Month: November 2016

Still or Sparkling?

dental-revelations-blog
Is sparkling water harmful to the teeth?

Erosion is a growing problem in dental health and our lifestyle is much to blame. Fizzy and fruity drinks are the biggest culprit but also diets high of sugar and starches. Fashionable and seemingly healthy diets like juicing do play their part as well in dental erosion (I will tell you more about juicing later on this post).

The reason I wanted to bring this subject up is that dental professionals do agree on the fact that fizzy drinks like coke and energy drinks, juices and alcohol are harmful to our teeth. But there seems to be a division amongst us when it comes to the sparkling water.

I have read health news in my country’s largest newspaper where dental professionals state that carbon dioxide in sparkling water is not harmful to the teeth as long as it is plain sparkling water, no flavours or lemon added. In my opinion and in my experience it’s not so black and white situation.

So is sparkling water harmful to our teeth? This is something I hope to find out by bringing this subject into discussion.

What Is Erosion?

To keep it short, the erosion is permanent loss of tooth structure caused by non-bacteria originated acids. These acids come e.g. from our diet, medications or medical conditions like gastric-reflux (heart burn) or bulimia.

The first structure on teeth to take the hit from these acids is the enamel. And when the enamel gets thinner this is what will follow:

  • teeth get more prone to decaying and hypersensitivity
  • the colour of the enamel gets yellower as the bone (dentin) under the enamel is darker in colour and starts to show through the thinning enamel
  • the tips of the teeth start to chip more easily and the tips become transparent and can make the tips look darker in colour as the oral cavity does not have very good lighting and this is what is showing through the thin tip of the tooth
  • the bite will become imbalanced as the tooth structure is eroding away. This might result in jaw joint problems

None of the above you should take lightly and all of them are costly to fix.

Why Do Some People Get Erosion on Teeth and Some Don’t?

Well, there are many variables that play a role in dental erosion. These are:

  • saliva’s buffering capacity – the ability to neutralise the acids. This is different with each person
  • the saliva flow. People with reduced saliva flow (dry mouth sufferers) are more at risk of erosion from acidic drinks. But even with healthy people the saliva flow increases and decreases over 24-hour period
  • the pH of the drink

Remember that the plain water’s pH is somewhere around 7 and it is not harmful to the teeth at any way

Sparkling Water and Demineralization pH <5,5

Sparkling water has carbon dioxide which will become carbon acid when it comes in contact with our mouths. The pH of the sparkling water varies but normally it is between 4-6 (click here to one bottled water company’s info page).

It is rare to find the information on the bottle about the pH of the water and often very cleverly they mention that the pH at the source is 7 which can be misleading.

Us professionals are familiar with the fact that demineralization happens when the pH in the mouth drops below 5,5. This a fact. And when knowing this, it is difficult to accept that the sparkling water is not harmful.

An example.

If the sparkling water has pH of 4,5 and the person keeps the bottle next to him at work and sips away every now and then (and perhaps even swishes it around in the mouth) then surely it is harmful to the teeth?

Another example.

Person is exercising at the gym and has sparkling water as a drink. She is dehydrated from the exercising and the saliva flow is poor due to this (= no saliva or very little saliva to neutralise the acids). She drinks sparkling water and swishes it around the mouth to ease the sense of dryness in the mouth. It must do a damage if this happens in weekly basis.

Please note that this same scenario with any other fizzy or fruity drink is even worse situation. Still water (tap) would be the best option.

Juicing

For those who are not familiar with this diet, it is a diet where the juices are extracted from the fruits and vegetables. It is not blending where you put everything in the blender and blend it away to a smoothie. Juicing is drinking fruits and vegetables as a juice.

From dental professional’s aspect this is very worrying diet. Let’s think about the worst kind of scenario where juicing can harm the teeth.

Person wakes up and makes a juice from various fruits for breakfast. One of the fruits is lemon. Then she drinks it and swishes (I use this word a lot in this post so people would get the idea what is harmful) the juice around the mouth to get a fresh feeling after the night. Then she goes and brushes her teeth – meticulously. What did she do that was harmful to her teeth?

  1. When we sleep the saliva flow decreases. When we wake up we have dry mouth and if you pour a very acidic drink (the pH of lemon juice is 2-2,6) in there, the damage is great. There is no saliva protecting and neutralising the acids
  2. It takes a while before the saliva starts flowing again in the morning. This normally happens when we chew our breakfast and start hydrating ourselves with drinks. Drinking juice won’t activate your saliva flow and acids can cause damage to the teeth in peace
  3. Brushing the teeth every morning after breakfast – especially after acidic juice breakfast – will erode the teeth for sure. You are brushing away the softened enamel

My Experience

Every once in a while I see a patient whose teeth are hypersensitive. I go through the patient’s diet, oral hygiene habits and medical history. Often the reason for hypersensitivity is snacking and poor oral hygiene (lack of fluoride and build up of plaque) but sometimes there is no other reason than the patient drinking sparkling water between the meals. Devices like SodaStream at home make it possible to carbonate drinks like water at home. Some people use them many times a day.

I once had a patient who had read the same article (mentioned above) in the newspaper in which dental professionals were saying it is ok to drink sparkling water. This patient had done research on the subject and was already in defensive mood about it. So there was no way for me to convince him otherwise. But then again I am merely a channel of information and it is patient’s right to choose whether to take the information on board.

It is easy to make people understand that flavoured sparkling water is very acidic due to the acidity of the flavouring. But many reject the suggestion that plain sparkling water could be damaging to the teeth as well. I don’t blame them as many of us dental professionals do the same. What I wonder is that how did these dental professionals come to this conclusion?

My experience in the clinical field has proven that it is not all that simple when it comes to erosion and it is damaging to the patient’s dental health to suggest that it is.

 

 

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More about Me – A Revelation

pigeons-taking-off
Source: Pixnio

It’s been a while since I wrote about me so it is time to get back on the subject. I was busy last time I wrote about myself as I was going back to work life after being a home mum for two years.

Guess what, I am even busier than before for many reasons. Both of my kids have been ill with all sorts of colds and other viruses the whole autumn (it’s that time of the year, yippee!). So we’ve been criss-crossing between work, home, daycare, doctor’s and the chemist.

In my country it gets pretty dark this time of the year and the lack of day light is affecting me more and more as the years go by. So I am tired. And when I am tired, I am not very creative or productive. As a result my blogging has suffered. Sorry about that.

My home has suffered as well. I am normally pretty organised and tidy person but in the past two months I have had to ignore most of the housework to be able to spare my energy to more important tasks like cooking a dinner to the family. Also laying  on the sofa next to my two-year-old after a hectic day at work is far more important to me than hoovering. Nothing beats those little arms that are squeezing me in an embrace.

As if it wasn’t busy enough, it will probably get even busier in near future as there will be changes in the horizon. What changes those will be, it remains to be seen. So keep an eye on this space.

I actually had something I wanted to tell you about me and it wasn’t nothing above. I just couldn’t help myself babbling. My revelation for you is that I am a bug phobic. Not pathological but to a certain extent. This profession of ours has made me like this I believe. And if there are fellow bug phobics out there in our profession please shout out (comment box) so I know I’m not alone!

You see, I see bugs everywhere like

  • in birthday cakes after the candles have been blown – the more candles or on the contrary the younger the kid is (how many times does he need to blow those two candles, can’t anyone help?) the more bug layered cake it is
  • in door handles – naturally
  • in the vinyl gloves of the Subway sandwich makers when they handle the money, touch the oven handles with the same gloves as they make the sandwiches
  • in the spoon a friendly coffee shop keeper gives you the handle first (the scissors you give handle first not the cutlery)
  • in the bowl of unwrapped sweets somebody put on a coffee table at work – the longer they stay there the more bugs
  • in the fruits and vegetables people have picked in their hands but put them back
  • in food buffet (this is the ickiest place for me, unless I am the first person to use the buffet) where the spoons have been touched by tens or hundreds of people and they are soaking inside the food container. Plus people are coughing/talking while reaching the salad/potatoes/sauce/whatever.
  • in a commuter train when someone sneezes – I try not to panic and hold my breath as long as possible and try to lift my scarf in front of my nose without anyone noticing before I breathe again – did you know that bugs can travel the length of a bus from one sneeze?
  • in the lift’s control panel buttons – I never use fingertips to press the buttons
  • in the air around a pigeon that just took off in front of me – my nightmare is a flock of pigeons on the square and a kid running towards them in an intention to scare them off… even a photographer side of me doesn’t see the beauty of it

But when my two-year-old wants to share his half eaten carrot that he has dropped couple of times on the floor, I do not hesitate to go for it. After all it is our duty as parents to show an example of healthy eating, isn’t it?

The FSC Is Putting an End to the Nonsense

The Federal State Commission (FSC) in the US has announced a new enforcement policy that will stop (hopefully) the false claims made by homeopathic drugs. This will naturally include the homeopathic toothpastes and it definitely is good news for us dental professionals. Isn’t it?

You can find more on the subject here.

The FSC: Federal State Commission Enforcement Policy Statement on Marketing Claims for Over-the-Counter Homeopathic Drugs

Welcome to My Surgery – Waterline Cleaning Video

Thank you for visiting my surgery! Please note that I do not get any financial benefit of introducing certain brands (although I am starting to feel I should – this blogging is hard work I don’t get paid for!).

Now it might be time to read two of my posts regarding the waterline cleaning so you understand why I posted this video:

It’s ok to swallow, it’s only water… Or is it?

Told You So, Part III

Compensation Culture Sucks

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A 30-year-old lady had been to see a hygienist for a scale and polish, went home and took a small mirror that she put inside her mouth to have a look behind her front teeth.

“Stains!!”

She went back to the surgery and complained to the receptionist about inadequate scaling. She was booked in to see another hygienist who confirmed there were some stains left behind (palatally) the upper front teeth. Otherwise the scaling was done well enough.

Patient left the practice seemingly happy but the next day she called the practice that she still wasn’t happy. She also complained about the dentist she had seen.

The hygienists and the dentist discussed about the patient and came into conclusion that this patient could not be pleased and the complaints would be never-ending. They all had had the same feeling about the patient when she was in the chair. It was a feeling of unease and of a need to explain excessively everything they were doing or saying to avoid a complaint. They decided together that the patient would not be welcomed anymore and the practice manager was the one to break the news to the patient.

Thankfully the practice owner was supportive over the decision.  He said

“We don’t need that kind of patient in our practice. She will only bring bad blood and it’s just not worth it. We can’t help her.”

The Compensation Culture

The compensation culture in the UK (and perhaps even more so in the US) is making a life of a dental professional very hard. It is ludicrous that the main focus of seeing the patients is in the avoidance of possible complaint.

The rotten apples amongst us dental professionals are perhaps to blame. And the media has done their share as well (has there actually been a program about rogue dentists?). The way the media is sharing news is focused on gruesome headlines and there seem to be less and less investigative journalists in the payroll of the media. Instead there are these copy-paste-wannabe-journalists whose main focus and reason for existence is to get as many clicks as possible on their news. Here’s one example:

“Dental anguish: Indiana man who expected to have four teeth pulled woke up in hospital TOOTHLESS” (Find the news here)

This and similar headlines were quickly released around the world without giving the dentist a chance to respond. He would have wanted to respond, I’m sure but there are laws that prevent us dental professionals responding publicly to the accusations made against us when it is about doctor-patient relationship.

Later on the dentist was allowed to discuss the patient case but far fewer media released his response (you can find the response here). So the dentist suffered financial loss over these headlines only because the media is fishing the clicks. Of course there wouldn’t be these headlines if there weren’t people clicking them…

Learn the Phrases

You know what? It is time to fight back the compensation culture. You can do this by learning to use certain phrases. I will list the phrases I use myself when I see a patient. And without sounding like a super human, I rarely get complaints. It is just the opposite. People are happy after they have seen me.

And before you tell me that there is no time to explain everything to the patient I will say that it takes no extra time. You can use the time when you have your fingers inside the patient’s mouth. Don’t wait until you are finished with the treatment. You chit-chatting might even relax the patient!

Ok here we go and remember these are just examples and you can easily create your own phrases for every situation.

The phrases need to cover:

Post-operative pain/sensitivity/bleeding and instructions

“The gums might feel tender afterwards and it is ok to take a painkiller for them. But do not take aspirin because it might make the gums bleed.”

“Sometimes the teeth get sensitive after scaling which normally will pass very soon. If prolonged it is advised to use a sensitive toothpaste.” 

“Some stains cannot be removed by scale and polish. They are in the deep grooves or inside the enamel or between the filling and a tooth and only replacing the filling will help.”

“The teeth will feel very different afterwards as the tongue has got used to the tartar. You will feel the gaps between the teeth.”

Looks and the feel of the new filling

“You might have sensitivity after new white filling and in the worst case the sensitivity can last for months but it should gradually get less and less. If not, you need to come back to have it checked. And if the pain gets worse you need to come back straight away.”

“The filling is never the same as your natural tooth (so you should think twice next time before you snack between the meals and neglect the teeth… )”

The list of these phrases is endless.

And the most important thing is to remember to write down every advice and information you have given so that it can be easily checked what the patient was told if they complain. In this digital age it is a matter of copy-paste if you have created templates on you computer.

Tell What You Do

It takes no extra effort to babble while you are treating the patient. Of course some people won’t like us talking while we treat them but telling the basic stuff is normally ok. This means very simply informing the patient what you are going to do next.

“I’m going to tilt the seat back…”

“I will rinse now..”

“I will use a drill next. There will be water and you will feel vibration…”

I hear it numerous times per week that the patient felt it was good that I told everything I did. I think it is only respectful thing to do. After all patients come to see us, trust their health in our hands and pay our wages.

There. Now go on and try these advises out! I’m sure you won’t regret it.

Are You Telling the Truth about Your Health When You See Your Dentist?

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Interview Is the Most Important Part of the Check Up

When you see your dentist for a regular check up it should always start by interviewing you. No matter how long you have known your dentist and you think they know you inside out, the same questions should be repeated every time. These questions make the treatment you might need safe to perform when it comes to your health.

If the dentist or dental hygienist does not ask about your medical history when you see them for a check up or an emergency visit, I would advice you to change the practice. In worst case your life might be at risk.

If your dentist or dental hygienist does ask about medical history, you are in good hands but only if you are honest. Do not hide anything even if  you think something is not relevant or you are embarrassed about it.

The most important ones to mention are

  • anticoagulants (all of them – even aspirin and omega 3-products) and why you have been prescribed these
  • allergies – all of them! The ones the patients often fail to disclose are food allergies and allergy to latex. One might think that why would food allergy make any difference to dentist but it does. There is milk protein in a product called GC Toothmousse that is used e.g. after teeth cleaning
  • antidepressants – you don’t need to be embarrassed about them, we are professionals and will take matters as they are
  • eating disorders – the past and current ones. There is no reason to hide them from the professionals. It might be actually a relief for you to share it with somebody (believe me, I have witnessed this several times during my professional life)
  • excessive alcohol consumption – even if you won’t tell us we can often see it from your mouth or how you response to the treatment. Heavy alcohol consumption may affect the effectiveness of the local anaesthesia – it might be difficult to get your tooth numb. Also certain drugs won’t be effective enough like antibiotics. These are just two examples. If you are interested to read my post about alcohol, please click here.
  • if you have artificial joint
  • all the systemic diseases
  • if your immune system is impaired – HIV, hepatitis A or C. This won’t change the way we treat you as we should treat all the patients in such way that no cross-contamination can happen. But we need know in case we see something in your mouth (e.g. soft tissues) we do not understand unless we know about your illness. Also the information will help us in the case of unfortunate accident if one of us professionals cut ourselves by contaminated instrument

It Is All about Trust

Everything you tell us at the dental office is confidential. Even if you are a public figure.

I must tell from an experience that I felt utterly disappointed and mistrusted once when a well-known person who had seen me for years, told in the press that she has had hepatitis C for a long time. You tell this publicly but not in a place you should. Why o why? Trust us god dammit!