Monthly Archives: January 2011

The fluoride controversy: The history, benefits and new Federal recommendations

Almost all drugs, medical products and techniques have some potential side effects, but we rarely hear much about those side effects when the risk is small or outweighed by the advantages. Fluoride is no different…we have known about its benefits for cavity prevention for nearly a century. So, why is it so controversial and what is the truth about this commonly used substance?

History of water fluoridation

In 1909 a dentist named Frederick McKay observed that some children in the Pike’s Peak region of Colorado developed a brown, mottled stain on their teeth; but despite the unattractive appearance, these children had relatively few cavities. After 22 years of research conducted by Dr. McKay and several other notable scientists, the cause of the phenomena was identified. Cryolite, an abundant mineral in the region, contains the element fluorine which was washed out during rain and snowstorms creating high concentrations (2-13 parts per million) of fluoride in the local water supply. By 1935 another researcher, Dr. H. Trendley Dean had concluded that when fluoride concentration in the water is maintained at about one part per million, tooth decay (caries) can be successfully prevented without the characteristic brown mottling of fluorosis.Fluoride History

Intentional fluoridation of the first U.S. public water system occurred in Grand Rapids, Michigan in 1945. The effect on the local school children was studied for 15 years and the fluoride was found to reduce tooth decay by 60%. In 1950, the American Dental Association officially accepted and encouraged the community water fluoridation as a means of caries prevention and today, about 67% of American communities benefit from this public health practice. Research has shown that as a result, the rate of tooth decay across America has been reduced by 29 % among children and 20%-40% among adults.

Benefits of Fluoride

Certain oral bacteria use the sugar and carbohydrates found in our food to produce acids that remove the minerals from the tooth. Over time, this demineralization weakens the teeth and leads to decay. Roots of the teeth, which are softer than the enamel and often exposed due to receding gums are especially vulnerable to decay and sensitivity.

Fluoride is absorbed into the enamel and root surfaces, forming a crystal that becomes part of the tooth structure, making it harder and more decay- resistant. Through this remineralization process it is actually possible to reduce sensitivity, stop the progression of early cavities and even reverse early tooth damage.

Although swallowing small amounts of fluoride is generally safe, it is not helpful. The real benefit of fluoride comes from frequent, low dose application to the surfaces of teeth that are already erupted. That is the reason it is found in so many different over the counter and prescription products, and often in the in the water supply.

The Controversy

Fluoride is an element, naturally occurring in concentrations typically too small to pose a problem- though it does accumulate in the body over time. That’s one of the reasons why it works so well to prevent cavities! On the other hand, ingesting very large quantities can be quite toxic, which is one reason why dental professionals recommend that children too young to “rinse and spit” should not be allowed to use fluoride toothpaste. Opponents of fluoridation have linked excessive fluoride intake to bone brittleness, cancer, and reproductive problems. Certainly, history has demonstrated that fluorosis (staining and brittleness) can occur when too much fluoride is swallowed during tooth development (before age 8).

Yet, the Center for Disease Control and prevention (CDC) named community water fluoridation as one of the “ten greatest public health achievements of the 20th century”… that that doesn’t mean that it is without controversy! The reason is an ethical one: Some people argue that putting fluoride in the community water supply takes away “informed consent” and obstructs the freedom to opt-out.

Just as with any other substance that is ingested, there are some precautions that should be taken regarding fluoride use. According to a study appearing in the Journal of the American Dental Association (2008), “There is weak and inconsistent evidence that the use of fluoride supplements prevents dental caries in primary teeth. There is evidence that such supplements prevent caries in permanent teeth. Mild-to-moderate dental fluorosis is a significant side effect.” Furthermore, the ADA recommends against using fluoridated water when preparing infant formula. Always confer with a dentist and pediatrician regarding the use of fluoride supplements for infants and children.

Caregivers should contact poison control if a child ingests a large amount of a fluoride-containing product like toothpaste, and they should be alert to signs and symptoms of overdose such as nausea, vomiting and abdominal pain. Drinking milk can inactivate the fluoride in the body and slow the toxic effects of a suspected overdose.

Current Recommendations

Fluoride is still a very safe, very effective and widely used method of preventing tooth decay – approved by the American Dental Association and the Food and Drug Administration both for children and adults. Current research indicates that most children are exposed to many more sources of fluoride (such as prescription or over-the-counter dental products, fluoride-containing sealants, filling and other dental materials, foods and beverages, etc.) than they once were. As a matter of fact, we have done such a good job as a society of finding ways to make it easily available to the public that most people no longer rely the water supply as a primary source of fluoride.

As a result, the U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency announced in January 2010 its recommendation to reduce level of fluoride that is added to the public water supply. The new recommendations propose that fluoride in most drinking water be set at the low end of the optimal range to prevent tooth decay (0.7 milligrams of fluoride per liter of water replaces the current recommended range of 0.7 to 1.2 milligrams). The EPA is also initiating review of the maximum amount of fluoride allowed in drinking water.

Communities always test their water to determine how much (if any) extra fluoride should be added in order to achieve the optimal safe amount. After much discourse, Long Island no longer fluoridates the community water supply, but there are hidden sources of fluoride about which consumers should be aware: private wells, springs, and water bottled in other locations – even the water in canned vegetables may contain fluoride! The USDA maintains a database with information about the fluoride content in foods, and consumers can sometimes obtain information by contacting the manufacturer.

Like almost all drugs and other substances used in medicine, the trick is to regulate the amount and frequency of exposure so that we can reap the benefits without any unwanted side effects. Dentists and hygienists make it their business to know how much fluoride is in the water in the communities where their patients live before prescribing additional fluoride-containing products. Whether we realize it or not, dental professionals have always made recommendations for fluoride use on a case–by-case basis, considering not only a patient’s level of risk for developing cavities but also their current exposure level… so, you can confidently follow your dental providers’ advice about using the fluoride products they recommend.

For more information about fluoride, ask your dentist or dental hygienist and check out the Center for Disease Control and the American Dental Association .

Advertisements

Porcelain Veneers

Porcelain veneers, aka dental veneers or dental porcelain laminates, are very thin shells of porcelain connected on the front side of the teeth to make a cosmetic improvement for a tooth.

Dentists regularly use porcelain veneers to create cosmetic alterations for teeth that are discolored, worn, chipped, or misaligned.

The technique of bonding porcelain veneers uses materials to firmly attach a thin shell of porcelain to a tooth. Although porcelain is typically fragile, when attached to a strong substructure (a tooth), the porcelain becomes very sturdy and durable.

Two of the benefits of having porcelain veneers rather than other cosmetic dental bonding procedures are:

1)   Porcelain veneers have a very realistic appearance of a tooth

2)   Porcelain veneers withstand staining


Halitosis

Ever suffered from bad breath? Maybe you never noticed your own stench, but maybe you noticed the reaction of others while in close conversation, or you noticed the uncomfortable smell coming from someone else’s mouth?

At some point in our lives, each of us has at some point suffered from halitosis. Noticing the smell of our own breath, however, can be hard to pick up on. The reason for this is because our nose is connected to an oral cavity by way of an opening in the back of our mouth, or the area of our soft palate. The nose generally filters out and disregards background smells, and therefore filters out and disregards the smell of our breath. As a result, it can be hard to realize how bad our breath really smells.

Want to test your breath?  If you cannot or do not feel comfortable asking a friend, spouse, or significant other, you can take this test. Lick your wrist, wait a few minutes for your saliva to dry, and then smell it. The way your wrist smells is the way the end of your tongue smells.

Here is a second test you can try out. Take a spoon a scrape it against the back of your tongue. Expect a thick whitish material to come off on the spoon. Smell it. How does it smell? The smell of the material reflects the smell from the anterior portion of your tongue, aka the way your breath smells to others. This whitish coating on your tongue is responsible for bad breath, since bacteria lives in this material.

If you are looking for more professional thinking you might really have halitosis, there are five ways a doctor can test you for halitosis.

The first method is organoleptic testing for bad breath. Simply, this means a researcher will test your breath by simply smelling. The nose can pick up on 10,000 various smells, but there can be some problems with this form of testing. This method is not always completely objective, and other factors besides odors can impact the testing, such as menstrual cycle, hunger, head position, consumption of coffee, tea, alcohol, or juice, etc.

The second method is a sure way to evaluate bad breath, and this method is gas chromatography. Gas chromatography can efficiently determine the level of various compounds present in a person’s mouth.

The next method, using halimeters, can determine particular aspects of a person’s breath by measuring levels of sulfide gases that create bad breath. Halimeters, however, provide less of a definite evaluation than gas chromatography, since halimeters only pick up on sulfides only, whereas gas chromatography tests for additional compounds.

The BANA method is the fourth method for testing for halitosis. BANA picks up on the bacteria that causes periodontal disease (gum disease), which contains some of the same waste products that contribute to bad breath. This bacteria can produce an enzyme that degrades the compound benzoyl-D, L-arginine-naphthylamide (BANA), and when a BANA testing is completed, the patient’s saliva is broken down, causing a color change in the testing medium.

The last testing method, a more recent one, uses chemiluminescence. Chemiluminescence can provide better selectivity and sensitivity when measuring low levels of sulfur compounds, in comparison with a Halimeter. Chemiluminescence mixes mercury with a sample of sulfur compounds from the mouth, which results in fluorescence.

For more information and original article/pictures, click here


What Are the Advantages of Dental Implants?

* Improved appearance. Dental implants look and feel like your own teeth. And because they are designed to fuse with bone, they become permanent.
* Improved speech. With poor-fitting dentures, the teeth can slip within the mouth causing you to mumble or slur your words. Dental implants allow you to speak without the worry that your teeth might slip.
* Improved comfort. Because they become part of you, implants eliminate the discomfort of removable dentures.
* Easier eating. Sliding dentures can make chewing difficult. Dental implants function like your own teeth, allowing you to eat your favorite foods with confidence and without pain.
* Improved self-esteem. Dental implants can give you back your smile and help you feel better about yourself.
* Improved oral health. Dental implants don’t require reducing other teeth, as a tooth-supported bridge does. Because nearby teeth are not altered to support the implant, more of your own teeth are left intact, improving your long-term oral health. Individual implants also allow easier access between teeth, improving oral hygiene.
* Durability. Implants are very durable and will last many years. With good care, many implants last a lifetime.
* Convenience. Removable dentures are just that; removable. Dental implants eliminate the embarrassing inconvenience of removing your dentures, as well as the need for messy adhesives to keep your dentures in place.


What Are Dental Implants?

Dental implants are replacement tooth roots. Implants provide a strong foundation for fixed (permanent) or removable replacement teeth that are made to match your natural teeth. They are made of titanium, similar to the metal that is used in artificial hips or knees.


Definition of Dentistry

Dentistry: Dentistry is defined as the evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body; provided by a dentist, within the scope of his/her education, training and experience, in accordance with the ethics of the profession and applicable law.

DDS: doctor of dental surgery
DMD: doctor of dental medicine

Indicates the degree awarded upon graduation from dental school to become a general dentist. There is no difference between the two degrees; dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association’s Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist, such as an orthodontist, periodontist or oral and maxillofacial surgeon.


Cosmetic Dentistry Specialist- Something You Should Know

Many dentists call themselves cosmetic dentist. Majority of practicing dentist in the United States are general dentist. They all have undergraduate degrees (BA or BS) and at least four years of postgraduate dental school (DDS or DMD). There is no cosmetic specialty in dentistry. Some dentist decide to focus on cosmetics. The American Dental Association (ADA) only has nine recognized dental specialties. All these specialties have had one to six years of advance training beyond dental school. They all have a certificate of their specialties. Some are board eligible and some are board certified. They are:

Dental Public Health: Dental public health is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis.

Endodontics: (root canal) Endodontics is the branch of dentistry which is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions.

Oral and Maxillofacial Pathology: Oral pathology is the specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations.

Oral and Maxillofacial Radiology: Oral and maxillofacial radiology is the specialty of dentistry and discipline of radiology concerned with the production and interpretation of images and data produced by all modalities of radiant energy that are used for the diagnosis and management of diseases, disorders and conditions of the oral and maxillofacial region.

Oral and Maxillofacial Surgery: (extractions) Oral and maxillofacial surgery is the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. Usually the specialist that takes out wisdom teeth. Some oral surgeon have a dual degree, one in dentistry (DDS) and one in medicine (MD).

Orthodontics and Dentofacial Orthopedics(braces) Orthodontics and dentofacial orthopedics is the dental specialty that includes the diagnosis, prevention, interception, and correction of malocclusion, as well as neuromuscular and skeletal abnormalities of the developing or mature orofacial structures.

Pediatric Dentistry: (kids) Pedodontist is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

Periodontics: (gum) is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

Prosthodontics: (crown, bridge, implant) A Prosthodontist has a dental specialty license pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes.