Teeth Care

Tooth decay, could be called an epidemic - widespread, not really treated - almost all adults, even those flossing regularly, eventually get dental disease; 1/5 Americans rate dental health as fair to poor; 1/4 of young people have gum disease; tooth decay 5x more common than asthma in childhood; etc. All sorts of diseases have been linked to it; cancer, acid reflux, heart problems, high blood pressure, stroke, insulin instability, infertility, premature birth, pancreatic cancer, bowel problems.

Health care systems mostly suck, often incentivize expensive treatments instead of prevention - good for research (obvious effects), bad for the people involved


Good dentist
* prevents problems, avoids drilling, if treatment is necessary, chooses minimally invasive procedure
	* ""minimal intervention"
	* avoids the common error of filling a perfectly sound tooth
		* fillings are damaged by acidity (tooth around it erodes, comes loose), various toxic chemicals - but can offer array of options
	* screens to help you prevent cavities, does not handle treatments or fillings directly
	* compare "drill, fill, cover" vs. leaving it in place and covering w/ porcelain pastes
	* preventative care
	* skeptical of industry claims
* communicative, source of info, experienced, knowledgable, caring, effective, etc.
	* believes in prevention, remineralization
	* "mouth fitness trainer"
	* interviews patients regularly to discover cause of dental damage
* has special equipment
	* ultrasound depth testing, Inspektor dental light, digital imaging fiber-optic trans-illumination (DIFOTI), DIAGNOdent laser (kavo usa), inspektorpro, x-rays, ...
		* see cavities, weakened areas
		* measure tooth strength/thickness
		* see at regular intervals
		* provides advance warning/praise
	* uses blunt instrument to check for rough spots, not explorer - see "Should a Dental Explorer be Used to Probe Suspected Carious Lesions?"
* hunts for new dental ideas or methods to stop dental problems
	* at least: dental school, journals, and education programs
	* attends lectures on preventative care
	* interacts with other dental professionals
	* reads * D J, J of ADA/Calif DA, J of D Education/Research, General/Pediatric Dentistry, Caries Research, Archives of Oral Biology, FEMS Microbio Reviews,  J of Clinical Microbio, Infectious Immunology, J of Clinical Pedia Dent--ry, oral health and preventitive dentistry, Micro-organisms of human mouth, J of Clinical Periodontology, A J Epidemiology, J of Endodontics, Annals of Pharmacotherapy,

Procedure: (2x / day, once before sleeping and once ~12 hours later)
1. Prerinse with pH-balanced/stabilized unflavored chlorine dioxide rinse (Closys/Retardex)
2. Brush teeth, in particular gum-tooth edge, all the way around the mouth
	a. Use toothbrush - head <1 inch in length, easily-grasped handle, soft/giving bristles w/ round ends, should be able to reach upper outside and lower inside easily
	b. Toothpaste - old-fashioned, boring, low-chemical, low-tech, no abrasives, few additives, no whitening, "gentle", sodium fluoride, ADA seal
		a. dicalcium phosphate dehydrate- abrasive
		b. recommend Crest Regular Cavity Protection
4. Disinfect toothbrush (1x/day)
	a. Swish bristles in 0.5oz undiluted antiseptic/antibacterial rinse (Listerine) for 30 seconds
	b. Rinse off w/ tap water
	c. Alternatively: use UV box
5. Store toothbrush w/ head upright, in cup, allowing bristles to dry completely before using again
	a. ensure head doesn't touch other brushes to avoid contamination
6. Use antiseptic rinse (listerine), swishing around everywhere in the mouth
	a. should have ADA seal, good taste, no plaque control/whitening/... - can dilute if needed
	7. spit out
8. After antiseptic, immediately use protective anticavity rinse, esp. before sleeping
	a. 0.05% sodium fluoride ACT
	b. goal is to rebuild teeth
	c. don't wash off afterwards, keep on as long as possible
	d. swishing toothpaste around your mouth w/ a small amount of water can be used instead of a rinse, but does require spitting

3-5x / day: eat xylitol (6-10g total)

explorer - pushing sharp point into weakened area makes it harder for tooth to repair itself
sticky spots not reliable diagnosis for cavity - only 24/100 w/ cavity in one study

mouth chemistry, factors increasing chance of cavities:
* hormones (pregnancy, adolescence, menopause)
* missing key minerals/vitamins in diet
* lack of sunshine
* dehydration/diuretics/medications w/ dry mouth (ritalin, ...)
* breathing funny
	* illness w/ fever or nasal congestion (cold, flu, allergies, ...)
	* mouth breathing (exercise, braces, hospital tube, ...)
	* talking a lot (lecturing, teaching, singing, acting)
	* change in oxygen (diving, outer space, ...)
* chemotherapy/old age/long-term illness/stress/fear/depression/emotional problems (chronic, acute, death, business, ...)
* gastric acid in mouth (acid reflux, bulimia, ...)
* acidic saliva
* dry mouth, low-mineral saliva
* braces (saliva reaches teeth with greater difficulty, maybe even keep mouth open)

structure of tooth is similar to egg - shell corresponds to enamel - immerse in vinegar, shell turns to rubber
soft teeth look dark or yellowish, just need time/care to harden/lighten - don't bleach
note that fluorescent lights make teeth look yellow regardless
tooth parts (outside to inside):
* Plaque - mesh/biofilm of protein strands, many bacteria types, and other substances, fluids, and cells; can have a protective or harmful effect on teeth
* gum - seals roots off from rest of mouth, protects roots
* enamel - continuously changing mesh of watery film and mineral crystals (calcium hydroxyapatite - key elements calcium and phosphate)
	* in presence of fluoride, crystals form faster, structure is calcium fluorapatite - larger, stronger, smoother, more symmetric, and shinier crystals
	* acid dissolves both types, some is normal but too much is bad
	* porous teeth are sensitive, fragile, and temperature-sensitive
	* demineralization/remineralization - shrinkage/growth of crystals
	* usually clear, like glass
* dentin - softer than enamel, very porous, creamy white, tubes
* pulp - soft living tissue w/ blood supply - odontoblasts


caries
* bad bacteria transferred by contact w/ infected saliva on food, utensils, hands, etc.
	* There are ~700 species of bacteria, mostly competing for resources in the mouth. Their functions are still an active research area, but it's clear that some are worse than others in terms of cavities, and you want to get rid of those, e.g. Streptococcus mutans and some lactobacilli. Yeast is another possibility.
* bacteria attach to a hard, non-shedding tooth surface
* eating - bacteria process some of the sugar and produce acid
* acid eats away at the nearby portions of tooth, weakening it and eventually causing cavities
* bacteria cause gum disease too, attach near gum/tooth line instead of on tooth

so, ways to prevent: (all of these happen naturally, but you can help the process by being conscious of it and using various products)
1. control which bacteria you have - don't share saliva, remove infected clumps of bad species
2. prevent bacteria from attaching to teeth - brushing, flossing (questionable), chew gum, healthy teeth
3. kill the bacteria - xylitol, antiseptic rinses, less mouth sugar/food
4. protect teeth (pH, minerals) - saliva flow (gum, ...), protective rinses, fluoride

fluoride rinse - last thing before bed, first thing in morning
spit at least twice to remove extra stuff
fluoride gels/foams only effective when applied for >4 minutes on disease-laden teeth
fluoride varnish - recent option for low-dose fluoride, numerous studies touting effectiveness
cleanings makes bacteria attach more easily
Xylitol - less buildup of plaque for some reason, 6-10g/day in 3-4 doses
Ellie 3-rinse method
avoid X, eat/drink Y
trays w/ goop, gels, foams
identify situations which damage teeth (enamel) or heal them

measure saliva pH (litmus, special probe), also amount (saliva buffer kit)
know pH of liquids you commonly drink
salivacontains minerals for rebuilding teeth (remineralization), lubricates teeth so they don't grind while eating; normal saliva contains all the needed minerals, specifically rinsing w/ minerals is generally unnecessary
dry mouth is related to dry esophagus, leaving it open to bacteria or fungi which could give symptoms of acid reflux
healthy saliva is neutral or alkaline; should return acidity to safe levels ~30 minutes after eating
saliva flow increases at mealtimes and reduces during sleep, varies according to person and situation
stress thickens saliva and make your mouth dryer

to take mouth acidity reading
1. Spit saliva into spoon
2. Test w/ pH detector
do when you wake up (base pH, should be neutral or alkaline, close to 7, <6 is worrying), then 10-minute intervals over course of day to see how drinks/foods change the pH - return to normal takes ~30min, less is better

good foods:
* potatoes, asparagus, broccoli
* fresh veggies/fruits, veggie juices
* herbs
* vitamins/minerals, and waters with them
* whole grains
* bananas, almonds, fresh apples, pineapple
* milk, cheese, other dairy products
* tea, coffee
* chocolate, licorice, pure cranberry juice - intense sweeteners
* alkaline soups/broths/water
stuff:
* propolis (bee product)
* xylitol
* plant fibers/leaves-  chew sugarcane=good
good activities:
* sauna, beach, relaxation, exercise
bad stuff:
* acidic food
* acidic drinks (worst to OK)
	* frozen fruit juice
	* lemon juice, lemonade
	* citric, apple, and grape juices
		* even diluted they still cause problems
	* soda, sports drinks, coffee, beer
* sugar/carbohydrates (if bacteria present)
	* Halloween candy
* corrosive, abrasive, or whitening oral care products
	* Listerine
* sugarless products (diet soda, sugarless cookies)
	* sorbitol causes gastric problems and feeds the bacteria too
* gastric acid

signs that you have a problem:
* gingivities - mild inflammation of gum, 1/7 adults
* enamel on outside surface of back molar teeth chips away (where teeth bend and flex)
* back teeth are sensitive
* bleedings gums
* periodontis - severe inflammation of gums
* periodontal pockets form
* fillings fail and need replacement
* gums need extra cleaning
* gum recession, exposed roots showing cementoenamel junction
* root-canals and crowns
* extractions, implants, bridges, dentures

brush bleeding gums, heals in a few days if bacteria are removed - use warm water + soft cloth instead of toothbrush if sensitive
baking soda,peroxide - sensitize gum, don't work
salt water probably would work
toothbrush inadequate for periodontal pockets, only goes ~4mm
waterpik works but breaks easily. plain closys 2-3minutes works too
fluoride - good for teeth in moderation (toothpaste, rinses), but otherwise bad - aluminum/lead poisoning, unknown effects

filter your tap water - fluoride, aluminum, ...

fluoride sources - foods, sodas, beer, infant formula, powdered iced tea, ...
stannous fluoride - reduces gum inflammation, but brown/black staining of teeth
sodium fluoride - well studied, pretty safe, expensive
silicon fluorides - who knows (commonly found in fluoridated water)

fluoride strengthens teeth, grinding stresses them
benefits mostly when in direct contact w/ outside of tooth, for as long as possible
topical high-concentration rinse doesn't do much to healthy teeth
recommend dilute ACT 0.05% fluoride, with no alcohol
very little is needed, just enough to coat the tooth surfaces (a few drops)
rinsing more often w/ fluoride gives better results

fluoride before age 3 can poison ameloblasts (teeth cells) and cause fluorosis
breast milk has low fluoride, infant formula might have high fluoride - bad


old method of fillings - cut grooves into tooth to retain filling
new method - etch, fill pores w/ plastic resin ("sealant")
sealants useful for small cavities, pits, grooves - worry about bacteria though

bleaching - damages enamel - sensitive teeth, inflamed gums, gum recession, etc.

xylitol - wood sugar, antibacterial fx, available in specialty stores
5g had strong effects, even with a 3 month break
6.5g a day - after 5 wks, reduced; afer 6 months, bacteria gone. for 2 years, plaque reduced significantly - no buildup at all.
past 10g/day, no generic effects, but some suggest for calcium absorption
xylose + other 8 sugars precursors to some important proteins
also reduces ear infections
stimulates saliva flow like other foods
15g naturally produced by body (though not in saliva)
100g/day eaten w/out obvious ill effects

xylitol wipes, gum, mints, rinses, etc. all available

pyrophosphate - adheres to the tooth surface and inhibits the formation or growth of calculus crystals
sodium hexametaphosphate - pyrophosphate which inhibits calculus and also loosens extrinsic stains