Dental Erosion and Tea

Seven_Sisters_Panorama,_East_Sussex,_England_-_May_2009.jpg

By Diliff – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=6739706

As a dental professional I worry about growing phenomenon of dental erosion on patients teeth. Yesterday I saw 6 patients of which 5 of them had erosion on their teeth ranging from mild to very severe. There is not necessarily difference between different age groups any more. Dental erosion affects all the age groups and often it is due to ignorance – not knowing that something we do everyday basis is damaging our teeth. And damaging for good. With this post I hope to raise awareness of one very common habit many of us have that could damage the enamel of the tooth. That is drinking tea.

What is Erosion?

People often know what erosion means when it comes to for example coastal erosion (hence the photo of beautiful Seven Sisters, UK). But when I mention the word erosion to the patient, they often look perplexed.

Dental erosion is one type of tooth wear where tooth looses its structure due to chemical dissolution by acids. These erosive acids enter the mouth through two routes – from outside (food, drinks, medicine, supplements) or from inside of the individual (stomach acid due to gastric reflux or bulimia). The loss of the tooth structure is permanent. It won’t grow back. So the prevention of the dental erosion is the most important thing to do.

With this post I will not go into all the things that cause dental erosion as I have written it in my previous post How Diet Affects Your Teeth? But what I didn’t write on that post was something I didn’t know back then. You see, this profession is constant learning as long as you are receptive. I knew that fruit teas are acidic but what I did not know is that only two types of teas are safe to drink when it comes to tooth wear.

pH of Different Teas

There are plenty of studies about the pH levels of different teas. Just google words erosive potential of teas. When I did this I also run into some worrying sites like this one where incomplete advice is given to people. The effects on teeth is completely left out when talking about alkaline diet even though the mouth is one important part of your overall health.

What people following alkaline diet are thinking is that foods consumed will become alkaline in your body. But remember when acidic foods (lemon, lime, berries, apples etc) or drinks (e.g. herbal and fruity teas, carbonated drinks, juices) enter the mouth, they stay acidic. Lets take the lemon as an example. In the alkaline diet’s pH chart they state that lemon is very alkaline (pH 10). But when entering mouth, it is highly acidic (pH 2.0)

The same site advises people to drink hibiscus tea as alkaline tea. A revelation, also hibiscus is not alkaline when entering mouth. It is in fact the most acidic tea there can be (pH level <3.0). Any drink with pH level below 5,5 will cause erosion on enamel if consumed regularly.

It worries me that people actually follow these constricted advices blindly. I don’t blame them. Many people are clueless when it comes to matters of health. Everyone following alkaline diet should read this article to determine if there are enough health benefits of the alkaline diet to risk the health of the teeth. The only downfall of this article is that it is not writing about health risks of alkaline diet.

Erosion-Enhancers

The herbal and fruity teas are acidic but certain factors can make them even more erosive. These are exposure time and temperature of the drink.

Nowadays people carry their drinks with them in a travel mugs enabling them to sip it during e.g. commuting and perhaps some of it is left for them to drink when they reach their desk. If the drink is acidic tea it means prolonged exposure to acids and if repeated often, it will result in tooth erosion. If there is sugar or honey added to the drink it will be even more erosive and also cariogenic.

Also the hotter the drink is the more erosive it is. And these travel mugs keep the drink warm for a long period of time.

Warning Signs of Erosion

The first sign of dental erosion is normally sensitivity to cold or pressure (when brushing the teeth or touching the surface of the tooth with your finger nail. The latter us professional do not encourage to do). This should raise an alarm in your mind and you should go through your diet to find out if you are consuming something regularly that is too acidic to your teeth. You will find help from my post How Diet Affects Your Teeth. Remember that the best drink teeth-wise between the meals is tap water because it is alkaline.

Another sign of tooth wear is change in tooth colour. As the enamel gets permanently thinner, the yellower tooth structure the dentin under the enamel will start to show through. Your teeth will look yellower than before and no whitening done will change that as the whitening substance is not able to reach the dentin.

When the shape of your tooth is changing, the erosion is already severe. Thinning enamel will easily chip off making your teeth look less attractive than they used to be. Often people feel embarrassed about their teeth at this point.

So my message to you all is to prevent dental erosion! Think what you put in your mouth and how often you do that. Occasional acidic drink will not make any difference but when consumed often, it will cause problems.

Is Any Tea Safe to Drink?

Yes! The pH level of green tea and black tea are on the safe side. Black tea also contains fluoride which helps to prevent tooth erosion. But remember, they are only safe if no sugar (including honey) or lemon is added. Sugar will cause the pH level of the saliva to drop below 5,5 and lemon is very acidic like I mentioned already above.

Here are some studies for further reading

Erosive potential of herbal teas

International Journal of Science and Research (IJSR): Dental Erosion and Tea: A Systematic Review

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Eeny Meeny Miny Moe – Which Type of Tooth Wear?

How Diet Affects Your Teeth

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The Ickiest Things You Can Do at the Dentist

Putting Your Finger Inside Your Mouth

It always hits me with surprise how clueless people are about transmission of infections. In the middle of the treatment they might show with their finger which tooth feels sensitive. That’s when I say Eew in my mind. Why would you put your finger inside your mouth? And it’s always the index finger which we use to operate our smart (and dirty) phones and push the elevator button (I don’t actually, I use the proximal interphalangeal joint (PIP) of index finger because of my fear of bacteria – read more about it here) that gazillion people have pushed before you with their dirty index finger. Some even do grosser things with their index finger.

So please, do not put your finger inside your mouth. Your tongue is able to do the job instead.

Carrying Your Toothbrush Without Cover

Some people are obsessed about brushing their teeth prior the dental visit. They might do it at the practice’s toilet just before they come in to the surgery. No problem with that, but when you walk in to the surgery with the toothbrush, your car keys and wallet in your hands and place them on our office desk, that’s when we go Eew again. Especially if the toothbrush doesn’t have any travel case. We don’t wipe all the practice’s surfaces after each patient, so there will be germs on the table surface where you leave your stuff. And where are you going to put it when you get back to your car?

Equally gross thing is to put your toothbrush inside your handbag without travel case. But at least then we are not able to see it.

“Sucking the Sucker”

By far the ickiest thing to my mind are the patients who close their lips around the saliva ejector or the high volume suction. I was horrified for the first time it happened with my patient. To be fair, it’s not their fault. They do this probably because some of the dental professional advise patients to do so. Honestly, fellow dental professionals, do your research and stop advising to close the mouth when the suction is inside the mouth.

Why?

It’s because of the backflow of bacteria and viruses. When patients close their mouth and form a seal around the tip of the saliva ejector, a partial vacuum occurs. That’s when the nasty stuff in the tube of the suction start travelling backwards – blood, viruses, saliva, bacteria, debris. They might travel as far as into the patient’s mouth. If you don’t believe me, read this.

If you are a patient and your dentist or hygienist advises you to close your lips around the suction, don’t do it. You don’t need to. This might of course mean that you need to swallow tiny amount of water, but the water is cleaner (or is it?) than the stuff that comes out from to suction with the backflow.

It is also absolutely your right to ask if they take care of the suction tube cleaning. They should answer you that

Yes, we flush the lines after each patient with clean water (this will take the nasty staff further away) and at the end of the day we flush the tubes with disinfectant. Also once or twice a week we use special cleaner for the suction lines.

Ok, there it was. Three of the ickiest things patients can do at the dentist. Do you know even grosser thing? Feel free to share it on the comment box below. Let’s see if it gets an Eew -reaction.


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Are Your Dentist’s Tools Clean?

Have you dropped your dentures in the toilet?

RDA Value in Toothpastes – Any Relevance?

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Gum & Enamel Repair Original Toothpaste

I promised in my post Oral-B Gum & Enamel Repair Original Toothpaste Review that if I find out the RDA level of this toothpaste I will announce it. Well I found it out recently, sort of. And this occurrence sort of made me annoyed once again. So I’m going to pour it out now.

I saw a representative from Oral-b recently. She was going to ask about our experiences of the Gum & Enamel Repair Original Toothpaste. I told mine and to my pleasant surprise she suggested we would fill an adverse reaction report. So we did. She said she had never heard anyone’s tongue getting numb from their toothpaste.

My most important question to ask from the rep was the magic RDA value of this toothpaste. I was dreading it as the reps are quite sensitive about the whole subject of RDA value. They know that it is thought widely amongst the dental professionals that the higher the RDA value is the more abrasive it the toothpaste is. So the manufacturers want to keep it a secret.

What Is RDA?

To explain it very simple way, the RDA is the grittiness of the toothpaste. If it is too high, it can cause tooth wear. But to explain RDA more elegantly, here is a quote by ADA (American Dental Association):

To help quantify the abrasivity of dentifrices, the ADA along with various academic, industry and government agencies established a standardized scale called Relative Dentin Abrasivity (RDA). This scale assigns dentifrices an abrasivity value, relative to a standard reference abrasive that is arbitrarily given an RDA value of 100.

All dentifrices at or below 2.5 times the reference value, or 250 RDA, are considered safe and effective. In fact, clinical evidence supports that lifetime use of proper brushing technique with a toothbrush and toothpaste at an RDA of 250 or less produces limited wear to dentin and virtually no wear to enamel.

ADA (American Dental Association)

So what this quote is saying is that most of the toothpastes are safe. Mind you, FDA (U.S. Food & Drug Administration) has set the safe limit of RDA to 200. But internationally it is the RDA 250 or below that is recognised as safe to use. I did a research and found out that many dental sites (both english and my native language) state that the highest safe RDA level has been set too high. It should be 100 or less.

Here is a link to one of the dental sites with a very good chart about abrasiveness levels in different toothpastes.

The Big Question

Ok, back to seeing the rep. I gathered all my courage and asked the big question.

Err, what is the RDA level of this toothpaste?

Oh boy, he looks annoyed. He asks if he has ever shown us a video about RDA. No, he hasn’t. He took his tablet out and put the video rolling. It was about RDA level of the toothpaste made by Oral-b. In the video they were demonstrating that it doesn’t matter what the RDA level is as long as it is below 250.

He looked victorious when the video ended. I asked again.

So, what is the RDA level of this toothpaste?

He said with a sigh that the RDA level of the Gum & Enamel Repair Original Toothpaste is somewhere between 100-200.  So this is what I meant when I found out the RDA level of this toothpaste, sort of.

Conclusion

It is good to remember that not only the toothpaste’s RDA level determines how much you will get tooth wear. If you brush your teeth straight after breakfast, with a hard toothbrush and with too vigorous technique (applying too much pressure), it has very little meaning what the RDA level of the toothpaste is.

You might be interested in these posts as well:

Testing Oral-b Smart Phone Holder, Take 1
Testing Oral-b Smart Phone Holder, Take 2
Oral-B Gum & Enamel Repair Original Toothpaste Review

Google for a Day – Comprehensive Answers about Cold Sore and Dentist

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To treat or not to treat? The answer should be easy one to answer. Why isn’t it?

My most popular post by far has been Cold Sore Is Herpes – Cancel Your Dental Appointment Because Your Dentist Won’t!. It proves that people certainly know that herpes simplex virus is not something that you could compare to common cold for example. They are unsure what to do when you have a cold sore and you have booked a dental appointment. And like with many other matters that you are not sure about, people turn to their all-knowing friend Google.

But it’s not only the patients who are unsure. Also the dental professionals seem to be confused and represent their questions to Google. How do I know this? Well, WordPress has very useful statistics that include also the search terms people have used when they end up to my blog. I have kept an eye on the search terms and I got this idea to write a post about them and act as a search engine for you. So here it is. The search terms (ST) and my answers.

ST: Can you go to the dentist with a cold sore?

Preferably not. Any treatment that can be postponed should be postponed.

ST: Can they take out a wisdom tooth with a cold sore?

Only the ones that cannot be postponed. If the wisdom tooth is risking your life due to an acute infection and signs of the infection are spreading to your bloodstream then it should be removed even if you have a cold sore.

ST: Why won’t the dentist see me when I have a blister in my mouth?

Because your dentist knows his business. Any responsible dentist would postpone the treatment if there are signs of herpes infection inside your mouth, lips or nose. But your dentist could explain a bit more why he didn’t see you so you wouldn’t have to google it. Here’s further reading about cold sore as an occupational hazard.

ST: Can dental treatment cause cold sores?

In theory, yes. If the practice’s cross infection control protocol is not up to the standards and they treat people with cold sores, the virus can be passed on to the next patient. The virus can stay infectious as long as 2 hours in the surfaces of the surgery and the instruments. If the next patient has never had any type of herpes infection, she’ll get primary herpes first. That’s nasty thing to have if you are an adult. Cold sore can follow as a secondary herpes after a while.

ST: Cold sore, herpes simplex, dental appointment.

I hope these things never meet in real world. Unless absolutely necessary.

ST: Does an orthodontist still take you if you have a cold sore?

If the treatment can be postponed, it should be postponed. But having said that, if the orthodontist treatment is such that no rotating, high-speed drills are to be used then it might be ok to do the treatment if the cross infection control is up to the standards.

ST: Can I have dentist with a cold sore?

Are you sure you want one? Wait until it clears and you’ll find that he is exactly the same person without cold sore. Just less infectious.

ST: Can I have a dental treatment with a cold saw?

Well, you actually could. We have instruments that look like a saw.

ST: Can you get oral herpes from the dentist.

Yes if your dentist’s cross infection control is not up to the standards and they treat patient’s with cold sore. Herpes virus can survive 2 hours in the surfaces that have not been adequately disinfected.

ST: How dental professionals can prevent from getting herpes?

Do not treat patients with cold sore. If you must (patient’s life is at risk), protect yourself with visor mask, take care of your skin as healthy skin on hands works as barrier to pathogens, use gloves, try to avoid using high-speed instruments and sonic scaler as they produce aerosols that carry pathogens, do only what is necessary until the time when the cold sore has healed. There’s no point in covering the cold sore with plaster or similar as the herpes simplex virus is also in the saliva. You should also read this article.

ST: Should a dental hygienist treat a patient with a cold sore?

Treatments the hygienists perform are rarely such that cannot be postponed. So do not take a risk. If you still act against my advise, protect yourself as advised above and do not use sonic scaler. And cross your fingers. You should also read this (scroll down to Case histories).

ST: Dentist refused to treat due to herpes.

Hooray! We have hope! Hold on to your dentist, he clearly knows his business!

ST: Dentist won’t treat me bc herpes.

Another good and responsible dentist somewhere out there! Be happy!

ST: Can I still have a filling with a cold sore?

No dentist should make you a filling when you have a cold sore. Making a filling requires high-speed rotating instruments that have water cooling system. They produce aerosol when used and the aerosols carry pathogens far and wide – possibly in the eyes of the dentist, nurse and yourself! Even if you wear protective eye-ware.

ST: What to do if patient has herpes simplex dental nurse.

I’m afraid there is not much you can do as the dentist is considered to be the one who is responsible for the treatment. The dentist decides if the treatment can be carried out. He shouldn’t of course treat patients with cold sore unless patient’s life is at risk but as you probably know the reality is very different. When you begin working with a new dentist, ask him how he deals with patients who have cold sore. If he is all about money, money, money, change jobs. Protect your health and your future as dental nurse. You can always show the dentist my article about cold sore or this article. Maybe that’ll convince him.

ST: Do dentist still remove teeth if you have a coleslaw.

We do find many things from people’s mouths. Sometimes even coleslaw between the teeth. I don’t think the dentist minds. He just wants to get your tooth out.

(It’s an obvious spelling mistake or an auto-correct error but I couldn’t resist making fun of it.)

Oral-B Gum & Enamel Repair Original Toothpaste Review

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Oral-G Gum & Enamel Repair Original toothpaste

Today I am going to review a toothpaste for the first time ever. It is a toothpaste that was given to me by a representative of Oral-b. It is called Oral-b Gum & Enamel Repair Original toothpaste and it is Oral-b’s newest toothpaste.

Here’s the manufacturer’s selling speech about the toothpaste on their website:

  • It defends against acid erosion and helps to repair enamel
  • It provides antibacterial action to help rejuvenate gums
  • For sensitive teeth – clinically proven
  • Oral-B Gum & Repair Original toothpaste comes with a mild flavour and a smooth texture

The Design

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The design of the packaging looks simplified and minimalistic which I very much like. This is welcome change from their previous toothpastes’ outlook that had too much information in a small space.

The tube is still easy to open, but there is small change in the lid. It used to be made of metal which at least in my opinion is better recycling-wise than plastic. Small detail but still. Can’t help this image of whales’ intestines full of plastic popping in my mind. But then again the whole tube is plastic.

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The Testing

Staying on the environmental subject. The plastic and the whales. There has been lots of talk over microbeads that are found in many consumer products. Even in toothpastes. These microbeads will eventually find their way into the sea and cause problems to the oceans as persistent pollutant. The representative who gave me this Gum & Enamel Repair Original toothpaste sample promised that there are no microbeads in it. The ingredient to look for is polyethylene when you want to make sure there is none of them. I found no polyethylene in the ingredients list (see at the end of this post). Great.

The texture of the toothpaste looks smooth as they promised but when you take closer look, it is not that smooth after all and the fear of microbeads is getting stronger again.

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The texture of the Gum & Enamel Repair Original toothpaste

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Closer look of the toothpaste reveals tiny beads.

The tiny granules are clearly visible but these could be actually hydrated silica (abrasive), not microbeads.

Ok, time to add toothpaste to my toothbrush. Like with Oral-b Pro-Expert toothpaste, this new one is also quite runny and can be messy if you are not quick enough. Once I had applied toothpaste to my toothbrush I was in a rush to take a photo before it dripped on to the table.

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I use my beloved Philips Sonicare

and with this brush the runny texture is actually better than the ones that are stiffer pastes. But I can see that the sink in the bathroom will have toothpaste marks here and there. Also, note to myself – do not let husband use this toothpaste as he brushes his teeth after he has put his suit on. Silly man.

So lets put the toothpaste in my mouth. It does begin to formulate foam which means there is soap in the toothpaste. Not the best option for somebody with sensitive soft tissues or dry mouth. Soap aka sodium lauryl sulfate can make the mouth dry and also it has been linked to canker sores aka aphthous ulcers (although nothing is scientifically proven and oh boy don’t I hear it from the rep e-v-e-r-y time).

Very soon I begin to feel burning sensation on first third of the tongue (the tip of the tongue), both top and bottom of the tongue. Also the tongue feels slightly numb. This carries on all through the brushing and after spitting the toothpaste out. Now, I do advise my patients not to rinse after brushing but the burning sensation is so strong that I must rinse lightly. Once I did that and bit my teeth together, I could feel biting on some grit. This made me think about the abrasiveness of the toothpaste. It is new toothpaste so the RDA value (Relative Dentine Abrasivity) was impossible to find. I will add the RDA value as soon I find it out.

Ten minutes after brushing the burning can still be felt. Also I feel that the layer of skin inside my lips is peeling off. This has been “a feature” with Oral-b Pro-Expert toothpastes and the reps have said it’s absolutely normal and will diminish when using the toothpaste for longer period of time. My colleague asked the rep if this new Gum & Enamel Repair Original toothpaste does the same. I must say that I cannot remember the rep’s exact answer but I think she said this toothpaste should cause less of the peeling of the mucosa. Well it doesn’t. At least with me. If anything I think the peeling of the mucosa is quicker than with Pro-Expert toothpaste.

Twenty minutes after brushing I can still feel the burning feeling slightly. I guess some people will associate this burning feeling with effectiveness of the toothpaste. The more it burns, the more effective it is. As a dental professional I must say that this is not true. No toothpaste should feel uncomfortable to use.

Would I Recommend?

To be honest, most likely I will not recommend this toothpaste to anyone. Not after I took a closer look at the ingredients. One ingredient has been nominated as Allergen of the Year for 2018 by American Contact Dermatitis Society. This ingredient is called propylene glycol.

The list of ingredients is long and to my mind the longer the list is the more side-effects there will be. My favourite toothpaste that I recommend to my patients a lot has only eight ingredients (aqua, crystalline sorbitol, hydrated silica, crystalline xylitol, PEG, anhydrous natural betaine, cellulose gum, sodium fluoride (1500 ppm F), sorbate). Oral-b Gum & Enamel Repair Original toothpaste has nineteen! Three of these ingredients can have adverse reactions to one’s health – propylene glycol, CI 77891 and sodium lauryl sulfate.

Also the fact that I got this burning feeling in my mouth tells me this toothpaste is not suitable for most of the people. Remember that it should not feel unpleasant to use a toothpaste. Certainly it should not hurt. So change if it does.

The Ingredients

Here are the ingredients of the Oral-B Gum & Enamel Repair Original toothpaste and short explanation of what they are (by clicking the link you will find more information):

  1. Glycerin – an organic compound most commonly from animal fat and vegetable oil
  2. Hydrated Silica – abrasive
  3. Sodium Hexametaphosphate – anti-stains and anti-tartar
  4. PEG-6 – an emulsifier and foaming agent
  5. Propylene Glycol – the American Contact Dermatitis Society’s Allergen of the Year for 2018. An emollient and emulsifier.
  6. Aqua – the main carrier for all ingredients. Helps dissolve other soluble ingredients. Helps the mechanical process of cleaning teeth in mouthwashes
  7. Zinc Lactate – such a difficult ingredient to find any information solely on zinc lactate. Lots of information on zinc but there must be difference in different types of zinc? If anyone finds trustworthy site with information on zinc lactate, please drop me a line.
  8. Sodium Gluconate – to sequester calcium and helps to prevent gingivitis
  9. CI 77891 – titanium dioxide (nanoparticles). A thickening agent and colourant.
  10. Sodium Lauryl Sulfate – soap, the foaming agent. Can work as an irritant.
  11. Silica – a mild abrasive to clean teeth.
  12. Aroma – a chemical compound which adds odours to dental products.
  13. Sodium Saccharin – an artificial sweetener
  14. Carrageenan – an extract from a red seaweed. Binds and gels all the ingredients together
  15. Trisodium Phosphate – stain remover and de-greaser
  16. Stannous Fluoride – the good in the toothpaste
  17. Stannous Chloride – antibacterial
  18. Xanthan Gum – a thickening agent
  19. Sodium Fluoride – the good in the toothpaste

If you are interested in other common ingredients in toothpastes, click here.

Edit 21.6.2018

Want to know what the rep told me about the RDA level of the Oral-B Gum & Enamel Repair Original toothpaste? Click here to find out.

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Anti-Patients

Dental Revelations - Dentistry for everyone

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I have a confession to make. I am not perfect as a dental professional even though my posts may give the expression that I do everything as we are taught at the dental school. I do my best but I have weaknesses as well.

Another confession. I sometimes feel quite overwhelmed by some patients’ way of arguing about the well researched facts on dental health. Banging your head against the wall is not fun in the long run and in our business it tends to make us cynical and worn out mentally.

Of course there are good days and bad days. On bad days I have thought about changing my profession to the one where I could sit between piles of paper and no-one to talk to (anyone care to hire me?). On bad days I have given up trying to convince the patient about cleaning between the teeth when I have faced a non-cooperative patient…

View original post 1,373 more words

How Diet Affects Your Teeth

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But I brush my teeth twice a day and floss them daily!”

I get cavities very easily. It runs in the family… We have weak teeth.”

Sound familiar? This is something I often hear when I tell patients they have a new cavity or early signs of them. Because my way of thinking is generally based on no-nonsense, I will not speak nonsense to my patients and therefore will correct any nonsense coming from their mouth. What I will say immediately to the person thinking bad teeth are hereditary is that there is no such thing as hereditary bad teeth. What can be hereditary is

  • diet and lifestyle habits (sort of… at least until you get to decide yourself what to eat and drink and how often)
  • bacteria (but not exactly hereditary, the baby is born without bacteria in mouth and bacteria will be transferred into baby’s mouth normally from the parents)
  • genetic susceptibility to periodontitis (but this does not mean you are doomed to have periodontitis)
  • position and the shape of the teeth

But it is only the diet and lifestyle habits that can be easily changed by person himself to such that is more tooth-friendly. So what is tooth-friendly and what’s not? I will tell you but I cannot do that before I tell you little bit about bacteria first.

Bacteria – the Beloved Enemy

There are bacteria in everyone’s mouth and so there should be. The bacteria keep the soft tissues healthy. Every day the bacteria try to find hiding and breeding places from our teeth forming this sticky glue around them. Bacteria and this glue we call plaque.

We can live in peace with the bacteria if we remove it regularly from the surfaces of our teeth. It is beneficial also to remove it from the surface of the tongue. Brushing twice a day with an electric toothbrush and cleaning between the teeth once a day (the best tool for you to use between the teeth should be checked at the dentist – preferably by the dental hygienist) will prevent the bacteria causing problems like cavities and gum disease.

But if the bacteria can stay in place for longer period of time, there will be consequences. Let’s first think about how it will affect the gums around the teeth.

Healthy gums will start to get inflammation after three days of bacteria presence (there is some individual variation to this) because the bacteria will produce toxins amongst other things. For example if you do not clean between the teeth for four days, the chances are high for you to notice bleeding from the gums when you finally decide to clean them. The bleeding is always a sign of an inflammation in the gum (gingivitis) caused by prolonged bacteria presence. It is never a sign of you doing something wrong with the tool you use. So consider the bleeding as a reminder for you to clean between the teeth more regularly as gingivitis can lead to more severe and irreversible type of gum disease (periodontitis).

The bacteria also produce acids from the carbohydrates in your diet. This is called the acid attack. The acids will affect the teeth.

The acids that the bacteria produce from the carbohydrates will make the pH of the mouth drop below 5,5 and this will remove minerals like calcium from the surface of the teeth. It is called demineralisation. The saliva neutralises these acids bacteria produce and also it is the saliva that will try to restore the lost minerals from the enamel but it is slightly slow process and normally after 30-45 minutes of finishing you dinner/snack the job is done and the pH has risen above 5,5. This is called remineralisation.

The teeth can take only certain amount of demineralisation per day without getting cavities. Too much demineralisation combined with inadequate oral hygiene habits will most certainly lead to decaying. Sometimes very fast decaying.

Not Necessarily What You Eat, but How You Eat It!

So now you know that the demineralisation will begin when you offer carbohydrates to the bacteria in your mouth. There are carbohydrates in pretty much everything we eat. The juices, milk, fruits & veg, bread, cereals, honey, pasta, rice – they all have it. Sweets definitely have it. Even just one tiny grape will begin the demineralisation which will last the next 30-45 minutes before the saliva has neutralised the acids.

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Teeth can take up to 5-6 of these acid attacks per day without getting decay. So if your eating habits include more than 5-6 meals/snacks/drinks with carbohydrates, you have a higher risk of getting decay. How fast the decaying is depends on your oral hygiene habits (plus some other factors like buffer capacity of the saliva but these details will only confuse you so let’s stick to the basics).

The worst you can do to your teeth is to snack every half an hour because this means the pH level that dropped when you began your session of snacking will never raise above the safe level of 5,5. So in the worst case scenario you might take e.g. cookie/fruit every half an hour from midday till you leave work around five to get you through the day. This means that you had a massive 5-hour-long acid attack in your mouth. If this happens often, it will definitely lead to decaying.

Sugar-Free Does Not Always Mean Tooth-Friendly

Soft drinks contain massive amounts of sugar. A 16 oz bottle of coke can have 13 sugar cubes (4g cubes). This is one reason some people switch to sugar-free soft drinks. Often people do not realise that the drinks that are better for the waist-line are still as harmful to teeth as regular soft drinks. The reason for this is the pH of the drink.

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The lower the pH the more harmful it is to teeth. The low pH does not cause decay as such but it causes dental erosion which is as damaging as decaying is. Erosion on teeth means the surface of the tooth is loosing minerals as a result of an acidic drink making the enamel thinner. Here is the most important sentence to memorise:

The enamel does not grow back!

So it is very important to prevent any loss of tooth structure before you are in trouble with sensitive teeth, colour change of the teeth to yellow (thinning enamel allows the yellow dentin under it to show through), decaying (thin enamel decays quicker) and possibly imbalanced bite due to the loss of tooth structure. These problems caused by enamel erosion are very difficult and expensive to treat.

Do not think these things are not happening in your mouth. They are. I see it every day with more and more patients. Remember that the acidic drinks are not recommended to be consumed daily and when you do, consume them with a meal and drink tap water after you have finished eating and drinking. This will neutralise some of the acids.

Here are a couple of examples of the drink’s pH value:

  • cola drinks from 2,32 (Pepsi Max 2.74)
  • lemon juice 2,25
  • 7up 3,24
  • Ocean Spray Cranberry 2,56
  • strawberry Dasani 3
  • pure water 6-8
  • Red Bull 3,3
  • Full Throttle 1,45

Remember that the plain sparkling water’s pH is around 5. But if you add flavour to it with your soda maker the pH will drop close to 3 or even below it. So it is always better to choose the plain sparkling water than the flavoured one but it is worth noting that there is still a debate amongst us dental professionals whether the plain sparkling water is harmful to the enamel.

If you want to find out more about the pH value of the drinks, click here. And here is an article worth reading: The Washington Post: Why flavoured waters are bad for you teeth.

Vegan Diet and Erosion

Vegan diet in a nutshell means that the diet is devoid of all animal products, including meat, eggs and dairy. The vegans who base their diet on fruits and vegetables are at higher risk of developing dental erosion. The culprit for this is the acidity of the diet and lack of calcium in diet.

Patient Case

50-year-old lady came in to see me for the first time. She had been on a vegan diet for almost all her life. She started the day with a lukewarm water with a splash of lemon followed by a smoothie after which she brushed her teeth with a non-fluoride toothpaste. During the day she followed her vegan diet, drank herbal teas between the meals. In the evening she brushed her teeth again with a non-fluoride toothpaste.

The clinical findings:
The enamel of every single teeth was riddled with severe erosion. The fillings she had were protruding from the tooth as the tooth structure itself had dissolved around them. She had suffered from sensitive teeth and could not eat or drink anything too cold. The enamel of her front teeth were so thin that the colour of the teeth was yellow from the dentin showing through. The front teeth looked like the gremlin’s teeth due to chipping of the thinned enamel. She would need extensive rehabilitation of the occlusion and the aesthetics with crowns and fillings. Needless to say that the treatment would cost a small fortune.

What was the downfall of her teeth? Well, many factors contributed to this severe dental erosion:

  1. The combination of acidic diet and lack of calcium-containing products in the diet. It is advisable to combine acidic food with a dairy product. For example by adding natural yoghurt to your smoothie.
  2. The breakfast should include something you chew. Your saliva flow has dramatically decreased over night and it is chewing that will make the saliva flow again. If you drink something acidic when the mouth is dry (in this patient’s case lemon water and non-dairy smoothie) there is no saliva to protect the teeth. It is the saliva that neutralises acids and restores the minerals back to the enamel.
  3. Non-Fluoride toothpaste. Fluoride will work like calcium on the enamel. It will form even a stronger layer on the surface of the tooth than calcium and other minerals found on enamel. So when using only non-fluoride toothpaste, you are relying on your saliva to do the remineralisation. But like with this patient it simply was not enough to protect the teeth.
  4. Unawareness. Not knowing how our diet affects your teeth is the downfall of many. This patient had acidic vegan diet plus drinks that are highly acidic like water with lemon and the herbal teas.

Other Harmful Diets

There are new fashionable diets popping up all the time and I might not know all of them. But to name a few:

  • Juicing – everything is in a form of a juice. The problem with teeth: no chewing means no saliva to protect your teeth! No dairy-products.
  • Smoothie diet. The problem with teeth: no chewing or no dairy-products.
  • Alkaline diet. No this is a bugger considering teeth. They have their own pH chart for the foods that can mislead people into thinking that some foods are absolutely safe to eat as often as desired. Their pH chart tells what the pH of certain food is when you digest it. Let’s take lemon as an example. In alkaline diet’s pH chart lemon has pH of 10, but when the lemon is entering the mouth, the pH level is 2.0 which is highly acidic and harmful to teeth if teeth are exposed to it often.

How to Protect Your Teeth from Your Diet?

  • If you decide to follow certain trendy diet, find out first how it will affect your teeth. Do not turn to Google if you are not able to tell the difference between fake health news and real, scientifically proven advice. Ask your dentist or hygienist instead.

    These fake health news -sites are very convincing. Even I almost started to believe in the nonsense they were writing when researching for this post. So be alert, trust the dental professionals who have many years of education that is based on science.

  • Think about your current diet. Does it include lots of acidic drinks or foods. You can find out the pH level of many foods and drinks from the internet.
  • Finish your dinner or snack to a slice of cheese. Chew it well. This will neutralise the acids and restore the calcium to the enamel (cheese is rich in calcium).
  • Finish your dinner or snack to a Xylitol. This will neutralise the acids after dinner. Two pastilles sweetened 100% by xylitol five times a day will also decrease a chance of decay. Want to find out more about xylitol, click here.
  • Use products like GC MI Paste Plus or GC Tooth Mousse to restore the lost calcium in your enamel. The GC Tooth Mousse can be used many times a day as it does not contain fluoride. The best time to use it is just before bedtime by applying pea-size-amount with e.g. cotton stick all over the teeth and leaving it overnight.
  • Use fluoride toothpaste twice a day and do not rinse your mouth after brushing. Just spit out.
  • Avoid fizzy drinks and juices. Only drink them at mealtimes and try to avoid daily consumption.
  • Avoid snacking. But if you do snack, remember that natural nuts are tooth-friendly snack.
  • Avoid alcohol or drink in moderation. Alcohol is always a risk to your teeth, mouth and general health. It is an acidic drink and the bacteria in your mouth will metabolise the alcohol into acetaldehyde which is carcinogenic in humans.
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Comeback?

Are you ready for my next post after my sabbatical? If you are still there waiting for me to write again, I thank you for being patient. To be honest, I do not have more time in my hands than before but I have decided to make an effort to write every once in a while.

A revelation to reward you for your loyalty. I am still in the dental business even though I would love to spend my time solely on writing. It is my passion. I must say that I have had a difficult year of ups and downs. Highs and lows. Times when I believe in myself and times when I have lost all the self-confidence. I have realised that I have an impostor syndrome which tries to demolish all my achievements by persistently telling me

Who are you kidding? You’ve achieved nothing! Shame you if you even think so!

This syndrome keeps on reminding me that I did not get feedback on my novel from THAT person I so much admire, and making me forget I got feedback from ten other people who are as important as that one person.

But I’m working on it. I am trying to remind myself that in this world of haste and demands, I am good enough. As mother, as wife, as dental professional, as writer and most importantly as myself. Being merciful to yourself is a difficult skill to master. But I am learning.

So, watch this space. There might be something coming up soon!

 

Guest Bloggers Welcome

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Guest bloggers warmly welcomed

While I am still not active with blogging (but hopefully will be soon), Dental Revelations Blog is open for guest bloggers. Mind you, I am quite picky and have allowed only one guest post so far. Will you be the next one?

Disclaimer – Dental Revelations Guest Post Standards

Dental Revelations aims to maintain certain standard for the content posted on our blog – it is of benefit to everyone. Therefore Dental Revelations:

1. Will proofread posts and amend them if needed.

2. Will not accept posts of low quality in content or grammar (certain errors will be corrected).

3. Will evaluate the content and writing style which should have the similar approach to dentistry as Dental Revelations Blog has.

4. Will not accept posts with links to spammy websites.

5. Will not accept posts with links to irrelevant sites (e.g. site selling car parts). The links need to provide additional value to the reader.

6. Will check the originality of the post (Copyscape) to avoid overload of the same approach to the same topic in the blogging world (e.g. one can write about implant surgery with unexpected, humorous way instead of just plain old why patient benefits of having an implant).

7. Will own the rights to the content on the moment the post is sent to us providing it is published. If not published, the rights to the content are with the author.

8. Will expect the posts to have at least 1000 words.

Further requirements:

1. The guest post should include an author bio. Author bio can have maximum of 2 links to the following sites: to the author’s blog/website/Twitter handle.

2. Guest author should reply to any comments made in their post as soon as possible.

3. Any image attached to the article needs to be royalty-free image.

3. Be creative. Write about dentistry in a way no-one has written before. Forget being polite and politically correct if something is bugging you. Pour your heart out and type away. People will love the genuineness and honesty.

 So if you feel you are up for the task, you will find my contact details here.