Amesbury Nixes Fluoride
December 5, 2011
Last week, Amesbury residents voted in a relatively narrow margin against the re-introduction of adding fluoride to the public water supply. Fluoride has been added to many public drinking water supplies all over the country for decades in an attempt to combat dental decay. The theory is that ingested systemic fluoride strengthens the developing teeth and makes them less susceptible to decay.
I would bet you would think that I am a proponent of public water fluoridation given my profession. I am not. In fact, I think it is unethical, unnecessary, ineffective, unsafe, inefficient, and unscientifically promoted. Although there is not enough space in this column to go into this in depth, let me give you an example of each.
Public water fluoridation is unethical because it violates an individual’s right to informed consent to mass medication. It is okay to put substances in the public water to make it safe, but not to medicate, and especially not a heavy metal that accumulates in the body. Public water fluoridation is also unnecessary because people, including children, can have healthy teeth without being exposed to systemic fluoride. This is different than topical fluoride which I will touch on later in this column.
Public water fluoridation is ineffective as research has shown that fluoride’s benefits are primarily topical and not systemic. Countries that have halted water fluoridation generally do not see increases in decay. It is unsafe as systemic fluoride accumulates in the pineal gland and in bones, making them more brittle. Also, where the fluoride comes from is an interesting topic of discussion. Many municipalities get their fluoride from China.
Public water fluoridation is inefficient for many reasons, one being that more and more people drink bottled water (which is loosely regulated) and most of the public water ends up washing dishes, in the shower or watering the lawn. If ingestion of fluoride did make sense there are better ways to make it available to people who want it. But, is it really necessary?
Lastly, public water fluoridation is unscientifically promoted. As stated by the US Centers for Disease Control, “Laboratory and epidemiologic research suggests that fluoride prevents dental caries predominately after eruption of the tooth into the mouth, and its actions primarily are topical for both adults and children”. I am a proponent of topical fluoride such as the fluoride found in toothpaste. And, as we age, the decay rate often increases due to exposure of more root surfaces of the teeth which are more susceptible to decay.
Research continues on the effect that fluoride has on teeth, both systemically and topically. The research also continues on the effects that ingested fluoride has on the rest of the body. There is also mounding research on products other than fluoride that show promise in combating dental decay.
I have a fair number of patients on prescription level topical fluoride that I feel are more susceptible to decay. My protocol may be changing soon due to pending research. However, one thing is certain, those with a good diet, impeccable homecare, and who visit a dentist at least twice per year, are much less susceptible to decay no matter what they brush their teeth with.
It Starts Before They Are Born
November 9, 2011
Research shows that babies are born without any harmful bacteria in their mouths. However, once bacteria colonize in the mouth, children are more prone to cavities in their baby teeth and permanent teeth. How do they get the bacteria? Caregivers.
Most parents don’t know that they can pass harmful bacteria from their mouth to their baby’s mouth. The most critical time is during the child’s first 2 and one-half years of life. Most children are born without a single tooth. Can bacteria passed to children without teeth affect their decay potential for their whole life? According to research the answer is yes.
Here’s a shocker…..If you have a history of poor oral health, including many fillings in your mouth, you are much more likely to transfer these harmful bacteria to children. How? Typically, this takes place through common parental or caregiver behaviors such as sharing utensils or cleaning a baby’s pacifier with your own saliva.
Prevention starts as early as 6 months into a pregnancy. Research shows that expectant mothers who chewed gum containing the sweetener xylitol are much less likely to have decay-causing bacteria in their saliva. So, take-home point number one is, it is essential for expectant parents and caregivers to keep their own mouths healthy. If you reduce the bacterial levels in your own mouth you are not only benefiting yourself but also that of your unborn child. Visiting a dentist regularly, even more often when you are pregnant, improving your homecare, and using products that specifically reduce bacteria, are all essential.
Your baby is born, now what? First, eliminate as many potential ways of transferring saliva to your baby. Do not share utensils or let grandma or grandpa lick a cloth to clean around a baby’s mouth. Wiping your baby’s gums with a clean cloth after meals is also good practice to help reduce bacterial levels.
Once a child starts getting teeth, diet plays a significantly greater role. Minimizing snacks and drinks with fermentable sugars is key. This starts with the bottle. Bottle syndrome, also known as baby bottle tooth decay, occurs when teeth become exposed, at length and frequently, to liquids containing a form of sugar. All liquids that contain sugar can cause bottle syndrome, including breast and cow’s milk (which contain the sugar lactose), formula, fruit juice (which contains the sugar fructose), soda and other sweetened drinks. It is caused by the constant presence of milk, formula, or fruit juice in a child’s mouth during the night, during breastfeeding, during naps, or for extended periods during the day. The liquid pools around the teeth and gums, providing food for the bacteria in plaque. The bacteria produce acid as a byproduct when they consume the sugar. This acid attacks your child’s teeth and causes decay.
When your child feels comfortable with a toothbrush, brush their teeth and gums twice a day with an extra-soft toothbrush. Use a pea-sized amount of toothpaste without fluoride until your child is old enough to spit. If your child doesn’t like toothpaste, it’s fine to brush without it.
Prevention starts before babies are born. It starts with taking care of your own mouth. Visit your dentist regularly.
Google YOUR Dentist
November 7, 2011
It amazes me how far technology has come in the course of my lifetime. To think that I made it through my whole educational career without a cell phone and without the use of the internet is mind-boggling. I also never thought that my children would get to the point where I was asking them how to do things.
For many of us, technology consumes us. I spilled coffee on my cell phone this past weekend and spent the better part of a gorgeous day running around trying to replace it. I felt like I couldn’t live without it. Another morning this week my website was down and I could not post some new information on it. I panicked and spent over an hour on the phone with tech support trying to resolve the issue.
Technology is not going anywhere. In fact, it seems like it gets more and more complicated every day. I feel like I can’t keep up. Do we really need to keep up? I guess that depends on the individual.
One of the simplest forms of technology is the use of Google. You can Google anything and have an unlimited source of information instantly at your fingertips. However, just like listening to the news, it is up to the viewer to decide how to use the information. Much of the data we hear on the news or view on our computer is distorted somehow or other.
In my world, Google has replaced the phonebook. I can’t remember the last time I looked in a phonebook. Other than finding someone’s local phone number, the phonebook has very limited information. Today, if I am looking for a service and have not had a personal referral from someone I trust, I “Google it”. Even if I had a personal referral, I do my research on the computer.
Need a dentist? Google it!! As I have said in previous columns, a personal referral is usually the most reliable way to find a dentist, but just because your friend likes the dentist doesn’t necessarily mean you will. Do your own research. Most dentists have a website. You can learn a lot from a website and it is just that much more information to help you make your decision.
One of the more recent additions to the digital world is the use of reviews. Reviews are comments written by individuals on various products and services. Google has its own review system and there are many more out there including Yelp, Trip Advisor, Citysearch and AngiesList. Although reviews can be helpful, they should be used to get a flavor of what other people are saying about a product or service. Every product or service should have good and bad reviews: that is reality.
In the dental world, many dentists, including myself, use a service to collect reviews from patients. In my office, an e-mail is automatically generated and sent after appointments. It gives people the option of writing a review about their appointment or our office. These reviews are then published to the web as well as evaluated by my staff to help improve the service we provide.
No matter what you are looking for, there are people out there in cyberspace who have commented on it. Take them for what they are worth, but I think they are helpful.
Is Dentistry Becoming a Commodity?
November 3, 2011
There was a time when it would have been unusual to see an “advertisement” for a health care professional. In dentistry, dentists used to be able to hang out a shingle and patients would come. Today, it is the opposite. We are bombarded with advertising and it is very rare to see a “from scratch” practice open.
Times change, and that is okay. My concern is that dentistry and the dental profession are moving towards a more commodity-based service and away from a relationship-based, well-respected profession.
It used to be that dentists were among the most respected professionals. Dentists always received high marks for honesty, including high ethical standards, and trust. Today, those numbers are dwindling. In our newer consumer-driven society, the dental professional is seen by more as a provider of goods and services rather than as a health professional attempting to build long-term relationships with patients.
Technology is partly to blame for this. Technology is the step forward in dentistry. Today we have the ability to use better materials that are prettier and faster to deliver. However, these same improvements in dentistry are also being used as marketing tactics for dentists. Advertisements, in print, radio, television and the internet for specific procedures are driving the profession to a more commodity-based service.
Low-cost dentures, same-day crowns, and discounts for specific procedures such as Lumineers or veneers are among those things being advertised. When is the last time you saw an advertisement that touted building a relationship based on mutual respect and trust? It is my opinion that we are headed in the wrong direction.
Dentists are small business people. We need to have a healthy business to continue to provide quality care. However, most of the things that are marketed to us have to do with how to run a business or how to perform more procedures in less time that result in greater profits. Rarely do we receive materials that promote learning how to help us better meet our patient’s needs and build relationships. It is up to us as individual dentists to maintain a proper balance between providing ethical treatment and the “selling” of our services.
Dentists and other health care professionals require an accumulation of a large amount of knowledge, extensive institutional and clinical training, and testing of competency and skills. It is with all of this training that we are then obligated to follow a certain code which in part reads, “The Association (ADA) believes that dentists should possess not only knowledge, skill and technical competence but also those traits of character that foster adherence to ethical principles.” The term “profit” is not mentioned anywhere in the code.
As I stated earlier, dentists are small business owners and need to make a profit for us to survive. However, we need to work harder to maintain a balance between potential financial rewards and professional and ethical care. Only doing what is in the best interest of our patients will move us in the right direction.
The Silent Epidemic
September 8, 2011
With more than 24 million diabetics and 57 million pre-diabetics in the United States, nearly a quarter of the nation’s population has already been affected by this disease. The connections between dental health and diabetes have 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 cuts 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.
This isn’t meant to be a scare tactic. These are simply the facts and, yes, they are sobering. But if you have diabetes or are pre-diabetic, you may want to brace yourself. Because we are going to talk straight about oral health and diabetes, two diseases that 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.
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 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 sever 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 time 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.
We will continue this discussion next week and talk about some things you can do to help this problem.
