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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Wednesday, May 3, 2017

Bustin' Mouth Myths Part III

Part III of busting up those dental myth - got my sledge hammer out!  This round of myths centers on breathing, snoring, tongue ties, and jaw development.  So many myths, so little time!

"Mom's teeth + Dad's jaw = crowded teeth in Junior" myth

Busted big time!
Crooked teeth are not the result of genetics. Dad's big teeth and Mom's tiny jaw is a myth perpetuated by misinformed dentists.  That's what I, too, remember learning in school and I incorrectly gave out that misinformation.  Shame on me for not researching this!  I know much better now.  I returned from the second annual Academy of Applied Myofunctional Sciences Congress (AAMS) in Chicago in early March and learned otherwise!  Instead, the culprits are our modern diet, bottle feeding, pacifiers, finger sucking, tongue ties, and mouth breathing.  Crooked teeth, malformed jaw bones, underdeveloped facial bones, allergies, and chemical sensitivities are fairly recent developments in humans.  Dr. Weston Price concluded most crowding is due to our modern diet and the lack of critical nutrients  - minerals and fat soluble vitamins A, D & K2.   Dr. Price studied isolated peoples at the turn of the 20th century.  He viewed what these groups of people ate, analyzing their diets/nutrition.  He photographed their children and concluded the crowding and changes in modern man's jaws were related to our modern diet.  Dr. Price's book Nutrition and Physical Degeneration is quite in-depth but I'm working my way through it.  There's a simpler version on the Weston Price Foundation Website.  Next time you wander through a museum and see skulls  - look at how straight and perfect our ancestor's teeth were.  No decay and no crowding.  That'll give you food for thought. 

"Mouth breathing is okay and n
atural" myth

Busted as well.
See above!  I chat about mouth breathing and all the problems it causes all the time to anyone who'll listen, and even some who won't.   It may be what folks "do" (walk through any airport and you'll see what I mean), however, it's not healthy!  Your mouth is only an emergency hatch.  It's not meant to be used as your main source of respiration.  Yes, I get that you do it, however, you'll be so much healthier if you breath through your nose.  What, you have a deviated septum and can't!?  Maybe it's time to fix that so you can.  Your nose has important jobs to do to keep you healthy.  It filters air (remember how dirty your house filter is? Your nose does that on a daily basis.)  It warms and moisturizes your air.  It purifies the air, filters out and kills pathogens, viruses and allergens.  It adds nitric oxide to your system.  Nitric oxide relaxes smooth muscles and increase oxygen uptake through dilating the blood vessels.  Nasal breathing helps reduce anxiety.   If you or other family members can't regularly nasal breathe, it's time to see a specialist or two such as an Allergist, or Ear, Nose and Throat doc. Yes, it's that important.  Mouth breathing is NOT healthy breathing.  It results in so many health issues.  Read my post: Breathing- Not Everyone is Doing it Right.  Then, close your mouth and breathe through your nose.  Really!

"Snoring is cute in babies" myth.

BUSTED!
I mean, yes, babies are super cute, but more important to their lifelong health is that I learned at the AAMS Congress that babies and snoring do NOT mix.  Snores sounds coming from your sweet li'l punkin' means punkin' is not breathing correctly while sleeping.  It means her airway is shutting down and is compromising her entire li'l body.  Babies brains grow at one percent a day for the first three months of life.  Mouth breathing can reduce baby's IQ by up to 15%.  Snoring means baby's oxygen levels are dropping and her cells aren't getting enough O2. The growing brain doesn't like this!

I realize you're not in there watching and listening to her sleep.  Download the sleep app SnoreLab.  Listen, see and be enlightened!  Your cell phone can now be much more useful.  Get your and baby's Snore Score!  And, FYI- snoring in children of any age is NOT acceptable!  As I did my research for this post I really tumbled to the fact many medical websites dismiss snoring as more of a nuisance than as a real medical and breathing problem.  Maintaining an airway and getting all the oxygen your body or your baby's body needs is vital to health and proper growth.  If your medical provider dismisses your concerns, it might be time to find another, just saying...don't ignore the snore.


"Kissing Tonsils will shrink as baby gets older" myth. 


Busted again.  
Maybe they'll shrink, BUT! meantime, think of the havoc they're creating!  (How the heck does this person breathe, swallow, or sleep well?)  These tonsils create airway issues that cause crowded, crooked teeth, narrow dental arches, high vaulted palate, and a long narrow face.  Mouth breathing can result and you know what I think about mouth breathing!?!  These type of swollen tonsils have other consequences as well, such as bed wetting, day time sleepiness, attention deficient disorders, and other behavioral issues (ahem, see again the snoring and mouth breathing topics).  
 I do realize any operation has risks and those risks must be weighed off against the advantages of doing the surgery, so investigate as to the cause of the swelling.  Is it allergies, acid reflux, viral infection, or bacterial infection?  Again, it may be time to video tape your child sleeping, see how much they toss, turn, and snore. 


"Tongue Ties will stretch or don't matter" myth. 

Bust! 

Under the tongue is a little piece of tissue called the frenum.  It connects the tongue to the floor of the mouth.  Sometimes, that tissue is short or just attached closer to the tip of the tongue.  The tethered frenum can cause just as much havoc as the kissing tonsils, just in a different location!  Tongue ties matter a lot!   The frenum can restrict the growth of the jaw (think crooked teeth), cause obstructive sleep apnea (tongue falls back into the airway during sleep because it can't reach its proper rest position on the  roof of the mouth), cause an abnormal swallow pattern (which creates an entirely new host of problems), and cause mouth breathing (see above!).  Just like any tissue, it won't stretch or get cut accidentally.  Releasing it is the way to go, and IMHO, the earlier the better. 


"Lip Ties don't matter" myth.

Bust 

Another area in the mouth that has frenums is the lower and upper lips.  These frenums connect the lips to the jaw.  Sometimes, nature gets interrupted during fetal development, and the lip or lips stay tightly attached to the jaw.  The problem with ties, especially for newborns, is that their lips are so tight they can't make a good enough seal around mom's nipple to nurse or nurse effectively.  Anyone who says these frenums do not matter or that they will resolve themselves are misinformed.  


"Pacifiers are okay, especially the ortho ones!" myth.


Bust! again
As I've mentioned before in other blog post, I had thought a pacifier was a good and safe alternative to digit sucking.  I was totally misinformed!  Actually, I was uninformed.  Now, having done my research, I can tell you pacifiers of all kinds can indeed cause problems with jaw development, resulting in crooked teeth and a guaranteed trip to the orthodontist. The research shows the beloved binky creates open bites, overjet bites, and posterior crossbites as well as making the roof of the mouth more narrow. (Which is all dental-ese for crooked teeth.) 
The photo is of my daughter, who still has a lateral tongue thrust, and therefore an open bite- even after ortho.  If only I knew then what I know now!




"Baby Formula is just as good as breast milk" myth.



Corn Syrup is the first ingredient! 
As I was doing my research to learn about proper feeding of baby for another post, I took a look at baby formula and about came outta my socks!  No wonder children are getting diabetes at such young ages.  The number one ingredient, very first listed on the can of baby formula I picked up is "sucrose" - sugar by another name. Check out this video and news report: http://www.nbcchicago.com/investigations/target-5-sugar-baby-formula-139339308.html 

Sucrose,  or corn syrup or any one of the other 61 names for sugar conditions baby to want more sugar.  Sugar in our infant formulas creates baby's dependence on sugar, rather like a drug addiction!  I understand, not all parents can breastfeed, however, it's time we had better baby formula. Of course, breastfeed if at all possible. 



"Orofacial Myofunctional Therapy (Myo) doesn't work" myth.


BUSTED!
Dr. Michael Mew has a video that discusses the success of myo.  By working with patients to teach proper tongue rest posture and swallowing, teeth can be moved due to the changing of the position of the lips and the tongue.  It does take real work, but, hmmm, avoiding braces and having an attractive face, as well as a nice large airway is well worth the work!   
Very early dental pioneers in orthodontics: 
Dr. Edward Angles stated mouth breathing was the cause of crooked teeth and that every malocclusion has a myofunctional cause.
 Dr. Alfred Rogers stated that muscle function is the key in the treatment of malocclusion (crooked teeth).  
What's a "myofunctional cause"?  The causes of crooked teeth start very young with baby bottle feeding, tongue ties, thumb sucking, pacifier sucking, and mouth breathing, as well as other noxious oral habits.  

A few years ago (as I was learning about myofunctional therapy) I sat next to a pediatric dentist at a continuing education dental luncheon.  This man was quite adamant teaching folks to swallow properly just did not work, and myofunctional therapy was a hoax.  It was only a one sided conversation.  I tried to explain how it cured my daughter of her super burps.  He wouldn't listen. Sadly, for his patients, he doesn't know what he doesn't know.  He'll never see what I see.  Saddest of all, he'll never be open to learning more and improving himself.  Myofunctional therapy does work. 

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It's been a fun and educational three years of writing this blog post!  I've been learning a lot, hope you have too.  What stands out most to me, especially in this post, as well as the other two myth busting posts is the need to not just accept things because it is conventional wisdom.  Rather, do your own research.  I've made errors because I assumed something was true when it wasn't.  The internet makes it easy to learn and open your mind.  Don't be "misinformed"!

Keep smiling!
Barbara

Sunday, April 30, 2017

Inquiring Minds Want to Know

What an incredible month April has been here in the Pacific Northwest.  We're hit an all time high record for rain, which I didn't think possible.  Closer to home, this blog has been honored not once but three times!  I have had the privilege to be a  guest blogger for two other sites, and then was selected as one of seven dental blogs worth reading by Cloud Dentistry.  All in one month!  I've been busy writing, just not on here. (Which will soon be rectified!)

Molar System 

There's a new blog out there called Molar System.  On it, the lovely host reviews dental products and their effectiveness from a consumer's perspective.  Molar System has no ties to dentistry, and so can give you an honest appraisal of oral care products, some of which are very unique!  I've had the wonderful opportunity to be the first guest blogger, answering questions on products and procedures.  Please join me there as I discuss brushing, flossing, and many other great topics the Molar System had for me!  It was just posted last week.  Follow Molar System on Instagram!

Ages and Stages

Next, I had the opportunity to work with a seasoned blogger, nationally renowned speaker, author, and teacher- Diane (Di) Bahr.  She's a speech language pathologist who's on a mission to help children develop proper speech, mouth, and feeding development.  I had the honor of being featured on her most recent Q & A.  This post discusses my thoughts on taking baby to the dentist, what to expect and what questions to ask your doctor.  The question I probably get most from parents is: "When should Baby see the dentist?" Then they follow up with, "Why?!? Baby has no teeth yet!"  I have lots of good info for you there.   (It's rough when I'm limited to 650 words- there's always so much more information to share with you!  My director's cut of that interview will be posted on my blog in the near future.) This post went live this weekend.

Anyone with young children or grandchildren will greatly benefit from Di and her wealth of knowledge, as well as all her incredible guest contributors.  Please consider subscribing to her site, you'll learn lots and lots!  Di's passion is infectious.

Cloud Dentistry

My blog was one of seven dental blogs selected to be featured on Cloud Dentistry's website page. How fun and humbling to be part of this fabulous group of bloggers, and to be considered at the top of the dental blogging world!  Cloud Dentistry is a new resource tool for finding temporary or permanent dental workers, as well as many other web-based tools and skills. They're the future of dental employment agencies!  

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So, my faithful readers, it's been a crazy, fun, humbling and fantastic ride blogging this month.  What an honor to contribute to other blogs and share my perspectives on oral wellness.  I greatly appreciate my fellow bloggers for asking, and you, my readers for reading and making this such a successful blog!  A mind once stretched can never regain its original shape!

Since it was another rainy Pacific NW day, I  had the opportunity to write another blog post as well so that'll be posted later this week rather than the usual week or two between posts.  I'm so ready for Spring and warm, drier weather but at least I made the best of it and got to write!

'Til next time,
keep smiling,
Barbara






Tuesday, April 18, 2017

The Healthy Mouth - Healthy Body Connection is Connected

Finally!!
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.
video


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!

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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!
Barbara











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
Busted!
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
Bust
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!

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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,
Barbara



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.
             Alzheimer's
             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.

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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,
Barbara












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~

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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!

Sincerely,
Barbara