Why Do I Need Fluoride?

Many of our patients know that we consider fluoride an amazing tool. The increased use of fluoride has Fotolia_21298027_XS1-213x300changed dentistry radically over the past forty years or so. So although you probably are familiar with fluoride, this post is really to answer the question: Why do I need fluoride?  What are the benefits? What are the risks? So lets start with the facts:

Fluoride is a naturally occurring compound found in water, soil and food.

Fortifying drinking water has been recommended by the U.S. Public Health Service to aid in the prevention of tooth decay, they recommend adjusting the naturally occurring fluoride level of existing public and private water sources to reach the optimal level of fluoride which is 0.7-1.2 parts per million or milligram per liter. Fluoride helps prevent cavities by being absorbed into the enamel of the your teeth and fortifying it, making the enamel more resistant to decay and demineralization. This can help in preventing early weakening in the tooth structure and early decay.

What are the risks of using fluoride?

The CDC has done numerous studies, the most common risk noticed is dental fluorosis if fluoride is consumed in a high amount for a long period of time during the development of the adult teeth. Dental fluorosis is pitting or mottling of the enamel of the teeth. Children 8 and younger are the most at risk for dental fluorosis. Also, There has been some speculation about a link between fluoride and osteosarcoma however over the past 60 years of fluoride use and studies no link has been established between bone health and fluoride.
  • The CDC has listed water fluoridation as one of the 10 greatest public health achievements of the 20th century
  • The first city to adjust the level of fluoride in its water supply was Grand Rapids, Michigan on January 25, 1945
  • Although not all water supply is fluoridated around 72.4% of the U.S. population receive fluoridated water.
  • Aside from fluoridated water  you can obtain fluoride from a multitude of sources. Such as, fluoride multivitamins for children, in some foods, as well as many mouth rinses and toothpastes.
  • Fluoride is endorsed and recommended by the American Dental Association as well as many other state and local dental societies.
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A nice post

Frangella Dental medical team in Midtown Manhattan

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Am I Grinding My Teeth At Night?

Chronic teeth grinding or Bruxism is a condition that many people suffer from but are mostly unaware of.Fotolia_4104434_XS-300x184  Bruxism can occur during the day or night but for most people occurs at night. This habit can cause significant damage to the teeth and cause discomfort to the structures that hold your jaw and TMJ in place. Although many speculate what causes people to clench and grind often times there is no clear cause for it and may resolve on its own.

 Common signs that you may be grinding your teeth are:

  • Flattening of biting surfaces of teeth
  • Pain in jaw muscles and temples
  • Pain when biting in molar area
  • Scalloping or indentation of the sides of tongue
  • Scooping out of flat part of teeth along gum line
  • Popping and clicking of the jaw
If you are suffering from symptoms consistent with a chronic bruxer your dentist may recommend treatment with an appliance called a nightguard. A nightguard is a tray that overlays the upper or lower teeth separating them slightly. This helps protect wear of the biting surfaces of the teeth and relieves pressure on the jaw joint and surrounding muscles.]]>

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How To Keep My Toothbrush Clean? And other dental questions.

cavity free mouth and, all the great tools available to help you do so. Fotolia_5327278_XS-resized-600 Next comes the last part, maintenance of your repertoire of home care tools. So if you’ve ever wondered ‘How to keep my toothbrush clean?’ then read on..

Your toothbrush is the most important tool in your home care regimen so keeping it clean and up to date is very important. Here are the basics:

1. Whether using an electric toothbrush or a manual toothbrush it should be replaced every 3 months. The easiest way is to change your brush or electric toothbrush head with the change of the seasons or if the bristles begin to look splayed or frayed. 2. While brushing your teeth your brush is cleaning all the debris, plaque and bacteria that you’ve accumulated over the day. After brushing you should sanitize your toothbrush, we recommend rinsing it with Listerine then rinsing with water and letting air dry. 3. And lastly, When storing your toothbrush you want to store it head up allowing it to air dry in an area away from an open toilet. If you can store it in a medicine cabinet or something similar that is best.

Many of our patients own and use appliances at home whether they be retainers, Invisalign aligners, nightguards or sleep apnea oral appliances, these appliances need special care to maintain them and keep them clean.

1. In the morning upon removal of the appliance you should use a wet toothbrush to gently clean off the appliance, stay away from abrasive toothpastes when cleaning any appliance made of acrylic or soft rubbery material as the toothpaste may cause it to become porous and more susceptible to bacteria buildup. 2. Many of your appliances can be soaked in a chlorhexidine mouth rinse or Listerine for a period of time to help reduce bacteria build up as well. Please check with your dentist before you do so as some of these rinses may stain certain materials 3. Also, for clear retainers and Invisalign aligners, often over time the aligners may discolor due to normal wear. You can place your retainer or aligner in a small glass of water with a cap full of hydrogen peroxide, this will help clear up the stain on the aligner.]]>

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Energy Drinks and Your Teeth

Fotolia_40413702_XS-200x300The studies were spurred on by the increase in consumption of sports and energy drinks, especially by adolescents. The study warned that both sports drinks and energy drinks have pH levels that are at a level of acidity that can cause demineralization or weakening of the enamel. Also, they found that they both contain citric acid, included to help improve the taste and shelf life of the drink, which can also have an effect on enamel. The study showed, that although both sports and energy drinks are acidic enough that if  excessively consumed they can cause damage to dental enamel, energy drinks have a “significantly greater potential for enamel dissolution than sports drinks”. The study also brought to light some interesting information:

  • ” Approximately 30-50%  of adolescents and young adults in the U.S. consume energy drinks and that 51-62% of adolescents consume at least one sports drink per day”
  • Energy drinks are a fairly new and quickly growing product and there haven’t been many studies on the effects of energy drinks. One statistic showed that energy drinks are such a growing market that “200 new brands of energy drinks were launched in 2007 alone”. Also, because of new flavors and formulations are being created so frequently and the vast differences even between effects of flavors of the same brand, it is very difficult to generalize about these effects.
  • Different flavors within the same brand had different levels of acidity.
  • Of all the drinks tested “Gatorade Blue was found the highest titratable acidity” Also, Red Bull Sugar Free, Monster Assault, 5-Hour Energy, Von Dutch, and Rock Star had higher acidity than Red Bull, Rip It, Full Throttle Fury and MDX.
So what does this mean, should we stop drinking energy drinks? In my opinion that is not what this study means at all. These products when consumed excessively have the potential to create a more cavity prone mouth. So like all things they should be consumed in moderation. Also, due to the acidity of these products it is recommended by the Academy of General Dentistry to wait at least an hour to brush your teeth after consuming a sports or energy drink.    
A comparison of sports and energy drinks—Physiochemical properties and enamel dissolution; By Poonam Jain, BDS, MS, MPH; Emily Hall-May, MS; Kristi Golabek; Ma Zenia Agustin, PhD
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What is Sleep Apnea?

Fotolia_38233787_XS-300x199diagnosed with this sleep disorder but have not sought treatment. And, many do not fully understand exactly what sleep apnea is. Sleep apnea is a condition where an individual stops breathing for ten seconds or more during sleep. This typically can happen between ten and sixty times in a single night. The two types of sleep apnea are: Obstructive sleep apnea, which is the most common type of apnea; and Central sleep apnea. Obstructive sleep apnea is due to relaxation of the muscles around the throat causing an obstruction of air flow in to the nose and mouth. And, Central sleep apnea is caused by a disruption in the signal from the brain that controls breathing. Besides not being able to get a good nights rest, sleep apnea sufferers may be more prone to higher blood pressure and a decreased flow of oxygen to the brain. This may cause fatigue during the day and if left untreated can lead to impaired daytime function.  If you have a weakened heart already, sleep apnea can aggravate your condition by placing stress on your heart while you sleep.  This can lead to heart attack and possibly stroke. The gold standard for treatment of most sleep apnea patients is use of a Continuous Positive Airway Pressure system or more commonly known as CPAP. This type of machine provides constant pressure to help keep the airway open. Some patients are unable to tolerate the CPAP system and then are prescribed by their sleep physicians to have an oral appliance made to help keep the airway open. This appliance is made at your dental office. Your dentist will then  fit adjust and monitored your treatment with the oral appliance.  ]]>

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MRSA and Your Mouth

Over the last few years there has been an increase or reported cases of MRSA infections. Many of my patients ask me about the risk of oral MRSA infections and how it can effect them. Our mouths are home to over 300 different types of bacteria. Fotolia_17801369_XS-200x300In a healthy mouth, these bacteria work together to create a healthy oral environment. But, as in any other system, if things go awry and the balance becomes upset then we find different types of bacteria take advantage of this and begin to thrive.

So does the average person have MRSA in their mouth?

Studies have shown that the population that has the highest incidence of MRSA colonization are elderly patients in nursing homes as well as patients with advanced malignant diseases  suffering from reduced salivary flow rate.

What can they do to reduce the amount of bad bacteria in our mouths?

MRSA tends to like to grow on the porous surfaces of dentures as well as being found in plaque in the mouth. Some studies have shown that a good way to clean MRSA infected dentures is with a chlorhexidine oral rinse as well as soaking the dentures in chlorhexidine for 10 minutes once a week. Dentures should be cleaned daily with a stiff brush and soap and water, not toothpaste. And even, if you wear dentures you should be cleaning your gums and remaining teeth as well. Some studies also suggest microwaving your dentures for 3 minutes. However, I don’t suggest this if you have any portion of your denture that is metal.

What kind of risks are there if you have MRSA in your mouth?

There are no studies that offer clear associations of MRSA colonization in the mouth causing systemic and dental problems. Although, the bacteria having been found in some orofacial abscesses as well as some infections located on the gingiva and corners of the mouth commonly associated with denture wear. So although there have been few instances of this type of bacteria found in oral infections the concern is for the potential for these strains to re-colonize at other body sites or become a source of cross-infection to other patients or hospital/nursing home staff.
The ecology of Staphylococcus species in the oral cavity; A. J. Smith, M. S. Jackson and J. Bagg Staphylococcus aureus in the oral cavity: a three-year retrospective analysis of clinical laboratory data; A.J. Smith, D. Robertson, M. K. Tang,  M. S. Jackson, D. MacKenzie & J. Bagg MRSA infection; K. Valand & P.M. McLoughlin
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Worst Home Remedies For Dental Problems

Fotolia_21448390_XS-199x300Okay, I understand getting to the dentist when you have an emergency can sometimes be hard. And, yes I realize that it’s awfully tempting to try and fix the problem yourself. But, there are just some things you should not do at home. This brings us to this weeks blog post. The WORST home remedies for dental problems. Putting garlic against a sore tooth…. Besides making you smell bad, garlic is very potent and can irritate or burn soft tissues around the tooth causing even more pain and sensitivity. Shaving down a sharp tooth with tools from around the house… Besides the fact that you are putting something that has seen more dirty surfaces than I’d care to mention directly into your mouth, you are putting yourself at risk for damaging the tooth more or slipping and causing damage to your cheeks and gums. Using crazy glue to fix a broken natural tooth... Yes, I know people say the same stuff that’s in super glue is the same stuff used to seal battlefield wounds, and they’d be correct. However, the stuff used to seal battlefield wounds are made specifically to seal battlefield wounds. Using superglue to fix a tooth most likely will result in 1: You super gluing your finger to your lip, cheek, tooth or some variation of the aforementioned. Or 2: Pain from a tooth with a freshly injured dental nerve being assaulted by a brand of material that was not meant to see the inside of your mouth or to fix broken teeth. Trust me, its not pretty…. Whitening your teeth with lemon juice and baking soda… This one, although its gotten a lot of popularity throughout the years, is just not healthy for your teeth. Mixing an abrasive and an acid together and then scrubbing it on your teeth can cause abrasion to your gums while also removing and/or damaging the enamel on your teeth. And lastly, searching through your medicine cabinet and finding a left over prescription from those wisdom teeth you (or someone you know) had extracted about ten years ago… Its not a mystery that taking old, expired or another persons prescription medications is a bad idea. Taking one or two remaining capsules of an antibiotic is not only ineffective, it can also help promote bacterial resistance to antibiotics. Also, taking prescription medications that were not prescribed to you can put you right in the middle of an adverse or even allergic reaction to a drug that no one knows you are taking. So if you are having a problem call your dentist or doctor first before resorting to whats left over in the medicine cabinet. Also, whenever you are prescribed medication once you have finished the prescription if there are any tablets remaining they should be disposed of. So, I’m not saying there are not some things that you can do at home in a pinch to get you by until you can see your dentist. But, in an emergency situation, first and foremost, call your dentist and see when they can see you for an appointment and tell them your emergency. Your dentist will suggest the best way to get you comfortable and safely treated!]]>

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Link Between Bottled Water and Tooth Decay in Children

Fotolia_27127427_XS-300x199 possible link with bottled water.  Some articles have suggested that the increase in bottled water over tap water has decreased the amount of fluoride intake thereby increasing the rate of cavities in children. This statement is not entirely true. Although decreased fluoride intake can increase your susceptibility to cavities it is only one factor in a complex scenario. Also, keep in mind that many bottled water companies do offer water with fluoride in it and also many communities do not have fluoride in their tap water. Over the years dentistry has focused on preventative care with pediatric patients. We do this by recommending good home care, fluoride use, dental sealants and regular check ups. This is only one piece of the puzzle though. One portion of care that dentists do not get to address thoroughly is a child’s diet. With an increase in high sugar and carbohydrate intake, processed foods, and children with little opportunity to brush their teeth during the day, we are seeing more and more children with cavities at a young age. Bottled water is not the enemy, as the International Bottled Water Association stated in a recent article, bottled water does not have sugar in it and is a great and healthy alternative to other bottled drinks on the market. Fluoride is just one step to help our children achieve great oral health. We also have to focus on good nutrition, home care, and regular hygiene visits to help keep our kids healthy!]]>

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Dental X-rays and Brain Tumors

Physicianeffort to keep our patients informed on the most recent dental information we assembled the facts about this study and its findings and our views on dental x-rays. The study suggests that dental x-rays, particularly when obtained frequently and at a young age, may be associated with an increased risk of an intracranial meningioma. The study compared dental and therapeutic radiation histories in 1433 patients against a control group of 1350 subjects. The study was conducted via telephone interviews with patients and information accrued via patients memory. Due to dental records being held at various offices, researchers were unable to validate the samples history due to time and financial considerations.

  • The study states that: “No studies have reported on the association between use of computed tomography (CT) and meningioma risk” as well as: ” The studies that report on dental x-ray exposure are suggestive but are limited by sample size and by the inclusion of cases from time periods with higher dosing regimes than the current era”
  • Meningioma’s are common benign brain tumors originating in the meninges. As reported by the Cancer Brain Tumor Registry of the United States, “Primary brain tumors represent only 2% of all cancers, with 35,000 new cases diagnosed each year in the United States,”  “Meningioma’s occur at a rate of 7.8 per 100,000 per year, but only 25% are believed to be symptomatic, with the others being found incidentally.” Because the overall prognosis for this type of tumor is good and the tumors are commonly asymptomatic, only being found incidentally, many doctors do not recommend treating them and opt to observe the tumors instead.
  • Dr. Elizabeth Claus, the lead author of the study reported is quoted as saying: “Our take home message is don’t panic. Don’t stop going to the dentist” and ” Our study refers to exposures in the past rather than exposures that people are receiving in this day and age”
  • The American Dental Association’s position on dental x-rays is that dentists should order dental x-rays for patients only when necessary for diagnosis and treatment.
So the take home message from this study, as we have interpreted it, is that this is a subject that is important and should be studied further. Because of how the study was conducted and the resulting opportunities for misinformation I can only take this study as a suggestion of a correlation. This study has brought to light  possibilities for increased risk of tumors that should be evaluated using current day risk factors, including exposure to other forms of ionizing radiation as well as solid dental histories in order to give us a better idea of the true potential or x-ray risk and meningioma’s. That being said, x-rays are a crucial part of dental diagnosis, not only for cavities but for lesions of the surrounding structures as well. We have always followed the ALARA principle, which stands for As Low as Reasonably Achievable. In our practice we utilize digital radiographs to lower exposure to radiation and recommend radiographs depending on each patients risks level for new decay. Typically we ask for a full set of  x-rays every 5-7 years and check up x-rays every 1-2 years depending on the individual.
Dental x-rays and risk of meningioma; Elizabeth B. Claus MD, PhD1,2,§,*, Lisa Calvocoressi PhD1, Melissa L. Bondy PhD3, Joellen M. Schildkraut PhD4, Joseph L. Wiemels PhD5, Margaret Wrensch PhD5,6
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