Is Xylitol Good for You?

dental-revelations-blog2
Xylitol will help you to improve oral health

What Is Xylitol?

Well I was going to write about xylitol but when collecting facts I run into an article that comprehensively and distinctly gives you the relevant information on xylitol. Why produce something somebody else has done so well? So ladies and gentlemen please read through this article:

Xylitol: Everything You Need to Know (Literally) by Kris Gunnars, BSc at www.authoritynutrition.com

What I will add from an experience to this great article is that always choose a product that is sweetened by xylitol only. This will minimise the possibility of having stomach problems. It is not necessarily the xylitol that is culprit for the enhanced bowel movements but the other sweeteners like maltitol syrup. Trust me, I know from my personal experience. All I need to have is 3 or more pastilles sweetened with both xylitol and maltitol syrup and rest of my family will suffer from consequences – if you know what I mean…

dental-revelations-blog
Use chewing gum or pastilles sweetened 100% with xylitol

Here are couple of sites that sell products (chewing gum, pastilles) sweetened 100% by xylitol:

Peppersmith

Sweetlife – Spry brand

Fazer

Word of Warning

Even though the xylitol is absolutely harmless to us human beings (both children and adults), it can be fatal to dogs. So do not leave any xylitol product in the reach of your dog.

Controversy

Like mouthwashes and sparkling water divide us dental professionals, so does the xylitol. Some don’t know enough about it and some dental professionals take guidance from studies that are low of quality.

In 2015 the Cochrane released a review about xylitol which concluded that the xylitol has not been proven to be effective in prevention of decay. Many of us dental professionals most likely only read the abstract of the review, am I right? Very few of us had enough time or attention span long enough to go through the full version of the review. I mean really go through it – all the 10 studies they had included in their review.

Well I am going to make it easier for you now. I have looked into the full review and have simplified it in the next paragraph.

Cochrane Review and It’s Flaws

There are hundreds of studies about xylitol and caries (decay). In PubMed alone has over 500 of these publications. But yet the Cochrane review has been put together by using only ten of them.

In five of these studies the daily dosage of xylitol was lower than what is known and proofed by several clinical studies to be effective – that is 5 g per day.

Three out of these five studies were studies over toothpastes containing fluoride and xylitol. The levels of xylitol in toothpaste are always lower than the recommended, effective daily dosage of xylitol.

Clinical studies have concluded that the daily dosage and the frequency of use are the key factors in the effectiveness of xylitol. The xylitol should be spread throughout the day into small doses – preferably to 3-4 doses per day. As the xylitol is not antimicrobial compound, it needs to be used this 5 g per day to be effective in reducing the level of bacteria in mouth and therefore caries.

Let me repeat – five of out of ten studies included in the Cochrane review did not use sufficient dosage of xylitol. One out of these five studies wasn’t even a study over xylitol but probiotics – the xylitol was merely used as an adhesive (in milligrams – far from the 5 gram recommended daily dosage).

One out of these five studies did not even state the dosage of xylitol used. So why did they choose them for the review? I will try to find the answer in the Conclusion paragraph.

Ok, enough of those five questionable studies. Lets have a look at some of the remaining studies.

One of them the reviewers themselves think it has a “high overall risk of bias”. Well, they said it themselves – why include it?

Another study was conducted on kids with good oral health – how would you see if the xylitol is effective if there is nothing to improve in oral health? The ones executing this kind of study have been silly in the first place but the Cochrane reviewers are even sillier to include it in the review. What was the point?

Two studies had excellent results in the effectiveness of xylitol (see the other study here). Both of these studies used high enough dosage of xylitol.

Conclusion

It remains to be seen what magnitude of damage on public health one badly executed review has had. There are signs already that it has done great deal of damage. I did just a quick browse through the blogs and the internet and found several articles that were already declaring that the xylitol is useless referring to this Cochrane review. Some even state xylitol is harmful to us.

One must question the motives behind the Cochrane review on xylitol.

Has there been an involvement of the huge sugar industry that feels easily threatened by any alternative (and healthier) option for sugar as a sweetener? It is perhaps one reason why it is difficult to find xylitol products from many countries, especially the further west you go from Europe the more difficult it becomes.

Or was the review put together too hastily and with personal prejudices?

There are several food safety authorities worldwide that have accepted xylitol as food additive. The Joint (WHO/FAO) Expert Committee on Food Additives (JECFA) allocated xylitol’s ADI (acceptable daily intake) already in 1983 to “not specified” which is the most favourable ADI possible. Also the European Food Safety Authority concluded in 2006:

sugarfree chewing gum sweetened with xylitol is sufficiently characterised in relation to the claimed effects

(See the link for the full article at the bottom of this post)

Why produce a review that undermines the effectiveness of the xylitol when clearly there is no harm using it? Quite contrary, it most likely is beneficial to dental health when used appropriately and can have a positive impact on children suffering from middle ear infections.

The Cochrane reviewers are only emphasising their own self-importance and pettiness by this trivial review which will be in the world wide web forever and ever, with their names on it. It is an achievement I do not envy at all.

The Cochrane Library: Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV. Xylitol-containing products for preventing dental caries in children and adults.

European Food Safety Authority (EFSA) on xylitol

Advertisements

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.

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, slice of cheese or fluoride tablet once you are finished
  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.

Money-Saving Advice on Dental Visits

Dental Revelations Blog-3892
Are you seeing your dentist for a check-up too often?

Here we go again. I am annoyed about something that is waiting to burst out. I have written about integrity of the dentists in one of my previous posts and today I am going to touch the same subject.

This post is about dentist check-up frequency patients should have.

Many dental practices very commonly advise people on their websites and in the surgeries to see dentist every three to six months and they justify this by prevention of bigger dental problems.

A revelation:

Recommending the same check-up interval to all the patients is not up to the standards of modern dentistry. It is merely (once again) about maximizing the profit of the practice.

Check-up intervals should be decided after carefully evaluating the current status of the oral health, general health and oral hygiene routines. I will list the guidelines that are practiced in one of the leading countries.

Managing Decay

24 to 36 Months Interval in Check-Ups

This concerns the patients who have

  • no treatment requiring decay
  • no early decay that needs to be stopped or reversed
  • not had any decay for many years

It is important to check the patient’s eating habits to make sure that they are not harmful to the teeth and encourage patient to change them if needed.

6 to 12 Months Interval in Check-Ups

This concerns the patients who have

  • one or more early decay or advanced decay

It is important to make a plan together with a patient to stop the decaying. This might include visits to the hygienist.

Exceptions

Certain groups of people might need to see dentist more often than advised above. These are:

  • children and youngsters
  • people with illnesses and medications that reduce saliva flow
  • users of intoxicants
  • immigrants of certain countries
  • people with dental phobia
  • people with big life events (pregnancy, divorce, military service, retirement)
  • people of low education
  • smokers
  • people with illnesses or injuries that cause disability that prevent good oral hygiene
  • people with harmful eating habits and/or poor oral hygiene
  • people who use fluoride toothpaste less than twice a day
  • mouth breathers
  • people who are undergoing orthodontic treatment
  • people with dentures
  • people with erosion on teeth
  • patients who have had teeth extracted/root canal treated due to decay in the past 3 years

Managing Gum Disease

3 to 12 Months Intervals in Maintenance Visits

After a comprehensive therapy for the gum disease the patient needs to see periodontist/hygienist regularly for the maintenance visits. The interval of the maintenance visits is based on many risk factors like

  • severity of the bone loss
  • smoking status
  • overall health (diabetes)
  • genetics
  • age related (medications, illnesses)
  • gender (male)
  • low socioeconomic status
  • poor oral hygiene
  • condition of the teeth (restorations – especially subgingival crown margins, removable dentures)
  • furcations
  • anatomic abnormalities
  • residual pockets

The more advanced gums disease the shorter the maintenance interval. The more risk factors the shorter maintenance interval.

Conclusion

To recommend all the patients the same 3-monthly check ups is simply madness and it stinks of foul play.

Dear patients,

please be advised that you most definitely do not need to see a dentist every three months unless you fall into one of those risk factor categories above. But even in these cases a top-notch oral hygiene habits can make wonders and extend the check-up interval from three months to six.

Also if you do want to see a dentist every three months there is no harm done. Apart from you needing to pay unnecessarily for a treatment you don’t need.

Yours sincerely,

Dental Revelations Blog

Times change. So does the dentistry. Sticking to the old ways – “it has always been done like this” – is simply not what modern dental practice should do.

More on the subject click the links below.

NHS

Daily Mail

NICE – National Institute for Health and Care Excellence

Anti-Patients

Dental Revelations Blog-24982

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 the fifth time that day.

Fine, carry on practicing your beliefs…

Sooner or later you will learn I was right…

It’s your teeth not mine…

This does not happen often, but I wanted to bring out the great mental load we have on our profession. We need to have sort of a mental radar on ALL the time so that we can find the right approach to each patient. As each patient is different. But there will be a patient that slips beneath our radar. I have come to conclusion that with these patients there is no right approach. I call these patients Anti-Patients.

There are at least 5 types of Anti-Patients that I have listed below. If a new one comes to your mind, please share it in the comment box.

Anti-Fluoride

When I interview patients on their first visit, one of my questions is:

Which toothpaste do you use?

The most common reply is:

Dunno… Anything they sell in the supermarket.

But if the patient is a health-conscious one, they know exactly which toothpaste they use. And it won’t be just anything from the supermarket’s shelf. They also know that often their beliefs in health can be found controversial amongst the health professionals.

So after they have told that they use the aloe vera toothpaste/herbal toothpaste or any other non-fluoride toothpaste, they will carry on explaining the reasons behind it with fists raised into boxer’s pose (not really, but you get the gist?).

The fluoride is toxic..

There is fluoride in the drinking water anyway…

The fluoride is linked to health problems like cancer…

I only listen, let the patient finish and then carry on to the next question on the interview. I leave the toothpaste issue until I have build up a little bit more trust and until I have examined the patient’s mouth.

I know what I am going to find especially when the patient has used non-fluoride toothpaste for a long time. In my experience about 1 in 1000 patients has oral hygiene habits that good that my interference is not needed. One in thousand! And the likelihood that this one patient is the one who uses the non-fluoride toothpaste is close to zero. This means that poor oral hygiene together with non-fluoride toothpaste results in decay. And that is what I am going to find from the anti-fluoride patient’s teeth.

A faint white line on the enamel of the tooth close to the gum line that is the first stage of the decay. They are still reversible lesions of decay but they will often get discolouration that ruin the aesthetics of the smile. Sometimes the decay is already beyond stopping and requires a filling.

As some anti-fluoride patients take the advice on board, many don’t. And the most disheartening are the ones who practice their anti-fluoride beliefs on their children as well.

Want to know more impartial information on fluoride? Click here.

Anti-Amalgam

Amalgam has been used for about 150 years on people’s teeth. Although we have passed the peak of the amalgam phobia long time ago, there are patients who still believe the amalgam is a health risk. They either do not want to have a new filling made of the amalgam or they want to have the existing ones to be removed and replaced with white ones.

Now, there are dentists who have dollar/pound/euro (or whatever your currency) signs in their eyes whenever this kind of a patient walks in. They do not discuss about the reasons behind the patient’s wish or what the operation of changing the amalgam into white fillings mean. Of course they don’t. They do not want the patient to change their mind.

When a patient expresses this kind of a wish to me, they get this info every time:

  • Composite filling is not an option for an amalgam. Instead the ceramic or gold fillings are and those are many times more expensive than amalgam
  • Amalgam can last a lifetime, whereas average lifespan of a composite filling is somewhere way under 10 years and ceramic’s just slightly higher
  • If there is no problems with the amalgam filling, there is no reason to replace it
  • Replacing many amalgam fillings with white fillings will affect the bite
  • There are no health risks with amalgam as a filling
  • If choosing to have all the amalgam replaced with white fillings anyways, find a dentist who does laboratory-made ceramic/gold fillings and uses proper protection when removing the amalgam fillings as it is the most hazardous part of the life of an amalgam filling

I am always happy when I learn on the next visit that the patient has changed his mind about having amalgam replaced. And for some reason the patient is relieved as well.

It makes me sad when beautiful amalgam fillings have been replaced with composite fillings. It just isn’t right.

Note for professionals: Do polish the amalgam fillings regularly as the darkened amalgam fillings work as retention for bacteria. This is important especially with patients who have advanced periodontal disease.

Anti-X-Ray

X-rays are the vital part of making a diagnosis for the dentists and certain conditions will go undetected without them.

Refusing to have an x-ray taken is just pure madness. It is almost the same as if you would take your car to the car mechanic and tell him that

There is something wrong with the car but do not look under the hood.

In the worst case scenario, your life might be at risk. In the matter of the car and refusing the x-rays.

Anyone concerned about radiation with dental x-rays should read this and simply trust the dental professional’s judgement on whether or not you need to have x-rays taken.

Anti-Safety Glasses

Why on earth would you decline using the safety glasses that are meant for the protection of your eyes? Beats me.

We drill at high speed just a short distance of your eyes and anything can fly out of the patients mouth – a piece of an enamel, calculus (tartar), a broken bur and all sorts of nasty bacteria and viruses. We use chemicals that are acidic when making a filling. None of these you want in your eyes, believe me.

“We should not treat a patient who refuses to use the safety glasses”, I was told on one of the health and safety courses. In ideal world yes. But when you work at a private practice it is totally different story. What do you think that would happen if I send a patient home for not using the safety glasses. No income for the practice and who is the blame? Me.

So we let the patient to refuse the use of the safety glasses and tell them to keep their eyes closed. But they never do, do they?

Anti-Everything-You-Say-or-Do

I know the fear of the dental visit can bring out the worst in people. But it is always frightening when a patient comes across as aggressive from the moment you call the patient in. They walk to the surgery, throw their belongings to the side table and almost jump to the dental chair with arms crossed. They

  • dismiss everything you say
  • do not take the safety glasses
  • are suspicious of everything you do and want to see every instrument you have
  • tell you that they do not want to have a lecture
  • ask when you graduated
  • tell you how another dentist/hygienist did things differently compared to you

Thank goodness these kinds of patients are rare. But when I am faced with this kind of a hostile situation, I speak only when it is absolutely necessary and just do my job. I am glad when the patient is gone and hope we never meet again. But there is an exception. You see sometimes a miracle happens somewhere between the polishing and goodbyes.

The patient that just moments ago was a manifestation of the devil is suddenly the opposite and full of questions about oral hygiene. “Now he wants advice!” is my thought when I have couple of minutes time left before the next patient. But I do not have a heart to ask the patient to leave when I realise that all the hostility was due to the fear of the dental visit. Amazing fear!