New Natural Remedy (Fluoride-Free) for Decay

Dental Revelations

Just kidding. Just wanted to have your attention.

Today I am going to write about fluoride. And the reason for doing this is that I keep on running into articles and websites promoting fluoride-free toothpastes (and water). Not only they recommend non-fluoride toothpastes but also they tell that the fluoride is toxic or poison when entering body.

It is rather entertaining to read these articles but sooner or later the amusement turns into annoyance. Especially after comments like this

I love the look on dental hygienist’s faces when I refuse the fluoride treatments or toothpaste for me and my kids

When the adults practice their anti-fluoride beliefs on their kids it is simply heart breaking. I have seen kids whose milk teeth were so badly decayed that most of them had to be removed. I have seen kids in pain because of the decay.

Why would you want to put your kid through such experiences? They wouldn’t thank you if they knew what caused their bad teeth as an adult. But they will never find out the truth because they have been told that it runs in the family to have weak teeth… yeah right. There is no such thing as weak teeth that are hereditary. It’s all about oral hygiene habits and lifestyle habits.

What could be called hereditary is the bacteria in mouth that you might get from your parents as a baby. If the parents neglect their teeth (poor oral hygiene and lifestyle habits) there is great amount of cavity causing bacteria in the mouth and if that bacteria is transferred to the baby there are big chances the child will struggle with decaying. And this means this child needs fluoride. And if the parents do not offer it… pain, screaming in fear at the dentist, sedation/general anaesthesia, fillings, extractions, malposition of the permanent teeth because of the loss of the milk teeth… So unnecessary!

To be honest, I can understand the worry over the fluoridated water to some extent. After all it goes into your body.

But the fluoride toothpaste! You are not meant to swallow it, are you? With young kids you can’t prevent them swallowing the toothpaste but that’s why you use only very tiny amount of it.

But you adults, come on! The local effect of the fluoride is important in prevention of decay. You brush for 2 minutes (hopefully) and that’s the time the fluoride stays in your mouth. Then you spit it out and rinse with water (I don’t but that’s why I glow in the dark…ha-ha). No fluoride has entered your body.

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But still some people mix all sorts of things with “healing properties” to be used as a toothpaste. Herbs, clay, coconut oil etc. I just read an article about coconut oil that was recommended by Dr. Somebody to be used instead of fluoride toothpaste. And as if the article wasn’t full of baloney but the comments at the end of the article were even more so.

…I laugh when dentists tell their patients not to brush for an hour….. why leave the acidity on your teeth to do damage for an hour – five times a day – seven days a week etc…. it adds up!

This person refers to a previous comment where somebody said he vigorously rinses his mouth with water after eating anything (which is fine). I’m sure all the professionals know what will happen to the teeth if one brushes every day after every meal – five times a day – seven days a week etc.

Erosion or to be precise it is abrasion that will happen to the teeth and that is irreversible damage which will lead to hypersensitivity of the teeth and make the teeth more prone to decaying.

Facts Simplified

There are minerals in the enamel of the tooth (hydroxyapatite). Minerals like calcium are lost everyday from the enamel because of the acids the bacteria produce from the carbohydrates in the diet.

The saliva tries to minimise the loss of minerals by neutralising the acids (remineralisation) but saliva can’t do magic if the host’s lifestyle is giving it too much to handle. Snacking (eating more frequently than 5-6 times a day), drinking acidic or sugary drinks in daily basis between the meals, eating sweets the wrong way (yes, there is a right way of eating them), adding sugar to the tea/coffee (even milk contains sugar) and consuming them between the meals. All these habits produce too much acid for the saliva to handle and it is not able to return all the lost minerals back to the enamel.

Loosing too much minerals from the enamel means decaying.

So to prevent that you need to find a way to compensate the lost minerals. The most important one is the calcium. And when combined with fluoride it repairs the enamel with very strong fluorapatite that is hard for the acids to break. It is much stronger material than hydroxyapatite that the enamel is originally made of. Some professionals even say that area of the enamel that has been replaced by fluorapatite won’t ever get decay.

But even if you do use fluoride in some form you will get decay if you have poor oral hygiene and your eating habits are harmful to the teeth. The fluoride will only slow down the decaying process.

There are exceptions of course. There are individuals who neglect their teeth and never get a decay. They might not use fluoride toothpaste or they might not brush at all. I will emphasise that they are exceptions. Average Joe will get decay I’m afraid. I have already written about this on my previous post. I wrote that it is very rare for people to have good enough oral hygiene habits. It is about one in thousand patients who do not need my interference in looking after their teeth. So most of us need minerals (calcium and fluoride) to protect the teeth from our laziness and unhealthy lifestyle.

Fluoride we cannot get through our diet unless you eat fish with the bones but even then there is no localised effect on teeth. So we need it from somewhere else. And the fluoridated water is simply not enough as it passes through the mouth and does not provide long enough localised effect (so don’t use that as an excuse). That’s why we use the toothpaste.

Right Way of Eating Sweets (Thought You Might Want to Know)

You can eat sweets without getting decay. Us dental professionals are a living proof of that. You see we looooove to eat sweets but rarely get decay. I will tell you how we do it.

  1. If you buy pack of sweets eat them in one go and have xylitol chewing gum, slice of cheese or fluoride tablet once you are finished. If you eat one sweet every 10 minutes for the next two hours you will have an acid attack in you mouth for approx. 2 hours and 30 minutes. Or even worse example. If you take one sweet every 30 minutes for the full working day it means you have had an acid attack the whole time you were working. Acid attack means losing minerals. And I have already told you earlier what happens if you loose too much minerals which you certainly will do if you have 7-8 hour-long constant acid attack.
  2. Eat sweets as dessert. You get acid attack already because of eating and you can avoid getting an extra acid attack by eating the sweet in one go after a meal. Have xylitol chewing gum or pastille, slice of cheese or fluoride tablet once you are finished.dental-revelations-blog2
  3. Whenever possible and if you stomach can take it, buy sweets that are sweetened by xylitol. Now people often blame the xylitol for the laxative effect of sugar-free sweets. But it is often not the xylitol that causes the upset stomach. It is the maltitol syrup. So seek products that are sweetened 100% by xylitol.

 

Please note: This post is directed to healthy adults. People whose saliva flow is impaired through illness or medication need more intensive fluoride treatment on their teeth.

Hands up Who Knew That Zinc in Toothpaste Can Cause Dry Mouth?

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I have noticed it is very easy for a health care professional to get annoyed about different things by just browsing through dental forums and discussion sections of dental news.

This time it was the toothpaste.

Especially the toothpastes of certain big brand that promise all sorts of things but have side effects the representatives sweep under the carpet by saying casually

It’s perfectly safe to use

It’s normal

Yeah, peeling off the mucosa in your mouth is normal. I wouldn’t be so sure. Especially with the patients who have a sensitive mouth.

The salesmen of the manufacturers of oral hygiene products would sell their granny to promote their products. They can tell a fib or even lie to your face without loosing a good night’s sleep. All they want to achieve is that you will start to recommend their products. This is enhanced by giving the practices boxes and boxes of free samples which I have written about in my previous post Can you trust the recommendations given to you by a dental professional?

Are We Fooled by the Representatives and Adverts?

I remember an occasion when a representative of this big company came to my practice to introduce new products. These new all-in-one toothpastes. There were many different toothpastes in the same product family. One for everyone even though the first all-in-one toothpaste introduced not so long before these new ones was supposed to be the one to deal with e-v-e-r-y problem one could have. Slightly confusing I think.

Anyway, the rep went through these new toothpastes and recommended the sensitive version also for the sufferers of dry mouth. Then on the next sentence she mentioned that this sensitive toothpaste contains zinc…

Rather boring session got my interest immediately. Dry mouth and zinc? You got to be kidding me?

We dental professionals know our business. Every detail of it. Well at least I hope most of us do. Despite this I have noticed that many dental professionals are fooled by these selling speeches representatives give and do not notice that the things coming out of their mouths are simply bogus.

So I looked around to see if anyone else was looking puzzled? If anyone was about to say something? No, not a chance. They were just leaning back on their chairs with empty eyes staring at the products. But I couldn’t keep quiet. I never really have learned to keep my thoughts to myself especially if somebody is talking nonsense.

So I raised my hand to get a say (and I swear I could see my colleague roll her eyes meaning here we go again). The rep looked surprised.

Me: Did you say this toothpaste is for people with dry mouth?
Rep: Yes I did.
Me: And it has zinc in it?
Rep: Yes it has.
Me: But the zinc associated with dry mouth, isn’t it? It can make the dry mouth worse.
Rep: Err, I must say I do not have an answer for you now. But let me get back to you on that. What’s your e-mail address? I’ll find out and send you an e-mail as soon as possible.

A typical diversion from the subject. About month later I received an e-mail which said:

Hello,

I remember you asked something about the sensitive toothpaste. Care to clarify what was you specific question? All the toothpastes are well researched and tested. They are widely recommended by the dentists. Bla-bla-bla…

Yours truly,

Representative-that-will-not-come-to-my-practice-again-if-it’s-up-to-me.

Knowing Your Business in Depth

Now I must tell you that I did not know that zinc in toothpaste can be a culprit to dry mouth until another rep of another big oral hygiene product manufacturer (wouldn’t it be easier if I just told you which company?!) told me so couple of years ago.

I had recently tested their toothpaste for halitosis and got extremely dry mouth (honestly, I thought I will die of thirst between brushing my teeth and reaching the office in the morning). When I asked the rep about it she said that it could be due to the zinc in the toothpaste and asked me to file an adverse event report. She even gave me the document to fill in.

I was impressed. Not about the Sahara-Desert-in-mouth toothpaste but about the honest rep who could tell me something I didn’t know.

Since then it’s not been just once or twice that I have found out that my patient who is suffering from a dry mouth is using a toothpaste containing zinc.

The dentistry is constantly evolving. It is hard to keep up to it but we must. It is the only way we can give the correct advice to the patients.

Conclusion

It just occurred to me that I might be taking the visits of the representatives of oral hygiene products the wrong way. Perhaps it is accustomed way to let the reps babble away without questioning what they are saying. Am I considered to be rude to interrupt them when they are just trying to do their job? Should I just sit in silence when they are clearly not on the right path?

Perhaps, but I’m afraid it won’t happen in the near future. Or never. You see, isn’t it so that the annoying sides of one’s personality is only enhanced when one gets older?

Anyway. Be cautious of the advertising speeches of the reps. Read scientific studies about the ingredients and then make up your own mind if you will recommend certain products. Try them yourself and pay attention to how your mouth responds.

My advice for the patients is to use a toothpaste that feels good in their mouth. If the toothpaste burns, stings, makes your mouth numb or if you experience any other uncomfortable feeling STOP USING IT.


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Cold Sore Is Herpes – Cancel Your Dental Appointment Because Your Dentist Won’t!

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Zovirax can be used to make the cold sore heal quicker.

A patient came in for a long appointment to have a bridge done. This appointment was to include filing down the teeth to abutments which meant that the high speed drill was to be used. A lot.

High speed drills have water cooling system and this means there are aerosols in the air when the drill is used. And the aerosols carry pathogens from the patients mouth as far as two metres (about 6,6 feet) from it’s origin.

The nurse noticed that the patient had a large cold sore on a lip. Dentist appeared as if he had not noticed it and asked the patient to sit down in the patient chair. Chair was tilted back and when the dentist put his fingers inside the patient’s mouth the nurse discreetly pointed out the cold sore. The dentist carried on with the treatment and ignored the cold sore.

The nurse was worried. Very worried. And she had all the right to be. She knew the cold sore virus – herpes simplex – can easily spread to her eyes and hands, dentist’s eyes and hands, patient’s eyes and mouth via the aerosols produced by the high speed drill.

Herpes simplex virus in the eye can result in blindness.

Herpes infection on hands (herpetic whitlow) of a dentist/hygienist/nurse might force a career change as one cannot do any treatment on patients when the herpetic whitlow is active.

But the nurse didn’t have any other option but to continue with the treatment as the dentist is considered to be the one who is more educated in the matters of health and carries the responsibility of the treatment. This means the dentist makes the decisions behalf of the nurse and the patient whether to continue with the treatment or not.

Now it might be a good idea to read one of my previous post about integrity of dentists so you understand the motives behind the dentist’s decision in this story.

So on they went with the high speed drill. For an hour and a half.

Less than a week later the nurse developed a bad head ache and the next day she had sores in her mouth. Two days later she had temperature of 40 degrees and the mouth, gums and lips were full of painful sores. The GP diagnosed a primary herpes and prescribed anti-viral medicine. She was off work for a week.

When the patient with the cold sore was seen the next time in the surgery he had small blisters near the operated site.

Cold Sore Aka Herpes Simplex 

Before the anti-viral medication was developed the primary herpes used to be an infection that was often lethal. The doctors treating the patients with primary herpes could only cross their fingers and hope the patient will make through it. Many didn’t.

It can still be lethal but we have medication to treat it.

Most of the people get the primary herpes as a child and it often is asymptomatic. If contracted as an adult the primary herpes can have more difficult symptoms.

The primary herpes can be followed by secondary herpes (recurrent infection) – most commonly as a cold sore on a lip. The most frightening one of the recurrent infection of herpes simplex virus is encephalitis.

Guidelines for Treating Patient’s with Cold Sore

I asked my friend Google and she quickly found me several sites that were unanimous about what us dental professionals should do if we see a patient with a cold sore.

Do not do any treatment that can be postponed!

To convince you I copy-pasted guidelines from couple of sites.

Elective dental treatment should be deferred for patients with active lesions as aerosolization of the virus may occur during dental procedures, placing both the patient and oral health care provider at risk for possible infection or re-infection.

Elective treatment should be postponed until the lesion has healed completely. Though the patient may be comfortable after you have applied a topical medication, there is still the risk of spreading the disease to the health-care provider.

Because herpes is transmittable to patients from dental health-care professionals who have active lesions, there is a risk of spreading this disease. The guidelines from the CDC are clear. Each of us has to keep patient safety and staff safety a priority.

Conclusion

The guidelines are clear. The medical facts are clear. Why do dentists still treat patients with cold sores and risk the health of the nurse and the patient, let alone their own health? They if anyone should know how serious risk it is.

So why?

I’m afraid you might know what’s coming (especially if you read my post Morals in Dentistry). Yes, the only reason for this kind of selfish and negligent behaviour from a dentist is GREED. And perhaps small amount of twisted enjoyment of having power – being almighty in this little world that has two people the dentist can make decisions for.

When the patient walks in the surgery with a cold sore it is simply just not acceptable from the dentist’s perspective to reschedule the appointment even though everyone’s health is at risk. No, no. Profit overrides reason. Shame you who just recognised yourself.

I know there are also hygienists who see the patients with a cold sore. But this is because they don’t either know better or because they are not practice owners. Refusing to see a patient with a cold sore is not considered to be in the best interest of the practice. Plus what can you do if the patient with a cold sore just saw a dentist for a filling and is scheduled to see you for a scaling. How can you say no when the dentist said yes?

It requires lot of self confidence and experience to be able to stand up for you right to decide for your own health. Something the nurses do not have a chance to do. It proves once again how the dentist-nurse relationship is nowhere near about equality as co-workers. Not even in the matters of personal health.

I reschedule the appointment if the patient has a cold sore. And the next appointment won’t be sooner than a fortnight. I also use the opportunity to inform patient about the herpes simplex and ask patient to cancel the appointment next time when he gets a cold sore before the dental appointment.

And seriously (for all the dental professionals):

Applying Zovirax and placing a plaster on top of the cold sore before doing the treatment is just simply bonkers.

Here’s some further reading about the guidelines of seeing a patient with a cold sore.

Remember to share this post if you think there was important information that everyone should know.


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