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.)

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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.

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.