I have had a few patients ask recently about the order of oral hygiene activities. Does it matter if you brush or floss first, and should this be done before or after breakfast? Based on available research, it seems opinion matters as much as scientific facts.

A spokesman for the American Dental Association and a professor of restorative dentistry at the University of California, Los Angeles, recommends flossing first. His rationale? Get the unpleasant task out of the way to avoid the temptation to not do it. “Let’s face human nature, if you’re going to skip one, which one will you skip?”

By contrast, a professor of oral health sciences at the University of Washington in Seattle, advises her patients to brush with a fluoride toothpaste, then floss. She says that way your mouth will be awash with fluoride as you are maneuvering the floss.

So, what’s my opinion? I was taught and have always maintained that flossing before brushing is better. The rationale behind this is that plaque and other debris is dislodged during the act of flossing allowing toothpaste and the mechanical action of brushing to better penetrate the different surfaces of the tooth. Does it really matter? I don’t think so.

Have you heard your dental hygienist or dentist tell you to floss to prevent cavities between your teeth? Based on research, the main reason for flossing is not for prevention of cavities. Rather, flossing’s main benefit is stimulation of tissue to reduce gum inflammation known as gingivitis. Gingivitis can lead to more advanced gum disease and things like bad breath. That is why I believe that regular use of a water pik and an electric toothbrush is most ideal.

A review of 12 randomized controlled trials found that people who brushed and flossed regularly had less gum bleeding than the brush-only camp. No surprises there. There have been no studies, that I am aware of, reporting a reduction in cavities from flossing. Of course, these are difficult studies to conduct. There are many factors that contribute to decay occurring between the teeth.

There are also different schools of thought whether to brush and floss before or after breakfast. I don’t know about you, but I cannot eat or drink anything (especially orange juice) after I brush my teeth. So, although you might expect the solution to be brushing after breakfast, there is some risk with that.

If you eat or drink something sugary or acidic—like the fruits, juices, and other breakfast foods many of us eat in the morning— the mouth is in an acidic environment for at least 30 minutes after consumption. These acids weaken tooth enamel, and brushing too soon can cause damage to the enamel. If you know you’re going to eat or drink something very acidic ahead of time, you may want to brush your teeth first.

Alternatively, you can wait 30 minutes after you eat for your saliva to neutralize the pH of your mouth. Or, re-balance your oral pH right away with an alkaline mouth rinse and then brush. In the end, it depends a little on what you eat. Take stock of what you’re eating for breakfast and judge when you should brush based on its sugar or acid content.

Everyone, well…..almost everyone, can stand some improvement with their oral hygiene. Many dental problems are completely avoidable with excellent home care, which is in your control. Ask your dentist or hygienist how to improve your home care. Strive for constant improvement.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

Last week I talked about a sometimes not so silent epidemic – sleep apnea. This week’s epidemic is much quieter but shares the general idea of decreasing the quality of life.

With more than 24 million diabetics and 57 million pre-diabetics in the United States, there are a lot of people affected by diabetes. That’s nearly a quarter of the nation’s population. The most up to date research shows the connection between dental health and diabetes has never been more critical.

As an indication of our general health, the rapidly rising rate of diabetes should be ringing alarm bells everywhere. The litany of health implications from diabetes is a long and grisly list. It is the sixth leading cause of death in the U.S. That is probably vastly understated because as many as 65% of deaths from diabetes are attributed to heart attack and stroke. People with diabetes have about twice the overall risk of death as those who don’t have the disease.

Complications from diabetes cut years off productive lives and interfere with the quality of those lives through a host of debilitating health effects. Heart disease and stroke rates are as much as four times higher among diabetics. Nearly three-quarters of diabetics have high blood pressure. Each year, diabetes causes blindness in as many as 24,000 Americans. It is the leading cause of kidney failure, nervous system disease, amputations – the list goes on.

The facts about the connections between oral health and diabetes are even more alarming than those about diabetes alone. Here are just a few:

Diabetics are twice as likely to develop gum disease. This is especially true if your diabetes is not under control. The gum disease then worsens your diabetes through an automatic response that your body uses to fight the infection.

People with gum disease are 270% more likely to suffer a heart attack than those with healthy gums.

People who have diabetes and severe gum disease have a premature death rate nearly eight times higher than those who do not have periodontal disease.

Those who have gum disease and diabetes together are more than three times more likely to die of combined heart and kidney failure.

In people who have type 2 diabetes, gum disease is a predictor of end-stage kidney disease.

In people who have pre-diabetes – blood glucose levels that are higher than normal but not in the diabetic range – gum disease makes it more likely that they will become diabetic.

Once established in a person who has diabetes, the chronic infection that causes gum disease makes it more difficult to control diabetes, and increases damage and complications in blood vessel disease.

These are simply the facts and, yes, they are sobering. If you have diabetes or are pre-diabetic, make sure you are doing all you can to control these diseases. These two diseases can twist each other into a tight downward spiral of amplifying negative health effects. Unless they are halted by your physician and your dentist working in tandem as a health care team, together with your commitment to hold up your end of the bargain, these effects can continue to compound.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

Last week I discussed teenager sleep patterns and issues. This week we start a conversation about sleep for the majority of those reading this column.

My body has become accustomed to a certain amount of quality sleep. I have always had difficulty sleeping past a certain time in the morning, regardless of what time I go to bed. On the days over this holiday period that I stayed up later than I normally do, my amount of sleep hours was less and my quality of sleep tended to be lower. This had an impact on the way I felt the next day. Sleep “hygiene”, including regular bedtime, is so important.

There are many reasons for poor quality sleep. Everything from a poor mattress, poor pillow, sleep position, medical issues, diet, alcohol consumption, and work schedule can have an impact on the quality of sleep that we get. Although some people can notice subtle changes in sleep quality, many others do not realize that some of the issues they have routinely can be caused from poor sleep quality.

Sleep plays a vital role in good health and well-being throughout our lives. The way you feel while you’re awake depends in part on what happens while you’re sleeping.

Sleep helps your brain work properly. Studies show that a good night’s sleep improves learning. Studies also show that sleep deficiency may cause you to have trouble making decisions, solving problems, controlling your emotions and behavior, and coping with change.

Sleep plays an important role in your physical health. For example, sleep is involved in healing and repair of your heart and blood vessels. Ongoing sleep deficiency is linked to an increased risk of heart disease, kidney disease, high blood pressure, diabetes, stroke, sexual dysfunction, ADHD, obesity and depression.

Sleep issues can affect the young, the old and everyone in between. The many changes that take place in our bodies as we age can increase the risk of sleep disorders.

Sleep apnea is one of many sleep disorders. It is a serious, potentially life-threatening sleep disorder that affects approximately 18 million Americans. It comes from the Greek meaning of apnea which means “want of breath”. People with sleep apnea have episodes in which they stop breathing for 10 seconds or more during sleep.

People with sleep apnea usually do not remember waking up during the night. Some of the potential problems may include morning headaches, excessive daytime sleepiness, irritability and impaired mental or emotional functioning, excessive snoring, choking/gasping during sleep, insomnia, or awakening with a dry mouth or throat.

Some simple questions to ask yourself are: Have you been told that you snore?

Do you often feel tired, fatigued, or sleepy during daytime?

Has anyone ever told you that you stop breathing while you were asleep – or- Have you ever woken yourself up with a gasp?

Do you have high blood pressure or are you on more than one medication to control high blood pressure?

Is your body mass index greater than 28?

Are you a male with a neck circumference greater than 17 inches or a female greater 16 inches?

If you answered yes to more than two of these questions, or if there is anything else in this column that makes you believe you may not be getting the quality of sleep you would like, please discuss these with your physician.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

When we were all young children, most of us got plenty of sleep, and for that matter, we didn’t think much of it. Our parents told us it was time for bed and we went to bed. We slept until the morning at which time we were woken by our parent’s gentle touch.

As we progressed into our teenage years, our responsibilities increased. This typically led to staying up later and getting up earlier to be able to keep up with these added responsibilities. Today, it seems that getting enough good sleep is even more of a challenge for our teenagers.

One of the contributing factors of this teen sleep crisis is that parents are not as strict with setting rules for sleep as they were when their children were younger. It is not uncommon for teenagers to say to their parents they are going up to their room to do homework and then go to bed.

I recently asked my daughter (a freshman in college) what time she generally “packed it in” and settled down to fall asleep. She told me that after she finishes her homework she will lie in bed and watch something on her laptop until she feels sleepy. This trend is an antithesis to good sleep and one that must be discussed with every teenager by their parents.

Rules about electronics, which include cell phones, computers, games and the television, are especially crucial. In a study done by the National Sleep Foundation, it was determined that teens who have electronic devices on prior to going to sleep, get an average of 30 minutes less sleep. There are other studies that show that the quality of sleep is also greatly affected by this same practice.

Another, more obvious rule that parents must enforce, is the consumption of caffeine at night. Any form of caffeine should not be consumed after dinner. Studies indicate that caffeine in the system accounts for almost a full hour less of quality sleep. We, and our teenagers, cannot afford this deprivation of sleep.

We all start our days at different times. For the teenager, getting up to get ready for school can start pretty early. There is a “start school later” movement that recently received a powerful boost from the Centers of Disease Control and Prevention (CDC). The CDC report showed that teenage students have biologically different sleep patterns and needs than in other stages of life. Starting school a half hour later or more provides the teenager the opportunity to consistently get a better night’s rest.

For the teenager, managing homework and extracurricular activities is also definitely a barrier to sufficient sleep. We as parents must discuss this with our children to provide support with time management. If necessary, we must also not be afraid to discuss this with teachers and coaches if our teenager is struggling to get everything accomplished, thus affecting their sleep patterns.

As adults, many of us have our own routines that could use a revision to get more quality sleep. That is a subject for another time. As parents, it is our responsibility to guide our children to practice good habits. Discussing and enforcing better sleep habits is a gift that keeps on giving.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

Xylitol is a naturally occurring sugar alcohol that is commonly used as a sweetener in many products, such as chewing gum, toothpaste and nasal spray. Xylitol kills bacteria by disrupting their ability to metabolize glucose, which is a necessary process for their survival. When bacteria consume xylitol instead of glucose, they are unable to use it effectively as a source of energy, leading to a depletion of their energy stores and eventual death.

The dental benefits of xylitol have been known since the 1970’s. Xylitol is not metabolized by the decay-causing bacteria Streptococcus mutans (S. mutans), making it non-acidogenic and thus noncariogenic (not decay causing). Studies have also indicated xylitol decreases the levels of S. mutans in both plaque and saliva. As a result, patients who use xylitol have demonstrated a reduction in decay.

Xylitol is slowly absorbed by the human intestines; as a result, it has minimal side effects on humans. There are some minor side effects, mainly diarrhea, although this generally occurs after ingesting large amounts xylitol (four to five times the recommended amount for cavity prevention). A 1982 study suggested that the body can adapt to higher dosages of xylitol and that symptoms can subside as the body’s tolerance increases. However, even in small quantities, xylitol is toxic to dogs.

While the dental community embraces xylitol for its cavity prevention, most people, including dental professionals, are unaware of its toxic potential to dogs. While xylitol has little effect on insulin production in humans, dogs can experience rapid and severe increase in insulin production after just a small amount of xylitol ingestion. A dog that ingests a xylitol equivalent of three to four pieces of gum is at risk for hepatic (liver) failure and necrosis (tissue death).

Dogs tend to be scavengers by nature and their likelihood of encountering potentially toxic substances in and around the house is common. The ASPCA web site lists a multitude of substances, many of which are harmless to humans but potentially dangerous to dogs. Chocolate, grapes, raisins, avocado, onion, and citrus fruits make the list. However, xylitol is unique in that it is contained within foods; as a result, consumers may not even be aware that a product or food item contains xylitol.

For dogs suspected of ingesting xylitol, early intervention is paramount. Prompt medical treatment for uncomplicated xylitol-related hypoglycemia can yield a good prognosis. Xylitol hepatic toxicosis yields a much graver prognosis.

While veterinarians have been aware of the potential danger of xylitol to dogs for several years, that awareness has escaped most of the dental community – and the general public. This has become a more significant issue as more dental professionals promote products that contain xylitol for its human benefits.

It is important for dog owners to know the different foods and products, such as xylitol, that can be harmful to their pooches. Make sure to keep these items out of a dog’s reach – and that includes the garbage. If you suspect ingestion of any of these foods, including xylitol, contact your veterinarian immediately.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

There aren’t too many people who really want a denture, but for many people, this is a viable way to replace loss of teeth. Regardless if it is replacing one or all the teeth, it is something removable; that is, the patient takes it in and out of their mouth.

As with many things in life, there can be a significant difference in the quality, appearance and functionality between different dentures. Here’s what Wikipedia says about making dentures:

“The fabrication of a set of complete dentures is a challenge for any denturist, including those who are experienced. There are many axioms in the production of dentures that must be understood, of which ignorance of one axiom can lead to failure of the denture case.

One of the most critical aspects of dentures is that the impression of the denture must be perfectly made and used with perfect technique to make a model of the patient’s edentulous (toothless) gums. The denturist must use a process called border molding to ensure that the denture flanges are properly extended. An endless array of never-ending problems with denture may occur if the final impression of the denture is not made properly. It takes considerable patience and experience for a denturist to know how to make a denture, and for this reason it may be in the patient’s best interest to seek a specialist, either a Denturist or a Prosthodontist, to make the denture. A general dentist may do a good job, but only if he or she is meticulous and usually he or she must be experienced.”

It is true that fabrication of dentures can be challenging and requires a strict protocol. If the techniques taught in dental school (a dental student usually makes about 2 or 3 dentures) are the only techniques used, the outcome will be mediocre at best. People may be able to get by with a $395 denture advertised on television. You can also drive around on 4 flat tires for a while.

The impression is the key for a successful denture. However, simply taking an impression of the tissues in the oral cavity is not enough to produce a high quality, precision fitting prosthesis. Using a technique called a functional impression produces a far superior result over conventional techniques. The functional impression takes a couple more visits than a traditional impression, but it is much more accurate.

Other differences of a custom denture vs. a conventional denture are the materials and laboratories used to produce the prosthesis. The quality of the materials, including the teeth themselves, play a huge role in producing a denture that not only fits meticulously, but also looks natural and life-like. Poorly made dentures are often easy to identify in normal conversation.

Staining of the “gum” portion of the denture, by a laboratory technician trained and qualified to do so, adds an even more life-like appearance, which far surpasses any conventional technique. A denture made with this technique rarely needs any adjustments, and will fit well for years.

Dental implants can be used to secure lower dentures, or eliminate the palatal coverage of an upper denture. These are the two main issues that patients have with dentures: the lower denture flops around, and the upper denture covers the palate, which decreases enjoyment of eating.

Poorly fitting dentures can decrease quality of life, cause discomfort, difficulty eating, speech problems, oral sores, bone loss and social anxiety. It makes a world of difference to have a well-made denture.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

In an online report I recently read in a journal that was forwarded to me by a patient, they listed 9 “healthy” habits that they claim are a waste of time. Three of them had to do with oral health. Let’s take a look.

The first on the waste of time list was to see your dentist twice per year. I have seen this reported somewhere else in the media recently. According to the authors, close to 30 studies have apparently found no conclusive evidence supporting a need to see a dentist every 6 months. They went on to say, “If your teeth and gums are healthy, once per year is enough to catch developing problems.”

I absolutely agree. There are definitely people who only need to see a dentist/hygienist once per year. Most dentists use a classification system to rate a patient’s periodontal (gum) health. Type I patients are the ones that only need to see a dentist once per year. They are healthy, they have good homecare habits and are low risk for disease. In the average dental practice, I would say this is about 10-15% of the population.

Type II patients are those with gingivitis and should be seen twice per year. This group makes up about 50% of the typical dental patient population. Many of these patients could move into the Type I group if they had better homecare habits and technique.

Type III & IV patients are the remaining 30-35% of the population who should be seen every 3 or 4 months, and in some cases even more frequently. Because of genetics and/or bad habits, this group has active disease and is at high-risk for problems.

Let’s also not forget the other 50% of the population who don’t even visit a dentist once per year. While I think there are people who can be healthy and see a dentist once per year, it is irresponsible to make it seem that it pertains to everyone. The only one who can determine how healthy you are is your dentist. It should be up to you and the dentist you trust.

The #7 waste of time reported was to use a hard toothbrush. According to the report, a soft one cleans your teeth just as well and is less damaging to your teeth and gums. This is old news and is true.

The next one shocked me. The #8 waste of time – brushing and flossing twice per day. According to the authors, everyone only needs to visit the dentist once per year and brush and floss one time per day. They recommend brushing for at least 2 minutes before you go to bed and flossing one time per day. They also mentioned that people who did not floss frequently (whatever that means) are 3 times more likely to develop stomach cancer. I am assuming the author is relating lack of flossing to getting periodontal (gum) disease. More recent research is showing that, “Risk factors for precancerous lesions and gastric cancer are being identified, one of which may be periodontal disease”. Although lack of flossing does not automatically cause gum disease, poor oral health is clearly a risk factor for other health problems.

Here’s the bottom line:

1. Establish a relationship with a dentist you are comfortable with and trust. Determine with that person how frequently you should be seen.
2. Use a good quality soft electric toothbrush. Get instructions on proper use from your hygienist.
3. Brush at least twice per day, preferably at least 30 minutes after meals. Floss or water pik at night before you brush.

It is as simple as that.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

Last week I introduced Part 1 of “Breathing is Important”. For this week’s column to make the most sense, I would encourage you to read that column first. It can be found at www.thetowncommon.com.

In case you don’t have a chance to read it, here is a brief recap: I have been involved in treating patients with sleep apnea for a few years. These are patients who have been diagnosed with sleep apnea or Upper Airway Resistance Syndrome (UARS) by a sleep doctor. Some patients are referred who have mild-moderate sleep apnea as first-line treatment, and others are unable or unwilling to use a Continuous Positive Airway Pressure (CPAP) machine.

There is clear evidence that sleep disordered breathing affects more people in more ways than was thought in the past. As the research continues, more people will be able to be helped to breathe and sleep better. It is healthier to breathe well.

Although there are many people with obstructive sleep apnea who need treatment, there are many others who have the same signs and symptoms as people with apnea and poor sleep, but they “pass” a sleep study. Many of these people may have UARS, which is a lower-level sleep breathing disorder. The treatment options are often the same, including weight loss, CPAP, or dental sleep orthotics.

In most cases, sleep related breathing disorders start early in development, and progress throughout life. It’s actually an evolutionary/developmental problem. Jaw development in humans has weakened. Our prehistoric ancestors had bigger jaws because they breast fed longer, and had to really chew the things they ate. They never needed their wisdom teeth taken out because their jaw was plenty big enough to accommodate them.

Dentists have an extremely important role in helping to identify sleep breathing disorders in all phases of life, especially in children, where most of these problems begin. Identifying them early can allow intervention through orthodontics and other non-invasive therapy, and completely change the course of development, leading to a life of better breathing and better health.

Because adults have stopped growing, we are stuck treating the problem, usually for the remainder of life. Treating this however, can increase quality and length of life for many patients who have a sleep breathing disorder. Identifying and treating airway issues, both early in life and in adults, as well as offering more advanced resolutions as research continues, is where medicine and dentistry must grow together.

Sleep apnea is the end stage of this breathing disorder. Currently, treatment for those with sleep apnea is typically either the “gold standard” of CPAP, wearing a dental sleep orthotic, Inspire (hypoglossal/tongue nerve stimulation), or major surgery to fix the anatomy that is causing this progressive disease. Medicine’s goal, however, should be to identify and treat airway issues early in life, so this end stage disease is never achieved.

You would be amazed at some of the things that are potentially related to breathing issues, such as ADHD, developmental issues, memory problems, TMJ pain, poor quality sleep, snoring, and a host of other things. While research in this area is ongoing, there is plenty of scientific evidence already out there to support this information. Breathe well.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

About ten years ago I took a weekend course at Tufts University School of Dental Medicine entitled “Sleep Dentistry”. This was not a course in putting patients to sleep for their dental work. This particular course was an introduction to treating people who had been diagnosed with sleep apnea (a sleep breathing disorder) by a medical doctor, and could not (or would not) use the dreaded CPAP machine.

CPAP, which stands for Continuous Positive Airway Pressure, is a facial mask which blows air through the nose to create an “air stent” to basically hold the airway open during sleep. It is the gold standard of treating sleep apnea and works well for many people, but not all.

Patients with sleep apnea have been diagnosed with a progressive disease in which breathing is decreased by a significant percentage for more than 10 seconds multiple times an hour. Most people know someone who has been diagnosed with this disease and either use a CPAP machine, or cannot use it.

The “sleep dentistry” part of the equation is that for those who have been diagnosed with sleep apnea and cannot use the CPAP machine, the next line of defense is a dental device. This is worn at night to hold the lower jaw slightly forward and not allow the jaw to fall back during sleep. Holding the lower jaw (mandible) forward helps to prevent the tongue from falling back in the mouth during sleep and obstructing the airway.

I was excited about this course I had taken at Tufts, and thought that I was going to start treating all these people I heard about who were not able to tolerate or didn’t want to use CPAP. The problem I found was that sleep apnea needed a medical diagnosis, which meant that patients had to have already had a sleep study with a physician, have failure in the use of CPAP, and then somehow find their way to my office. I was frustrated. I wasn’t treating that many patients, but knew (or at least thought), I must need more education.

So, in 2017 I enrolled in a mini-residency program at Tufts for 8 months. This was a much more intensive program with heavy emphasis on the science behind the disease. The program was great and I felt I had now “figured it out”.

I was much more knowledgeable about things to look for in patients, and was referring many patients to physicians to be evaluated. Some patients would end up having a sleep study, be diagnosed with sleep apnea, go on CPAP, and then come back to my office and say, literally, “you changed my life.” There is no greater feeling than that. Even though I didn’t get to treat them with my fancy dental appliance, they were being treated for a disease that was slowly (or not so slowly) killing them.

There were also those patients who had the sleep study, were diagnosed with sleep apnea, were not able to (or didn’t want to) use CPAP and were referred back to me for dental appliance therapy. Great!!! However, I quickly became frustrated again. Far too many patients, with classic symptoms such as snoring and daytime fatigue, were returning to me, saying they had a sleep study that showed they did not have apnea. Now what?

I’m a dentist, not a physician. Sleep problems are medical problems. And, although I knew that many of these patients may have sleep issues that were out of my control as a dentist (there are over 100 sleep disorders), many of these patients had dental signs such as wear on their teeth, grinding and/or clenching problems, TMJ pain, and other anatomic issues that I had learned about that were likely related to breathing problems. So, what did I do? I decided I needed more education. …….continued next week

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

Last week I introduced you to a patient who has been struggling with dental decay (cavities), gum recession, and dental erosion (the chemical breakdown of tooth structure). I discussed how these dental problems are complex multifactorial diseases of epidemic levels affecting both children and adults.

I ended with the idea that a healthy mouth requires more than brushing, flossing, and “fillings”. With current scientific evidence and new technologies, patients and practitioners need to begin to look at these problems not just from a drilling and filling approach, but also from a medical (preventive/therapeutic) approach. If “we” continue to think the same way about dental issues, we will continue to have the same struggles and same results.

There are over 19,000 different bacteria that have been found in mouths and every person has about 1,000 different types. Not all of them cause decay, but many of them have also been found to grow on artery walls. The medical/dental systemic connection is real and we must pay more attention to it.

Dental decay is on the rise. Why the increase? Most of it has to do with dietary trends. We snack more, eat more sugar/carbs, drink more soda, have more gastric reflux, take more mouth-drying medications, etc. Dental caries (decay) is a pH specific disease. The right bacteria, plus sugar, create acid, which breaks down the enamel of the teeth. Add an already acidic environment and it is even worse. In most cases it is a preventable disease. The problem is that changing our thinking and behavior, the nemesis of all that is good or bad, is difficult to do unless there is an awakening among us.

It is time for the dental professional to take a different approach when treating this disease. More focus needs to be shifted to prevention of decay, rather just treating it. Filling teeth is treating the result of the disease, but does nothing to prevent it. The dentist needs to take a more active role in assessing individual’s risk factors. In the dental world one way to do this is to use CAMBRA, which stands for Caries Management By Risk Assessment.

Based on assessing an individual’s risk factors such as quality of home care, quality of salivary flow, medication and dietary issues, a caries-preventive strategy can be established. Dentists must take some responsibility and be open to a different management of this disease. They must also be able to motivate people to change habits. The bottom line is that if you want to be decay-free, you can be.

For those at high risk, specific behavioral modifications are almost always necessary. To become aware of these often requires an assessment by your doctor. Doctors need to shift time away from treating things to be able to assess more, and discuss the specific behavior modifications necessary for each individual patient. The patient needs to be receptive to hear and act on these changes.

There are also some great products currently available, and others on the horizon. Everything from new toothpastes and gels with ions in them to rebuild tooth structure, sprays to neutralize pH, and probiotics are on their way. Right now you can use things like the sweetener replacement Xylitol, which by itself is cavity-fighting, but also works synergistically with fluoride. Prescription level toothpastes are also available, and there is strong research for the topical application of fluoride varnish (the same stuff the kids get) for adults.

The evidence is very clear – this is a preventable disease. Next time you go to the dentist and find out you have a new cavity, stop blaming the dentist or yourself, and ask to get a specific protocol for prevention of this disease based on your specific risk factors.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com