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Lorna Flamer-Caldera, DDS, FAGD
Doctor of Dental Surgery • Fellow of the Academy of General Dentistry • www.orisonline.com
Tell us your philosophy about oral health.
I believe oral health is an essential part of beauty. Most people will agree that beauty has external, internal and spiritual components. While external beauty can be created through makeup, surgery and chemicals, it is often transient. True beauty has a strong internal component based in health and sustained through nutrition and lifestyle choices. The mouth is also the most important site for the immediate recognition of good health. Interestingly, more pathologic conditions can be detected in the mouth (especially in saliva) than any other organ. The smile of a beautiful and healthy person features clean tooth surfaces, fresh breath and smooth, clearly outlined gums. Our practice motto is "total body health only exists with optimum oral health".
Current dental developments to be aware of include the following:
Acid erosion is on the rise.
Acid erosion of the teeth is increasing, especially among patients in their 20's and 30's. Although this group grew up with the lowest risk of tooth decay, they now are at high risk for loss of tooth structure due to erosion. The main sources of acid are soft drinks (not just colas), energy drinks, coffee and red wine. These liquids are being consumed at high levels and the teeth don’t get a rest from the acid intake. Recaldent, a calcium based compound, is one of the products being used to treat erosion. It has been shown to remineralize tooth enamel and prevent new decay in people with ‘dry mouth’. It is available in a prescription strength paste that is remarkably easy to use and tastes good.
Low pre-term birth weight linked to gum disease in pregnant women.
Bacteria present in mouth plaque can enter the bloodstream through bleeding gums, then pass into the amniotic fluid and trigger early labor. This can arise from pathogenic bacteria in plaque, regardless of whether the mother has serious periodontal disease or simply gingivitis from pregnancy. A recently documented case directly links a stillborn birth to infection the fetus developed from bacteria originating in the mother’s mouth. Contrary to a common myth, dental care during pregnancy will not hurt the fetus. Pregnancy is prime time for oral care that can contribute to a healthy pregnancy.
Xylitol reduces tooth decay.
Xylitol is a naturally occurring sweetener that cannot be used by cavity causing bacteria to produce acid toxins, as they can with other sweeteners. It is available for easy use in the form of chewing gum or mints and can actually reduce the bacteria’s ability to cause decay. A mother of a newborn infant can decrease the chance of their child getting cavities in the future by chewing xylitol gum daily.
Diagnosis and treatment of sleep apnea
Up to 25% of Americans have sleep apnea, which is disrupted sleep pattern. This condition can cause heart failure, poor functioning at work, and contributes to motor vehicle accidents. It affects adults and children and can be diagnosed and treated by dentists.
Dental Concerns among Patients of Color
Although public health service and increased dental education continues to spread throughout the country, communities of color continue to lag behind the national average in dental health. People of
color still have higher incidences of periodontal disease, cavities, extractions and oral infection. There is also a genetic component. An African American will have a stronger inflammatory response to the same amount of plaque than a Caucasian. A stronger response means more destruction of the tissues, more periodontal disease, and so on. There is also a socioeconomic/education component. African Americans who do not finish high school and have low income, develop gum disease at twice the rate of any other ethnic group. I also believe that marketing in some neighborhoods actually steers people with low income toward products that, although cheaper, are high in sugar and acid and cause long term damage to the teeth and gums. Trick phrases such as '100% Vitamin C', 'all natural', 'fruit drink' (instead of fruit juice) are intentionally misleading and require lots of attention to catch. This is part of what I term culturally induced oral breakdown.
Dental Concerns for Women
Women have a higher risk of dental disease than men. Hormonal shifts will exacerbate any dental condition and cause greater damage. If you become pregnant, have your teeth professionally cleaned. Do so again in the 3rd trimester. And don’t forget dental checkups during menopause. Loss of estrogen at this time can cause dry mouth as well as accelerate periodontal problems. Partner with your dentist to discuss oral health issues related to hormonal changes, in advance. Find out what lifestyle and nutritional habits you need to be aware of, especially as you age.
Common questions
Toothpaste with Fluoride
The question of fluoride safety has come up time and again. Fluoride is a naturally occurring chemical that has been added to many water sources and toothpastes because of its ability to reduce the risk of tooth decay by strengthening enamel. The amount of fluoride present in over the counter toothpastes is safe and with several daily uses does not reach anywhere near toxic levels. The benefit of fluoride is significant as it has provided protection for teeth in many groups where adequate dental care is not available. Since fluoride does not need to be swallowed to prevent tooth decay, those concerned with toxicity from ingestion can filter it out of their drinking water; it will still be effective in toothpaste form.
Toothpaste for Sensitive Teeth
Why do the labels on toothpaste for sensitive teeth warn us to refrain from using it for more than four weeks? Sensitivity that lasts longer than four weeks may indicate a deeper problem that should be checked out professionally. The toothpaste itself is not harmful and if the examining dentist says that you are just one of those people who has sensitive teeth, go ahead and continue use for as long as you wish. A product that may help is MI Paste. Ask your dentist about it because it’s not available in stores.
A wide array of over the counter products exist for dental care, both therapeutic and cosmetic. I have researched these products and endorse some because they work well. They include:
1.Rembrandt Whitening toothpaste. Best used after a professional whitening procedure to maintain the new shade and keep staining at a minimum.
2. Sonicare and Oral B brands of electric toothbrushes. These have been proven more effective at removing plaque and allow less room for error than manual toothbrushes.
3. Listerine Smart Rinse mouthwash. This is a great training tool for children because it reveals plaque with a color highlight. By using it, they can clearly see how thorough their toothbrushing has been each time.
4. Economically priced, store bought tooth whitening systems, such as Crest Whitestrips, work moderately well to lighten teeth (a few shades only). But best results are obtained with high concentration products available at your dentist.
5. Brands of chewing gum which use Xylitol as the only sweetener, such as Spry and Zapp and Carefree Koolerz.
Final Message and Words of Advice
This is an amazing time in dentistry for both the patient and the doctor. We can employ technology to reduce discomfort, optimize treatment and educate the patient. I am aware that many people still
avoid the dentist due to anxiety or a poor past experience. They need to know that there is so much available to assist them, from hypnosis to anti-anxiety medicines. Life expectancy has increased significantly over the last 30 years and we cannot ignore the need to examine and make health choices that will allow us the quality of life we desire in our senior years. The time may come when tooth decay is rare, but other oral conditions arising from longer life may develop. I feel fortunate to be at the height of my profession at a time when I have the best tools to treat the mouth as part of the whole person. I draw on my experience as an artist and medical illustrator with an innate understanding of facial form to create magical smile makeovers. I assist patients in understanding their nutritional components and I draw on my knowledge of multiple forms of medical care to develop sound oral health practices. My goal is to deliver outstanding results while reinforcing the value of good oral health.
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