10 Facts about baby teeth

We’re a family here at WWDC and we understand your worry to take care of your baby’s oral health. For those first time parents – you may have many questions about your new child’s teeth and oral health. Here are 10 facts about baby teeth.

  1. There are 20 baby teeth as opposed to 32 permanent teeth.

  2. Baby teeth are whiter in color than permanent teeth. This is why permanent teeth look more yellow when they erupt.

  3. Baby teeth start forming when babies are in utero.

  4. The first baby teeth to erupt are typically lower central incisors.

  5. The first baby teeth to be lost are also the lower central incisors.

  6. Baby teeth have thinner enamel (the outer white hard layer). This means that when a cavity starts it progresses much faster than a cavity in a permanent teeth that has thicker enamel.

  7. Baby teeth serve many purposes but one of the biggest is holding space for the permanent teeth.

  8. Many children grind their teeth when they are younger. Don’t worry, this usually stops when they get a few permanent teeth in their mouth.

  9. Baby teeth should be brushed as soon as they erupt.

  10. Extended bottle feeding not only contributes to decay early on but also increases the risk of childhood obesity.

If you have any questions about your baby’s teeth, please make sure to reach out to us!

Mouth Guards

This is the time of year when our dental attention is turned  toward the safety of young (and not so young ) athletes. 

Of course the traditionally accepted reason for wearing a mouth guard is protection of the teeth.  According to the NFL and NHL fact sheet, “five million teeth are knocked out in sports-related injuries every year in the U.S.”  Those are better odds than winning the lottery but all based on bad luck and some failure to prepare.

Athletic mouth guards are an essential part of an athlete’s safety equipment.  No one would suggest that football player (American football) go onto the field without a helmet to protect from or at least reduce the chance of a head injury.  There is a chink in the armor of a helmet however and that is the lower jaw.  Speaking from personal experience a fist or forearm can get under the face mask of a helmet and reach the unprotected lower face. 

When a skull is viewed either directly or with an x-ray there is a very thin layer of bone between the  “ball” of the lower jaw and the base of the brain.  This thin layer of bone may more closely resemble a membrane than bone and in some cases may actually have a perforation or void in the bone’s integrity.   

If the lower jaw is displaced towards the back of the mouth by even a relatively minor blow, the energy of the impact can be transferred directly to this area of the brain.  This is the basic mechanism of the “knock out” punch to the chin.

While a mouth guard is usually associated with protecting the athletes teeth, which it does, a greater  value is in protection of their brain during impact.  This is accomplished by distributing the energy of the impact through the teeth and into the facial bones rather than focusing all of the energy onto a single point in the weakest area of the skull. 

I recognize that words like “skull,” “facial bones” and “impact” may conjure unpleasant images for some individuals yet I feel it is necessary to speak directly and clearly regarding the importance of these protective appliances. 

Some sports are not considered contact sports so wearing a mouth guard may seem less important.  This is not so.  After 40 years of treating sports injuries I can attest to the value of a mouth guard in basketball, baseball and even tennis.  To this point I have not seen a mouth injury related to the actual game of golf although I’m sure injudicious management of a score card might provoke an oral injury peripherally associated with the game.

There are a multitude of reasons to wear a mouth guard that would make this blog way too tedious to read but are all important and can be easily researched by those who want the information.

Lest anyone think these comments are being made only as a self serving effort to “sell” mouth guards let me say that by going to any athletic supply store you can get a serviceable appliance for less than ten bucks. In some cases way less than ten bucks.  It does require the effort to do the job yourself and follow instructions but it may save more than your smile.

Activated Charcoal Dentifrice - Risks and Benefits

Because of long experience in the dental profession I have witnessed tremendous swings in what is considered “common” or accepted knowledge.  I actually participated in research in the mid 1970’s that suggested implants were not a practical replacement for missing teeth.  In the early 1980’s new, “exciting” research told us that implants made with special materials would solve all of our missing tooth problems and that the implants would last forever.  A few more years passed and lo and behold we found implants have some of the same problems as natural teeth and they could be lost in similar ways including peri-implantitis or gum disease around an implant.  We currently accept that implants are a very useful procedure for the replacement of missing teeth but that they are not the panacea they were thought to be as our real knowledge was being developed.

 

The point of this preamble is, neither I nor the “experts” “know it all” despite our best efforts to do the right thing by and for our patients. So when someone brings a new topic, procedure or product to my attention I like to do some real if superficial research regarding those topics, procedures or products and to wear my scientist’s hat and keep an open and malleable mind. 

 

The most recent surge in questions being posed to me is related to the efficacy and safety of activated charcoal in dentifrices being promoted and sold; do they work and are they safe?  So rather than just “blowing smoke” or admitting, “Hell, I don’t know,” I did some research that I will share here.

 

Many dentists and dental hygienist have taken the stance of not backing any charcoal dentifrice and suggest staying away from them because we do not have the clinical evidence to confirm or deny claims. We don’t!  However, in order to best serve our patients, it is prudent to become informed on what products are on the market and what our patients are using.

A literature review in Journal of the American Dental Association (January 2017) concluded that there is “insufficient clinical and laboratory data to substantiate the safety and efficacy claims of charcoal and charcoal-based dentifrices. Larger-scale and well-designed studies are needed to establish conclusive evidence.”  We were also advised to be “cautious when using charcoal and charcoal-based dentifrices with unproven claims of efficacy and safety.”  To an old country dentist like me this is absolutely a “cover your butt” statement by an organization that has probably been burned in the past by publishing strong opinions that were later proved to be wrong. 

I am skeptical but curious about the trend and the claims of activated charcoal containing  products.  I want  to adequately inform my patients about the proper use of the products if asked.  While I may not personally use or even advocate the use of the product I do not want to just give a biased opinion without any real facts because some of my patients do use the product and I feel obligated to be able to discuss the subject knowledgably. 

Let’s take a look at a few questions surrounding the use of activated charcoal..  What is it?  How/why is it supposed to work?  What are the expectations of the patient? What have they been using, and what changes do we see that have occurred in their mouth since the last visit? Different people can and will react differently to a product containing activated carbon just as they will with a regular toothpaste. 

Activated charcoal is not the same as your BBQ briquettes.  There seems to be various ways to create activated charcoal but they generally seem to require exposure of charcoal to some chemical such as a solution of calcium chloride for several hours and then filtering and drying the charcoal.

The substance created is able to adsorb toxins such as bacteria and stains. A medical dictionary states that “activated carbon is pure carbon specially processed to make it highly adsorbent of particles and gases” by increasing the surface areaecffsabuqsvsxwebuyswq available for adsorption.

At this point I need to point the difference between adsorption and absorption. Absorption is a reaction of elements which allows assimilation into the blood stream. Adsorption binds to a surface due to a negative electric charge, causing positive toxins to bond without internal resorption.                                            

While activated carbon (charcoal) is mostly beneficial when taken internally, it can also reduce the absorption of different medications.  The Mayo Clinic advises, “Certain medicines should not be used at or around the time of ingestion of charcoal since interactions may occur.” It is generally believed the small amount potentially ingested with toothpaste  is unlikely to have any serious effects on the body or health in general.

We need to clarify a couple more definitions.  At least for the purposes of this blog, whitening is the removal of surface stains vs. bleaching which changes the inherent color of teeth. Professional bleaching definitely has longer lasting effects. This may be one reason the dental industry is slow to embrace other whitening dentifrices.

Thus the long-lasting white smile that many people are looking for and that is being promised through advertising for activated charcoal can be misleading, however, for an individual who consumes coffee, tea, red wine, and other foods containing tannic acids  its use can obtain positive outcomes.  Sometimes activated carbon has been described  as a “sponge,” that extracts the stains off of teeth.  The use of activated carbon in a dentifrice is intended to be used as a day-to-day maintenance.

 

Some products are available that contain an ingredient that coats the tooth surface with a blue tint that influences light reflection and reduces the yellow discoloration, thereby providing an additional whitening effect without the use of active chemical agents.

Toothpastes generally rely on mild abrasives to remove surface stains. Some contain polishing or chemical agents to achieve this. Charcoal is abrasive in the instance of direct application. Thus, activated carbon can potentially cause damage due to its abrasive consistency.  

It is thought, but not yet proven in a clinical trials, a toothpaste containing activated charcoal is less damaging then powdered products since the activated carbon is a smaller portion within a mix of other ingredients.

The powdered formulations usually require a longer brushing time to achieve the whitening effect and tend to be messy to use.

The majority of products on the market today do not contain any fluoride, in particular the DIY products seen frequently on the Internet that are intended for internal use.

Advertising claims that a product “contains” activated carbon/charcoal doesn’t mean it’s an active ingredient, and the rest of the product’s ingredients should be considered as well. Using charcoal toothpaste from a reputable brand to avoid inflicting damage to that perfect smile is recommended!

 

 

 

Your mouth, The Window of Wellness

Some 20 years ago I used to do a radio show called “The Window of Wellness” on a local radio station.  The owner of the station, now departed, was a patient and needed extensive treatment.  He was always curious about the world and asked a lot of questions about, before, during and after his treatment.  We became friends as seems to happen with many of my patients and he suggested that I formalize some of our discussions to develop some radio advertising. 

At the time a national radio personality, Paul Harvey, was doing a syndicated program every day at 4:30 in our market called, “The Rest of the Story” and my friend suggested that I pattern my presentations after Mr. Harvey’s model. 

The general idea started out that I was going to do a brief 30 second dental health primer as an advertisement but as it developed they got longer and some were even entertaining. Finally,  they became a regular part of the programming and some local adds were sold as sponsors for the little segment. 

The purpose of the segment was to point out that the mouth often provided indicators of health or disease in the rest of the body.  Signs and symptoms of systemic disease are often manifested in the mouth via the saliva, the soft and hard tissues, the location of various lesions, etc.  By sampling saliva, for example, high blood sugar can be detected as well as other disease entities from genetic anomalies to tertiary syphilis to vitamin deficiencies and on and on.  Mouth malodor can also indicate pathology and even the ingestion of substances that are harmful. I was not suggesting then nor am I now that I am a diagnostician that is able to make remarkable discoveries about anyone’s health from examining their mouth but I, and most dentists, have seen enough normal mouths to recognize an abnormal situation and make an appropriate referral when or if we see such. 

While there are numerous potential subjects for us to discuss in the venue of a blog I truly would like to address topics that my audience would like to learn about.  Therefore if any readers have questions or suggestions I would be happy to address those topics.  In the meantime as most of you know I don’t have trouble pontificating about mundane, arbitrary and trivial topics I might come across in the course of a day at the office.  In the event that one of our discussions leads to a question that would benefit from further   

Commoditization

Depending on how one looks at their health care and specifically their dental or oral health we should be aware that treatment in general is being commoditized.  So what does “commoditized” mean?

Commoditization

Wikipedia defines commoditization in business as the process by which goods that have economic value and are not distinguishable in terms of attributes (uniqueness or brand) end up becoming simple commodities in the eyes of the market or consumers. It is the movement of a market from differentiated to undifferentiated price competition and from monopolistic competition to perfect competition. (https://en.wikipedia.org/wiki/Commoditization)

 

Commoditization occurs when consumers can buy the same product or service from different small or large businesses. Price is the only distinguishing factor in commoditized products, because there is no significant difference in quality or in how consumers use these products.

Commoditization is often related to agricultural goods such as grains or livestock.  However even in these cases there is some differentiation as to quality.  Wheat for example may be differentiated by the moisture content or the protein content of various samples thus differentiating various shipments despite the general commoditization.   Variation of these qualities will affect the price even within the category. 

Perhaps another example of commoditization would be for the purchase of dollars.  Let’s face it every dollar bill is exactly the same as is every other dollar bill.  Why then are there various “prices” as we buy or rent money from the bank if as a commodity it is the same in all ways?  The obvious difference isn’t the commodity or the dollar, but the consumer.  The variation of the price is now contingent on the credit worthiness of the “buyer” not the value of the product.  There is also some consideration for the service involved with or provided by the institution to the consumer but that is a topic for another discussion.

So what does this all have to do with health care and specifically dentistry?  Consider this - there is an extreme and concerted effort on the part of “Wall Street” venture capitalists to try and commoditize dentistry and health care in general.  To be sure there are some good aspects in reducing the supply of dentistry to a commodity level such as direct price competition.  A problem arises when the individuality of the patient, the disease, the treatment of the disease or the restoration is reduced to an individual or common modality. 

Each and every restoration performed by your dentist is a custom restoration.  It cannot be transferred, transformed or replaced by another common restoration.  There are some similarities in the delivery of the services provided by the dentist but they certainly do not reach the level of a commodity.

Since there are infinite types of situations and numerous if not infinite number of operators addressing those situations the idea of trying to commoditize treatment is not a good one.  The idea that price is the only difference between treatment and restorations is an example of false frugality.  There will always be cheaper materials and various shortcuts that will reduce the initial cost of treatment but the old adage that you get what you pay for is especially true in medicine and dentistry.

Alleviating the lack of knowledge...

I have been around the block, for that matter around the sun, enough times to realize that just because knowledge exists does not mean it will be applied.  People, humans, like most other species are innately indolent. We’re lazy!  If work or a change of habit is required the masses will likely find some emotional reason to avoid making the changes or doing the work unless the reward is immediate and substantial.  We all “know” if we save a little every pay day, invest even as little as a cup of coffee each day, we can achieve significant wealth. (The coffee example may be too big at today’s prices.) But the process is slow and the rewards are delayed so the majority of us do not even make the effort or if we start we “fall off the wagon” rather than sticking to the plan.

Sadly the same is true when it comes to applying knowledge to our health and well being.  We may know what is necessary to achieve one degree of health or another but somehow the ability to apply that knowledge eludes us.  From the summer of 1977 until the summer of 1981 I was stationed at Pearl Harbor Hawaii as a brand new dentist.  I had occasion to live in a duplex with a nuclear submarine commander and his family next door.  As it turned out his family and mine were “demographically” similar.  We had the same age and number of children, two boys at the time, our wives were close to the same age and he and I were very near the same age although he did out rank me.  Physically we could not have been better selected for a matching “controlled” study  since environmentally we could only be closer if we slept in the same bed. 

Our source of water was the same, our food was virtually the same, our personal and family activities approximated each other’s, yet there was a distinct difference in our family’s dental health.  As a dental officer I could have discreetly brought my family into the dental clinic and treated them for any dental needs they might have had only they didn’t have any dental needs. The submarine driver did not have that option. 

Despite the propaganda distributed by the Navy, their basic attitude is “if we wanted you to have a wife or family, we would have put one in your sea bag” therefore getting dental treatment for a sailor’s family was nearly impossible if that sailor wasn’t the dentist.  Thus this family had to go out onto the civilian market and pay full bore for any dental treatment.  Even though I was able to “sneak” some care for the kids when they were in severe dental pain, there was no way I could care for them in the way that would have alleviated their disease or provided a satisfactory long term solution. 

At the same time my family, with its unlimited access to dental care had no need of any treatment.  The only difference that I can put my finger on was the fact that I had specialized training in dental disease prevention.  The nuclear engineer/submarine commander while every bit as intelligent (likely smarter) as me did not have that specific training to lead his family away from dental disease and therefore had to try to “restore” dental health at considerable expense.  It just doesn’t seem fair yet the knowledge and the application of that knowledge is the only variable I can put my finger on to demonstrate the difference in our family’s dental health.

The point is knowledge and the application of that knowledge circumvents or alleviates most dental problems by preventing them from occurring.  In reality today many of our medical problems are the result of poor choices.  Smoking is associated with everything from lung cancer to heart disease to saggy skin.  Dentally speaking sugar and refined carbohydrates are at the root cause of most of our oral health issues.

This blog is my humble attempt to at least alleviate the lack of knowledge so individual choices can be made and ignorance cannot be claimed as an excuse for poor oral health.  

 

It's a question of sharing the knowledge...

After over forty years of practicing dentistry why would a reasonable person take the time to  write a blog about dentistry?  Perhaps one reason is that I am not a reasonable person and therefore am not bound by the normal restrictions of reason.  The truth, however, is I love my profession and as  long as I am not a liability to my patients and can provide service and can have a positive professional and personal impact on those patients, my team, my family  and my community, I want to continue having fun being an “ivory carpenter” for as far into the future as I am able.

Some may ask how it is possible to do the same thing for forty years and still really love that thing.  I completely understand that question.  However, I have come to realize while I still practice dentistry I do not practice the same dentistry I was taught or practice the same way I did forty plus years ago.  In many cases it would be malpractice to use the same materials, techniques and procedures I was taught as “state of the art” back then.  For that reason the constantly evolving, ever changing art and science of dentistry is constantly refreshed and continually different; only the teeth are the same and the rest of the dental world has moved on or around them. 

I am very lucky to have had fantastic mentors that taught me the art of living as well as the art of creating and innovating.  One mentor introduced me to a quote of Francois Auguste Rene Chateaubriand from over two hundred years ago on the integration and mastery of the art of living and leisure.

            “A master of the art of living draws no sharp distinction between his work and his play; his labor and his leisure; his mind and his body; his education and his recreation. He hardly knows which is which.  He simply pursues his vision of excellence through whatever he is doing, and leaves others to determine whether he is working or playing.  To himself, he always appears to be doing both.”                                                                                                                                 Francois Chateaubriand

Another reason to take the time to write a blog about dentistry (or hopefully to read such a blog) is to share some beneficial knowledge related to our oral health.  A great many of the disease entities discussed are completely preventable.  My goal is to share knowledge that could virtually eliminate the medical necessity of my profession if applied.  This is not to say there would be no need for dentistry as humans will likely always want to change their appearance for vanity if not health. 

 

Kicking the tobacco habit is good for your mouth...

While the current percentage of Americans who smoke cigarettes is the lowest it’s been in
decades, those who continue the habit remain at risk for heart and lung disease. Additionally,
while we know smoking is also bad for our oral health, most don’t understand just how bad it is…
More Than Just Stained Teeth

From its seemingly mild side effects (bad breath, tooth discoloration, buildup of plaque and
tartar), to the more sinister (increased risk of oral cancer, loss of bone within the jaw, gum
disease and any number of resulting complications) – tobacco is indeed an oral health risk.

Tobacco can cause serious health issues by breaking down the attachment of bone and soft
tissue to your teeth. Because of this breakdown, the use of tobacco makes smokers much more
susceptible to infection and diseases. In fact, 90% of people who have cancer of the mouth,
throat, or gums admit to using tobacco in some form.


Cigarettes, cigars and pipes aren’t the only culprits; smokeless tobacco can be just as detrimental
to oral health, if not worse. In fact, there are twenty-eight chemicals found in chewing tobacco
alone that are proven to increase the risk of cancer in the mouth, throat, and esophagus. Chewing
tobacco and snuff contain higher levels of nicotine than those found in cigarettes and other tobacco products, making it exposes the roots, and ultimately makes teeth more susceptible
to decay.

HELP IS JUST NEXT DOOR

The only way to help eliminate these risks is to never start using tobacco products, or to quit if
you do. In fact, simply reducing tobacco use is proven to help lower your risks. If you feel that it is time to reduce your risk of cancer, gum disease, infection and other oral complications, your dentist or doctor can help you create a plan to help you quit using tobacco, along with
prescribing certain medicines or programs to help you kick the habit.

Remember, it is never too late to quit. If you’re interested in getting help to quit, let us know
the next time you’re in for an appointment.