The Truth About Kids, Cavities, and Fluoride

This year Portland, Oregon made national headlines when the majority of voters rejected a measure to add fluoride to the city’s public water system. The debate was heated, and as a whole, the final decision was criticized by many as ill-informed and not in the best interests of our children. As a dentist, it may surprise you to know that I do not believe Portland was wrong in their decision, but my reasons have little to do with the fluoride itself.

Certainly, I am fully aware of the dental benefits that topical fluoride can provide to children and adults under the right circumstances. The scientific evidence is clear that fluoride does contribute to stronger enamel development and thus helps prevent cavities. In our modern society, however, tooth decay simply does not happen because we lack fluoride. It happens because of what we eat and how we take care of our teeth. Fluoride can be a helpful aid in the battle against decay, but it is not the cause or the ultimate solution to the problem.

Tooth decay is caused by pathogenic bacteria that live in our mouths. Everyone has this bacteria and there is no way to remove it completely without also removing beneficial forms of bacteria that live in the mouth as well. Preventing the development of tooth decay is all about controlling the numbers of these pathogenic bacteria through diet and home care (brushing and flossing).

The bacteria responsible for tooth decay thrive on sugar, refined flour, and acid. Diets high in sugar, high-fructose corn syrup, white flour, and acid are the quickest way to multiply the number of pathogenic bacterial colonies in the mouth. Sugar-sweetened beverages are especially attractive to these bacteria because they often contain high amounts of both sugar and acid.

The most common chronic condition in Oregon children is tooth decay. In 2011, the Oregon Public Health Division reported that in Oregon, more than 177 million gallons of sugar sweetened beverages are consumed each year (read report here). That amounts to approximately one gallon per week for every man, woman, and child in the state. The same report quoted a survey of Oregon mothers indicating that about half of the 2 year olds in Oregon drink sugar-sweetened beverages at least once per week.

What troubles me most about these statistics is that they do not include all the other food sources of sugar and acid in a child’s diet that also contribute to tooth decay (and childhood obesity). Fruit juice, for example, may not be sweetened with sugar but can still have the same effects on the teeth and the body. Fructose is a naturally occurring form of sugar found in all fruit and bacteria feed on it just as easily – especially when all the fiber of the fruit itself is removed during the juicing process. And certainly, when a child is drinking a sugary beverage, the likelihood that he or she is also eating a meal or treat that is high in sugar, acid and/or refined white flour is fairly high.

In the battle against tooth decay, every little bit counts, and when tooth decay in children reaches epidemic proportions, water fluoridation as a stop-gap is an option we all need to consider. But consider this as well: If a child’s diet is filled with sugars, highly-refined flours, and acid, fluoridated water is simply not enough. And if that same child also does not brush and floss his or her teeth – or they do not know how to do it correctly – then nothing (including fluoridated water) will be able to prevent tooth decay from developing.

Information is perhaps the most powerful tool there is in preventive medicine. In my continuing effort to provide relevant information on how to care for your teeth and prevent decay no matter where you live or what kind of water you drink, I have created several informational resources that I hope you will take the time to review for your own health and the health of your children.

Kids and Cavities
How to Brush and Floss Your Teeth
A Parent’s Guide to Oral Health for Kids and Teens
Drinks That Eat Teeth
A Guide to Added Sweeteners

As always, I encourage you to read and learn as much as you can from as many reputable sources as possible in order to make the best decisions possible for yourself and your family.

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Avoiding Dental Emergencies

While there are many ways that the mouth or teeth can be injured during an accident that might require immediate care, the fact is that most truly emergent dental conditions (abscesses and other forms of rampant bacterial infection) do not evolve overnight, and most are completely preventable.

Unfortunately, when it comes to health and dental care, we all succumb to the ‘if it ain’t broke, don’t fix it’ philosophy now and then. The problem with that analogy when it comes to our bodies is that we often cannot see the breakage that is already underway until it is too late. Bacterial changes in the mouth begin at a microscopic level, and cracked or weakened teeth are generally not visible to us in the bathroom mirror. These are the signs that an emergency situation is developing. We may not know exactly when the tooth will break or the abscess will occur, but we do know that it won’t get better by ignoring it.

Just as we would never wait for a bridge to fall into the river before we make a plan to fix it, we should never wait for a weakened tooth to break or a minor infection to develop into an abscess before we make a plan to treat it. Necessary dental treatment tends only to get more complicated and expensive the longer we wait to have it done. And if we wait too long, the severity of the infection or breakage may make it impossible to save a tooth at all.

When possible, regular dental care combined with a healthy diet and good oral healthcare habits at home are your best defense against a dental emergency. Your dentist and hygienist can help you identify the areas of your mouth that are susceptible to decay, infection, or breakage and help you make a plan to improve the overall health and stability of those areas before further damage occurs.

Of course, emergencies can still happen. Even with regular dental care, it can be a few months between visits and conditions can sometimes change in the mouth in a matter of weeks. Stress, changes in diet, accidents, increased clenching or grinding habits, and medications can all affect the delicate balance in the mouth. Whenever you notice a subtle change in your mouth that recurs or does not go away within a day or two, take notice and call your dental office for advice if the trend continues.

There are some situations where simply taking notice is not enough though, and for that we have created A Guide to Dental Emergencies. Here you will find an index of symptoms that can develop in the mouth, what they can mean, and how soon you should consider seeking dental or medical care. When in doubt, however, you should never hesitate to call your dentist to ask whether or not you should come in for an appointment. Communicating your symptoms and concerns to your dental team is the most important part of your partnership with your dentist in preventing future dental emergencies.

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Healthy Teeth Begin at Home

When I was in dental school, the professors used to tell us that we would see an end to tooth decay in the United States within our lifetime. Our understanding of the mechanism of decay along with the readily available tools and information about nutrition and home care techniques made us all believe that this could be true. Unfortunately, the reality has been quite the opposite.

If anything, tooth decay seems to be on the rise. It saddens me to say that more than a few of my young patients have come into the office in recent years with a sudden development of 10 or 12 cavities, or more. Processed, highly refined, and highly concentrated foods and beverages that contain large amounts of sugar, simple carbohydrates, and acid are certainly a huge part of the problem. But in every single case of extensive decay that I have seen in both children and adults, inadequate home care is always a factor.

I firmly believe that the most valuable teachings we can offer our children about healthy living are based in good nutrition and personal hygiene. And the hygiene of the mouth is a critical part of that picture. What happens in the mouth – what we eat, what we drink, and the bacteria that thrive as a result – can have a profound influence not just on our teeth, but on the health of the entire body.

I have not given up on the idea that tooth decay will someday be a thing of the past, but the key to that change starts at home. It’s never too late to improve the health of your mouth, and it’s never too early to start your kids on the right path to developing good oral hygiene habits. This month, I’ve created a resource specifically for parents to help you guide your children through each stage of their dental development at home. It is my hope that this information will help your children develop habits that will allow them to keep their teeth for a lifetime and get us all one step closer to the end to tooth decay.

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what the mouth can tell us

Speech may well be one of the most powerful gifts our mouths have given us, but it’s very possible that the health of the mouth itself could be telling us so much more than anything we can say.

In my practice, I have always been amazed by the way chronic disease, stress, and hormonal fluctuations are reflected in the bacterial environment in the mouth. Often these changes are noted long before a medical diagnosis can be made, and I always encourage my patients to have regular medical check-ups – especially when a major change in the mouth that cannot be explained by diet appears.

Recently, Christina Warinner, an archeological geneticist, appears to have taken this idea even further in her studies of the fossilized dental plaque found on the teeth of ancient peoples. By analyzing the microbial DNA captured in the fossilized plaque, she has been able to extrapolate information about the kinds of diseases and infections these people lived with and possibly even died from. In her TED Talk, she even jokes that we could all do future archeologists a favor by not brushing our teeth because the data is so intriguing.

Of course, as a dentist I would never recommend that you stop brushing your teeth for the sake of science. But what does excite me about these findings are the possible diagnostic applications for the future. Imagine if we could take a sample of dental plaque from a living patient and have a more precise indication of what system in the body may be compromised just by the types and numbers of microbes that are present. Non-invasive screenings based on the interrelationships between bodily systems may not be as far off as we think. And the idea that we are what we eat may very well turn out to be more meaningful in terms of whole-body health than we ever thought possible.

We still do not understand exactly how oral bacteria and chronic disease are related, but we do know that they are. This month, I’m talking more in depth about what dental plaque is, how it grows, and how we can all protect our teeth – and possibly even our bodies – from the damage that an overgrowth of oral bacteria can create. I hope that you will take a look at The Story of Plaque, and feel free to ask me or my staff any questions you may have about the specific environment in your mouth at your next appointment.

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does flossing matter?

I really try not to give the dreaded “flossing lecture.” I really do. I believe that people should have control over their own health and if they choose not to do something, that is their prerogative.

But the more I read about the connections between gum disease and other chronic health conditions, the harder it is to keep quiet. I don’t pretend that flossing will change the world, but it might change your health.

Shortly after I began working in a dental office in the early 1970s, I discovered that my father had advanced periodontal disease. He was seeing a dentist whose only advice was “I am going to have to make you dentures in six more months.” The dentist I worked for at the time believed in prevention to his core, and it was from him that I first learned about proper home care. When I next visited my father, I taught him everything I had learned. The results were astounding, and even his dentist couldn’t believe the improvement. My father, of course, found a new dentist who also shared a preventive philosophy. And since that time, he has only lost two more teeth. One was lost because of decay on the roots (stayed tuned for more on that), and the other had tipped severely from losing the tooth in front of it due to his periodontal disease years ago.

I continue to be surprised by the number of new patients I meet who haven’t been properly taught to care for their teeth. They may have been told to brush and floss, but these are skills that must be learned and practiced. Telling simply isn’t enough. This month we have posted a brushing and flossing resource article specifically designed to teach you these skills. Even if you have been brushing and flossing regularly for years, I urge you to review this article. I cannot tell you how many people brush and floss regularly with the best of intentions, only to discover that their efforts are ineffective because of improper technique.

Obviously, the home care techniques we recommend are designed to aid in the prevention of decay and periodontal disease. But we continue to learn that controlling oral bacteria may play a role in the prevention of so much more. Recently, I read an article in the Journal of Periodontology that details research which demonstrates that many respiratory diseases may have their beginnings in the aspiration of oral bacteria and other organisms into the lower respiratory tract. Pneumonia can originate from the mouth and inflammation in the mouth seems to exacerbate COPD.

The research messages are becoming clear: To stay healthier, you must reduce the bacterial load in the mouth as much as you can. And flossing and brushing are the best first defense in this effort to control bacterial growth. You owe it to yourself to take the time every day to thoroughly clean your mouth.

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