Big Red Tooth – Dr Candice Schwartz

Where teeth and health meet

What is preventative dentistry?

What is preventative dentistry?


The days of false teeth and dentures are in the past. It is now expected to retain all your natural teeth throughout your lifetime, and every measure is taken to prevent the loss/extraction of an adult tooth. The care and awareness of the mouth and teeth needs to start from birth. Children who have a healthy, cavity free primary dentition, usually have a strong, healthy adult dentition with fewer problems. One of the key elements in maintaining healthy teeth starts with good preventive strategies. It is important to find a dentist that practices preventative dentistry and focuses on the prevention of dental decay.

Does your dentist practice preventative dentistry measures?

Birth – 1 year of age


During the first year of your baby’s life is an exciting time of learning and experiencing the world. Your baby will encounter new sensory experiences every day. From birth you must clean your baby’s gums and sulci (the space where milk collects between the cheek and the gums) and the tongue. Using a soft piece of gauze in the mouth in conjunction with a xylotol based (fluoride free) age appropriate toothpaste to clean the mouth twice daily will reduce the risk of Candida infection (thrush) and will reduce the amount of bacteria living in the mouth. At 6 months of age (or when the first tooth appears) it is time to move onto a natural rubber finger brush. Massage your baby’s gums and brush their newly erupted teeth with Xylotol based toothpaste.


Why Xylotol?


Frequent eating of foods high in sugars and starches promotes tooth decay. Xylitol may reduce the risk of tooth decay if used whilst maintaining a low sugar diet. Many large-scale clinical studies have shown it to have long-lasting dental benefits. Over 25 years of clinical testing confirms that Xylitol is the best sweetener for teeth, which has led to official endorsements by dental associations in Finland, Norway, Sweden, England, Ireland, Estonia and the Netherlands of products containing high levels of this sweetener. A toothpaste containing Xylotol is one of the proven methods of reducing acidity in the mouth and reducing the incidence of dental decay.


What’s next?


Your child’s first visit to their dentist should coincide with their first birthday. Do not expect too much from your child at this stage, however it is an important time for your pediatric dentist to educate you about the dos and don’ts of taking care of your child’s teeth. Let your baby play in the dental chair, spend time getting to know their new dentist and become familiar with the dental setup at the practice. Every positive experience at the dental surgery will reinforce a good relationship with their dentist and build trust.


At one year of age it is time to bid farewell to your baby’s nighttime feeding habits. At this age, infants no longer require any milk for additional nutrition, as their nutritional needs should be met in full with solid meals during the day. Milk bottles after one year of age serve only as a pacifier and this habit is extremely difficult to break. Milk bottles/breast feeding before bed or during sleep time will wreak havoc on your child’s immature, newly erupted teeth. Nursing bottle caries occurs in infants who are left to suck on a milk bottle/breast fed throughout the night. Sugary drinks (fruit juice, honey sweetened tea) given in a bottle/sippy cup will also result in rampant decay of your infant’s teeth. Give only water at night. Never dip your baby’s pacifier in honey or any other sweetener.


2 -3 years old


By the time your child reaches 2 years of age, they should be familiar and completely comfortable with their dentist. They should feel happy to sit alone in the dental chair and experience having their teeth polished and inspected by their dentist. Children should visit their dentist every 5 months throughout their childhood. At approximately 2 ½ year of age, you should initiate a flossing routine. Flossing the teeth should be done every night after brushing. If practiced regularly, it will setup a lifelong habit of flossing for your child.


Fissure sealants


The fissures are the grooves present on the top surface of molar teeth. These run deep within the tooth’s structure and their full depth cannot be penetrated during brushing by toothbrush bristles. For this reason, your pediatric dentist will place sealants to close up these fissures. This prevents dental decay occurring in the fissures- one of the most common sites of dental decay in children’s teeth. Fissure sealants can be placed as early as 2 ½ years of age, if your child is compliant and relaxed in the dental chair.




It is essential to brush your child’s teeth in the morning and at night. Regular removal of plaque from the teeth is the only way you will effectively prevent dental decay. If your child puts up a fight when it is time to brush teeth, nothing sends the message home faster than a dental check up, cleaning and a chat with the dentist. Your pediatric dentist has many tricks up their sleeves when trying to convince and teach children the importance of brushing. Once again, a good relationship between your child and their dentist will prove highly beneficial when trying to motivate and improvement in their brushing habits.




Many thousands of years ago, dental decay did not exist. The reason for this lies in the diet of prehistoric man. Early man had a diet high in raw fruits and vegetables and a relatively low protein content. Food was also very fibrous with zero refined carbohydrates and very low sugar content. They drank only water.

Minor dietary changes will make a great impact on the health of your child’s mouth. Fruit juice is extremely acidic and destructive. Children should drink only water. Limit the intake of refined carbohydrates like potato crisps, bread, muffins, cake, and cookies. Do not allow unhealthy between meal snacking. Give only sugar free between mean snacks. Steer clear of sticky sweets like fizzers, toffees and suckers.


Prevention is better than cure


Above all else, develop a trusting, positive relationship with your dentist. If you and your child trust your dentist and visit regularly, the road ahead will be a smooth, cavity-free journey.

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Diet and teeth.

How does diet affect your children’s teeth?


Diet is the key to a healthy, cavity free mouth. Many parents believe that choosing the best toothpaste will protect their young one’s mouths from holes and problems. This is unfortunately not the case. In order to fully understand the concept of diet affecting our teeth, you will need a short biology lesson.


Streptococci Mutans and Lactobacilli are the most common bacteria in the mouth responsible for tooth decay. When sugar is present in the mouth, these bacteria thrive off it, but unfortunately for us, through their own digestive process of these sugars, the waste products produced are acid. Specifically known as lactic acid, these by products leach out the calcium present in the teeth, thereby slowly weakening it. Over time, this demineralization (leaching out of calcium) of the tooth surface produces a hole. When sugars are present in high amounts, plaque forms. Plaque is the white/yellowish fur that we brush off our teeth every day. If plaque is left to ferment on the tooth surface, a cavity will result.


The goal in controlling plaque formation and cavities is to ultimately reduce the total intake of dietary sugar. It must be stressed however, sucrose (found in all sweets) is not the only sugar which damages teeth. Glucose (found in breads and rice), fructose (found in fruit), maltose (found in cereals and pastas) and lactose (found in milk) are all easily digested by mouth bacteria to form acid and destroy teeth. Dietary changes to alter the acidity of the mouth will directly reduce amount of plaque build up on the teeth, thereby reducing the chance of dental decay.

Our bodies do have a natural defense against acidity and this is saliva. Saliva acts as a natural cavity fighter. One of the key strategies in cavity reduction/elimination is to keep your mouth at a more alkaline pH (reduce bacterial acidity) throughout the day for longer periods. You do this by increasing saliva production and encouraging saliva production between meals.

This is how it works: When we eat a meal the pH of our mouths change in accordance to the type of food we have just eaten. Food containing higher amounts of carbohydrates and sugars will leave the mouth with an acidic pH, ranging from 1- 5. Increased saliva production will kick in and our saliva will buffer this acidity, slowly raising it back to the resting pH of approximately 7.5. If immediately after eating your main meal you have a sweet treat (piece of chocolate or a dessert), the acidity of your mouth does not change by much. Saliva is still produced and your mouth will quickly recover back to an alkaline pH, which does not allow sufficient time for bacterial colonization and acid production. The problem encountered, particularly with children, is sugary snacks given in between meals. Sugary snacks given an hour after a main meal will bring the pH of the mouth back down to an acidic level and bacteria will begin to thrive and produce more acid. It does not give the mouth time to recover from the acid overload and the mouth remains acidic for most of the day. This gives bacteria plenty of time to produce acidic waste and demineralize the teeth.

Give your children sugar free snacks between meals. Example: whole fruits and vegetables, nuts, sugar free (xylotol containing) chewing gum, cheese. Beware of dried fruit; this is very acidic and very high in sugar and not a good choice for in between meal snack.

Quick easy steps to making your child’s diet a tooth friendly diet


–     Allow sugar intake (sweets and treats) directly after main meals only. When sugar is given between meals as a snack, this leads to a high incidence of decay. The frequency of sugar intake has more impact than the amount of sugar intake. Between meal snacks should contain no sugar.


–      The best type of sweet for a child is chocolate. Sticky sweets like toffees/fizzers/jelly sweets/suckers stick in between and around the teeth and result in destruction of the teeth for a much longer duration as the sugar lies in and around each tooth. It is difficult to clean this sugar off the teeth and they are extremely acid producing.

–      Beware of dried fruit; this is not a good snack. It has a very high sugar content and high acidity. It not only causes dental decay but acid erosion of the teeth.

–      End each meal with a small piece of cheese/some milk/xylotol chewing gum. This neutralizes the mouth and stimulates saliva production.

–      Limit fruit juice intake to ½ a cup per day (if needed). I always advise parents to try to eliminate all juice and sodas from the diet. They do not give hydration. Children should only drink water. If your child does drink a soda/fruit juice, ensure they drink it through a straw, so it bypasses the mouth and the teeth and is swallowed immediately.

–      All babies must be weaned off their nighttime milk bottle/breast feed by the age of 1. At 1 year old they no longer require the nutrition of the milk during the night, as their diet is predominantly solid food. If your child still enjoys the bottle as a pacifier at night, put only water in this bottle. Rampant dental decay results if children are kept on a bottle/breast past one year of age.

–      Never add sugar/honey to rooibos tea. This sugar will rapidly decay teeth, especially if given through a bottle/sippy cup.

Dental decay is a preventable disease. Diet is at the centre of this preventative concept. Without a lower sugar intake, you cannot expect a cavity free mouth. The acidity produced by sugar does not only affect the mouth. This type of acidic environment in the body allows viruses/bacteria/infections to thrive and leaves the body more susceptible to disease. Reducing/eliminating sugar from your child’s diet will have positive effects in all the bodily systems. Change their eating habits today.




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There are many myths associated with teething which date back to the dark ages. Babies are protected by their own natural immunity that was transferred to them through their mother’s placenta and this immunity lasts until approximately 6 months of age. A large majority of babies are also breast fed up until 6 months of age and gain immunity through the breast milk. So at 6 months there is a sudden drop in these forms of natural immunity and protective antibodies, which increases risk for infection. Coincidentally it is at around 6 months of age that the first teeth usually appear. For this reason it is doubtful that teething causes symptoms (like fussiness, diarrhea, runny nose and fever) but in actual fact these common symptoms are not related to teething at all and just coincidentally appear at the same time as emerging teeth. In addition the increased stress associated with teething could make your child more vulnerable to infection right before a new tooth appears.

I advise parents to keep a watch for vomiting and listless behavioral patterns, as these are almost always a sign that the problem is not teething. Keep a close eye on the behavior of your baby.  If your baby starts vomiting and has a fever for an extended period of time, exceeding 38 degrees Celsius you must contact your doctor. Teething should not require emergency care. If there is any concern that something other than teething may be causing symptoms, contact your health-care provider. The only signs that should be associated with teething are restlessness, increased salivation and fist/hand chewing.


Teething remedies

I am a firm believer in Baltic Amber bead teething necklaces. Amber beads release Succinic acid, which is then absorbed into the body when kept in constant close contact with the skin. The long-term exposure to Succinic acid reduces inflammation that in turn eases the pain and discomfort stemming from the chronic oral inflammation of the mouth during teething and boosts immunity and the body’s ability to fight infection during this susceptible period. It works with the body to support the immune system, restore health, and reduce infection as well as pain. I recommend that this necklace be worn from 2 months of age, every day. At night, secure the necklace around the ankle of your baby with their sock so it does not present as a choking hazard.

I also recommend a visit to your homeopath. A homeopathic teething remedy and immune supporting remedy (like Oscillococcinum) taken from early on, in combination with teething beads has shown very effective results in alleviating teething pain and other illness accompanying the teething period.

Give your baby something fibrous to chew on like a cold carrot stick/apple slice. Natural rubber teething rings chilled in the fridge are also effective. Their gums are itchy so help them out by massaging the gums with a natural rubber finger brush combined with a Xylotol based toothpaste.

Do not give your child teething biscuits/rusks as these are high in sugar and promote plaque accumulation. Do not give your child any sugary drinks (fruit juice, sweetened tea etc) in their bottle. This may pacify your child short term, but the long-term damage and addiction to sugar is irreversible.

And finally is not helpful to apply commercial teething gels as these topical preparations have little to no effect- the child swallows most of the gel and continuous application is impractical and may lead to sensitivity to benzocaine.


Teething is a time when your child needs above all else, love and support.


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Do I need to floss my child’s teeth?

Flossing one’s teeth is probably one of the most tricky skills to master in this lifetime and that is why most people do not do it. However consider this analogy: after a day of gardening and digging in the dirt with your hands, they are covered in mud and sand. You go to the basin and wash your hands vigorously with your most potent hand soap. You rinse the soapy water off only to reveal your finger nails filled with dirt underneath. Only when you take a nail brush a scrub under your nails is all the dirt removed. Imagine if you just left all that dirt and bacteria to live and remain under your nails indefinitely…

The same applies to your mouth and especially your child’s mouth. We eat and drink all day long, bathing our teeth in sugars and carbohydrates which allows bacteria to thrive and easily attach to all the surfaces of the teeth. After a rigorous scrubbing with the toothbrush, you are only removing the plaque/food/debris from the outer surface of your teeth; you are only cleaning 60% of your tooth surfaces. This leave 40% of tooth surfaces uncleaned, covered in plaque and susceptible to breakdown by bacteria. Flossing removes the bacteria below the gums. Decay occurring between the teeth is the second most common site of tooth decay in children. Decay between the teeth of children is very difficult to detect and even more difficult to treat.

The types of cavities that develop as a result of not flossing are in my opinion “silent killers”. The hole starts directly in between two teeth and slowly burrows into the center of the tooth. You are usually completely unaware that this hole exists because you cannot feel it with your tongue and the pain is not felt because the open tooth structure is shrouded between the adjacent teeth or compacted with food (nummy!). Only once the hole has increased in size enough, does the unsupported covering of enamel fracture/cave in. This is when people decide to visit me; once it is too late and the tooth generally requires a root treatment/extraction/pulpotomy(in primary teeth).

Silent destruction that ultimately leads to abscess development

The other important reason for flossing is to prevent gum disease from occurring in the gum areas between the teeth. Brushing alone is not adequate to keep the mouth healthy and free of disease. Bad breath is often caused by masses of bacteria/plaque breeding and thriving in the areas between the teeth. Plaque matures every 24 hours, so it is imperative to break this cycle and floss every day. Bleeding gums when you floss is a sign that you need to floss more!

Example of how to floss around the gum line

To prevent these disaster cavities from developing and to prevent gum disease you need to clean away the plaque/bacteria/food that accumulates under and around the gumline in between the teeth. You do this with dental floss, every night, last thing before bedtime. Flossing must be initiated in children from the age of 2 years. Even if their molar teeth have not grown out yet, start to floss around the mouth each night and entrench this habit into their daily routine. This will set them up for a lifetime of good oral health.

You only need to floss the teeth you want to keep…

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The benefits of chewing gum

I recommend my patients chew chewing gum between meals. And NOT sugary gums. It must be a sugar free chewing gum (usually they contain xylotol or another type of natural sweetener). Chewing gum changes the pH of your saliva. Bacteria thrive in an acidic environment and it is this acid that cause the dissolution of your teeth and ultimately leads to tooth decay. If the pH of your saliva becomes more alkaline, you are less likely to have bacteria living in your mouth and therefore less likely to have cavities.

The second benefit of chewing gum, is that it stimulates more saliva production. People who suffer with a dry mouth (or are mouth breathers) are more susceptible to tooth decay. So another effective strategy for reducing your risk of tooth decay is by bathing your teeth and mouth in a constant fresh flow of saliva.

And lastly, chewing gum mechanically removes excess plaque and food from the surfaces of your teeth. This is turn removes the decay causing bacteria from your teeth.


So carry a pack of sugar free gum in your pocket and chew in between meals!


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What is a Periodontist ?

Many patients come for a routine dental visit and are then referred off to see a “periodontist“. Here I will answer what a periodontist does and you can then decide if you need one.

I am going to being with a few definitions to get us on the same page:

PERIODONTIUM: This refers to all the supporting structures that surround the teeth. The specific tissues that make up the periodontium are the alveolar bone, periodontal ligament, cementum and the gingiva (or gums).

PERIODONTICS: This is the study of the periodontium and the branch of dental specialty that treats diseases of the periodontium.

Therefore, a periodontist is a specialist dental practitioner who treats and manages diseases and conditions of the periodontium. Most often a patient requires the expertise of a periodontist when they suffer from periodontal disease. Anyone can develop periodontal disease. It is usually a slow process (but sometimes can be very acute & develop rapidly) of destruction that develops over time when the oral hygiene of the mouth is poor. Initially patients suffer with bleeding gums. People assume that this is normal and do not seek treatment. Bleeding gums then become a part of their daily life. The bleeding is caused from a chronic inflammation of the gums due to the presence of bacteria in dental plaque. This is known as gingivitis. The dental plaque present on the tooth surfaces will turn to calculus, a hard accretion that cannot be removed with a toothbrush. The gingivitis, if untreated, will turn into periodontal disease which causes the destruction of the alveolar bone that houses teeth. The result is loosening of the teeth and if untreated, eventual loss of the teeth. The primary role of a periodontist is to treat periodontal disease, by removing the calculus that has accumulated and reverse the chronic inflammatory process. The objective is to halt the destructive process of bone loss through a number of minor surgical and non surgical procedures.

In addition the treating periodontal disease, a periodontist may place dental implants, surgically extract problem teeth, place bone grafts and place gingival grafts.

In general, it is advisable to see your dentist for an assessment first before booking directly with a periodontist. An astute dentist will be able to assess the severity of any possible gum problems and refer you to a suitable periodontist if you need one.

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Do I need to visit the dentist when I am pregnant?

YES YES YES. For some reason women think that because they are pregnant they do not need to visit the dentist. It is quite the opposite. It is during this time that the most damage can be done to your teeth without you knowing it. It is very common for pregnant women to complain of bleeding gums during their pregnancy. This is the first sign that you must visit your dentist asap. Gingivitis is more prevalent while women are pregnant. The general oral hygiene of most women suffers during this time because they are concentrating on their developing baby and there is such a massive shift in their body that they tend to neglect their mouths. Bleeding gums is aggravated further by the change of hormones during pregnancy. This is known as pregnancy gingivitis. Some expecting mothers out of fear of bleeding avoid proper brushing or flossing. This further worsens the situation.

The unavoidable consequence of inadequate oral hygiene is an increase in dental plaque which leads to dental decay. Cavities will rapidly develop. Often women will come to me for a dental check up, after having their baby. I will find numerous teeth that are severely decayed and extensive restorative dental treatment is then required. It is far better to prevent this from happening. I recommend seeing your dentist at the beginning of your pregnancy and every 3 months thereafter for a scaling and polishing and a quick look over of the mouth (without xrays) till you have had your baby. 8 weeks after your baby’s birth you should come in for a full routine dental checkup with full xrays. If any fillings are required they may be completed at this appointment.

Dental treatment is possible during pregnancy however. Most dental procedures can be completed while you are pregnant. It is not in your interest, nor your baby’s interests to leave underlying infection in the mouth. Especially if you are in any sort of pain, rather see your dentist early on so the problem can be diagnosed and treated. There is a large amount of research that supports the notion that bacteria from the mouth can enter the bloodstream and affect your unborn baby. Do not neglect your mouth during your pregnancy. Visit your dentist and take responsibility for the things you have complete control over during your pregnancy. Excellent oral hygiene is the first step. Be Proactive! See your dentist today.


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What is a nesbit denture?

A nesbit denture is used to replace a lost single tooth, on one side of the mouth. Often teeth which have had a root canal treatment many years prior, present to me with a recurrent abscess. The treatment options are limited and depend of the size of the abscess and the extent of damage. If patients live with type of condition for a long time is becomes chronic (occurs over a long period of time) and they do not notice the pain. This is coupled with resultant bone loss around the tooth root. In these cases tooth extraction is needed. Sometimes patients want to hold on to their teeth and it may be viable to refer to patient to a specialist to have an apicectomy procedure. This may prolong the lifespan of the tooth, however the abscess generally will recur a few years down the line and the tooth will need to be extracted.

When a single tooth has been extracted there are a few different options for replacing it. A dental bridge, a dental implant or a removable partial denture may be used. These patients may not be ready for implant placement if a large amount of bone loss occurred, or they may not want an implant. The solution to replacing a tooth temporarily or a removable long term option is a nesbit denture. Traditionally these appliances contained metal clasps. However the nesbit denture is constructed completely out of an acrylic vinyl material. It is light and if made properly has good retention capabilities. These are now commonly used as interim replacements while patients are waiting for implant restoration.  They do require a natural tooth posterior and anterior to the edentulous space and are not appropriate for “free end saddle” situations (patient has no posterior tooth to support the partial denture).


The procedure for making a nesbit denture is very simple and requires some dental impressions which are then sent to the laboratory. After a week or two most patients are comfortable and used to wearing their nesbit denture. The nesbit denture is a cost effective, quick solution to tooth replacement.

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