases have been around for 30 years and handled by scores of individuals to be clean.

Also in 1998, we were the first to implement CEREC crowns to our office. Since we were one of the first to be able to afford and master the new technology, we were tapped by the company for years to give demonstrations to other area dentists. This amazing technology allows us to fabricate crowns, onlays and inlays in a single appointment, utilizing infrared 3-dimensional cameras and computers to design and mill them while we wait. This eliminates the need for impressions, temporaries and additional appointments.  We have placed well over 6,000 restorations since 1998, far more than any other office in West Michigan.

By the way, they keep getting better every year!

We recently added Single Tooth Anesthesia (STA) to our technological tool belt. STA replaces the dreaded shot of anesthesia used to numb teeth before drilling. You know, the one that was poked through your gums, was questionable as to whether it had taken effect or not, and then left your tongue, lips and cheeks numb for hours? We’ve found a better way, and our patients are loving the results!

With today’s technology, there really is no excuse for not finding better ways to care for your teeth. Is your dentist keeping up with technology? Ask your dentist what tools he’s using, how long he’s been using and how often he evaluates new technology. Is she using something we don’t offer? Let me know! I love to hear what others are doing to keep the practice of dentistry moving forward.

Several years ago, an article by the same title was posted on DailyFinance. I found it to be an interesting article, not only because it was good insight into what patients might be thinking, but also because I AGREE with most of the points here.

In an 10-part series, we’ll explore each of these points and take a look at why your dentist might not want you asking these questions—and why it’s critical that you should. All dentists have room for growth, myself included, but when your oral health and beautiful smile are at stake, you owe it to yourself to make sure you have all the facts.

• Secret #1: Your dentist may not be as educated as you think.
• Secret #2: Your dentist may not have the latest technology.
• Secret #3: Your dentist may be using mercury.
• Secret #4: The lab may be more important than your dentist.
• Secret #5: There’s more to good dentistry than filling cavities.
• Secret #6: You are probably using the wrong specialist for dental implants.
• Secret #7: Bad dental advice about dentures can be fatal!
• Secret #8: Your dentist may not know enough about sleep apnea.
• Secret #9: Not all cosmetic dentists have the skills to really improve your smile.
• Secret #10: How to avoid the root canal your dentist says you need.

See full article from DailyFinance: http://srph.it/9j15r6

Secret #1: Your dentist may not be as educated as you think.

I couldn’t agree more that this is a critical question to ask your dentist.  The evolution of dentistry keeps picking up speed every year.  While the state of Michigan only requires 20 hours/year of continuing education, I personally think that 100 hours/year is the minimum needed to keep up.  Since the early 1990s and the growth of bonded dentistry (both porcelain and composite), Cad/Cam milled restorations, implants and cosmetics, I have averaged over 120/hours of education a year.

In 2009, I spent 132 hours in Detroit and Philadelphia at the Misch International Implant Institute learning the placement and maintenance of dental implants. Dr. Carl Misch is certainly the most recognized leader and innovator in implant dentistry, and I couldn’t have learned what I needed to know about performing dental implants in 20 hours, or the equivalent of 2.5 days.

Perhaps the most important topic that relates to everything in dentistry is occlusion, the understanding of how the teeth come together.  This is the most complicated and controversial topic in our profession as it involves not just the teeth but the jaw joint (anyone out there have experience with TMJ?), bone alignment, neuromuscular programming and muscle coordination. Because of the multitude of different philosophies throughout the country, more than 30 percent of my studies have involved this topic.

Additional Areas of Study

LVI Global: I went there when first started.  At that time, Dr. David Hornbrook, a fine educator and excellent cosmetic dentist, was with them.  He taught me a ton about cosmetics and I have continued to take courses from him. However, when I was there in the 1990s, I felt the philosophy of LVI Global was leading to overtreatment.  Dr. Bill Dickerson, the founder, frequently uses the phrase “instant orthodontics” to improve the smile.  While 10 veneers or crowns can be placed in a couple of weeks, creating a beautiful smile, I personally recommend 18 months of orthodontics and whitening at half the cost and no drilling.  Obviously, every patient is different and some teeth may require treatment but this should be done only when necessary.

My personal philosophy? “The best dentistry is the least dentistry” – Dr. John Kois

The Dawson Academy: While The Pankey Institute has a more popular reputation, I elected to study under Dr. Pankey’s old partner, Dr. Peter Dawson.  The Dawson Academy is in St. Petersburg, Fla. Dr. Dawson is a brilliant and conscientious man who I feel brought the study of occlusion (jaw alignment) into everyday  practice.  His book, Functional Occlusion, was the bestselling book in dentistry for years, until Dr. Carl Misch’s Contemporary Implant Dentistry was published.

The Kois Center: No list of dental education centers would be complete without the inclusion of The Kois Center.  Dr. John Kois has been an instructor at the University of Washington for years and has his masters in both Periodontics and Prosthodontics.  Dr. Kois is in my opinion the greatest dental educator I have ever met.  He is a genius of the highest standard and truly teaches with a philosophy that “the best dentistry is the least dentistry.” Needless to say, he places a huge emphasis on prevention—a focus I bring to my own patients at Northway Family Dentistry.

As you can see, there is a lot to learn and 20 hours a year of continuing education just isn’t going to cover it all. My point in sharing my educational history and activity is not only to demonstrate for my own patients that I do take education seriously, but also to show others what an important factor this is when choosing a dentist. The care of your teeth involves much more than keeping them clean and white. Your oral health—and your overall health—should be placed in the hands of someone with a greater understanding of all the facets of dentistry, and a passion for keeping pace with new discoveries and practices.