Big Red Tooth – Dr Candice Schwartz

Where teeth and health meet

What is a dental microscope ?

The use of a dental microscope in routine dental treatment has truly revolutionized the way dentist operate and the level of care that is provided. With a dental microscope, procedures can be carried out more accurately and more reliably using up to 24 X magnification of the teeth and surrounding structures. The dental microscope is the single most significant acquisition to enhance an operator’s clinical skill set. All dentists can do better work with the operating microscope. Margins that might inadvertently be left open can be closed. Cracks can be more accurately diagnosed, and treated. Caries that, in the past, needed to progress until seen with the naked eye can be treated earlier. Most dental needs can be treated more conservatively, with less loss of healthy tissue.

Never before has the dentist been so well equipped. A dentist using a microscope is better able to diagnose pathologies. The dual advantages of increased illumination and magnification provided by the surgical microscope make the delivery
of dental care easier. The initial rewards of vision enhancement are improved visualization, greater accuracy in eye-hand movements, and improved ergonomics.

Improved lighting, coupled with magnification, provide a clear distinction between surfaces that may look similar in color or texture under traditional working conditions, but look very different under the microscope. Decay, dentin, enamel, composite and porcelain are easily distinguishable from one another and can be viewed with unprecedented detail under the scrutiny of a microscope.

Dental microscopes can play a fundamental role in the daily comings and goings of an experienced dental practitioner. It is now widely regarded as one of the most important pieces of equipment in a dentist’s room. Dental microscopes are also beneficial for patients, as the microscope enables the patient to see inside their mouth, giving them a better understanding of what is going on and enabling them to participate in the treatment process. The microscope may be particularly beneficial for patients who are a little anxious about having treatment, as the dentist can explain what is going to happen more clearly.

Through the use of dental microscopes general dentistry has been allowed to advance and modernize, giving both dentists and patients a level of care and treatment that is second to none.

I am extremely proud and excited to be introducing the Seiler Evolution XR6 dental microscope to my practice. This is a huge step and will elevate the level of care I give my patients to even greater excellence. Read more on the Seiler website…

 

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Tooth decay and your diet

This post looks at how to reduce tooth decay through your diet.Teeth are constantly changing. The tooth consists of different layers. The innermost core of the tooth (called the dental pulp) contains a mass of nerves and cells. These cells have a regenerative function. So teeth are able to heal themselves. This is why some cultures like the African Wakamba tribe can file their front teeth into sharp points without causing damage. The process of regeneration is slow (like the process of tooth decay). Fortunately, a decaying or broken tooth has the ability to heal itself. Pulp contains cells called odontoblasts, which form new dentin if the diet is good. Below is a copy of what Dr. Edward Mellanby commented about his wife’s research on the subject. This is taken from Nutrition and Disease:

Since the days of John Hunter it has been known that when the enamel and dentine are injured by attrition or caries, teeth do not remain passive but respond to the injury by producing a reaction of the odontoblasts in the dental pulp in an area generally corresponding to the damaged tissue and resulting in a laying down of what is known as secondary dentine. In 1922 M. Mellanby proceeded to investigate this phenomenon under varying nutritional conditions and found that she could control the secondary dentine laid down in the teeth of animals as a reaction to attrition both in quality and quantity, independently of the original structure of the tooth. Thus, when a diet of high calci­fying qualities, ie., one rich in vitamin D, calcium and phosphorus was given to the dogs during the period of attrition, the new secondary dentine laid down was abundant and well formed whether the original structure of the teeth was good or bad. On the other hand, a diet rich in cereals and poor in vitamin D resulted in the production of secondary dentine either small in amount or poorly calcified, and this happened even if the primary dentine was well formed.

Drs. Mellanby set out to see if they could use their dietary principles to cure tooth decay that was already established in humans. They divided 62 children with cavities into three different diet groups for 6 months. Group 1 ate their normal diet plus oatmeal (rich in phytic acid). Group 2 ate their normal diet plus vitamin D. Group 3 ate a grain-free diet and took vitamin D.

In group 1, oatmeal prevented healing and encouraged new cavities, presumably due to its ability to prevent mineral absorption. In group 2, simply adding vitamin D to the diet caused most cavities to heal and fewer to form. The most striking effect was in group 3, the group eating a grain-free diet plus vitamin D, in which nearly all cavities healed and very few new cavities developed. Grains are the main source of phytic acid in the modern diet, although we can’t rule out the possibility that grains were promoting tooth decay through another mechanism as well.

Dr. Mellanby was quick to point out that diet 3 contained some carbohydrate (~45% reduction) and was not low in sugar: “Although [diet 3] contained no bread, porridge or other cereals, it included a moderate amount of carbohydrates, for plenty of milk, jam, sugar, potatoes and vegetables were eaten by this group of children.” This study was published in the British Medical Journal (1) and the British Dental journal. Here’s Dr. Edward Mellanby again:

The hardening of carious areas that takes place in the teeth of children fed on diets of high calcifying value indicates the arrest of the active process and may result in “healing” of the infected area. As might be surmised, this phenomenon is accompanied by a laying down of a thick barrier of well-formed secondary denture… Summing up these results it will be clear that the clinical deductions made on the basis of the animal experiments have been justified, and that it is now known how to diminish the spread of caries and even to stop the active carious process in many affected teeth.

Dr. Weston Price also had success curing tooth decay using a similar diet. He fed underprivileged children one very nutritious meal a day and monitored their dental health. From Nutrition and Physical Degeneration (p. 290):

About four ounces of tomato juice or orange juice and a teaspoonful of a mixture of equal parts of a very high vitamin natural cod liver oil and an especially high vitamin butter was given at the beginning of the meal. They then received a bowl containing approximately a pint of a very rich vegetable and meat stew, made largely from bone marrow and fine cuts of tender meat: the meat was usually broiled separately to retain its juice and then chopped very fine and added to the bone marrow meat soup which always contained finely chopped vegetables and plenty of very yellow carrots; for the next course they had cooked fruit, with very little sweetening, and rolls made from freshly ground whole wheat, which were spread with the high-vitamin butter. The wheat for the rolls was ground fresh every day in a motor driven coffee mill. Each child was also given two glasses of fresh whole milk. The menu was varied from day to day by substituting for the meat stew, fish chowder or organs of animals.

Dr. Price provides before and after X-rays showing re-calcification of cavity-ridden teeth on this program. His intervention was not exactly the same as Drs. Mellanby, but it was similar in many ways. Both diets were high in minerals, rich in fat-soluble vitamins (including D), and low in phytic acid.

Price’s diet was not grain-free, but used rolls made from freshly ground whole wheat. Freshly ground whole wheat has a high phytase (the enzyme that degrades phytic acid) activity, thus in conjunction with the long yeast rises common in Price’s time, it would have broken down nearly all of its own phytic acid. This would have made it a source of minerals rather than a sink for them. He also used high-vitamin pastured butter in conjunction with cod liver oil. We now know that the vitamin K2 in pastured butter is important for bone and tooth development and maintenance. This was something that Dr. Mellanby did not understand at the time, but modern science has corroborated Price’s finding that K2 is synergistic with vitamin D in promoting skeletal and dental health.

In these early studies, it is clearly evident that diet is a huge contributing factor to tooth decay. This fact seems to have fallen to the back of most dentists’ minds and their patients. It is important to remember that tooth decay needs a substrate of carbohydrate to occur. Without this, the decay process cannot take place. It is almost impossible to eliminate this carbohydrate substrate from our diet entirely and from our mouths, however when it is reduced, the impact is exponential and the decay process is halted in its tracks.

More emphasis needs to be placed on diet. A combination of a caries-preventing diet and good oral hygiene practices will inevitably result in a reduction and elimination of decay.

Some elements to bring into your new and improved “decay reducing” diet I have recommended below:

  • Bread and refined grain products (like cereals) should be limited/avoided.
  • Limited nuts; beans in moderation, only if they’re soaked overnight or longer in warm water (due to the phytic acid).
  • Increase your intakes of GREEN, leafy vegetables
  • A limited quantity of fruit and especially fruit juice
  • At least two portions of cooked/raw vegetables daily
  • Vitamin D3 supplements (this also boosts the immune function)
  • Eliminate all processed and “fast” foods from the diet.
  • Constant sipping of water throughout the day.
  • Eliminate all fizzy cool drinks and “sticky sweets” (like toffees and fizzers)
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