Healthy Lifestyle Doesn't Always Mean a Healthy Mouth
You would think that all those healthy marathoners, triathletes and endurance athletes who live extremely healthy lives would have a healthy mouth, right? Well, there is a dangerous mix of habits that actually is increasing tooth decay in the healthiest of people. Sipping and eating carbohydrates during long races and training days bathes your teeth in acid and sugar and breathing through your mouth creates an environment that allows Streptococcus mutans (the bacteria responsible for cavities) to flourish.
Carbohydrate Loading and Replenishing Glycogen Stores
Besides generally eating more carbohydrates before races athletes who train for hours at a time need to replenish their glucose stores and usually do so in the form of gels, bars and chews that are very high in sugar. Sports drinks are even more common for all people who exercise have very high sugar and high acid levels which increase tooth decay and erosion of dental enamel, respectively.
Training for a full marathon and long distance triathlons like an Ironman, you can easily bathe your teeth in this dangerous mix for 2-8 hours of training a day. Now most people will not be doing anything of the sort so in that case water is much more beneficial than sports drinks if you are working out for less than 1 hour at a time.
A review article in the American Journal of Dentistry states Individuals engaged in physical activity may be educated to the lack of benefits of sports drinks over water and should be encouraged to avoid dehydration and swishing acidic drinks in the mouth to prevent dental erosion.
Oral health educators should be reinforcing important practices to sports drink users such as decreasing the time that the sports drink remains in the mouth and avoiding dehydration. Finally, compared to water, the benefits of a sports drink for most recreationally active individuals is negligible.
As an athlete spends many long hours training and racing, breathing either fully or partially through the mouth, it can become drier. A drier mouth means less saliva flow and diminished concentration of acid neutralizing enzymes to fight tooth decay and therefore the tooth decay process is accelerated. An article in the Scandinavian Journal of Medicine and Science in Sports saliva flow rates decreased and saliva pH increased significantly. Resulting in a higher risk for dental erosion, exercise-dependent caries risk. They concluded that the need for risk-adapted preventive dental concepts in the field of sports dentistry.
What Can an Endurance Athlete Do?
It's not all doom and gloom. As a triathlete myself I am not going to give up training (by the way, that's me on the right in the picture up there.) We need to fuel our body for how hard we push it but at the same time we cannot jeapordize our dental health in the process and we don't have to. There are some simple things you can do:
It is hard to balance your training with the other responsibilities in life. I know because we have to do it ourselves. Following these tips will help you spend more time out biking, running or swimming rather than in the dental chair. See you out there my fellow triathletes!
I usually write posts based on questions from our patients. Recently we had a mother-to-be come in and ask if she can still have a cleaning while pregnant. It is very important to make sure you have proper dental hygiene during your pregnancy for you and baby. It is also very important to have a checkup before planning your pregnancy to avoid potential dental emergencies.
The American Dental Association, the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics all encourage women to get dental care while pregnant. “It is a crucial period of time in a woman’s life and maintaining oral health is directly related to good overall health,” says Aharon Hagai, D.M.D.
The American Dental Association is a very good resource for expectant mothers. Here are some common questions and concerns that we hear at Brentwood Progressive Dentistry.
What dental related issues could arise when pregnant?
Because of the many of changes in a mother's body and fluctuations in hormones one of the most common symptoms is pregnancy gingivitis. Inflammation of the gums causing bleeding and sensitivity is common. Some women also can get a pregnancy tumor also known as a pygogenic granuloma, an overgrowth of gum tissue usually found in between two teeth that is red and puffy. These usually go away once you are no longer pregnant.
Pregnant women are more at risk for cavities also because of the increase of acid in the mouth from morning sickness and frequent snacking and increased intake of carbohydrates.
Is it safe to come to the dentist while pregnant?
We encourage mothers to come in for checkups to prevent dental issues but when you do need treatment it is safe to come to the dentist. The dentist and obstetrician work together to make sure mom and baby are healthy. It is always important to tell both doctors your current medications and conditions so they can work together to come up with the best care options for mother and baby.
If you do need dental care, it is shown that local anesthesia and xrays do not increase the risk of any pregnancy complications in a healthy pregnancy. There have been recent studies done in the Journal of the American Dental Association to show local anesthesia can be used safely if you need dental work and also radio xrays can be taken if needed. However, prevention is key and having a check up before you decide to become pregnant or during pregnancy is best.
Keeping a healthy mouth also is helpful for your baby. Good oral hygiene is especially important because poor habits during pregnancy have been associated with premature delivery, intrauterine growth restriction, gestational diabetes and preeclampsia.
We want to make sure mother and baby are happy and healthy. If you have questions please feel free to call or email us. In a nut shell, keep up with your oral hygiene and come in for checkups and cleanings. If you need any dental work, it can be done with the input of your obstetrician so you can have a safe and healthy pregnancy.
Many of us as children have gotten silver fillings or amalgams placed in our teeth. Most of the time they have lasted a really long time and haven't given us any problems. So, one day you go to your dentist and they mention that you have a filling that you need to replace and you wonder why.
Its normal to be skeptical when something has been in your mouth for so long and has never bothered you. So why bother it? I just wanted to take a minute to show you why your dentist might be recommending to replace and old filling. Here is life of a silver filling:
When its placed the very first time it is usually because bacteria ate the sugar that you had left in your mouth and made acid. That acid made a cavity in your tooth. The dentist might have removed that part of your tooth that was decayed leaving a hole in your tooth. A silver filling is placed sealing that area from the outside world of your mouth. That means bacterial, sugar and saliva stay out.
Over the years this filling serves us very diligently. Crushing food 3 or more times a day (and sometimes working overtime at night as we grind our teeth) all in a dark, moist environment with varying amounts of sugar and acid (depending on what we eat and how we clean our teeth) day in and day out for years. You can see that can easily cause wear and tear over the years.
When we see something that might pose a problem we let the patient know and give them some treatment options. If caught early it can be a simple filling replacement. If not treated early it can be more invasive treatment like root canal treatment, crowns or even it get to the point we can't save the tooth and have to extract the tooth.
Here are some old silver or amalgam fillings and their different stages of wear.
In this picture you see the filling coming apart and not sealing the tooth anymore which is evident from the gaps between the filling and the tooth. This allows bacteria, sugar and saliva to flow into those cracks and seep into your tooth causing a cavity. At this stage you can usually just replace the filling.
In this picture you see the similar pulling away of the filling causing a gap. There is also a small fracture line seen. This happens when bacteria and sugar seep into the cracks and start causing decay. Now you have an inflexible metal filling on a squishy base in your tooth. Every time you bite down, the metal filling acts like a wedge pushing into your tooth and causing it to split apart... and that is where those fracture lines come from. At this stage you still might not feel any symptoms but there are obvious problems brewing.
In this picture you see the old silver filling, the gaps around the side, fracture lines and decay not only under the filling but next to it too as seen by the darkness seen below the surface. At this stage, depending on how far the fracture line has spread and how much the decay has destroyed the tooth our treatment options start to become limited and fall into the more invasive and expensive side.
This is what we are trying to avoid. If we notice fracture lines, and decay and fillings that are no longer sealed this could happen. A tooth can fracture. In this picture we were able to save the tooth with a crown. However, it is best when we are able to control the situation instead of treating it after something has happened.
When you come to our office we can take pictures of your fillings so you can see for yourself what state they are in. Also, its completely normal to need to have a filling replaced from normal wear and tear. The best thing to do is never get a cavity but... we are all human right? In conclusion, take care of something when its small so it doesn't snowball into major treatment and save yourself some time in the chair and money in your wallet.
Radiation is never something you want to have unless necessary. We see a lot of patients who are concerned about how much radiation is in a dental x-ray. I always explain to our patients to weigh the benefits vs. the risks.
Here are some dose examples:
Mammogram (per breast)......................................... 500 mrem
Spine x-ray............................................................. 347 mrem
Here are some medium dose examples:
Hip......................................................................... 72 mrem
Femur (leg)............................................................. 21
Here are some examples of radiation exposure:
Living in a brick house.............................................10 mrem a year
Cooking with natural gas..........................................10 mrem a year
Sleeping next to a person......................................... 2 mrem a year
Here are examples of dental x-rays:
One dental x-ray...................................................... 0.5 mrem
Full mouth series..................................................... 9 mrrem
As you can see, the radiation from dental x-rays are very low. But I still have patients say, "Doc, but it is still radiation..." This is when I tell patients about the risks vs. benefits. The risks, radiation are very low but benefits are very high. When a dentist looks in your mouth they can only see a little bit, like the tip of an iceberg. 90% of what is going on can be in the bone, roots, nerves, inside teeth or even under the dental restorations you have. This can't be seen with just an exam. Major issues like infections, bone loss and diseases wouldn't be able to be diagnosed. Catching things early like a bone diseases or cancers, infections would be much better than missing these conditions.
It would take 10,000 x-rays a year for a person to exceed the maximum dose for radiation but that is well beyond the normal 4-20 x-rays taken a year. Folks, its in your best interest to have these x-rays taken and not refuse them. The dentist cannot do a proper exam if they can't see 90% of what they need to evaluate. Refusing dental x-rays is like saying, oh its just a little bit of ice, who cares what lies beneath and try to sail right past.
Want to read more?
The Federal Drug Enforcement Administration aka DEA made a decision to make hydrocodone drugs (commonly know as Vicodin) a Class II drug. What does that mean for patients who are taking it?
This most likely will not be an issue for dental patients who are usually not on prescription pain medications for chronic pain. If you want to learn more visit the DEA website.
I get this question all the time. It is no wonder since if you have been told by your doctor or dentist that you have to take antibiotics because of a heart issue or artificial joint issue you don't want to mess around.
However, recent studies have caused a change and there are now new guidelines for patients who have heart issues and/or have had artificial joints placed. These new guidelines now do not recommend doctors to give their patient's antibiotics for a lot of reasons they used to.
Here is what the American Dental Association has to say. When in doubt, just call your doctor or dentist and we can help you.
Keeping your hygiene in tip top shape is very important so we limit the amount of bacteria that is milling around in your mouth and body. That means brushing and flossing and seeing your dentist and hygienist on a regular basis.
When should you kids have their first dental appointment?
This was a question I was asked yesterday, and a question we get asked often. The answer might surprise you.
The American Dental Association recommends for your child's first dental visit to be at the age of 1 or within 6 months after his or her first tooth comes in. That might seem very early but this is as much of a visit for the parents as it is for the child.
The dentist and team can talk to you about how you can help your child avoid dental issues that occur with not having the right information when your child is young.
Its always a good idea to have the child get used to coming to the dentist when there is no discomfort. This way they won't associate discomfort or be anxious every time they see the dentist. When they need help, they will be very comfortable coming to the dentist for treatment.
This give you an opportunity to ask questions about how to care for your child's teeth so you can avoid problems like cavities or oral habits that could lead to treatment.
We have seen and treated children as young as one year at our office. We feel it is a great honor to be the first dentist that a patient sees and we do not take it lightly. What we want to do is to make that appointment as fun and easy as we can so that that little 1 year old will have an easier time in life when they feel like going to the dentist is no big deal and actually kinda fun.
This sets them up for a lifetime without dental anxiety. Hopefully what we do when they are here for their first visit makes the patient feel comfortable to go on a regular basis as older children and adults so problems can be caught early and treated with the least invasive procedures instead of letting fear or anxiety cause them to put off care leading to more invasive dental work.
So bring them in to the dentist early! Its also fun to have a cute picture of your little one sitting in a dental chair to post on Facebook for your friends and family to see.
Oil pulling is an Ayurvedic treatment which is an Eastern medical practice of Indian origin. This alternative medical practice of swishing oil (sesame or sunflower) in the mouth for a 2-3 minute period has been in practice many years before but seemed to recently been highlighted in our culture.
It is easy to get swept up in remedies that are shown to us on television shows but it is always a good idea to research this independently since sometimes the health or medical information you get from these places might be toted more for ratings rather than your well being. Doing a Google search will not be helpful since there is a lot of unsubstantiated information all over the internet.
There are many complementary and alternative medical treatments that could benefit you greatly so they shouldn't be dismissed. You should look for topics in medical or dental journals which have peer reviewed articles based on scientific studies.
I know that not everyone can read those without their eyes crossing. That is why it might be a good idea to ask your medical and dental professionals. They can sift through all of it for you and boil it down to an answer to your question
That being said, this article, a review on holistic approaches to dental health seemed to summarize it best. Oil pulling works as an add on to proper brushing and flossing (brushing twice a day for 2 minutes each and flossing once a day) not as a replacement. Sorry folks, we still have to floss.
The studies didn't mention gum disease only inflamed gums. So if your gums are pretty healthy and you would like to add a holistic approach to your oral health care go ahead and try oil pulling.
Dentist: "There is decay on your tooth. It has just past the protective layer of enamel but now we will need to restore it. Your options are a filling to remove decay or do nothing and the decay will spread."
Patient: "But how can I have a cavity if it doesn't hurt?"
We hear this exchange often and I am going to let you know why you shouldn't wait till things hurt. Actually, that sentence is self explanatory: Why not treat something now before it gives you symptoms of pain and discomfort.
However, a cavity is not a cavity is not a cavity. Let me explain. You need three things for a cavity: tooth structure, bacteria and sugar. When bacteria eat the sugar you leave behind on and in between your teeth they make acid and that acid breaks down the tooth. This makes a nice little hidey hole for bacteria to hang out in. They continue to eat the sugar you leave there and make more acid making a larger hole.
Your teeth are made out of layers. The outside is a very hard enamel made of minerals. right below the enamel is the dentin, a softer material with channels leading into your nerve. At the core of your tooth lies your pulp which is where your nerve and blood vessels are.
If we see the bacteria working a little into your enamel, you still have a chance to reverse it. You can do this by using floss at night so you wipe the area clean, then use a rinse with extra fluoride. This fluoride will plug up the damage done by the bacteria.
If we see a cavity that has just started, meaning the damage the bacteria has made is past the protective layer of enamel and just started to get into the layer below we will recommend to have it repaired with a filling. The smaller amount we have to remove and replace with a filling, the longer the filling will last and the less invasive the procedure, meaning quick healing time and less sensitivity as the tooth heals.
If you wait until it hurts the bacteria and acid have burrowed their way very close to the nerve and destroying your tooth in the process. Now a lot of your tooth is decayed. That large amount has to be removed so there is not a lot of support for the filling. These fillings do not last as long and it take a while for your tooth to heal after it is placed.
That is of course if those bacteria haven't used those channels to take a highway to your nerve. Once they get in there, no filling can fix the tooth, the infection is irreversible and more complicated treatments need to be done or you can lose the tooth all together.
So when you have the chance to fix something when it doesn't bother you, think about what it means to wait till it hurts. I hope this information is helpful.
Thank you for visiting the inaugural post on this blog. I wanted to start this blog for a number of reasons. First, I felt myself thinking I wish my patients knew <insert not-so-secret-way-of-having-healthy-teeth here> a while ago. It might have saved them time, money or discomfort. Secondly, patients ask me questions. I thought to myself, if one patient spoke up about a question they have there must be so many more people wondering the same thing.
I also wanted a place that people can go to just learn about their oral health that isn't too stuffy. I will try not to fill this post with a bunch of dental jargon that you will have to look up online. If you are an existing patient you have probably heard me say things you will be reading in this blog but bear with me there might be some fun new stuff for you guys too.
Well, if this sounds like something you are interested in, come back and visit often. I hope to have a weekly snippets of information for you. So if you want to learn how to take better care of yourself, find out some basic Dental 101 knowledge or just are bored and feel like reading something slightly educational check back soon!
Dr. Ila Mankad is a general dentist in Brentwood California. She wants to teach patients the not so secret ways of achieving a healthy mouth.