Where the everyday person can learn more about how to take better care of their mouth! There's a new subject every week, so stay tuned.
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Tuesday, April 18, 2017

The Healthy Mouth - Healthy Body Connection is Connected

Brand new research by Drs. Amy Doneen and Brad Bale definitively connects cardiovascular disease to bacteria found in periodontal disease!  Gum disease and heart disease - one causing the other.  This, my friends, is huge, important research!

Why does this matter?

 Eighty-five million people in the US have some form of cardiovascular disease, and 200 million folks have gum disease.  Worldwide statistics are similar.
Additional research also shows that people with periodontal diseases are twice as likely to have heart disease.  It can start in your teens, and it's a silent disease- most people don't know they have heart disease until they have a heart attack or stroke.  Then it may be too late.

This study is important, not only because it connects the two diseases, but it finally implicates specific periodontal disease bacteria as culprits.  This means we can look for these bacteria when we do saliva and plaque biofilm testing.  

So!  If you have bleeding gums, gum disease, diabetes, heart disease, stroke and/or atherosclerosis in your family history, it may well be time to ask your dentist or your family doc to test your saliva for the following bacterial pathogens:

Aggregatibacter actinomycetemcomitans (Aa)
Porphyromonas gingivalis (Pg)
Tannerella forsythia (Tf)
Treponema denticola (Td)
Fusobacterium nucleatum (Fn)

Should you be interested in how they are connected- click here.  I was trying to simplify that connection but Dr. Nagelberg does a better job.  Suffice it to say, the two diseases are finally, and firmly linked.

What to do with this information?  

Do you want to live a long, healthy life?  Then it's time to get rid of those bleeding gums once and for all.  Even Gingivitis infection is cause for concern. (Gingivitis is infection located in the gum tissues, with no bone loss. Read more about it by clicking my link here.)  Gum disease, just like heart disease, is silent.  It DOES NOT HURT, at least until the final stages.   Let's be aggressive- eliminate gum disease, and help your heart, arteries and the rest of your body as well!  There are so many oral-systemic connections - click here and here if you want more on the latest.

(You know I love lists!) so here are my suggestions:
#1. Demand an OralDNA or Oravital saliva test to look for the above mentioned pathogens.  If you are lucky enough to have a dental office with a phase contrast microscope - lucky, lucky you!  Test that way too!  Then you can actually see the pathogens alive and moving around on a slide.  Treponema denticola is a spirochete and very easy to see if they are on a slide!  They wiggle like a snake.

Without testing, your dental professionals are working blind and so are you.  Sorry to say, but unless you test, you have no idea what is lurking under your gums.  Test, test, and retest!  If your office doesn't or won't? Time to find one that will.  Your health depends on it.  It is time to do more than "just a cleaning". (You know how I feel about that.)  If you'd like help finding a dental office with a microscope or one that will send in a saliva test, please contact me.

#2. Get an electric tooth brush and use it twice a day.  I like to recommend using wet baking soda as toothpaste for at least two minutes.

#3. Purchase a Hydroflosser and irrigate daily with baking soda water, or bleach water ( yes, laundry room 6% bleach diluted at a 1 part bleach to 25 parts water ratio) or Therasol concentrate (diluted 1:8) and get underneath the gumline.  Gargle with that solution so you clean your throat and tonsillar region too.

#4. Clean in between your teeth.  Got floss? Go get that plaque out.  Prefer other tools like TePe or Piksters?  Use that instead!

#5. Clean your tongue twice daily.  I love my Tongue Sweeper but you can flip over a spoon and scrape with that too.

#6. Retest your saliva and be sure you got the pathogenic bacteria done and gone! If not gone then back to the drawing board and see where you are leaving plaque biofilm.

#7. Stay on top of this.  Retest periodically.  Have all other family members tested as well, even children.  Remember that your bacteria is contagious.  Prevention is key here!


Let's start a dental health revolution and eliminate heart disease while we're at it!

  I know you were expecting the third installment of Bustin' Dental Myths but this just came across my desk and I had to share.  Awareness of The Oral-Systemic Link is crucial to your continued good health.

Happy Spring!  Be well my friends and keep smiling!

Wednesday, April 5, 2017

Busting More Dental Myths Part II

"It ain't what you don't know that gets you into troubleIt's what you know for sure that just ain't so." - Mark Twain

April 1st is April Fools Day, rather fitting to be working on a post about dental procedures and protocols that may well be incorrect- a myth.  This is Part II of dental traditions that may benefit from a second look.

"You NEED your teeth cleaned twice a year" Myth
There must be scientific reasons to see your dental hygienist every six months... right?  Nope!  It all started with a commercial jiggle from Amos 'n' Andy - selling Pepsodent Tooth Powder.  The commercial talked about brushing your teeth twice a day and seeing your dentist every six months.   No science, just all Madison Avenue.

So, what do you really need?  It depends.
If you have gum disease (and 50% of the US population has some form of gum disease) or tooth decay (91% of folks have active tooth decay!) you really need a much more frequent recare schedule. Sometimes I wish I could see folks once a week or at least every two months.  Plus, these folks need more than "just a cleaning."  (More on this in a moment.)
Then there are folks that have a healthy mouth- no bleeding gums, no decay, no concerning activity on my chairside microscope.  They need a yearly exam, oral cancer screening, and quick appointment.

IMHO, each and every person should have a customized, individualized treatment protocol. (So, more than "just" a cleaning)  My goal is to have you be healthy between appointments. no bleeding gums, no tooth decay, no bacteria related to tooth decay or gum disease.  It can be done - you just need a dental hygiene health coach that'll look more closely at your oral situation and find better tools for you so YOU can get the job done at home.  Getting your teeth cleaned twice a year only means your teeth are super clean for two days a year.  If there's bleeding, no doubt about it, your mouth is NOT healthy.  Customize and individualize treatment rather than doing only what insurance dictates and will pay for.  You can do it!

"Teeth need to be scaled before they can be polished" Myth
This might be specific to dental professionals, but...
Busting that one up too.
Tradition is hard to overcome.  For about thirty years I scaled- scraped and cleaned teeth, then dutifully polished them up.  That's the way it's done in school.  Then, I decided to try something new, I polished first.  Now I don't have to move plaque around to find the tartar, and I feel I'm doing a better job because of it.  Plaque's the soft stuff on teeth, also called biofilm, and tartar's the calcified, petrified plaque, also called calculus.  No research says it's better to do it one way or the other.  I like that it cleans the debris so I can see the teeth, and the remaining tartar.  It sure makes it easier to do a periodontal charting of the numbers around each tooth.  And, it's easier to get the tartar off too.
Tartar and Gum Disease

Do you even need a polishing?  Well, sorta.  The polisher breaks up the plaque biofilm and leaves the teeth surfaces cleaner. Polisher pastes vary so you can request one less gritty.  I use one that starts out gritty and then the particles quickly break down to a fine grain and are thus less damaging to the tooth surface.  Can you do this with a toothbrush?  Absolutely!  Ideally, your teeth should feel like I've just polished them every day.  You can achieve this slickery feeling best with an electric brush (a must) and wet baking soda.  Brush until they feel clean and smooth.   "Slickery" is my new favorite word to describe how slick, smooth and slippery your teeth should feel.  If they don't feel good, get in and have a professional get them clean so that you're then able to maintain them.  Your favorite hygienist will need to remove that tartar though-  that's on there like cement.

Editor's Note:  I have a scaling-related anecdote that's a bit off topic, but I thought I'd share.
Barbara cleans my teeth, so I'm probably a bit spoiled as a patient- she's my mom!  There's nobody I could feel more comfortable with.  Still, I hated when she had to scale my teeth.  It's like nails on a chalkboard to me- just ew.  I finally got it in my head that if I dutifully brushed and flossed daily, to that point of "slickeriness" there would be minimal scraping/armrest gripping.  That was my "a-ha" moment.
It's possible!

"Insurance should cover all your dental needs" Myth
Busted again
Dental "insurance" is actually not really insurance.  It's a benefit, sort of a prepayment for future dental care.  It started in the 1950's and 1960's with a maximum $1,000 benefit.  That'd be enough money to take care of all your dental needs.  Cleanings and fillings cost $5.00 then.  Today, most maximums are still $1,000!  Sixty years later and it sure did not keep up with inflation.  Yet too many people rely on it for "all" their dental needs.  They don't go to the dentist because they don't have insurance.  People!  Please!  Do not wait to have treatment just because you don't have insurance.  It really is all about priorities and values.  If you wait, that tooth may abscess.  It will cost way, way more to have a root canal, crown, and then, eventually, an implant than it is to have a filling.  Dental neglect is what's expensive, really expensive.  Prevention is not!

Unfortunately, dental insurance doesn't pay for Oral Health Coaching and an individualized plan (or, as it's termed- Oral Hygiene Instructions) but that's the best way to keep your mouth healthy and not spend thousands of dollars long term.  Put down that smart phone, buy a smart toothbrush and be smart about oral wellness.

"But it doesn't hurt, so why bother" Myth
This tooth never hurt but it's just a matter of time. 
Following right up behind the insurance myth, this one's a biggie.  Gum disease and tooth decay DO NOT HURT until your nerve is infected.  Your teeth go into a self preservation mode, making what's called tertiary dentin to shield your tooth's nerve.  It's your body's way of trying to protect you from the coming pain.  It can't last forever though.  It's a gamble- a roll of the dice- to wait, because eventually it will hurt.  At that point it's a crisis.  If you are told you have tooth decay or gum disease, treat it and work with your dental team to figure out why it occurred.  THEN!  fix the "why" so you never have that problem again.  It absolutely will save you more time and more money than the insurance company will give you towards a root canal, crown, and eventual implant.

"Let's 'watch' the tooth" Myth
Sorta busted
Cracks & Broken Down Silver Fillings
Teeth don't always need treatment right away.  There are things worth watching, like cracks in teeth and early decay (as long as there's no sensitivity or discomfort in the tooth).  However, when I see these things I like to send patients home with a prevention plan including home care instructions and tools to help reverse the problem.  Cracks and sensitive teeth-  let's remineralize them and protect the teeth from further cracks!  Is the cracking coming from clenching or sleep apnea?  Is it an airway issue?  Is it a habit or caused by a habit?  Small areas of tooth decay along the gumline need a higher pH and more remineralizing.
We can reverse tooth decay if we catch it early and DO something to address it!  Watching and not doing anything else will just kick the can down the road and ensure a bigger filling or problem later.  Stop watching decay get bigger!  We need to know WHY there are cracks and decay, and then treat that WHY.
One thing not to ever watch though (IMHO), is broken down, old, decayed silver mercury fillings.  These need to be restored now, now, now.  They have decay lurking underneath 'em.

"Deep Cleanings Cure Gum Disease" Myth
Again, sorta busted 
Deep cleanings certainly help start healing the infection caused by gum disease pathogens and your body's immune host response to the bacteria.  However, it only starts the process because the pathogens are still prowling around in the gum tissues and in the tooth tubules.  Scaling doesn't get rid of all the bacteria on the teeth either.  It really is up to you and your oral health coach (that's me!) to put together a plan with the right tools, diet, and medicament to change the plaque biofilm to a healthy environment.  Then keep it that way.  If you don't change your home healthcare habits, you are wasting your money.  If you are not monitoring your bacteria with tools like Oral DNA testing, and the phase contrast microscope or the BANA test, how do you even know if your gums are healthy?!  You or even your dental health professionals can't always just look at your gums and know the gums are healthy.  You have to test, just like your medical doc's do.  When the bacterial level's down, there are products such as probiotics for repopulating your mouth with good bacteria, as well as baking soda products that  raise the pH so your mouth stays healthy.  Read more about other procedures and protocols to help you have a healthy mouth.   Bottom line: deep cleaning's a good start but that's not the whole enchilada!

"Brushing and Flossing are Enough to Prevent Gum Disease and Tooth Decay" Myth
Busted too!
Following a theme here! Just because you brush, floss and use that fancy toothpaste, doesn't always protect your teeth and gums from infection.  It's important to look beyond plaque removal.  In addition to getting all the plaque off, it's even better to look at risk assessment for future decay and gum infection.  Finding the cause involves monitoring bacteria, as well as looking at current habits like sipping those daily lattes or energy drinks, snacking on carbs, or family history of gum disease.  This is vital information in creating the very best, most well rounded oral health program for you.

"Fillings Cure Tooth Decay" Myth
Busted - you betcha! 
The best predictor of future decay is current decay.
 If you have a current cavity, there's a 63 to 88% chance you'll have a new cavity within 12 months.  Now, the bigger issue- even if you get that tooth repaired and the decay drilled out, the decay bacteria are still skulking around.  They're in your mouth, on other teeth, or in the tonsillar crypts.  You kiss your significant other?  They probably have it too, and you pass it back and forth.
The drill does not address the environmental causes of decay.  Low oral pH, carbohydrates that you eat or drink, and dry mouth or mouth breathing all play a role in your risk of getting future cavities.

"Mouthwash Cures Bad Breath" Myth
Wish this weren't busted. 
Morning Breath

Sadly,  mouthwash does not cure bad breath.  I've written an entire post dedicated to cures for bad breath titled, Addressing Kissability.  Mouthwash just makes your bad breath smell like minty bad breath, and it only does so for about, oh, ten minutes...  Then it's back to regular old stinky bad breath.  Find and treat the cause.  Mouthwash just blankets the symptoms and doesn't really even do that very well.

"Baby Teeth aren't Really Important" Myth
Busted again.
Cutie! Have teeth will eat! 

Baby teeth are just as important as permanent teeth.  Yes, Baby'll lose them eventually, but some not until she's 12 or 13 years old.  Baby teeth serve many important, and even vital functions.  Teeth are needed to break down food to start the digestive process.  They are place holders in the jaw for the permanent teeth.  No teeth = no space in the bone for those bigger teeth.  Would you like to have decayed, painful, broken down, or missing teeth for years?  Absolutely not!  Tooth decay can transit from a baby tooth to the developing permanent tooth under the gums, as well as from tooth to tooth.  Beyond being terribly unhealthy, missing or decayed teeth are not appealing or pleasant to look at, and children know it.  Then there's speech - without teeth, Baby and then Child will lisp and not speak clearly.
Teeth are an important part of Baby and Child's self esteem and overall health.  Information on Baby's mouth, teeth development and oral care deserves its own entire post - stay tuned for that!


Ten more dental myths busted.
When I was thinking about what to write for a post, I started this list, thinking it'd be one post's worth.  Here it is, 20 myths already and Part III is in the works with another seven or eight.  So many things we think of as gospel and truths are, in actuality, fabricated and falsehoods.  When someone tries to tell you that's "the way it is," do your homework.  Know the facts!  You are your best advocate.  Treat the cause, not just the symptoms.  And, of course, prevention is the best medicine!  Ask your dental hygienist to be your personal oral wellness coach and develop a plan to be healthy.  This'll be a personal wellness plan you'll actually stick with every day!

Be well my friends.
Until next time,
Keep smiling,

Sunday, March 19, 2017

Bustin' up Some Dental Myths

Don't you just love hearing the phrase "because that's how it's done"??  Yeah, I don't either.  There are so many things in dentistry that are sacrosanct - things that may well have been true at one time, looong ago.  Yet the times, they are a-changin', and these theories need an update, or even need the boot!  I've been busy creating a list and oh boy, is it long.   Dentistry needs a makeover.  It's time to join the 21st century, and change the way some things are done.

Teeth Brushing Myth
Brushing with a manual toothbrush does as good as job as brushing with an electric brush.

The better option if you stick with a manual brush
Busted:  Most folks brush with too much tooth paste (more on toothpaste in a moment) and only brush until they foam up.  Then, they spit and rinse.  Research says that takes approximately 30- 45 seconds.  In my experience, it takes about 10 to 15 minutes to really get all the plaque off with a manual brush.
To illustrate this, while giving a lecture to high school students, I gave disclosing solution to groups of volunteers.  This solution stains plaque hot pink!  I then had them brush until that hot pink plaque was gone.  Took about 15 minutes.  The latest Cochrane report meta-analysis of current research says electric brushes do a better job of removing plaque.  Remember, plaque is super sticky- and becomes more and more difficult to remove as it grows and hardens.  Most people actually brush for two minutes with their electric brushes.  My vote is to buy the very best electric brush you can afford.  We know the modern toothbrush is about 400 years old.  It's time to upgrade folks, it just works better!   (You have a fancy cell phone??  You've probably updated that withing the last two years.  Time to upgrade to a smart toothbrush too!)

The less effective manual option
If you must use a manual brush, use one with multi-levels of bristles, preferably angled. Angled brushes remove 61% more plaque than flat brushes.

I do recommend dry brushing when using  a manual brush- no toothpaste.  This is the best way to tell if you are properly cleaning your teeth.  Toothpaste numbs the tongue, but when dry brushing you can run your tongue over your teeth and feel the clean!  Keep brushing until your teeth feel as silky smooth as they are after your favorite hygienist ;)  is done polishing your teeth.  Yes, you can make your teeth feel that good.  THEN use a dab, and only a dab, of toothpaste, spit, and don't rinse.  Done!

Toothpaste Myth
You have to use commercial toothpaste.
Busted:  Nope, another myth down the drain.  You actually don't even need toothpaste.  We have been led to believe we need toothpaste to help scrub off that sticky, icky plaque but it really is not true.  It's really all in your brushing technique (see above!).  Toothpaste is mostly a yummy cosmetic- it makes your mouth taste better, so maybe you'll brush a little longer.  There are lots of questionable ingredients in toothpaste which deserves an entire blog post at another time.  Meanwhile, click here for more info from a fellow RDH.  She spells it out well.
Too Much Toothpaste! 

Please just use a pea size amount rather than that ribbon of paste the commercials on TV suggest.  Babies get a smear, and children- a dab'll do ya!

There are tooth pastes that are more medicinal.  For more information read my post Creating a Healthy Toothpaste for more information on toothpaste.

"Floss is Floss" Myth
All floss is created equal.
Busted: No, many satiny/Teflon-coated kinds of flosses just glide over the plaque, leaving it on your teeth.  (Maybe that's why your hygienist accuses you of not flossing?)  Floss, in my opinion, needs to be fluffy and absorbent.  It should grip the tooth and disrupt that sticky, tenacious plaque biofilm stuck on your teeth.  Slippery floss has its place- when there's food stuck between your teeth (steak and corn on the cob come to mind), nothing works better than that kind of floss.  But for real, honest to gosh tooth cleaning, woven floss used correctly is, in my opinion, the best floss.
Floss on a stick- it's great for removing food debris, not so great removing plaque.  Sorry :)
Ask your wonderful dental hygienist to help you learn proper flossing technique.  It's really important to do more than remove food debris.  Be the boss with floss!

"Flossing Doesn't Work" Myth 
Floss does not prevent gum disease or tooth decay.
BustedI know there was a big report out summer of 2016 that flossing was not all it was touted to be and do.  Really, do we need a study?  I promise you, as a professional with 37 years of experience, I can tell right away who's a real flosser, who's a "floss on a stick/food picker-outer type flosser," and who "does not know how to floss properly flosser."  Big difference.  The results show up in bleeding gums, decay between teeth, and from the video screen full of bacteria on my chairside phase contrast microscope.  The bacteria don't lie!  The more plaque is left alone, the more organized and destructive it gets.  It's really all about getting the plaque off.  Check out my post: It's all about the Plaque! (No Tartar)  and then watch the bacteria on this post: It's a Small, Small, Extra Small World, to see what bacteria really look like.  Then, go ahead, stop flossing, if you dare.  (My microscope will tell on you.)  Personally, I floss like my life depends on it, because, quite frankly, it does!

"Fluoride is a Cure-All" Myth
Everyone needs Fluoride.
Busted:  This is a controversial subject that warrants its own blog post.  I will only address topical fluoride today.  At this point, I still recommend fluoride for those that have active tooth decay or are at moderate or high risk of getting a new cavity. (Moderate  risk is defined as one or more new cavities within the last three years.)  In my opinion, every patient should get a dental decay risk assessment, as well as a tooth decay bacterial screening test.  According to the American Dental Association (ADA), if as an adult, you have a low tooth decay risk level, you will not benefit from additional fluoride treatments in the dental office.  Yes, that from the ADA.  Before you spend that extra $45.00 or more (because most insurance companies won't cover adult fluoride treatments) ask about your tooth decay risk level.  Then you can spend your money wisely.  My preference?  Find out what your risk level is, then correct the problems causing your tooth decay and prevent it from going further, don't just mask the symptom.  Before they slap some fluoride on your teeth, ask WHY you need it and what benefit you'll get.  I'd vote for a toothpaste called Enamelon instead of the twice yearly fluoride treatment. Way better use of your money!
 For dental professionals: assess why you treat the way you treat.  What is truly best for the person sitting in your chair?   I've worked in an office that pushed fluoride on every patient, and I just said no, showing them the ADA recommendations.  A better use of the patient's time and money is looking at tooth decay risk level, and treat accordingly.

That being said, there are times I recommend fluoride varnish- it closes the tooth tubules and reduces tooth sensitivity.  That's a great reason for using fluoride.
open tooth tubules

Closed tooth tubules after Fl varnish

"Yearly X-rays for All" Myth
Time for your yearly bite-wing x-rays.
Busted:  Do you really need those x-rays every year?  Dental x-rays, or as I like to call them, diagnostic images, should not be taken routinely.  According to the ADA, if you are a healthy adult with low decay risk levels and without gum disease, no, you need them only once every 18 to 36 months.   Dentists are suppose to practice something the ADA calls  ALARA- as low as reasonably achievable.  Dentists need to assess risk and treat according to each individual.  There's that risk level assessment again!  Save your money, reduce exposure to ionizing radiation, and stay healthy.  I hate to say, but since insurance covers it, some dental offices do yearly x-rays to increase production, not because you really need it.  And, even more important, dental diagnostic images don't always show the true extent of the tooth decay.
This is why we take diagnostic images!

There certainly are times when taking images is definitely necessary, and are an important part of my daily treatment of patients.  I use them to assess bone levels, screen for decay between teeth, look for tartar on teeth and pathology in the bone.  (As an RDH, while not allowed to "diagnose,"  I can certainly see when things are not healthy on the images I take.)

"Dental Silver Amalgam Fillings are Safe" Myth 
Getting a new silver filling is fine.
Busted: This topic also warrants its own blog post.  The ADA stands by their product. Sometimes I agree with the ADA and sometimes I don't... Amalgam (the trade name for a silver filling) has been used for 150 years.  It is cheap to use and quick to place.  However, new research is showing there are health risks associated with exposure to amalgam placed in teeth, as well as the mercury vapors that result when drilling out old fillings.  We know for a fact that mercury is a poison - New research says it effects the brain, heart, kidney, lungs and immune system, and that it can cause damage even at low levels.
Please consider saying no to any silver fillings and really consider removing those you do have safely.  Do your research and make wise choices.
             Antibiotic resistance
             Neurodevelopmental disorders in infants
             Metal allergies

Large, Old, Failing Silver Amalgam  Fillings

"Sometimes Gums Just Bleed" Myth
Bleeding gums are normal
Busted:  This one makes me roll my eyes to rival a teenager.  No, gums don't "just" bleed.  There's always a cause.  Most of the time it's because of gum disease.  Other causes: hormonal changes such as pregnancy or menopause, poor diet, stress and cortisol, smoking cigarettes, tobacco and cannabis, medications, dry mouth, mouth breathing, Vitamin K deficiency , Vitamin C deficiencyVitamin D deficiency, other health issues such as leukemia, dengue fever, lichen planushemostatic (bleeding) disorders, blood vessel disorders, liver disease, rosacea and the more every day ones: improper toothbrushing, poor oral hygiene, crooked teeth, and aggressive flossing.  Find the cause and fix the problem.  As I mentioned before in this blog, I found an early case of leukemia because both the patent and I wanted to heal her bleeding gum problem.  Lucky for her, she took my suggestion to see her MD and found what was the real cause of her bleeding.  She caught it very early and was able to say she's a cancer survivor!  Her doc was impressed that her dental hygienist sent her in to be checked out.  I never thought she had cancer but I did think maybe vitamin deficiency.  It makes my heart so happy to hear she is alive and well.
Mouth Breathing = Inflamed Gums

"Sealants are Good Prevention" Myth
Dental sealants are good.
Busted (sorta):  Properly done dental sealants are great and will last years, preventing tooth decay in the vulnerable grooves of molar teeth.  
The problem arises when corners are cut, and/or treatment is given by those who are not properly trained.  Dental sealants are placed in the pits and grooves of teeth that are newly erupted and theoretically don't have tooth decay.  Proper preparation of the tooth is vital for quality sealants.  The tooth MUST be cleaned by air polishing to get all the plaque and debris out of the nooks and grooves.  Then, the tooth must have the laser cavity detector run over all the grooves.  If there's even a hint of decay it is time to rethink the sealant.  Too often, decay is sealed in under the material because these steps are skipped.  It was originally thought the sealant sealed out the oxygen, vital to tooth decay development.  Unfortunately, time has proven this theory wrong. Decay bacteria can adapt to an oxygen-free environment and thrive under sealants (there's nothing to disrupt them!).  Also, sealants that are not properly "sealed" can start leaking, and decay gets in under the sealant material.  As many as 50% of sealants fail within the first five years.  It's important to select the teeth that need sealants, test them for decay, then- and this is a point where most dental offices will look at you blankly- I recommend spraying the teeth with ozone gas to kill any decay pathogens lurking on or in the tooth.  Continue preparing the teeth, including great isolation- saliva contaminates the sealant, guaranteeing failure, and placing glass ionomer filling material into the grooves.  No overfilling the grooves.  Do it right the first time.  (Please do read the article on ozone and dentistry!)

"Receding Gums are From Brushing Too Hard" Myth
Exposed roots are from scrubbing with a toothbrush
Busted: You're not using that steel bristle brush on your teeth again, are you?  Nope, didn't think so. And you're no longer scrubbing back and forth like you did when you were six years old?  Good, then consider that these other issues may be the culprits:
  Most likely:
 #1. Gum disease and inflammation
 #2. Clenching and grinding
 #3. Orthodontics/bite issues
 #4. Poorly fitting dental appliances or other continuous trauma
 #5. Bone defects missing from birth- resulting in thin bone covering the roots
 #6. Abrasive toothpaste
  #7. Smoking or chew tobacco
  #8. Oral jewelry - see #4
Does all gum recession need to be repaired?  No, as long as it does not hurt or bother you in any way. Ideally I like gums to be snug up to the necks of the teeth but 58% of adults have some level of recession.  As long as the gums are clean, healthy, not sensitive, and no longer receding we can just keep a watchful eye on them.  They are more susceptible to root decay because they are not as strong a surface as tooth enamel.  Working with your dental health provider to keep your teeth healthy and decay-free is a must.
Some people take pictures of great looking food, I take pictures of old, broken teeth.

These sacrosanct ideas need to be put to pasture.  There are so many better ways to treat and prevent dental problems.  These are only my first ten, stay tuned for the next batch!  I have at least 15 more I think worth discussing. (Oh, is that a lot?) If you have any you want to add, please email me.


It feels good to be back at my computer, writing and researching for you.  Between the holidays, a vacation, and then a trip to Chicago for the Orofacial Myofunctional Congress, I've been away from this computer and blog too long.  I do have lots of things to write about so stay tuned!  I appreciate all the positive feed back I receive form you, my great readers.  This blog has now crested over 101.000 page views.  I'm honored and humbled you take the time to read.  Thank you from the bottom of my heart!
(I'd still rather take great pictures of colorful, delicious food on beautiful plates but, alas, that's not my specialty.)

Please keep smiling!  Spring will get here.
Thanks again for reading,

Tuesday, December 27, 2016

The Tale of Cranky Kat and the Happy HyGenius

She was beautiful, blonde, and already angry- not a good way to start a dental hygiene appointment.  I'll call her Cranky Kat (not her real name, but you knew that).  She'd been dismissed as a patient from her last office so I was already on high alert. (It takes a lot to be dismissed as a patient.)   She told me in no uncertain terms, "do not touch" her front teeth, there was bonding holding them together.  The last hygienist managed to undo it and break that bond.  That's when I put everything down and just listened to her.  Then I heard about the real problem.  She'd had invisalign braces six years ago.  It was only suppose to take nine short months.  Six years later, her teeth are still moving, daily.  Kat wears her last invisalign tray every night and moves her teeth back in line, but, by the end of the day, her teeth have moved yet again.  Now I understood her anger and frustration with her previous professionals.  I also knew what they all did not, and I had not even looked in her mouth.  Am I psychic?  No, but stay tuned for the answer!

Today's talk is about orthodontics.
Why would Kat's orthodontics fail so profoundly?  Why do people need to get braces again and again?  We're going to talk about braces, a little bit of history, and why we get crooked teeth.  Then let's chat about "ortho fails".  I freely admit to not being an orthodontist.  However, I've seen so many folks have repeat orthodontics-- why?  Here's my opinion and with some research mixed in!

(Quick reminder- all my sources are cited in the clickable links! and if you have any further questions please email me, or comment below.  I am more than happy to provide specific information if you're interested!)

 Evolution of the Human Jaw 

Prehistoric man had beautiful straight teeth and big wide dental arches. There was room for all 32 teeth.  They had big, broad faces and widely developed jaws which created wide open sinuses and wide open airways.  No mouth breathing or  sleep apnea here!   There was little malocclusion or crooked teeth at that time.  Toothbrushes had not been invented, yet little gum disease or decay was noted in the remains that have been found.  Babies were all breastfed, training the tongue to be in its proper position on the roof of the mouth.  Their jaws developed around their tongue.  Also, their coarse diet was great for their teeth - both for wearing any early decay down, and for jaw development, causing prehistoric man to develop big, robust jaws from using his jaws to chew this coarse food.  No tooth decay, no gum disease and no crooked teeth for our prehistoric ancestors with nary a dentist or an orthodontist in sight!

Cha-, Cha-, Cha- Changes 

 What's changed?  Man went from hunter/gatherer to farmer and field.  Good changes in some
areas yet problem-creating in others.  Tooth decay was first detected approximately 13,000 years ago by something so simple as the switch to farming and change in diet.  The switch between low sugar/high fiber Paleolithic diet to high sugar/low fiber diet, increasingly processed foods triggered the change in oral flora leading to tooth decay.  Then along came the Industrial Revolution of the 18th and 19th centuries.  Wow, a lot more changes.  Since as a whole we are no longer chewing hard foods and not encouraging long-term breastfeeding, our facial development changed drastically.  We sped up evolution.  This is called epigenetics. (Changes to our DNA genes due to interaction with the environment. Chemicals, nutrition and habits that change our facial development. I've link to two fantastic blogs that are very well researched.)  The tongue, our mighty tongue, was no longer up on the roof of the mouth, creating those big, strong jaws and beautiful straight teeth.  Pacifiers, baby bottles, soft food, and lack of breastfeeding have instead resulted in our developing long narrow faces, narrow jaws,crooked teeth, and high narrow palates with small sinus passages- the sinus passages are directly above the roof of your mouth, so the development of the latter greatly impacts the former.  All these changes but we still have 32 teeth, plus we have a too-big tongue in a too-small jaw, blocking the airway and creating what is now called  "Sleep Disordered Breathing," which encompasses snoring, mouth breathing, obstructive sleep apnea, and upper airway resistance syndrome.  Twenty percent of the US population has various forms of sleep disordered breathing and 90% of those folks are undiagnosed!  Lack of proper oxygenation of our cells has been connected to many severe health issues from depression, anxiety, diabetes, cancers, cardiovascular diseases and dementia to name but a few.  I highly recommend the brand new book  GASP!: The Hidden Path to Wellness by Dr. Howie Hindin and  Dr. Michael Gelb which discusses this in more detail.

Braces Again and Again

Nope, didn't like them the first time and yet, as my teeth moved, I did them a second time.  Why did my teeth move back?  (Even after wearing my retainers all those years! I was diligent!)  It comes back, yet again, to the tongue.  The pressures of the cheeks and the tongue on the teeth are normally about even - counterbalancing each other and preventing teeth movement.  Braces move teeth ever so slowly and gently through the bone. The bone cells, when pushed upon, breakdown, allowing us to move teeth through this semisolid mass.  They remake new bone behind the teeth.  It is quite a miracle!  Then braces come off.  If the tongue's in its proper "tongue rest posture" on the roof of the mouth all is well and stable.  Hollywood smile complete!  If the forces are not even or there's no retainer, teeth move.  Often, the culprit is force from the tongue.  Incorrect swallowing, with the tongue gently but constantly pushing the teeth with every swallow causes the tongue to act just like your braces.  We swallow every 30 seconds while awake - which amounts to around 2000 swallows a day.  That's a lot of unthinking pressure on teeth and it does indeed move them.

Peek a boo! 

I had previously worked for a dentist who just expected to wear braces for yet a third time.  She assumed that was the natural way of teeth.  Unfortunately, she didn't know what she didn't know.  Now you, my favorite readers, know more than a dentist!

Cranky Kat and the Big Reveal  

Finally, back to my patient, Cranky Kat.  Poor Kat was beyond frustrated with her teeth, her smile and her dental personnel.  Were it me, I'd be too!  I'd be angry, frustrated and generally disgusted with having spent precious time, lots of money and for no results and no answers.  I put on my detective hat and like Columbo set out to learn.  Before even opening her mouth, she and I discussed her teeth movement and then I asked about her sleep habits.  She reported she did not sleep well.  Sleep aids were on her medical history.  Does that all relate to her mouth?  You bet it does - keep reading!  As I did my exam and lifted up her tongue, I saw what no one else had for six years or maybe even 36.  She was moderately tongue tied.  (It's called ankyloglossia and it's caused by the little piece of string that connects the tongue to the floor of the mouth.)   I asked her about it and she said: "no one had ever mentioned her tongue tie before.  Her sister was so tongue tied, it effected her speech and she had a frenectomy."  Nobody had ever discussed Kat's tongue, and the fact it was mostly anchored down to the floor of her mouth.  She "functioned well" so no one had even thought to check it.  Functioning well only means she had no lisp and could swallow food.  She had many other issues no one ever connected to her tongue tie.  As I've mentioned before, the tongue has a "proper rest posture" on the roof of the mouth.  When one swallows, it should move the food or liquid backward.  Kat's tethered tongue instead moved forward, pressing against her front teeth, 2000 times a day.  No wonder her teeth moved daily.

Poor Kat had every right to be cranky!  All the evidence was right there.  Even before looking in her mouth, her medical history told the story.  She has sleep issues, and is taking a sleep aid.  She probably has sleep apnea and that's directly connected to tongue ties.  Research shows there's a direct correlation between a tongue that is tethered and sleep apnea.  Since it's stuck in the down position, it falls back and closes off her airway when she sleeps.  She was tense, had head aches and shoulder/neck pain.  Tongue ties cause the lower jaw to not develop properly.  It anchors the muscles down and causes neck strain, and can contribute to head aches.  (I have entire posts on tongue ties, tongue position, jaw development and sleep apnea.)  Lack of oxygen from sleep apnea can contribute to body pain.  All of Kat's signs and symptoms fit together like a puzzle piece.  I have to admit to being thrilled, a little smug, and very happy I "discovered" her tongue tie and gave her hope to resolve her many and varied health issues.  Time to look more closely at her tethered tongue and release it!  This is "to be continued"...

So now you know the Tale of Cranky Kat and the Happy HyGenius (that's me!).  The moral of the story is look at ALL the pieces, read the medical history, listen- really listen to the entire story, and look for the causes of the problem.  Don't stop until you find what you are looking for.
                                                                     ~The End~

Happy New Year to all my many readers.  I am excited to report this blog has had over 70,000 page views.  I'm amazed and astounded, and very honored you stopped by to read and learn.  Knowledge is power.  Have a wonderful and powerful 2017.

And keep smiling!


Wednesday, November 16, 2016

Binkies, Bottles and Thumbs, OH NO!

"So cute!" 

Babies with a thumb in their mouth always elicit coos and smiles from adults.  Until recently, even I thought that pacifiers were "okay", and that at least it wasn't the thumb in the mouth.  Now, though?  When I see babies and young children sucking on a thumb, pacifier, bottle, or sippy cup, I think oh nooo!  This baby, this child is permanently altering bones of their face, a change that can lead to severe consequences for their entire life.  Nobody is talking about this very real health issue that we are allowing to be created.    

When you know more, you see more.  Now I know, and am here to share with you what happens when things other than food or breast nipple are introduced to a baby's mouth.

Thumbs, fingers, sippy cups, arms, cheeks, blankets, you name it- babies and children suck on it, some for years and years.  You, as the caregiver, are charged with the well being of this child and it is up to you to give them the best upbringing you can.  I realize it's hard to take away that pacifier or sippy cup (more on this in a moment), but look at the lifelong consequences of not intervening early.    Here's a list of very real, very detrimental repercussions from what we, in the profession, call "Non Nutritive Sucking":  

     Crooked teeth                                Deviated nasal septum

     Underdeveloped jaw                     Jaw joint pain/dysfunction
     Wisdom teeth impaction               Snoring
     Obstructive sleep apnea                Sinus infection
     ADHD                                           Head and neck pain
     Ear infections                                Poor eye sight
     Allergies                                        Early wrinkles
     Elevated stroke risk                      Relapsed orthodontics
     Long face syndrome 

How does this happen?

Your baby's wellness begins on day number one!  It starts with oxygen, and creating/developing a great airway.  

Brace yourselves, here's the technical why: When thumbs, fingers, blankets or pacifiers are in the mouth, baby's bones mold around it because of the strong vacuum the sucking creates, and this then results in incorrect swallowing habits, that are likely life-long.  This non-nutritive sucking pattern also trains the tongue to rest on the floor of the mouth.  When the tongue rests down, behind the lower front teeth, facial development and growth goes awry.  The face bones grow down and back, resulting in an underdeveloped jaw, chinlessness and crooked teeth.  This then creates a narrow airway.   No air equals obstructive sleep apnea (OSA), even in children and sets them up for a lifetime of problems such as attention deficit disorder, stroke, heart attack and early death, yes- it's that serious. (Click on the underlined words for more information on sleep apnea and breathing.)   

When the tongue is down, the mouth is open.  When the mouth is open, the child "mouth breathes".  Mouth breathing, open mouth chewing, and lisping are all signs there's a problem with proper tongue placement and breathing.  The nose is made for breathing, that's its job.  The mouth is made for eating and talking, and only in an emergency, breathing.  The tongue, the mighty tongue! is the keystone of the head- it sets the groundwork for all facial development.  It's place, it's home, is on the roof of the mouth about a half inch behind the front teeth (not down on the floor of the mouth).  This placement encourages proper facial growth and development.  People always wonder why our jaws are shrinking and teeth "don't fit".  Folks, we are doing it to our own children.  We are  allowing the creation of crowded, crooked teeth and small, underdeveloped jaws.  This process is called klinorynchy.  We are speeding evolution along, and not in a good way. 

Sippy cups - even I'm guilty of giving them to my children.  I didn't know how bad they were for facial development (but boy, are they convenient - click here for a better, healthy spill proof cup and click here for a fabulous cup for little hands) unfortunately, they teach the tongue to sit down low behind the front teeth.  They interfere with developing a mature swallow.  Drinking from bottles and sippy cups instead of drinking properly and eating hard food also leads to insufficient jaw joint size and bone density as well as smaller, weaker face and neck muscles.  Pacifiers, blankets and fingers do the same.  

Here's the even sadder part, but probably the most important part- most pediatricians and dentists say: "no worries, the child will outgrow this habit by the time they are five years old, and that there's no real damage to them".   These doctors heard this in school and have never bothered to update themselves.  They could not be any more wrong!  Sixty percent of the child's facial development occurs by age four, and by age nine it's 90% completed.  Click here for my reference.  Most orthodontists wait until age 12 to start braces.  In my opinion, that's way too late. The jaw is too developed by this point, and the tongue's too big for the underdeveloped jaw - breathing problems continue, teeth are crooked, and bad habits are hard to break.  I attended the AAMPD Airway Summit in Tucson, AZ in September and heard Dr. Kevin Boyd, orthodontist, discuss how important it is to develop a good airway in children before the jaw develops.  A six year old in his orthodontic practice is an old child, almost too late to fix!  Crowded teeth are an indicator the face is NOT developing and forming properly and is actually collapsing.  Braces may fix the crowding but ignores the real root of the problem- the tongue position and the airway development.   Did you ever wonder why your ortho failed and you needed a redo?  Yep, it's a tongue and airway issue that was never corrected.  

Infants- breastfeeding is best, for as long as possible.  Breastfeeding provides unmatched nutrition.  The immunoglobulins and human protein in the breast milk help infants resist allergies.  Formula, on the other hand, provides a significant source of protein allergies and stuffy noses- and stuffy noses cause mouth breathing.  Breastfeeding teaches baby to swallow correctly and breathe while eating.  If you need to use formula, and most parents do at one time or another, please, sit baby nearly upright and use a nipple with the smallest hole possible so baby works his jaws to get the milk out.  Laying baby down with a bottle can result in ear infections

Okay, moving along from that intense section- take a deep breath (in and out through your nose!)

Mouth breathing- what to look for in your child

               Tongue should not be obvious when they talk except for the TH sound.
                Dark circles under the eyes from allergies
                Slumped shoulders
Flaccid lips, lips parted, upturned nose
                Poor sleep
                Large tonsils and adenoids
                Open mouth chewing
                Parted lips
                Upturned nose
                Flaccid lips

We'll talk about what do do in a minute.

 Next: the Thumb. 

I totally understand that babies need to suck to learn to soothe themselves.  I nursed my babies far longer than most folks thought "normal" for that very reason.  They need to suck.  One hundred percent of babies suck.  And I have no intention of ever shaming a child because they suck things.  I also understand they won't quit until they are ready.  

However- Parents, pay attention to what's happening.  The thumb pushes the lower jaw backward.  A lower jaw that is pushed backward creates an airway issue- no ifs, ands, or buts.

Often thumb sucking is accompanied by a bed wetting issue.  I wonder if this isn't linked back to lack of oxygen and a narrow airway?  When a child or adult is in deep sleep, they do not produce urine. When there's a lack of oxygen, the body puts out a hormone that makes more urine.  I wonder if the child, by sucking on something never reaches that deeper stage of sleep, but doesn't wake up enough to use the bathroom?  This is only my hypothesis, for now.  I'm still looking for data that discusses how deep babies and children sleep while sucking. 

Another ponder-able thought: the connection between tethered tissue under the tongue (tongue tie) to thumb sucking.  When the tongue is tethered to the floor of the mouth, it cannot reach "the spot".  (I did an entire post on The Mighty Tongue and discussed how important the spot is to correct facial development.)  "The spot" is the proper "rest posture" for the tongue, which I alluded to earlier.  It's just against the ridge you feel about a half-inch behind your front teeth.  This special spot is where the nerve endings from the trigeminal nerve open to the mouth.  When this place is rubbed, it releases endorphins.  (I know that sounds funny, but here's the source.) Also, rubbing this area stimulates the pituitary gland to release growth hormones.  Chewing, sucking and rubbing this area makes your child feel good.     

Again, I have a hypothesis- could the child have what's called a tongue tie?  There's a little piece of skin under the tongue,  and sometimes this short tissue holds the tongue down so it cannot reach the roof of the mouth. Read my blog post on tongue ties.  This can be gently cut to release the tongue.  Again sadly, most professionals don't know about or even recognize a tongue tie and the value of releasing it.  There is an association of professionals knowledgeable about tongue and lip ties called the International Affiliation of Tongue Tie Professionals if you have any concerns your child may have a tethered tongue.  

How Do I Help My Child?

1. Read Helping the Thumb Sucking Child by Rosemarie Van Norman.  Learn about the cause(s) of your child's habits,  so you can understand and address the whole behavior.  There are indeed gentle, constructive, and effective techniques to help your child.  Begin your efforts by reading Rosemarie's fabulous book to help guide you.  (Available on Amazon).   

2.  Seek out a myofunctional therapist.  When there's a finger or thumb involved, get help.  A myofunctional therapist can help your child in a positive way with behavior modification.  It is an extremely complex behavior.  Ignoring it and hoping it'll go away is not constructive. 

 3. Pacifiers are easiest to make disappear if they are "disappeared" one by one. (Again, I confess that I am guilty of encouraging my children to use a pacifier because it soothed them to sleep, and I admit, I wanted a decent night's sleep.) 

I've heard of parents snipping a tiny hole at the tip of the pacifier, which renders it un-suckable.  I suggest you keep pacifiers only in the crib to be used at bedtime.  Often, pacifier use will accompany a blanket.  Blanket and pacifier stay in bed.  Sometimes, when the blanket disappears, the accompanying habit may stop as well. 

  4. Sippy cups.  Use a real cup. Throw away those sippy cups.  Four-year-olds should not be using them. Period.     

My least favorite approach:

Palate expander and crib - do you want that in your mouth? 
Many dentist will recommend an appliance called a "crib".  It's basically a rake that pokes out so the thumb or fingers won't want to go in the mouth.  The problem with that, in my opinion, is the tongue needs to be on the roof of the mouth to expand the palate organically and with those spikes there, no tongue will rest up on the roof of the mouth.  Read my post on The Mighty Tongue to see why that's so important.  Once the crib is removed, the thumb goes right back in.  The root of the problem was never resolved. 

I have not touched on speech issues or speech-related issues, this is because I am not a speech language pathologist, so I cannot address speech issues with any authority.  

The benefits of proper facial development: 

               Strong jawline
               Optimal growth and physical performance
               Straight teeth
               Balanced facial features
               Higher IQ 

So: Moms, Dads, Grandparents, and relatives, the precious bundle you'd give your life to protect is in your care. Will you allow this to happen now that you know the very real consequences?
Put away those sippy cups, throw away the pacifiers, work with a myofunctional therapist to teach your child how to keep those fingers out of their mouths.  Your child needs you to be the parent.  Being nice and ignoring these problems is detrimental to their total health, development, and life-long well being. 

A healthy face looks good and has good tone.   

Do you want your child to look like Jamie (I'm a big Outlander fan) or Napoleon Dynamite when they reach adulthood? I vote for Jamie.
Sam Heughan as Jamie in Outlander 

Jon Heder in Napoleon Dynamite

It's in your control.
Til next time,

Health starts with you.  Now, you know more and see more.

Keep smiling,
Dental Hygienist Extraordinaire ;) 
Specialist in Orofacial Myofunctional Therapy