You have before you an owner’s manual for your mouth created by the acquired knowledge of thirty plus years of dental learning, practice and accumulated experience that has led me to an understanding of what can go wrong with your oral health, what is required to fix it when it needs fixing and how to keep it healthy so less fixing is necessary. I have spent my professional life rescuing and repairing damaged mouths and the dental care need is so high that there is no danger that I will need to go out of business due to lack of mouths to fix. If anything the need for dental care increases as each year goes by.
There is another danger that has motivated me to write this owner’s guide and that is the reality that the cost of major mouth rescues is simply too large for the majority of Americans (this may be true elsewhere) to afford. This is especially true for those who live on a tight budget or those who can’t obtain credit in order to make monthly payments for their care. The cost in lost health, lost quality of life and lost years of life this will cause is a real tragedy in the making.
The cost of providing dental care continues to climb while the average income remains too low for many families to afford much more than the basic necessities. Dental insurance, for those who have it, has abdicated its original purpose of helping policy holders keep their mouths healthy, by keeping policy maximum benefits right where they were in the 1960’s. The current reality is the coverage is so low in comparison to the costs of care that the objective of the dental insurance industry is solely to make a profit by keeping patients perpetually needy, never allowing them to achieve a healthy mouth, that going forward would only need routine maintenance, so the insured will need to continually pay the high price for an ever decreasing amount of actual benefit.
This book is loaded with dental health tips, ideas and cost cutting information that if applied will not only save you on your dental bills, but provide great life benefits as well. This book is not a substitute to visiting your dentist and hygienist; it is designed to assist you in doing all you as the owner of your mouth can to keep it healthy and attractive.
Let the information flow and the learning and doing begin!
Dentist Saves Patients Life! 8
Add 6 years to your life 11
Heart Disease and Stroke 11
Pregnancy and Premature Babies 13 Soft Drinks 18
Why Teeth Get Cavities 22
Some ways to prevent Tooth Decay 28
Things Other Than Cavities That Ruin 34
Your Teeth Grinding (Bruxing) 34
Proper Brushing 38 Erosion 39
Bulimia and Acid Reflux 39
Sports Injuries 40
What You Need To Know About Gum 41
Disease Assess your Gum Disease Risk 47
Common Signs of Gum Disease 52
Good Foods That Can Keep Teeth Healthy 54
A Sweet and Natural Way to a Healthy Mouth 62
Xylitol 64
Healthy Mouths for Babies and Young Children 72
Formation of Baby Teeth 72
Tooth Decay 75
First Dental Visit 78
Thumb Sucking 78
Losing those Baby Teeth 81
Almost Everything You Need to Know and Do in a Dental Emergency 84
Tooth is Knocked Out and Lost 84
A Broken Tooth 89
Something Stuck Between Teeth 91
Lost Filling 92
Crown (Cap) Comes Loose 95
Problems with Braces 97
Injury to Lip, Cheek, or Tongue 98
Mouth Sores 99
Oral Abscess 105
Things to Consider with Oral Piercings 106
What’s New in the World of Smile Makeovers? 113
Invisible Braces 114
6 Month Braces 116
Veneers 117
Teeth Whitening 118
Dental Implants 121
The Almost Every Other Question Answered Chapter 126
Sleep Apnea in Adults and Children 126
Use of Fluoride 129
Sealing Teeth 131
Dry Mouth 133
TMJ-What Is It and Do I Have It? 138
10 Questions to Ask Before Choosing Your Dentist 141
Conclusion 153
Acknowledgements 157
About The Author 159
Wow, what a story this is going to be, saving lives in the dental office. Sure, dental office personal are CPR trained and yes many have an AED device to shock your heart if necessary to save your life and they would be good people to have around in an emergency, but that is not what this chapter is all about. I am writing to you about the connection between your dental health and literally how long you live and how comfortable your life will be.
As part of every adult examination in my office my patients stick their tongues out. They are not trying to make a social statement, no they are helping me do a thorough tissue screening for any signs of mouth cancer and the tongue and the back of the throat are prime spots to check for mouth cancer along with the back of the throat. Mouth cancer doesn’t get the press that some other cancers do but don’t be fooled by this: it is a killer.
Did you know that more people die from oral cancer (8,000 to 10,000 deaths) than from cervical cancer or melanoma, which is a serious skin cancer? Early detection is critical to reducing the death rate.
Here are the risk factors associated with oral cancer!
Tobacco use
40+ years of age
Men twice as often as women
African Americans are moresusceptible than Caucasian Americans
Alcohol consumption
Compromised immune system
Damaging exposure to sunlight
What may be surprising is that 25% of all oral cancers occur in people who have NONE of the risk factors! A thorough oral cancer screening at each dental exam is a prudent way of helping ensure that a patient’s life could be saved with early detection. A while back we discovered a small lump in the corner of a patients’ mouth. The biopsy determined that cancer was present. Early detection coupled with removal of the lump and associated lymph nodes by the surgeon saved the life of a 33 year old man with a young family. Routine dental visits combined with routine cancer screenings made this a story with a happy ending. We now use the advanced early cancer detection device called a Velscope which uses fluorescence of the mouth to detect unhealthy tissue. Healthy tissue fluoresces and cancer cells and damaged tissue do not. Many offices provide this cancer detecting procedure at no additional cost with each examination.
In life saving, oral cancer is just the beginning!
Do you want to add over six years to your life?
Dr. Michael Roize, University of Chicago internist has been making headlines with his “real age” program, which he designed to provide a person with a valid age reduction plan. You may have read about it or seen him on Oprah or 20/20 or you may even have purchased his book. Maybe you were surprised that flossing and brushing ranks right up there with quitting smoking, taking your vitamins and reducing stress as one of the five things you can do to reduce your “real age”
In fact keeping your teeth and gums healthy helps you add over 6 years to your life! How so? Just keep reading!
The nation’s number one cause of death is heart disease! One out of every two women will die of this disease. Did you know that there is a strong connection between people with gum disease (a serious bacterial infection that destroys the attachment fibers and supporting bone that holds your teeth in your mouth) and people that suffer heart disease? The risk of heart attack and stroke is about twice as high in people with periodontal (gum) disease. It seems that certain bacteria involved in gum disease can also damage the lining of blood vessels which can cause the formation of potentially fatal blood clots. There is a protein formed in the body called C- Reactive Protein that has been implicated in causing damage to blood vessels and to the heart. It is a product of chronic infection which accurately describes gum disease. This may also help explain why approximately 50% of the heart attack victims didn’t have high blood pressure.
These same heart damaging and stroke causing bacteria can also cause lung infections. Gum disease bacteria have been implicated in bacterial pneumonia and also they are apparently a cause of chronic obstructive pulmonary disease, (COPD). The research in these areas is ongoing.
In a letter I received from Peggy Fleming in October of 2004 she stated “stroke is the number one reason that people move into nursing homes and the third leading cause of death in the United States” She stated further “50% of all strokes occur in people who show no symptoms.” Peggy, having had serious health problems in her own life, encourages everyone to have screenings done to possibly save their own life or the life of a loved one. Needless to say, a stroke or multiple strokes can end a persons’ life or seriously reduce the quality of its victims’ remaining months or years.
There is more!
Did you know that 12% of the babies born in the United States are born prematurely? (Before 37 weeks of pregnancy) which increases their risk of death and lasting disabilities. These include mental retardation, cerebral palsy, lung and gastrointestinal problems, vision and hearing loss, all of which are horrible to contemplate in the life of children and for their parents! Pre-term, births have soared to become the #1 obstetric problem in the U.S. Research has shown that this can probably be avoided by simply seeing a dentist for a periodontal examination before and during pregnancy. The recommendation during pregnancy is to have a visit with the hygienist every three months which is only one more visit than the every six month recommendation for routine preventive dental care! Recently insurance companies, recognizing the health benefits for expectant mothers, are covering the additional hygiene visit.
Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early or too small. Research shows that the bacteria that cause periodontal (gum) infections cause a faster-than-normal increase in the levels of prostaglandin and other factors that cause labor to start early, leading to premature delivery. Getting rid of the bacteria that cause this condition through a simple procedure called scaling and root planning is the key to an on time delivery and a healthy baby. This common dental procedure has been shown to reduce a mother’s chance of having a pre-term birth by up to 84%. The second trimester is a safe time during pregnancy to do dental procedures. After all, every mother wants to have a healthy baby!
So what are some of the signs of gum disease?
Bleeding gums while brushing
Red swollen or tender gums
Gums that recede away from the tooth
Persistent bad breath
Pus between the teeth and gums
Loose or separating teeth
A change in the feel of your bite
There are currently ongoing studies looking at a possible oral health connection with such general health areas as arthritis and Alzheimer’s disease. The scientific researchers have made some startling discovers in the last decade with more to come, I am sure.
Should you now find yourself motivated to want to keep your teeth and gums healthy, and take care of the rest of your body at the same time, it’s almost as simple as regular brushing and flossing. Some suggestions that will be well worth your time and effort are:
Use a soft tooth brush and toss it when the bristles fray
Use a fluoride or xylitol containing toothpaste to reduce cavities
Brush gently, angling toward the gums for about 2 minutes
Gently floss (Glide is a good brand) between each tooth
Check your brushing with a disclosing solution or tablet ( if in doubt)
Stop using tobacco products (dentists can help)
Watch for signs of gum disease. (see page 15)
Be aware of habits such as destructive teeth grinding (dentists can help).
Some drugs such as contraceptives, antidepressants and heart medicines can negatively affect your oral health by reducing saliva flow which dries the mouth.
Regular hygiene visits and maintenance visits are some of your weapons against gum disease.I read an insurance article recently entitled “The True Cost of a Cavity” The article explained that the average cost to maintain a restored cavity (filling) in the molar of a ten year old reaches $2,187 by the time he or she is age 79. Dr. Max Anderson explains in the article, “There are currently no permanent materials available to treat cavities, so the lifetime cost of maintaining teeth that have been treated for decay far outpaces any out of pocket costs you might spend to prevent decay in the first place. When a patient works with his or her dentist, cavities are almost entirely preventable.”
Add the latest information on soft drinks to the things you can do, or in this case leave out, in order to keep your mouth healthy. Be aware that the decay rate has shot way up, back to pre-fluoride days. Soft drinks are being blamed for this large upsurge in teenage and adult tooth decay. The average consumption of soft drinks in the U.S. in 2002 was approximately 53 gallons per person per year. That is 16 ounces per day. Realize that some people drink no soft drinks, while others drink several cans a day. Typically soft drinks consumed at mealtime are less injurious than those gradually consumed over time. Continuous sipping is considered more harmful to teeth than drinking an entire beverage at once. The acid content has been implicated as the cause of decay even more than the sugar and corn syrup in the sodas.
Most soft drinks contain one or more food acids; phosphoric and citric acids are common, but malic, tartaric and organic acids also may be present. These acids cause tooth erosion, and irreversible, painless loss of tooth enamel. There is no question that erosion causes significant damage to dental enamel, particularly among young people. Understand that bacteria work to get through the enamel, which has little “food value” for them where as the inner part of a tooth, the dentin, seems to be more to their liking. Acid erosion makes their job a lot easier and so the decay rate skyrockets!
SO ARE SOME SOFT DRINKS BETTER AND SOME WORSE? I THOUGHT YOU WOULD NEVER ASK!
Tap water and root beer have little to no effect on enamel. Brewed black tea and black coffee dissolve enamel several times faster than water. Cola drinks dissolved enamel 55-65 times faster than water and root beer. Non-cola drinks were 90-180 times faster at dissolving enamel than water! IT DID NOT MATTER IF THE SOFT DRINK WAS A DIET OR REGULAR VERSION! Root beer appears to be the least damaging soft drink for the health of tooth enamel while non cola drinks including canned ice tea such as ‘Arizona Brand’ were worse. Sports drinks, “energy drinks, such as Gatorade, Red Bull, and the Snapple tea products contain a greater amount of acid. There are numerous other reasons to avoid soft drinks in our diet, such as the epidemic of diabetes occurring in America. Suffice it to say ongoing research is painting a not so pretty picture of soft drinks and health. So” a word to the wise” as they say. What you decide to do is up to you!
This chapter was written in the hope that it would arm you with information that would enable you to make wise decisions regarding your dental health and as you can now see these decisions have a major impact on your general health and quality of life as well. Dr. Charles Mayo of the Mayo Clinic fame, stated years ago from his observations over the course of his practice life that a healthy mouth added ten years to a person’s life. I believe that he was correct. Now you also know how to add a decade and a healthy decade, not one in a nursing home, to your life. Go for it, make those changes.
In this chapter I will explore the causes of tooth decay, why teeth are so susceptible to attacks from external forces, and what we owners of teeth can do to help protect them from the sources of tooth decay and help protect our wallets from the cost of repairs. First let’s discuss tooth anatomy and what it is about teeth that make them so susceptible in the first place. When our teeth were first forming down in the bones of our jaws the cells that were building the tooth started at the top portion of the tooth and began lying down the outer covering we call enamel. Depending on which tooth they were building they either made relatively smooth surfaces such as are found on the front teeth, which are designed for cutting or they made teeth with lots of hills and valleys for chewing as are found on teeth that are further back in the mouth. The further back in the mouth the more hills and valleys were formed. If you could look at the bottom of the valley you would see that the narrowest part of the valley actually dips below the surface of the tooth forming a tight fold dipping in and coming back out again. This fold of enamel varies in depth with each individual tooth. This is important as it relates to tooth decay, more to come on this.
Enamel is mainly made up of minerals such as calcium with very little edible structure. It is designed to be a very hard durable surface for withstanding the forces of wear and tear from chewing. Below the enamel is the dentin layer which supports the outer layer of enamel. Without this support the enamel loses the ability to resist forces placed upon it and will break like glass. This is also very important in the discussion of tooth decay.
The dentin, situated between the enamel and the tooth nerve, is alive with significantly more organic matter built into its structure. Dentin contains microscopic fibers that connect it to the tooth nerve which, if they are exposed, cause pain. This also helps the nerve tissue sense hot and cold.
The nerve tissue and the blood supply for the tooth that brings oxygen and nutrients to the tooth is housed in the center of the tooth and runs down the middle of each root where it connects with the rest of the body. The hollow centers are called the root canals. See the tooth diagram below:
The diagram leaves out an important detail, the narrow folds or grooves of enamel that dip down towards the dentin. These become hiding places which are important in the tooth decay process. Know that all back teeth and some front have them; it’s how the teeth were formed. In the chapter on biofilm and plaque formation I discuss the process whereby mouth bacteria adhere to enamel which protects the bacteria from being swept out of the mouth and swallowed. It only takes a few hours to go from clean teeth to the beginnings of plaque formation as the bacteria glue themselves to the teeth surfaces. They are most successful at building this sticky matrix around the necks of the teeth where they are less likely to be whisked away by the tongue or cheeks. If allowed to stay in place, as explained in the previously sighted chapter, the acid loving anaerobic (without air) bacteria in the plaque start the release of acids which then work on the calcium in the enamel dissolving it away.
In addition to the areas around the tooth, the grooves and crevices as discussed above make excellent hiding places. The narrow folds are too small for a tooth brush bristle to penetrate and so it is no surprise that the majority of cavities occur in the valleys of the chewing surface areas of teeth. The drawing (page 26) shows the grooves and some more advanced acid damage to the enamel of the tooth top grooves and in this case also in the side groove. Once into the tooth as far as the decay in the drawing indicates, the bacteria can now start the decay process in the dentin which has organic edible material which serves as a food source for the bacteria.
Another hiding place that works in favor of the bacteria is the edges of old fillings especially old amalgam (mercury/silver fillings). The gradual separation between the metal filling and the tooth occur over time as acids and chewing forces and the natural interaction of the several metals in the amalgam fillings break down the margins as the photo (page 27) shows.
This photo shows the decayed crevices in the center of the upper tooth and the recurring decay in the crevices around an old filling in the lower tooth. Both are hiding places for bacteria. Remember that bacteria are so tiny that they can only be seen using a microscope so areas that look small to the eye are wide open spaces for the germs. Remember, enamel is like glass when not supported by solid dentin. Decay eats the dentin softening it into a dry mush-like consistency leaving the tooth enamel unsupported, and ready to fracture under regular chewing pressure.
Research estimates that 90% of all the amalgam fillings in the mouth are re- decaying. Metal fillings expand and contract with hot and cold foods and drinks, more than the teeth can accommodate which results in millions of cracked teeth. These cracks become hiding places for decay causing bacteria. In addition the cracks weaken teeth making them susceptible to fracturing which is the number one cause of broken teeth and the number one reason dentists put protective crowns or caps on teeth.
Here are some ways to help prevent tooth decay.
First, get really committed to keeping a clean mouth. Brush the area next to the gums on the teeth surfaces to remove the buildup of sticky smelly bacterial plaque that forms daily around the teeth. Notice the angle of the tooth brush in the drawing on the next page where the bristles are angled towards the gums.
I personally recommend electric toothbrushes, especially the sonic type brushes as I have both personal and patient experience showing better cleaning with that type brush. Few of us brush for the recommended 4 to 5 minutes so anything that cleans quickly is a plus.
Flossing using the newer flat type floss, as found in the ‘Glide brand’ floss will clean the areas around the neck of the tooth that a brush won’t reach. This between the teeth cleaning will prevent numerous cavities and it also helps the gums stay healthy while stopping bad breath caused from rotting food debris left between the teeth.
Using xylitol, a good tasting, natural sugar alternative, found in certain brands of gum, mints and toothpaste can also help stop the decay process. It works by being ingested by tooth-decaying bacteria that cannot metabolize it into the acids used to cause decay. (See the chapter on xylitol)
The grooves on the chewing surface of teeth are still unprotected since toothbrush bristles can’t penetrate those areas leaving the hidden bacteria to dissolve the enamel folds and consume the dentin. Sealants have gone a long way to solve that problem. A dentist can apply a coating over the grooves in the valleys of back teeth after cleaning and disinfecting the tooth surface. This process closes off the access points so bacteria can’t enter the tooth by way of crevices on the surface. Sealants do wear out in time and may need to be replaced after several years on the tooth. (More on sealants later)
The decay rate can also be cut way down if sodas, energy drinks and high acidic fruit juices are avoided or only rarely consumed.
Soft drinks are big business in the United States, with an annual production of more than 10 Billion 192-ounce cases. About 28% of beverages consumed by Americans are carbonated soft drinks; a 500% increase over the last 50 years. We average 1.5 to 2 twelve-ounce cans per day. As previously mentioned, this equals 53 gallons per year per person.
You might be surprised to learn that the epidemic increase in tooth decay that is present all over the country is not related just to the sugar content of soft drinks as diet soft drinks are sugar free. It turns out that the types of acids found in soft drinks are believed to be one of the main culprits
when it comes to substances that aid the acid loving bacteria by dissolving the enamel so teeth can be entered and decayed easier. Interestingly, non-cola drinks such as Sprite, Seven Up, Mountain Dew and canned ice tea were far more aggressive than root beer and all cola drinks at dissolving enamel.
So what about all of these popular sports drinks and energy drinks? It turns out that the research done on Gatorade, KMX Powerade, Red Bull and even Snapple classic lemonade demonstrated that sports drinks are much more aggressive than black tea, root beer and the cola drinks at attacking enamel. I haven’t seen results for Monster yet but I wouldn’t get my hopes up for better results. The varieties of acids in these drinks are there apparently to make them more palatable. Remember that the non-cola and energy (sports) drinks show the most aggressive attack on our teeth. This is perhaps a good reason not to buy them for your family or yourself as the decay rate in the U.S. population has returned to the days before fluoride was introduced into the water supply of many cities.
In conclusion, keep the mouth clean, develop good home care habits, no excuses! Get to the point where having plaque on your teeth grosses you out. Have the routine dental checkups done preferably from a dentist who uses all the modern decay detecting methods. Replace old leaky fillings, especially the old amalgam type, with the newer, bonded ceramic, materials. Seal all back teeth and use bacteria fighting xylitol products to keep the bacteria population in check. You will have gone a long way towards having no cavities and the good news is that it doesn’t take but four to five minutes a day to accomplish it all.
This chapter will go into detail on how teeth are badly damaged by forces other than bacteria. A person can literally have teeth that appear to be worn out and much older than they in fact are. By allowing excessive forces to work on the hard enamel tooth surfaces the tooth’s integrity is compromised; giving the appearance ofteeth that are discolored, often foreshortened with jagged and chipped, generally unattractive, edges. There are several factors that can damage teeth in this way. Each will be discussed in some detail and ways to prevent the damage potential with each factor will be covered within these pages.
One of the most common ways to wear out teeth; and I say common because the vast majority of people do this to one extent or an other, is the habit of grinding, or bruxing as it is also called, upper and lower teeth together. This back and forth or side to side muscle activity rubs the enamel surfaces against each other. When this is done atnight, where grinding occurs most often, the sound is an eerie, almost chalk board scraping sound or the sound of pieces of glass being rubbed together hard. If you have heard someone grind their teeth you will know what I am describing. The sound makes one believe that certainly small pieces of tooth must be breaking off inside the bruxer’s mouth. Spouses wake up atnight with this dreadful sound and many a sleeping grinder gets elbowed or shaken to get them to stop that noise.
The Academy of General Dentistry describespotential bruxer personality types as individuals who are naturally nervous or who have difficulty handling stress. A person who has life stresses especially thosethat they feel they have no control over is more susceptible to grinding. Sleep apnea, which is discussed in a later chapter, as wellas emotional pain and frustration are also implicated as causative agents. Small children are known to grind their teeth (parents are encouraged to read theinformation on sleep apnea, ADHD and children. Grinding seems to be a learned response to some stimulus in an individual’s life. I suspect not all the factors resulting in bruxing are known. There are signs and hints that bruxing isoccurring, which if observed and caught early can prevent major damage and costly repairs; let’s review them here. Upper and lower teeth, although they are designed to fit together, are not meant to be in contact with each other with few exceptions such as during swallowing and lightly during chewing. The action of grinding teeth together is detrimental to the enamel surfaces, wearing them down, causing the teeth often to crack, be sensitive, with broken or chipped edges and giving the appearance of old worn out teeth. Sincebruxing is often habitual the individual may not even be aware of the habit until she/he catches themselves with clenched teeth or notices in the mirror that teeth seem to beshorter than they used to be.
The rule to follow if you are a clencher/grinder is ‘lips together, teeth apart’. If you catch yourself with your teeth together, relax and give yourself an awareness point and knowyou are starting to correct the habit.
