Big Red Tooth – Dr Candice Schwartz

Where teeth and health meet

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…

Advertisements
Leave a comment »

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.

Leave a comment »

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)
Leave a comment »

Your teeth will LOVE us !

The Big Red Tooth Dental Practice offers a full spectrum of dental services. Please visit our website for all the details http://www.bigredtooth.co.za.

I would like to use this blog as a forum for exchanging information and a tool to answer dental related questions.

Please follow my blog and be informed about your mouth.

Leave a comment »