3 Surprising Ways to Keep Your Teeth Healthy

In addition to brushing and flossing, a healthful diet (with natural or added fluoride) protects teeth from decay and keeps the gums healthy. Read on to discover how to keep your smile safe and strong.

Tooth decay (cavities and dental caries) and gum disease are caused by colonies of bacteria that constantly coat the teeth with a sticky film called plaque. If plaque is not brushed away, these bacteria break down the sugars and starches in foods to produce acids that wear away the tooth enamel. The plaque also hardens into tartar, which can lead to gum inflammation, or gingivitis.

A well-balanced diet provides the minerals, vitamins, and other nutrients essential for healthy teeth and gums. Fluoride, occurring naturally in foods and water, or added to the water supply, can be a powerful tool in fighting decay. It can reduce the rate of cavities by as much as 60 percent.

Dental Health Guidelines
Start right by eating right during pregnancy. Make sure that your children’s teeth get off to a good start by eating sensibly during pregnancy. Particularly important is calcium, which helps to form strong teeth and bones, and vitamin D, which the body needs to absorb calcium.

You need lots of calcium for healthy teeth and gums. Low-fat dairy products, fortified soy and rice beverages, canned salmon or sardines (with bones), almonds, and dark green leafy vegetables are excellent sources of calcium.

You need vitamin D to help absorb the calcium. Vitamin D is obtained from fluid milk, fortified soy and rice beverages, margarine, fatty fish such as salmon, and moderate exposure to the sun.

Fluoride is key. To a large extent, cavities can be prevented by giving children fluoride in the first few years of life. Fluoride is supplied through fluoridated water (not all municipalities fluoridate their water supply, however), beverages made with fluoridated water, tea, and some fish, as well as many brands of toothpaste and some mouthwash. Fluoride supplements are available for children who don’t have access to fluoridated drinking water. It is wise to check to see if the water supply in your area is fluoridated. Excess consumption of fluoride can cause mottling of the teeth.

Also needed are phosphorus, magnesium, vitamin A, and beta carotene. In addition to calcium and fluoride, minerals needed for the formation of tooth enamel include phosphorus (richly supplied in meat, fish, and eggs) and magnesium (found in whole grains, spinach, and bananas). Vitamin A also helps build strong bones and teeth. Good sources of beta carotene, which the body turns into vitamin A, include orange-colored fruits and vegetables and the dark green leafy vegetables.

Children are particularly vulnerable to tooth decay; parents should:

* Provide a good diet throughout childhood
* Brush children’s teeth until they’re mature enough to do a thorough job by themselves (usually by 6 or 7 years old)
* Supervise twice-daily brushing and flossing thereafter
* Never put babies or toddlers to bed accompanied by a bottle of milk (which contains the natural sugar lactose), juice, or other sweet drink
* Never dip pacifiers in honey or syrup

1. The sugar factor. Sucrose, most familiar to us as granulated sugar, is the leading cause of tooth decay, but it is far from the only culprit. Although sugary foods, including cookies, candies, and sodas, are major offenders, starchy foods (such as breads and cereals) also play an important part in tooth decay. When starches mix with amylase, an enzyme in saliva, the result is an acid bath that erodes the enamel and makes teeth more susceptible to decay. If starchy foods linger in the mouth, the acid bath is prolonged, and the potential for damage is all the greater.

Be careful when eating dried fruits. Dried fruits can have an adverse effect on teeth, because they are high in sugar and cling to the teeth. Even unsweetened fruit juices can contribute to tooth decay — they are acidic and contain relatively high levels of simple sugars.

Fresh fruits, especially apples, are better choices. Fresh fruit, although both sweet and acidic, is much less likely to cause a problem, because chewing stimulates the saliva flow. Saliva decreases mouth acidity and washes away food particles. Apples, for example, have been called nature’s toothbrush because they stimulate the gums, increase saliva flow and reduce the build-up of cavity-causing bacteria. A chronically dry mouth also contributes to decay. Saliva flow slows during sleep; going to bed without brushing the teeth is especially harmful. Certain drugs, including those used for high blood pressure, also cut down saliva flow.

2. Gum disease. More teeth are lost through gum disease than through tooth decay. Gum disease is likely to strike anyone who neglects oral hygiene or eats a poor diet. Particularly at risk are people with alcoholism, malnutrition, or AIDS/HIV infection or who are being treated with steroid drugs or certain cancer chemotherapies. Regular brushing and flossing help to prevent puffy, sore, and inflamed gums.

Gingivitis, a very common condition that causes the gums to redden, swell, and bleed, is typically caused by the gradual buildup of plaque. Treatment requires good dental hygiene and removal of plaque by a dentist or dental hygienist. Left untreated, gingivitis can lead to periodontitis — an advanced infection of the gums that causes teeth to loosen and fall out. There may even be more serious consequences of gum disease. Studies have shown a link between poor oral health and heart disease. Bleeding gums apparently provide an entry port for bacteria or viruses that can cause heart problems. Women with tooth or gum problems are also more likely to give birth to premature babies.

Bleeding gums may also be a sign that your intake of vitamin C is deficient. Be sure that your diet includes plenty of fresh fruits and vegetables every day; munching on hard, fibrous foods, such as a celery stick or carrot, stimulates the gums.

3. Helpful foods. You can protect your teeth by concluding meals with foods that do not promote cavities and may even prevent them. For instance, aged cheeses help prevent cavities if consumed at the end of a meal. Chewing sugarless gum stimulates the flow of saliva, which decreases acid and flushes out food particles. Rinsing your mouth and brushing your teeth after eating are important strategies to prevent cavities. Here are some tips:

* Consume Plenty Of Calcium-rich foods, such as low-fat milk, yogurt, and cheese.
* Fresh fruits and vegetables for vitamins A and C, and for chewing in order to promote healthy gums.
* Tea, which is a good source of fluoride.

* Limit Dried fruits and other sticky foods that lodge between the teeth.

* Avoid Sweet drinks and snacks.
* Steady sipping of acidic drinks for prolonged periods.

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Mother’s Gum Disease Linked to Infants Death

Pregnant woman’s gingivitis caused baby to be stillborn, scientists say

Pregnant women with untreated gum disease may have more at stake than just their teeth. They may also be risking the lives of their babies, a new study shows.

Expectant mothers have long been warned that gum disease can cause a baby to be born prematurely or too small. But for the first time scientists have linked bacteria from a mother’s gums to an infection in a baby that was full-term but stillborn, according to the study which was published Thursday in Obstetrics and Gynecology.

Scientists from Case Western University made the discovery after a 35-year-old California woman contacted them to help investigate the death of her baby. Earlier studies by the same researchers showed that an oral bacteria called Fusobacterium nucleatum could spread from the bloodstream to the placenta in mice. The woman wanted to know if it was possible in humans.

Bacteria from the mouth can easily get into the bloodstream once a woman’s gums are bleeding, explains the study’s lead author Yiping Han, an associate professor of periodontics and pathology at Case Western University. Generally, this type of bacteria can be easily combated by the immune system of the mom-to-be, whether mouse or human. But because of special conditions that exist in the womb, the fetus can be more susceptible, Han suspects.

“Once the bacteria are in the blood, they can go almost anywhere,” Han says. “The placenta is an immuno-suppressed organ, compared to other organs like the liver and the spleen. And that makes it easy for the bacteria to colonize the placenta.”

The California woman told researchers that she had experienced heavy bleeding from her gums – a sign of gum disease – during her pregnancy. Bleeding gums aren’t unusual in pregnant women, with about 75 percent developing the condition due to normal hormonal changes. Mild gum disease can be treated simply by brushing and flossing more often. Pregnant women with more serious cases may need dental surgery.

Usually women’s uterine infections, which can harm a fetus, are caused by bacteria that work their way up from the vaginal canal, says Han. But the researchers detected a bacteria in the baby not typically found in the vaginal region. Plaque samples from the woman’s teeth were found to be positive for the exact same strain of the oral bacteria found in the dead baby’s stomach and lungs.

Women shouldn’t be overly alarmed by the new study, says Dr. Richard H. Beigi, an obstetric infectious disease specialist and an assistant professor of reproductive science at the University of Pittsburgh Medical Center.

“This is just one case,” he explained. “Most pregnant women have bleeding gums and most don’t have dead babies. This can happen, but it’s rare. And this finding doesn’t mean that it’s increasing.”

Still, Beigi says, it should serve as a reminder that pregnant women with bleeding gums should see a dentist to treat their gingivitis. Gingivitis can increase the risk of preterm birth anywhere from twice to seven times, studies indicate.

The new study underscores the importance of oral hygiene not only for pregnant women, but also for those contemplating pregnancy, says Dr. Michael Lu, an associate professor of obstetrics, gynecology and public health at the University of California Los Angeles Medical Center.

“We know that gingivitis doesn’t happen overnight and that it’s important for women to enter pregnancy in good health,” Lu says. “I would love to see every woman who is contemplating pregnancy get pre-conception care that includes an oral-health check-up.”

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Why It’s so Hard to Tell Which Tooth Has the Ache

When it comes to a toothache, the brain doesn’t discriminate. A new imaging study shows that to the brain, a painful upper tooth feels a lot like a painful lower tooth. The results, which will be published in the journal Pain, help explain why patients are notoriously bad at pinpointing a toothache.

For the most part, humans are exquisitely tuned to pain. The brain can immediately distinguish between a splinter in the index finger and a paper cut on the thumb, even though the digits are next-door neighbors. But in the mouth this can be more difficult, depending where and how intense the ache is.

“We don’t know much about tooth pain,” comments dentist and neuroscientist Alexandre DaSilva of the University of Michigan in Ann Arbor, who was not part of the new research. The new study is one of the first to address the puzzle of toothache localization, he says.

In the study, researchers led by Clemens Forster of the University of Erlangen-Nuremberg in Germany analyzed brain activity in healthy – and brave – volunteers as they experienced tooth pain. The researchers delivered short electrical pulses to either the upper left canine tooth (the pointy one) or the lower left canine tooth in the subjects. These bursts of electrical stimulation produced a painful sensation similar to that felt when biting into an ice cube, Forster says, and were tuned such that the subject always rated the pain to be about 60 percent, with 100 percent being the worst pain imaginable.

To see how the brain responds to pain emanating from different teeth, the researchers used fMRI to monitor changes in activity when the upper tooth or the lower tooth was zapped. “At the beginning, we expected a good difference, but that was not the case,” Forster says.

Many brain regions responded to top and bottom tooth pain – carried by signals from two distinct branches of a fiber called the trigeminal nerve – in the same way. The V2 branch carries pain signals from the upper jaw, and the V3 branch carries pain signals from the lower jaw.

In particular, the researchers found that regions in the cerebral cortex, including the somatosensory cortex, the insular cortex and the cingulate cortex, all behaved similarly for both toothaches. These brain regions are known to play important roles in the pain projection system, yet none showed major differences between the two toothaches. “The activation was more or less the same,” Forster says, although he adds that their experiments might have missed subtle differences that could account for why some tooth pain can be localized.

Because the same regions were active in both toothaches, the brain – and the person – couldn’t tell where the pain was coming from. “Dentists should be aware that patients aren’t always able to locate the pain,” Forster says. “There are physiological and anatomical reasons for that.”

DaSilva agrees that the brain’s inability to tell top-tooth pain from bottom-tooth pain “pairs really well with what we see in the clinic.”

Understanding the pathway from tooth to brain may help researchers devise better treatments for acute tooth pain, such as cavities or infections, and more-chronic conditions, DaSilva says. One such condition is phantom pain that persists in the mouth after a tooth has been removed.

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Green Tea May Strengthen Your Teeth

Researchers suspect antimicrobial molecules contained within green tea helps preserve teeth (as long as you don’t add sugar).

* People aged 40-64 who drank one cup of green tea a day were less likely to lose teeth.
* Drinking unsweetened coffee had no effect on keeping teeth.
* Antimicrobial molecules called catechins may account for green tea’s benefits.

A cup of green tea a day may keep the dentist away.

That’s the finding of new research published in Preventive Medicine. The findings show that drinking at least one cup of green tea a day increases the odds of keeping your teeth as you age.

The researchers suspect that antimicrobial molecules called catechins present in green tea and in lesser amounts in oolong tea provide the benefit. But be careful if you like your tea with sugar: sweetener may negate the effect, the team found.

“Green tea may have bacteriocidal effects, which would affect teeth, but only if you drink it without sugar,” said Alfredo Morabia, of Columbia University in New York and editor of Preventive Medicine, who wrote an editorial accompanying the new research.

“They also reported that drinking sweet coffee was actually deleterious,” he added. “Coffee alone had no problem, but sweet coffee would actually make you lose your teeth.”

Yasushi Koyama of the Tohoku University Graduate School of Medicine and colleagues looked at more than 25,000 Japanese men and women between age 40 and 64 in making the determination.

They found that men who drank at least one cup of tea a day were 19 percent less likely to have fewer than 20 teeth (a full set including wisdom teeth is 32) than those who did not drink green tea. Tea-drinking women had 13 percent lower odds.

One possible explanation for the benefits of tea drinking is that warm drinks wash out your mouth. But coffee, which also provides a mouth rinse, had no benefit, suggesting something else is going on.

Catechins have been shown to kill mouth bacteria associated with tooth decay and gum disease, so the researchers suspect this is what gives green tea its dental benefits.

“Previous research has indicated that regular consumption of green tea may lead to a lower instance of periodontal disease, a leading cause of tooth loss in adults,” said Samuel Low of the University of Florida College of Dentistry and President of the American Academy of Periodontology in a statement to Discovery News.

Maintaining healthy teeth and gums is part of maintaining a healthy body, Low said. “That is why it is so important to find simple ways to boost periodontal health, such as regularly drinking green tea — something already known to possess certain health-related benefits.”

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Tooth Regeneration Gel Could Replace Painful Fillings

Could this new gel be the biggest dental breakthrough since the introduction of fluoride?

Dentists could soon hang up their drills. A new peptide, embedded in a soft gel or a thin, flexible film and placed next to a cavity, encourages cells inside teeth to regenerate in about a month, according to a new study in the journal ACS Nano. This technology is the first of its kind.

The new gel or thin film could eliminate the need to fill painful cavities or drill deep into the root canal of an infected tooth.

“It’s not like toothpaste,” which prevent cavities, said Nadia Benkirane-Jessel, a scientist at the Institut National de la Sante et de la Recherche Medicale and a co-author of a recent paper. “Here we are really trying to control cavities (after they develop).”

Drilling teeth and filling them is safe and effective. Dentists fill millions of cavities each year across the United States. However, though dentists numb the tooth, many patients still rue the sound of that drill.

The new research could make a trip to the dentist’s office more pleasant, said Berkirane-Jessel. Instead of a drill, a quick dab of gel or a thin film against an infected tooth could heal teeth from within.

Cavities are bacteria and pus-filled holes on or in teeth which can lead to discomfort, pain and even tooth loss. When people eat acidic foods, consume sugary snacks or simply don’t maintain proper oral hygiene, bacteria begin to eat away at the protective enamel and other minerals inside teeth.

The causes of cavities are varied. But for most cavities, the treatment is the same: drilling into a tooth, removing the decay and filling in the hole to prevent further damage.

The gel or thin film contains a peptide known as MSH, or melanocyte-stimulating hormone. Previous experiments, reported in the Proceedings of the National Academy of Sciences, showed that MSH encourages bone regeneration.

Bone and teeth are fairly similar, so the French scientists reasoned that if the MSH were applied to teeth, it should help healing as well.

To test their theory, the French scientists applied either a film or gel, both of which contained MSH, to cavity-filled mice teeth. After about one month, the cavities had disappeared, said Benkirane-Jessel.

Benkirane-Jessel cautions that the MSH-containing films or gels only treat cavities; they don’t prevent them. People will still need to brush, floss and use mouthwash to help prevent cavities from forming in the first place.

Treating cavities without drilling “would have its advantages,” said Hom-Lay Wang, a dentist at the University of Michigan. Cavities and drilling can destroy the nerves and blood vessels inside a tooth, making it more brittle and likely to fracture. Regenerating a tooth could help avoid crowns after a cavity has been filled.

That said, regenerating a tooth from within would only be useful in a relatively small number of cases. Most cavities would still need to be drilled and filled.

In the meantime, patients can’t slacken their oral hygiene either. Numerous clinical trials over several years will have to be completed before the MSH-containing gels or films are available to treat cavities in humans.

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How to Stop Teeth Grinding

Roughly 20 percent of adults grind or clench their teeth to the point that they’re at risk for permanent tooth and jaw damage, dentists say.

Here are tips for protecting your pearly whites:

Recognize the symptoms. Those include flattened, worn or chipped teeth; jaw pain or tightness; gum sensitivity to hot or cold temperatures; and earaches and headaches, especially right after you wake up. Bedmates also may hear clicking or squeaking noises as you sleep. Call your dentist right away.

Work to relieve stress. Regular meditation, deep breathing, exercise and enjoyable hobbies will help; some people also benefit from talking to a therapist. It’s especially good to do right before bedtime. Take a bath, listen to soft music, read a favorite book or drink a glass of warm milk. Holding a warm washcloth against your jaw for about 10 minutes can help relax those muscles.

Wear a mouth guard. Protective dental devices keep teeth from rubbing together at night. Such as the DenTek Comfort Fit Nightguard.

Cut back on alcohol and caffeine. Both can make a grinding problem worse, especially if you eat or drink either shortly before bedtime.

Train yourself not to clench. During the day, notice if you are pressing your teeth together and work to hold them apart even if your lips are sealed. Putting the tip of your tongue between your front teeth may help.

Talk to a doctor. People with a severe grinding problem may benefit from a temporary prescription for muscle relaxants or even surgery. Just be aware that medical interventions may have unpleasant side effects. Relaxants, for example, can be addictive over time.

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Virus Behind Oral Cancer Epidemic

Oct. 13, 2010 — Researchers warn of an ongoing epidemic of oral cancer caused by the sexually transmitted human papillomavirus (HPV).

A study in Stockholm, Sweden, finds that cases of oral cancer — primarily cancer of the tonsils — increased sevenfold from 1970 to 2007.

They find that while HPV caused only 54% of oral cancers from 1998-1999, it caused 84% of these cancers in 2006-2007.

“It looks like HPV-positive oral cancers are rising quite sharply in the past 10 years, while HPV-negative oral cancers went down. That is why we say it is an epidemic,” study leader Tina Dalianis, MD, PhD, professor of tumor biology at Sweden’s Karolinska Institute, tells WebMD.

HPV is a well-known cause of cervical cancer. But researchers have only recently begun to appreciate its role in oral cancer, says HPV-oral cancer expert Gypsyamber D’Souza, PhD, of Johns Hopkins Bloomberg School of Public Health.

“Yes there is a startling increase in the incidence of oropharyngeal cancer, and that increase is being driven by HPV,” D’Souza tells WebMD. “But while many experts agree that there’s an epidemic rise in HPV-related oral cancer, the cancer remains rare.”

The risk of developing oral cancer increases with the lifetime number of oral or vaginal sex partners, but many people with HPV-related oral cancer have five or fewer lifetime sexual partners. Men are more likely to get oral cancer than are women, and people with HPV-related oral cancer tend to be younger than people with non-HPV related oral cancer.

It’s becoming clear that oral sex is a factor in the spread of HPV-related oral cancer. Less clear is whether deep kissing can spread the virus. D’Souza says that despite some inconclusive evidence of mouth-to-mouth HPV spread, it’s unlikely.

“I did one study to suggest it might be transmitted by deep kissing, but the risk was small — so I think it is unlikely that HPV is transmitted by French kissing,” she says. “People with oral HPV infection should not be concerned about interacting with their loved ones in a normal way. Salivary transmission of HPV is very rare.”

Smoking and high alcohol consumption are risk factors for non-HPV-related oral cancer. People who smoke also have worse outcomes if they get HPV-related oral cancer.

Oral cancers are extremely deadly, but survival rates are much better for people with HPV-related oral cancer. Because of the high fatality rate for oral cancers, doctors tend to treat them very aggressively. It’s not yet clear whether less aggressive therapy might be appropriate for HPV-related oral cancer.

Two vaccines now are approved for prevention of HPV-related cervical cancer. It’s not yet known whether the vaccines will protect against oral cancer, but the same HPV types that cause cervical and vulvar cancer cause oral cancer.

“As a virologist, I am not aware of a vaccine that works in one part of the body and not in another, so I think this vaccine would prevent oral cancer in boys as well as in girls,” Dalianis says.

The Dalianis study was not funded by pharmaceutical companies. D’Souza reports receiving research grants and consulting fees from Merck, which makes an HPV vaccine.

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Metal Piercings Pose Greater Risks to Oral Health

Studies have shown that oral piercings can cause numerous problems in the oral cavity, including chipped, fractured, or cracked teeth and gingival recession. And yet they continue to remain popular with many patients, especially teens.And although dental practitioners would prefer their patients not get any piercings at all, if the patient insists, dentists can tell them to get plastic jewelry instead of metal because it may be less harmful.

That’s the conclusion of a study in the Journal of Adolescent Health (January 18, 2011) that found that stainless steel jewelry can accumulate more bacteria than jewelry made from plastics such as Teflon (polytetrafluoroethylene or PTFE).

“In our previous study on the prevalence of periodontal complications with median lip piercings (Quintessence, October 2010, Vol. 41:9, pp. 731-737), we observed significant biofilm development on the subjects’ own piercings,” lead author Ines Kapferer, MD, from the department of restorative and operative dentistry at the Innsbruck Medical University Dental School, told DrBicuspid.com. “Therefore, we were interested in which species colonize on oral piercings and whether biofilms on oral piercings might be a risk for systemic infections or periodontal infections.”

While it is not surprising that total bacterial load is higher on titanium and steel piercings than on PTFE or polypropylene piercings, Dr. Kapferer said, this is the first study to consider such a wide range (80) of bacterial species, he noted.

Working with 85 subjects with tongue piercings, Dr. Kapferer and her colleagues conducted baseline dental exams, then randomly allocated the patients to sterile piercings of four different materials: stainless steel, titanium, PTFE, and polypropylene. Two weeks later, the researchers collected and processed microbiological samples from the study participants.

Among their findings:

  • Nearly 29% of subjects reported lingual recessions, while 5% reported tooth chipping on one tooth each.
  • With the exception of Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum species, and Parvimonas micra, bacteria associated with periodontitis were not commonly found in the samples from studs or piercing channels.
  • Of the 80 bacterial species, 67 were found at significantly higher levels in samples from stainless steel than from PTFE or polypropylene piercings.
  • Pathogens found in statistically significant higher counts on stainless steel piercings than polypropylene or PTFE included Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenza, and the paropathogenic species Porphyromonas gingivalis, Eikenella corrodens, Prevotella intermedia, F. nucleatum species, P. micra, and Campylobacter rectus. Also, staphylococci were found on steel and titanium studs, but not on polypropylene and PTFE.

“The low bacterial counts from piercing channels suggest that having a tongue pierced would not contribute to an increased risk for oral infection,” the authors concluded. “The present study demonstrated that studs made of steel might promote the development of a biofilm, whereas those made of polytetrafluoroethylene or polypropylene may be rather inert to bacterial colonization.”

The finding of staphylococci on steel and titanium studs may suggest an elevated risk for complication if the piercing channel is infected, they added.

Consumers should avoid stainless steel and titanium studs in favor of polypropylene or PTFE because of bacteria and a potentially higher risk of local infection of the piercing channel, as well as the risk of tooth chipping and gingival recession, according to Dr. Kapferer.

“Bacterial transmission has been shown for teeth and dental implants, and it has been shown that sterile dental implants are colonized after insertion within one week with (paropathogenic) bacteria from surrounding teeth,” she said. Studs should be removed before the placement of dental implants and for periodontal treatment, especially with the treatment protocol of full-mouth disinfection, she added.

Sawsan Tabbaa, DDS, MS, an assistant professor of orthodontics at the University of Buffalo School of Dental Medicine who has also done research on the adverse effects of oral piercings (Journal of Clinical Orthodontics, July 2010, Vol. 44:7, pp. 426-428), expressed surprise at these results since stainless steel is a smoother surface than PTFE and other plastics.

“I would have expected it to be the other way around and am surprised that stainless steel accumulated more bacteria,” she said.

In addition to the infection issue and other potential complications — including hemorrhage, infection, chipped and fractured teeth, trauma to the gums, and, in the worst cases, brain abscess — Dr. Tabbaa opposes oral piercings because of their orthodontic implications.

“Teeth can actually move because of habitual movement of the tongue, and both plastic and metal jewelry will do that,” she said. “I had a patient who had a piercing, and it had actually moved her teeth and caused a gap. Tell your patients the piercing may cost just $100, but it can cost them thousands in orthodontic treatment.”

And although metal is harder, “there is no significant difference between the two materials when it comes to orthodontic side effects,” Dr. Tabbaa said. “I had a patient who shifted between plastic and metal and still had a gap in her teeth.”

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Fruits and Vegetables Can Prevent Oral Cancer

Oral healthcare professionals can play an important role in preventing oral cancer by educating patients about oral cancer prevention strategies, including eating lots of fruits and vegetables, according to a study in the Journal of the American Dental Association (JADA, February 2011, Vol. 142:2, pp. 166-169).

“Current evidence supports a recommendation of a diet rich in fresh fruits and vegetables as part of a whole-foods, plant-based diet with limited consumption of meat, particularly processed meat,” wrote Nita Chainani-Wu, DMD, PhD; Joel Epstein, DMD; and Riva Touger-Decker, PhD, in the JADA article.

In addition to discussing tobacco and alcohol use with patients (and, if relevant, betel nut and gutka consumption), as well as the risk of sexual transmission of human papillomavirus (HPV), clinicians should provide dietary advice for preventing oral cancer as part of routine patient education practices, they recommended.

Why fruits and vegetables?

Over the past 50 years, researchers have conducted more than 40 epidemiologic studies of the relationship between fruits and vegetable consumption and oral cancer risk, the JADA authors noted. A 2006 meta-analysis identified strong evidence of the protective role of vegetables and fruits, particularly citrus fruits, in the prevention of oral cancer (American Journal of Clinical Nutrition, May 2006, Vol. 83:5, pp. 1126-1134).

Similarly, a cohort study of risk factors for second primary cancers in patients with a history of oral and pharyngeal cancer (OPC), researchers at the National Cancer Institute of the National Institutes of Health found that eating fruits and vegetables has a protective effect (Nutrition and Cancer, 1994, Vol. 21:3, pp. 223-232). In another study, researchers at the School of Dentistry in San Juan, Puerto Rico, found fruit consumption to be protective against oral premalignant lesions (American Journal of Epidemiology, September 15, 2006, Vol. 164:6, pp. 556-566).

While the mechanisms by which diet influences cancer risk are not fully understood, the JADA authors wrote, certain compounds in food may be protective against cancer. Vitamins C and E have antioxidant properties and may prevent DNA damage by reducing exposure to free radicals of oxygen. Terpenes, a group of compounds present in certain plants such as citrus fruits, can influence cell cycle progression and induce apoptosis. In addition, fruits and vegetablescontain micronutrients — also known as phytonutrients — that may act synergistically to prevent cancers, including OPC, the researchers noted.

Fruits, particularly berries that are high in ellagic acid, help prevent oral cancer, as do the isothiocyanates in cruciferous vegetables such as broccoli, cauliflower, cabbage, and Brussels sprouts, according to Tieraona Low Dog, MD, a clinical associate professor of medicine at the University of Arizona Health Sciences Center.

“We should all be helping our patients learn how to incorporate a minimum of five servings per day of fruits and vegetables into their diet,” Dr. Low Dog told DrBicuspid.com.

In addition to cancer prevention, a growing body of data demonstrates the beneficial effects of omega-3 fatty acids, probiotics, and vitamin D for preventing periodontal disease, she added.

Other food components, such as nitrites in processed meats, which may form carcinogenic nitrosamines, may increase the risk of developing cancer, the JADA authors noted. In addition, eating salted meat, processed meat, and animal fat increases the risk of developing oral cancer. A 2008 study conducted at the Louisiana State University Health Sciences School of Public Health showed that high consumption of dairy products is a risk factor for head and neck squamous cell cancers and also has been associated with an increased risk of developing prostate cancer and ovarian cancer (Head & Neck, September 2008, Vol. 30:9, pp. 1193-1205).

Education is key

In addition to performing thorough head and neck and oral mucosal examinations to identify precancerous changes, oral healthcare professionals should educate patients about oral cancer prevention, including nutrition, the JADA authors concluded. This is particularly important for patients at an increased risk of developing OPC, including:

  • Those who use tobacco or have a history of tobacco use
  • Those who consume alcohol, betel nut, or gutka
  • Patients with oral premalignant conditions such as leukoplakia, erythroplakia, submucous fibrosis, or lichen planus
  • Those with a history of head and neck or upper aerodigestive tract cancers

“I applaud the dental community for increasing the education and awareness of their professionals with regard to the importance of nutrition and oral health,” Dr. Low Dog said.

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Are There Other Alternatives for Improving Your Smile?

Not everyone is a candidate for whitening. Bleaching is not recommended if you have tooth-colored fillings, crowns, caps or bonding in your front teeth — the bleach will not change the color of these materials, making them stand out in your newly whitened smile. In these cases, you may want to investigate other options, like veneers or bonding.

* Veneers are thin pieces of porcelain or plastic glued to the front of your teeth. For teeth that are severely discolored, chipped or misshapen, they create a durable and pleasing smile. Veneers are difficult to stain, making them popular for people seeking a perfect smile.

There are two types of veneers:

* Porcelain (indirect) veneers, which must first be created to fit your teeth in a dental laboratory and require two visits to the dentist. Porcelain veneers cost between $900-$2,500 per tooth and last from 10 to 15 years or more
* Composite (direct) veneers, in which enamel is bonded to your tooth in a single visit. Composite veneers cost significantly less, around $250 per tooth, but only last five to seven years

Bonding uses composite resin to restore chipped or broken teeth, fill in gaps and reshape or recolor your smile. After applying a very mild etching solution that slightly roughs the surface of your teeth and permits the bonding material to adhere, your dentist applies the resin and sculpts, colors and shapes it to provide a pleasing result. A high-intensity light hardens the material, which is then finely polished.

* Many people choose bonding over silver fillings because it looks more natural — the material can be matched to your natural tooth color
* The disadvantages of bonding versus silver fillings are that they cost more (from $300-$600 per tooth), and because it is porous, smokers will find that it yellows

Your dentist can tell you if you are a good candidate for veneers or bonding.

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