J.B. Dental Blog

The controversy over fluoride is not new, but at times it’s hard to make an educated decision when you have so much hype to sift through. Is it helpful or is it poison? Does it cause cancer or prevent disease? Let’s look at the facts, and the recommendations, and see what makes the most sense.

Fluoride is a naturally occurring element, found in most water sources, including rivers and lakes. Originally termed “nature’s cavity fighter”, fluoride helps to strengthen tooth enamel by remineralizing it, to make it more resistant to acid attacks after bacteria has been introduced to the mouth. It is also “bactericidal” which means it kills bacteria. Fluoride has been added to community water supplies for the last 70 years at the rate of 0.7-1.2 parts per million, with the most current recommendation from the Department of Health and Human Services being 0.7ppm.

Studies have shown that children had three times as many cavities prior to community water fluoridation, and currently it is credited with a 25% reduction in childhood tooth decay. Because of these outstanding results, community water fluoridation has been proclaimed one of the ten great public health achievements of the 20th century by the Centers for Disease Control.

Besides being available in the community water supply, there are topical ways to apply fluoride to the teeth to reap the benefits. Any toothpaste with the American Dental Association (ADA) seal has a fluoride content of at least 1000ppm. A typical fluoride varnish applied after a dental cleaning has 22,600ppm. Why the difference in amount of fluoride from the water supply? The water supply is a systemic means of delivering fluoride, and as such needs to be a very minimal amount to deliver benefit and avoid any risks to the body. The toothpaste and fluoride treatments are topical, not meant to be ingested, and work when applied directly to the teeth.

The current recommendations for topical applications of fluoride by the ADA are as follows:

1. Brush twice daily with a toothpaste that contains fluoride and has earned the ADA seal. Children 6 years of age and older, use a pea sized amount. Children younger than 6, use a very small smear of toothpaste to prevent swallowing. Remember, this is a topical application, and is not meant to be ingested.

2. Topical fluoride treatments in the form of varnishes, gels or foams applied once every six months to anyone with a moderate caries (cavity) risk. Risk is assessed per patient and includes diet, family history, medical history and dental history.

Fluoride has not been shown to cause cancer. Studies done in the 1980’s and 1990’s found that there was no way to correlate fluoridated water with a rise in cancer between populations that were both exposed and not exposed to community water fluoridation. Even in studies done on animals, there was no clear risk associated with fluoridation. Studies as recent as 2011 are still showing the same results. 70 years of clear scientific research fully supports the responsible and repeatable use of both systemic and topical fluorides as a method of cavity reduction in at-risk populations.

Please bring your questions about fluoride to your dentist or dental hygienist. We are always more than happy to help you understand your cavity risk and why fluoride may be recommended to help your specific risk be lowered.

1. Paige Tscherpel, RDH, BSDH

Consulted Sources Include:

http://www.mouthhealthy.org/en/az-topics/f/fluoride

http://www.newsweek.com/us-government-recommends-lower-level-fluoride-water-325760

http://www.cdc.gov/fluoridation/fluoride_products/

http://www.ada.org/~/media/ADA/Science%20and%20Research/Files/cavity_prevention_tips.pdf?la=en

http://www.ada.org/~/media/ADA/Science%20and%20Research/Files/report_fluoride.ash

http://m.cancer.org/cancer/cancercauses/othercarcinogens/athome/water-fluoridation-and-cancer-risk

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC180028/

“You are not healthy without good oral health.”
-U.S. Surgeon General

The mouth is the gateway to the rest of the body and as such is highly connected to the overall health of a person. Did you know that losing all your teeth before the age of 65 puts you at a 50% higher risk of death from all causes? Increasing amounts of research show that an unhealthy mouth can have significant  ramifications on a persons well-being.

The bacteria living in your mouth certainly don’t stay there. The circulatory system that keeps your heart pumping and oxygen flowing can also be infected with damaging bacteria if they are being harbored in your mouth. The same bacteria that causes periodontal (gum) disease has been found to negatively affect patients with diabetes. Uncontrolled or poorly controlled diabetics have a weakened immune system that puts them at higher risk for developing periodontal disease. Adversely, if a patient has chronic periodontal disease, it can negatively affect their efforts at controlling their diabetes.

The connection doesn’t end with diabetics. What about heart disease? Heart disease is the leading killer of men and women in the United States. Research shows that the same bacteria responsible for periodontal disease is a major contributor to worsening cardiovascular disease. In fact, those with periodontal disease are twice as likely to suffer from coronary artery disease AND have an increased susceptibility to strokes.

Not a diabetic and in fantastic cardiovascular health? Then consider if you, or someone you know, has been or is pregnant. Periodontal pathogens are able to cross the placental barrier. The nature of periodontal bacteria is to cause a heightened immune response, wherein the body attacks itself to attempt to rid itself of the bacteria. This can cause preterm contractions and thus premature birth and low birthweight babies. Just increasing oral hygiene to cut the amount of bacteria in the mouth can reduce these risks by approximately 50%.

Patients suffering from respiratory diseases are also at risk when oral hygiene isn’t optimal and periodontal disease is prevalent. Inhaling small droplets with infectious bacteria can worsen existing conditions like bronchitis, emphysema and COPD. It can also be a leading cause in developing pneumonia. With periodontal disease being prevalent in approximately half of the adult American population, and almost 70% of the over age 65 population, the effects of having an ongoing oral infection are most certainly systemic and treating these infections can absolutely benefit your overall health.

Let your dentist or dental hygienist know right away if you are experiencing any concerning symptoms, such as pain, sensitivity, swelling or bleeding gums. Practicing good homecare, like brushing twice daily and flossing routinely, as well as scheduling your biannual checkups and cleanings will help keep your oral health optimal.

S. Paige Tscherpel, RDH, BSDH

Consulted Sources Include:
http://www.toothwisdom.org/resources/entry/mouth-body-connection
http://www.rochesterperiodontal.com/periodontal-disease/the-mouth-body-connection/
http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475?pg=2

When a patient is facing or has endured tooth loss, the end of the conversation is not the appointment to remove the tooth. The end of the conversation needs to be to discuss how to replace a missing tooth. Often having a tooth extracted is a less expensive treatment in the short term, however there are several long term effects of a missing tooth. Firstly, the tooth that used to oppose the missing tooth now has nothing to chew against, so eating function is compromised. Secondly, that tooth also now has nothing to keep it in place and may start to grow out of the bone and gum tissue, a condition called super eruption. Super eruption can then lead to cleansing issues by exposing more of the root surfaces, which can lead to periodontal or “gum” disease around the tooth. And lastly, when a tooth is missing, there is nothing to hold the bone in place and that will start to create bone loss in the area of the missing tooth which can affect the surrounding teeth.

With all of these negative effects of tooth loss, it is extremely important to have the discussion with your dental provider about what to do when you’re faced with losing a tooth. Although there are options that many people are more familiar with, for example a fixed prosthetic called a bridge, or a removable prosthetic called a partial denture, these both have their limitations in that they also affect the surrounding teeth. Bridges are created by cutting down the teeth on either side of the missing tooth and bonding crowns to those teeth with a fake tooth adhered between them and supported by them. This takes away perfectly healthy tooth structure just to help replace a missing tooth. Partial dentures require clasps to hold them in place. These clasps can create pockets of gum tissue around the teeth the hold on to, they can harbor bacteria, and they also put unnecessary stress and force on the surrounding teeth. While these have been the go-to restorations of the past, dentistry is moving forward, always trying to perfect our methods and offer patients better, healthier options. This is why we now recommend dental implants as a solution to missing teeth.

A one-tooth solution for a one-tooth problem.

What is a dental implant? An implant is essentially a titanium or titanium  post, which is placed in the bone where the missing tooth was.

Titanium is used because it is lightweight, strong and biocompatible. It osseointegrates, or fuses to the bone, which prevents bone loss and helps stabilize the bone and improve density. Titanium is the most widely used metal in dental and other types of bone implants (such as orthopedic implants), but above all, dental implants have the highest success rate.

After the titanium screw is placed, a healing period must occur to allow for osseointegration to occur, typically anywhere from 3-6 months. After the healing period has taken place, a fake tooth, or crown, is placed atop the implant. This fake tooth is the only portion of the implant that the patient can see. It restores chewing function, improves esthetics and allows for better cleansability of the area by keeping food particles out of the open space. Add to that the success rate of dental implants is approximately 95%, implants are clearly the number one choice of dentists when it comes to replacing a missing tooth.

If implants are the best option, why don’t more patients have them?

Many patients hear the word “implant” and instantly think it will be too expensive. This used to be the case. With insurance companies not helping with the bill, many patients faced the cost of implants completely out of pocket. However, most insurance companies are now offering their customers a discounted rate on implants and at times even paying a portion of the discounted fee. As dentistry progresses, so must the insurance companies who carry coverage of dental procedures for the vast majority of the population.

Another thing to consider is that once an implant is placed, it is typical that it will last a lifetime. Bridges are usually replaced after approximately 20 years, due to breakdown and their propensity to get cavities, and partial dentures must be replaced once their fit becomes compromised after bone loss occurs in the area of the missing tooth (not to mention the effect they have on surrounding teeth, which will then require restoration). While these options may seem more cost-effective at first, they can cost exponentially more in the long run.

For more information on implants, cost of implants, or to find out if you’re a candidate, schedule a consultation with your dental experts at JB Dental to discuss all the options available to you to help replace your missing teeth.

Paige Tscherpel, RDH, BSDH

Sources Consulted Include:

https://dentalimplants.com

http://myoms.org/procedures/dental-implant-surgery

There are two main infections of the gum tissue that a patient can experience. The first is gingivitis. Gingivitis is characterized by reddened, swollen, sometimes painful gum tissue, that bleeds when measured or cleaned. Gingivitis is reversible. This is a key factor of distinction regarding this type of infection.

The second major type of gingival infection is called periodontal disease. Also known as “gum disease” or “Periodontitis”, periodontal disease is defined as “inflammation of the supporting tissues surrounding the teeth”. To make matters simple, periodontal disease includes not only all the symptoms of gingivitis, but also adds in the destruction of the supporting ligament and bone of the teeth. While periodontal disease can be treated and stabilized to prevent further bone and attachment loss, the loss experienced can never be replaced. Plainly, periodontal disease is treatable yet the damage is irreversible.

So why do some people have gingivitis, and some people have periodontal disease?

It all comes down to how your body deals with bacteria. In much the same way that some people catch a million colds, yet others get the sniffles once a decade, some people react harshly to bacteria and others fight it well. Everyone knows somebody who barely brushes their teeth and yet they’ve never had a cavity in their life. Similarly, it’s hard to predict when your body will start fighting you instead of the bacteria.

Eventually the bacteria in plaque and calculus (tartar) build up to a point where your body can no longer handle the toxins they produce. This phase is called gingivitis. Once your body crosses that threshold, it will literally start producing an immune response that destroys the bone and structures that support your teeth. This phase is called periodontal disease. Untreated, periodontal disease can lead to tooth loss. The pathogens associated with periodontal disease are also linked to diabetes, cardiovascular disease and preterm/low birth weight babies in affected mothers.

Approximately 47.2% of US adults have some form of periodontal disease, and as we look at adults over the age of 65, that percentage climbs to 70.1%. These are not small numbers. The American Academy of Periodontology recommends a yearly periodontal exam to screen for disease, which your hygienist should carry out during your routine cleanings and exams. There are warning signs you can be looking for as well, which include:

• Red, swollen or tender gums or other pain in your mouth
• Bleeding while brushing, flossing, or eating hard food
• Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
• Loose or separating teeth
• Pus between your gums and teeth
• Sores in your mouth
• Persistent bad breath
• A change in the way your teeth fit together when you bite
• A change in the fit of partial dentures

Of course, these symptoms are indicative of moderate-to-severe periodontal disease. Early periodontitis and gingivitis can be completely symptom-free, which means that you may have no idea the disease process has begun in your mouth or the risk it is posing to your overall health.

To assess your risk and ensure your gum health, call today to schedule your routine exam and cleaning. Be sure to bring any concerns you may have to the attention of your dentist or dental hygienist.

S. Paige Tscherpel, RDH, BSDH

Consulted Sources Include:
https://www.perio.org/consumer/types-gum-disease.html
http://www.hindawi.com/journals/ad/2014/596824/
http://www.ncbi.nlm.nih.gov/books/NBK2496/
https://www.perio.org/consumer/cdc-study.htm

As a dental hygienist for the last 7 years, I’ve heard plenty of reasons about why people don’t take care of their teeth. Most patients are well-meaning, but life gets in the way. I’m a mom and wife, with a career to attend to and plenty of laundry and grocery shopping to do as well. Trust me, I understand the lack of time that goes along with a busy life. Dental providers are people too, we know the stress of day to day routines, and not even we have perfect homecare.

There is one excuse that has to be dispelled though, as it’s a common one that takes all responsibility and opportunity away from the patient. We hear it so often as dental providers that we are quick to dismiss  it without often explaining why it doesn’t have to apply.

“I have cavities/gum disease because my mom/dad had them/it.”

Actually, yes, you do….and no, you don’t.

And here’s why.

I’m blond because my grandparents were blond, and I have green eyes because my mother has green eyes.

My grandparents on both sides have heart disease, but I do not.

My parents are both afflicted by cavities and gum disease, but I am not.

Your genetics predisposes you, it does not condemn you.

My teeth look like my mom’s, but they are not undergoing the same problems because of how I care for them. Our genetic predisposition means that we have a compilation of our family DNA, and we are more susceptible to certain diseases and afflictions because of how our bodies react to certain bacterias and environments. We have been given the DNA and bacteria we grow up with by our parents, which we cannot help. What we can help is how we care for our bodies, which determines how they thrive or break down.

In short, if I don’t want heart disease, I probably shouldn’t eat a pound of bacon every day, because my body is more susceptible to heart disease.

And likewise, if I don’t want cavities and gum disease, I need to make sure I remove harmful bacteria regularly from my mouth, because my mouth is more susceptible to cavities and gum disease.

Tooth decay is 60% affected by genetic risk factors. The other 40% is the environment you expose your teeth to. Periodontal (gum) disease is 40-80% affected by genetic risk factors. The remaining 20-60% is the environment you leave your gum tissue in. These numbers prove that yes, your genetics play a role, but no, they are not the only factor. You have an opportunity every day to drink the soda or to choose water, to eat the candy or the apple, to floss or let the bacteria buildup on your teeth. YOU are in control, this means something wonderful…you CAN keep your teeth for life. You are not at the mercy of your DNA, you just have to learn your risk factors and manage them.

Your dentist and dental hygienist are your ultimate partners in this journey. Tell us your family’s dental history, be explicit with your own medical history and we will tell you what your risks are and what you can do to combat them. We want success for you and we are here to assist you in every way possible.

S. Paige Tscherpel, RDH, BSDH

Consulted sources include:
http://www.cnn.com/2014/07/03/health/tooth-decay-causes/
http://www.rdhmag.com/articles/print/volume-20/issue-1/feature/genetics-periodontal-disease.html