This is the first of a two-part series that discusses the effect of foods on our teeth. Part One will review those foods considered harmful to the teeth, and Part Two will discuss foods that can actually help to rebuild them.
Generally, more attention is given to the former than the latter. From a viewpoint of prevention, this has its value. Nevertheless, a good understanding of which foods are beneficial to dental health is, in my opinion, of no lesser importance. In actual fact, this understanding may hold the key to not only improving an individual’s dental health, but very possibly their general health as well.
While there are usually several components to any program that leads to improved dental health, of these, it is my opinion that diet is paramount.
Dentists generally spend the bulk of their time discussing the importance of hygiene. I, too, have addressed this topic in several articles. Nevertheless, over time, I have come to see the value of spending a great deal more time with patients reviewing and modifying their diets. Truthfully, this is more challenging – and meets with greater resistance. But it is vitally important.
I don’t think it is important to the exclusion of hygiene, however. Yet, I have come across some opinions that promote diet only. So let’s take another look at this area more broadly, just to put it into perspective.
Hygiene involves care of the entire body. Naturally, that includes the mouth. While good personal hygiene is generally something one should practice for themselves – it is also important to insist others maintain it as well. Consider the following example:
Let’s say you have adopted a diet of fresh organic food and you are now on your way to your local butcher to purchase some fresh meat. You arrive and are greeted by someone who smells as though he hasn’t bathed in a week. His hair is greasy. His hands are dirty and after he unceremoniously coughs into them, he wipes one hand on a dirty shirt. Then he reaches over for your fresh cut of meat and holds it up for inspection.
You would have a right to refuse it. Not because there is anything wrong with grass-fed, hormone free meat. Rather, it would be because the person clearly practices poor hygiene and may infect you – and whoever else they come into contact with. You wouldn’t be wrong to say something about it.
Similarly, good oral hygiene is simply a reflection of the total care of one’s body. This also means getting sufficient rest and exercising regularly.
That having been said, let’s take a quick look at what types of food cause people dental problems.
These can be simplified into three broad categories. As you will see, however, they comprise a very wide array of commonly consumed foods.
Sugar and Sweeteners. The first category I will mention is the one nearly everyone focuses upon and possibly falls into the category of “common knowledge.” Despite this fact, you might be surprised by the quantities of sugars and sweeteners that are regularly consumed in a typical diet. When the quantity of sugar in the blood rises it upsets the balance of calcium to phosphorus in the blood as well. This has the effect of pulling calcium out of our teeth and bones. Low phosphorus levels likewise affect the mineral content of dentin, which is the layer of tooth structure supporting tooth enamel.
Low Fat Foods. This includes such items as skimmed or low-fat milk, which many individuals assume helps their teeth if they consume it in sufficient quantities. Unfortunately, this is a fallacy that gets many people in trouble. Milk that is homogenized and pasteurized has been stripped of its nutritive value. Pasteurization kills off the probiotic (good bacteria) quality of raw natural milk. Paradoxically, this can allow pathogenic (bad) bacteria to grow more easily in pasteurized milk. Also, the absence of healthy fat can affect hormonal function which, in turn, may affect mineral levels adversely.
Bleached (White) Flour. Products that contain white flour can also be damaging to teeth – especially when combined with sugars and in the absence of healthy animal fats. If one stops to consider how many foods are made with white flour, this can create quite a dietary challenge. Furthermore, if not removed after meals, these foods will create a thin sticky layer of what is basically a form of sugar. Because this, in turn, can stick to the teeth for hours – and becomes acidic – it can accelerate that demineralization process that breaks down the outer layer of your teeth, resulting in tooth decay. Also, the bleaching process typically adds chlorine dioxide or benzoyl peroxide to make the flour appear bright white. You don’t need these in your diet.
In the next article, we will cover what foods are good for your teeth. The positive side to this story is that there is good news and you can do something to remineralize or rebuild your teeth; however, knowing how foods come into the picture and which ones are detrimental to your teeth and gums is a critical element for taking control of your dental health.
Let’s face it: seeing a doctor – any sort of doctor – can be expensive. And dentists are no exception. But if a person’s diet and home care have been lacking, the cost of dental treatment can quickly sky-rocket. One of the problems with dental care has to do with the fact that many patients still suffer from the idea that if they don’t feel anything wrong with their teeth, then all is well.
Unfortunately, when it comes to teeth, most people miss the boat entirely with this concept. The reason is simple: the outer part of the tooth – the enamel – is mostly mineral and has no nerves. That means you can have a cavity and not know it. Several, actually. Most dentists will attest to the fact that many patients are shocked to learn they have any cavities at all.
The trouble is that by the time a cavity actually gets big enough to pose a problem, it’s a PROBLEM. For most people that trouble is spelled P-A-I-N.
It’s really no small wonder that so many individuals associate going to the dentist with toothaches. For those patients, it is the only time they will actually make an appointment. They go because they now know they have a cavity. Pain is a huge motivator. . . .
By the time a tooth hurts, though, the cavity is usually pretty close to the nerve. This means that if there is still enough tooth structure left to work with, the dentist may consider a root canal to remove the source of the pain – in other words – the nerve. Usually, this is not cheap. A root canal on a molar can cost over a thousand dollars when performed by a specialist. Then the patient has to go back to the dentist to have the tooth built up again (because so much tooth structure was lost to decay) and finally, the tooth may even need a crown. Lacking a blood supply and nerve thanks to the root canal, the tooth is now brittle and can break. Since your back teeth get a lot of pressure when you chew, failing to crown it may result in the tooth cracking and all that money you spent on the root canal goes out the window.
In a number of cases, because many people simply fear getting a root canal (not because they actually had one, but because they heard that a friend of a friend had a bad experience, and they never want to go through THAT), they opt to remove the tooth instead.
But now they have to replace the missing tooth or else their teeth will shift around and their bite goes awry. And fixing that new problem typically costs even more!
It can be frustrating.
Many people figure no one will see a missing back tooth, so why not pull it, since that is cheaper? At least they think so – until they notice their front teeth starting to form gaps, and find that food gets stuck all over the place whenever they eat. But then again, what if it’s a front tooth that needs to go?
You possibly think: “Wow, this is a problem, but I still really need to find something cheap.” OK, then. If you live in Philadelphia, you may Google “affordable Philadelphia dentist” or “cheap dentist.” A number of listings for dental implants appear, maybe some for “affordable cosmetic dentistry.” Wow, this isn’t sounding at all affordable!!! Wait! A couple of dental schools come up too. “Hmmm. Do I really want someone in their first year of dental clinic restoring my front tooth? It will be less expensive. But, then again . . . .”
The affordable dentist is someone who will understand your situation and can help you to find a workable solution for your circumstances. Many offices offer low-cost or interest-free programs that help you get the work you need today and then spread payments out over time. In some cases, it may be helpful to set up a lay-away program, especially if you have specific needs for which you have been given an estimate of treatment costs. In this manner you won’t end up spending your money on other less-essential items. Many offices will assess a minor fee to manage this plan, but it is usually quite small.
In the meantime, it is essential to keep yourself out of trouble with good preventive dental practices. Learn what diet has to do with your teeth and which home care habits are best. Remember, when it comes to teeth and gums, “no pain” most definitely does not always mean “no problems”.
“If it ain’t broke, don’t fix it.” Isn’t that how the saying goes?
Well, when it comes to teeth, most people really can’t tell if it’s broken.
Consider these interesting dental tidbits:
Periodontal (gum) disease is the number one cause of tooth loss world-wide. That’s basically a condition in which you lose the bone that surrounds your teeth, so that even healthy teeth may fall out.
Most people who get cavities diagnosed by their dentist didn’t have any idea that they even had a cavity.
A substantial number of patients who clench or grind their teeth — resulting in worn-out, chipped, and cracked teeth — swear that they don’t.
Some patients who come into a dental office convinced that they have a cavity because of pain, actually don’t have a cavity at all.
What the heck?! Yeah, it can get a little confusing, and that’s probably why at one point or another many people find themselves confronting a dental emergency. Some emergencies are simply the result of accidents. After nearly twenty years of practice, I have seen quite a lot of these too. But in reality, the vast majority of dental emergencies are simply caused by neglect. So here are a few tips on how to stay out of trouble:
1. Never open anything with your teeth. Just don’t do it. I have restored countless teeth after people tried to open or hold objects with their teeth. It’s not worth it. Grab a scissor, pliers, bottle-opener or whatever you need to do the job. Your teeth were made to chew your food.
2. Use an athletic mouth guard if you play sports. Sports are fun and can be great exercise. They can also cause teeth to get punched out, kicked out or knocked out. Use a professionally made mouth guard if you play sports.
3. See your dentist regularly. Some things can even be tough for your dentist to detect. Unless you have x-ray vision and can see inside your own head, you will never know if you have decay between your teeth until it is so large that it starts to look ugly or pieces of the tooth actually fall apart. Also, you don’t want your first realization that you have periodontal disease to come from noticing that your teeth are loose. Your dentist should also be checking for oral cancer at your examination visits. If you have it, early diagnosis can be a matter of life or death.
4. Brush and floss your teeth daily. There is simply no substitute for prevention. Brushing your teeth after every meal and flossing at least once a day goes a long way in protecting you from oral diseases — not to mention bad breath.
5. Wear a custom night guard if you grind or clench your teeth. Bruxism — the term used for the grinding or clenching of teeth, has been observed by dentists to be increasing in frequency among their patient populations. No doubt, stress has a great deal to do with this, but if you have been diagnosed with bruxism don’t take it lightly — because your teeth won’t either. I have also noticed a significant rise in bruxism over the last 10 or so years and its effects can be devastating.
Oh, and that emergency dentist you were thinking of using. You know, you saw the billboard on the way to work. He’s the one that is willing to see you 24/7. So, in the worst case scenario, you will have someone to go to, right?
I wonder how many people he has actually treated at 3:00 AM? If it happens at all, I’m certain it doesn’t happen often. Sure, you can CALL him 24/7, but you’ll be seen at the first opportunity. And if he does agree to see you after hours or on a weekend, it will likely cost you a few extra hundred in addition to the cost of your treatment. By the way, be prepared to bring cash, because he may not accept checks or a credit card from a brand-new emergency patient.
The moral of the story is simple. Use common sense and just don’t let things get that far along. If it has been more than six months since you have seen your dentist (unless you have full dentures) you are over-due. Even patients with dentures should see their dentist at least once a year to check the fit of their dentures, be evaluated for adjustments or relines, to have the dentures cleaned, and to check for oral cancer.
How long has it been since your last dental visit?
Here is an interesting article about sleep apnea solutions. Our office provides an extensive complement of night-time apnea and snoring solutions. Ask us about aveoTSD — the latest simple, inexpensive, and noninvasive anti-snoring medical device.
Dr. W.
By Brent Arends
Is there room for two gold standards in the world of sleep? In 2011, most sleep physicians still put CPAP in the gold category, with oral appliances taking the second-place silver slot. If Sheri Katz, DDS, has her way, that hierarchy may someday be a bit more nuanced—perhaps with CPAP at 18 karats and oral appliances at 14.
CPAP has the benefit of time and the respect that goes with it. Among patients, however, oral appliances frequently carry a significant preference advantage. “Given the option, about 70% of patients choose oral appliances,” says Katz, president of the American Academy of Dental Sleep Medicine (AADSM), Darien, Ill. “Oral appliances are noninvasive, convenient, discreet, easy to travel with, and it’s a therapy that works. Dentists who are interested in participating in this field must take the correct training and know the proper protocols. We need more dentists to do this, but only as many as we can properly train and accredit.”
As a sleep apnea sufferer and oral appliance user herself, Katz believes wholeheartedly in the efficacy of dental sleep medicine. Despite evidence and consumer preference, she knows respect in the medical community is built on positive experiences. “Satisfaction depends on patients working with qualified dentists,” stresses Katz. “Sleep physicians and other referring specialists are going to be disappointed if they send [a patient] to just anyone, and the patient is not titrated properly or brought through a proper protocol. By the same token, we can be disappointed by blindly putting everyone on CPAP. If we work together and build relationships, we can form effective teams.”
AADSM membership is growing quickly every year, and the Dental Sleep Medicine Facility Accreditation Program, launched earlier this year, figures to make it easier to find qualified dentists. “How can the public, referrers, and third-party payors—including Medicare—identify who is well trained in the field?” asks Katz. “Every dentist can make an impression and probably get some sort of device inside a patient’s mouth. But should they be doing this if they do not have the proper training? The answer is no.”
Katz hopes that AADSM facility accreditation will serve as a seal of approval to guide entities beyond mere state licenses. “State licensure has really been more of a tax revenue source, and not successful in identifying who is really competent,” she says. “The facility accreditation process demands that we demonstrate our knowledge through a policies and procedures manual. Facility accreditation requires certain levels of education, so many hours in the field, and eventually a board certification, which we offer.”
DIFFERENT DECADES, DIFFERENT ATTITUDES
When Katz began practicing dentistry in 1978, CPAP had not yet been invented. Restorative dentistry ruled dental school curriculums from coast to coast, with only occasional showings from the so-called “fringe” disciplines of orofacial pain and TMJ.
Steven Scherr, DDS, graduated from dental school just 3 years after Katz began practicing, and he had “never heard of sleep apnea” up to that point. A little more than a decade ago, that all changed when a physician asked him to make an oral appliance. “I hardly knew what sleep apnea was,” admits Scherr, owner of the Sleep Disordered Breathing and Facial Pain Centers of Maryland, Pikesville, Md. “I figured I would try anything once, and it worked out. The patient was thrilled. She had tremendous success, and felt much better. The referring physician sent more patients, and his partner sent even more. Within 2 years, 50% of all my patients were referred for treatment of sleep-related breathing disorders.”
Scherr’s growing stable of referring clinicians represents an overall awareness in the medical community that mirrors a massive push in the consumer media. Initially skeptical physicians have taken the time to read the research, and converts are now embracing the idea that CPAP is not the only viable treatment for sleep apnea.
The American Academy of Sleep Medicine (AASM) opened the door by publishing practice parameters in 2006. The report concluded that oral appliances are indicated for use in patients with mild to moderate sleep apnea.
Don A. Pantino, DDS, agrees that medical understanding has taken “a huge jump” in oral appliance acceptance, and he predicts that will only grow. “In 2006, we looked at the new data and oral appliances were doing well,” says Pantino, who owns a private dental practice in Islip, NY. “As a matter of fact, they should be offered as a first-line therapy for mild and moderate patients. Patients should be educated and given a choice. The conventional wisdom is still that CPAP is more effective for severe patients. However, if that does not work, it is OK to try an oral appliance or combination therapy.”
With the research question partially answered, concerns shifted to insurance companies that largely would not pay. As of January 2011, however, a custom fabricated mandibular advancement oral appliance used to treat OSA is covered if certain criteria are met, according to a new local coverage determination. “CMS officials did not make that decision lightly,” says Scherr. “In this economic age, medical directors would much rather not introduce a new therapy that they must pay for. But they also did an extensive literature review, and they felt the literature strongly supported the use of oral appliances for the treatment of sleep apnea.”
Recognizing the growing importance of dental sleep medicine, officials at Tufts University, Boston, ultimately installed a formal dental sleep medicine curriculum—a move in line with the university’s past accomplishments within the nonrestorative realms. Pantino, an adjunct professor at Tufts, points out that as recently as 1999, sleep garnered about 2 hours of instruction during a 4-year medical school stint—a time frame he views as absurd in light of the fact that humans spend one third of their lives sleeping.
Even in 2011, promoting sleep at the dental school level is necessary. With this in mind, Pantino has used his role as president of the American Board of Dental Sleep Medicine (ABDSM) to help develop a digital PowerPoint presentation to introduce the academy and explain the importance of a sleep curriculum.
Beginning in March 2011, students have an opportunity to learn through accompanying modular lessons in the classroom setting or online. Call it an educational initiative or even a marketing tool, but it is all part of an ambitious goal to convince 100% of dental schools to develop formal dental sleep medicine programs.
Pantino believes a greater focus in the academic setting will naturally lead to a cultural shift among dentists who, at the very least, should be actively checking for signs of sleep apnea within every patient. “Every patient who snores or suffers from hypertension, diabetes, depression, and obvious anatomical landmarks should be considered,” says Pantino. “As medicine goes toward a more holistic approach and we screen for more things, oral appliances make perfect sense. So many patients are going to be diagnosed, and CPAP can be noisy, painful, and not ideal for everyone. When oral appliances are properly applied, with the right adjustments, and administered to the proper patients, they can have a remarkable benefit.”
And given enough time and evidence, that old gold standard may gradually change. “In general, it takes 15 to 20 years to get new advances through the system, and then another 5 to 10 for insurance companies to catch up and pay for them,” adds Pantino. “The gold standard is usually the first thing out there. I make it clear to my patients that I really want them to try the CPAP, and if it works, that is wonderful. I am not here to sell patients appliances. I am here to make sure they get the best therapy that is going to work for them.”
In today’s challenging economic climate, people find themselves having to make every dollar they spend count. As a result, individuals considering cosmetic dental work face the additional problem of not having such procedures be covered by dental insurance. For some, that puts treatment a little farther out of reach.
While it may be a common perception that cosmetic dental procedures are completely elective, many prospective job seekers have come to realize that having an unattractive smile could make the difference between being hired and being passed over for employment.
One of the most common methods used to improve flaws in a person’s smile has been the use of dental veneers. These are typically thin shells of porcelain that are bonded to the surfaces of a patient’s teeth and can be used to correct a variety of problems: from unsightly old fillings to crooked teeth or chips in the teeth. They can also close gaps, lengthen short teeth, or permanently brighten discolored teeth.
Porcelain has been traditionally chosen for the job because it looks natural, transmits light beautifully, and has excellent color stability. The life expectancy is also good, with many veneers lasting up to fifteen years. Unfortunately, at $1,000 to $2,500 per tooth, they can also be rather expensive.
Nevertheless, apart from the cost, their many advantages have made them a popular choice. There are several disadvantages, however. Among these is that most porcelain veneer procedures are irreversible. This means that the slight amount of tooth reduction necessary to create a natural appearance commits the patient to future veneers. Also, in most cases, multiple visits are required – with anesthesia. And should a veneer ever become damaged, or should it break, it is not easily repaired. It typically requires replacement.
Fortunately, an alternative form of treatment exists. As long as the dentist does not have to restore tooth decay as well, it can generally be performed without anesthesia.
This is known as a direct composite resin veneer. Instead of using porcelain to cover the tooth, a dentist places a very thin layer of composite resin – essentially, a tooth-colored filling material – over the tooth in order to create a similar effect. Whereas in the past, this solution sometimes resulted in a dull, lifeless appearance for a tooth, current composite resins available to dentists have improved significantly. Products on the market today have enhanced physical and optical properties that also allow the dentist to accomplish a dramatic change in a patient’s appearance in as little as one visit. Many composite resins can also be placed with little or no alteration of the tooth’s structure. Every person’s case is different, however. Your dentist should be able to give you an idea of what will be required to obtain the optimal esthetic result for your case. Expect to pay anywhere between $350 to $695 per tooth.
What if you break or chip a composite resin veneer? The repair is usually easy to accomplish in a single visit and at a significantly reduced cost to replacing a porcelain veneer. Are there any disadvantages? Frankly, these are among the most technique sensitive of all dental veneers. The skill of the dentist and their attention to detail are critical elements in achieving a good result.
Talk with your doctor about which options are right for you. It may still be possible for you to enjoy the benefit of veneers – at nearly half the cost. Most dental offices today offer flexible financing options, many of which are interest free. Your perfect smile may be much closer than you think!
Dr. Richard Walicki is a dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.
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